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I'm aware this may be an unpopular statement, but I don't completely agree with the idea of pain-free bodywork. In an environment that promotes relaxation under the guidance and reassurance of a qualified bodywork professional, I believe a client's brain can be trained to associate slow, precise, graded-exposure stretching maneuvers with security instead of pain. Pain is essentially a threat warning, so pain exposure therapy (PET) requires time for the brain to process these bodily changes. In the myoskeletal application of PET, therapists and clients use active feedback while working at the feather edge of the client's painful barrier, just above comfort level. Muscle energy, fascial hook, and pin-and-twist maneuvers, such as those demonstrated in Images 1–3, encourage the client to engage the painful barrier with active movements and gradually push the discomfort level a bit further with each repetition. By progressively introducing stretch to areas that have been problematic in the past, the nervous system begins associating the new movement with safety instead of pain. Throughout a series of sessions, I've noticed a marked decrease in protective muscle guarding, and an increase in pain tolerance and joint range of motion when following these key guidelines: • Create a safe environment with active client feedback and participation. • Work at the feather edge of the painful restrictive barrier, and introduce graded- exposure stretches to diminish discomfort. • Include novel stimuli during sessions by exploring new movement patterns that attract and hold the brain's attention. • Offer home-exercise suggestions that reinforce the new movement patterns. 90 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 7 technique MYOSKELETAL ALIGNMENT TECHNIQUES Pain Exposure Therapy All Pain is Not Created Equally By Erik Dalton, PhD 1 With the client's hip flexed, the therapist slowly extends the knee to the first restrictive pain barrier. The client gently knee flexes against the therapist's resistance to a count of five and relaxes. Working with the client's nervous system, the therapist again extends the knee to the feather edge of the painful barrier and repeats the action until functional range of motion is restored. 2 The therapist's extended fingers hook the constricted tissue and stretch to the first painful restrictive barrier. The client performs slow pelvic tilts while the therapist gradually increases pressure working with the central nervous system at the feather edge of pain.

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