Enroute to Doctorate of Physical Therapy

Four weeks from today, I start school in New Hampshire toward a Doctorate in Physical Therapy. While I know that this will be a long, hard road, I am excited by all the information that I will be learning on the way. I hope to find topics along the way to share.

Serratus Anterior

One thing that I have tracking lately with clients is a connection between serratus anterior tension/tenderness and levator/upper trap tension, especially when paired with pectoralis major tightness and scapular protraction. Tenderness to the inferior/lateral scapula and into the side of the ribcage seems to be present in many clients (male and female) who also have protracted shoulders and pain to the upper shoulders.

I am curious to know if other therapists are seeing a similar correlation.

Skin Sensitivity in Clients

As our world changes, auto-immune diseases are more prevalent, allergies are more widespread and the choices that we, as therapists, make in our oils and lubricants are more likely to have an impact on our client. Asking about skin sensitivies and allergies ensures that your clients can confirm compatibility with your lubricant and oil choices. Personally, I have known two massage therapists who have developed contact allergies, one to coconut oil, a common ingredient and the other to a specific brand of lubricant. Presumably these two developed their allergies from repeated long-term exposure.

So take heed, vary what oils you use and make sure that your clients don't have any known reactions to what you are using.

Ahhh, the lowly clavicle

The clavicle is such an underappreciated bone. This small strut serves to link our whole upper extremity to our trunk and is the bony connection from the scapula to the sternum. As such, the clavicle serves a very important job. Without the freedom afforded to our clavicle, much of what we know of upper extremity range of motion would be unavailable to us.

Restrictions along the clavicle will impact the range of motion available to the rest of the upper extremity. In order to externally rotate the humerus in abduction, the clavicle must also rotate along its axis with the humerus. It is my experience that easing restrictions along the clavicle will facilitate ease in the upper trapezius muscles and possibly the rhomboids.

A way to gain appreciation for the support the clavicle is through a pressing motion above the head, such as a military press or downward dog. At full extension, the line of force will be through the arms, the scapulae and the clavicles into the sternum.

This post comes as a result of my own experiences with my clavicle the past several days and those of a few recent clients. I encourage any massage therapist to explore the willing clavicles available to them for further research and discovery.

Chapman's Reflexes and Semiotics

On her blog the Healing Presence, Kate Sciandra posted about the juxtaposition of metaphors in "the healing presence". I totally agree that we have great systems forfooling ourselves into thinking we have more "knowing", more control, than we actually do." Clients come to me for stress reduction, often complaining that their stress is mental. It is only once I start to work with them or probe deeper in questions that they remember where they notice it in relation to the rest of their body. As part of my Practitioner training program, I attended a class with Morel Stackhouse about Chapman's system of reflex points. The most striking part of the class was that she commented though we know where these points are located, we don't really know what they do to the body.

For those not familiar, Frank Chapman was an early-20th century osteopath who described a pattern of points which corresponded to various ailments/disorders. Dr. Charles Owens continued Dr. Chapman's work and subsequently documented some of the patterns into a book, "An Endocrine Interpretation of Chapman's Reflexes" .
As Kate stated in her post, "The map is not the territory" and this seemed to be especially true with my experience with this class. It is my understanding that Luann Overmyer conducted a study working with selected Chapman's points, which was discontinued due to a tremendous and overwhelmingly negative response to the work performed. As told to me, the clients all chose to discontinue treatment of their Chapman's points, since they became ill or at least uncomfortable.

The lesson that I took away from Morel's class was acknowledge the existence of Chapman's points as a system, with no expectation of using it for diagnosis (outside of our scope of practice) or for treatment (We don't really know what the result is of treatment of Chapman's points).
Another example of "the more we know, the less we know".

Alignment and reality in relativity: Scoliosis

After a recent visit by a client with scoliosis, I have been contemplating the notion of alignment. Prior experience with scoliosis reminded me that a small amount of change can be very potent. Instead of being oriented to an external level, a person with scoliosis is aligned to their curves. This is to say that what they are accustomed to is not what measures as “level.”

During the session, I was cautious to provide very little structural work in order to "balance" her structure. Knowing that her reality is not one of symmetry but one of curves and rotations which move both anterior/posterior and bilaterally. During the intake, she remarked that she had strong previous "rejections" of therapy, a reminder again, that a little structural change leads to a significant alteration in perception of "reality" or "alignment." Had I set about to work with her entire spine and balanced it according to what she presented with on the table into symmetry, she would most likely have faced much discomfort and pain.

When faced with a client who has scoliosis, ask them what modalities they have had success with and ascertain their goals. Do they want to be "level" and are they prepared for the journey there. Such a journey may not be easy or comfortable, as they have to leave a form of their body that they are accustomed to, in order to change their structure.

Such a transition may not be possible. One possible cause of a scoliosis is a vertebra that is not “square”, causing a lateral distortion in relation to the superior vertebra. It is important to ask the client what information they know about their curvatures (Direction of curves, degree of curvature), anatomy and history of treatment.

In closing, when a client with scoliosis comes to your table, be cautious. Their body may not respond favorably to “level” since it is not what is “normal” to their body. If you undertake structural work with them, ensure that they are prepared for emotional and physical changes.

Why is body awareness important?

Have you ever wondered how you, as a client, can get more from your massage session? Have you ever wondered why your clients keep coming back for the same ailments? One of the causes could be a lack of body awareness.

Our medical society is relied upon to tell us what is wrong with our bodies, rather than allowing our inner senses to tell us when something is wrong. The maxim, "If it hurts, don't do it" is simply not an option. To whit, the athletes that compete and win in events such as Ironman Triathlon, Iditarod, and the Tour de France just to name a few. These individuals push their bodies to the extreme. In order to do this, a person must be well versed in the use and care of their body.

By reflecting on the aches and pains that nag us, we are able to stave off further injury down the road. By asking a client to make a before and after assessment of their body, I am opening the door for them to find words for their sensations. If they are able to make the connections about what changes have happened on the table, then they will have greater access to the changes off the table.

Whenever a client presents to me with a specific problem, I ask for a great deal of feedback. I want to know how their body is responding to the work and I want them to follow the internal changes that are occurring over the course of the session. While the changes may seem more profound if they get to explore only at the end of the session, the client loses out on the process of change. This process allows them to connect their issue to their life (That reminds me of when I ...) and their experience beyond that of the table.

Your clients may just surprise you if you offer them these chances on your table.