Soon after I graduated from massage therapy school, I immersed myself into the massage Facebook world. There was a simmering debate between a “musculoskeletal approach” and the “pain science approach”. I found myself in the middle of it before understanding that it was such a hot topic. When you find yourself in such a position, you begin to realize the importance of precision in language and, eventually, the near impossibility of precision because of the level of uncertainty in medicine.
The debate had all the signs of one group of people selling their course and gaining apostles and the other side selling their course and gaining apostles and because of that, they needed to display how much more empirical their approach is over the other and it all seemed to lack appreciation for the limitations of empirical research on these issues and that any solid conclusions were likely far off . . .
or . . .
. . . it could be that some research had indeed refined what was understood before but in order to declare it groundbreaking, a mischaracterization of what was believed before had to be conducted.
For instance . . .
Janet Travell co-wrote a book about trigger points and she is a medical physician. Throughout her book, she assumes and even states the role of the nervous system in contracting muscle tissues and yet, it seemed that some people were mischaracterizing her work as though it didn’t assume the role of the nervous system in muscle contraction/trigger points. I was puzzled by this.
After a few months of reading and engaging on those forums, I realized that it was better for me to retreat into my own clinic and gain some firsthand experience and learn from my husband who has had twenty years of experience in manual therapy.
So, my experience in clinic in the past year is this . . . massage therapy does help to increase your range of motion. You may leave my clinic still with pain and, of course, any permanent disadvantages caused by surgery/injury will remain, but the one consistent result is that your freedom of movement will be better when leaving.
This result can be significant for some people and insignificant for others. If you are already engaged in moving through exercise, yoga, Pilates . . . the occasional or regular massage can help your body more freely engage in those activities, but you are already doing what is most beneficial for your body and what no massage can accomplish.
The controversy presented by these two opposing groups seems to be much to do about misunderstandings and misrepresentations. It is the classic dilemma of mind versus body. The mind is the nervous system and the body is the actual muscle and the question is what plays a greater role in pain and how does a massage therapist approach pain. Setting aside whether we should be addressing pain directly or not, a discussion that will be had in another post, my answer is that it is both/and. It is both the nervous system and the muscle.
The muscle doesn’t contract unless the nervous system tells it to and palpation of the muscle is the means by which the therapist knows what the nervous system is communicating to the muscle.
The therapy should then be conscience of both the nervous system and the muscle.
Similar dilemmas show up in other places . . . nature/nurture, particle/wave, free will/determinism. And the difficulty is that we need to live and act in this world even when we don’t fully understand the interplay of these realities and when our language seems to fail us when describing them.
A healthier approach to this issue might be that it is our language failing us rather than us being in clear disagreement. This issue is so complex that it much more likely that that we are just speaking in different dialects or from different vantage points rather than that we are at opposing sides in a clear disagreement.
Would you agree?