As an RMT you know better than anyone that every patient is different. In fact, every injury and condition is different and can affect patients in different ways. Because of this you may encounter patients who come back to you following an initial treatment with concerns of pain or sometimes even worse pain than when they arrived. Understanding the difference between aggravation, pain and contraindications is key to making the right decision at their next appointment.
Reaction: No Pain, No Gain
Massage therapy can be one of the most challenging to perform for patients with complaints of pain. Pain management infers that the pain will be alleviated which in some cases is not the first or expected result. Many patients do not realize that when undergoing any form of pain management in certain scenarios the no pain no gain phenomenon actually applies. For example a patient who has complaints of pain and stiffness may feel relief at their first appointment but within a few hours following their appointment begin to feel discomfort again. Although this is a normal “reaction” it can make a negative impression on the patient. In some cases, because their first feeling was relief, when the pain returns they may interpret it to have worsened when in fact it is either the same or slightly lessened. The cause of this reaction is the increase in blood circulation returning to the area. You might liken it to the case of a foot falling asleep that when returned to action tingles and hurts until the circulation is completely returned. Although the pain is unpleasant, once circulation returns the pain is relieved. As with returning mobility and decreasing pain the return of blood circulation is temporarily unpleasant but a necessary reaction to improve the overall condition. Knowing this will make patients less nervous about continuing treatment.
Aggravation: Pain, No Gain
In the case where a massage causes aggravation this is a pain, no gain scenario. Aggravation can be caused with massage improperly applied. Too much aggression, pressure or too vigorous a massage can work to make the area undergo further trauma and result in unwanted aggravation such as developing trigger points and facet joint subluxation. It is not an intentional occurrence but it shows how important choosing the right technique for each patient is vital to the success of their therapy. Sometimes a patient themselves requests a more aggressive massage which can be misleading to you as an RMT. It might seem they require a deeper massage because the patient is associating the pressure as effective. It is important to consider the patient’s condition and if it is wise to apply further pressure. If it does not make sense it is important to explain to the patient that further pressure or aggression could actually cause damage. Ignoring the basic rules of contraindication will cause aggravation and worse, serious damage to patients.
A common mistake for many massage patients is to feel sudden relief and want to test out their new flexibility. They may reinjure the area without even realizing it and associate the new pain with something that occurred during the massage. It is important to review with each patient how best to treat their improving range of motion and that they must avoid any undue or excessive strain even if they feel better. If they understand that it is possible to strain or sprain the area as a result of their new flexibility they are more likely to continue with their more cautious movements until treatment is completed and they have the thumbs up to return to exercise and activity.