Ep 485 – Beyond Gate Control Theory with Jason Erickson

0:00:00.0 Kristin Coverly: Massage therapists, are you looking to enhance your skills and improve your practice? Here's your chance. The American Massage Conference is back. This three-day event will be at Disney Springs in Orlando, May 16th to 18th, and kicks off with Free Friday, which is open to everyone. The weekend has over 20 educators offering approved continuing education and a tribute to the late, great Eric Dalton, as well as nightly cocktail receptions to network and unwind. Head over to massagetherapymedia.com/conferences to secure your pass and join us in connecting therapists globally.

0:00:36.8 Darren Buford: Hi, I'm Darren Buford.

0:00:38.0 KC: And I'm Kristin Coverly.

0:00:39.2 DB: And welcome to the ABMP podcast, a podcast where we speak with the massage and bodywork profession. Hello, Kristin.

0:00:45.9 KC: Hi, Darren. It's so fun to be back together.

0:00:49.2 DB: Back in the saddle. Fun to be doing some interview pods again. So our first guest today is Jason Erickson. Jason co-owns and practices at Eagan Massage Center. A former chronic pain patient, he is internationally recognized for continuing education as a provider teaching classes on pain science, dermo-neuro modulation, sports massage, research literacy, and more. His articles and podcast appearances are widely featured. Including our very own Massage and Bodywork Magazine. And for current information on his CE classes, visit healthartes.com. That's health, A-R-T-E-S.com. Hello, Jason. And hello, Kristin.

0:01:32.9 Jason Erickson: Hello. Thanks for having me on.

0:01:35.3 KC: Jason, thank you so much for being with us. Let's jump right in. Obviously, pain science is near and dear to your heart. So tell us a little bit more about that. Where did that passion start for you? 

0:01:45.1 JE: It really started from the fact that I had gone through a period of several years of being in terrible chronic pain that, unfortunately it progressed, to the point that I could barely drive my car or work a desk job. At first, I just thought I would just tough it out. And eventually, there was just no way. And I finally realized I needed to find help. And eventually, I was able to find some people that were able to start helping me make some progress. But it did take a while for me to fully recover. But having made that journey from painful and how depressing and awful that can be to basically being pain-free and able to do whatever I wanted to do, I was able to return to competitive athletics. And I just thought, you know, at the time, I'm just going to become a fitness trainer on the side and just help people out with the exercise piece.

0:02:45.4 JE: And then I realized that the people that were the most satisfying to help and who really needed the help most were people that had a lot of pain or disability. And so I realized, "I should try this... " "I should learn more about the therapy side of things." And I learned a lot in my initial massage therapy education, but I noticed that my teachers had also all had a ton of extra continuing education. So I started studying and learning what I could. And just by pure luck, I started learning about pain science back in 2008 or '09. And very quickly, I started realizing, "Wow, this really just broadened my perspective beyond the gate control theory that I'd learned about in school," and just really took me beyond that. And as I've continued with it, I realized that now it's been over 10 years since then, over 15 years, I guess. And I still feel like I've just got something new to learn every day. You know, what I'm able to do to help my clients has dramatically broadened and changed as well.

0:04:00.7 DB: This is a perfect segue for us. Jason, can you give us a pod-sized summary for our audience of gate control theory and a neuromatrix model? 

0:04:09.8 JE: Sure. The gate control theory was a hypothesis developed and published in 1965 by doctors Robert Melzack and Patrick Wall. And what they were looking at was they were looking at older, prior explanations for how pain works, going all the way back to Descartes and his idea of the separation of mind and body. And the idea that if something bad happens to the tissues, we're going to feel pain. You know, it's the old issues in the tissues thing. But really, medical folks have been discussing and debating the nature of pain and why we feel it going back thousands of years before that. And there had been a lot of attempts to try to find more modern explanations for pain as we were learning a lot more about the different ways the nervous system can contribute to it. And Melzack and Wall were the first to find and detail a series of mechanisms that gave the central nervous system a role that could be understood in modulating how much pain we feel and why. Because there's... The terms pain point and pain center and pain signal and pain path, these are things that a lot of us have heard or used.

0:05:36.0 JE: But the thing is, is that the body doesn't actually have a pain receptor. It doesn't actually have a pain pathway or a pain center in the brain. What it is, is that there's lots of different sensory information coming in and our nervous system is trying to decode, like, what does this mean about our surroundings and what's happening to us? Does this feel safe and comfortable or does this feel potentially dangerous? And so just as this sensory input is getting to the spinal cord, there's already some specialized neurons in the spinal cord that are kind of doing an initial level of filtration about like, "Okay, which things potentially represent danger?" "Okay. Those things are going to take this pathway up to the brain." Things that don't represent danger are going to take this other pathway up to the brain and then up in the brain, then it gets processed. So just the fact that there's this filtering and sorting of what information means at the spinal column was a huge step forward.

0:06:40.0 JE: And one of the big things that was acknowledged at the time was that this gate control mechanism could potentially be harnessed or stimulated in a way that could potentially help reduce or possibly altogether change the way the brain was perceiving what people were experiencing. But one of the things that I thought was particularly cool was that they also recognized right away that this was a partial explanation. Is that there's a lot of things that the gate control theory simply could not explain. For example, if somebody loses an arm or a leg and they end up with phantom pain symptoms, and that could be an itching or buzzing or agonizing pain, they realize that the tissue is gone. So you would think that if it was just a matter of sensory receptors sending a signal to the central nervous system, is, when those receptors are gone, it should just be numb, right? That's what the gate control theory would suggest. But that's not what we're seeing. And so the gate control theory couldn't account for that. And so even as early as the early 1970s, Robert Melzack was writing books like 'The Puzzle of Pain', in which he's basically saying the gate control theory is pretty cool, but here's a whole book about all the ways in which it falls short and things that we should need to think about and additional problems we need to solve. You know, reading that book really kind of opened my eyes to the fact like, "Okay, we need to go beyond that."

0:08:25.0 JE: And even Patrick Wall, he wrote a book called 'Pain: The Science of Suffering'. And again, he's going into a lot of things that were unanswered questions as well as some advancements that had been made in the years since the gate control theory had been published. So there's a lot of continuing work, but the model that Robert Melzack developed is what's called: The Neuromatrix Theory. And the neuromatrix theory is kind of still evolving to some extent. And it's one of the most... But it's one of the most popular and well-known models for thinking about how biological, psychological, and social elements can all impact not only how we perceive what's going on, but also how our body responds. And so, sometimes you know for a fact that what just happened was no big deal, but your body's responding in a completely different way. Or maybe you know that something is potentially a big deal, but your body is telling you, "Ah, no, we can just walk it off." And the neuromatrix model helps us understand that. But what I find particularly interesting is that it also provides implications for what can we do consciously in our roles as massage therapists? Can alter what we say and what we do, the environment we provide, to maximize as much positive input as possible and also possibly make some changes to minimize as much negative input as possible.

0:10:11.0 KC: Let's take a short break to hear a word from our sponsors.

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0:10:45.6 KC: Oh, Jason, such great information. My mind is buzzing, and loving the idea of sort of the gate control theory and the neuromatrix model, sort of the one is still valid the other is more encompassing. If they were an ____ group it would be a yes-and situation. So, we love that. It's all just building on each other, building, building, building. And that leads us right into dermoneuromodulation and also asking for a podcast host, can we refer to that as DNM in the future? Because that's a mouthful. But tell us all about dermoneuromodulation, what we need to know as practitioners, and how we can use that to help our clients? 

0:11:23.2 JE: I was fortunate in that as I was starting to learn about pain science, I had kind of stumbled into an online discussion group, as there are so many, but fortunately, this was dominated by people that were really already well familiar with pain science to the nth degree and were really able to guide me towards really good evidence-based sources. And they were all working towards having a better understanding of how to apply it. And it was a wide range of professions. There's physical therapists, there's OTs, there is doctors of osteopathy, there was medical doctors, and there were some massage therapists in there. And so we were all contributing from our own perspectives. And in some cases, I didn't have a whole lot of science to bring to the table, but I could share some of my own prior experiences having been a chronic pain patient, and before that, a competitive athlete in mixed-martial-arts-type stuff. But then I realized that there was like a whole subsection of the group that was really focused on looking at some of the things that a PT named Diane Jacobs was talking about. And she had come up with this... She had coined this term dermoneuromodulation.

0:12:36.6 JE: The term neuromodulation had been around for a long time. And that's basically they stimulate the nerve in some way to see how the person responds. Does it work? And unfortunately, a lot of us, if we've experienced some type of neuromodulation tests or nerve function tests, it's usually not pleasant. You know, a lot of times it takes the form of running an electrical current along your nerve. Fortunately, massage therapists don't do that sort of thing. So the thing is, is that she was looking at like, "Hey, what is it that they're testing?" They're testing the cutaneous nerves. And most cutaneous nerves primarily lay between the layer of the skin and hypodermis and then the first layer of muscle. And a lot of them run on the outside of that first thick layer of more fibrous fascia, of what they call the deep fascia. And so if we're applying pressure to an area, we've got to apply pressure through the skin and through the hypodermis, but there's also a chance that we might be applying pressure directly onto one of these nerves.

0:13:45.7 JE: But then she's like, "Okay, what else are these nerves doing?" Well, a lot of those nerves have branches that help with motor control, and so they innervate the muscles, but then a lot of them also have branches that go up into the skin, they go up into the skin, a number of different areas, and then they branch out and cover a whole huge field of skin that provides a wide variety of sensory input which is then conducted down to that cutaneous nerve, and that cutaneous nerve then carries it towards the spinal cord. And then any information that's coming back from the central nervous system, whether it's a spinal reflex or whether it's something coming back down from the brain, that's, again, conducted along those cutaneous nerves back into the relevant areas. So the book, 'Dermo Neuro Modulating' was written by Diane Jacobs as an expansion upon the things she'd been writing about online for years and years in blogs, in all kinds of social media posts, but also what she had been sending and sharing with colleagues and with people like myself that... I didn't feel like I could count myself as a colleague of hers at that point 'cause I knew I had a lot to learn.

0:15:10.2 JE: But she was writing and putting out manuals that people could download for free that included practical examples of manual techniques that we could use to stimulate the nervous system just through changing a person's body position or through just gently manipulating the skin. And one of the things that really kind of blew my mind, and was blowing the minds of all these other folks around the world, was the fact that these techniques were in many cases so incredibly simple and so incredibly gentle. And if you have somebody that's already in pain, it's easy to inflict a little bit more pain in hopes that they'll feel some relief afterwards. But if that person's really in a lot of pain, sometimes you can barely even touch them. You might not even be able to touch them in the immediate vicinity of where they are experiencing a sense of discomfort. And with DNM concepts, by applying those, whether it's one of the examples that Diane gives in the official textbook, or if it's me just adapting the concepts to fit this particular person, I'm often able to provide relief without causing additional discomfort along the way.

0:16:30.0 JE: And the other thing that's really beautiful about it is that depending on what it is that I do that brings them relief, I might be able to turn that into a teaching moment, if they want to learn, and if I do a simple technique that I realize, "Hey, I know a way that I could convert this into a self-care method," I might ask them, "Would you like to know how to do a version of this for yourself?" And most people will say, "Yes." Immediately because they want to have a sense of agency, a little sense of control. And if you're a chronic pain patient, one of the things that's the most frustrating is that loss of sense of control over what's going on with your body. If you can regain a sense of control by being able to... Maybe you can't get rid of the pain, but maybe you can just turn that dial down a little bit and just lower that volume of uncomfortable sensory input. That brings a sense of a greater relief because over time, you're more likely to repeat that. And one of the things with chronic pain is that, chronic pain is defined as pain that persists for more than 12 weeks. And so in that case, it's common that the initial reason for why it started may have already resolved. But the nervous system has already started to make changes.

0:17:58.0 JE: Neuroplasticity is, again, the nervous system is trying to figure out how to be more efficient and effective. And one of the things that that can occasionally work against us is the fact that... There's a saying, "Neurons that fire together, wire together." And so if neurons connect and transmit signals that contribute towards the perception of discomfort, there's a greater chance that the next time that they're stimulated, that those two are going to connect again. And then that becomes increasingly efficient. And so whereas it used to take a fair amount of stimulation to generate a certain level of discomfort, over time, it may take less and less and less and less and less discomfort in order to stimulate the same level of perceived discomfort. And so the idea with dermoneuromodulating is now we have a way of stimulating things where we're less likely to trigger those patterns. But then hopefully over time, maybe we can make it possible for that person to be able to tolerate a little bit more and a bit more and a bit more with less chance of things having a big flare up or something like that.

0:19:16.7 DB: Jason, does DNM kind of dominate your session, or does it mesh with other techniques that you're bringing to the table? 

0:19:24.2 JE: I would say there was a time early on where I would say that it kind of dominated my sessions, and partly because I was thinking about it so much, and I was really trying to understand how to use it well. And I feel like I need to apologize a little bit to some people that saw me back in the early days of when I was learning about pain science, because part of me was thinking like, "Okay, I need to communicate some of these ideas." And so part of my intake discussion that I would have with people was not just me asking them questions and getting relevant information, but often trying to give them a little quick two-minute synopsis of all of pain science. And I remember a few people looking at me like, "What the?" It was just too much. And I've realized that people don't need to know any of that stuff, their bodies will do the talking for them. So, if I provide an environment in which they feel safe and comfortable, and which is pleasant and which doesn't have things that are noxious to them, the more likely they are to have a good experience and a good outcome. And so I'll take that.

0:20:43.4 DB: Jason, as we're about to bring this podcast to a close here, are there any kind of closing thoughts? You've given us tons of references. And listeners, we're going to put all of those notes and all of those resources in the notes to this podcast, including Jason's article that he wrote for Massage and Bodywork Magazine about DNM. Jason, do you have any final thoughts here? 

0:21:02.2 JE: You know, it's been a long time since I started learning about this stuff. And I don't know if it's coming through my tone of voice, but I'm still really excited about what I'm doing and how I'm doing it. And one of the beautiful things too, is that, you know, I've been a massage therapist for over 18 years. And as I've learned more about these things, I found that I don't have to exert myself nearly as much. And there's techniques that I used to use much more frequently that were a little harder on my body and frankly, sometimes a little harder on my clients too. And it's like, I can still use those techniques, but in many cases, I don't have to use them as aggressively. So consequently, a lot of my clients are so much happier to see me than they used to be. And it's also, it's like, I find my body I can work four or five days a week and I'm fine.

0:21:56.8 JE: I've just found that it makes my job so much easier. And the other thing is that because I've been able to start finding ways to give people specific suggestions, like, "Okay, so we did this technique, your neck and shoulders settled down, your pecs are feeling more relaxed, and so forth. Okay, here's how you could do that technique for yourself." And they're so happy to have something that will give them some agency. And the people that really follow through and really use information I give them, more agency over their body, seem like they make faster progress. And I've seen some people go from quite severe injuries, whether it was sports-related or work-related or car accidents, to being essentially pain-free and fully abled within a year. Sometimes less, but I like a challenge, but I just find that a lot of cases are a lot less challenging than they used to be.

0:22:58.0 DB: Thank you so much, Jason. I want to thank you for being our guest today. And for more information, listeners, you can find the good work he's doing at healthartes.com. Thanks, Jason. And thanks, Kristin.

0:23:09.3 JE: Thank you so much for having me on. I really appreciate it.

0:23:12.4 KC: Well, Jason, we really appreciate you and thank you so much for sharing such great information on pain and pain science with our listeners. We appreciate you.