As you can imagine, this is a sizeable subject with differing opinions dependent on knowledge, and experience.
My approach comes from a degree in sports rehabilitation, followed by further study, and cemented by my experience with clients and from living with a skull fracture.
This background has created an approach that is very focused and person specific. Each individuals needs should be met with the right techniques and each technique is dependent on the tissue that is being worked on and how it is presenting. Therefore you will find my sports massage may not be what you are used to in the form of an all-round painful sports massage. Yes they get results and people certainly talk about their therapists, but it’s a blanket approach to the tissue issue and I would rather take a more targeted approach using the exact treatment technique that the tissue needs at that point. So a general massage is used but I also use more advanced techniques when they are required.
In short, I would rather work smarter not harder unravelling unravelling a larger number of the tissues issues without too much stress or load on the system.
So I guess the simple answer is no, it doesn’t have to hurt, however it might if done for the right reason…
The science behind my approach.
The body is made up of numerous types of tissue and structure, each structure has differing receptors that send information to the localised structures, the spinal cord and the brain.
Each tissue type has a multitude of different ways in which it can be dysfunctional.
These differing dysfunctions all require a different response from the body to elicit a positive change and therefore all have to be treated differently.
Each treatment technique will irritate the cells, receptors, nerves and brain differently and depending on what response you want to get will determine what receptors are irritated and if the technique will be painful or pain-free.
Damage and dysfunction in the tissue will change the reactivity of the receptors to allow them to transfer pain signals more readily thus prevent further damage so areas that are damaged give a higher pain response.
So to give a slightly more complex answer than before, treatment may hurt if the structure you want to alter needs changing via a cue that creates a higher pain response, or it may be a relaxing experience that doesn’t cause any pain but softens the tissue and calms the nervous system.
Still confused? Here are some examples.
Please excuse the number of words but this is not simple and takes a bit of time to explain so I have kept it to a few examples and reasons. Its probably best explained in the treatment room but lets give it a go on paper.
Lets start with something simple, tight muscles what we would call “hypertonic” (hyper - too much; tonic - level of tone or tissue tightness)
As therapists we need to ask, ‘why is that tissue tight? / ’How did it get into that state?’,
Option A: Frequent Gym Visitor with no issues
Repetitively stimulated muscles (soft tissue) and nerves that have been worked under a load that has increased the blood supply to feed the muscle contraction and therefore a need to remove waste to an equal level.
Job of the therapist:
a) Increase bloody flow to remove waste products and initiate cellular healing and muscle growth.
b) Quieten the nervous system and regulate its firing pattern to allow muscle relaxation, flexibility and balance.
Pain level = Mild to moderate. Blood supply is increased and the nervous system is re-calibrated meaning
You walk out more mobile and feeling uplifted and the muscle feels more elastic and stronger.
Option B: Gym Visitor with muscular dysfunction
Working the tissue on a dysfunctional movement patterns means it isn’t used effectively therefore creating micro-trauma and compensation patterns, if too much load is put trough the tissue it will create an acute trauma. If the load is small stiffness occurs and the micro-traumas and their healing process build up on top of each other (overuse injuries). This creates a protective tightening of the surrounding tissue to hold everything together and take the pressure off the damaged area.
The job of the therapist:
a) Get the tissue to reassess trauma and to initiate healing process to the level of the damage.
b) Release reactive trauma in the tissue which would have set-off the trigger points.
c) Aid health of the tissue and rebalance the system.
Pain level = Moderate to high. Depending on the damage in the tissue. Trigger-points in the tissue can elicit high however once released new blood flows in and resets the system and the pain can completely go.
You walk out more mobile, with less pain but and increased awareness that the inflammatory processes is working. You will feel stronger but energy will be directed towards the inflammatory process so you may feel tired.
Option C - Stress related muscle tightness
Stress has meant the nervous system has been on overdrive irritating the muscle receptors. The muscles may not have been involved in a trauma but are being held in a tense position. No movement or increase of blood supply has occurred but the muscle fibres have been in a consistent low level of contracture thus causing trigger points.
The job of the therapist:
a) Calm and comfort the nervous system, long slow strokes suggest to the receptors that the muscle is lengthening and able to relax.
b) Increase the blood supply for waste removal and to bring in an influx of nutrients.
Pain level = In theory low but can be high dependent on the stress or damage held in the tissue, neurological irritation and underlying issues can be exacerbating the stress response in the muscle and may need to be worked on to reinitiate the healing process. Trigger points are commonly painful but are well worth treating as they are the muscle command centre of the muscle.
You walk out more mobile, relaxed, calm and in control, however maybe don’t do anything too serious or strenuous after as your brain may be internally focused on helping you do the best it can for you and not on the task in hand.
Well done if you got this far….
You are currently in control of a body so unique and so amazingly complicated that no blog would ever do it justice but I hope you can understand just a little bit more about how it works and also how we as therapists work with it to help you heal and feel better. We have this and more sorted so you can just let us work and let the magic that is the human body do the rest.
Look after your body and it will look after you… of that I can guarantee.