{"id":1411,"date":"2019-02-20T09:00:59","date_gmt":"2019-02-19T22:00:59","guid":{"rendered":"http:\/\/blog.amt.org.au\/?p=1411"},"modified":"2019-02-20T09:48:19","modified_gmt":"2019-02-19T22:48:19","slug":"does-poor-function-always-cause-pain","status":"publish","type":"post","link":"https:\/\/blog.amt.org.au\/index.php\/2019\/02\/20\/does-poor-function-always-cause-pain\/","title":{"rendered":"Does Poor Function Always Cause Pain?"},"content":{"rendered":"\n

By Aran Bright<\/h2>\n\n\n\n

There is a fundamental error that has emerged in the massage field that I\u2019d like to see stop. It is the assumption that changes in function are the cause<\/em> of pain. Too often we assume that because someone has \u201cpoor\u201d posture or \u201cless than acceptable\u201d range of motion, this must<\/em> be the cause of their pain. What is much more likely is that changes in function are the result of pain.<\/p>\n\n\n\n

Changes in range of motion and posture are a normal protective mechanism, and that\u2019s ok.<\/p><\/blockquote>\n\n\n\n

The Problem<\/strong><\/h4>\n\n\n\n

The perfect example of this error in clinical reasoning is a postural assessment for someone with a sore neck. Let\u2019s assume a client has lost rotation and sits with a forward head posture. When I learnt assessment, it was normal to blame the muscles involved in posture and the loss of rotation as the cause<\/em> of the problem. Oh no, it must be the dreaded Upper Cross Syndrome.<\/em><\/p>\n\n\n\n

Normally, muscles like levator scapulae, trapezius and SCM will be blamed for being \u201ctoo tight\u201d, and rhomboids and the deep neck flexors blamed for being \u201cweak\u201d. This is a real issue, because we are talking about function and mistaking it for pain. If the focus of our treatment is about restoring normal function, then sure, this is a perfectly logical approach to treatment. But, if we are talking about the source of pain, we are making a fundamental error.<\/p>\n\n\n\n

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In an old school remedial massage treatment, having identified the perpetrator of the crime, we can begin an all out assault on the SCM, Trapezius or any other poor, innocent muscle. Assuming it is the fault of this delinquent muscle, we also assume there is something wrong with this muscle and it must be punished. It is at this point where anything short of beating it with stick seems to be justified to fix<\/em> the client\u2019s pain.<\/p>\n\n\n\n

Naughty Muscles (<\/strong>musclus naughtius<\/em><\/strong>)<\/strong><\/h4>\n\n\n\n

It is absolutely possible that massage or manual therapy to the SCM or another specific muscle can reduce the client\u2019s pain, but it is more likely that a general massage sequence over the neck and shoulder area will reduce their discomfort just as effectively. In fact, when we look at the evidence of general massage and targeted approaches (such as Myofascial Release), it appears that general massage appears to be the more effective option for pain management. (Source<\/a>, source<\/a>)<\/p>\n\n\n\n

The most likely reason for this is that reduction in pain is the result of changes at the level of the spinal cord and brain, rather than local changes to the target tissue that a therapist may treat.<\/p>\n\n\n\n

BUT! Targeted approaches have been shown to be very effective for function. Manual trigger point approaches are typically associated with improvements in function, and that is very useful. If the goal of your treatment is to improve posture or range of motion, then methods such as trigger point therapy can be quite useful, but please note, it is not \u201cfixing\u201d anything. (Source<\/a>)<\/p>\n\n\n\n

So What Is Going On?<\/strong><\/h4>\n\n\n\n
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Changes in muscle tone and function are all regulated by the Central Nervous System, and this is most likely the only thing that is changed in a massage or manual therapy treatment. Unless, of cause, we are successful in our all out assault on our target muscle and the whole thing just explodes (bruises) \u2013 that would probably qualify as change?<\/p>\n\n\n\n

Instead of targeted annihilation of musclus naughtius, <\/em>keep in mind that reduction in pain occurs in areas of the body you can\u2019t rub, but you can talk<\/em> to it by touching someone. What exactly are you saying in your tactile communication? Is it \u201cyour muscles are evil and must be punished\u201d or maybe a little more \u201cit\u2019s OK, I got this, you can relax now\u201d?<\/p>\n\n\n\n