Making Movement Possible

Making Movement Possible

Much has been written about the value of exercise, especially corrective exercise and movement. My last client represents a principle that we, as massage therapists, need to keep in mind.

My person was a woman in her 50's who had been in debilitating pain for several years. Most of her pain was pelvic but, unlike most people with pelvic pain, her pain was suprapelvic.  Her plight is a long story, but the bottom line is that she could hardly move without pain. Daily life was overwhelming. There were times when all she could do was be at home and on her couch. 

It is important to remember that this person wanted nothing more than to resume her life as she had known it. She was previously quite active- this sedentary existence was not of her choosing. When I first saw her two months ago, she was understandably very frustrated. I saw her again today and she is now walking, cooking, serving at her church, going to conferences, and doing water walking and exercise at the YMCA. She is one very happy camper. There are still times that she hurts, but she can now use movement and activity to help alleviate her pain.

This is the important point. When I first saw her, every increase in activity was overwhelming and produced pain. This wasn't just kinesiophobia, she seriously hurt every time she challenged her musculature. She had tried every way possible to be active, to no avail. Exercise, as a way to rehabilitate herself out of this morass, was not helpful and made her plight worse. It is simply not possible to exercise when every movement or challenge is perceived as a threat or overwhelming obstacle by the nervous system. The frustrating aspect of this dilemma is that if you cannot move, getter better is highly unlikely; a fact that she knew all too well.  

The real value of the PNMT work I did with her was to make movement possible again. After the first two sessions, she found herself doing more than she had previously. This increase in activity was largely not from her pushing herself through exercise, but finding herself being more active in daily life. She was walking more, standing longer at the stove, and was able to get groceries without collapsing on the couch as soon as she returned home. She would just put away the groceries like the rest of us does and then go about the next task on her list. The change was remarkable to her in that she was not pushing herself- this was more of an organic improvement. 

Finding that she could move more, she decided to confer with her doctor about the possibility of more formal exercise. The doctor was enthusiastically supportive, and recommended water therapy to start. This was a great suggestion. She continues to slowly increase the activity level in both daily life and her exercise program with no ill effects. 

One of the things she said today was that she had awakened one day last week to more pain than she was used to. Taking it slowly, she was able to go to the Y and do water walking. By the time she was finished, she felt fine and was fine for the rest of the day. This is an enormous victory. Descending inhibition, your brain's blunting of pain when activity is increased, was actually working for her. Now, instead of activity making her worse, activity makes her more comfortable. 

The value of intelligent corrective exercise and movement is hard to over-state. Yet, it is also important to understand that PNMT made it possible to utilize this important therapeutic approach. All of us in health care have a role to play; we just need to be clear about what that role is and where it fits into the larger picture. I see PNMT as a way to open the door so that the movement work can happen. The movement and corrective exercise work is often the larger piece of the equation in the road to recovery. Our job is do do our craft so well that movement and corrective exercise therapists can do theirs. 

Taking Exception to Exceptionalism

Recently, my wife and I spent some time with two foreign exchange students. These courageous and adventurous students take a year of their young life to immerse themselves in a new culture. My wife and I have hosted several short and long term exchange students and we have experienced the rich exchange of culture firsthand from these remarkable young people.

In the midst of the conversation with these two students, a theme became evident. There was a feeling that Americans aren't very interested in learning about these student's home cultures. There is a sense that, after all, the USA is simply the best and anything else is "less than". As a result, there is little desire to explore and learn from other ways of understanding the world. Their observations were not in any way complaining or demeaning, just a statement about what they had experienced. I was very saddened to hear this.

When Ronald Reagan used the "shining city upon the hill" concept to describe this country, it was interpreted by many to mean that we have attained that position in the world, that it was our rightful place. American exceptionalism became a point of pride; we are a beacon of light for the rest of the world to follow.  To be that shining city, that guiding light, is an ongoing process, not one that is ever completely attained. The best light you can have is the one reflected on you when shining your light on someone else. We all know people who seem to make everyone around them better; these people seek to be interested, not interesting. We gravitate towards people like that- their bright light is a result of their interest in others. 

Exceptionalism can take many forms, both personal and professional. The field of massage therapy, like every other discipline, is also susceptible to this attitude. I have certainly been guilty of this more often than I would like to admit. Some lessons last forever, some lessons take forever. 

Years ago I was speaking with a world-class musician who happened to mention that he is not a fan of the music of Gustav Mahler. Almost immediately, he added, "I am sure that is because I just don't know enough about his music to be interested." I never forgot his statement, especially coming from someone of his caliber. In the years following, I too have noticed that those things that do not interest me are the ones I know the least about. Once I have some insight, I find much to explore. 

With regard to massage therapy, there are scores of approaches to massage therapy. Those that have been with us for years must have some value to have lasted so long. It seems as though there is a place for everything, but real wisdom is knowing what to use when and why. What often gets us into conflict is the idea that <fill in the blank> approach is best, and applicable in every case. It is the "I have a fabulous answer and I hope it matches your question" model. 

From my perspective, more respect and curiosity could only help us be better therapists (and better people). The more deeply we understand others, the more deeply we understand ourselves. My first visceral experience of this happened in 1992 while on a Rotary exchange to Japan. It was my first time out of the country and my Japanese hosts had many questions about American culture. In the beginning, I had little to say. After all, if you grow up in a house that is red, and everything around you is also red, how can you explain the color red? After two weeks or so, I was much more articulate about American culture because I could contrast it with my growing understanding of Japanese culture. Thus, my appreciation for my American heritage actually grew, in direct relationship to my deep respect for Japanese culture and how it differed from my own upbringing. There are aspects of Japanese culture that have stayed with me ever since, laying on the backdrop of my American heritage. 

I recognize that there is a bit of irony here, since I teach (and live and breathe) a very specific approach- Precision Neuromuscular Therapy (PNMT). My passion for this approach should not be interpreted to mean that everything else is "less than". Over the years, it has become abundantly clear that PNMT isn't for everyone. Not every therapist resonates with the problem solving and technical aspects of PNMT. The technical demands don't make PNMT better, they just utilize a different skill set. If a specific approach does not resonate with the therapist, clinical results will be hard to attain. We do best for the client when we practice what we do best. That means each of us must recognize our strengths and identify our weaknesses. As the years go by, I want to be clearer and clearer about what conditions we excel at addressing and perhaps more importantly, identify what conditions we address poorly so we can direct the client to a more appropriate therapist or approach. 

The myriad of approaches to bodywork create a rich palette from which to choose. The key is picking the right approach, for the right reason and at the right time. The better we are at that, the better we can serve those who come to see us.