Additional methods that modulate pain sensation and perception that can be incorporated into the massage are: simple applications of hot and cold hydrotherapy, analgesic essential oils, calming and distracting music, and so forth. Before highlighting a number of these important clinically associated topics, the fundamental process of adaptation needs to be revisited so that the role of therapeutic intervention is clearly established.

A wide range of methods, modalities, and techniques can be usefully employed by therapists to reduce the effects of adaptation influences, or to encourage better coping with these.

Those that will be considered, later in this chapter, in relation to pain include:

Scope of practice limitations may not allow all massage therapists to utilize some of these methods, or to advise clients/patients specifically – for example, about nutritional influences on their symptoms; however, knowledge of these topics is important, so that at the very least, if they seem to apply in any given case, appropriate referral can be made. See Chapter 9 for more specific information on these methods.

There is a need:

Janda (1982) describes a typical postural pattern, in an individual with TMJ problems, involving changes in upper trapezius, levator scapulae, scalenii, sternocleidomastoid, suprahyoid, lateral and medial pterygoid, masseter, and temporalis muscles. In this pattern (described below) all these muscles will show a tendency to tighten and/or to develop tendencies to spasm, tenderness, and the evolution of trigger points.

The postural pattern associated with TMJ dysfunction might therefore involve:

The message that can be drawn from these examples is that dysfunction patterns first need to be identified before they can be assessed for the role they might be playing in the person’s pain and restriction conditions, and certainly before these can be successfully and appropriately treated.

Additionally, general full body massage that does not overtask the adaptive process is the intervention of choice when these adaptive patterns predominate. Initially (and maybe never) it is unlikely that we will know what is causing what. Where the current pain is located is likely not the causal factor of the pain but instead related to the adaptive response. We must realize that adaptation is important for function in the midst of the onslaught of life. The adaption that has occurred has been the best the body could do. Without this appreciation, the massage therapist may inadvertently unsettle a productive compensation pattern and the client ends up in more pain. The lesson is to progress slowly and rely on the massage approach as presented in this text. As the massage continues for the individual it is imperative to gather information so that the general massage can be refined to best assist in pain management. Ongoing assessment needs to identify:

What’s short? What’s tight? What’s weak? What’s loose? What’s affecting neighboring structures negatively? What’s causing these changes, and what can be done about it without aggravating the situation?

In any given case your role is to try to identify what can be done to help ease the current pain symptom (see previous chapters, and also Box 7.1), as well as what might be done, or what the person might do, to reduce the likelihood of further symptomatic episodes.

In these examples, using a biomechanical model of care, incorporating massage and appropriate soft tissue modalities (see Box 7.1) and rehabilitation strategies (posture, breathing, etc.) should certainly help to alter/improve the soft tissue status, enhance circulation and lymphatic drainage, and, if appropriate, assist in the deactivating of trigger points that may be contributing to pain.

The biomechanical model outlined in Box 7.1 is one way of managing such problems. Other proposed models for effective care of musculoskeletal dysfunction incorporate somatic, as well as behavioral features. For example, Langevin & Sherman (2006) have described a model in which a broader therapeutic approach to musculoskeletal dysfunction in general can be understood.

This is an ‘integrative mechanistic’ model that addresses both behavioral and structural aspects, as well as pain psychology, postural control, and neuroplasticity.

This model emphasizes the need, in many instances, for multidisciplinary treatment protocols, possibly including direct biomechanical/manual approaches including massage, movement reeducation, psychosocial interventions, and where necessary, pharmacological and/or nutritional treatment methods and modalities that meet the particular needs of the individual.

In this way long-term preventive approaches might also include: