Massage & Bodywork

March/April 2013

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best practices Business side | Q & art | table lessons | savvy self-care Knowledge is Power Help Clients Understand Their Conditions By Douglas Nelson I greeted Mrs. N. in the waiting room, happy to see this energetic, 70-something woman again—it had been a while since our last visit. "What brings you in today?" I asked. "How is your back doing?" "My back is doing fine. It has been quite good for many months. I am here today because of my left shoulder. After five months of pain, I am ready for it to end." "Was there any event that initiated this pain, or did it escalate slowly over time?" I queried. "I can't think of any specific incident, other than painting the two back bedrooms in the house. After a month of pain, I went to see my doctor. She diagnosed it as impingement syndrome and gave me some medication, which makes me tired and doesn't help very much. After a few weeks, she also referred me to physical therapy. I have been doing the exercises, but it hasn't helped, and the pain is really starting to wear me down. Is this something you have seen before, and can you help me?" "I have seen this many times, and there is every reason to think that precise soft-tissue work can help," I replied. "First, I'd like to check something." Putting her humerus into full internal rotation, I passively lifted her arm into forward flexion. As soon as we went past 90 degrees, it recreated the pain in her shoulder. This test confirmed that impingement was likely. At that point, I asked her to lie on her side on my table, so that I might palpate the supraspinatus. "Before I forget," she said, "I want to ask a question. For years, my husband and I have always slept in the same positions. Unfortunately, that means that I sleep on my left shoulder, which is the one that hurts. I think sleeping on it makes it worse, but changing to lying on my right side messes up our sleeping routine. Is it bad to sleep on my left side?" Before I opened my mouth to give her an answer that seemed obvious, I thought about a much larger concept that might be far more important. "Has anyone explained to you what impingement syndrome actually is?" I asked. "No, not really," she replied. See what benefits await you. 35

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