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26 m a s s a g e & b o d y w o r k j a n u a r y / f e b r u a r y 2 0 1 5 m a s s a g e & b o d y w o r k j a n u a r y / f e b r u a r y 2 0 1 5 TABLE LESSONS best practices "I'm worse. Way worse. This is so discouraging." These are not the words you want to hear from a client at the beginning of a session. I tried (probably unsuccessfully) to hide the disappointment I felt. Failure is something I am familiar with, but this turn of events completely surprised me. "I thought you were doing better after our last session. Wasn't the pain down the leg receding?" I inquired. Ms. H. had fi rst visited my offi ce about three weeks before, complaining of back pain that radiated down the right leg. Her pain had the presentation of a classic radicular issue, typical for an L5 nerve root distribution. She had seen her physician for this problem and an MRI did not show anything conclusive. There were some degenerative changes and slight abnormalities, but nothing that would explain the pain she was experiencing. Her physician prescribed physical therapy. Multiple visits resulted in no improvement. After consulting with some friends, Ms. H. sought my services. I had seen her three times, and during our last communication she informed me that the pain down the leg was better. But her sudden fl are-up of symptoms had me totally perplexed. "I was doing better," Ms. H. said. "The symptoms got much worse after my physical therapy appointment last week." "What happened at that appointment?" I asked. "I had the chance to see a physical therapist in Chicago. She did a really thorough assessment and postural evaluation. During the structural examination, she found a signifi cant distortion in my spine, which may ultimately be responsible for my back pain. We did some corrective exercises for the distortion multiple times that day. By the time I left, my back was really hurting. On the way home, my leg pain reappeared and has been there ever since. I am just devastated." "Were you having leg pain before your appointment?" I inquired. "Only occasionally at that point," she said. Defect or Defense? By Douglas Nelson Is the distortion the cause of the pain, or a response to it?

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