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"I think it might be worse," she said. "The problem might be spreading to other areas of my arm." My eyes widened as I tried to make sense of what Ms. M. was telling me. Ms. M. was a pianist who had first come to see me six days earlier with pain in her right lateral epicondyle. I had only seen her once, but three days after that first treatment, she sent me an email in which she was ecstatic at the results achieved. How could things have gone south just days since that massage? "Gosh, I'm a little stunned," I admitted. "I thought your elbow was significantly improved after our session last week." "Well, it was better, but now I am feeling the pain here," she said, pointing to her triceps muscle. "I don't think I ever felt pain here before. Perhaps the problem is more widespread than I thought." "Before we began the work last week, you mentioned that the action of brushing your teeth was extremely painful. Were you able to brush your teeth with your right hand this week, or did you have to use your left hand again because of the pain?" "Um, no. I have been brushing my teeth using my right hand for probably the last four days," she said, giving me a puzzled look. "I kind of forgot how difficult that was for me." "Are you still taking as much medication for pain as you were before we worked last week?" I asked. "No, I haven't taken anything for the last few days," she admitted. 30 m a s s a g e & b o d y w o r k j a n u a r y / f e b r u a r y 2 0 1 8 TABLE LESSONS best practices The Loudest Voice Wins By Douglas Nelson

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