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Client Self-Direction Produces Better Outcomes By Douglas Nelson Mr. C. had visited my office with complaints of leg pain in the right lateral thigh. We sat down and discussed his experience. "When and how often do you experience this discomfort?" I asked. "I often feel it after sitting for any length of time, and sometimes when I am going up stairs. The pain is on the lateral side of my knee. It's not a sharp pain, more like a deep ache." "How long has this been going on?" I asked. "Several months. I should have come in sooner, but I thought it would be better by now. It's not getting worse, but it certainly isn't getting better either," he replied. I asked Mr. C. to stand up and do a squat for me, hoping to replicate the pain. As he did, he was able to point to an area just anterior to the iliotibial band, likely on the vastus lateralis. Transferring to the table, I began to thoroughly explore the area. As I approximated the area of his pain, I saw him react with discomfort. essential skills | TABLE LESSONS 86 m a s s a g e & b o d y wo r k m a rc h /a p r i l 2 0 2 2 "I assume this is the sensitive area?" I inquired. "That's certainly more tender than I expected it to be," he said. "Does this feel like the exact area you described earlier?" I asked. "It is a very tender area," he answered. "Yes, but is it the exact area?" I challenged. "You know, not really," Mr. C. replied, after some hesitation. "Close, but that's not it." In response, I moved my finger just a few millimeters in either direction, then made slight pressure changes, guided by his perceptions. When that didn't produce results, I changed the angle of my pressure without moving my finger. Finally, the pressure and angle were perfectly aligned. "Wow, that is exactly it," he said. "Right on it! I can't believe how painful that is."

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