Recently, I saw a post by one of my teaching staff, Seth Will, on the PNMT Forum. Here is the post:
People with painful conditions fall through the cracks. It's a fact. And this fact is in good part what my practice and teaching is based on. Today I saw a new patient with 8-10/10 morning low back pain and pain with walking that's been ongoing for over a year. He's physically active and has been told by multiple physicians, PTs and one neurosurgeon that his scans looked ok and it's probably muscles. He's continued to do exercises that have progressively made his pain worse. During the history he explained to me that he desperately just wants to identify what things might be making this worse and what things might make it better. He described how rolling over in bed is excruciating and how it exacerbates his pain every morning.
We spent ten minutes identifying that clearly that spinal extension replicates and progressively worsens his symptoms and this movement is included in most of his daily exercises. We identified how he could still exercise and yet not worsen his back pain. We then spent 5 minutes going through rolling on and off the table and then I made him repeatedly do it again and again, establishing a pattern that was now pain free.
These are super simple things, that don't take a lot of time or expertise to do but it's these things that I consistently find that patients have never been shown. This is the reason I emphasize these topics in low back classes because as much as I think therapists often assume someone else has shown them how to do these tasks, in my career, I can't think of one that's come to see me for these issues that's been shown. These are easy ways to make a major change in people's life, far beyond the miracle methods in which one magic technique somehow "deals" with all of these process oriented issues.
Seth's experience deeply resonates with me for multiple reasons.
First and foremost, my personal mission and the mission of my teaching institute is to help people who generally fall through the cracks of health care. This accounts for a great number of people who struggle with pain. Our work is targeted to people who aren't getting help anywhere else.
Second, simple functional issues are commonly overlooked. As luck would have it, one of my first teachers was Moshe Feldenkrais. Moshe had a sense of functional anatomy and he applied neurological principles in ways that few, if anyone, in his day had ever dreamed of. It took me years, long after his death, to grasp the full impact of what he was exploring. Although my own path has taken me in a different road, Moshe's influence will always be part of me. What Seth did with this client would make Moshe proud. Turning over in bed is a very complex series of movements, the sum total of which we call "turning over". There are, however, many variations to how one turns over. (Ever ask a client on the massage table to turn to the other side and scratch your head when you see how they accomplished this?) The simple action of "turning over" can be done many ways, each way of turning over having a multitude of variations. If you deeply understand this, then one can alter the sequence to avoid the offending movement, or discover what to treat to solve the issue. In the words of Moshe, "If you don't know what you are doing, you don't have a choice."
All of this is part of the world of PNMT. The deeper the understanding, the better the outcomes. Well done Seth.