Bodywork Treatment for Chronic Pain – how to get the best from your treatment…

I decided to write this blog as I realized I should develop an advice sheet for clients with chronic pain including things they would find helpful to learn (or accept), and lifestyle advice which will help them optimize their recovery from chronic pain/illness. There are things the client can do before, during & after treatment, and in their day to day lives, which will increase any therapy benefit, so aiding their recovery. The following advice is also indicated for suffers of chronic illnesses, autoimmune disorders, stress related health problems, headache/migraine and chronic fatigue syndrome.

What Causes Chronic Soft Tissue Pathology (i.e. chronic pain)?

As you can probably imagine, this is not a straightforward question, with one simple, straightforward answer. There are, of course, many varied causes of chronic pain in humans. Some may be obvious to us (including the causes of our own pain condition/s) such as traumatic injury. Others may be less obvious, or we may not yet have comprehended that our pain has different diverse causes (including emotional/psychological factors). The mind-body link is very relevant when it comes to chronic pain (& health) conditions; negative feelings, stress, and trauma often, over time, manifest as soft-tissue (myofascial) pain.

A good way to identify factors which can cause soft-tissue pain/pathology is to consider it can be ‘anything which is bad for you’. Its important to note that this does not does not just apply to things which are bad for the body (e.g. junk food, poor posture) but also things which are bad for the mind & spirit (e.g. trauma, stress, negative emotions). Everything which is bad for the body, mind and spirit can cause soft tissue pathology in the form of painful trigger points, myofascial adhesion’s and muscular spasm. Scar tissue can also dehydrate, tighten and adhere over time; an old injury or operation might be far more problematic years after its occurrence for this reason! Doing what we can to reduce the contributing factors of our pain is a gift we can give ourselves; it will also benefit our general well-being, and can make our therapists job easier!

How to Limit the Development/Deterioration of Soft Tissue Pathology (ie. trigger points, myofascial adhesion’s, muscle spasm)

So, to establish what might contribute to our pain, we would be wise to consider factors which are bad for our body, mind and spirit, and how we can omit these, or reduce their impact. Its important to highlight at this point that we must ‘go easy on ourselves’! Many of the causes of our pain might be unavoidable and/or not be our fault; avoiding them entirely might also not be practical, possible or desirable. For example, if we are depressed then socialising might be too much. This is ok, just do what you are able at this time. It may also not be easy, or possible, for you to simply ‘drop’ harmful negative emotions, or forgive those who wronged/abused you. This is again ok, I am not telling you how you should feel or who/when you should forgive, just making you aware of factors which can manifest as chronic pain. Trauma can play a big part in chronic pain so having a psychotherapist or trauma healer (i.e Somatic Experiencing) help us process this (and any related guilt/resentment) can be cathartic, if required. We also can’t help suffering with mental illness, though we may of course be able to do more to help ourselves (and related pain/symptoms). Fears and insecurities are also part of being human; the fast paced nature/pressures of the modern world are also somewhat outside of our control – we need to cut ourselves some slack . Progress, not perfection, is the aim!

Factors which may contribute to chronic pain/illness:

Dehydration – drink more water/fluids & less caffeine/alcohol.

Stress – learn a relaxation technique, meditate, take time out for yourself, get into nature (i.e. a walk), work less.

Alcohol, drugs, smoking – Quit drinking (or drink less). Quit drugs & smoking. Pursue alternative pastimes. Work a 12 step program and/or indicated cognitive behavioral therapy (CBT).

Isolation/loneliness – Arrange to see friends. Get a (sociable) hobby. Accept help from individuals, groups and agencies. Accept invitations to social events.

Poor posture – Do rehab to correct posture. Stretch tight areas. Learn Alexander Technique. Correct your posture when working/sitting/walking.

The pain/stress of active addiction – Face your denial & confront your addiction. Use a 12 step program and/or CBT to address your addiction. Accept help, attend support groups.

Overwork – Stick up for yourself (i.e to Manager/HR): refuse to work over whats reasonable . Change jobs. Delegate, even when you don’t want to.

Trauma – Get psychotherapy. Read indicated books. Use help groups (inc. online). Do trauma healing.

Injuries – Do your rehab (see rehab PT, Physio, Sports Therapist), stretch injured areas, rest injury if required. Google rehab exercises on YouTube.

Rushing through life – Remind yourself to ‘slow it down’. Take your time, settle down and ‘reground’ yourself as required. Take some deep breaths, or a time out.

Disease/illness – Follow your doctors/therapists advise. Change your diet if indicated. Rest when required. Take medication if helpful/essential.

Hypermobility/being too flexible – Do Pilates/core strengthening. Strengthen muscles supporting painful joints (i.e rehab). Don’t overstretch, or do too much Yoga.

Stiffness/lack of flexibility – Stretch daily, especially tight areas. Do a regular Yoga class. Warm up before & stretch after physical activity/exercise. Google YouTube exercises to help tight areas.

Hate/resentment (i.e. People, family, circumstances, past events, institutions, employers) – Consider if forgiveness and/or reconcile are possible. Can you ‘let this go’? Be mindful of this feeling. Get therapy.

Repetitive Strain (on muscles/tendons) – Have ‘recovery days’ between ‘sport days’ (i.e. don’t do the same sport/run day after day). Do the aggrivating activities less often, or for shorter times. Talk with your employer about reducing/mitigating aggrivating activity.

Sedentary lifestyle/lack of movement – Go for a walk each day. Do a sport you enjoy 3 x week. Get up and move about regularly. Learn & practice Tai Chi.

Poor diet – Avoid junk food. Eat more fruit, veg and pulses . Take a quality multi. Avoid unhealthy snacks. Cut down on processed food and sugar.

Fixated/stiff joints – Do a regular Yoga class and/or Shiatsu/Thai Massage treatment. See a good Osteopath or Chiropractor, to have this addressed.

Psychological incongruence – Be our ‘true self’ (i.e. don’t try to be someone we are not). Behave the way we feel we should. Follow our own morals and principles.

Scar tissue – Stretch and move the area. Apply indicated oils & balms. Get myofascial treatment. Strengthen affected/antagonistic muscles, if indicated. Stay hydrated. Consider scar tissue problems when doing cost-benefit analysis of potential operations.

Being overweight – Look to change your lifestyle, rather than unsustainable/fad diets. Eat less unhealthy snacks. Reduce portion sizes and alcohol intake. Explore your reasons for overeating with a psychologist.

Guilt/shame/regret – Learn to forgive yourself. Accept we cannot change the past (but can improve the future). Make amends with those you have wronged. Get therapy.

Family ‘stress’ – Make sure you have ‘me time’, away from your family. Do not take on their problems as your own (i.e. if they are adults). Practice mindfullness. Learn to say no. Try not to ‘enable’ their poor/selfish behaviour.

Lack of exercise/unfitness – Commit to exercise 3 x week. Go for walks and avoid using the car/lifts/escalators, if possible. Find active pastimes you enjoy.

Mental health problems – Study and implement indicated CBT. Learn mindfulness. Explore different types of psychotherapy. Accept medical help/medication if indicated.

Lack of strength – Do a regular Pilates class. Get a strength and conditioning PT, or join a gym and get a bespoke strength program from the PT’s. Google YouTube workouts.

Taking on too much – Learn to say no. Try not to ‘live for others’. Try to make sure family/colleagues/friends do their fair share (and if they don’t, don’t do it for them).

Fears & insecurities – Try to identify, understand and accept our fears and insecurities. Use CBT and psychotherapy to explore these, and reduce them (if possible).

Go through the above list and consider which apply to you, and how you might reduce them, or mitigate their impact on your health/pain. This is, of course, easier said than done. We must show ourselves kindness and accept that we are human and being ‘perfect’ is unrealistic; perhaps pick 2-3 key issues to work on? After all, having overly high expectations of ourselves we cannot live up to will also cause us spiritual pain, which may manifest as physical pain.

‘Feeling’ your Pain & Experiencing your Uncomfortable Feelings/Emotions

As humans we are hardwired to avoid unpleasant things. Often this is to our advantage; taking our hand off a hot plate to avoid burning ourselves, for example. However, it is becoming increasing clear in the fields of psychology & bodywork that this natural self-protection strategy can backfire, causing us emotional discomfort and even physical pain. What has been accepted in Buddhism & Asian culture for centuries is now gaining understanding and acceptance in the West through the study and promotion of mindfulness and mindfulness based stress reduction (MBSR). Anyone suffering chronic pain (or chronic ill health) would be wise to read about mindfulness, take a course and practice regular mindfulness-meditations!

Those of us in chronic pain need to learn to really ‘feel’ & accept our physical pain, to pay attention to its quality & sensations. Trying to ‘shut the door on it’ mentally doesn’t work, we must be open to it, and any painful related connotations. To do this we ideally need a mindfulness teacher, though much can be learnt from a good book. We also need to learn to let in our emotional/spiritual pain, and unpleasant feelings, not (mentally) run from it. Trying to hide from our pain can make us spiritually unwell, and can cause it to manifest in our soft-tissues (i.e. muscles, tendons, ligaments, FASCIA) as physical pain/tension! We need to learn to ‘lay out the welcome mat’ for emotions and feelings we find uncomfortable, and to sit with them, experiencing them viscerally. This can help our soft-tissues to heal, letting go of pain, tension and trauma locked within them (i.e. due to us trying to hide from our emotions, feelings & ‘spiritual pain’).

Exercise and Stretching for Chronic Pain

Your massage/bodywork therapist can only do ‘half the job’ when it comes to the treatment of soft tissue pain & injury, the rest is up to you. We cannot stabilize your core, ensure your muscles/fascia are stretched and moved daily, improve your lifestyle, strengthen your weak muscles, or exercise on your behalf. Although there is much a good bodyworker can do, which the individual (or medical staff) cannot, the important aforementioned points can only be done by you! Its important you find the motivation to do these things, put in the effort and find the time. Again, we are looking for progress not perfection, but help us help you, and take some personal responsibility for your recovery from pain or injury (its not only your therapist’s job to treat your pain, you need to help yourself!).

Part of taking responsibility for your recovery from pain might be finding and attending a regular exercise class, or joining (and attending) a gym. If you are hypermobile (i.e. very flexible), or get back pain, I recommend you attend a Pilates class. People that are stiff and/or have joint issues would be wise to find a suitable Yoga class; Hatha/relaxing Yoga may also be a good fit for stressed/overworked individuals. If you suffer with fibromyalgia/CFS/long-COVID then a Tai Chi class might be just what you need, or a specialist (i.e. low intensity) Yoga class. I don’t recommend Yoga if you are flexible/hypermobile, at least ensure you don’t do it too often, or engage in strong/prolonged stretching on muscles which are not tight. If you are weak/frail then you need a strength & conditioning personal trainer, physio, or sports therapist (or ask your gym PT’s to develop an exercise plan). Take the time to learn how to stretch your tight muscles, or painful areas, ensuring you do this after physical activity & work (if it tightens them). Another important habit to develop, to reduce myofascial pain, is to ‘move’ your body regularly! Take your limbs, joints, head & neck through their range of movements regularly – this will help keep the fascia supple and stop it sticking – so less pain!

Frequency of Treatment & Committing to the Initial Course

Frequency of treatment is a very important factor concerning how much benefit you get from treatment. I know your commitments, modern life and your therapists diary being booked up can all make getting your regular treatment challenging. Also, for many people, cost can also be an issue (especially at the initial stage when regular treatment 1-2 times per week is required). However, this is important and needs to be a priority for your time and your money! Your health, being relatively pain free and having a body which functions well are all very important (not just for you but also for your work, family and friends). If this means rearranging/adapting social commitments, childcare, work (a good boss/manager should see that having you functioning, and in less pain, will also benefit them) or skipping a hobby/sport/exercise session, then so be it. I appreciate this can’t always be done, but if it can, prioritize your treatment!

When you start your treatment, you are going to need to commit to (at least) weekly sessions. For acute conditions, recent injuries and more severe ailments (i.e. which deteriorate quickly) you may need treatment twice a week to begin with (with at least 2 days between treatments, for your body to process-recover). Progress will be allot slower (so treatment cost allot more), if you have sporadic treatments, here & there, to ‘fit in with your busy life’. The reason progress will be slower (or you may not even improve, in this instance) is that you will be allowing time to deteriorate again, between treatments. For progress to be steady/continuous you need to be having your next treatment BEFORE you start to substantially deteriorate again, otherwise your progress will go up and down. This means, at least weekly treatment, until you have significant improvement, is essential! If you need to, book a few in to get your desired time (you can always cancel them nearer the time, if you don’t need them/can’t attend). Further down the line you can of course space these treatments out more (i.e. fortnightly > 3 weekly > monthly) and maintenance treatments are recommended every 1-2 months, for most chronic pain issues; follow your therapists advice though!

Before Treatment – advice

The treatment should still be beneficial regardless of what your up to beforehand. However there are a few do’s & don’t’s which can put you in a better place for bodywork treatment, and/or improve the outcome:

Recommended:

Try to relax – Take it easy and chill before a treatment (if possible). Perhaps meditate if you have time?

Leave extra time to get to your appointment – you wont be centered or relaxed if you are rushing, or late for your appointment.

Have a wee – its better if you are relaxed during treatment, not needing a wee aids this (plus might avoid the disruption of you needing to use the loo during treatment).

Turn off your phone – Your phone can disrupt you and your therapists relaxation & concentration. Even if you don’t answer it, you might fret of who and why someone called.

Avoid taking painkillers & antiinflamatories for 4 hours prior to treatment – Its best not to have your pain sense dulled for treatment. Also the drugs may affect your healing reactions to treatment.

Have a hot bath* – To relax muscles and warm/hydrate fascia. *Avoid if you have a recent injury, acute pain or inflamed body part/s.

Not-recommended:

Drink alcohol or coffee – being under the influence of alcohol or drugs contraindicates treatment. Too much caffeine will also overstimulate you – not good for treatment.

Have a big/heavy meal – Its better your not overly full; best to leave an hour post eating before treatment.

Do really heavy exercise – Light exercise shouldn’t be a problem, but its usually better you haven’t done ‘hardcore exercise’ before treatment (unless having post-event sports massage).

Do very stressful work – Not always possible, but its better if you arrive relaxed and not under too much pressure/stress.

During Treatment – advice

Firstly, its important to say that this is YOUR treatment, so how you chose to enjoy it and IF you choose to follow any of the following tips is your call! Don’t feel you should or shouldn’t be a certain way, feel a certain way, or react a certain way; there are no expectations on you. However, you may find the following advice helpful:

Try to let the therapist take the weight of your limbs/head – relaxing the head and limbs (unless instructed otherwise) can help the therapist release your tissues better.

Tell your therapist if something is too uncomfortable/painful – We want to avoid anything over a 6/10 (i.e. pain scale), so you don’t tense against challenging work.

If you don’t want a specific area worked, do say – Even if not painful/rational; emotional stuff can get held in the tissues, you may not be ready to have it released yet – that’s fine.

Try to ‘relax into’ any discomfort – If you find any massage work uncomfortable (e.g. trigger points, deep frictioning, direct myofascial work) try taking in slow deep breaths, then letting go of tension as you breathe out.

Try to relax your body and mind – Let your muscles soften and your mind calm – try not to ruminate on life’s worries for this short, precious time.

If you need to make a noise, cough, laugh, fart, cry or move; do so – Its important you are comfortable during treatment, your body may also need to do certain things to help ‘release’ emotions or body tissue. Trust your instinct & body.

Try to stay present, in the body (For myofascial work [slow, focused work, without oil] or trigger point therapy [treating the painful points which cause pain]) – Try not to ‘dissociate’ with whats going on. It can be helpful to try and stay with the experience, in the moment, feeling what the therapist is doing to your body tissues. This is not essential, if it doesn’t suit you.

Don’t feel you have to chat to your therapist – You are of course welcome to chat, but if you need some quiet time then that’s fine, its your time.

Ask if you need extra towels, bolsters, or a change of position – Your comfort is paramount so ask if you need something – we are also trained to treat clients in a variety of positions, so we can probably amend your position if required.

After Treatment – advice

The following advise is for immediately after treatment, and for the following 48 hours:

Drink plenty of water after a treatment – To help rid the body of toxins released and also to re-hydrate the muscles & fascia (connective tissue).

If possible rest & relax after treatment – To allow your body time to process & recover. Avoid work, exertion and stressful situations (as much as possible) for 2-3 hours; take a nap if your body wants this.

Avoid strenuous exercise for 24 hours after treatment – Also avoid heavy exercise involving any specific problem areas/injuries worked for 48 hours after treatment.

Do not apply heat to the area worked (or have a hot bath/sauna) for 24 hours after treatment, longer if treated areas are sore/tender. Apply an ice pack or cold peas (wrapped in a tea towel) for 15-20 minutes to sore/tender areas.

If possible, do not drive straight after treatment (esp. if lightheaded) – Wait for a quarter of an hour or so until you are fully alert, keep a car window open and drive slow/with care.

Avoid alcohol, recreational drugs, excessive caffeine for the rest of the day – Unless you are dependent and avoiding them will cause you withdrawal symptoms.

Do not eat straight after treatment – Make your next meal light and nourishing.

Contra-actions:

Although most reactions to receiving massage/bodywork are positive, some people may suffer temporary odd, or negative effect/s in the 48 hours following a treatment. These may include headaches, soreness, symptoms of illness, lightheadedness, feeling ‘wiped out’ or unusual moods/emotions. You may notice other effects, such as increased urination/perspiration, feeling hot, vivid dreams, fatigue or altered sleep. These reactions are usually a sign that the treatment was much needed, and are due to the detoxification process, your body processing the treatment and beginning to heal & re-balance.

Firmer massage & myofascial work can also cause localized tissue inflammation (causing local heat & discomfort, often the following day) and even sometimes mild bruising. If you have tissue soreness, apply an ice-pack to the affected areas regularly (you can also use anti-inflammatory’s such as ibuprofen gel [consult a pharmacist], or supplements such as devils claw or turmeric) to calm tissue inflammation. Rest and protect any reactive areas and contact your therapist if the reaction is overly sore, or lasts over 48 hours.

There is much we can do to help ourselves, and improve the outcome of our therapists bodywork. Anything we can do to bring the body and mind back into balance may help our pain and/or illness. Making peace with ourselves, our pain and our uncomfortable emotions may really help make the difference in our healing journey.

Recommended further reading:

Tai Chi for Beginners & the 24 forms: Dr Paul Lam (+ DVD Tai Chi for Arthritis & Fall Prevention)

Yoga for Chronic Pain – 7 steps to aid recovery from fibromyalgia with Yoga: Kayla Kurin

The Trigger Point Therapy Workbook – your self treatment guide for pain relief: Clair Davies

The Anatomy of Stretching – your illustrated guide to flexibility and injury rehabilitation: Brad Walker

Adrenal Fatigue – the 21st century stress syndrome: James L. Wilson

Myofascial Release – healing ancient wounds: John Barnes

Fascial Fitness – practical exercises to stay flexible, active & pain free: Robert Schleip

The Body Remembers – the psychophysiology of trauma and trauma treatment: Babette Rothschild

Waking the Tiger – healing trauma: Peter Levine

Overcoming Chronic Pain – a self help guide to using cognitive behavioral therapy: Dr Francis Cole

The Mindbody Prescription – healing the body, healing the pain: John E. Sarno

Mindfulness for Health – a practical guide to relieving pain, reducing stress & improving well being: Vidyamala Burch (+ audio meditation CD)

Seven Minutes to a Pain Free Back – Yoga and Pilates to ease back pain, strengthen your core & improve your posture: Melinda Wright