Gary Karp is a well-known speaker in disability circles, a tall man who sits erect in his wheelchair and appears relaxed as he talks, sometimes he even entertains by simultaneously juggling as he speaks. He’s now 57, having logged 39 years as a para in a chair since his accident at age 18, and he strives to keep his body in good operating condition, knowing how important his upper body is to his lifestyle. As part of staying flexible and strong, he has relied a great deal over the years on massage.
“My love affair with massage began back in rehab,” he says. “Whenever someone would come around offering a back massage, I was quick to take them up on it. It only lasted a few minutes, but it made a big impression on me, the tremendous release of tension, just luxuriating in that wonderful relaxed feeling.”
His interest in massage eventually led him to an extreme form of it — Rolfing (deep tissue massage). At the time of his injury, Rolfing was very popular at California’s Esalen Institute, known around the world as a kind of magical place on the golden coast where longhaired people practiced all kinds of unusual and new self-awareness techniques. As it happened, Karp eventually came to know someone who had been trained in Rolfing by Ida Rolf, its creator. At this time, Karp was about 40, with more than 20 years in a chair, and he was beginning to notice a strange disconnect in his body.
“From working hard in rehab and using my upper body, I had built up a good mass of muscle, but somehow I felt weak. I didn’t really understand it.” So when his friend offered to work with him using this extreme form of massage that was somehow supposed to release tension and tightness and build strength, Karp decided to go for it. “The very first time was amazing. This kind of massage goes deep, very deep, hands pushing deep into muscles, and it’s really painful, but also really productive.”
With each session, Karp seemed to gain tolerance for pain, and the pain itself mixed with pleasure. Best of all was the outcome. His muscles relaxed, tension was released, he became more flexible, and his strength and stamina increased.
How Does Massage Work?
“With Rolfing, I felt like I had recovered the strength that was tied up in my body. Tendons can grow thicker over time, and they can get kind of ‘welded together,’ with muscles, and these adhesions can be worked out to make your muscles more efficient. Rolfing frees up what has been lost or impeded,” says Karp.
Strength is not all that gets freed up, according to Karp. “We hold our emotions in our bodies,” he says. Like muscle memory, our bodies act as a repository for past emotions that have not been fully expressed. “Under the guidance and skilled hands of my friend, Rolfing opened up my emotions. I had the most amazing cathartic cleansing. I cried like I had never cried before. And when it was over, I felt like I had experienced a new beginning.”
Karp was no stranger to grief, having lost loved ones in difficult situations. “All of the grief of our lives is wrapped up in our bodies. For me, I had not stopped to feel the pain at the time it was happening. I was too busy getting on with my life and adapting to my paralysis.”
That one breakthrough experience was enough to set Karp on a course of body awareness and make him a dedicated massage enthusiast. He couldn’t always afford it as often as he liked, but he stayed connected with regular massage as a way of staying “tuned up.” Something like maintenance is to a car.
Karp says that bodily toxins tend to build up in muscles that are underused or overused, and massage can release the toxins. Worst of all are muscle contractions that are “held” rather than a product of movement. Static contractions create an almost poison-like substance that needs to be “pumped out.” Movement and massage help with that process. So does stretching.
What About Repetitive Stress?
Besides upper body tension and tightness that needs to be worked out, one of the most troublesome areas of everyday pain is what is commonly known as repetitive movement strain. Karp, besides being a frequent speaker, also has done hundreds of work-site consultations for people who are experiencing repetitive movement strain.
“I think that term is a misnomer,” he says. “The real problem is not so much related to movement as to lack of movement.” Typically, a person who works long hours at a computer, for instance, will feel pain from too little movement during the day, what Karp calls “held contractions” or “static contractions.” Too little movement, too often, without a break.
“People need to move around and stretch their arms, neck, and back.” Also, when they have muscle or tendon soreness, he says, “a little self-massage will go a long way. “You can massage your forearms by running a thumb along the “grain of your muscles, always moving toward your heart.” If that is difficult or impossible for you, he says, ask someone else to do it. “The worst thing you can do is nothing but just keep on doing the same thing every day. Take time to vary your movements. Movement is the key.”
Where’s the Evidence?
As with many alternative treatment modalities, there is precious little scientific evidence to back up claims of enthusiasts and practitioners of massage. But there is no shortage of anecdotal evidence. Many of the nation’s premier rehab centers include massage as an alternative therapy. Usually, people who experience it report an immediate gain in a feeling of well-being. To be most effective, massage should be done on a fairly regular schedule, but that does not mean it has to happen every day, or even every week.
One survey study on massage, included among other alternative treatments, was reported on in The Journal of Spinal Cord Medicine in 2006 by Dr. Diana D. Cardenas and Mark P. Jensen, Ph. D., who were based at the University of Washington at the time. Dr. Cardenas has gone on to the University of Miami, where she has overseen much important SCI research on a national level. The study, “Treatment for Chronic Pain in Persons with Spinal Cord Injury: a Survey Study,” surveyed over 100 participants. Of these, 73 percent reported they had tried at least one of seven alternative treatments for pain — massage, marijuana, acupuncture, chiropractic, biofeedback, magnets, and hypnosis. The survey concluded that “the most relief was provided by massage and marijuana.” Most treatments provided relief for hours; however, “pain relief for massage and acupuncture lasted for days for a subgroup of about 25 percent who received these treatments.”
A more recent study (2011) by Norrbrink and Lundeberg of Sweden’s Karolinska Institute attempted to evaluate the effectiveness of massage and acupuncture on persons with SCI who were experiencing neuropathic pain, a notoriously difficult kind of pain to treat. A group of 30 was divided in two, with each group receiving either massage or acupuncture therapy twice weekly for six weeks. Norrbrink and Lundeberg concluded: “Neuropathic pain following SCI is often only partially responsive to most interventions. Results from this study indicate, however, that both acupuncture and massage therapy may relieve SCI neuropathic pain. For this reason, larger randomized controlled trials are warranted for assessing the long-term effects of these treatments.”
What About Other Disabilities?
SCI is not the only disability group that has shown beneficial effects from massage. People with spastic cerebral palsy and multiple sclerosis also seem to benefit from pain reduction following massage. In addition, there is some indication that tension from spasticity can diminish and range of motion can improve from massage therapy.
Massage is not the only therapy that can help with pain, spasticity and range of motion. Stretching, heat application, and traditional physical therapy should also be used to get the greatest benefit.
With any disability, it is important to exercise care in seeking out a qualified practitioner. Not just anyone knows how to practice therapeutic or medical massage. Some conditions, for instance where skeletal pain, clotting, or pressure sores are present, may require a doctor’s approval before embarking on a program of massage.
Cost varies and may or may not be covered by insurance. Some schools of massage offer free sessions with graduate students, much like dental schools.
A good place to begin your search for a qualified masseuse or masseur is to consult your physician, rehab nurse, physical or occupational therapist.
• American Massage Therapy Association: www.amtamassage.org
• American Medical Massage Association: www.americanmedicalmassage.com
• National Certification Board for Therapeutic Massage and Bodywork: www.ncbtmb.org