There are no special techniques to work with musicians, but there is something else many therapists overlook.
I never thought that I would be working with rocks stars in this lifetime. I toured with a popular British band — the 1975 — around the U.S. and Canada for seven weeks last fall working as a massage therapist. I worked primarily with the drummer, George, who had chronic pain in his hands, arms, and shoulders for almost two years. I have worked with the lead singer, Matty, a couple of times for low back pain, and once for both guitar players — Adam and Ross — on their hands and forearms.
Although it was initially hard for me to get used to sleeping between one to two in the morning almost every night and wake up in a different city almost everyday, working with music celebrities was not that much different than working with the “average” client back in San Diego and Catalina Island. While the pain experience in each person is different, the mechanisms that influence pain are fundamentally driven by biopsychosocial aspects.
When I first met George and the band, I thought I had some sort of high responsibility to keep them “pain-free” should they have any acute or chronic pain. Although I have never heard of them before until I got he job last year, I was a wee bit “starstruck,” knowing that they may be as popular as the Rolling Stones or The Beatles in their early years. So I can’t really screw up, right?
There was no exact work schedule for me during the tour, and I was always on call in case one of the band members or crew member needed me. When George or anyone else needed treatment before and/or after the show, the sessions often run between 15 to 30 minutes, rarely longer than 30. Even with this limited time, I can sometimes squeeze in a little bit of pain education — if they ask why their back or arms hurt or what causes pain. Oftentimes, letting them tell their story of their pain experience helps both of us understand their pain better.
There is no special hands-on technique to treat rock musicians, at least none that I’m aware of either anecdotally or in scientific literature. But during that seven-week period, I realized how important having a therapeutic and professional relationship is between the therapist and the client. In fact, I think it’s just as important — if not more — than having a barrage of techniques to influence outcomes. In massage communities, I often see and hear that massage therapists are often looking for the “next best technique,” similar to how personal trainers are looking for the next new exercise equipment or certification to give them an “edge” in the market.
But many massage therapists are missing out on building relationships and trust.
Rather than reinforcing nocebic beliefs about pain, like tight muscles or poor posture, I asked George questions, like how well did he sleep the night before or how does he feel about his next show. Rather than telling him what I felt during a treatment, I asked him how he felt when I compress on the arm or hand or stretch his arm over his head. Oftentimes, such question can reveal a little bit more about the client’s lifestyle, thoughts, and expectations that may likely influence the treatment and outcome. With this information, I can adjust my hands-on treatments accordingly and how I communicate with George.
How Much Effectiveness Does Therapeutic Relationship Contribute?
Despite a small number of studies that examined the association of therapeutic relationship between clinicians and patients in pain, a 2014 systematic review and meta-analysis, which pooled data from 13 qualified randomized-controlled trials, suggests that “patient-clinician relationship has a small, but statistically significant effect on healthcare outcomes.”
The authors added that even medical interventions has a small effect on patients’ health conditions and outcomes. They mentioned that the effect size (d) for aspirin in reducing myocardial infarction over five years is only 0.06, and the effect size for the influence of smoking on male mortality over eight years is 0.08. In layman terms, the effect size is extremely small, considering that statistician Jacob Cohen classified d = 0.2 as a “small effect.”
“Effect sizes in medicine are often small because there are many factors that influence health outcomes (e.g., severity of disease, ancillary treatments, co-morbidity, psychosocial stressors, natural course of illness, regression to the mean, etc.),” the authors mentioned in their paper. “For these reasons, the therapeutic relationship — like many other important variables — may only account for a small fraction of the variance in health outcomes.”
So would this apply to massage and pain reduction? Probably. Considering that pain is influenced by many factors in the biopsychosocial realm, what clients sense while laying on the table and getting treated is part of the process that constitutes pain sensation. There are a number of other factors, such as prior beliefs of the treatment, room ambiance, stress levels, health history, and sense of safety. So we may toss in the quality of the therapeutic relationship between the therapist and the client into the cycle.
In the case of George and I, creating an environment where he could just lay down in a quiet room and be away from screaming fans and demands from his duties — for even just 15 minutes — could affect how intense his pain was. The treatment itself, the small talks he and I exchanged, and his expectations of massage therapy all play their part in changing his pain perception and sensation.
At the end of the tour, George still has some pain but it was much less than we first met. I don’t expect his pain to go away any time soon, especially if it took him many years to develop it. The only way for him to stop the pain that I could think of is to stop drumming and performing. Uh, no! That’s not going to happen, not any more likely than a world-champion mixed-martial art fighter to stop competing because he has back spasms.
In terms of hands-on work, working with musicians wasn’t that much different than working with soccer moms and dad, office workers, and the elderly. What is more important is how we therapists communicate with them and the people whom they work with.
The entertainment business is very fast-paced, quite different than the quasi-nirvanic atmosphere of a spa or clinic. Learning techniques and searching for the “next best thing” should not be the primary focus when it comes to treatment. If massage therapists would like to work with any professional musicians, therapists need to know with whom they are working with, understand basic pain science, and be able to quickly adapt to new and changing environments if they are on the road with them.
1. Kelley JM, Kraft-Todd G, Schapira L, Kossowsky J, Riess H. The Influence of the Patient-Clinician Relationship on Healthcare Outcomes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Timmer A, ed. PLoS ONE. 2014;9(4):e94207. doi:10.1371/journal.pone.0094207.
2. Sullivan GM, Feinn R. Using Effect Size — or Why the P Value Is Not Enough. Journal of Graduate Medical Education. 2012;4(3):279–282. doi:10.4300/JGME-D-12–00156.1.