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TABLE LESSONS best practices 26 m a s s a g e & b o d y w o r k n o v e m b e r / d e c e m b e r 2 0 1 5 Accompanied by her mother, my newest client (a young girl of 14 years) carefully described her symptoms. "This pain began several months ago— actually more of a deep ache than a pain. It was gentle at first, then increased over time. Starting first in my calves, it spread to my ankles." "Was it more on one side than the other?" I inquired. "It started on the left, but quickly spread to the right as well. The pain has kept me from doing many of my favorite activities. Now, my knees hurt and I cannot play soccer, basketball, or any other serious athletic activity. In fact, just going for a walk is hard. The longer this goes on, the more limited I am." I informed Miss D. that, using my hands, I wanted to explore the musculature of her legs. The moment I pressed on her tibialis anterior, she recoiled in obvious discomfort. Pressure on the posterior calf created the same reaction, as did any pressure near the ankle. Sensing that further palpation in this area was unwise, I decided to go elsewhere. I cautiously palpated the rectus femoris about mid-thigh and again Miss D. recoiled, but slightly less than when I palpated her lower leg. With so much widespread pain, I began to think about other possible mechanisms and explanations. Turning to her mother, I asked whether they had consulted a physician. "That is part of what makes this situation so perplexing," her mother said. "My daughter does not seem to fit into any of the traditional boxes, and no one seems to want to pursue treating her pain because it isn't life threatening. It is, however, life altering. We are at our wits' end." The Master Volume Switch The Magic of Our Central Nervous System By Douglas Nelson The mother went on to describe the copious number of health-care providers they had seen. All of the medical conditions I would be concerned about had already been explored. With these eliminated, I could explore the soft-tissue possibilities safely. After speaking to the mother for perhaps five minutes, I happened to notice that Miss D., while lying on my table, had been applying pressure to her throat the whole time. Her mother, aware that I noticed her daughter's rather peculiar action, felt compelled to explain. "My daughter often applies pressure to the front of her neck. Whenever there is a moment, especially when she lies down, she presses her throat." Miss D. looked rather embarrassed at having this revealed to me, but she did not take her hand off her throat. "Generally, we do what we do for a reason," I assured her. "There must be some reason you find pressing on your throat helpful." "I don't know why, but pressing here seems to help me feel more relaxed," she said, gesturing to her throat. "It just quiets me." "If I am gentle, may I explore the muscles in the front of your neck?" I asked. "Perhaps there is a reason that pressing on them is helpful." I began with a mobility test of her hyoid bone and discovered it did not move symmetrically. Movement to the left was restricted, implicating the omohyoid and digastric on the right. After releasing these muscles, I retested the mobility, finding it much improved. I showed Miss D. how to move her own hyoid to relax and mobilize the muscles attached to it. This movement gave her both a measure of comfort and validation. The sternohyoid and sternothyroid were very sensitive bilaterally, as was

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