Erik Dalton is a respected leader and educator in the massage therapy field. In a recent article in Massage &
Bodywork magazine, Dalton published an article in which he proposes massage therapists employ pain - in limited, controlled quantities - as a useful tool to the therapeutic process. This is known as Pain Exposure Therapy (PET) and is used in many rehabilitative settings and modalities. The premise behind this method is that we can decrease pain by “normalizing sensitization by providing constant stimulus to the affected area for short periods of time.” Or more simply, we can show the brain that the body is not in danger by controlling the amount of pain felt in a given movement. Levels of pain felt are reduced as the nervous system registers that whatever threat caused the injury is no longer present.
Dalton’s main application for PET is with therapeutic stretching. He notes “traditional stretching routines produce an immediate increase in muscle extensibility,” but “more permanent extensibility” is seen when PET is utilized.
Two possible reasons are offered for why the results are longer lasting. The second proposed is because the feedback loop between the central nervous system (brain and spine) and the peripheral nervous system (all the other nerves; specifically the area of pain in this instance) is being reorganized. The first Dalton states is likely more important; “the client’s willingness to tolerate the discomfort associated with the stretch.” A client’s active involvement is allowing him or her push through barriers created in attempt to stave off pain, effectively illustrating in real time that fears can be calmed and avoided behaviors can be reintroduced into normal routines. Essentially, the therapist is helping the client to involve the physiological and the psychological elements of the central nervous system to resolve pain more quickly.
While I see the benefit of utilizing minimal, controlled pain to speed the therapeutic process, I have found there are work-arounds. We can decrease central sensitization - the process by which the central nervous system goes on high alert in an effort to guard against injury - by engaging the nervous system in softer ways than stretching sometimes offers. I do this through other myofascial work and Spontaneous Muscle Release Technique (SMRT).
Part of the effectiveness of PET is that the therapist is introducing “novel stimuli” to an affected area. With SMRT, the novel stimulus comes through the subtle nature of the holds and the activating force of the compressions. The nervous system can be directly involved in the conversation in ways that are usually drowned by the “loud,” larger movements of everyday life. We then engage your psychological state by having you test your range of motion, creating visual and tactile evidence that your pain has decreased. What I find most amazing about this work is that even when the pain returns as is likely to happen after a few days after the first few sessions on an ongoing issue, it is often greatly diminished or has shifted to reveal another element of the compensation pattern that is ready to resolve.
Overall, there are some legitimate reasons why pain might be experienced during a massage session and therapeutic pain can be helpful in your healing. But, as I have asked so often, if you don’t have to experience pain, why should you?