In my San Antonio, Texas based Massage Therapy and Bodywork practice I'm often asked by clients how it is that I assess clients and approach my work. There are a number of methods I use but when it comes to musculoskeletal pain one set of guidelines are "The 7 Perpetuating Factors of Pain". These factors were originally presented to me during my training in Neuromuscular Therapy and Medical Massage and are based on the work of Drs. Janet Travell and David Simons (and others). By recognizing these factors during assessments and treatment a Massage Therapist's potential to help the client achieve pain relief increases tremendously. The factors are:

1) Ischemia;

2) Trigger Points;

3) Nerve Compression or Entrapment;

4) Postural Distortion;

5) Biomechanical Dysfunction;

6) Stress;

7) Nutrition

Each of these factors plays a part in a person's musculoskeltal pain. Any one of these factors can be the cause of pain, but usually a person will have more than one factor at work - sometimes all of them.

ISCHEMIA is a local deficiency of blood supply and the oxygen transported by the blood. Ischemia can occur for a variety of reasons including direct injury to tissues, abnormally tight or overworked muscles, clothing or shoes that are too tight. Sometimes ischemia may be caused or exacerbated by off-the-shelf splints for tennis elbow, or other braces. Specialized nerve receptors in muscles report pain in ischemic areas due to chemical changes that occur.

TRIGGER POINTS are hyperirritable spots in a muscle associated with a palpable "knot" or a "taut band" of tissue. Trigger Points are painful on compression and can refer pain and tenderness to other areas. Trigger Points are usually ischemic and often cause an entire muscle to be too tight, weak, and more easily fatigued. Trigger Points can be caused by overworking or overstressing muscles, direct trauma to muscles, or even chills.

NERVE COMPRESSIONS and ENTRAPMENTS are areas of abnormal pressure on nerves which can cause pain, numbness and tingling, or muscle weakness. A Nerve Compression occurs when a hard tissue such as a vertebrae or vertebral disc directly presses on a nerve. A more common occurance is a Nerve Entrapment. Nerve Entrapments occur when a soft tissues such as muscle, tendon, ligament, or fascia abnormally press on a nerve. An example of a nerve compression would be sciatica. Examples of a nerve entrapment include Carpal Tunnel Syndrome and the lesser known Piriformis Syndrome, but encompass a wide variety of painful conditions.

POSTURAL DISTORTIONS are another factor contributing to musculoskeletal pain. Distortions such as the head being to far forward, leg length discrepancies, or an elevated shoulder cause muscular imbalances and joint abnormalities which lead to pain.

BIOMECHANICAL DYSFUNCTIONS include joints that are either excessively mobile (hypermobile) or have an abnormally limited range of motion. These Biomechanical Dysfunctions cause pain in the joints themselves and contribute to some of the other perpetuating factors including postural distortion, ischemia, and trigger points.

STRESS may be the most common of all perpetuating factors of pain. A person experiencing physical, mental, emotional or spiritual stress produces larger amounts of stress hormones and usually has a nervous system that's in overdrive - fight or flight syndrome. Stress leads to pain in so many ways that it's impractical to list them here; however, stress can cause pretty much all of the other perpetuating factors.

NUTRITION is one area often overlooked in the treatment of musculoskeletal pain. Unfortunately, Massage Therapists are seldom trained, qualified, or legally able to provide nutritional advice. However, most Massage Therapists, including myself, do know healthcare professionals in their locale to help with the nutritional side of treating pain. These professionals often find that there are nutritional deficiencies just a Drs. Travell and Simons did during their research.

Treatment regimens that address all of the 7 Perpetuating Factors of Pain tend to be more successful and long lasting. Massage Therapists who can identify and address these factors in clients can assist the client in attaining pain relief, better posture and joint movement, reduced stress, and a general feeling of wellness.