THE 5 BIGGEST MYTHS ABOUT TREATING PAIN 

Chuck Duff 
Founder, CoachingTheBody.com 

Myth #1: Most Pain Comes From Injuries, Inflammations or Adhesions 

In my 20 years of working on shoulder pain, I would say that virtually all of my clients had
already been given some sort of pathological explanation for their pain — ​bursitis, rotator cuff
tear, arthritis, frozen shoulder syndrome​.

In the beginning, I found that very daunting, especially when these scary-sounding diagnoses
were accompanied by MRIs and other imaging evidence. I didn’t believe I had the skills or
knowledge to help them.

But diagnoses are very often ​unrelated to the actual experience of pain.

And in hundreds of successful cases, I’ve been able to produce , a dramatic impact by applying
my Coaching The Body™ approach.

At first, this really surprised me.. But my initial clinical observations were borne out by some
findings from modern neuroscience.

There is actually a very poor correlation between soft tissue damage / disease and the
experience of pain. In the words of Dr. Lorimer Moseley, a neuroscientist from the
University of S. Australia, “Soft tissue damage is neither necessary nor sufficient for
pain.”

Moseley’s model of pain is that it’s an “opinion” rendered by the central nervous system, based
on an assessment of all the inputs coming in from sensory organs.

In other words, we don’t actually have “pain sensors;” we have tiny organs in our peripheral
tissues that sense when something is awry, called ​nociceptors​. Nociceptive input flows to the
central nervous system (CNS), which renders an opinion on whether the situation is dangerous
or not.

The nervous system is constantly monitoring nociceptive input, and over a period of time, a
steady stream of nociception will cause it to create new synaptic connections. During this
process, long-dormant synapses can be turned back on (known as ​upregulation​).

This effectively increases the flow of danger signals into the brain, and can lead to a decision on
the part of the brain to interpret the situation as painful. ​Thus, chronic pain can flow from
neuroplastic upregulation of the nervous system, long after the initial problem has been
resolved.
Dr. David Hanscom​ is a major spine surgeon who experienced an extended period of severe,
disabling pain. In researching his own pain, he discovered these neurological principles and
found that he could resolve his own (and many of his patients’) chronic pain through expressive
writing, mindfulness, and other techniques.

Dr. Hanscom found that emotional pain and distress are highly potent perpetuating factors for
chronic pain. Emotional pain is processed in the limbic brain, the same area that responds to
signals of physical danger.

He now uses ​downregulation of the nervous system ​as his first approach with patients, often
helping them to avoid surgery altogether.

Another major source of nociception is trigger points, microscopic areas of stagnation within the
muscle fibers. Enter Myth #2.

Myth #2: Trigger Point Therapy Doesn’t Work  

Trigger points arise because of temporary or chronic overload. They aren’t truly injuries,
because they occur on a very small scale and can often be resolved quickly. However, trigger
points produce symptoms at a macro level, and can result in dramatic levels of perceived pain,
taut fibers in muscle, and other sensations.

Unfortunately, while trigger point phenomena are easily demonstrated clinically, trigger point
therapy has not gained much traction in the medical field. There are many likely reasons for this:

● Understanding trigger points requires knowledge of muscular anatomy, which many

practitioners do not use or retain in their practice.
● Many practitioners simply don’t have the time to spend with a patient that trigger point
work requires.
● There has been a poor understanding of how to treat trigger points effectively, so
practitioners and students come away with the impression that trigger point therapy
doesn’t work.

Much of the burden of learning and applying trigger point theory has fallen upon massage
therapists, because they have the ability to spend an hour or more with their clients. One of my
early mentors, Clair Davies, trained as a massage therapist as part of his trigger point
education. He went on to write ​The Trigger Point Therapy Workbook,​ which became extremely
popular as a self-treatment guide to pain from trigger points.

Pain referral as a trigger point phenomenon was also documented by Drs. Janet Travell and
David Simons in their medical textbook, ​The Trigger Point Manual.​ Referred pain is experienced
in a location that is usually distant from the trigger point itself, which confuses practitioners of all
kinds.

On top of this, most practitioners — even trigger point experts like Clair — are not typically
taught to include joint movement in of their work. This is a big problem, which I will address in
Myth #3.
What I would like to point out here is that referral from trigger points, in my view, comprises a
major stream of nociception that feeds into the central nervous system.

In other words, trigger points are a major, hidden source of nociception, which feeds the
sensation of pain.

Myth #3: Massage Therapy Is An Effective Way To Treat Pain 

Disclaimer: I’m going to make some generalizations here which may or may not apply to you
and/or your training, but they are the results of having taught probably a couple thousand
massage therapists in my career.

My position on massage can be controversial sometimes (especially to massage practitioners,

who understandably have a lot of skin in the game). I just ask that you read on with an open
mind (and don’t throw rocks at me)!

In general, the massage industry doesn’t focus on movement, but rather on applying the classic
techniques of massage to the client as he or she lies relatively passive.

This practice was developed as a way to move fluid in muscle tissues and provide an extensive
sensory experience of touch — both of which promote many health benefits.

Resolving trigger points, however, is not one of those benefits. That just isn’t what massage was
developed to ​do​.

Trigger points aren’t just lumps in muscle that have to be (or even can be) rubbed out. They
result from some form of overuse, which for a muscle fiber involves a process of contraction and
stretch. Taut fibers (a.k.a. “adhesions”) happen because the center of a bundle of sarcomeres
pulls together and stays in permanent contraction.

This is not scar tissue or some kind of damage to the fascia — either of which would be
slow to change. Taut fibers can resolve in a matter of seconds.

Clair Davies used classic massage technique as his vehicle for doing trigger point therapy. He
recommended applying around 12 cross-fiber strokes and then moving on. In his view, the body
would integrate the work on its own.

However, when you put that into practice (like I did, at first), you’ll find a significant number of
cases in which the taut fibers don’t soften, or they soften but return a short time later. That ​could
be because of the neurological relationships that each muscle has with its antagonists and
synergists.

In my system, trigger points are viewed not just as a symptom of overuse, but as ​a sensible
attempt by CNS to stabilize joints that seem injured​.

Unless you coach the body to move in the specific ways the CNS is preventing (i.e. “showing” it
that the joint is okay), you can’t convince it that this stabilization is no longer necessary.
Many of the practitioners who actually set out to learn trigger point therapy are massage
therapists, but they’ve been ill-equipped because they weren’t given techniques that really work,
and they weren’t taught to employ movement and neurological reeducation.

The inevitable result has been legions of people emerging from massage school with the belief
that trigger point therapy doesn’t really work, or only applies in certain, specific situations. This
has been a major inhibiting factor in the acceptance of this theory as a key for resolving pain.

In my practice (Thai massage), I was trained in an art that employed a great deal of movement. I
applied those techniques to trigger points, and found that they worked much better than the
static approach. Since, my focus on movement has only increased.

Myth #4: Rubbing Where It Hurts Is Effective 

While it’s tempting to rub the spots where you feel pain (and may feel good in the moment),
unfortunately this has a tiny chance of actually helping. A classic example is pain felt between
the shoulder blades. If a client comes in with this complaint, most therapists are going to spend
a substantial amount of time digging into the rhomboids with their elbows, attempting to strip the
hard fibers they feel.

The problem is that the most pain in the rhomboids doesn’t originate in the rhomboids; it comes
from the muscles in the neck: scalenes and levator scapulae. So the therapist sweats and
groans, the client braces themselves for the inevitable tenderness, and both parties get worn
out. It feels better for maybe an hour, and then the pain returns.

Well, that makes for a good weekly maintenance client, but you aren’t really addressing the true
source of their pain.

The first step is to understand ​first-order referral:​ which muscles directly refer pain into which
areas (if troubled). n this case, the most common muscles would be the scalenes and the
levator. If you can resist the urge to dig around their rhomboids and check those two muscles
instead, you have a good chance of giving your the client substantial relief.

However, there’s more to this than ​what​ and ​where.​ . ​Why​ are those muscles troubled? In this
example, one common perpetuating factor breathing dysfunction. ou need to see if the client
has developed some bad breathing habits, such as overuse of the muscles in the high chest
and neck. That alone could be perpetuating an issue like this.

A second — and super important — consideration is ​satellite referral.​ The low trapezius can
refer into the mid and upper trapezius, which lie on top of the rhomboids. It has to be considered
as a first-order referral possibility. But there are some important muscles that refer pain into the
low trap, such as the serratus anterior.

Serratus is also commonly disturbed, and subject to breathing dysfunction. It tends to shorten
and pull the scapula forward, developing trigger points. Those trigger points can refer into the
low trap. And by overpowering the trapezius, it also introduces a functional imbalance which
further disturbs the low and mid trapezius.
So there are three different relationships that that must be considered in order to understand
and treat the true source(s) of pain — and ​none​ of them include “rubbing where it hurts.” These
include first-order referral, satellite referral and agonist/antagonist functional relationships.. And
then you need to discover the perpetuating factors that might be keeping these muscles
unhealthy.

It might all sound like way too much to learn and keep track of!. Believe me, it took me decades
to piece it all together — but at this point we’ve documented the most important relationships in
each area and this knowledge is baked into every Coaching The Body™ protocol.

Myth #5: All I Need Is A Fancy Tool  

You can be a master at whisking eggs and oils into emulsions, using a whisk — or even the
latest fancy immersion blender — but that doesn’t make you a chef.

A skilled chef has a deep knowledge and understanding of flavors, colors, shapes, and textures.
She knows what combinations and techniques will result in food that tastes and looks amazing.
And she knows WHY.

In the business of treating pain, can have all the gadgets and gizmos in the world, and it won’t
make you a master at effectively treating pain. On the other hand, when you understand how
pain functions in the body (and why), you can be quite effective using the most basic tools of all
— your hands.

But just like the master chef saves herself a lot of time and physical exertion by using, say, a
standing mixer, pain practitioners can accelerate the process — and protect their own bodies —
by utilizing the proper tools.

I have a friend who studied traditional Japanese carpentry, and he knows how to do it the old
school way — small hand tools, no nails. However, he also has a beautiful, high-precision table
saw and a few other tools, because he isn’t bound by the worldview of traditional Japan, and it’s
much faster, and he can continue doing this work for longer because he’s saving his hands..

I developed my Coaching The Body (CTB) approach to bodywork as a method that didn’t
require the use of tools. But over the years, I’ve added a couple that I rely on a great deal,
because they speed things up and produce better results.

One is the ​EPS point stimulator​. For certain muscles, I’ve found that it’s just the most effective
way to treat.

The other is the Muscle Liberator™, which is what the FDA classifies as a “therapeutic vibration”
tool.

Chiropractors often run these tools along the spine to soften the spinal erectors and facilitate
their adjustments. That’s how my team and I first became aware of these tools ‚—but we
decided to design our own device because we wanted to use it for trigger point therapy, not just
tenderizing tissues statically.
After designing and building this device and putting it into practice, we found it to be an
incredible accelerator for our approach. Yes, you can use it to tenderize meat with the best of
them. But that doesn’t resolve pain.

We use this tool as a sophisticated way to eliminate taut fibers and trigger points, but it is just
one component of our proprietary methodology.

Coaching The Body integrates key trigger point ideas (distraction, percussive micro-stretch, and
twitch responses) with an analysis of functional relationships and satellite referral. We also use
a lot of movement in our practice, with a specific intent for each muscle.

The net result is a form of “training” in which the body downregulates its pain responses on the
fly.

Let me just say — it is REALLY cool to see this in action. And I’m not saying the tool is useless
— otherwise I wouldn’t have spent so long perfecting it, and I certainly wouldn’t be sharing it
with other practitioners. What I’m saying is, the tool is sexy; it’s often what draws people to my
trainings.

But the tool alone won’t get you very far, without the understanding behind it.

That’s what ​How to Fix Your Clients’ Pain​ is about. In this free training, I’m going to share with
you what I’ve learned in my 20+ year study of pain, and teach you the techniques I’ve
developed to resolve pain at its source.

I hope you see you there!

Chuck