Issue link: https://www.massageandbodyworkdigital.com/i/108504
table lessons The more completely clients understand a problem, the more likely we are to create effective solutions together. I am not sure how long I hesitated in replying, but the implications of her statement cascaded me into a sea of thoughts. You might make the case that previous health-care providers did explain impingement to her and she didn't understand or remember, but this is an extremely bright woman who could not explain it to me now. How can a person know what to do or what not to do without understanding the nature of the condition itself? I have seen countless clients who have been given a diagnosis, yet possess no real understanding of the mechanics of how that translates into real life. In our rush to perform a treatment, we neglect to form a deep understanding of the problem in our clients. The more completely clients understand a problem, the more likely we are to create effective solutions together. "Let's spend a few minutes with my skeletal model before we get on the table," I said, inviting her to my desk. "Do you see this deep space?" I asked, pointing to the supraspinatus fossa. "That is where a muscle called the supraspinatus is located. It attaches at the top of this bone called the greater tubercle of the humerus. Notice how the tendon has to pass under this bony shelf. If there is too little room, the tendon gets squished, and therefore inflamed." "What would cause it to get squished?" she asked. "There are two common reasons: a fall or repeated small traumas," I said. "Watch this." I raised the humerus into abduction. "Anytime your upper arm is above 90 degrees, you compress the available space. Or, if you fall with your arms outstretched, the humerus is jammed up into the socket, which smashes the tendon and the bursa." "Uh oh," she remarked. "Uh oh?" I questioned. "I did have a little fall before the pain started. I started painting the bedrooms within days of the fall, which might have been the last straw. I was planning on painting the kitchen next. I bet using a brush and roller overhead isn't going to be a good thing for my shoulder right now." "Correct. Plus, what happens to the available space when you lie on that side?" I asked. "Lots of compression. No wonder that hurts." After Mrs. N. left, I thought about how differently she must feel about her shoulder pain. No longer just a condition with a name, she now understood what was happening, why it was happening, and how she could avoid it. That knowledge alone is powerful healing. Douglas Nelson is the founder and principal instructor for Precision Neuromuscular Therapy Seminars and president of the 16-therapist clinic BodyWork Associates in Champaign, Illinois. His clinic, seminars, and research endeavors explore the science behind this work. Visit www.nmtmidwest.com or email him at doug@nmtmidwest.com. www.abmp.com. See what benefits await you. 37