Along with acupuncture and Chinese herbal medicine, bodywork therapies are an important part of Traditional Chinese Medicine (TCM). Within the domain of TCM, bodywork techniques form the system of “Tuina” or what could be called Chinese medical massage. Related you have have “shiatsu” from the Japanese pool of techniques and, of course, western massage therapy which is further divided into techniques ranging from light touch (i.e. craniosacral therapy) to deeper touch (i.e. neuromuscular massage) and a multitude of other techniques. Bodywork would be one of the first most natural forms of healing; rubbing your arm when you bump into the side of the cave for example.
In modern times, bodywork therapies are used for a broad range of health issues either with other techniques such as acupuncture or western medicine or used completely alone. They are an important part of pain reduction programs, rehabilitation programs and general stress reduction. A multitude of studies support their efficacy.
The study I am going to write about today looks at the importance of the engagement of the patient within their massage therapy treatment to increase efficacy. Researchers from medical institutions in Rome including the Policlinico Umberto I Hospital at the University of Rome recruited 51 patients with chronic low back pain. As 70% or more of adults will experience low back pain at one point or another in their life and, in the US at least, being the second most common cause of disability, it is critical to find non opiate ways of resolving or at least managing back pain. Certainly acupuncture has a well described and researched role here as well, but as stated above it is often combined with tuina and/or cupping for better manipulation of the tissue.
The patients in this study were limited to those who have had back pain for more than 3 months and it wasn’t from known causes such as neurological conditions, arthritic conditions, previous surgeries, etc. They were then divided into two groups, one a more standard massage therapy treatment group and a the other a more experimental treatment group.
The standard massage treatment group, did basically that. It’s the standard – Oh, hi how are you, what’s going on, ok lay down and we’ll do massage and if you talk I’ll talk a little, but otherwise we’ll just be quiet type massage.
The experimental group, however, handled the interactions quite a bit differently. Within that group they started the massage treatment with initial “pleasant” (i.e. soft) contact and then worked with the patient to begin describing what they were feeling. As the patient would feel comfortable contact without pain they would have the patient remember that sensation. That is, remember feeling that area feeling pain-free, not only remembering it as a painful area. Further as they continued the therapy they would further allow the patient to describe how the area feels. Perhaps initially describing the area as “hard as rock” moving on to describing the area has more “adaptable”.
For the bodywork therapists that work in my acupuncture clinic, I stress to never tell the patient that their muscles are tight or anything along those lines really. Part of this is because it is all relative, one level of tension on a person might be great progress for them while on another person it would indicate a tremendously tense holding pattern. But the major reason I have always recommended this to my therapists, and practice it myself, is exactly what this study found. If you tell someone they are tight and let them keep telling themselves they are tight (painful, restricted, whatever) – then they are more likely to continue being that way regardless of what benefit you are offering them through your therapy.
Within this study they found that both the standard massage therapy treatment and the experimental treatment were helpful. The more engaging feedback therapy treatment, however, did lead to both a larger reduction in pain according to the pain scales used, but perhaps more importantly, led to better maintenance of results at the 3 month followup.
These types of responses have been noted with a range of techniques not just within the realm of massage therapy. Earlier this year in the US there was a fairly interesting program on national public radio (NPR) entitled “How Meditation, Placebos And Virtual Reality Help Power ‘Mind Over Body’” which covered in detail many of the techniques now showing useful for pain reduction. Much of this is presented in the text Cure: A Journey into the Science of Mind Over Body byJo Marchant which is a useful read for those dealing with and/or in the role of treating chronic pain.