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Looking Back, Looking Forward

This April, I celebrated my 38th anniversary of practicing massage therapy, a milestone that I never expected to accomplish. Looking back over this period, it is very clear that my career, and the nature of the work itself, has changed dramatically over the years. Part of the reason I am thinking about my career is that one of my clients asked me this question- Knowing what I know now, would I still have chosen this path? In the past, the answer was a quick “yes”. This time, I thought about his inquiry for a few moments before answering in the affirmative. His question caused me to both look backward to the past and also reassess what is important now with regard to the mission and the function of my chosen path. It is only natural and appropriate that time and experience has reshaped the fabric of my work. The result of such a long career is evolving clarity about the mission of this work, where it fits in the larger picture, and why that is important.

Looking back on those very early years, I was completely enamored with the novelty of massage therapy; it felt as though I was a pioneer down a new and important path. Years later, as I discovered neuromuscular therapy, it felt like a new chapter in my massage career had unfolded. The work required far more anatomical and technical skill than general massage and I was inspired by the challenge and the possibility of massage as a corrective and truly therapeutic modality.

During that time, it is also with a bit of embarrassment that I recall my overzealous assessment of the value of massage therapy in the treatment of musculoskeletal pain. There is an effect in psychology called the Dunning-Krueger Effect; the people who know the least are the most confident. That was certainly true for me during this time; I was unaware of that which I did not know.

As I dove ever deeper into the science of the work in the mid 1990’s, I became more and more deeply aware of the endless mysteries associated with this (and any field) of knowledge. The more I learned, the less sure I was about that which I had never previously questioned.

At the same time, a different kind of confidence began to emerge. Every client I saw became a learning experience. Research endeavors that had unexpected outcomes took me down previously unknown routes of exploration. Instead of being devastated and demoralized by research failures, I was rediscovering the same wonder for massage therapy that I had in the very beginning of my career. That sense of wonder continues to the present moment.

As many of you know, I don’t typically see people for general massage therapy for relaxation these days. Not because massage for relaxation isn’t valuable in its own right, but because I can best serve others by using my skills to solve very difficult problems. This is the interesting part with regard to my practice; as my skills have elevated, the complexity of the conditions I see has also increased. Each day is filled with deep challenges and complicated cases that push the limits of my ability.

Part of the reason that I share this background with you is that even though my career and type of massage I do has changed tremendously over the years, the mission, far clearer today, is still the same as it was in 1977. Hands-on therapy such as massage can play a vital role in health care. Far too many people suffer from musculoskeletal pain thinking that nothing can be done to help them or that the pain they experience is somehow “normal”. The development of Precision Neuromuscular Therapy (PNMT), the work that I teach, is based on effectiveness and efficiency.

As I travel and speak at conferences across the country, I have heard many presentations from researchers, health care providers, and educators from our top health care institutions and places like the National Institutes for Health. The picture they paint isn’t pretty; the data on the effectiveness and efficiency of standard approaches isn’t just underwhelming- it is a high cost that all of us are paying. This trend is not sustainable; we just cannot afford to waste money on approaches that don’t yield real benefits. As technology increases, the costs have gone up substantially. If the outcomes increased in proportion to the cost, then this increase may be justified. In fact however, our outcomes aren’t better at all. Only the cost has increased. In 2011, we Americans spent 13 Billion dollars on spinal fusions alone. The annual cost of back pain is estimated to be in the neighborhood of 90 Billion dollars! Is there a way that massage therapy, specifically Precision Neuromuscular Therapy, can fill gaps in the system and save both individuals and our health care system valuable resources?

This questions consumes my thoughts these days and demands that we clarify exactly what we are best at, especially targeting conditions that are not well served by traditional approaches. My goal for BWA is to keep better outcome data to help us know exactly that; did what we do work and how we can tweak it to be even more effective.  A condition like TMJ (jaw pain) is a prime example of how we can be effective and efficient and save both the individual and the health care system substantial amounts of money and aggravation. Typically, with just three sessions, our success rate with pain in the jaw is very high. The total cost of these three sessions is a tiny fraction of what other more invasive approaches can cost. The science is also clear- more invasive approaches to TMJ pain are very expensive and do not produce favorable outcomes. My goal is to have a whole set of areas with which we are clear that we can help. On the flip side, it will also be clear that there are some conditions in which we have little to offer, therefore should refer to other disciplines who are more effective. We should know what we are good at, and what we are not. 

More than ever, I believe that there is a place for our specific form of massage therapy called Precision Neuromuscular Therapy. While we have lots to do in the future, our track record with many common muscular ailments is one of effectiveness and minimal cost. Our commitment as an office is to continue to improve and refine our approaches to maximize results. You, our clients, deserve nothing less. 

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That Which is Overlooked

When we have discomfort, the over-riding impulse is to identify exactly what hurts. Actually, the "what" question is much easier that the "why" question. Here are two examples of when the actual cause isn't what we feel at the time.

TMJ issues and Neck Pain
 

Imagine that you have multiple tender areas in the muscles of the neck. What you might guess is that you have neck tension, but nothing seems to help. Although you may not put them together, my staff might ask you about any tension in the muscles of the jaw you might not have noticed. Why? Problems in the muscles of the jaw often increase the tension level of the muscles of the neck, which then presents as neck discomfort.

 In one research study, subjects with advanced arthritis of the jaw were given an injection to anesthetize the joint. Where one would expect the relief to occur is in the area immediately surrounding the joint. In fact, where the greatest relief occurred is in the muscles of the neck!

Thoracic Restriction and Low Back Pain

Pain in the low back is far more common than pain in the thoracic spine (mid-back). There is however, a good deal of evidence that restriction in the thoracic spine can lead to pain in the low back. Here's why.

The low back is built for stability, not mobility. Rotation of the whole low back is less than ten degrees! The thoracic spine is ideally suited to rotate to more than fifty degrees. If your thoracic rotation is restricted and you are trying to create rotation, such as to swing a golf club or tennis racket, you will try to accomplish that action by rotating your low back instead. This will result in low back pain, but all the treatment of the back will ultimately fail.

What the mid-back cannot do, the low back tries to accomplish. This is not going to go well!

Strangely, symptoms are not always felt in the problem source such as the low back or jaw, only in the area that overworks to compensate. The staff at BWA is very mindful of these relationships and wants to address not only the symptom, but the possible cause. 

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It Must Be Arthritis. . .

It is a comment that I hear quite often; "At my age, my pain is probably due to arthritis."

While this is possible, it is by no means a given. Arthritis may be the source of most of your pain or perhaps the soft tissue surrounding the joint may be largely the culprit. 

I recorded this six minute video to explain- I hope you find it useful

Doug Nelson

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I Exercised Once. . .

The other day, I had a client ask me a perplexing question. He had referred a friend to BWA, who saw Eric for a one hour session. The person had been having sciatic pain down the leg for three months and no one had been able to help him previously. In a last ditch attempt, he decided to try coming to see us after speaking with my client. After the session with Eric, the client was now free from pain for seven days, the first pain relief he had for three months. After a week of no pain, the deep ache down the leg slowly returned. My client was asking if there was someone else his friend should see or another treatment available. 

What I find very sad about this question is the idea that you can have pain for months and yet expect one session to "fix" it. Oh if it were only true. So much in life is about building momentum, more process than event. 

Thank about statements like:

  • I tried exercising once and didn't lose any weight. . .
  • I took a lesson on the violin and still couldn't play Bach. . .
  • I ate healthy once and didn't feel any better. . .

We at BWA are very sensitive to possible time and monetary issues with regard to appointments. We don't ask you to come for a long series of sessions or make you sign a yearly contract. At the same time, it is important to understand that if you are coming in for a specific problem, a series of three to four sessions is probably in order. In that way, whatever gains we make will not be lost over time. Plus, it can take a session or two to localize the real problem, which isn't always apparent in the beginning.

When and how often should you return? The ideal is that if you experience a lessening of symptoms after your session, you should return before the symptoms resume in earnest or re-escalate.  In our former example, the person should have come back after about five days. The third session should probably have been about 7-10 days after the second session. In all probability, that should have solved the issue. All things considered, especially compared to the cost of other interventions in terms of time and money, our Precision Neuromuscular Therapy is very efficient. As with so many things it isn't just what, but how often and for how long. Working together, we can make progress and problem solve through the many variables on the way to better muscular health. 

Best,

Doug Nelson

President, BodyWork Associates

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Stress: Two Simple Strategies

We have two different parts of our nervous systems, one that lights up when we are under threat "fight or flight" and one that is often labeled "rest and digest".  

  1. Being under stress and in "alarm" mode changes our breathing.To switch from alarm mode to rest and digest, try this simple exercise.  Place your hands on your lower ribs.   As you breath in, feel your lower ribs expanding outwards, against your hands. This movement of the ribs is a cue for the nervous system to switch from alarm to rest.  The neurobiology is complicated, but the science is clear. (This is different than "belly" breathing, which does not have this effect on the nervous system. 
  2. During the "alarm" phase, massive amounts of glucose are released into the bloodstream and are targeted for the lower extremities. (There is some really good data about chronic stress and adult onset diabetes as a result). It makes sense that when you are under increased stress, do your best to vigorously exercise your legs. Bike, run, walk briskly, whatever. You will feel the difference afterwards.

 

 When stress increases, the effect is as physical as it is mental. The good news is that we can use physical strategies to combat the effects of stress as well.  

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The Land In Between

A fundamental issue that every business must address is this: Who do we serve? And why?

For all of us here at BWA, we are clearer than ever about those two questions and I would like to share some thoughts with you.

Fundamentally, we straddle two very different worlds. We clearly are not a spa and we are also not physical therapists. We serve the land in between those two, which happens also to be where the greatest need is.

While we aren't a spa, the work that we do is inherently relaxing and renewing. Few things give my therapy staff greater pleasure than to see the smiles of our clients after a session. We have the sense that we have contributed to his/her day, allowing them to resume their schedule with a little more ease and grace.

On the therapy side, most people who come to see us initially have some sort of muscular discomfort that has made their life more difficult. Often, these muscular problems weren't severe enough to address with their doctor, just an annoyance that made everyday life that much harder. Moreover, many of them ascribed the pain to aging or considered these problems "normal" until they saw us for Precision Neuromuscular Therapy.

This is our place in the community, our niche and our mission. So many people hurt and don't know that our special form of massage therapy can truly help. We are massage therapists, but we emphasize the therapy part of the equation.

To have the skill to accomplish real results in muscular discomfort requires a far deeper understanding of anatomy and much greater clinical skills than general massage. For all of us at BWA, this isn't a hobby or a part time job, it is our mission and our place in the world. Thank you for being part of it and part of our family.

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Stress: Dispelling Misconceptions By Doug Nelson

Somewhere along the way, the meaning of the word stress went astray. Today, stress is usually considered a negative, and most active people view stress reduction as impractical at best.  To better understand stress, we must first look at its history.

 

Stress research began in the 1950's with a growing understanding of how it affects the body. Early pioneers in the field were people like Walter Cannon and Hans Selye. The concept of stress was new at the time, so Selye borrowed the term from mechanical engineering in an attempt to define the physiological response he was identifying. Ultimately, stress research became a new field of human health, but the foundations of his research are often misunderstood, as is the effect of stress on the system.

 

What is stress?

 

Selye defined stress as simply the cost of adaptation. When the human nervous system senses change, a response is needed and adaptation is required. The collective cost of all adaptations is called stress. Selye made no mention of whether the stimulus (which can be emotional, mental or physical) was by nature good or bad; any change requires response and adaptation. Therefore, stress is simply responding to life, and life is stressful. Lack of stress is called rigor mortis. Not much of a choice!

 

Many people become “turned off” when someone talks about the evils of stress. Others believe if you simply breathe deeply, life will be better. But, breathing deeply isn’t enough. So, how do we reduce stress? Close the business? Sell the house?  Get rid of the pets? Not much of a choice...

 

With today’s hectic pace of life, it is imperative for us to understand and deal with stress appropriately. Here are a few points to consider:

 

  • Stress is cumulative. The initial effect of stress is to stimulate the system, much the way a performer is energized by adrenaline before a performance. If that adrenaline rush lasts too long or is too intense, performance suffers. The cost of constant adaptation is cumulative; unrelenting stress will damage the system over time.  
  • Bodies are battlegrounds. Have you ever come home after a tough day and said, “Wow, it’s a war out there”? The battleground of this "war" is your own body. Each skirmish, each victory or defeat, leaves a few casualties on the battlefield. Eventually, the “wounded” are strewn everywhere. Self-care approaches, such as physical exercise or playful activities clear the field (body) and are enormously helpful in reducing the harmful effects of stress.
  • Stress can be managed. To attempt to eliminate stress completely is misguided. Every active person must learn to intelligently address the cumulative residual effects of stress and find reasonable methods to manage it.  What works for one person may not work for another, but understanding and committing to a method that works for you can help improve performance, productivity and overall health. 

 

Let’s face it: For a boat to push forward in the water, waves must be created. Boats that do not move in an effort to avoid stress may as well be called docks. Those of us with a mission in life don’t want to sit, we want to sail! Sailing can be stressful. Managing stress shouldn't be.

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