The Value of Ethics

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The Value of Ethics

The Value of Ethics

By Nancy Dail

Aristotle, Plato, and Socrates were Greek philosophers who laid down the foundation for Ethics in society. The word ethics comes from the Greek ethikos meaning “arising from habit”. The motivation to behave ethically as a moral standard is to believe that if you act appropriately you will support character traits that are in line with socially acceptable behavior, support legal standards, and promote professionalism in the business community. You would in essence make a habit of acting appropriately for the benefit of society.

 

Where did you develop character traits that support ethical practices? Family, school, mentors, community figures, heroes, the media, religion, literacy, and even the time in which we live all have an impact on the development of character traits that influence how one acts morally. “Cardinal virtues” of wisdom, courage, temperance and justice were Aristotle’s answer to the most important character traits with the understanding that it is paramount to balance the virtues and not let one overcome another. Since our actions impact others in indeterminable ways, it becomes necessary to follow codes of ethics that spell out our boundaries that are the ethical parameters of practice.

 

Each practitioner upon entering a profession is invested with the responsibility to adhere to the standards of ethical practice and conduct set by the profession. A therapist must therefore be operating legally, exhibit maximal competence, continually seek advancement through continuing education, join a professional association and follow the code of ethics set forth by the profession. Practitioners must be very clear about their professional identity otherwise ethical dilemmas will be more frequent and difficult to resolve. Clarity can be a challenge in the dynamics of our industry. States are all over the map with licensing and requirements for different hours. There are many continuing educational workshops that may not provide enough information for the practitioner to become confident in the modality. Is it made clear by the CE provider what it takes to advertise the subject of the workshop? Whose responsibility is it anyways to make that determination? Where is the value in being ethical in this situation? What benefits the client and what benefits the practitioner?

 

After pioneering in this field for almost 40 years, I have seen the massage therapy profession come a long way. We have schools, licensure in most states, national certification, a rich industry of continuing education, vendors, research organizations and multiple associations. But ethics is not a finite set of rules that do not change, in fact, ethics is an adventure in the values and ideals that shift and evolve with the profession. The value of ethics must be a benefit for the client and will be the foundation of the practitioner’s success. Exploring the value of ethics brings meaning to the industry, helps support professional character traits, and promotes clarity of practice.

 

Nancy Dail teaches courses in Dimensional Massage Therapy and Ethics at workshops and conventions internationally. She is the lead co-author of Kinesiology for Manual Therapies published by McGraw-Hill. For more information about Dimensional Massage Therapy or Ethic workshops see other pages on this site. See her schedule for workshops in your area on this website or contact her at ndail@aol.com.

 

 

Forming a Walking Club

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Forming a Walking Club

According to statistics from the website Healthy Maine Walks www.healthmainewalks.com/connection.php :

v     The percentage of overweight young people has almost doubled in the last twenty years for children aged 6-11 years and almost tripled for adolescents aged 12-19 years.

v     In overweight children, risks for heart disease and stroke such as diabetes, high blood pressure, etc., have been shown in children as young as five years old.

v     Nearly half (46%) of Maine’s adults have a sedentary lifestyle which means that they are not getting enough physical activity to enjoy health benefits.

v     Thirty-eight percent (38%) of Maine high school students do not participate in vigorous physical activity three or more days in the past week.

v     Sixty (60%) of Maine adults are overweight or obese – almost one quarter (23%) of all Maine adults are obese.

v     Eleven percent (11%) of Maine high school students are overweight, and fourteen percent (14%) are at risk for becoming overweight.

 

This is our collective human challenge. What can we do about it? The fact is, any community can bring more of an awareness to the need for physical activity by starting a walking club and either creating new trails or utilizing existing ones. We have become so motorized, so sedentary, and so technologically entranced with gadgets, we have forgotten we have feet and what they are used for! It is time to dust them off, warm up our winter muscles and see how we can shed some excess pounds and enjoy ourselves in the outside air at the same time.

 

The benefits of walking include but are not limited to:

v     Reduces the risk of type 2 diabetes, coronary heart disease, stroke, breast and colon cancer, and high blood pressure

v     Gives you more energy

v     Helps your heart and lungs work more efficiently and improves circulation

v     Helps build and maintain bones, muscles, and joints

v     Helps you cope with stress and depression

v     Lowers total cholesterol and increases good cholesterol

v     Tones and strengthens your muscles

v     Improves your sleep habits

v     Helps maintain a healthy weight/ helps with weight loss programs

v     Provides companionship walking with someone for individuals who live alone

(Thank you Boston Steps for above benefits!)

 

Turns out that forming a walking club is not such a hard endeavor and in fact there are websites that assist by promoting walking kits and walking information like the Boston Steps: www.bphc.org/bostonsteps . America Walks (americawalks.org) has a national vision statement for a Walkable America that “By 2020 walking in everyday life is embraced across America.”. Communities can register existing trails here in Maine on the Healthy Maine Walks website and others or could get help building a trail or walking route through the resources on www.healtymainewalks.com/createaroute.php such as the American Hiking Society www.americanhiking.org . You do not have to reinvent the wheel. There are existing clubs for biking, walking, skiing, etc. but not in every town and some are just too far away to participate in on a regular basis.

 

There is even a weekend here in Maine called the Great Maine Outdoor Weekend,  www.greatmaineoutdoorweekend.org  on March 3rd and 4th, 2012.  In honor of this weekend and in order to kick off our quest, Waldoboro and Healthy Lincoln County will host a Walk on March 3rd from 9:30AM-11AM on our very own Neil Lash Nature Trail at the Medomak Valley High School here in Waldoboro. The trail is over a mile long with sculptures, benches, a beautiful bridge and art donated and or made by the students and the community.  There will be water, hot cider and snacks and gift bags. Medomak Valley Land Trust will be available to talk about other existing trails in Waldoboro and there will be information at the refreshment table about the formation of a walking club for our region. Our next meeting is scheduled for March 23, 2012 at the Downeast School of Massage at 3:30PM and all are welcome.

 

Together, a community can take steps to add awareness for more physical activity and the need to invest in our children’s health (as well as in adults!) now rather than waiting until they are adults when they will have to deal with a life-long condition or disease. Prevention is worth a pound of cure! Dust off those hiking shoes and join us in our walk on March 3rd or just go for a walk yourself or with a friend. All our roads can lead to health!

 

(This project to create a walking club is a community effort with members from our schools, the recreation department, members of the Waldoboro Business Association, and interested individuals. Incorporating area events adds to the life of the idea of a walking club. Anyone interested in this effort can contact Nancy Dail at ndail@aol.com or at 832-5531.)

 

 

Cuboid Syndrome

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Cuboid Syndrome: A Painful Experience

Recently, I went to my favorite Freeport store to get new boots. They fit well but they had a toe-off feature that I thought might be good for my gait. Evidently not. The inflexibility of the new boot with the toe off feature made my foot vulnerable to injury. What can a bad old inversion foot and ankle sprain and new footwear add up to? A Cuboid Syndrome. “Cuboid Syndrome is typically defined as a minor disruption or subluxation of the structural congruity of the calcaneocuboid portion of the midtarsal joint.” (Stephen Patterson) The subluxation irritates the surrounding joint capsule, ligaments, and the peroneus longus tendon. Cuboid Syndrome, according to Stephen Patterson of the University of Wisconsin, can be also referred to as subluxed cuboid, locked cuboid, dropped cuboid, cuboid fault syndrome, lateral plantar neuritis, and peroneal cuboid syndrome. There is extreme point tenderness on the cuboid bone laterally just below the fifth metatarsal. The extensor digitorum brevis is likely to spasm and the entire lateral dorsal foot locks making walking a limping if not impossible experience. As the cuboid bone stays subluxed, the muscles start a spasm cycle on a cataclysmic scale. Plantar flexors referred pain to the leg and pulled with spasm onto the bottom of the foot. Since I was walking on the inside of my foot to not put pressure on the cuboid bone, my arch and the point of attachment of the peroneus longus started screaming with discomfort. And just to make it all worthwhile, if I stepped just right, it felt like I was spraining it all over again and felt and heard audible crunches. Those really hurt. What to do? I knew I had not sprained the ankle. I did not fall or twist the foot. I had originally sprained my ankle and foot in 2005 and knew at that time that I had done some damage to the cuboid area and ligaments. Truly, not many listened to me. I think now, that I could have walked around with a subluxed cuboid for some time. I found an article on the internet about Cuboid Syndrome : A Review of the Literature by Stephen Patterson. In the article, Patterson clearly reviewed the anatomy, etiology and conservative measures needed to deal with this painful problem. The cuboid bone is the only bone in the foot that articulates with both the tarsometatarsal joint and the midtarsal joint. It is a link to the transverse arch as it houses the peroneus longus tendon and gives stability to the foot. It has numerous ligamentous attachments.

My chiropractor helped. She did electric stimulation, ultrasound and acupuncture. But as suggested by the article the real help was having it manipulated by my osteopath. The longer the cuboid is subluxed the more manipulations it might require. It is also not something you can do for yourself. Massage really helps. I am grateful I am surrounded by massage therapists. Leg and foot muscles need additional treatment to recuperate from this foot condition. Once the bone is manipulated correctly, the discomfort subsides substantially. Irritated muscles will take a while to calm down, but conservative measures of massage, stretching, strengthening, and hydrotherapy are just the ticket to restore normal healthy gait and happy feet. For more information about this problem you can link to: http://www.jssm.org/vol5/n4/18/v5n4-18pdf.pdf This article is very complete about a little known problem. Thank you Stephen Patterson!

Cuboid Syndrome: A Review of the Literature, Stephen Patterson, Dept of Exercise and Sport Science, University of Wisconsin-La Crosse, La Crosse, WI 54601

As you know the nature of a blog is to be short and sweet. Please check this article for more thorough information. NWD

The Body Blitz – A Real Spa Experience

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The Body Blitz – A Real Spa Experience
By Nancy Dail

What was it like to dwell in the time of the Roman era and partake in a real Roman Bath experience? Since I do not have a time machine, I might never have known if I had not partaken in the hydro experience at the women only, Body Blitz in Toronto, Canada this past week. Imagine if you will a sea salt water pool with multiple waterfalls spilling from a central flagstone structure and 24 water jets able to massage you underwater. The pool was the size of a regular swimming pool with a circular cold plunge pool on one end and a hot green tea pool on the other end. Lounge chairs lined the long length of the pool and showers headed one end and a water fountain and open lockers were at the other end. The experience included a suggestion for the Therapeutic Waters Circuit. It began with a 5-10 minute sea salt pool soak after, of course, a shower. From the sea salt pool one went into the steam room for 5-10 minutes if you can take the extreme wet heat. Don’t wear glasses as you will instantly not be able to see! The steam is followed by a rinsing shower to remove the toxins and a 1 minute cold plunge. It is recommended that you go in up to your neck to stimulate your thyroid; I would not do this slowly if I were you. It might be construed as torture! Following the cold plunge is relaxation time with rehydrating. It is important to continually replace the water you lose in the circuit. For a more in-depth detoxification, the infrared sauna awaits for roughly 10 minutes. Rinse again and enter the cold plunge pool for another pore seal. Next is the hot green tea pool immersion (for at least 5 minutes) for a further relaxation of muscles and a boost for the immune system. Rinse again and another cold plunge supposedly for a whole minute. Finish off with the sea salt pool for a final relaxation soak and to regain normal body temperature while absorbing minerals from the sea salt immersion. It is recommended that the whole experience be for an hour circuit with a maximum stay of 2 hours. We did complete a medical history prior to the hydro circuit that could have been also used for a massage or shiatsu treatment if we had been so inclined. Contraindications could include a cardiac or respiratory condition, high or low blood pressure, pregnancy, or any other health condition needing a physician’s approval. For additional cost, was a juice and/or tea bar that is available during the spa experience. The result? Ultimate relaxation. I slept really well that night. I can see me being a spa critic traveling from spa to spa – a girl can dream can’t she?

Graduation Speech for Massage Therapists

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Graduation Speech Downeast School of Massage January 2011 Class

The Dalai Lama, when asked what surprised him most about humanity, answered “Man. Because he sacrifices his health in order to make money, then he sacrifices money to recuperate his health. And then he is so anxious about the future that he does not enjoy the present; the result being that he does not live in the present or the future; he lives as if he is never going to die, and then dies having never really lived.”

As a massage therapist then, I would say that we have our work cut out for us. When we advocate for man and woman we can present a reasonable positive perspective of prevention that includes holistic health, compassion, referral, and quality care. We can give our clients opportunity to change and/or relief from pain and stress. It is after all, their treatment, their time on the table, their choice in direction. Our responsibility lies in our representation of ourselves and our profession. Now as graduates, you represent the profession of massage therapy. This is now your vocation – as Thomas Moore says: “In a sense all work is a vocation, a calling from a place that is the source of meaning and identity, the roots of which lie beyond human intention and interpretation.”

We always ask perspective students why they want to come to massage school. Mostly students will say it is because they feel called to this service; they want to help people directly through touch and not just through paperwork. In a way touch releases the work and transcends it to a source of meaning and identity. But there are many paths that you can choose during and after massage school. DSM has provided the experiences to shape your future choices; we have given you a foundation to build on. Education is the concrete you needed – the foundation of your practice. The paths you choose back and forth to the foundation will be up to you.

Whatever path you choose make sure that your soul is involved in your choice.

Quote: Thomas Moore, Care of the Soul: “When the soul is involved, (or inner self), work is not carried out by the ego alone; it arises from a deeper place and therefore is not deprived of passion, spontaneity, and grace.”

If we can but help to reverse the direction of man we have to look at how we practice our work, that we are intentful and present with each client and represent passion and caring. We need to gently help clients to help themselves, reduce their stress so they can take time to assess life and its meaning. Reducing pain, stress, and discomfort is a noble path. Helping man and woman to recognize that they have a whole body, mind, and spirit is a calling.

What path will you take?

The Road Not Taken by Robert Frost

Two roads diverged in a yellow wood,
And sorry I could not travel both
And be one traveler, long I stood
And looked down one as far as I could
To where it bent in the undergrowth.

Then took the other, as just as fair,
And having perhaps the better claim,
Because it was grassy and wanted wear;
Though as for that the passing there
Had worn them really about the same.

And both that morning equally lay
In leaves no step had trodden black.
Oh, I kept the first for another day!
Yet knowing how way leads on to way,
I doubted if I should ever come back.

I shall be telling this with a sigh
Somewhere ages and ages hence:
Two roads diverged in a wood, and I–
I took the one less traveled by,
And that has made all the difference.

Graduates, I hope that when you assess what you have accomplished at DSM that you have created your own experiences to reflect upon. Your bodies will always remember the hours of sincere intent you have each put into this course and the massage you have received as a result of your class work and each other’s skill. Your experiences in school will help you choose your path for your future and carry you forward to your aspired goals. Although the future is unpredictable, you are not alone. You have bonded with each other with your experiences here. You have a physical and energetic link to each other and to the school. You could no more separate yourself from your memories than a wave could separate itself from the ocean and still be a wave.

Treat your practice and therefore yourself like every day is the dawn of a new day. Let it continually revive your soul and inspire your heart. Anything less is beneath your capabilities. Trust yourselves, your skills and listen to your instincts. Listen to your inner truth that you have been cultivating here. Have confidence in your abilities, you have proven yourselves here. Experience will now be your teacher. I trust that should you need our support here at DSM, you will reach out to us. Graduation is a beginning, not an ending. It is time to share your gifts with others. Good luck. It has been a privilege to work with you. May the path you choose make all the difference.

Congratulations graduates!!
Nancy Dail
Director Downeast School of Massage

Blessings for Massage by David Lauterstein

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In Deuteronomy it says, “Blessed be the work of thy hands.”

When I was a child, I was entranced by the beautiful book, The Family of Man. This had incredible photographs from all over the world. People in families, giving birth, dying, at war, at work, playing, kissing, making music, leaping up in the air. It gave me a clear feeling of being akin to all the peoples of the earth.

Particularly heartwarming to me was a photo of an old woman’s hands. I carefully sketched them because they moved me so.

To this day, the work of our hands moves me deeper than words. All the things we do for each other!

And in massage we find this common human facility to touch each other with care. Whether we are black or white, gay or straight, woman or man, young or old, in Africa, South America, Russia, Europe, or Asia – every person deserves the highest quality of touch.

It is a dream – one all therapists share – to want the feeling that comes from caring touch to be a universal experience.

Blessed be the work of thy hands.

The above is an article by David Lauterstein; to compliment his blog I will add the following poem:

Look deeply into the palm

of your hand

you will see your parents

and all generations

of your ancestors

all of them are alive

in this moment

each is present

in your body

you are the continuation

of each of these people

Thich Nhat Hanh

Nancy Dail

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Short Upper Arms

Often in a practice we run across individuals with similar problems in a series that can sometimes be blamed on the season or weather. Certainly clients with back issues come to us after shoveling snow or during gardening season. For what ever reason, however, lately, I am seeing several clients with short upper arm structures and resulting issues from their genetic frame. Normally, if you measure the arm or humerus in our upper extremity it expands from the glenoid fossa of the scapula superiorly to the distal end (olecranon process of the ulna) inferiorly to the waist and iliac crest. Individuals with short upper arms have humeral bones that do not measure down to the iliac crest. Usually they have no idea why they have leaned forward their entire lives or why they may not have been able to reach something on a top shelf when someone the same size can. Often these folks will have more trouble with work stations and are likely to develop carpal tunnel-like symptoms.

A medical history and a visual observation will reveal clients with short upper arms present with over pronated forearms; very hypertonic pronator teres and resulting numbness and tingling to wrist and fingers. The structure itself lends to abducted scapulae with prominent medial humeral rotation, more so on the dominant upper extremity. Add repetitive actions and non-ergonomic work areas and you have a laundry list of muscles to unravel and release entrapments and a recipe for carpal tunnel syndrome, pronator teres syndrome and possibly double crush syndrome.

A Dimensional approach begins the sequence in a supine position with techniques to release hypertonic trapezius, SCM, posterior cervical muscles and pectoralis minor and major muscles. Active engagements techniques help to pin and stretch pectoralis minor and subscapularis. Both muscles are usually very tight on these types of frames. Moving on to the upper arm, release and stretch arm muscles with elliptical movement and dual-distraction moves. Release the elbow joint with movement and techniques. Elliptically move the forearm muscles and release the pronator teres. Sidelying is next with serratus anterior as a star target. Position the client prone lastly to release the soft tissue of the back. Exercises are suggested.

There are a wide variety of techniques massage therapy uses on clients with all kinds of structural issues. The above is my approach for short upper arms and clinical issues that often present themselves to this target group. Other considerations could be hip and pelvic positions, gait, and lower extremity factors. One fact remains apparent that the structure we have contributes to a reaction to our repetitive activities. A wise massage therapist will see beyond the repetitive action!

Nancy Dail teaches courses in Dimensional Massage Therapy and is the co-author of Kinesiology for Manual Therapies published by McGraw-Hill. For more information about Dimensional Massage see other pages on this site. See her schedule for workshops in your area on this website or contact her at ndail@aol.com.

The Trapezius and the Sails of Life

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We use our shoulders, arms and hands to take action. On the other hand, they are used expressively in talk, they are parts of speech. Gestures with shoulders, arms and hands reveal with connotative clarity what we really mean. We see also in writing and sign language an entirely linguistic use of shoulders, arms and hands. Massage itself meaningfully bridges these two worlds of action and language. We perform our strokes with shoulders, arms and hands and use them to convey anatomical information and non-verbal messages.
We have all seen clients whose shoulder blades virtually adhere to the ribcage. Structurally and energetically, the shoulder blades’ ability to glide freely over ribs is of enormous importance. Without that freedom, stress, instead of “rolling” off our backs, can become “impacted”, affecting the free excursion of ribs, spine, ultimately the lungs and heart.
The energies flowing vertically through the body intersect in the shoulders and upper limbs with horizontal flows reaching out to the world around us. This can be seen as an axis of love.
TRAPEZIUS
The trapezius is one of the body’s primary energetic shock absorbers, just as lower limbs are the body’s main physical shock absorbers. As stress comes and goes, trapezius’ tension increases then dissipates. However, with chronic stress or acute trauma, the body may absorb stress, rather than letting it go.
In the trapezius virtually every adult carries some residue of past life tension with a resultant diminished capacity for dissipating everyday stress. When shock absorbers start losing resilience, the effect of stress stays longer and goes deeper into the bodymind.
A primary purpose for trapezius work then is to let go of any residue of the past that no longer serves us and to initiate new habits of handling stress by letting go, rather than by absorbing it.
The freed trapezius allows the full excursion of breath underneath it. It amplifies healthy movement of upper limbs and torso. The healthy trapezius is a sail. Freed, it enables us to tack into the winds of life with optimized momentum and wastes no energy holding onto what we no longer need.

DEEP MASSAGE FULCRUM FOR THE TRAPEZIUS
Therapist: comfortably seated at head of the massage table
Client: Supine (If neck is lordotic – chin higher than forehead – put a small pillow under the head.)

Before putting your hands on, center yourself. Breathe. Position yourself so that even seated, your touch will gracefully derive from your body weight and gravity, rather than effort. Position your treatment chair or stool to allow space between your body and that of the client. Let all your joints be gently rounded, wrists aligned, elbows only slightly bent, shoulders and breath relaxed, an open space between the sides of your ribs and the insides of your arms. With hips and knees relaxed and soles of your feet on the floor, feel grounded.
Briefly review in your mind the particular life stresses the client may have revealed in the pre-session interview (and in past sessions if this is a repeat client). Realize that you are not just touching the trapezius, a muscle positioned in the client’s body/space. You are equally touching time and the accumulated content and tension from many years of life. Every touch that impacts the client’s ongoing life takes place at the intersection of space and time.
• Let your fingers rest on the clavicles. With your thumbs begin to explore the trapezius’ belly. Start near the base of the neck and work your way out in at least 4 areas each more lateral than the last, with mindful, caring touch, using light pressure. Note any associations that palpating this client here evokes for you. Some clients feel thickened; others frozen; others with overall freedom but with a few specific nuggets of tension, that seem to have been there a long time. Sometimes I feel like I’m a prospector, palpating for long-lost treasures underlying tension. Work your way out in successive points near to where the clavicle and scapula meet.
• Now return to the trapezius’ belly immediately lateral to T1. Be conscious and contact clearly with both your physical structure and your energy, mentally, emotionally, and spiritually engaged in what you’re doing. Press in with both thumbs, down toward the feet and easily rest in just lateral to T1. Give the client a moment experience this initial contact. Pause.
• Now press in further, engaging tensions found more deeply. (If you find no tension, clearly disengage and explore points more lateral.) Continue yourself to breathe and relax, sinking into the tension. Commonly at this point, you can see from the client’s breathing and facial expression that she or he is engaged. Pause.
• Rest in yourself more completely. Deepen your breathing, be patient. Lean gracefully further in, letting gravity be the therapist. Find the optimum depth for this fulcrum. Now pause again, without letting go of any vectors. It is important that you the therapist now go to a “witness” state, not moving. Allow the client time to let go, from the inside out, of successively deeper, “sedimentary” layers of tension that have developed here over the course of life.
• When you sense it’s been long enough – usually two to seven seconds will do fine – clearly disengage and move on. Then press in an inch more laterally on both sides. Repeat the steps above. Keep alive your sensitivity and patience. These tensions accumulate over a lifetime. They need the gift of time and touch to let go of the layers and years of tensions held.
• Continue working the belly of the trapezius in successively more lateral areas until you’ve given attention to four or five areas bilaterally. Even if you find more tension on one side than another, maintain conscious contact with both sides. The bilaterality of contact is important since we are looking to restore the feeling of having wings, rather than a yoke here. These wings are needed for flight!

Wonderfully, this work with the trapezius is one of the easiest fulcrums to perform. But don’t underestimate it! It has global consequences on the health of our clients’ minds and bodies. When we approach the trapezius with reverence, respect, patience, and skill we are given the opportunity to let go of lifetimes of stress and to regain the sense of the lightness of being.

David Lauterstein is Co-Director of Lauterstein-Conway Massage School in Austin, Texas, for 23 years one of the premier schools in the Southwestern U.S. He has been a bodywork teacher since 1982 and is a 2011 World Massage Therapy Hall of Fame Inductee. He is the author of Putting the Soul Back in the Body and the forthcoming Deep Massage Book from Complementary Medicine Press.

The Negative Language of Back Pain

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THE NEGATIVE LANGUAGE OF BACK PAIN
“Patient complaints that originate in the musculoskeletal system usually have multiple causes responsible for the total picture.” -Drs. Travell and Simons
“The first treatment is to teach the patient to avoid what harms him.” -Karel Lewit, MD “He who treats the site of pain is lost.” -Karel Lewit, MD
After seventeen years of running a private rehabilitation clinic, I’ve seen my share of back pain in my patients. It is one of the most common ailments I see, but it is also one of the most misunderstood concepts for the patient, mainly because of the confusing, and often negative, language in the medical field. Patients with back pain – much like pain anywhere in the body- are confused about why it exists: “How did it happen?” “I woke up with this,” are common statements. When the healthcare provider informs them “your back is out,” or “you have stenosis,” and “you have degenerating disks,” the patient assumes the worst ( “I’m degenerating?”). While these physical items might very well exist, and yes, back pain can be related, chances are the patient’s pain has nothing (or very little) to do with them. Yet the patient is told an MRI is “bad” because a disk is herniated (recent studies show that patients with herniations have no pain related to them).1 The patient begins to believe he or she is doomed. After an MRI is ordered – and they are processed at an alarming and completely superfluous rate in the United States 2 – the patient is hit with an onslaught of impossible medical jargon. Does the patient need to spend time listening to the radiologist so she can have a better understanding of the issues? Yes, but the delivery of such information needs to be filtered and converted into a more positive and educational bits. Over the years, many MRI reports I’ve read showed a myriad of structural changes (spondylolysis, lumbar stenosis, protruding disks, et al), yet in my own clinical experience most of the patient’s pain was not a result of these physical findings. Yet the MRI places the patient into an anxious mindset for therapy because of these “physical” findings and their foreboding visuals of “it,” the one thing that is the cause of it all. I’ve seen it again and again, the patient in obvious jabbing pain, unable to sit comfortably, pushing the MRI report in front of me exclaiming, “It’s the stenosis.”
The first thing I try to do when a patient brings in an MRI report is help relieve some of the anxiety associated with a “bad” MRI. For any therapy to take place, the clinician must establish a positive mind-set for the patient from the initial evaluation. I do this in part by explaining, in layman’s terms, how soft tissue reacts to stresses of the skeletal system, and how structural changes to the spine often are not the issues causing the back pain. I try, ultimately, to get her mind off that one thing that she believes is the problem. For example, I’ve had many lumbar stenosis patients who do not have every symptom of pseudoclaudication, but have a thoracolumbar muscle region that is completely dysfunctional. Yet most physicians overlook this. (And others, too. At a recent physical therapy symposium I attended, I asked the physical therapist who taught a course on back pain if he ever considered the sacral ligaments and related soft tissue in his manipulations. “No,” he said, “They really are not important.” Huh?) I also explain to the patient that, while we cannot eliminate the stenosis or structural change, we can focus on releasing the thoracolumbar area to relieve the pain and postural dysfunction. (That’s why massage therapy is so effective for back pain. See the story on NPR.) I have improved pain and quality of movement in my patients on this very premise, and have reproduced this result over and over in patients who thought they were destined for surgery. So “bad” MRI’s are not necessarily a ticket to debilitation and poor quality of life, and the patient, once she understands this, is in a remarkable position to improve her dysfunction.
Some of the Poor Language of Back Pain
• Your back is not “out.” This is one of the most common phrases I hear both told to and from
patients, and it’s understandable why it is used by the patient. The patient may often feel something is “out” when the thorocolumer region is in spasm. If disks are misaligned, research shows they will resolve themselves over time, sometimes with a little self-help. 1
• You are not “degenerating.” Yes, our bones undergo arthritic changes as we age, which means we need more muscle stability to help protect them, but we are not literally disintegrating.
Patients are not damaged but have dysfunction!
• It did not happen over night. While it might seem as though the pain suddenly developed over night, usually this is not the case. Soft tissue dysfunction has a snowballing effect; it develops from a single event that gets worse over time. 3
• Does the patient really need an MRI? Getting a second opinion is always a good idea. I recently visited a podiatrist to get a mucoid cyst removed from my second toe. He insisted he must order an MRI, even though it is one of the most common cysts that occur on the hands and feet. (I refused and the cyst resolved itself.) Radiological films are always a good start, too.
Timothy Agnew
***
1. Cherkin D, Deyo R, Battie M, Street J, Barlow W. A comparison of physical therapy, chiropractic
manipulation, and provision of an educational booklet for the treatment of patients with low back pain.
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