I got a text message from a Therapist stating that she has gotten a new client who has had a stroke and is suffering from severe pain whenever movement is required. She wanted to know if I had any suggestions to share. I started responding: You should brush him… Then I stopped, remembering that she is not on my mailing list nor is she internet savvy so she would not have read what I wrote about using the blush brush. Knowing that she is fairly recently married and putting in the necessary efforts to keep things that way, I did not want her to occupy her thoughts with how she will kept such an activity from her husband in the name of helping a client; though that might not have been the first consideration. She might have to think of significantly upping her price as once the brain is affected, the organs of the body don’t play too well, which means hard work. I deleted the message and stared over with a proper explanation before using the word ‘brush.’ The odd things is, what we perceive could be strange so we put some effort into communication to help reduce the strangeness. Like me telling a client that I bought a pink cake for my son’s birthday. After paying the cashier for bread, I turned and saw the cake and decided I should probably take it, and only afterwards did I consider that the colour might be an issue. He said there is nothing for me to worry about as every guy wants a pink cake.
Later, a student and I had a rendezvous to massage some cricketers and on my way there I found the conversation between the taxi driver and a passenger very interesting. Apparently she has a salon and was inviting him to visit to have his hair cut. He inquired who was the Barber and she proceeded with a description and he suddenly recollected that he knew the guy. She told him there were other services as she had hired a ‘girl’ to do eyelashes and there was a ‘red’ woman in an adjoining area who is a Refexologis. Then she paused. Said that is not how the word is pronounced. She tried again. Reflexologist. He asked if it is the ‘swassy’ lady. Yea! Swassy, swassy! Yes, he knew the woman too. The lady said that she is ‘mad’ and so are her clients. Them – she gesticulated indicating ‘up-there’ women – with they big bags and big keys and big cars. Ms. Swassy has a fridge in her section with drinks, alcoholic ones, and they would carry on at a rate in there. She is always smoking, always, even when working. But she is good. She does…am, what they call it?…brazilian waxing. The driver wanted to know what is that. Them women waxing they pom-pom for $300.00. Well, he was fascinated. Said he never saw that. She asked how he expected to see such. It is private, unless he carries his girl. She said Ms. Swassy usually turns up her music very loud during sessions as the women could be heard screaming at the top of their lungs. He asked if it pains that bad. She turned her head and rolled her eyes at him. He said: nah boy, I prefer shaving. She said she too.
I do recall a student once saying that ‘hair is not for there.’ Obviously Ms. Swassy’s clients share her conviction and want to root the dreadful hair out despite the pain. And I asked myself, again, what really is pain? I’d say it is an invisible and intangible form of communication that should never be ignored as it tells us that there might be something wrong with our bodies. For example, pain could be caused by a growth eating the tissue, inflammation, blockages, strain, or a sprain. Thankfully most pain is short-term and can be dealt with using home remedies or OTC medications. But there is pain that can be severe which does not respond to those treatments, and in cases where they do, it is only partial. Chronic pain fits that bracket as it can be life-long and has a debilitating effect on both the emotional and physical health of the sufferer. I know folks who have become depressed from prolonged pain spells. It affects their personal relationship, their professional commitments, and even their self-image. Example? Migraine. You are blessed if you never had one.
As Therapists it helps to understand the issue surrounding pain for while we may feel deep empathy and want to reach out and help, it is important to know when to do this. Pain has types. One we hear of from time to time is referred pain. This is where the pain does not occur at the actual site of the injury/condition, but is found elsewhere. I heard someone mention angina recently. That is a good example. The source of the pain stimulus is actually near the heart, but persons often experience the pain in the left arm. I recall a student explaining on several occasions during class that he had pain radiating from his left shoulder into his upper arm. We have spoken about the possibility of nerves reacting due to the pressure of him probably sleeping frequently on his left or fetching weighty things with that arm, but I have never suggested that he might have a heart problem. I don’t know that. I am not sure that I want to know that, or that he does. What we were both glad about is that after a massage from one of the students, he always experienced relief. And so it is, we can’t just blurt out to a client that we feel they might be headed for a heart attack. Gentle suggestions over time would bring the person to realization, or create the opening for us to disclose our concern. Meanwhile, let’s not be too eager to dig deeply into the arm to stop the neuromuscular trigger because we learnt a technique on Youtube.
Okay. So we have the joint and muscular pain that sends us racing to the Pharmacy or Doctor. We have the pain that burns from over-use that eventually causes RSI, from a stab or bullet wound, and from the trauma of an accident. We also have the neuralgia set of pain that is said to originate from the peripheral nerves which are so crazy that they fire off without reason. We have the vascular pain that treats us to bouts of headache or migraine. We have the Cancer pain that could result from the tumour pressing on a nerve, or better yet, eating away at the nerves. Have we seriously thought of that? Why patients are heavily medicated and sleep a lot? To be bitten by a dog is bad enough. To awake to the sensation of something on the inside nibbling at your flesh continuously… Jeez! I’m not done yet. We also have the phantom pain. I do recall sharing an experience where I went to do a massage for a lady at the request of her sister. While working with the one leg, she kept insisting that I do the other leg as that was the painful one. The leg was long amputated so I had no way of massaging the pain out of it.
There is mention of the need for care during a deep massage to ensure that we do not exceed the client’s pain threshold for just as no two fingers have the same print (outside of lab experiments) so too pain is a personal and subjective experience. The deep tissue massage that the client requested might reduce him/her to tears, while another client might insists that you apply more pressure. And the former client might have honestly thought that he/she could handle the pressure, because they did the last time they had a massage, but the pain threshold is determined by biochemical and emotional factors, and on this occasion the factors were not in sync causing the usual pressure to create sensations of neuralgia. We cannot take things for granted. Every session has to be respected and treated as a new session.
Effleurage is understood to be essential at the beginning and ending of massage treatments. The emotional aspect of pain, if nothing else, is good reason for starting with effleurage. It soothes and comforts, and that is just what is needed if the client is one who anticipates pain and expects the massage to have them bawling. They might have had an injury and decided on massage, but is skeptical of experiencing the acute pain they felt initially. If we think of it, fear of pain causes the client to experience twice the pain because even though the strokes are soothing, he/she is pained in the mind as they actively await the sharp pain. Anticipation in this regard is very stressful and that is a type of pain in itself. And, if that is not enough, consider that their mental stress is causing their muscles to contract, so that every time you stroke anywhere near the injured area, they are ready to leap from the massage table. It can be helpful to say what you are doing, and what you are about to do, so that their thoughts are occupied by what you are saying and that forms the basis for their anticipation.
When it comes to the biochemistry of pain, I learnt that men are actually less sensitive to pain than women. Seems contrary to what we believe, especially when we recall those TV scenes with men fainting in the labour room. However, if we look at life generally and observe the behavior of men to women, you can’t help but consider that something is off. Exceeding amounts of insensitivity is displayed quite casually like nothing at all is wrong; which brings to mind the Sports Medicine lady who suggested that the footballers be massaged hard to the point of tears. Yes! Go right ahead! Make men sensitive! In that case it might have been rubbing salt into a wound because our chemical make-up dictates that once we suffer from fatigue the pain we experience suddenly intensifies. Playing a football game, even for the fun of it, is fatiguing.
Getting back to chronic pain, the participation of Physiotherapists is always helpful as exercise with proper guidance can bring about great benefit to the client. Apart from that, we could choose to practice assisted stretching with our clients. Like massage, exercise helps to release endorphins. We could also recommend that the client engage in a low-impact activity like swimming. It is not in the interest of family or society that we curl up and wait to die because we are in pain. We need distraction as well as to be free of the anxiety and tension. Massage is perfect across the board. There are billions of sensory receptors on the surface of the skin and within the body that keep the brain informed about temperature, the condition of the organs, etc., that communicate through the network of nerves. These nerves have large and small bundles that have specific functions. The large bundles carry impulses related to touch, and the small ones feel it is their duty to tell tales about pain. Both meet at the spinal cord where there is a gate-like system that can be shut and opened to various stimuli. During a massage, the large bundles are in charge and the gate closes to the chitter-chatter of pain that the small bundles are eager to communicate. Hopefully we can appreciate why some folks want a forever-massage, or why when we take our hands off the client the pain returns.
It is said that alleviating pain itself is not difficult. The difficult part is knowing when to do so. Consider the person for whom pain has become a way of gaining control over others and has their family riddled with guilt for not jumping at their whim. Then someone gets smart and hires a Therapist, and the poor Therapist seeing ning-ning because the client is most difficult to work with. It is often the case that the pain the client is experiencing has some authentic cause, but over time he/she might have realized that there is much to gain by remaining in that state…attention, love, or getting to stay home from a much hated job. The Therapist might realize what is going on, but cannot blurt out that the client is effectively using the pain as an avoidance or attention mechanism. The truth is that this might be an unconscious act and the client might be outraged at such a disclosure. If he/she has the patience, they could continue to work with the client, gain their confidence, and gradually help them to unlearn the habit of the need for pain. I had a friend whose mother would be doing chores and humming until he started preparing to go out. By the time he is out of the bath she is usually in bed calling out to him to pass the Limacol for her.