Massage & Bodywork

January | February 2014

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best practices TABLE LESSONS Anatomical Sleuthing Finding Clues for Effective and Efficient Treatment By Douglas Nelson I met J.'s father unexpectedly at a social event. A no-nonsense executive, he took me aside to ask if I might treat his teenaged daughter. I met with both of them the next evening. "It first began as a pain in my shoulder, somewhere around here," J. said, pointing to her right upper trapezius area. "I thought it would go away, but it just kept hanging on, getting slowly worse. That's when we went to see the doctor." "The doctor sent us to physical therapy," her dad said. "They diagnosed it as scapular instability. She has been going for therapy two to three times a week for almost four months. She is getting stronger, but the pain is really about the same as it was in the beginning. J. is a two-sport athlete and a very good one. I don't want this condition to affect her playing soccer or volleyball." J. nodded, showing frustration on her face at the thought of not being able to play the sports she loves. "OK, I understand this affects your participation in sports," I said. "But is that when you feel it the most?" "Yes, at first it only hurt when I was playing. Over time, it kept hurting even when I wasn't playing. Even now though, it is far worse when I play. I have to severely limit my playing time, if I can play at all." "Is there a certain movement or action that makes it hurt the most?" I inquired. "Yes," answered J. emphatically, "running." "Running," I restated, looking at both of them. Like Alice in Wonderland, I was lost down the rabbit hole in a cascade of thoughts. Shoulder instability? I understand this is a common diagnosis for athletes, especially young females, but this makes absolutely no sense if her pain is worse when she runs. Moreover, four months of treatment, multiple times per week, hasn't helped, which is kind of a clue that instability isn't the problem. This was hardly effective, or efficient, therapy. Coming back to the moment at hand, I decided to take a different course. Shoulder instability? Like Alice in Wonderland, I was lost down the rabbit hole in a cascade of thoughts. It pays to be ABMP Certified: 33

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