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The Pain-Spasm Wheel:  How Stress Transforms into Pain

What is the pain-spasm wheel? It is an illustration that depicts how stress can perpetuate multiple, associated effects leading to the result of pain from muscle tension.


The Causes of Muscle Tension

Before we examine the wheel, let’s look at how someone gets on the wheel in the first place. Think of this paragraph as the onramp to the wheel. The three main causes of muscle tension are overuse/overload, trauma and compensation. Imagine a carpenter whose task is to use a screwdriver all day, every day. Certain muscles in the hand and forearm would be used in the same way, repetitively, for an extended period of time. This is a form of overuse which can cause actual injury (strain) or pain from constant aggravation or a singular event. Trauma is direct injury from an incident such as a bad fall, a sports injury, a car accident or surgery. Compensation refers to other muscles that are overloaded as a result of an injury to or underuse of another muscle. For example, if you sprained your left ankle, your right leg would have to work harder to make up for the loss of functioning in your left. Additionally, muscles surrounding the injured joint would automatically spasm (tighten and stay tightened) to protect and support it.


Physical Stress Perpetuates the Wheel

Now let’s look at the pain-spasm wheel. The first thing to notice is that STRESS is at the center of it all. Stress comes in more than one form. We naturally think of mental stress first, caused by the frustrations of daily living. Psychological stress is indeed a contributor to the center of the wheel and can cause physical changes. Even if a person is safe and comfortable in a warm bed, if she is extremely worried about something, stress hormones may be triggered in her body causing visceral stress (such as rapid heartbeat). Skeletal muscles may contract without her recognition (such as jaw clenching), stimulating the spokes of the pain-spasm wheel.


Overuse and Repetitive Motions

To a larger extent, the form of stress represented in the pain-spasm wheel involves overuse and repetitive-motion injuries which are the perpetuating factors for most muscle tension. Repetitive motions aren’t always as obvious as the carpenter with the screwdriver. Prolonged, poor posture is a repetitive motion. There are several forms of overuse, but some examples would include using a computer mouse with the wrist unsupported, carrying a child consistently on the same hip, cocking the head to a shoulder to keep a phone in place and carrying a heavy purse. By-products of overuse, trauma and compensation include muscle shortening, trapped wastes and trigger points. All of this can contribute to PAIN at the top of the pain-spasm wheel.


Tight Muscles Press on Nerves

Let’s examine the spoke called muscle tension (and) pressure on nerves. We learned in the first paragraph what causes muscle tension but what most people don’t realize is that when a muscle is tight, it can pull on bones or press down upon nearby nerves and vessels. For example, if hypertonic muscles in the neck are causing the collar bone to compress the brachial plexus (a bundle of nerves that innervate the arm) certain undesirable sensations can follow such as numbness and/or tingling down the arm. Tense muscles attached to the spine can tug on individual vertebrae. A tight hamstring (back of the thigh) can pull on its pelvic attachment, effectively changing the lumbar curvature of the spine, which can then irritate nerves and cause low back pain.


Shortened Muscles Can Shrink in Size

Now let’s jump to muscle shortening. This is caused in two ways. When a muscle is tense, it is shorter than it should be. Imagine a game of tug of war. You are pulling a rope in order to bring the center knot closer to you. So you are pulling your arms IN, towards your body, in effect, making them shorter. That is what a muscle does when it is contracting. Also, certain postural positions can slacken muscles which is a passive form of shortening that can yield the same results. If I wear high heels, the muscles in the back of my calves are slackened because my heel is coming up off the floor, no longer keeping those muscles taut at full length. Imagine how bacon shortens and bubbles up when it cooks. Those little bacon fibers are being compressed as the strip shrinks. The same thing happens to human muscle during an active or passive contraction.


If a muscle is in a contracted position for a long period of time or put in a slackened position repetitively, a couple of things can happen. One, trigger points can develop (which I’ll explain a little later) and two, that muscle can become so used to that shortened position, that it can become shorter… literally. A muscle can re-set its length to a shorter length, which may then lead to two other spokes on the wheel. The first is restricted movement which is a decreased range of motion. For example, perhaps you can’t turn your head all the way to the left or right. The other is reduced circulation which means that less blood will infuse that muscle because the microscopic fibers are so tightly condensed, they can’t absorb it as well. Also, as we learned earlier, tight muscles can press upon vessels, which can restrict their blood flow. The result is that less nutrients will be brought there and less wastes will be taken away.


Trigger Points Take Muscles Hostage

With less wastes being taken away, trigger points can develop. Microscopic muscle fibers tend to spasm (seize up) surrounding irritating metabolic wastes and toxins trapped in muscle tissue. Imagine you were made of sand and someone threw a rock into your belly button. The sand surrounding the rock would compress around the diameter of it and form a NODULE. This nodule, or clump of tightly compressed muscle tissue, is called a trigger point. A trigger point can cause pain exactly where it is or it can remotely refer pain to another area. For example, trigger points in the sternocleidomastoid muscle (front of the neck) can refer pain behind the eyebrow or eye socket causing a tension headache.


Massage Therapy is the Remedy

So what does massage therapy have to do with all of this? EVERYTHING. Massage by its very nature lengthens and broadens muscle tissue, like a rolling pin does to dough. This increases your range of motion (makes you more flexible) thereby making activity more tolerable. Massage brings vital blood to the area being worked, just like pressing on a gas pedal brings a flood of gasoline to your engine. That blood brings oxygen which is incredibly healthy for all tissue types including your skin. Blood also removes wastes therefore helping to prevent trigger-point formation. Proper therapy to existing trigger points may dissolve them and eliminate the pain they cause. Relaxed muscles may ease up on your bones, promoting more successful chiropractic adjustments.


Through massage therapy, health and vitality may be brought back to your body making you feel better physically. Knowing that you are doing something healthy for your body and experiencing the relaxing effects of massage can reduce your mental stress, which can then temper muscular tension you may be experiencing unconsciously. Additionally, massage tends to help people sleep better, and that can have positive effects on your immune system. Your therapist can help you identify overuse and postural issues that may be contributing to your muscle tension so that you can change those patterns. Massage has a lot of beneficial domino effects that most people don’t realize, including the fact that loose muscles are less prone to injury – great news for athletes and exercise enthusiasts.


You may not be able to do a whole lot about your mental stress or your repetitive motions right now, but your pain might be reversible. Regular massage therapy can make pain preventable. Get off the pain-spasm wheel. See what therapeutic massage can do for you.


Emily Hagen BCTMB, CNMT

Board Certified Neuromuscular Therapist

Right as Rain Massage, LLC