How leading massage therapists and manual therapists look at psychosomatics.

Psychosomatics, as an objective phenomenon, is no longer in doubt, however, extreme positions on it are still encountered in the provision of psychological and medical care: “to treat the disease only with medical manipulations, and the psychological request only with psychotherapeutic techniques”, “to treat only with medical manipulations everything up to to the question of the meaning of life”, “through psychotherapy to influence everything up to coma and venous bleeding.”

Usually, psychologists assign the maximum role in psychosomatics, although initially these phenomena were described by doctors and physiologists. And there may be an erroneous opinion that this is just a fashionable word, with the help of which the psychologist, experiencing a “feeling of insufficiency” (according to A. Adler), tries to fit into medical practice. But no, specialists working with bodily needs turn to psychosomatics.

Most of all, psychologists who work in body-oriented practices love psychosomatics, which is logical. But how do specialists “on the other side of the barricades” — chiropractors, massage therapists, physical therapists — relate to psychosomatics?

From a physiological perspective, it is obvious that the greatest connection between the psyche and the body is through the nervous and neuro-endocrine systems. At the end of the 19th century, systematic research began to be carried out on the positive effects of massage techniques on peripheral nerves. It was found that massage has a stimulating effect on regenerative processes in nervous tissue, and also restores the functions of peripheral nerves.

With the advent and development of the teachings of I.P. Pavlov, already in the middle of the 20th century they began to study the effect of massage on the Central Nervous System. Thus, V.M. Andreeva, N.A. Belaya (1965) discovered that under the influence of massage the bioelectrical activity of the cerebral cortex improved.

I.M. Sarkizov-Cesarin (1957) noted that weak stroking has a calming effect, and with prolonged action it is one of the most effective “local painkillers and anesthetics.” It was found that with strong mental stress, increased electrical activity of the muscles occurs. And the greater the mental load and the stronger the fatigue, the faster it happens, the stronger the generalized muscle tension. Thus, N.A. Akimova (1970) observed that during fatigue, points of increased muscle tone are localized in the cervical and thoracic regions, which often leads to hyperalgesia (formation of triggers/painful muscle thickening).

Finally, L.A. Kunichev (1980) directly points out the importance of psychotherapeutic procedures for somatic requests and indicates rational psychotherapy and autogenic training as the main methods. In addition, he notes that it is important to explain to the client that massage is not a panacea or an immediate healing effect.

K. Löwith (1983) also speaks about the importance of the mental factor, noting that “purely” psychogenic pain and pain of organic origin are possible.

Their differences lie in the fact that “purely” psychogenic pain is extremely rare; with “purely” psychogenic pain, the patient gives evasive descriptions: “a feeling of pressure,” “a feeling of heaviness.” In addition, he notes that sometimes after treatment of the spine and objective normalization of the condition, complaints of pain remain, the cause of which is mental, in particular endogenous depressive states. K. Levit emphasizes that psychotherapy is needed not only when overcoming the psychological factors of vertebral disorders, but is especially needed when neurosis is diagnosed.

As already mentioned above, K. Löwith indicates poorly differentiated and not precisely localized pain as a criterion for “purely” psychogenic pain. However, G. A. Ivanichev notes that often after eliminating the trigger point, pain may remain that resembles the phenomenon of phantom pain with a lost limb, and the patient can palpate the size of the trigger point. The essence of this phenomenon is that, due to the long-term existence of painful muscle compaction, an afferent model of the painful point is created in the central nervous system. After treatment sessions, the real trigger disappears, but the afferent image can sometimes remain. G. A. Ivanichev notes that in such cases, only psychotherapy can “erase” the pathological image (false afferent model) of the absent object.

D.G. Simons, D.G. Travell, myofascial pain specialists also believe that certain psychological factors may contribute to the long-term persistence of myofascial trigger points.

Thus, patients may experience a feeling of hopelessness, the reason for which is their belief that physical disorders are incurable; being in fear of aggravating your physical condition when moving or doing physical work. For this reason, they avoid movements that could help restore temporarily lost activity.

They also note the relationship between depression and chronic pain, especially when the patient does not understand the reasons for the pain, but there is fear that it could be even worse, or the pain is a symptom of terrible diseases. In this case, depression can be either one of the causes of pain or arise as a result of persistent pain.

Anxiety and tension, as mentioned above (N.A. Akimova), severe melancholy, restlessness and anxiety are expressed in the form of muscle tension. The peculiarity of such people is that they often do not notice their muscle tension.

The “great guy” syndrome (D.G. Simons, D.G. Travell) is the opposite of the hypochondriacal syndrome. Such people try to ignore pain when doing physical work or exhausting themselves with sports. By doing so, they overstrain the muscles and activate painful trigger points.

In addition, D.G. Simons, D.G. Travell draw attention to the presence of a primary benefit from their painful condition — a neurotic patient unconsciously causes himself physical symptoms that help him free himself from mental stress. And secondary benefits — when the patient consciously discovers certain advantages in his situation.

As you can understand, many serious specialists in the field of somatic disorders pay tribute to the mental factor in the occurrence, maintenance and rehabilitation of somatic (psychosomatic) disorders. In this article I did not describe the views of V.D. Topolyansky, V.M. Strukovskaya and the school of A. M. Wein, since they deserve separate consideration, and the article would be greatly overloaded.