Here at massage.physio.co.uk, our highly skilled therapists have the ability to treat and reduce the effects of pain. The way pain is created can be explained through the pain gate theory.
The pain gate theory
The pain gate theory, developed by Melzack & Wall, suggests that the signals (carried by nerve fibres) from different stimulus have to meet at ‘nerve gates’ located within the spinal cord. In order for pain to occur, these signals must be cleared through the gates to reach the brain.
There are many factors that are taken into consideration in order to determine how the signals are processed at the nerve gates. These factors can include:
- How intense the pain signals are
- How intense touch, temperature and pressure sensory signals are (when generated around the issue area)
- Whether or not the brain itself will send the pain signals or not
Large and small nerve fibres that are carrying sensory signals end in the dorsal horn of the spinal cord (one of the 3 horns of the spinal cord that receives sensory information from the body). This is where the signals are delivered to the brain. These nerves travel to two areas; the substantia gelatinosa (SG) found in the dorsal horn and the first central transition cells (T cells) located within the spinal cord. The SG is what acts as a gate and controls what pain signals are transmitted to the T cells where they will then be carried to the brain.
If pain signals transmitted by the small fibres are less intense than non-pain sensory signals (touch, temperature & pressure), the SG blocks the transmission to the T cells and therefore do not reach the brain and so no pain occurs.
If the pain signals transmitted are more intense than the non-pain sensory signals, the SG becomes inactivated and the gate is opened. T cells will then receive the transmission and carry these to the brain thus, creating pain.
It is stated that a non-harmful stimulus such as massage can inhibit the transmission of the harmful stimulus by overriding the pain signals sent the SG so that the gate can be closed and no signals reach the brain. By doing this, pain can be reduced.
Regular massage sessions can help to ease the symptoms of many different common types of pain including:
- Acute pain
- Tendinopathy
- Frozen shoulder
- Headaches
The most common types of pain our therapists treat include acute pain, tendinopathies, frozen shoulder and headaches.
Acute pain
Acute pain is a type of pain that would normal last less than 3-6 months or is directly linked to soft tissue damage. Acute pain would tend to be more sharp and severe than chronic pain and is normally more localised or specific to one area. Acute pain can lead to being unable to work for several days or weeks, high levels of discomfort and stress and, of course, high levels of pain.
There are various different causes of acute pain including:
- Soft tissue injury
- Surgery
- Joint sprains
- Whiplash
- Muscle spasms
Massage can often be an essential form of treatment during management of acute pain. A massage can help to reduce acute pain by increasing healing and increasing soft tissue relaxation.
Increased healing
One of the most common causes of acute pain is injury or soft tissue damage. When left untreated, pain can progress and worsen or generally not get any better. By increasing healing of the affected area, the effects of injury or trauma are reduced and pain is decreased. A massage can help to increase healing by increasing blood and lymphatic circulation.
The blood circulation contains all the healthy nutrients essential for soft tissue repair and growth following injury. Lymphatic circulation is responsible for filtering and draining excess fluids, waste products and toxins from the body. Following injury, it is common to have areas of swelling that can inhibit healing. Increasing lymphatic circulation will help to flush away any excess fluids so that healing can occur more efficiently.
Increased soft tissue relaxation
Another cause of acute pain is muscle spasms. Muscle spasms are involuntary contractions, often known as cramp, that can cause intense pain. Muscle spasms normally occur due to a build-up of muscular tension and tightness, dehydration or muscular fatigue. A massage helps to increase soft tissue relaxation by increasing tissue temperature and breaking down tension.
During massage, factors such as friction created between the skin and fingers and an increase in circulation cause the temperature of soft tissues to increase. By increasing soft tissue temperature this allows tissue elasticity to increase and muscles to relax. By encouraging relaxation of muscles, muscular tension can reduce. By improving tissue elasticity and decreasing muscular tension, a person is able to physically and mentally relax resulting in reduced pain.
Tendinopathy
Tendinopathy is caused by the inflammation of the tendon. This is normal as a result from micro tears within the tendon when it is acutely overloaded with a force to heavy or too sudden. It is common for tendinopathy to occur in those with jobs that require repetitive movements or within sports that require repetitive short bursts of movement or carrying heavy weights. Tendinopathy can cause increased pain, limited range of movement and the inability to play sport or work until recovered. Many different types of tendinopathy affect different areas of the body. These include:
- Achilles tendinopathy- this is the most well known type of tendinopathy. This is commonly caused by sports injury however can be due to poorly fitted/non supportive shoes and rheumatoid arthritis.
- Tennis or golfers elbow- also known as lateral epicondylitis, tennis elbow is described as a pain on the outside of the elbow than can sometimes radiate towards the wrist. Golfers elbow or medial epicondylitis, is a pain located on the inside of the elbow and can again, refer towards the wrist.
- Supraspinatus tendinopathy- this is when the tendon found on the top of the shoulder joint becomes inflamed. This can cause pain during arm movement.
- Trigger finger or thumb- this occurs when the tendon sheath in the palm of the hand becomes inflamed and thickens preventing smooth movement of the tendon. Normally causes the finger or thumb to become fixed in a bent position.
- Wrist tendinopathy- this occurs due to repetitive movements of the wrist. Commonly found in some musicians (i.e. timpani players) or sports people such as badminton players.
The main causes of tendinopathy include:
- Rapid injury
- Overuse/overload of the tendon
- Repetitive movements over time
Our therapists use massage therapy to help manage the symptoms of tendinopathy. Massage can help by improving recovery time and increasing blood flow.
Improved recovery time
One of the most common effects of massage is improved recovery time. Tendinopathy can cause restricted movement, increased pain and increased soft tissue tightness, all of which can inhibit or pro long recovery. A massage helps to improve recovery by reducing pain and increasing tissue elasticity.
During a massage, a number of techniques are used to create friction between the skin and fingers and increase blood flow. A combination of these help to increase tissue temperature. Increasing temperature of tissues including soft tissues within muscles and connective tissues within tendons, enables tension to decrease and tissues to relax. Relaxing tissues allows their elasticity to increase therefore improving range of movement. By increasing range of movement, pain, restriction and tightness all reduce.
Increased blood flow
A massage can help to increase blood flow. Blood flow contains plenty of nutrients and oxygen vital in the recovery of damaged soft tissues. When someone has tendinitis, it is common for this to be caused through overload or injury where soft tissues have become damaged or inflamed causing an increase in swelling and pain.
One of the main benefits of increasing blood flow is that it helps to combat swelling and inflammation o help encourage healing and reduce pain. As well as this, an influx of healthy nutrients and oxygen can be delivered to the area to further aid in healing and recovery and improve tissue strength.
Frozen shoulder
A frozen shoulder, also known as adhesive capsulitis, is a condition that causes stiffness and pain for months or sometimes even longer. Commonly affecting people between the ages of 40-60, a frozen shoulder is believed to be caused by a build-up of scar tissue within the shoulder joint. This results in the thickening and tightening of the joint capsule leading to reduced mobility and increased pain. A frozen shoulder can affect a person by limiting range of movement, disturbing sleep, increasing stress and much more.
Although the exact cause cannot always be identified, there are various other known causes of frozen shoulder including:
- Injury
- Bursitis
- Rotator cuff injury
- Surgery
Massage is an effective tool used to help treat symptoms of a frozen shoulder. A massage can help a frozen shoulder by relieving muscular tightness and improving blood flow.
Reduced muscular tightness
Muscular tightness occurs for many reasons. One main (and positive) reason muscular tightness develops, is to help control and stabilise areas of pain or weakness to prevent further damage or injury. Although this natural defensive mechanism can be useful, it is common for too much tightness to occur due to increased pain, a lack of movement and stress. One of the main benefits of massage is the reduction of muscular tightness.
During a massage, a range of specialised techniques are used to strip through muscular tightness and tension to help break down knots and trigger points and encourage muscular relaxation. A combination of deep and superficial techniques may be used in order to break down the tightness and then relax and soothe the muscles. By stripping through tension and increasing relaxation, muscular tightness can reduce therefore improving range of movement, reducing stress and most importantly, reducing pain.
Improved blood flow
The blood contains all the essential nutrients and oxygen required to maintain healthy muscles and encourage healing. When someone has a frozen shoulder, it is common for weakness, fatigue and muscular imbalance to occur due to restricted movements and a build-up of tension.
The techniques used within a massage all encourage an increase in circulation towards the area of concern. By increasing circulation, waste products and toxins can be flushed out and replaced with healthy nutrients and oxygen that all work together to help maintain muscular strength, reduce any inflammation or swelling and improve or speed up the recovery process.
Headaches
Headaches or more specifically, tension headaches are the most common type of headache a person will experience and one we all mistake for our everyday type of headache. When experiencing a tension headache, a person may also feel tightening of their neck muscles, weightiness or heaviness of the head and pressure behind the eyes. A tension headache can last anywhere from 30 minutes to several days depending on many factors.
There are an array of reasons tension headaches can our including:
- Poor posture
- Stress and anxiety
- Dehydration
- Tiredness and fatigue
- Muscular pain and tension (around the neck and shoulder area)
- Certain smells and noise
Massage therapy is popular and very effective form of treatment that helps to reduce the frequency and intensity of tension headaches. Massage helps by decreasing muscular tension and reducing stress.
Decreased muscular tension
Tension and tightness is the most common cause of tension type headaches. As well as tension itself contributing to headaches, a build-up of tension can result in muscular knots or trigger points that worsen the effects of headaches. Once knots or trigger points form, it is difficult for tension to release and break down causing tension headaches to occur more frequently or intensely.
A massage works by using different techniques such as trigger pointing to help break down trigger points and strip through tension. Easing off trigger points and reducing tension enables soft tissues to relax therefore reducing the frequency and intensity of tension type headaches.
Reduced stress
Stress can occur for personal reasons or due to factors such as work. Not only can stress cause tension headaches, it can also worsen these tension headaches when they occur. An increase in stress can prevent relaxation both physically and mentally as well as increase the frequency of tension headaches. A massage helps to reduce stress by inhibiting the release of stress hormones and increasing the release of our feel good or positive hormones.
During a massage, different relaxing and soothing techniques can prevent the release or reduce the circulation of our negative hormones such as cortisol. Cortisol is the most well-known hormone that increase stress, anxiety and depression. A massage also stimulates the release of our feel good hormones including endorphins, serotonin and dopamine. These are responsible for increasing relaxation, bringing feelings of happiness and giving a sense of positive wellbeing. By reducing the circulation of negative hormones and increasing circulation of feel good hormones, stress can reduce therefore preventing and reducing tension type headaches.
