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TABLE LESSONS best practices The Nocebo Effect By Douglas Nelson Ms. K. was an elegant woman in her late 70s. Her many years of dance training were evident in the way she carried herself. When I asked her how I might be of help, her reply was very clear. "I have been diagnosed with severe degenerative arthritis of my spine and my right hip. I don't know how much you can do for arthritic degeneration, but I would be happy with any small improvement." "I assume this has been coming on gradually, getting progressively worse?" I asked. "No," she replied, looking at me as though I had gotten it all wrong. "This started December 20, right before Christmas. It was a stressful time." "And before that?" I inquired. "Not bad, except for being a little stiff in the morning. After the holidays, I went to see my doctor and he took X-rays. The diagnosis was degenerative arthritis in my lumbar spine and right hip. He said there isn't really anything to do for the back and that the hip isn't bad enough to do a replacement." "Show me where your back is hurting," I said. Ms. K. stood and pointed to her low back and sacral area, and stated that the pain was bilateral. While Ms. K. was standing, I palpated her erector spinae in the lumbar area. I took her hand and placed her fi nger on the muscle. "What do you feel?" I asked. "I feel my spine." "Actually, that's a muscle," I replied. She looked at me in disbelief. "It feels hard because it is working like crazy, but this muscle should be fairly relaxed while you are standing." I placed her fi ngers over the muscle again and began altering her body's position, bringing her spine over the gravitational line. "Oh my goodness, I just felt it soften." "Exactly," I replied. "By altering your position, you let the bones in your spine bear your weight instead of the muscles, allowing the muscles to relax. Can you feel the difference? Lean forward and feel the muscle contract again. Now, bring your weight back again and feel the muscle relax." "That's wonderful," she exclaimed, staring at me in amazement. "I can practice this at home, too, correct?" "Yes, you can," I said. "Could you lie on your right side on my table? Let's examine your muscles in that position." With Ms. K. lying on her side, I began to palpate her multifi di and erector spinae. While several areas were quite sensitive, it wasn't until I touched the multifi di attachments at about S2 that she reacted strongly. "Goodness, that is tender," Ms. K. exclaimed. "No wonder I hurt." 1.800.558.5571 universalcompanies.com 1.800.558.5571 universalcompanies.com SAVE $1.45 per pack and $3.15 per roll! SUMMER SAVINGS on Spa Essentials Pellon Waxing Rolls & Strips While Supplies Last! Use code P1SEROLL for Rolls Use code P1SESTRIP for Strips O• er expires 8/31/14