Clinical Massage Therapy

Your pain may have a muscular component to it?

There is a large population of people who live with chronic pain on a daily basis. Many pain sufferers find relief through medical/clinical massage. Medical massage doesn’t consist of any one particular modality but it aims to treat specific medical conditions such as tennis elbow, plantar fasciitis and chronic hip/back and neck pain. Muscular imbalances from muscular overload, repetitive strain injuries and poor posture all have one thing in common; Muscles!

Clinical and Medical massage therapists tend to work closely with chiropractors, physicians, and physical therapists.

The Value of Soft Tissue Therapy

Few people, even some health care providers, fully understand and appreciate the benefits of soft tissue therapy. Some of the key elements of this innovative and unique approach to clinical massage therapy and structural bodywork include:

1. An in-depth understanding of chronic, excess muscle and nerve tension (CEM&NT):

… is the amount of pressure or depth applied in a manual technique or stretch; the ideal level applied is that which produces the greatest amount of tension or stress reduction in the client, with the least amount of resistance or negative reaction in the client’s psycho-neuro-muscular system. The edge is different for everyone at different times, and it often changes rapidly and dramatically. Yet working effectively with the edge is much of what determines how quickly, efficiently, and permanently a client’s neuromuscular and myofascial structure will relax. The therapist and the client must maintain a close rapport and open communication (relational yoga) throughout the session so that the therapist can stay attuned to the client’s edges and make the necessary moment-to-moment pressure adjustments. While it is the therapist’s responsibility to watch for clues, it is the client’s responsibility to inform the therapist about whether pressure is too deep, not deep enough, or just right. Th e edge concept also applies to mental and emotional yoga, which is outside the scope of this text.

Edgework is based on principles of physical, mental, and relational yoga. Many texts discuss “tight” muscles, but few explain what muscle tension actually is, where it comes from, why it is hard to eliminate, and the multiple problems it can cause. However, this knowledge offers therapists a whole new perspective on how to work with CEM&NT, and it offers clients insights into why effective therapy often requires more time than the typical duration of more commonly available treatments. Classical neuromuscular therapy works quite well. Yet when such commonly available treatments fail or produce only temporary relief, it is necessary to determine the factors that prevent the standard approaches to treatment from working.

2. Unique insights into structural analysis and postural assessment:

Structural balancing looks at the structural strains and/or neurologically transmitted irritations that develop in many CEM&NT clients. For example, for many people with chronic tension in the neck and shoulders, the true source of tension is the abdominal muscles that pull down on the rib cage and cause the neck and shoulder muscles, through a process of structural homeostasis, to contract in opposition to the abdominals. And, until this imbalance is resolved, every time the client does sit-ups or crunches to “strengthen” the abdominal muscles (the primary contractors), the increased downward pull on the rib cage and consequently the neck and shoulders (the secondary contractors) is made worse and more chronic. Yet, most of the time, the client feels pain in the secondary contractors and does not feel pain in the true, distant origins of tension: the primary contractors. Finding the primary and secondary contractors requires some detective work by the well-trained clinical massage and structural bodywork therapist.

3. Playing the Edge — Why NO Pain Means More Gain:

Edgework is based on principles of physical, mental, and relational yoga. The Edge is the amount of pressure or depth applied in a manual technique or stretch; the ideal level of pressure applied is that which produces the greatest amount of tension or stress reduction in the client, with the least amount of resistance or negative reaction in the client’s psycho-neuro-muscular system.

The edge is different for everyone at different times, and it often changes rapidly and dramatically. Yet working effectively with the edge is much of what determines how quickly, efficiently, and permanently a client’s neuromuscular and myofascial structure will relax. The therapist and the client must maintain a close rapport and open communication (relational yoga) throughout the session so the therapist can stay attuned to the client’s edges and make the necessary moment-to-moment pressure adjustments. While it is the therapist’s responsibility to watch for clues, it is the client’s responsibility to inform, as best as possible, the therapist about whether pressure is too deep, not deep enough, or just right. The edge concept also applies to mental and emotional yoga, which is outside the scope of this text.

Ultimately, being an effective soft-tissue therapy bodyworker requires clarity and honesty about one’s hands-on limitations. Even experienced bodywork therapists continue to be amazed, though not necessarily surprised, by the effectiveness of manual soft-tissue therapies in treating various conditions of the body and mind.For certain problems, manual therapies, such as massage, bodywork, and related modalities, are the most effective and least dangerous forms of healing. When hands-on work is warranted—and it often is—other modalities are merely palliative or miss the healing opportunity altogether, often to the detriment of the client. The challenge is for the client’s primary physician to determine whether CEM&NT is the client’s primary concern.

Unfortunately, massage therapy is often thought of as palliative but not effective for real healing. Many of the more commonly known massage techniques do not involve aggressively therapeutic massage and bodywork. Swedish massage, for example, is excellent for general relaxation and surface circulation, but it cannot create the deeper psychoneuromuscular and myofascial changes necessary to facilitate certain levels of healing, especially when the origin of the problem is structurally related. Swedish massage directly addresses only superficial tissues. While the indirect and deeper effects of Swedish massage are substantial, they are not sufficiently focused on structural change, which is often necessary to create healing. Many clients have tried a wide range of treatments with minimal results. Yet improvement was dramatic once the structural issues, or distant neurologically transmitted irritations, were addressed.

Neuromuscular therapy and similar treatments are excellent for focused work on trigger points or specific tensions; however, they do little for structurally transmitted strains. While these treatments do address some neurologically transmitted irritations, also known as referrals they do not usually treat the more distant, extreme, or elusive irritations.

Effective healing often requires exploring a wide range of modalities and practitioners—because one size does not fit all. It is important to educate potential clients about the vast range of diverse techniques that encompass “bodywork.” Being able to describe the differences between the various approaches is an important part of being a manual therapy practitioner. Although both education and experience are vital to one’s ability to produce results, experience—an education in itself—is more critical. Well-educated practitioners, however, gain far more from their experience than do practitioners with little or no education on which to build.

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