So how does massage reduce pain? – Part 1

I said in a previous post that scientists are interested in finding out how massage works.  So if we accept that massage reduces muscle pain, that leaves the question, “How does massage reduce muscle pain?”.

In 1965, Ronald Melzack and Patrick Wall outlined a scientific theory about psychological influence on pain perception; the ‘gate control theory’.  According to the gate control theory, pain signals are not free to reach the brain as soon as they are generated at the injured tissues or sites. They need to encounter certain ‘neurological gates’ at the spinal cord level and these gates determine whether the pain signals should reach the brain or not. In other words, pain is perceived when the gate gives way to the pain signals and it is less intense or not at all perceived when the gate closes for the signals to pass through.

Cutaneous mechano-receptors are stimulated by touch (massage) and transmit information within large never fibres to the spinal cord.  These impulses block the passage of painful stimuli entering the same spinal segment along small, slowly conducting neurons.

This theory gives the explanation for why someone finds relief by rubbing or massaging an injured or a painful area. For example, the pain gate theory explains “how”  a child feels better after mum or dad intuitively rub their knee when they have fallen over.

In summary massage produces short term pain relief by being a particularly effective trigger for the pain gate process.

References

Melzack R, & Wall PD (1965). Pain mechanisms: a new theory. Science (New York, N.Y.), 150 (3699), 971-9 

Moayedi M, & Davis KD (2013). Theories of pain: from specificity to gate control. Journal of neurophysiology, 109 (1), 5-12

Jacobs M. (1960) Massage for the relief of pain: anatomical and physiological considerations.  Physical Therapy Review, 40: 93-8

Melzack R, Wall PD. Pain mechanisms: a new theory. Science. 1965 Nov 19;150(3699):971–979.

Wells PE, Frampton V, Bowsher D. (1988) Pain: Management and Control in Physiotherapy.  Heinemann Medical.  Chapter 13.

Watson J. (1982) Pain mechanisms: a review.  1. Characteristics of the peripheral receptors.  Australian Journal of Physiotherapy.  27:135-43

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  • So how does massage reduce pain? – Part 2

    Previously I explained the scientific theory for  "How does massage reduce muscle pain?" in the short term .  But what about the long term? I would like to introduce to you the "descending pain suppression mechanism." The brain is not a passive receiver of sensory messages, but rather a centre that interprets them and makes constant adjustments accordingly. For example, everyone knows that the way you perceive pain will be influenced by whether you focus on it or think of something else instead. And it seems reasonable to suppose that evolutionary selection may have favoured those individuals who could ignore pain signals for long enough to take actions that let them escape and survive danger.

    Unpleasant cutaneous sensations stimulate nuclei within the mid brain.  These nuclei in turn initiate activity in the descending spinal tracts that release endogenous opiates (inhibitory neurotransmitters) within the spinal segment receiving the painful input.  This diminishes the intensity of the pain transmitted to the higher centres. Sports and Deep Tissue massage techniques can reinforce a naturally occurring discomfort, causing much greater release of opiates and achieve a more profound pain suppression.

    References Basbaum A, Fields H.  (1978) Endogenous pain control mechanisms: review and hypothesis.  Ann Neurol 4: 451-2. Watson J (1982) Pain mechanisms: a review.  3. Endogenous pain mechanisms.  Australian Journal of Physiotherapy 27: 135-43