"Don't worry about me. Do what you've gotta do"
"I know it will feel better in a few days"
"No pain, no gain right?"
I probably hear comments like this at least a few times a day in my practice. Manual therapy has a dirty little secret. It has perpetuated this idea that a therapy has to hurt to work. This is a travesty. The International Association of the Study of Pain (IASP) defines pain as being associated with actual or potential tissue damage. Why are we liberally assigning therapeutic value to causing our clients pain?
As a brand new massage therapist, I also subscribed to this terrible principle. My education and the industry put a bigger premium on therapists who could perform aggressive, deep, "painful" techniques. Some clinics even charged more for it. This was viewed as somehow more effective than what people labelled "fluffy" massage. The flip side of this is that therapists who could not exert huge amounts of force were sometimes made to feel inferior. In my youthful ignorance, I jammed elbows and thumbs into the ailing soft tissues of many many people. They spent a couple days after the treatment feeling bruised and beaten, and came back for more a few weeks later. I thought this meant I was good. I was wrong.
I'm not saying that deep techniques are bad. If you can handle it then more power to ya! It's all about tolerance. But no one should be convinced that they need to grit their teeth and bear pain beyond their tolerance in order to get better. Period.
So now lets talk truth. Truth is that pain is a manifestation of the nervous system NOT of the soft tissues (one day I will write more about this). Manual therapy has this amazing ability to moderate pain but it can't be done by damaging tissue. Seems obvious. We need to view stretching, manual therapy and the like from a bit of a different lens. If we look at it from the perspective of a type of altering of the nervous system, stretching becomes less vigorous and forced, massage manipulations become slower and less painful and our view of how we approach pain manifesting in tissues gets turned upside down.
If you are a manual therapist, it is your responsibility to do your due diligence. Read more. Questions more. Learn how to investigate and critique the current literature around manual therapy. Do not continue to accept the antiquated ideas and concepts that are still, unfortunately, taught in our schools. Drop the dogma!
Need a starting point? Investigate the most recent science behind the use of ice to improve healing. You might be surprised at what you find.