This article is a brief summary of an article which was published in STRUCTURE, FUNCTION, INTEGRATION, the Journal of the Dr. Ida Rolf Institute, available on Amazon, in December, 2024.
To see the full article click here
This article seeks to understand what chronic pain is and how Rolfing structural integration can be very helpful for people suffering from chronic pain.
Chronic pain can be extremely frustrating for the sufferer and can profoundly impact their quality of life, affecting sleep, mood, self-esteem, physical fitness, relationships, finances, and work. People often experience frustration and fear as their pain persists or worsens, leading to feelings of helplessness and guilt over their inability to perform daily tasks. The predominant emotion associated with chronic pain is fear: fear of the pain itself, fear of further damage, fear of a never-ending situation, and fear concerning the numerous life areas affected by the pain. This accumulation of stressors intensifies the pain, creating a vicious cycle.
The problem is that the nature of pain is widely misunderstood. It is commonly equated with tissue damage when in fact many other factors may be involved and tissue damage may even be absent even though pain is experienced. The account of Lorimer Mosely in his TED talk Why Things Hurt illustrates how pain can be disproportionate to tissue damage.
As a child, Mosely frequently played in tall grass, accustomed to the minor scrapes and grazes that came with it. While hiking through tall grass as an adult, he felt a painless nick on his leg, dismissed it, and continued walking. Later, he noticed two fang marks and went into anaphylactic shock from a bite by the deadly Australian Eastern Brown snake, requiring life-saving treatment: there was potentially lethal damage but no pain. Years later, while hiking again, Mosely felt excruciating pain in the same spot on his leg, but this time, the cause was a minor scratch from a twig: there was much pain but no damage.
This illustrates how context and perception are deeply intertwined with pain. How could Mosely’s pain be so disproportionate to the actual harm? Contemporary neuroscience suggests that pain serves as a protector rather than a mere detector of tissue damage. Pain is generated in the brain, not solely in response to physical injury.
The pain might have started in the big toe, but the brain is the thing that gives you the ouch. Up until then it is not pain. — Irene Tracy, head of the Nuffield Department of Clinical Neurosciences at the University of Oxford
So How is Pain Produced?
Understanding the production of pain involves recognizing its roots in the brain. Pain is a complex interplay of sensory input, emotional context, and cognitive processing. It is influenced by past experiences, current circumstances, and even expectations about the future. The brain synthesizes these factors to produce the experience of pain, serving as a protective mechanism rather than a direct measure of tissue damage.
Understanding Acute Pain
Acute pain, often lasting less than three months, is a critical protective mechanism for the body. It typically diminishes over time, responds well to analgesics, and presents with visible physical symptoms such as redness or swelling. This type of pain serves as an adaptive response to potential threats, prompting immediate protective reflexes, enhancing the body’s defense capabilities, and initiating inflammation to isolate and repair damaged tissues.
Acute pain begins with nociceptive input, which consists of signals generated by nociceptors. These sensory receptors respond to potentially harmful stimuli and send pain signals through the nervous system to the brain. The journey of these signals involves three neurons: one transmitting from the site of injury (e.g., the toe) to the dorsal horn of the spinal cord, another from the spinal cord to the thalamus, and a final neuron carrying the signal from the thalamus to various cortical regions where the brain creates the sensation of pain.
Pain is ultimately an output of the brain, which integrates sensory inputs along with emotional and cognitive inputs. Emotional responses to pain, such as fear and distress, drive the motivation to escape or alleviate the pain. Cognitive aspects involve how pain is appraised and interpreted, influenced by an individual’s thoughts, beliefs, and past experiences. For example, Lorimer Moseley’s experience with pain highlights how previous encounters can shape the brain’s interpretation of new pain stimuli.
Despite often reflecting tissue damage, the intensity of acute pain can sometimes be disproportionate to the actual damage. This discrepancy arises because sensory input is modified by context, and nociception (the sensory process that provides signals leading to the perception of pain) is neither necessary nor sufficient for pain to exist, meaning that there can be pain without nociception and nociception without pain.
People may notice cuts or bruises without having felt any pain, and extreme stress-induced analgesia can result in a lack of pain despite significant tissue damage, such as in soldiers during battle. Conversely, pain can occur without nociception. A notable example involves a British builder who felt excruciating pain when a nail pierced his boot, convinced it had skewered his foot. However, upon removing the boot, it was revealed that the nail had passed harmlessly between his toes. This incident underscores the brain’s role in creating pain based on perceived threats rather than actual damage.
These mismatches between pain and tissue damage illustrate that pain’s primary purpose is to protect the organism rather than detect tissue damage. The brain generates pain based on its best guess from various inputs to ensure the organism’s survival. In life-threatening situations, such as in battle, the brain may suppress pain to allow for escape or defense. Conversely, in the builder’s case, visual information prompted the brain to produce pain, believing it necessary to motivate a response to the perceived serious injury.
As Giandomenico Iannetti, a sensory neuroscientist at University College London, states, with acute pain, “generally, you feel what it’s useful to feel.” Pain is not an objective entity identifiable in the body but an experience produced by the brain, acting as an action signal rather than a mere detector of tissue damage. This distinction is crucial for understanding and treating chronic pain, where pain persists beyond the typical healing period and requires different therapeutic approaches.
Understanding Chronic Pain
Chronic pain, often lasting more than three months, fluctuates in intensity, and is less responsive to analgesics. Unlike acute pain, which usually indicates tissue damage and has visible symptoms, chronic pain is often invisible and originates from issues within the nervous system.
Chronic pain can exist without any detectable tissue damage. Phantom limb pain, where individuals feel sensations in amputated limbs, exemplifies this phenomenon. V.S. Ramachandran’s research on neuroplasticity and phantom limb pain led him to describe the body as a “phantom” constructed by the brain for convenience!
Most myoskeletal injuries heal within three months, yet some individuals continue to experience pain long after the initial injury. This is because pain protects against perceived threats, not actual threats. The brain’s perception of threat can be influenced by various factors, including stress, anxiety, fear, memory, social exclusion, culture and feelings of helplessness. Pain is produced by the brain based on these factors rather than just tissue damage.
Believing that pain equates to damage can exacerbate pain, while treatments that provide knowledge, confidence, and hope can be genuinely effective. Monty Lyman, author of The Painful Truth, likens chronic pain to a thorny weed in a garden. It grows in soil — unchangeable factors like past tissue damage, trauma, upbringing, and genetics — but also needs watering with stress and inflammation, including psychological stress, smoking, poor diet, insomnia, lack of exercise, anxiety, and social isolation.
For example, a person feeling a muscle twinge in their lower back might believe their spine is damaged, especially when exposed to terms like “slipped disc” or “bone on bone.” This fear leads to avoiding movements and bracing to protect the perceived injury, creating tension around the painful area and perpetuating discomfort. This avoidant behaviour, driven by the anticipation of pain, fosters a cycle of anxiety and irritability that worsens the pain. Eventually the avoidant behaviour occurs in anticipation of pain instead of in response to it.
In fact there is a poor correlation between back pain and structural anomalies. A 2015 study in the American Journal of Radiology found that 37% of pain-free twenty-year-olds and 96% of pain-free eighty-year-olds had signs of disc degeneration on scans. Misinterpreting correlation as causation can lead to unnecessary surgeries based on MRI findings of degenerated or bulging discs, often with mixed results, without exploring other treatment options.
Pain and the Brain
Chronic pain results from changes in neural circuitry: nerves sending pain signals from the body to the brain, the brain processing these signals, and nerves returning signals to the body. Chronic pain is a learned response by the neuroplastic brain and nervous system, causing pain to persist long after the injury has healed. This is due to central sensitization, where the pain threshold is lowered, and neurons in the central nervous system become more responsive to sensory input. In chronic pain, pain becomes the disease itself rather than a symptom of an underlying condition.
The encouraging news is that the neuroplastic brain can change according to input. Just as the brain can rewire itself to create chronic pain, it can also rewire itself to recover from chronic pain. By understanding and addressing the complex interplay of factors that influence the brain’s creation of pain, effective treatment and recovery are possible.
How Rolfing can help with Chronic Pain
Rolfing structural integration is extremely effective for aligning the body, making the various parts of the body congruent with each other and aligning the whole body with the gravitational field (i.e. improving posture). In my practice I have also treated many clients who suffer from chronic pain and in many cases the pain has reduced or disappeared.
The reasons Rolfing can effectively help with chronic pain are:
- Safe therapeutic container
- Pain education
- Refinement of body maps
- Graded Exposure
- Counterirritation
1. SAFE THERAPEUTIC CONTAINER
Ensuring a safe therapeutic environment is crucial, especially for clients with chronic pain. Chronic pain stems from the brain’s response to perceived threats. Healing involves retraining the autonomic nervous system to transition from the sympathetic fight-or-flight state to a relaxed state of rest and repair. This means that good communication is important, the client’s boundary is respected and the touch can range from deep to extremely light according to what is deemed to be necessary and appropriate. This aspect of the work is in line with Dr. Rolf’s intention for Rolfing to be a treatment that invokes health rather than cures disease.
2. PAIN EDUCATION
As Monty Lyman says in his book The Painful Truth:
“If people living with persistent pain are given a sense of controlled empowerment, the intensity and unpleasantness of the pain should diminish. Clearly, the best way of doing this is by explaining what pain is and what it isn’t.”
Undergoing the Rolfing Series is an opportunity to be in conversation with your Rolfing practitioner in order understand the nature of chronic pain. A good resource for learning about chronic pain is the Pain Revolution website.
Pain Revolution is the charity run by Lorimer Mosely, whose TED talk I mentioned above, and supported by the University of South Australia. In its mission to provide individuals with the knowledge and skills needed to conquer persistent pain, Pain Revolution has distilled four essential pain facts based on an eleven-year study where individuals who had recovered from chronic pain were asked to identify the most crucial insights for their recovery.
The four essential pain facts (EPFs) are as follows:
EPF #1 — Pain protects us and promotes healing
EPF #2 — Pain overprotects us and prevents recovery
EPF #3 — Many factors influence pain
EPF #4 — Therefore there are many ways to reduce pain and to slowly recover or to slowly retrain the pain system back to normal
EPF #1 — Pain protects us and promotes healing
The cliff analogy illustrates pain’s healthy protective role: pain prevents us from reaching the danger zone (the cliff edge). Injury inflames tissues, heightening sensitivity and moving the protective barrier away from the edge. As inflammation resolves, sensitivity decreases, and the barrier returns, allowing normal activities near the edge again.
EPF #2 — Pain overprotects us and prevents recovery
Clients often mistake chronic pain for unresolved damage. However, if no injury is found, it may be due to hypersensitivity in the nervous system, acting too enthusiastically, like an overprotective parent. The good news is neuroplasticity, encapsulated in the phrase “Neurons that fire together, wire together”, enables the pain system to adapt to new information and to recalibrate.
EPF #3 — Many factors influence pain
Many people naturally think that tissues cause their chronic pain, but factors like memory, fatigue, negative predictions, poor nutrition, past traumas, and stress also contribute. A 2018 study led by Tor Wager at the University of Colorado Boulder placed participants in an fMRI scanner and showed them visual cues of “high” or “low” while they were subjected to blasts of high or low heat. Despite no correlation between the cue and heat intensity, participants felt more pain when they saw “high,” showing expectation’s effect on pain perception.
In another study published in the Journal of the American Medical Association participants wore an electric bracelet through which they received electric shocks while given a placebo pill, described as a painkiller. Half were told the pill cost $2.50, and the other half ten cents. Those believing the pill was expensive reported significantly less pain, demonstrating how expectation can modify pain experience.
EPF #4 — Therefore there are many ways to reduce pain and to slowly recover or to slowly retrain the pain system back to normal
The process of undergoing Rolfing treatment can significantly help clients to retrain their pain system towards normal because of refinement of body maps, graded exposure and counterirritation (explained below).
3. REFINEMENT OF BODY MAPS
The brain’s depiction of the body in the sensorimotor cortex, known as a body map or sensorimotor map, can become altered in chronic pain conditions due to neuroplastic changes. This can result in distorted body maps, often termed as “smudging.” Todd Hargrove explains that imprecision in these maps contributes to chronic pain spreading beyond actual tissue damage, shifting between areas, or becoming harder to pinpoint. He notes that chronic pain sufferers often struggle with tasks requiring precise perception of body location and motor control.
Rolfing therapy provides extensive sensory input which acts as reorganisational information that helps to refine body maps and enhance body awareness. Clients often experience increased awareness of body parts and make comments such as: “Wow, I didn’t even realise that I had a muscle there!” Accurate body maps are crucial for chronic pain recovery, and Rolfing’s rich body-wide sensory information can aid this process.
4. GRADED EXPOSURE
Graded exposure involves gradually introducing challenging stimuli to reduce the nervous system’s sensitivity. Rolfing practitioners can employ this method by using careful touch and movement to address hypersensitive areas of the body in clients with chronic pain. By framing discomfort as protective and collaboratively exploring touch strategies, clients can learn to feel safer. This approach fosters agency, reduces perceived threat, and often decreases discomfort levels even with consistent touch pressure, promoting positive brain-body communication.
5. COUNTERIRRITATION
Rolfing can help to mitigate pain perception through tactile stimulation of the body’s connective tissues by using counterirritation which triggers a process called descending inhibition. This process involves neurotransmitters such as serotonin or norepinephrine, which inhibit pain signals in the spinal cord. According to Todd Hargrove, this mechanism operates within the context of “good pain,” where the brain perceives the stimulus as beneficial to the organism. When clients feel safe, trust the practitioner, and believe in the therapeutic benefits of Rolfing, descending inhibition allows them to interpret deep tactile pressure as a positive sensation, albeit sometimes a little uncomfortable, because it addresses significant tension in the body.
In essence, the expectation that the tactile stimulus will alleviate pain enhances the effectiveness of descending inhibition. This phenomenon underscores the role of psychological factors in pain modulation, where positive anticipation of pain relief can amplify the brain’s ability to suppress pain signals. Therefore, by fostering an environment of trust and therapeutic optimism, Rolfing not only addresses physical tension but also optimizes the brain’s inherent pain-reducing mechanisms.
Conclusion
Chronic pain can be very frustrating for the sufferer, who may have seen several practitioners of different modalities before trying Rolfing. Rolfing often produces good results in cases of chronic pain because the whole body is treated as an interconnected myofascial system and coverage of touch ranges throughout the whole body. As a consequence clients usually “settle into their body”, become more relaxed and grounded and often their nervous system comes out of the hypersensitive state that feeds into their chronic pain. With skilful holistic treatment there is realistic hope for improvement for chronic pain sufferers and Rolfing is an excellent option to achieve this.