BodyInMind, an organization that researches pain, and headed by Lorimer Moseley PhD, has done some amazing work highlighting the importance of the so-called new biopsychosocial model of pain, and as seen here, specifically with regards to low-back pain.
…One intervention that has reported large, clinically important improvements in pain and function associated with CLBP is Cognitive Functional Therapy (CFT). In brief, CFT can be summarised as an individualised behavioural intervention grounded in biopsychosocial principles that challenges maladaptive beliefs and associated dysfunctional behaviours, to enhance pain control and take the patient on the journey back to their valued goals
Hargrove nails it – health professionals, in the manual therapy field especially, often look for small and immeasurable discrepancies in a system which is so complex that we don’t understand it in the first place.
“Given this level of uncertainty, the problems of movement and pain look more like raising a child than rocket science. Expertise is clearly useful, but (given current levels of knowledge) it does not lead to a full understanding and control of the issues, and cannot be expected to significantly outperform good common sense.
That doesn’t mean you can’t make progress reducing chronic pain! Simple common sense interventions work for chronic pain, just as they work to raise a healthy child.
- Get support from family, friends and healthcare practitioners. Go to a PT. Get a massage.
- Learn more about pain. Maintain an optimistic outlook and internal sense of control.
- Experiment or play with with different ways to move. Confront your fears.
- Apply a Goldilocks level of exercise stress to the painful area to encourage adaptation without further injury.
- Exercise, sleep well, eat well and try to reduce stress.
None of these tactics are the kind of targeted, scalpel-like interventions that make highly predictable changes in complicated systems. They don’t involve the kinds of algorithms, recipes or blueprints sold by movement gurus.”
Conclusion. Based on the evidence, massage therapy, compared to no treatment, should be strongly recommended as a pain management option. Massage therapy is weakly recommended for reducing pain, compared to other sham or active comparators, and improving mood and health-related quality of life, compared to other active comparators. Massage therapy safety, research challenges, how to address identified research gaps, and necessary next steps for implementing massage therapy as a viable pain management option are discussed.
Nice podcast on foam rolling mechanisms –
Bottom-line is that foam rolling can possibly acutely increase range of motion, but not in the long-term. The mechanisms are most likely neurophysiological, i.e. not mechanical (not breaking down fascial adhesions, not breaking down scar tissue). May be helpful for recovery post-workout.
“Most patients and therapists never suspect that trigger points are a significant injury complication because they don’t think that trigger points (if they know about them at all) can possibly be as bad as the injury pain. I have come to the point where I believe that you should simply never underestimate a trigger point. They can absolutely produce pain that is both nastier and longer-lived than the pain of an injury.” – Paul Ingraham, PainScience.com
Jason Silvernail speaking eloquently as to the changing way in which we understand pain.
Paul Ingraham of PainScience: “A routine misconception about muscle pain is that it is caused by “inflammation,” and the term is often used almost interchangeably with pain, as though anything that hurts is, by definition, inflamed. In fact, by the correct definition, all inflammation is painful, but not all pain involves inflammation. In particular, muscular trigger points are one of the most common of all painful experiences, and are assumed to be inflammatory and subject to the effect of anti-inflammatory medications … and yet they are not inflamed, or not much, and anti-inflammatory medications are not likely to have much effect on most muscle pain.”