How Does Massage Werk
There is a popular idea that massage and other types of body work relieve pain by putting something ‘back in place’. That by freeing one structure from entrapment by another we are able to relieve pain because symmetry and structural function have been restored. Research into the mechanism of action at play in massage and body work (more generally termed ‘manual therapy’) confounds this traditional view.
A therapist can certainly increase range of motion at a joint by stretching it, articulating it, massaging it, but these gains are usually temporary. Most people are assymetrical anyway, and while it may play a role as a predisposing factor, it is not determinent of pain. Pain relief doesn’t seem to be achieved by putting the structure ‘back where it should be’. In their comprehensive 2018 commentary on the mechanisms of action of manual therapy, Bialosky et al. describe how the mechanisms underlying the pain relief attributed to manual therapy are “multifaceted” and “comprise specific and nonspecific factors related to the intervention, the patient, the provider, and the environment in which the intervention is provided”.
Pain is a complex neurophysiological phenomenon that is stoked by tissue damage, real and perceived. There are powerful emotional components to it. There can also be chronic components to pain where, even after an injury heals, the nervous system expands its sensitivity and facilitates the transmission of the signals that our brain ultimately perceives as pain. While pain perception can be decreased through the introduction of alternative stimuli like pressure, vibration and stretch, your back doesn’t feel better just because I gave it rub. Nor just because of the incense, lighting and music or my effervescent personality*. The effects of manual therapy, massage, are achieved through a combination of all these things.
A stretch, a pressure point, a soothing stroke along the back, a word, a check-in, are the therapist’s interface; not just with the structure where the pain is perceived, but the entire nervous system, the entire peson. It doesn’t make sense that pain is relieved by a single factor in an intervention and indeed, it is not.
How I address the pain with massage i.e. do I gently stretch the hip, inhibit the lumbar erector spinae, swoop my hand up the flank and work intricately between ribs, matters. My ability to understand the structural, anatomical contributions to a client’s pain is vital to target treatment. But what I’ve also learned from the many years that I’ve been in practice is that environment and connection is equally important. Safety and comfort matter. Trust, which is earned by me as a therapist, is also a major predictor of whether a client steps off the table feeling refreshed and relieved. Reassurance can help them find the resolve to keep going when they leave.
When I place my hands on someone to treat their sore back, their sore shoulder, I take on enormous responsibility for an entire person. To treat someone’s pain is a privelege and I’m grateful for the honour.
An absence of pain i.e. Taiwan, ruined part of the Alishan Forest Railway, 2023
