by Jamie Johnston
A New Beginning With Pain Science
The name alone used to scare me, let alone applying it in practice. As someone who struggled with the study of the "sciences" in massage college, every time I heard the term "pain science" I would shudder a little.
Each time I would see posts on Facebook or see the activity in Facebook groups, it seemed more like an argument than a learning opportunity, which only made me shy away from the topic more. Most of the time it just made me feel stupid when I looked at it.
My frustration with the topic grew to the point that I started to shut out reading or even looking at anything to do with it. However, it still seemed like an important topic that was gaining more and more relevance. Massage colleagues and friends started to challenge old beliefs, change the way they did things, and encouraged me to take another look.
Then I did the unthinkable and took a course in the dreaded topic!
Learning Pain Science
The time eventually came and I decided it was time to learn about this. First, it started with Greg Lehman's course, "Reconciling Pain Science With Biomechanics". I entered the course with some trepidation and honestly didn't think I'd be smart enough (maybe some imposter syndrome going on).
However, as it turned out, this was the start of a massive change. Fortunately, Greg and I have a similar sense of humor and the way he presents things isn't intimidating in any way, shape or form.
He simplified things and made it less confusing. He introduced new topics, which brought a greater understanding of what is happening with someone in pain.
I learned a new word, "smudging". Smudging is basically when brain cells become activated easily or become dis-inhibited which spreads pain or makes it move around. Pain is changing the map of the body within the brain making parts of the body poorly defined within the brain. Smudging can cause a decrease in sense of balance, decrease in proprioception, and a change in muscle strength and timing.
This gives massage therapists a great opportunity to help their patients. When we are treating, we are actually giving feedback to the brain that it needs to help improve those maps in the brain.
A light went off that helped me recognize what we are actually doing.
The education continued when I took my second pain science course with Eric Purves. While Eric has a different approach than Greg, he still managed to continue to simplify things. Well backed by research, he managed to change my thinking on many things I was taught in massage college.
Realizing trigger points aren't what we thought they were, there was no such thing as an innominate rotation, and how research demonstrates when a patient comes in experiencing pain, a lighter, gentler approach is far more effective than the way I used to do things.
Essentially, both courses were game changers, which resulted in a change of approach I thought would never happen.
Then, the course that really brought it all together, Cory Blickenstaff and Edgework. Finally, a manual therapy class (I'm a better hands on learner than book learner) that demonstrated how to apply pain science in the treatment room. And even better, it was all about movement!
I've been wanting to incorporate more movement and exercise into treatments and with what I had learned previously, this brought it all together. Those previous classes taught me more about communication with patients, how to understand thing and convey it to them in an easier to understand explanation. Edgework allowed me to incorporate that explanation into movement.
Getting a patient to move easier, trust their body, and more importantly, trust their therapist has brought about greater success in practice and outcomes. And it's easier on my body, getting them to do all the work!
Next step is the San Diego Pain Summit this year. I understand the focus will be on pain science and exercise. Exactly what I want to learn about.
My interest is attending is bigger than just learning from the speakers. I've been told by other friends who have attended, that the best part is the camaraderie and support of the other therapists in attendance.
They are building a community and I need a community in life!
A Change In Approach
Early in my career, I wanted to be a "deep pressure" therapist. I treated trigger points like I was taught in school, as pain and referral pattern subsides, apply more pressure until it's gone. Pressure, pressure, pressure.
I was all about learning to techniques to build up that toolbox. Continuing education had to be a manual course so a new technique would make a difference for my patients. I wanted to use 12 different modalities every time someone came in.
Since learning about pain science, everything has changed. Realizing that "approach" is far more important than modality, I have watched a change in the patients I deal with. Being able to explain things to them garners far more appreciation from a patient than any modality I have ever used.
Explaining that there aren't actually "knots" in a muscle and those referral patterns (I used to explain as trigger points) are a result of the nervous system reacting, makes more sense to my patients. Using a different language with patients makes a world of difference. Their pelvis is no longer "rotated" or "out of alignment" but rather, the pain at their SI joint is just an alarm the brain uses as a protection mechanism.
I have the ability to explain to patients that the pain they are feeling isn't a result of dysfunction but just the nervous system being ramped up and it's my job to help it settle down.
The way I communicate with patients has changed drastically. Usually when I explain things, there are no longer words in my vocabulary like "damage" or "dysfunction". As I learn more, I realize those kinds of words are probably doing more damage than whatever the injury is that brought them in. Instead, it's more about encouraging and reinforcing the positive things they can do, rather than bringing up the negative. Giving the simpler explanations of what is happening helps set the patient at ease and their recovery is quicker.
Now the difficulty lies in the false information another practitioner has given a patient before they come in. Just recently, a patient was told by another therapist, they would never get better. After a littel time, better explanations, and a couple treatments, confidence was renewed in the ability to progress.
Unfortunately, all too often, some practitioners use fearful language as a way to keep patients coming back on a regular basis. I honestly never thought taking pain science courses would make such a huge difference, not only in my understanding of things, but also in outcomes with patients.
While I still don't have the confidence to comment in most of those Facebook groups, at least I'm not as scared of them as I used to be. Maybe one day I'll get there!
Jamie is a Registered Massage Therapist in Victoria BC. He also runs a collaborative blog for massage therapists called The Massage Therapists Development Centre, in order to help change the perception of massage therapy and highlight the great things massage therapists are doing.
The San Diego Pain Summit is actively looking for contributors to share their stories of how learning pain science changed your clinical practice. Learn more: https://sandiegopainsummit.com/contribute
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