Retraining the Musculature: Where Massage Therapy & Pilates Meet Pain Science

By Jody E. Clouse, LMT, BCTMB
April 2, 2018

Digital Exclusive

Retraining the Musculature: Where Massage Therapy & Pilates Meet Pain Science

By Jody E. Clouse, LMT, BCTMB
April 2, 2018

Digital Exclusive

As massage therapists, we aim to improve the pain and discomfort of our clients and employ various proven techniques to reach that goal. However, many of our clients leave our offices just to repeat the same movements and reintroduce the same postural alignment that put them in pain in the first place. In fact, "chronic neuromusculoskeletal pain is the leading cause of disability in our society and around the world."1 How can we assist these clients in their quest for pain free movement? With a combination of massage therapy and pilates through the lens of pain science.

Progress Through Pain Science

To understand the link between how our bodies respond to massage and how bodily movement corresponds to pain, we need to understand a bit about pain science. Although the pain science community is still unsure as to the exact mechanisms related to the cause and perception of pain, there are four theories that are most influential—Specificity Theory, Intensity Theory, Pattern Theory, and Gate Control Theory.

These theories include much of what we learn in our schooling as massage therapists. However, "theories about (somaesthesis and) pain have continued to evolve as knowledge accumulates concerning the structure and function of pathways underlying pain perception and pain modulation."2

As these theories evolve, new techniques to limit pain must be explored. Some techniques in massage therapy take pain science into account and are able to narrow in on better ways to assist in alleviating pain symptoms. Everything from Neuromuscular Release Therapy to Myofascial Release Therapy to Positional Release Therapy has been linked to different areas of pain theory by making claims of breaking the pain-spasm-pain cycle, interrupting neural-gating mechanisms and resetting the muscle-spindle mechanism.

When massage meets pain science, we are able to work in ways that benefit our clients. As concluded in— "Massage Therapy Attenuates Inflammatory Signaling After Exercise Induced Muscle Damage," "because musculoskeletal problems have a significant impact on daily function and quality of life, it is important to validate treatments that enhance recovery, moderate inflammation, and reduce pain in skeletal muscle."3

When the anatomical structure is out of alignment in a static state, regardless of the cause, the body typically experiences pain. In a study analyzing neck pain, the authors found that workers who sit for 95 percent of their working time are at risk for neck pain. "Working in a sitting position will lead to a continuous static load on the neck muscles, especially if the design of the workplace is not suitable for the worker."4

This analysis leads one to focus more on the movement aspect of pain relief therapy. A benefit of many techniques used in massage therapy is increased range of motion. Techniques such as pin and stretch, simple broadening and lengthening, PNF stretching, and so on, require the therapist to actively or passively put the joints of the client through their range. "Wellness is maintained by multiple interconnected web-like components, and the loss of your health over time is from a combination of many different factors in the ecology of your well-being."1

Pilates as Movement Therapy

Pilates is one of a variety of ways to incorporate increased movement in a controlled manner. Pilates is a core-based exercise regimen that focuses on movement with correct alignment while working to retrain the body to increase natural muscular contraction and limit compensatory muscle action. Because traditional exercise routines target muscle groups, the supporting kinesiology is sometimes disregarded.

"They (old exercise regimes) are based on isolating muscles and working each area of the body individually rather than treating the body as the integrated whole it is."5 With this in mind, pilates may be a more effective form of movement therapy specific to pain reduction. However focused movements in pilates may be, the body must work as a whole.

Combining Pilates With Massage Therapy

When pilates is combined with massage therapy, the results of each therapy can be maximized. By incorporating both modalities, we are aiming to bolster the effects of each with the end goal of decreasing neuromusculoskeletal pain.

Clients who take advantage of both pilates and massage therapy choose to do so in various combinations. Some choose to receive massage therapy prior to their pilates lesson to prepare their body for the workout. Some choose to take their pilates lesson prior to receiving massage in order to take advantage of the relaxation aspect of massage in addition to the decrease in delayed onset muscle soreness. Others choose to completely separate the two modalities and receive massage therapy on days they do not take pilates lessons.

Battling Chronic Pain

Combating Hip and Pelvic Pain

Heather, an active runner who travels quite a bit for her job came to the studio seeking relief from pain in her hip/pelvic region. Her chronic pain was making it difficult to run, which is her preferred method of exercise. She experienced hypertonicity in the muscles of the pelvic girdle and limited ROM in the hip joint.

When asked how the combination of pilates and massage therapy have assisted her in her healing/maintenance process, Heather replied, "The combination has proved complementary: pilates is progressively effecting change in my posture, alignment and range of motion—as well as my strength and bodily conditioning (over a long-range time-period); massage works both in the shorter term to respond to increase in pain, muscular tension and tightness and over the longer term in maintaining greater flexibility and pain-management."

Heather also summarized the experience succinctly, "If undertaken and worked at consistently, and if provided by teachers/therapists who know what they are doing and are good at figuring out the character of each individual's particular issues, pilates and massage therapy work well together in improving and maintaining muscular-skeletal [sic] strength, alignment and posture over the long-term and provide a non-invasive, non-chemical way to address pain arising from everyday mechanical issues."

Staving Off Hip Replacement Surgery

After visiting her doctor, Cynthia knew that she would eventually need hip replacement surgery. However, her energetic personality and active lifestyle guided her to alternative therapies in order to stave off the inevitable surgery for as long as possible. She was able to avoid the surgery and continue to hike and kayak until she finally decided it was time for the replacement. About four weeks after the surgery itself, Cynthia returned to massage therapy sessions to which she attributes her speedy recovery and returned to pilates.

In terms of her overall pain experience, Cynthia stated, "Regular exercise like pilates and massage are a terrific combination. I felt infinitely better, both more relaxed and yet invigorated at the same time after a session - whether pilates or massage." Knowing that the combination of massage and pilates is an invaluable combination for her daily well-being, she continues to interweave the two modalities into her schedule.

Struggling With Low Back and Nerve Pain

Pam, among other pain diagnoses, originally began her wellness journey to combat chronic lower back and S1 nerve pain. Although Pam is sometimes unable to receive massage directly after her pilates session due to time constraints, it is her preferred sequence. Pam said, "the stretching aspects of pilates allows the massage therapist to do deeper work."

Her pain is decreased by both the pilates and the massage sessions, though due to the specific presentation of her fibromyalgia, she feels the most relief from the massage sessions two days following the session. Her thoughts on the combination are as follows, "I almost always find that the movement of pilates really helps release muscles of their tightness which leads to less pain. Regarding massage, always tell the practitioner what you need, what feels good, what is too deep, etc. I am very distressed when I have to be away from either one for any length of time. It is not only the act of doing the exercise or having the massage, but the emotional support that I feel coming from massage therapist and trainer that is so helpful."

It is of interest to note that when asked specifically about the pain relief aspects of massage/pilates that emotional relief was mentioned.

Overall Muscle Tension, Nerve Issues, Fascial Restrictions

Nadine, the owner of the pilates studio at which the other clients have lessons is certified in Stott Pilates, a form of exercise based on the collaborative efforts of physical therapists, sports medicine professionals and fitness experts. She is well versed in anatomy and applies that knowledge during both pilates lessons and while receiving massage therapy.

She constantly makes connections between what she is feeling during a massage therapy session and how her own structural issues limit certain movements. Nadine found pilates as she was recovering from chronic back pain due to an injury incurred as a high-jumper in high school. Though the pilates helped relieve her of the back pain, she often struggles with the residual effects of the damage.

Her muscles in many areas have adapted to protect the damaged areas and often become overly tense. She has noticed that as this occurs, fascial restrictions become a detriment to her movement. While her chronic pain can be linked to a previous injury, she has found that through a regular combination of pilates and massage, she maintains consistent relief.

Implications for Future Research

With each new study and research development, we learn something new about pain science. It is imperative that we take these findings into consideration and use them to continue to research new ways to manage chronic pain. Combining massage with a movement routine such as pilates may be one such strategy. While this study is based on a very small and specific sample, I believe that further research in the area of combining massage with movement could assist in developing therapy combinations that would help clients better manage chronic pain.

References

  1. Fors G. Why we hurt: a complete physical & spiritual guide to healing your chronic pain. Woodbury, Minnesota: Llewellyn Publications, 2007.
  2. Moayedi M, et al. "Theories of pain: from specificity to gate control." Journal of Neurophysiology, 2013 Jan;109(1):5-12.
  3. Crane JD, et al. "Massage Therapy Attenuates Inflammatory Signaling After Exercise-Induced Muscle Damage." Science Translational Medicine, 2012 Jan;4(109).
  4. Ariens GA, et al. "Are neck flexion, neck rotation, and sitting at work risk factors for neck pain? Results of a prospective cohort study." Journal of Osteopathic Medicine, 2001;4(1):36.
  5. Siler B. The Pilates Body: The Ultimate At-Home Guide to Strengthening, Lengthening, and Toning Your Body--Without Machines. New York: Random House, 2000.

Resources

  • Barker V. Posture Makes Perfect: The Missing Link in Health and Fitness. Auckland, New Zealand: Waiwera International, 2005.
  • Thernstrom M. The pain chronicles: cures, myths, mysteries, prayers, diaries, brain scans, healing, and the science of suffering. New York: Picador, 2011.