“Exercise is an analgesic” – Greg Lehman
Coming out of college, I felt like I had a pretty good handle on things.
Although the sciences were not my strong suit, I didn’t think I needed to know everything about it. Lately there has been a strong move toward evidence based practice, advanced research and pain science.
With so much information out there, sometimes it gets confusing.
Watching facebook groups, blog posts, social media and other constant influx of information, how much of the information is fact or just opinion?
Ever read posts on Pain Science and feel like you’re looking at authentic frontier gibberish?
Maybe I’m alone on that but I quite often get confused and lost in what I’m reading. Almost like people are trying to make is confusing.
So I figured I had to do something about it. One of my neurology instructors from college posted on Facebook that he was bringing out Greg Lehman to teach on the subject of pain science. I signed up right away.
Last weekend a number of us attended “Reconciling Biomechanics With Pain Science For Healthcare Professionals” and it is one of the more rewarding continuing ed courses I’ve taken.
So here is a few of the things I learned in the course.
How Massage Therapists Can Recognize Pain As An Alarm
Greg used a great analogy that resonated with me (although I’m sure he didn’t know it).
He compared pain to a fire alarm. Do you actually need a fire to make the alarm go off? Does it tell you the severity of the fire?
The answer is no, and I know this firsthand.
When I work as a fire dispatcher, or when I’m responding to an alarm bells call on the truck, 99 times out of a hundred it’s a false alarm. Or the alarm has gone off because someone burnt something on the stove and it’s not actually a fire.
Turns out pain works the same way.
Pain is an alarm in the brain that warns us of the threat of damage, not necessarily that there is damage (although it recognizes that as well). The brain is listening to signals throughout the body, evaluates them and then signals action to protect it. Once the brain recognizes there is a problem it produces pain as a protection mechanism to help you.
However much like that fire alarm it doesn’t always recognize the severity of what’s going on. It is not a great damage indicator.
A year and a half ago I separated my A/C joint. When it initially happened there was a significant amount of pain and it caused a step deformity (brain recognized there was a threat of damage).
I went to the hospital and they determined that putting the shoulder in a sling for a week and no surgery was the only intervention needed. Within a few days the pain diminished and now I just have a funny looking shoulder. It still functions well even though there is torn ligaments and I can hear a grinding noise in my golf swing.
My shoulder is no different now than it was the night I injured it but the brain realizes there is no longer a real or perceived threat, so I’m not experiencing pain. Even with a significant amount of damage there is no pain to indicate a problem.
Pain And Sensitivity For Massage Therapists
I had always thought that when a patient came in who was experiencing pain it was because something was damaged.
I would give them explanations of what I thought was happening and why their shoulder or low back was experiencing pain. Ie: the muscle is damaged and is creating or making that pain.
Like so many other times in life, I was wrong.
Pain can persist past healing because for some reason the brain still thinks it has to protect something. Pain has more to do with sensitivity, not so much about damage. This means that you hurt but are not harming yourself.
How many times have you treated someone who was concerned about continuing to harm an injury if they kept up with a certain activity? As pain persists after healing we just become more sensitive to the pain. Our pain threshold is lowered so people start to experience pain sooner with less stress placed on the tissue.
It doesn’t even mean that anything has been damaged, we are just becoming more sensitive to the pain.
When we are providing therapy to our patient we are trying to change their thoughts from being fragile and weak to thoughts of strength so the brain no longer thinks the body requires protection.
This is where communication with your patients becomes invaluable. While we would never want to bluntly say “the pain is all in your head”, a good explanation of why the brain is registering pain can go a long way to improving their condition. We are basically just trying to decrease that sensitivity.
Massage Therapists And Smudging
In addition to everything else in the course I got to learn a new word.
Smudging is basically when brain cells become activated easily or become dis-inhibited which spreads pain or makes it move around. Pain is changing the map of the body within the brain making parts of the body poorly defined within the brain.
This is where we come in. Massage Therapy gives feedback to the brain that it needs to help improve those maps in the brain.
Greg showed us a great example of how just altering someone’s position can change the way they are moving and experiencing pain. He showed a video of a therapist treating someone who was experiencing low back pain and couldn’t bend forward. The therapist got the person onto the Massage table and put them into table top position, then had them rock back and forth hinging at the hips.
Once the person saw that they were able to move, it helped re-work that map in the brain and the person was able to move easier getting off the table.
I used that exact same method at the start of a treatment later that week. A new patient came in who had chronic back pain for years.
They were experiencing a flare up and had never tried Massage Therapy. They were having difficulty walking and couldn’t bend forward at the start. I used the same technique prior to the Massage portion and included it again at the end and recommended it for home care.
They came in four days later for a follow up treatment with no pain and increased range of motion. Getting them moving in a different way helped tremendously in restoring function.
I had a boss years ago who introduced me to the K.I.S.S. rule (keep it simple stupid (well at least that’s how he explained it to me)), and as far as pain science goes, that’s exactly what Greg’s course has done for me.
Understanding that pain involves multiple systems of the body including muscular, immune, nervous and emotional changes has given me a greater understanding of what’s going on with the patients that come and see me. Realizing that pain doesn’t necessarily mean damage but that it is just an alarm the brain is using as a protection mechanism will change the way I communicate and treat my patients. Now, with an understanding of what “smudging” is, I am incorporating more movement therapy, especially with patients who come in dealing with acute pain.
There is so much more that I could blog about in regards to this course but I wouldn’t do it justice. I think it’s better for you to just take Greg’s course when you get the chance. If you don’t get the opportunity, at least download his pain fundamentals workbook to give yourself a better understanding and for better outcomes with your patients.
And hopefully pain science won’t sound like this to me anymore:
“I wash born here, an I wash raished here, and dad gum it, I am gonna die here, an no sidewindin’ bushwackin’, hornswagglin’ cracker croaker is gonna rouin me bishen cutter”
– Gabby Johnson, authentic frontier gibberish