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by Barbara Rotthaler

“My knee (foot, shoulder, wrist, hip etc.) hurts, because I had an accident and even though it is better now, I still have pain and cannot do the things I would normally do.”

Or: “I strained my ankle a while ago and still have a lot of pain” or “I had a knee replacement and still can not bend it totally”.

These or similar complaints are common in my daily practice. 

In this article I want to encourage you not to give up in situations like these. There are more ways to relieve pain and to improve flexibility than just taking pain medication or muscle relaxants.   

Massage is well known as something that feels good, is beneficial for the overall health and well being. For some people it has a bit the “touch” of luxury.

What most people don’t know is the amazing effect of therapeutic deep tissue massage in combination with trigger point therapies for pain relief.    

First it is important to understand what happens in the tissue after injuries, what the natural healing response is and how it affects the area around the injury.

The healing process goes through 3 characteristic phases: inflammatory, proliferative, and remodeling phase. The goal of this inflammatory-reparative sequence is to regenerate the tissue.  

Gentle soft massage and lymphatic drainage for the first phase

During the inflammatory stage when the area is hot and swollen a very gentle soft massage or lymphatic drainage can relief pain and shorten the healing process.  It is important to apply it only around the area and not direct on the injury. During the massage the congested area becomes softer, it reduces the swelling, minimizes the pressure on the nerves (cause of the pain) and increases the circulation. 

Deep Tissue Massages and Trigger Point Therapy for the second and third stage of injury 

Sometimes seemingly simple injuries can become the focus of debilitating chronic pain. The tissue becomes tight and painful, the skin “sticks” to the underlying connective tissue (called adhesions), motion is restricted and of course, pain is present.  The necessary rest after an injury, surgery or fracture leads to lack of circulation and therefore more pain with the accumulation of waste byproducts and the occurrence of trigger points. 

Trigger points are hyper-irritable painful nodules in a taut band of muscle fibers. They affect not only the muscle where the trigger point is located, but also causes "referred pain" in other locations supplied by nerves.   They can also pull on tendons and ligaments around joints and mimic arthritic pain.  The tightened muscle fibers affect the pain receptors of the related nerves and they constrict capillaries and prevent them from carrying off the waste and toxins to the body's recycling system (liver and kidneys). The buildup of these toxins in a muscle bundle feels like a tight muscle.  

Trigger points are a common cause of many everyday aches and pains and not knowing that basic concept often leads to not dealing effectively with the condition.

Deep Tissue Massage

The therapist first searches for these abnormal areas by using long strokes slowly gliding over the tissue, “rolling” the skin to check for adhesions and congested areas,  also observing differences in skin temperatures and restricted motions.

Then, depending on the intensity of the pain, a gentle and slow but intense and deep massage is applied to increase circulation, loosening up the constriction, providing oxygen and nutrients through increased blood circulation thus removing congestion and waste substances. 

Trigger point therapy

The easiest form is by applying pressure on the little nodule. The pressure can be painful, but most people feel it is some sort of a “good hurt”. I like to use the comparison with digging warm fingers in a snowball and the feeling when the snow melts away underneath – that is exactly the feeling when we use trigger point techniques. Especially in areas of older injuries it takes often a few minutes of constant pressure on one little area until the releasing effect occurs. Inch by inch has to be worked through. It is time consuming but very effective.

All the above described methods require a careful sensitive approach by a skilled person, especially in conditions after injuries etc. But on easy reachable areas (knees, arms etc) I show my clients how they can support the healing between sessions by applying the technique on themselves

Treatments usually last between one hour and one hour and a half and sometimes have to be repeated.  Improvement is noticeable already after the first treatment.

See also earlier articles about pain management on my website.