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TABLE LESSONS best practices As Stated by the Client Addressing Client Concerns for Better Therapeutic Outcomes By Douglas Nelson "The scalenes," said one of the therapists. "I think I could make a really good case for scalene involvement for a number of reasons." "I could make a case that the pectoralis minor might be slightly more important," countered one of the other therapists. "I think this is true because of her scapular position. We could test whether this is correct, but I like the pectoralis minor as a major player." "Maybe, but I still like the scalenes," the first therapist replied. Since I did not respond, the six participants looked at each other, thinking they must be missing something. After a quiet pause, more muscular influences in thoracic outlet syndrome were explored and debated. When I still didn't say anything, the flow of ideas gave way to silence. Before going further, let me explain the context. A few times a year, I conduct an advanced training where six therapists and I see clients together, in the tradition of grand rounds. Most often, as in this case, I have never met the client previously, so the situation is as real as possible. These clients aren't coming in to be models for educational purposes—they expect results. When Ms. M., our present client, addressed the group, it was clear she was extremely reticent and seemed 28 m a s s a g e & b o d y w o r k j u l y / a u g u s t 2 0 1 9

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