Navigating Muscular Guarding & Pain in Massage: tips for at-home care

Have you ever had a friend or loved one agree to massage a sore spot only to have them fixate on smashing your most intensely sore area and poking it like an angry dragon, trying to coax it to settle down and stop breathing fire with more and more pressure and prodding? Maybe you even got some relief in the end, or maybe not. What each of us that have ever been on the receiving end of this kind of treatment can relate to is that it just plain hurts! Pain was present prior treatment and after this type of treatment, whether you were relieved or agitated, the original pain typically persists. Well, if you are looking to give or receive some at-home massage and you’d like to avoid these kinds of events, here’s some pro tips to help guide you toward more successful and lasting at-home relief. So let’s say, for example, that you’ve been asked to help your loved one with a very stiff and immobile shoulder. You may expect and you are likely to find that the muscles surrounding each side of the shoulder blade will be hypertonic (contracted/”stiff”/”tight”) and you may simply conclude that if you can apply enough pressure to these muscles in the correct way I can coax them to stop contracting. If that is only partially effective, you may even experiment with stretching them back to a more appropriate resting length.  This method of reasoning/treatment has its merits, and it’s a great place to begin for the average stiff shoulders.

However, to illustrate the limitations of this common approach, consider the same example but now add in one simple variation. Imagine now this same loved one experiences pain at 6+ out of 10 with even mild pressure to the muscles surrounding the shoulder blade. If you were to continue to use the previous method you can imagine that person is probably going to either stop you or walk away in some serious distress. Causing people pain is NEVER the way to lasting relief. Not one single study or piece of scientific evidence suggests that causing humans PAIN leads to favorable outcomes in managing PAIN.

In fact, causing humans pain typically elicits a phenomenon known as muscular guarding.  Guarding, sometimes loosely referred to as spasm, is a natural and necessary reaction of nervous system to protect the body from a perceived threat. The following excerpt provides some additional background on this tricky yet vital process:

“After injury, muscles that surround the injured area contract in effect to splint the area, thus minimizing pain by limiting regional movement…Muscle guarding is appropriate in the acute and subacute healing process. Massage application should not attempt to reduce muscle guarding until later stages of the subacute phase.”

If muscle guarding is “necessary” and “appropriate”, what’s so wrong with a little guarding then? The problem with guarding is that it often persists long after the acute and subacute phases of the healing process are complete. When no threat is present and the muscle guarding persists, then the behavior has the opposite effect, promoting more problems than it aims to resolve. The consequences of long term guarding begin as irritating and tend to snowball toward completely dysfunctional. People who’ve sustained a minor muscle strain to one small area around a shoulder may, over time, see the guarding that naturally occurred at the time of trauma develop into a completely frozen shoulder that is persistently painful even at rest. No Bueno! You can see that pummeling your friends/loved ones in a guarded and painful area is BAD idea that often makes pain worse, and an equally bad idea is doing nothing and leaving them hoping it will resolve on its own. Well, what can be done to help resolve guarding?

There are two key steps involved in resolving muscle guarding. The first and most important step is to identify where and under what conditions muscle guarding is taking place. In a clinical setting a proper pre-treatment assessment and discussion will clue in a skilled manual therapist to be on the look out for guarding when needed. For the at-home or amateur caregiver it means finding out more about the friend/loved one you are attempting to help, specifically as related to any recent or past events that may have caused a notable threat perception. Note: it does not need to be an injury per se. While injuries typically come with a strong threat perception so do near misses while navigating dense traffic on the commute home. So make sure that you first take time to discuss and really listen and don’t just set right to pushing and prodding.

The second step is to find a relaxing, pain-free, and comfortable way to lower pain and threat perception. Consider everything about your approach and the environment of the treatment to support the feeling of safety for the person you trying to help; such as lighting, positioning, and choice of words used to describe and communicate during the treatment.  Indeed, there are even more factors that a professional therapist may consider and many more techniques that can be useful. One of my favorite ways to address guarding is to use movement.  Taking part of the body passively through a slow and steady movement in the direction of ease will avoid the person’s guarding and should begin to decrease hypertonicity in the guarded area. It’s important to choose a ROM (range of motion) that is already easy for the person being treated, and then to specifically fight the urge to move them towards a restriction. Instead, passively taking over the work that they typically do with ease will create an even greater feeling of ease and will often have the effect of granting this same feeling of ease to the entire body.

Careful observation and listening skills are required to accommodate a person with moderate to severe pain and to move with their body, rather than attempting to reshape or correct it. When a caregiver is equipped with these skills relief can be achieved for people who are experiencing significant pain. The sooner guarding can be identified and effectively treated the sooner the muscles that have been chronically contracted to protect from a long-gone threat can return to normal and pain-free function.

So, in essence, when you encounter an area that really puts up a fight, remember:

“If you can’t beat ‘em, join ‘em.”

References:

  • Fritz, Sandy. Sport & Exercise Massage: Comprehensive Care in Athletics, Fitness & Rehabilitation. N.p.: Elsevier Health Sciences, 2012. Print.
  • Wolfe-Dixon, Marian. Myofascial Massage. N.p.: Lippincott Williams & Wilkins, 2006. Print.