Massage & Bodywork

September/October 2009

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table lessons BY DOUGLAS NELSON WAIT, DON'T HANG UP! "What did you say?" I couldn't quite believe my ears. "I said that I understand if you don't think you can help me. Every doctor I have seen thinks I'm nuts. I guess this thing just can't be helped. I can at least stop the ringing in my ear for a while by pushing up on my jaw. Thanks for listening anyway," the caller said. "Whoa, that's what I thought you said—the part about pushing on your jaw to make the ringing stop. You can do that?" I asked. "Yes," she replied. "Isn't that weird?" "I want to see you Monday," I exclaimed. "I think there is a chance we can solve this." Let me back up just a bit. Mrs. B. had been a client of one of my students for soft-tissue discomfort. During her session, she had mentioned to him that she had had ringing in her ears for more than a year and it was highly annoying. She thought it may have begun after a car accident, but it was difficult to tell. As the ringing got worse, she tried to see physicians about the condition. After many hearing tests, otoscope examinations, and neural exams, she was no further along. She was even referred to a temporomandibular joint (TMJ) specialist who was unfamiliar with any connection between TMJ issues and ringing in the ear. (Has this person read the literature?) 94 massage & bodywork Every symptom may have multiple causes. Ringing in the ears is really complex. There are many possible reasons and many of them are not in the realm of soft-tissue treatment. For instance, kidney dysfunction will cause ringing, as will prolonged exposure to loud noises. Since Mrs. B. was going to have to drive a couple hours for appointments with me, I really didn't want her to do that unless I had a reasonable chance of helping. In that light, I explained the multiple possible causes of tinnitus and how I was hesitant to have her drive so far for an appointment. Discouraging her from coming was the right choice until she revealed the part about stopping the ringing by pushing up on the jaw. Of all the possible causes, exactly none of them would be influenced by pushing superiorly on the mandible. Your kidneys do not care if you push on the mandible or not. Her ability to stop the ringing by pressing on the jaw showed that the source of Mrs. B.'s ringing must be mechanical in nature, since a mechanical act affects it. This is huge! I was encouraged by my own clinical experience in treating tinnitus and I was relying on the literature. In a study by Carina A.C. Rocha and Tanit Ganz Sanchez from the University of São Paulo School of Medicine, researchers looked at 94 patients with tinnitus and examined trigger points in the masseter, splenius capitis, sternocleidomastoid, and temporalis muscles. These muscles turned out to be the same ones bothering Mrs. B. The researchers found that 72 percent of the 94 patients with tinnitus had relevant trigger points. Mrs. B. also had relevant trigger points, mostly in the masseter and the temporalis muscles. The researchers also found that 60 percent of the group september/october 2009 experienced a lessening of their tinnitus after treatment of the trigger points. The researchers also looked at another aspect—correlating pain on one side of the upper body with the tinnitus. A strong correlation existed between the side of the worst tinnitus and the side of the upper body in the most pain. (This was true for Mrs. B.) This is extremely important to know and convey to our clients. Mrs. B. is not unusual in one respect: because the people treating her could not connect all her symptoms, the easiest strategy was not to believe her. When looking at an array of symptoms, any clinician must decide if they are relevant. The deciding factor is the knowledge base of the healthcare provider. Three skills are crucial: listen carefully to all details, hear what the client describes as connected, and know the literature. I have often thought that the greatest service I have provided to many clients is connecting their symptoms—moving from chaos to a place where people understand the context of their experience. I can often hear a sigh of relief as I show them the literature that connects the presenting symptoms. Mrs. B. is no exception. She is relieved to know she isn't really nuts after all, there is an answer, and I can put my finger right on it. Mrs. B. continued to improve very nicely over three sessions. I'm just glad she didn't hang up. So is she! principle 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. or e-mail him at Douglas Nelson is the founder and

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