1/11/13 EDIT: I needed to address some confusion that a client discussed with me earlier today. The edit is at the end of the post.
You blink, and just like that, break is over and school begins again.
Like any good student, I should be doing homework and I decided to play on the internet. It feels like forever since I’ve posted, so I wanted to put together a quick post about a couple of links that have come across my radar as of late.
As a premise, I should begin by quoting physiotherapist and chiropractor Greg Lehman from a post on his approach to persistent pain:
“Very simply manual therapy can modulate the nervous system’s production of pain. We have more than two decades of research showing that the means that manual therapy work is through changing nervous system function. This is not about joints being out-of-place, breaking down scar tissue or merely strengthening or stretching muscles. Immediate changes in the perception of pain, production of strength or change in range of motion can be seen. It’s not logical to assume that a 30 minute treatment session healed tissue, broke down scar tissue or suddenly made a muscle stronger. The only physiological component that can change this quick is our nervous system. Manual therapy affects the nervous system and can improve our function. All manual therapy techniques can be effective.
Treatment can included peripheral nerve mobilizations, soft tissue massage, joint manipulation/mobilization, movement pattern corrections (e.g subtlely changing how we move to not activate the pain signature), dermoneuromodulation and mobilizations with movement. Treatment is typically pain-free. I’m of the opinion that pain begets pain and treating with aggressive painful techniques can reinforce our pain habits in some patients. While a short-term pain relief can be felt following aggressive treatment (mostly likely due to something called Diffuse Noxious Inhibitory Control) I feel that this is temporary and unlikely to effect long-lasting change.”
Nervous system? Short-term relief from being too aggressive?
How many times have you worked on your mobility and gone into what Kelly Starrett calls “the pain cave”, only to need to work on the same area on a regular basis? I know I’ve been guilty of doing such, and encouraging clients to “find those tight spots and work them out.” Turns out my advice, failing to recognize the neural component, wasn’t optimal for motor pattern change.
This brings me to the links I wanted to share. The first comes from Greg (again) and is titled Stretching The Power of Manual Therapy. This post was followed up by a guest post on Greg’s blog from Chris Beardsley, titled An analysis of Robert Scheip’s paper on Fascial Plasticity. I was particularly interested in the ”Related questions to think about” at the end of the post. He states:
“If you foamroll do you think that you are changing “tissue quality”? If so, how are you changing quality and what exactly is tissue quality? Could any changes to “tissue quality” merely be the nervous systems response to your rolling rather than changes in the structure properties (e.g. ground substance, extracellular matrix, collagen etc).”
When I posted the link of Chris’ guest post to twitter, Greg responded by sending me a link titled If We Cannot Stretch Fascia, What Are We Doing? It provides information along the same lines as Greg’s links above.
I am going to really start looking into the nervous system and its response to pain as I begin to practice massage in the real world. Stress reduction will also play a vital role. I want to utilize massage and the techniques I learn for recovery and movement quality, while using the tools I learn about pain to my advantage for the best results possible for my clients.
“Reasons for injury: poor movement, inappropriate program design, stress management.” – Patrick Ward
The next post is on 3 massage myths you should stop repeating. If you know me, I’m driven toward logic and truth. Because of this, I am not a big fan of astrology, cleanses, calorie-restricted diets, and massage claiming that it ”flushes toxins” from the body. This topic, plus “massage spreads cancer” and “massage isn’t safe in the first trimester” is all discussed. And I’ll leave you with a YouTube video from one of the links in the article:
Edit: If you’re working on soft tissue change, I wanted to address a few things. First, if you’re seeing change, keep doing it. My goal isn’t to scare you out of it, it’s for you to realize the change happens neurologically. If you have to continually repeat the same things, you are probably not addressing the ideal motor pattern change. I, for one, will not discontinue foam rolling, stretching, or self-myofascial release work with the lacrosse ball. I will also promote the benefits of massage. I will realize, however, that the changes come from the neural response to those activities. If change occurs, I will continue to perform those stretches/self-massage techniques. If they don’t help, I will move on to try something else.
The second thing I wanted to address is length of time in a stretch. Kelly Starrett recommends staying in a stretch for at least two minutes for any kind of appreciable change to occur. In the end, these strategies are about body awareness and motor control. Once you’ve built the confidence to move well, the reduction in pain and improvement in quality-of-life is what’s important. I hope I didn’t confuse you too much and I hope you didn’t give up on your body’s maintenance.