Pain Management Blog

Can massage therapy relieve my pain? This is a question asked by many clients at my massage therapy office in Orlando over the years. Each person's situation is unique, but I have many clients that have found their pain eliminated or greatly reduced with the application of specific massage therapy. I also have clients that use massage therapy as an alternative to surgery or taking medication for pain management. 

Today I want to start my pain relief blog with an explanation of how pain in the body may be caused by soft tissue. I'm going to focus on four common causes of soft tissue pain When I discuss soft tissue I may refer to muscular dysfunctions but fascia envelopes and permeates muscles. So if I am discussing muscles in particular, please keep in mind that I am also treating the fascia.

 As a certified Neuromuscular therapist , I specialize in the treatment soft tissue. Soft tissues that I treat includes the skin, fascia, muscles, ligaments and tendons. So how can these soft tissues cause pain? The four primary sources of soft tissue pain I look for when I client comes to me are ischemia, neural interference, postural distortions, and trigger points.

Ischemia is the most common source of soft tissue pain I come across in my practice. Ischemia just means the lack of oxygen caused by reduced blood flow. When a muscle becomes hyper-tonic or tight it restricts the blood flow to the area. The theory is that because the blood flow is restricted there is a buildup of cellular metabolic waste that causes the pain receptors in the tissue to become very sensitive. The great thing about massage therapy is that it improves blood flow. But ischemia is usually just part of the picture when it comes to soft tissue pain. When I treat a client that has ischemic tissue, I always ask myself why is this tissue so tight? Massaging the tissue to increase blood flow will help with the ischemia, but if I don't figure out the cause, it will just come back.  

Another source of pain in the body is neural interference. The most common type of neural interference that most people have heard about comes from the vertebral bones and the disks between them. The nerves exiting from the vertebrae can be compressed or “pinched” by these structures. Massage therapy can help with intervertebral disk neural interference by reducing the amount of distortion of the disk caused by muscular imbalances in the tissues attaching to the vertebrae. But most people don't realize that soft tissue can also compress on nerves and cause the same type of symptoms. Shooting pain, burning, numbness, tingling and muscle weakness are just a few of the symptoms that can be caused by not only bone but also soft tissue causing neural interference. There are many places in the body where soft tissue cause neural interference. For instance the nerve that services the arm can be compressed in several places on its way from the cervical (neck) vertebrae down to the hand. When the nerve exits the cervical vertebrae it travels between two muscles called the anterior and medial scalenes. If these muscles are tight and inflamed they can compress on the nerve. The nerve continues on passing under the clavicle (collar bone). Underneath the clavicle is a small muscle called the subclavius that can also press on the nerve. A short distance away the pectoralis minor can also press on the nerve on it's way to the arm. It's not unusual for clients suffering from carpal tunnel syndrome symptoms to actually have their pain, numbness and tingling coming from the neural interference caused by the muscles I just described. There are other muscles and even fascia that can cause neural interference throughout the entire body, but I just wanted to give you a simple example of how soft tissue can cause neural interference.

Postural distortions or muscular imbalances can also be a cause of soft tissue pain in the body. Earlier when I described ischemia, I mentioned that it's important to understand why the tissue is tight, causing painful ischemia. I'm going to use the shoulder girdle as an example of how muscular imbalances can cause postural distortions and ischemia.  

The shoulder is a good example of an area of the body that can be adversely effected by postural distortions or muscular imbalances causing pain. The shoulder blade (scapula) is basically a flat, slightly curved bone that is suspended and encapsulated by muscle. The only connection the scapula and it's attached arm has to the skeleton is through the collar bone (clavicle). The clavicle mostly acts as a support strut for the scapula and arm. Movement for the scapula comes from all the attached muscles. These muscles help the scapula glide over the rib cage. Because the scapula is suspended in muscles and floats or glides over the ribcage, it can move in multiple directions.

When you reach forward there are muscles that glide the scapula around the side of the ribcage towards the front of the body with your arm. When you reach upward, muscles slide back, rotate and depress the scapula back around the ribcage so your arm can reach up. There are also muscles that lift or elevate as well as muscles that can drop or depress the scapula. These are just a few examples of how the muscles can move the scapula. When all these muscles are balanced the shoulder girdle is very mobile and pain free.

Unfortunately if the muscles are not balanced, there can be distortions causing pain and reduced range of motion in the shoulder. For example, many clients that visit my Orlando massage therapy office, have shoulders that are rounded forward. This can happen when muscles and fascia in the front and side of the ribcage are placed in a shortened position for extended periods of time. An easily recognizable posture that can cause this is habitually sitting hunched over a laptop day after day. This tissue can become fixed in a shortened position pulling the scapula forward. As I described earlier, the scapula is encapsulated with muscles that attach from multiple directions to glide it over the rib cage. If the muscles pulling the scapula forward are fixed in a shorten position, then the muscles pulling the scapula back are going to be stretched long. The result is pain in the stretched muscles even though the cause for the pain is from the opposite short muscles on the front. If I were to only massage the tight stretched muscles, I would relieve some of the pain by increasing blood flow to the tissue and relieving painful ischemia, but the pain would come back because the true source of the pain was not addressed. If the source is not treated, the stretched muscles pulling the scapula back will actually be stretched even more by the short opposing muscles, causing more postural distortion and pain shortly after the treatment. Also, if the scapula is not gliding properly because of muscular imbalances the arm will not have full range of motion. It's not unusual for me to see a client that can't reach up to get an item out of the kitchen cabinet because their scapula is restricted and therefore the arm attached to it can't have full normal movement.  

Trigger points are the last of the four common sources of soft tissue pain in the body that I treat at my massage therapy office. Trigger points can cause painful sensations similar to neural interference and actually mimic many painful syndromes. Trigger points can cause shooting pain, numbness, tingling, burning and muscle weakness among other painful sensations. In my Orlando massage therapy practice, I've treated many clients that have been diagnosed with carpal tunnel syndrome, migraine headaches, pinched nerves in the neck, sciatica, and herniated disks, that have had all of their painful symptoms relieved by disabling trigger points. In order to understand how a trigger point forms, I need to explain how a muscle functions. To keep it simple, a muscles receives a signal from the nervous system to contract. This signal is communicated through a neuromuscular junction near the center portion of a muscle. Once the nervous system stops sending a signal, the muscle normally will stop contracting. A trigger point can form when the muscle continues to contract even though it is not receiving a signal to do so. This causes a nodule or knot near the center portion of the muscle to form. The nodule will be hypersensitive and cause pain and other sensations that radiate around the nodule or most often away from the area completely. For example, a trigger point in the upper trapezius on the top of your shoulder can refer pain to the temple area of your head or even into your eye. Another common trigger point located in a hip muscle called the gluteus medis can cause shooting pain down the leg mimicking sciatica. These are just a couple of the documented trigger point referral patterns throughout the body. I believe any muscle can develop a trigger point and have it's own painful referral pattern. Most of the major muscles in the body have documented referral patterns, but even skin, tendons and ligaments can develop trigger points .

As a neuromuscular therapist I take into consideration these four sources of soft tissue pain. There are other factors to consider, but this blog entry is my attempt to simply explain how powerful massage therapy can be in treating pain in the body caused by soft tissue. If you have any questions or would like more information, please feel free to contact me