Caring for our Bodies is Sacred Work by Nancy Dail

Caring for Our Bodies is Sacred Work
Love of Self
For Broad Bay Congregational Church on August 23, 2015 in Waldoboro, Maine
With Nancy Dail

When I think of sacred my mind automatically shifts to the sacrum……
“The sacrum is one of the most fascinating bones in the body – beginning with the spiritual clue in its Latin root from “os sacrum” meaning “sacred bone”.” The sacrum is a v-shaped bone that is the foundation of your spine and links to your pelvis on both sides.
“Irene Dowd likens the sacrum to a keystone arch in a church. The downward force of the arch keeps the columns in place. Of course in the body the columns are our legs and far more subtlety is needed to adjust to the constant micro movements we make even when we are still. Add to that the 19 ligaments in and around the pelvis plus the 57 muscles that have a connection to the pelvis and you have a cross over area where there is a translation of the heaven to earth forces…the sense of the spine connecting from the sacrum up to the brain and the doorway to allowing our grounding forces to flow.” – Jeff Lennard (private correspondence) From David Lauterstein author of Deep Massage Book.
I am going to give you permission to stand if you want to. If you are uncomfortable sitting, please feel free to get up. I will not take offense. My students lay on the floor, bounce on balls and stand up. Freedom of movement is self-care.

I want to thank Nancy Duncan for inviting me to speak here today at Broad Bay Congregational Church. It is a daunting task to speak about Self-Care in a way that does not make one feel guilty if you do not participate in an activity. It is my goal today to shed light on how one can “Care for our bodies and insist on taking time to enjoy the benefits of prayer, reflection, worship, and recreation in addition to work.” But I also want to link back to number 10: “Claiming the sacredness of both our minds and our hearts, and recognizing that faith and science, doubt and belief serve the pursuit of truth.”

It is daunting to speak to this congregation as I know that you are a group of caregivers and being one myself, I know we are probably the toughest group to propose self-care to. Care of self usually comes last on the list of the caregiver, so whether you are a mother, father, grandmother, grandfather, reverend and I know there are inordinate amount of reverends in this group, being a caregiver does not mean you are supposed to sacrifice yourself in the care of others. It is all about balance and that is often the toughest act to accomplish. We need to remember that we are human. We are our own worst enemy – we judge ourselves for that what we do not do.

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.”

There is unfortunately a pile of truth in that statement. I will not get into a discussion of our insurance system however today. But I hope to lead instead to understanding the sacred role that self-care has in your life. I believe that mankind makes most everything more complicated than we need it to be. We need to strike a balance instead of reaching for the extremes.

In the process of learning self-care there is no right or wrong. One should not judge yourself with self-care. Chastising yourself for not doing something beneficial is counterproductive. It wastes time on the negative. Having a positive attitude helps. Applaud yourself for doing one thing for your self-care. Avoid the guilt trip. There is a poem I would like to read in its entirety by Thomas Merton called “Great and Small.”

Great And Small
The Way of Chuang Tzu
By Thomas Merton

When we look at things in the light of Tao,
Nothing is best, nothing is worst.
Each thing, seen in its own light,
Stands out in its own way.
It can seem to be “better”
Than what is compared with it
On its own terms.
But seen in terms of the whole,
No one thing stands out as “better”.
If you measure differences,
What is greater than something else is “great,”
Therefore there is nothing that is not “great”;
What is smaller than something else is “small,”
Therefore there is nothing that is not “small,”
So the whole cosmos is a grain of rice,
And the tip of a hair
Is as big as a mountain-
Such is the relative view.

You can break down walls with battering rams,
But you cannot stop holes with them.
All things have different uses.
Fine horses can travel a hundred miles a day,
But they cannot catch mice
Like terriers or weasels:
All creatures have gifts of their own.
The white horned owl can catch fleas at midnight
And distinguish the tip of a hair,
But in bright day it stares, helpless,
And cannot even see a mountain.
All things have varying capacities.

Consequently: he who wants to have right without wrong,
Order with disorder,
Does not understand the principles
Of heaven and earth.
He does not know how
Things hang together.
Can a man cling only to heaven
And know nothing of earth?
They are correlative: to know one
Is to know the other.
To refuse one
Is to refuse both.
Can a man cling to the positive
Without any negative
In contrast to which it is seen
To be positive?
If he claims to do so
He is a rogue or a madman.

I use this poem when I teach ethics for a basic understanding that if there were no wrong, we would not have to worry about being right and be ethical. It also speaks to the balance of positive and negative. Just like trying to balance on a see saw, somehow we need to reach a balance in our lives.

From my perspective, as a massage therapist, when I touch someone, I am working on the whole person. For me there is a spiritual acceptance that there is a whole person, body, mind and soul on my table. The emotional component is every bit as important as the physical. I have worked on individuals who were so wrapped in the emotional plane that letting go and relaxing is not an easy feat. I can tell when I touch someone whether there is still voluntary tension being held versus straight forward tight tissue. We carry around levels of tension and stress, and are often are not even aware we are emotionally supporting physical tension. I am constantly reminded that I work on human beings. My job is to help you help yourself, and I do not fix anything. The human body is capable of doing that all by itself, but often with a nudge or catalyst.

I have prepared for you a Self-Care Wheel that is divided into four separate parts. (It is just a big circle with four parts if you wish to recreate it). Spiritual, Physical, Intellectual and Emotional. The best way to fill in the blanks is with a group of people, because we learn from others and it opens our minds to possibilities. For example, physical for you may only be taking a walk. To someone else, it might mean dance, Tai Chi, or any type of movement. Getting enough sleep is also part of the physical. Discussing self-care in a group might lead to walking in pairs or in a group. You do not have to do pushups to get physical exercise. These categories can be combined and you will see that they lend to each other, for example, if you put nature in the spiritual and you go for a walk in the woods, you might stop under a tree and have a moment as you listen to the wind as it rustles through the leaves.
I have a birch tree outside my office window and sometimes I will ground myself by listening to the tree make natural music.
This chart represents self-care for the whole body, Body, mind and spirit. Seeking someone to help you find your self-care is honorable. I recommend it. It is your personal journey.

Besides this chart, I have a few recommendations to help you with your journey of self-care.

1. Take charge of your health care. Make sure that when you have a diagnostic test or surgery that you have a copy of every report. Do not put all your faith of your health care in the hands of one person. When you go to a physician, write down your questions before you go, so the time you spend with your health care professional is profitable to your health and to your understanding of your health. If you cannot read the report you are given, find someone else who can. Understand your condition before you do something that is irrevocable. Think of yourself as being the center of health care. What health care professionals do you need to help you find optimal health? I know that this is bold, but this is the idea behind holistic health. (recent airport experience)
2. Pay attention to your symptoms. Signs and symptoms are what Doctors use to give you a diagnosis. Only you can report on symptoms as they are only felt by you. Pain is a symptom. Headaches are a symptom not a diagnosis. Look at symptoms as warning signs! Get maintenance checkups!
3. Take a close look at your posture and the repetitive actions you do daily. Your head weighs about 10-12 pounds. Because our head sits on top of our cervical spine, it is kind of like carrying around a bowling ball on a stick. Just our tendons, ligaments and muscles act as guy wires to keep our head upright. If your head is on top of your spine you will have 12 pounds of pressure on your posterior cervical muscles. For every inch that you head is in front of your spine you multiply that times the weight of your head. So if your head is 3 inches forward or your head is flexed forward and suspended, you will have 36 pounds of pressure on your posterior cervical muscles. This leads to headaches, neck pain and discomfort in between your shoulder blades. It could also lead to pain and discomfort down the upper extremities. We know have syndromes from technology: Computer vision syndrome, Digital vision syndrome, and Text neck.
4. Sleep posture is as important as day posture. Try to not sleep in a fetal position all night long. Hug a pillow. Do not sleep with your arms over your head, it will cut off your circulation and nervous innervation to your upper extremities.
5. Take more breaks during all kinds of repetitive actions.
6. Have a care as to how you lift things. Use your legs, not your back. Balance yourself first; try not to lift things in awkward positions.
7. Include some form of movement in your life. Like the exercises we did with the children. Warm your body up before you do exercise.
8. Try to find something that will decrease stress in your life. The stress hormone is cortisol. Find something that counteracts stress. It could be walking, massage, exercise, dance, laughter, or listening to the wind.
9. Hydrate! The brain is a selfish organ – it requires so much water that if you are dehydrated, the brain will steal water from your other organs.
10. Breathe. Be conscious about breathing fully, expanding not just your chest but also your abdomen. Breathing done consciously can exercise your internal organs as well as support good posture.
11. Include beauty, art, music, and anything cultural in your life in some form.
12. I believe that caring for your soul can mean that you are enlisting ways to unite your body and mind. Thomas Moore says: “Care of the Soul requires craft – skill, attention, and art. To live with a high degree of artfulness means to attend to the small things that keep the soul engaged in whatever we are doing, and it is the very heart of soul-making.” He also says, “No one can tell you how to live your life. No one knows the secrets of the heart sufficiently to tell others about them authoritatively.” We all have to experience life ourselves, so you all have your own personal journey. Combining the sacredness of both our mind and heart, accepting faith and science, pursuing truth to take care of your body in a variety of ways achieves a balance that we all need in our lives.

Robert Browning said:
“Truth lies within ourselves; it takes no rise from outward things, whate’r you may believe. There is an inmost center in us all, where truth abides in fullness and to know rather consists in opening out a way whence the imprisoned splendor may escape than in effecting entry for light supposed to be without.”
You will all find your own truths in your own time. Have confidence in your abilities. Thank you for this opportunity to talk with you today and enjoy your journey.

Nancy Dail, BA, LMT, NCTMB, Director Downeast School of Massage
542-6207 ,

CORE Structural Integration and Myofascial Therapy: A Lifetime of Improving Structure and Function George P. Kousaleos, LMT

CORE Structural Integration and Myofascial Therapy:
A Lifetime of Improving Structure and Function
George P. Kousaleos, LMT

It is interesting that a cervical injury during a college rugby match lead me to my first Swedish massage. After four weeks of treatment the massage therapist sent me to my first Iyengar Hatha Yoga class, where I experienced more discomfort during exercise than I had ever felt in my lifetime. Six weeks later the Iyengar teacher gave me an article on Rolfing, and in a few short weeks I received my first session of Structural Integration. Each step of the way I experienced significant improvement in decreasing my pain levels, improving my overall flexibility, and becoming more aware of my optimal physical alignment and balance. It took three years to realize that I was ready to change my life even further and started my training as a professional massage therapist and Structural Integration practitioner.
From the earliest days of my study of the disciplines of Structural Integration and Myofascial Therapy I was fascinated with the importance of recognizing the foundational relationships between structure and function. Indeed, over many years and decades of practicing and teaching this incredible work, I never lost sight of those relationships that not only improve structure and function, but increase neurosomatic awareness and restore a sense of physical and mental confidence.
From the early 1980’s I worked in New York City with leading ballet dancers, opera singers and classical musicians. They quickly appreciated the performance benefits of this precise work and cherished the added level of skill mastery they acquired through regular clinical treatment.
Later that decade I practiced and taught in Germany, applying this work to patients at a holistic center for homeopathic medicine and psychiatry. Through various seminars I taught Myofascial Therapy to European massage therapists and physiotherapists in 13th Century Bavarian castles, on the Greek island of Santorini, in the oldest yoga school in Vienna, Austria and at the healing warm springs of Passau. I appreciated even more the effects of slow, powerful, and carefully orchestrated pressure that changed the pliability of even the densest tissues, the most hardened of bodies.
After opening the CORE Institute in Tallahassee, Florida in 1990, and creating an entry level professional massage therapy program that included structural and myofascial education, I looked for opportunities to help prepare my students for the day that each of them would embark on their professional journey. I was thrilled when the British Olympic Association decided to hold their warm-weather preparation camps at Florida State University to prepare their athletes for the 1996 Atlanta Olympics. British Olympians from 13 sports received regular treatments from CORE students during three weeks of strenuous two-a-day practice sessions during the summers of ’95 and ’96.
The Atlanta Olympics lead to my involvement as a Co-Director of the International Sports Massage Team of the 2004 Athens Olympics & Paralympics. One hundred and eighty therapists were chosen from 18 countries to provide therapeutic massage to over 15,000 athletes and coaches. Many athletes had never experienced massage therapy in their home country and relished at the improvement to form and function at the most meaningful time of their life. An Italian gymnast, who came to the clinic daily, won the gold medal in the horizontal bar in one the biggest upsets of the Athens Olympiad. The next day he came to the clinic to take photographs with the therapists who helped him prepare for his “lifetime moment”.
Later that decade I began teaching in England, Scotland and the Republic of Ireland from 2009 to 2011. Many of those students from London, Manchester, Chelsea, Bath, York, Edinburgh, Aberdeen, Galway and Dublin assisted their Olympic teams at the 2012 London Games. Each of them took their place with those who preceded them in offering a sports and performance therapy that increased balance, responsiveness, ease of movement, and kinesthetic agility.
At the same time I was engaged in creating Myofascial Therapy protocols for the leading athletes of the Florida State University Football Team. From 2011 to this day these athletes receive twice a week treatment from 10 CORE Institute graduates during the regular season as well as during all spring and summer training camps. During this time, soft-tissue injuries decreased by 75% and FSU won three ACC Championships and the 2013 National Championship. Over 30 of these athletes are now playing in the NFL, with many of them continuing their commitment to regular myofascial therapy.
Last Fall I was honored to travel to Sydney, Australia and teach leading sports therapists from all across Australia and New Zealand. Many of these therapists work in allied medical fields, including physiotherapy, podiatry and acupuncture. On the ninth and final day of the intensive seminar we invited current and former professional and Olympic athletes to a special clinic. Each athlete responded favorably to their sense of improvement from a 90-minute full body session, with several emailing us later in the week with amazing stories of how their training had improved. The common theme we heard was “I feel more awareness of my body and how integrated my movements have become.”
I am more than satisfied that during the past four decades I have represented one of the finest approaches to structural and functional improvement from the disciplines I studied 37 years ago. Each year I look forward to introducing this work to curious and dedicated therapists who are searching for the keys to providing long-lasting health and wellness to those they serve each day. Each day I enjoy my clinical sessions with professional and amateur athletes who want to maintain elite athletic levels, with clients rehabbing from serious injuries and disease, and with those who simply yearn for a deeper sense of self. Each day I find happiness.

Join us at the Downeast School of Massage to welcome George at his Core Myofascial Therapy Seminar on July, 10, 11, and 12, 2015. See description of his workshop at:  Register on line or call 207-832-5531.

Stiff Neck – Un-puzzing the Problem by Nancy Dail

Stiff Neck – Un-puzzling the Problem
By Nancy Dail

Clients regularly complain of having a “stiff neck”. It may hurt to rotate, flex, extend or laterally flex the head or just feel like the head does not respond to movement well. Complaints may also include pain or discomfort on top of the head, general headache, or specific headache pain patterns. Discomfort may run from the back of the head through to the front, and include the entire superior area of the scapula to between the scapulae medially. Multiple complaints may also include upper extremity pain in the shoulder or elbow joints and/or hand and wrist.
The medical history form and interview will help to answer many questions – occupation, repetitive actions, injuries and accidents, sleep patterns, pain patterns, activity and response to other types of care both medical and holistic. What aggravates the condition? What relieves it? Observation will answer postural questions. Is there a head forward posture, protracted shoulders, short upper arms, and a marked handedness? How much pressure is on the posterior cervical muscles based on the head forward posture?
Posture is a repetitive action, and can over time, cause as much discomfort as a sudden injury. The constant head forward posture and position of the shoulders, causes isometric holding patterns for the head extensors, and puts additional stress on the deeper suboccipitals. What other repetitive actions (shoulder girdle and shoulder joint) the individual has, determines what other muscles will play a part in the dysfunction. Muscles work in groups and in paired opposition. This is the aggregate muscle theory – a kinesiology theory that pairs agonist and antagonist action. So, when analyzing and unraveling the stiff neck, the massage therapist must determine active and passive range of motion for the head, neck, shoulder girdle, and shoulder joint. What contributes to the discomfort? Does the individual elevate the shoulder with actions? For example, have you ever tried to shovel snow without lifting the shoulder?
Armed with action information, determining which muscles are culpable is next. Muscles work as agonists, antagonists, synergists, stabilizers, and neutralizers. Some muscles may be primary, but others assisting in the action may also have to be treated in order for the issue to be resolved. There is also order involved. What muscles do you work on first and in what position? In the case of the stiff neck, the sternocleidomastoid, is a primary muscle. It is often shortened because of posture or my personal favorite when I travel, “hotel pillow syndrome”. Passively shortening this muscle is key to unwinding it quickly. Flex the head and lateral flex the head. Short strip the muscle off the mastoid process while rotating the head toward your thumb. Grasp the length of the SCM with a pincer palpation and work towards the sternum and clavicle. Deep transverse friction the sternum and clavicular attachments.

Working on the SCM before you begin releasing the longissimus dorsi and splenius capitis will allow a more efficient treatment plan. These muscles assist in lateral flexion with SCM being a prime agonist. With SCM’s release, the lateral flexors palpate easier than before SCM’s treatment.



Releasing the SCM may also assist the relaxation of the trapezius. The two muscles share the same nerve – the accessory nerve. Bilaterally, the trapezius is the antagonist for flexion of the head – the prime action of the SCM.
Of course this is only the beginning of unraveling the stiff neck and solving the puzzle of the involved muscles and actions. There are many more muscles to visit in a specific order to release the stiffness, increase range of motion, and relieve pain from lack of movement, headache, or posture issues. Levator Scapula, splenius cervicis, specific suboccipitals, and even the scalenes play important roles in contributing to the common “stiff neck”.

Sorry I could not get the pictures to copy here!!! ND

Sternocleidomastoid diagram by Barbara Cummings illustrator; Myofascial Pain and Dsyfunction, Trigger Point Manual, Travell and Simmons
Technique picture from Kinesiology for Manual Therapies, McGraw-Hill, Dail, Agnew, and Floyd.

For more practice on the neck and for specfic conditions of the head, neck and upper extremities, consider:

Techniques for the Neck and Multiple Crush Syndromes
Dimensional Massage Therapy with Nancy Dail
At the Downeast School of Massage
February 28 and March 1, 2015
Saturday 9-4 and Sunday 9-4
As massage therapists we have a wide variety of clientele who grace our tables. Some come for relaxation but more and more clients seek massage for relief of discomfort. Pain is a great motivator to seek treatment and there is no shortage of poor posture and repetitive actions causing many nerve related conditions. Do you know the difference between nerve entrapment and nerve compression? Do you know when to refer for diagnosis and/or how to work with another health professional with specific conditions?
Join Nancy Dail as she defines, evaluates and treats many difficult syndromes and conditions including: anterior scalene syndrome, “stiff neck,” pectoralis minor syndrome, thoracic outlet, whiplash, pronator teres syndrome, median nerve syndromes and carpal tunnel syndrome, lateral and medial epicondylitis, tendonitis, tendonosis, tenosynovitis, cubital tunnel syndrome, double crush syndrome, bicipital tendonitis, bursitis, sprains and strains, Dupuytren’s contracture, De Quervain’s tenosynovitis, and more. Expand your treatment capabilities in your massage therapy practice!
Nancy will lecture on the skeletal and neurological anatomy of the neck and upper extremity, with particular emphasis on the brachial plexus and its distal destinations. She will also address the specific etiologies, signs, symptoms and massage treatments related to the pathologies of these areas. She will demonstrate hands-on evaluation techniques designed to assess the pathologies discussed. Special attention will be given to discuss the history and exam findings that would warrant health professional referral. Nancy will provide by lecture and power point review of the muscles and soft tissue structures. She will discuss trigger points, and referred pain patterns and repetitive actions of involved muscles. Nancy will demonstrate techniques used in Dimensional Massage Therapy and provide supervision for hands-on practice by participants. Dimensional Massage Therapy techniques are deep tissue strokes and methods that have been designed to balance joints by working on all the muscles that produce, assist in, or oppose the actions of, or stabilize the joints. They include a wide variety of dual-hand techniques, elliptical movement of soft tissues, active engagement techniques and determining the appropriate sequence for many conditions. Careful attention will be given to the execution of these techniques, specific muscles and their idiosyncrasies, and to the individual structure of the receiving person on the table. Good body mechanics and safe use of the hands and wrists will be emphasized. Tables and minimal lubrication are required for the hands-on exchange.
Nancy W. Dail, BA, LMT, NCTMB has been a professional massage therapist and member of the AMTA since 1974. She is the founder and director of the internationally known program at the Downeast School of Massage in Waldoboro, ME (1980). A leader in her field, she has served on the AMTA national board, numerous committees, and was the charter President of the Maine AMTA Chapter. Nancy has taught and presents workshops internationally, is certified in Orthopedic and Sports Massage, and has developed the working philosophy of Dimensional Massage Therapy as lead author in Kinesiology for Manual Therapies published by McGraw-Hill. Her BA in Health, Arts, and Science from Goddard College helps her balance her administrative duties as Director with teaching Dimensional Massage Therapy, Advanced Skills, Kinesiology, Ethics, and related subjects at DSM. Nancy enjoys her therapeutic practice for her clientele, traveling and teaching, and playing with her grandsons, Alexander and Kingston whenever possible at her home in Waldoboro.
To register or for more information, contact Downeast School of Massage, 207-832-5531.

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.
N Engl J Med 1998;339:1021-9.
2. Magnetic resonance imaging and low back paincare for medicare patients. Baras JD, Baker LC.
Health Aff (Millwood). 2009 Nov-Dec; 28 (6):w1133-40
3. Bogduk N, Twomney L. Clinical Anatomy of the Lumbar Spine. Churchill Livingstone