Pain Reduction or Induction?



Last week COSTATT had their health fair at NAPA and I was invited to hang out with Adepeju at the OMO and BestStart booth.  When I arrived lunch was served so I participated.  One of the persons sitting at my table (or was I sitting at hers?) was from St. Ann’s Hospital and I did not give her breathing space.  I wanted to know about this drive to take vagrants off the streets and dump them in her facility.  She explained the difference between being mentally and socially displaced and I had to ask if the officials behind the drive are unaware of the difference.  She said she often wonders.  We both agreed that the monies spent on public awareness campaigns via television should be redirected to better services allowing awareness to be spread by the man on the street based on the evidence he sees.  Now, now, if that is done then we won’t be playing politics, would we?  So at the price of maintaining her fixed income, she is stressed out with work that she does not need to do while those who could use more of her attention will never get it.

When I first entered the auditorium, the plainness that greeted me made me wonder if it was the right place.  There was a security guard and two ladies at a booth.  I enquired where was the health fair.  One told me that they were a part of it.  I adjusted my lenses (the ones in my head) then noticed that her t-shirt had a modest indication that she was from COSTATT.  She escorted me further in and I saw a drama in full swing, which I later learn was staged by the St. Ann’s folks geared at clearing up misconceptions about the mentally displaced.  I did not linger long enough to recognise that, it was my dining partner who advised me of such.  Around the corner from that performance were two Massage Therapists looking all professional with their fancy chairs working silently.  A few persons stood in line awaiting their turn.  I asked my escort where were they from and she said something about a ‘Light’ organisation that I did not get fully.  Then I found Adepeju and settled down to lunch while keeping an eye on the massages.  The Therapists could go up for the next Olympics.  Category: Synchronized Massage.  That’s a compliment.

Having stuffed my guts I ventured further in to visit a booth (Health Food Specialists Ltd) that had several Canadian-made products that were gluten free.  And guess what?  I saw herbal nicotine-free cigarettes geared at breaking the smoking habit.  Lollipops are a more attractive idea.  Anyway, someone is trying and must be compliment for the effort.  20 per pack for $20.  I thought that their variety of powdered protein was quite economical when compared to popular brands.  About half the price of one particular brand I know.  I then passed the Avon folks, but did not stop.  They are good at their marketing, but I did not want anyone tinkering with my face, or taking my hand to rub a sample of this or that so that I could see how well it matches my complexion.  I’ve been slow-frying over the years walking about in the sun with olive oil on my skin.  At least 20 years.  My skin might rebel if I stop cooking it now.  And finally, I arrived at OMO.  It did not take 5 minutes for me to have a patron.  Someone said something, and the next think I heard was: I’d like to have a massage.  I pulled a chair in front of the booth and got started.

My first client was familiar with massages.  She goes to a gym and the Instructor indulges her every now and then.  She had tried doing what was done to her on her mother and gotten only complaints.  I asked her to explain what she does.  Deep massages.  Okay.  I took her hand and demonstrated deep by gradually working my thumb into the flexor muscles.  Is this what you do?  No.  Can you feel thumb gently penetrating deeper into your muscles?  Yes.  And you think that your mother would appreciate this better?  Yes!  She would like that.  Good.  I returned to working her shoulders while she explained that the hard massages that she gets at the gym were best as they work well for her and she had honestly expected her mother to be appreciative.  I explained that her mother is in a differently place physically and mentally and the pressure of the massage should be adapted to suit her otherwise she might develop an aversion and hastily say ‘No’ at any invitation to such.  I told her to think of massage as bonding time during which touch is done with love, otherwise she might start feeling rejected because her mother does not want to be touched by her.

My interactive massages continued for the next few hours with me still working even after most the booths were dismantled by the maintenance staff, the cleaners were sweeping the carpet, and everyone else (except the few who were awaiting their ride) had left.  Most of the clients were students from COSTATT, but I also had one from the AVON booth and another from the Optometrists booth.  The showdown was between the AVON lady and a student.  She told him that she had been waiting and four persons got their massages ahead of her and she had to have hers before she left.  I decided to stand back and let them work it out.  He had been waiting too, and felt he should have a massage having missed most of the activities because he was at classes, and now he had a long ride to Sangre Grande which is usually taxing on his body because he is too big for most of the car seats that the Japanese folks made for themselves.  In the end, it was ladies first.  He waited.

She explained how she usually gets stiff-neck and feels it has to do with the amount of stress she has to deal will.  I’m always amused at how an invisible thing like stress is blamed for pain.  How exactly does stress cause pain?  She said: well, you know…  Uh-huh.  I know.  But I was hoping for a step-by-step guide as to how nothing climbs onto the body and becomes something.  So I said what I know, limiting it to perception and how that affects the endocrine system causing it to release too much of some hormones while suppressing others.   She is a nervous case too.  Said there are times when her head suddenly jerks back.  Hmmm.  She needed a separate consultation under difference circumstances.  The guy was still waiting, and a lady who appeared to be a supervisor of the day’s operations seemed to be waiting for me to get out.  The guy said he does massages for his mother and other folks, free.  He spoke of taking on people’s pain.  The flexors of his left forearm were particularly painful and he explained that he had recently gotten a puppy and had to fetch it on his arm while carrying his heavy bag on the other and strained his muscles in the process.  But it was worth it, for now it’s not just his mother for company, but a cute puppy also.  Bless you.  A grown man and his puppy.  Are wives becoming outdated?

Getting back to the first client who does/likes deep massages…  She reminded me of a story I heard from a student.  She had gone to the savannah to hopefully work with some members of a football team and encountered a Medicine Woman (MW) who was attached to the team.  The lady studied Sports Medicine.  The MW advised the student to do deep massages on the guys, to put pressure on injured areas too, break up the stuff, make them cry and thing, and most of all, don’t pamper them.  Poorly articulated for someone who pursued the level of studies that she did.  But nonetheless shocking to me – her request.  Are these the intentions that we are seriously supposed to have?  No wonder the sporting world has ignored me.  I lack the ‘right’ intentions for the job.  The student called for my advice because on the one hand she wants to get in her hours of practice, but on the other hand she did not want to be accused of not following orders by doing what she considered best for the athletes based on direct consultation with them.  And as if that is not tough enough, the MW advised her that if she pulls this off well, she will refer her to some other clubs that she works with.  So here are the prospects of a sparkling future in the world of sports, if only she could make the guys cry.

When it comes to physically working with athletes, the Therapist is obligated to being knowledgeable about:

  • Anatomy, Kinesiology, and Exercise Physiology – which facilitate understanding physical activity and movement and greatly assists with the processes of identification and assessment.
  • Fitness Instruction – helps the Therapist to be totally attentive to details, and develop excellent communication and demonstration skills, which facilitate reaching the client at their point of need.
  • Sports Injuries and Rehabilitation – this helps the Therapist to properly advise the client on appropriate exercises that would facilitate the healing process.  First Aid comes in handy here.
  • Sports Psychology – this helps the Therapist to motivate and encourage the athletes and also examine the effects of stress on their performance so that they can make more informed decisions.

Some programmes squeeze in a bit of massage with as many as five persons working with one client on a table (overseas in recognised places).  The programmes usually entail much more than the points above, but I am unaware any curriculum including pain induction as a motivator, or the necessity of making the athletes cry.  We need to be mindful of a person’s pain threshold.  I got a new client recently who is into sports.  He had a ‘keyhole’ incision which was medial and inferior to the knee through which the knee was dealt with.  Gentle circular friction was done around the keyhole and though the surgery was done a month ago, I could feel heat radiating from the tissue.  What’s the difference between surgery and a sport-related injury?  Should I have poked the keyhole and made him cry while telling him I’m doing deep tissue massage?  After an injury we understand that there can be severe pain due to inflammation, along with nerve and other soft tissue damage (not considering hard tissue here).  In addition there may be swelling, heat, discoloration, etc.  How does a Therapist conduct an assessment, recognise any of the above symptoms, and still poke into the tissue?  Lymphatic drainage and vaso-constriction should be the main focus, and as time and healing progress the techniques used can be deepened being careful not to destroy the newly formulated fibrin, and later still, more depth can be added with the view to reduce scar tissue so as to maintain appropriate range of motion.  This process of working out the kinks from onset of injury to full recovery does incur some discomfort, but it is the deliberate induction of pain that I am concerned about.

If the use of pain as a motivator has merit (then children should be flogged at home and in school) like the use of reverse psychology, then it is for the Therapist to distinguish such among players.  If this is found to be the case, the Therapist is still obligated to monitoring the speed, skill, stamina, suppleness, and strength of the athlete and treating him/her with a view of maintaining fitness in all the areas.  I will agree with the Psychologists here and say that behaviour can be learned, and learned behaviour can be adjusted/changed, or improved upon, so that the athlete who gets his/her adrenaline rush from pain could be re-educated to source it in a more healthy way, as speed is not the only component for success.  Getting back to massage…  It is a ‘tool’ of fitness that is often underestimated.  Effleurage, for example, is the culprit that ‘pampers’ the athlete, but it is excellent for soothing the nerves and inducing relaxation, which is critical to obtaining maximum results in healing and performance.  Tension creates exhaustion.  Exhaustion and weakness go together.  What does that do for motivation or performance?  But who cares?  Let’s flex our arms, crack our knuckles and vie for the Petrissage/Percussion/Deep Tissue crown.  While we are showing off, the athletes are suffering.

So the question is, why am I not ‘involved’ in the Sports Industry?  Firstly, the application of knowledge (which needs to evolve into understanding) gained under the banner of Sports Therapy, Medicine, Rehabilitation, Psychology, etc. is not limited to service in the Sports Industry.  But I have other excuses…  2 Many athletes don’t know their self-worth so we find extremes of low and high self-esteem which affect their appreciation/perception of the attention given to facilitate their advancement.  3 Training is sometimes an emotional thing (it has to be ‘fun’), which interferes with dedication and consistency.  Success only comes before work is in the dictionary.  4 Payment is never a problem, yet is has to be ‘gotiated,’ negotiated, and renegotiated, which is tiresome.  5 Working frequently with some athletes can degenerate the professional relationship, but that’s okay as evidence proves that coupling-up can be an invaluable form of support. 6 As if this is not enough, among ourselves as ‘professional’ Therapists there are multiple standards and each one of us is right about our methods based on our training and/or experiences.  I dare say we are right not because we actually are, but because we have weak/sensitive egos that are afraid of censure.  We swat every fly that passes by looking like it knows what we know lest the pedestal on which we are ill at ease is ascended by another.  And that’s good.  Life must be lived with some degree of passion…something to live for, or something to die for.  So, if the current methods are working, let’s fight tooth and nail to maintain them, but if they need adapting, we should fight with as much gusto for the change.  All in all I am glad that the exposure is helping students to see how drastically different perceptions can be, and they can use this information in deciding the arena in which they want to function after certification.

One of the new students who is a Muslim was remarking that she came to do the course because she wanted to be involved in ‘therapeutic’ massage so that she could work with athletes who have injuries as against clients who might be seeking a sensual massage.  We were discussing the Human Energy Field, and our connectivity to people and things as a result of energy starting with our own aura, and the therapeutic effect of our intentions being channelled through us, so that it is not merely our physical touch and how we bend our fingers and arms that alleviate distress, but energy through touch facilitating healing.  She was fine with that and reiterated her desire to therapeutically touch athletes and maybe people who have stroke and the likes.  Another student remarked to her that while she desires to function ‘above board’ some men in sports suffer from groin injuries and she would have to massage them.  Whaaat?!  That’s true Miss?  I confirmed such and she panicked.  We discussed it and she understood that as we build our practice we get a feel of what works for us and that specialization is always an option.  She mentioned a cousin of hers who does Chiropractic work and fills out insurance forms for her clients, and wanted to know if she would be able to do the same if she gets a Massage License.  I told her the Insurance companies will not be able to offer support for Massage Therapy until we sort of the legality of the license, which is also why Doctors could only suggest, but not prescribe massage treatments.  Almost exactly at 5pm her phone rang.  I permitted her to answer it.  It was the home-front reminding her that she had to return home for prayers.

The next day she contacted me in hyper mode relating how dangerous it is to be involved in a massage career, hence she no longer wanted to do the course.  Interesting.  For two months this young lady has been calling to remind me to ‘keep a space’ in the new class for her as she wanted to do massage for a long time and has finally gotten her finance coordinated to facilitate such.  I expected that her decision had something to do with not wanting to massage men’s groin, or not being able to get insurance.  But apparently after she went home there was some screening and the wiser heads decided that the information in the hand-out contradicted their teachings/beliefs so she was now trying to explain to me how threatened her life would be if she had energy exchanges with clients.  The level of fear she was displaying was irrational to me.  I pointed out that living with family members, going to the supermarket and joining a line of customers, or even working in an office with several persons all facilitate exchange of energies multiplied several times over as compared to working with one client at a time.  Besides, how could exchanges be all negative when the presence of positive helps us to determine negative?  She said that she understood what I was saying, but insisted that she cannot continue because of the many things that could rub off on her and from clients, and I realised that her fear was being generate by whoever is the figure of authority in her life rather than the principles of energy exchange.

After our exchange I shared the experience with a past student who is also a Muslim and this was part of her response:

It is so funny you should say that because I know exactly how that girl feels because I was once there myself.  The Muslim religion in our country for the most part thrives on frightening people about jinns, entities and anything we cannot see.  Ironically, those same Muslims openly go to the muftis who are equivalent to shamans who openly communicate with these other beings.  And it’s not even the religion, it’s the people who are oppressive.  Because of this inbuilt fear it has taken me a long time and is still taking me a long time to realize my own natural healing gifts.  

When my friends who are highly intuitive kept telling me I too have similar gifts it bothered me to the point that I know things are there for me but I can’t access them.  So I started to pray for about a month to find and use what is my right.  I don’t know by what force made me google massage –that would have been the very last thing on my mind.  Then the day before the first class starts I find your page.  I don’t even have male friends, much more to touch people in such a personal level.  Even at the first class I was very uncomfortable seeing all these faces, I didn’t know what to think, I had never done anything like this before, yet; it felt sooo good, I knew I had to follow through with it.  I am in the mindset now to start doing things that scare me the most.  For me, one of those things was touching people physically.

I suppose my point is, a lot of people in Trinidad are not ready to think independently.  A lot has to do with the upbringing.  It’s only as we get older we realize the only happiness in this life is what we create for ourselves.  Don’t be surprised if sometime in the future that girl comes back.  Massage is like Reiki and I think with any healing work, we are called to it.  So in a couple years she may get restless again and be drawn to it once again.  Thank you for sharing the story…it put my own in perspective.

For me this was another humbling experience that has created a deeper appreciation for every student who has journeyed with me to the end of the programme.  Obstacles have arisen that made many consider dropping out, some were discussed, others remained private, but perseverance prevailed.  The only dead student is Nathaniel and that was as a result of a vehicular accident, not while doing massages.  I only hope that among ourselves we find strength in the determination we had in the beginning, and forge forward to attain the goals we set for ourselves.  Goals, I would want to believe, that were not associated with pain induction in the name of therapy.  Within the physical context of injury management we understand that some massage techniques stretch the skeletal muscles significantly, like friction (circular, transverse/cross fibre), and the athlete would experience some degree of discomfort.  However, going into a session with the intention to induce pain takes us back to the psychological aspect of things where the Therapist is indirectly/subconsciously sending messages to the client which are being received and processed; and because of the incredible influence of the mind/body – psychosomatic – process, the pain can in fact become exaggerated, triggering tears.

We can also consider that some injured athletes might suffer from emotional problems if their self-esteem is based solely on their ability to perform and thus may cry more easily if additional pain is added to the fact that they can no longer participate as desired.  Some personality types are less prone to the negative suggestions of Therapists, but the subconscious is remarkably clever and it knows what is considered to be the physical cause of pain, and it takes advantage of the real structural weaknesses and creates realistic and convincing pain symptoms that can even become chronic.  I cannot imagine why we would want to deliberately induce this.  If healing/therapy takes place through the exchange of human energies, why don’t we channel therapy through our massage?  There are other ways to get people to cry us a river.  No need to impose such on an athlete who merely wants to get back into the game.  Seeking help from a Therapist is a dis-empowered state because the athlete is basically saying: you know what is best for me.  Let us use Massage as a motivational tool, as a means of support geared at helping the athlete to regain some measure of control, and as an education for a better life through greater self-understanding.  The body is predisposed towards health, and it is our role to facilitate this.