PT vs. Massage: Will physical therapy do better than massage for pain?

Being in the therapeutic massage business for all these years, it’s only natural that we tend to revolve in a similar orbit as the world of physical therapy. Yet as much as I have read about PT and heard about it from our own massage patients and clients, I had never really experienced it for myself. I am used to turning to massage for pain management, not PT.

When massage can’t do it all:

I’ve suffered from low back pain for more than two decades and recently decided to be more aggressive in treating it. Of course, I’ve had a lot of massage therapy (as expected of the owner of a massage therapy service!). But when you’ve got a severely herniated disc with arthritis, massage therapy can have limitations in treating that kind of chronic pain.

Massage therapy can’t directly treat nerve pain. It can help to relieve muscle tension and joint restrictions and other things that could lead to pushing on nerves which could cause pain. So in that way, massage therapy can in fact, relieve pain related to disc problems. However, it’s not a direct effect. It is more of a referred effect.

To me it seems surgery is the most likely path, but it’s not a direct line there.

The first thing the orthopedic surgeon wanted me to do was to get some physical therapy. He and I agreed that it may or may not help, but the fact is that with our current healthcare insurance system, the insurance company is going to require trying it to make sure that a less invasive solution can be found to resolve the pain.

What about insurance for massage or PT?

Unfortunately, major medical health insurance still won’t pay for therapeutic massage in any kind of way that resembles the way that physical therapy can be offered through major medical insurance. That said, there are two kinds of insurance that can currently reliably pay for therapeutic massage services, including in-home massage therapy through insurance. These are:

• auto insurance carriers which cover medical expenses in case you are in a car accident with injury
• workers comp compensation insurance that will pay for medical needs – including massage therapy through your claim when prescribed after an injury at work.

Body Well offers massage through workers compensation claims as well as therapeutic massage for auto injuries nationwide. If you’re interested in getting a free analysis of your injury claim, please visit here and send us your information.

For more information pertaining to the question of “is massage is covered by my insurance”, you can visit an article I wrote previously covering that topic.

Starting on the Physical Therapy path:

So, getting back to my prescribed PT regimen, I hopped on my health insurance website and found the closest physical therapist who, fortunately, had availability just the next day.

I went to Excel Physical Therapy and met Greg an MPT who has been doing PT for more than 20 years.

I explained my situation and we agreed that we would make a good faith effort to see what we could do despite the fact that I have serious structural problems in the L5 S1 joint and feel that surgery is almost inevitable. Specifically, as mentioned earlier, my particular problem is a herniated disc plus lots of arthritis.

Once Greg and I had talked about how physical therapy could help with my chronic pain, we also discussed longer term considerations about the pros and cons of surgery. Of course, no medical suggestion was made because he’s not my doctor and doing so would be beyond his scope of practice). He, like any responsible medical professional, communicated that not getting surgery would be preferable. That’s obvious. Surgery is more of a last resort. It’s basically something I’ve become resigned to being a necessity at some point, but I’m willing to give this physical therapy a fair chance to see what it might do.

One of my concerns about trying to resolve my problem with physical therapy and exercise rather than surgery is the longer term implications. Am I going to be able to or have the motivation to continue to do these exercise exercises in 10 years when I’m in my 60s? Will I be a candidate for surgery at that point? Will they have come up with some better non-invasive solutions by then so I should wait anyway? There are a lot of questions That don’t have clear answers.

In any case, I’ve had a few sessions now at the physical therapy clinic and so far I do feel like the exercises that I’m doing there and they’re teaching me could very well benefit me. I’m honestly a little bit surprised to be admitting that because I was coming into this with quite a bit of certainty that given the depth and duration of my specific issue, the physical therapy would have limited benefit.

That said, I feel like the exercises we are doing are effectively targeting the low back / lumbar and sacroiliac areas of concern. We are doing things to strengthen the core, including abdominal exercises like crunches, and other types of exercises that help to strengthen the core and muscles connected to the pelvic area, including the abdominal and the pelvic/gluteal regions. The piriformis muscle is a commonly targeted muscle as well.

I’ve shared a few images from a couple of the exercises that I’ve been doing there so far. Most seem to involve using the legs in order to activate the desired muscle groups. A yoga or exercise ball is often used. The non-static nature of the ball, which moves freely underneath you, helps add balancing elements to the movements. The exercises can become tiring quite quickly, but afterwards I do feel much looser – almost like that feeling after getting a massage! I guess I’ll have to see how things go over the next three weeks and at that point I’ll be meeting the orthopedic surgeon to report on any progress or other results of the physical therapy.

Body Well complements physical therapy with mobile massage services

I’ve also had to deal over the years with lots of chronic neck and shoulder tension. The difference with those though is that massage therapy is always very helpful and provides instant relief. This is because the pain I experience in these areas is directly related to soft tissue hypertonicity and other types of tension and restrictions that prohibit full range of motion and can cause pain.

So for me or anyone experiencing any kind of muscle related pain because of tightness, that’s where massage can really shine. There are a lot of different techniques you can use to address specific types of pain issues. One of the most common is simply deep tissue massage, which gets below the superficial layers to directly manipulate and massage the muscles. This has an effect of breaking up adhesions and lengthening muscles to essentially provide more slack in the line.

Body Well offers mobile massage services nationwide and regionally depending on the type of massage and frequency needed. In a nutshell, if you’re going to be needing at least a half dozen massages or more on an ongoing basis, we can provide customized in-home massage packages nationwide. However, if you’re just looking for a relaxing massage at home one or two times or once in a while, we can do that in our primary current service territories, which included mobile massage in most of Florida and the Washington DC Metro area. Just contact us by phone or use this form.

I’ll try to submit another update once I’ve completed my physical therapy or any other changes occur in my condition related to it.

Be well!

Dan Melmed, LMT

Founder & General Manager, Body Well