The "Where You Start" Approach to Pain Management Massage

Massage Magazine Article for December 28, 2023; Author Amy Bradley Radford

Beginning a pain-management massage session distant from where the client is experiencing pain can result in successful pain relief.

When I was a student in massage school, it seemed like each teacher had a handful of signature massage approaches that were remarkably successful for a few specific issues.

I remember asking if there was some kind of book to buy that had a compilation of all these great approaches to the body or manual overrides of knowledge and skill for massage therapy.

The answer of course was no, and I have since learned that what many of those teachers were graciously sharing was their personal success experiences at the massage table.

In that same spirit of sharing success experience, I offer one of the approaches I use that can create a positive difference for pain-management massage therapy.

It is the concept of beginning a massage distant from the pain of which your client complains of.

Why Select a Different Starting Point Distant from Pain?

If you are a seasoned therapist reading this article, you likely already understand this concept. You also understand that if you approach an area in pain directly and it doesn’t work, then you go looking for other areas that take the pressure off the pain.

Through both experience and a process of elimination, we learn there are always a couple of ways to work certain kinds of pain patterns and the muscles will respond to one of those approaches.

When these approaches stabilize into repeatable concepts that work for most clients, these are what I call Universal Principles.

These principles will stand true at the core when working with pain issues and can provide you with the needed principles and protocols to follow for success.

One of those principles is that where you start the massage, locally or dynamically, can create a positive difference and can impact, to a greater level, how much the body will decrease in pain and inflammation for that treatment or session.

The reasons for this are rooted in kinesiology, but the outcome to this concept is best explained by physics.

A Simple Physics Principle

As a teacher, when I mention the word physics, sometimes people start to mentally check out. Rest assured I’m not going to make this a complicated physics lesson.

I will start out by giving you the answer of why to start distantly from pain and then break it down just a little more. The answers are:

• When dealing with pain cycles, there are muscles that are contracted into an over-shortened position which automatically is forcing other muscles to be in an over-lengthened position.

• These longer muscles are typically the ones experiencing the pain.

• This can be a localized issue such as a few muscles in one area struggling to oppose and operate correctly.

• Or this lengthening force can be very distant from where the shortening is occurring, involving a good portion of the muscular system which is struggling to function, oppose and operate correctly.  

This explanation about the habits and behavior of all muscles working together as one unit when pain is present follow the third law of physics which states that “for every action there is an equal and opposite reaction.”

One of my favorite physics resources is the Physics Classroom. In the lesson for the third law of physics there is this paragraph:

“Th[is] statement means that in every interaction, there is a pair of forces acting on the two interacting objects. The size of the forces on the first object equals the size of the force on the second object. The direction of the force on the first object is opposite to the direction of the force on the second object. Forces always come in pairs – equal and opposite action-reaction force pairs.” 

This statement does describe several different components of muscle and contraction behavior.

To translate that statement into muscles and function:

• There are two interacting objects which are two opposing muscles or two opposing groups of muscles.

• Size of the force relates to the muscle or group of muscles that begin this contraction sequence and how much they are contracting.

• Size and force of the opposing muscle or group of muscles means how much these muscles must contract to balance against that first motion. (This is basic kinesthetic relationships of muscle pairs).

• The direction of force on the first object is opposite to the direction of force on the second object.

• For this muscle relationship, the shortening contraction of the first muscle (concentric) is equal to the lengthening contraction of the opposing muscles (eccentric).

This is the main component I wanted to explain. Both muscles are actively contracting but the direction of those actions are, and always will be, in opposite directions.

One muscle is in a contraction state of shortening and the other muscle is in a contraction state of lengthening. This is what is meant by equal and opposite reaction.

Yes, they are both contracting. But the one that started the motion is in a shorter state than the one opposing the motion which is in a longer state, and they are holding in those states. This concept took me years to understand but it explained to me why opposing muscles became weaker over time.

The pain model fits into this physics principle when you have a set of muscles whose chronically over-shortening force causes an equal and opposite reaction of an over-lengthening force of the opposing muscles. These lengthened muscles begin to fail, microtear and are more susceptible to injury perpetuating these forces further.

However, the body is prepared for this scenario. There are several fail-safes that the body activates with pain.

• Acute to chronic inflammation occurs to rebuild muscle tissue forming the strength to oppose.

• Pain signals and perceived pain restrict motion for healing.

• The body will also try to spread out this burden of imbalance and have other muscles give up some length to balance out the demand being placed on one specific muscle.

Given time and potential injury, the sharing of the burden can domino through several muscles and muscle groups, resulting in a body wide, dynamic version of the equal and opposite reaction.

How About this First with Pain-Management Massage?

It’s simple; where muscles are shortened, they need to be lengthened. Where the muscle is already lengthened, it needs to be given the opportunity to shorten. This will happen naturally if the massage is applied in the correct order.

(Red: Lengthening and pain. Blue: Areas of shortening. Graphic courtesy of Amy Bradley Radford.)

 The force of a massage stroke can only do one thing: massage lengthens tissue. As a therapist, if you select shortened areas to work on first, and lengthen out those tissues out, the opportunity is automatically created for the lengthened muscles to shorten. If a muscle feels a slack in tension, it will contract and reset to shorter length.

If you apply pain management massage on the area of pain first and lengthen it further, where exactly do you think the additional length created by the massage will go to? It is picked up by that shorter tissue that is dominating the pain cycle. I call this Universal Principle “feeding dysfunction.”

A simpler and less painful approach is to select to work on the shortened tissue first, allowing the ability to contract to return to the lengthened tissue to promote healing.

How to Select a Different Starting Point

Selecting a different starting point is a simple theory of opposites.

A common example of this concept is when massage is applied to the front of the chest and the pectoralis major to lengthen out the front of the body to take the pressure and pain off the muscles of the upper back.

A dynamic reaction means opposite ends of the body. This could be potentially seen as:

• A shortening in the neck region that shows up as lengthening (pain) in the lower leg groups.

• A shortening in the lower legs/feet that shows up as a lengthening (pain) in the neck with headaches.

• A shortening in the right lower leg group that shows up as lengthening (pain) in the left shoulder, neck, and headaches.

Even more dynamically, but no less common:

• A shortening that occurs in both the head and feet that shows up as a lengthening (pain) in the spine and low back.

• A shortening that occurs in the middle that shows up as lengthening (pain) in both the neck muscles and lower leg muscles as equal and opposing forces for a central shortening.

You can visually see the differing lengths with some clients and then others you pay attention to the location of the pain and go opposite of the pain to find the area of potential shortening.

It is beneficial to work both opposing muscles and groups, but for different reasons. Work the shortened tissue, first, to take the pressure off the lengthened tissue, and then work the lengthened tissue to bring in blood and healing, but not so much as to recreate the over lengthening.

When a client does not respond to treatment or gets worse from localized treatment, than a more dynamic approach is a valid option to pursue.

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