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TABLE LESSONS best practices Hostage Negotiation Clients May Bring More to the Table Than You Think By Douglas Nelson Walking into my waiting room, I greeted Ms. K., a client I had not seen for several years. I noticed she was wearing a surgical boot on her right foot and was also in possession of a pair of crutches, which had seen extensive use. I closely watched her gait as we walked the hallway to my treatment room; nothing about using crutches is easy. After entering my treatment room, we sat down to talk. What struck me now—as I remember it did when I fi rst met Ms. K.—was her quiet confi dence. Ms. K. was clearly comfortable in her own skin— so comfortable that it seemed all her energy and focus could be directed to the person with whom she was speaking. I admit feeling the need to elevate my level of attention to match her singular focus. "How can I help you?" I asked, thinking this was assuredly about back pain from wearing the boot. "My neck hurts," she answered. (So much for my assumptions.) "I thought it would get better on its own, but over the past three weeks the discomfort has been increasing, not decreasing." "Where and when do you feel the most pain?" I inquired. "I feel a deep ache around here," she replied, pointing to C6–C7 on the left. "The discomfort varies in intensity, but it never completely goes away. And then there is this place," she said, pointing to the C1 transverse process on the left. N e w ! A B M P P o c k e t P a t h o l o g y a t w w w. a b m p . c o m / a b m p - p o c k e t - p a t h o l o g y - a p p . 23 "This pain happens when I turn my head to the left. When I do, there is a sharp pain, very point- specifi c. I feel it in the same place when turning right, but the pain has a different quality, more of an ache." Thinking through her explanation in my head, I started making a list of all the muscles that attach to C1 and their roles in ipsilateral and contralateral rotation. Of that list, which muscle might also explain the lower cervical pain? Also, which muscles on the list would be irritated by her use of crutches? Remembering her gait, she had a pronounced forward- head position at the moment her crutches hit the ground. How might that play into this scenario? After populating my list of potentially involved muscles, I began to explore her tissue via palpation. While several muscles were tender, the levator scapula and the obliquus capitis inferior were extremely sensitive. Since both of these muscles are ipsilateral rotators, they could play a role in pain during left rotation and aching during right rotation. Observing how she

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