The 7 Perpetuating Factors of Pain

In my San Antonio, Texas based Massage Therapytypes of nerve impingement. These are areas of
and Bodywork practice I'm often asked by clientsabnormal pressure on nerves which can cause pain,
how it is that I assess clients and approach my work.numbness and tingling, or muscle weakness. A Nerve
There are a number of methods I use but when itCompression occurs when a hard tissue such as a
comes to musculoskeletal pain one set of guidelinesvertebrae or vertebral disc directly presses on a
are "The 7 Perpetuating Factors of Pain". Thesenerve. A more common occurance is a Nerve
factors were originally presented to me during myEntrapment. Nerve Entrapments occur when a soft
training in Neuromuscular Therapy and Medicaltissue such as muscle, tendon, ligament, or fascia
Massage and are based on the work of Drs. Janetabnormally press on a nerve. An example of a nerve
Travell and David Simons (and others). By keepingcompression would be sciatica. Examples of a nerve
these factors in mind during assessments andentrapment include Carpal Tunnel Syndrome and the
treatment a Massage Therapist's potential to helplesser known Piriformis Syndrome, but encompass a
relieve the client's pain increases tremendously. Thewide variety of painful conditions.
factors are:POSTURAL DISTORTIONS are another factor
1) Ischemiacontributing to musculoskeletal pain. Distortions such
2) Trigger Pointsas the head being to far forward, leg length
3) Nerve Compression or Entrapmentdiscrepancies, or an elevated shoulder cause muscular
4) Postural Distortionimbalances and joint abnormalities which lead to pain.
5) Biomechanical DysfunctionBIOMECHANICAL DYSFUNCTIONS include joints that
6) Stressare either excessively mobile (hypermobile) or have
7) Nutritionan abnormally limited range of motion. These
Each of these factors plays a part in a person'sBiomechanical Dysfunctions cause pain in the joints
musculoskeletal pain. Any one of these factors canthemselves and contribute to some of the other
be the sole cause of pain, but usually a person willperpetuating factors including postural distortion,
have more than one factor at work - sometimes allischemia, and trigger points.
of them.STRESS may be the most common of all
ISCHEMIA is a local deficiency of blood supply andperpetuating factors of pain. A person experiencing
the oxygen transported by the blood. Ischemia canphysical, mental, emotional or spiritual stress produces
occur for a variety of reasons including direct injurylarger amounts of stress hormones and usually has a
to tissues, abnormally tight or overworked muscles,nervous system that's in overdrive - fight or flight
clothing or shoes that are too tight, or evensyndrome. Stress leads to pain in so many ways that
off-the-shelf splints for tennis elbow. Specializedit's impractical to list them here; however, stress can
nerve receptors in muscles report pain in ischemiccause pretty much all of the other perpetuating
areas due to chemical changes that occur.factors.
TRIGGER POINTS are hyperirritable spots in a muscleNUTRITION is one factor often overlooked in the
associated with a palpable "knot" and a taut band oftreatment of musculoskeletal pain. Unfortunately,
tissue. Trigger Points are painful on compression andMassage Therapists are seldom trained, qualified, or
can refer pain and tenderness to other areas. Triggerlegally able to provide nutritional advice. However,
Points are usually ischemic and often cause an entiremost Massage Therapists, including myself, do know
muscle to be too tight, weak, and more easilyhealthcare professionals in their locale to help with the
fatigued. Trigger Points can be caused bynutritional side of treating pain. These professionals
overworking or overstressing muscles, direct traumaoften find that there are nutritional deficiencies just a
to muscles, or even chills.Drs. Travell and Simons did during their research.
NERVE COMPRESSIONS and ENTRAPMENTS are