“Intelligence: Not because you know everything without questioning, but rather you question everything you think you know.” ~Anonymous
While some fitness and massage professionals are understanding better about how pain works — that pain isn’t just about tissue damage or biomechanical problems — there is a tendency to lean heavily on either the biomechanical model or the neuroscience model. Some professionals blame a problem on a muscle, fascia, or joint; others blame the brain and neurons. Realistically, the true cause may lie somewhere among the vast grayness in between.
Last month, I was massaging a client who complained of minor lower back aches. While I applied a gentle compression upon her left lumbar region with my soft fist, her muscles spasmed a little for a couple of seconds before I was able to sink a little deeper into the tissues without further spasms. After the session was completed, she mentioned that her lower back ache has decreased a lot and was able to move more freely after the session.
Whether her chronic low back issue was mostly a biomechanical or neural issue, the touch that she received worked for her at that time. When she asked about the cause of her pain, I told plainly that I’m not sure since that was our first session, and I would need to work with her over a few more sessions to understand her issue better.
I usually get a chill up my spine when I hear some massage therapists, chiropractors, and personal trainers who marry to one or two philosophies or modalities. They have a tendency to treat everyone in almost the same way — their clients or patients are nails, their method(s) is the hammer.
As a professional, I often avoid making absolute statements when communicating with my clients or peers in any exercise, massage, and similar topics. In this case, I told my client that her back spasms and chronic pain may stem from multiple reasons or just one or two issues, such as stress, too much sitting, previous injury, and disease, such as bone cancer or typhus.
It is less wrong to say, “I’m not sure why you have pain. However, based on what you told me and what you wrote in your health intake, it may be caused by stress at work and not getting enough rest between workouts,” than saying, “Your back pain is caused by tight hip flexors and weak core muscles and glute medius.”
It’s okay to say, “I’m not sure” and refer out if necessary. Unless she gets examined by a qualified medical professional, fitness and massage professionals should not make absolute judgments about their clients’ pain issues.
Chances are, you are more likely to be more wrong and less right, and that’s okay. That’s part of being human.