One of the "double-edged sword" moments that many Registered Massage Therapists encounter periodically is having someone enter our office, gripping the ropes of despair.

They have been passed off from clinician, to practitioner, to therapist, and have been told that this is the "best it's going to get."

The problem, more frequently than not, is that their condition is etched in areas of the body that do not lend themselves to definitive quantitative diagnostic results, leading others to believe that the individual is actually fine and may just be hosting their own "pity-party."

Not the case, however. These individuals are experiencing real pain. In the initial session, we find out about the various ways this person's soft tissues (ie. fascia, muscles, etc.) cause them pain. If we assume the world of diagnostics is one of black and white, then the world of soft tissues is one of various shades of grey! 

The delicate balance of the autonomic nervous system (parasympathetic vs sympathetic OR "Rest & Digest" vs "Fight or Flight") rests amongst a volatile environment of easily-influenced circulation, metabolites, free nerve-endings, and fascia. Our daily movement forces fluids and metabolites throughout our internal vessels; transmits forces of compression, sheering, tension, and torsion throughout the soft tissues; providing stimulation and information pertaining to our environment and tasks for processing by the nervous system. The slightest change in circulation, pH, metabolite concentration, tension, pressure, or nerve ending stimulation can throw someone into a tailspin of pain and symptoms.

An appreciation for this delicate balance is often what is required in order to make any positive changes for these patients. An understanding of the biomechanics of the aforementioned tissues, both in and of themselves and as they relate to one another, is a key component in an effective treatment. Also, maintaining a high level of respect for how easily you may cause a spike in pain or symptoms on account of the volatility of the stressed internal environment is vital as a "GPS" of sorts.

The stress of a painful condition is often enough to facilitate a self-perpetuating cycle that seemingly never ends. The successful clinician tends to have a way of finding the appropriate level of the right type of contact/stimulation that will allow them to merge along with the patient's symptom picture and subsequently effect positive change in the person's condition.

While I have had success with cases such as this, there have also been a number of cases with which I have not had the same outcome. The plan of action here comes from the network of professionals that I have worked to develop over the last number of years. I have endeavoured to surround myself with clinicians in various areas of healthcare, from sports medicine to chiropractic and physiotherapy, from osteopathy to naturopathy and acupuncture. One of the most difficult abilities to develop as a practitioner comes in two parts. The first is the ability to know when you have exhausted your own abilities and it is no longer appropriate to continue treating the patient. Then to send them to someone with a skill set that you believe may benefit your patient.

This practice is not only the right thing to do ethically and morally, but the patient will fee valued! They have likely had too many experiences where they have felt "dropped". When you explain that you feel as though you may not be able to do anything more for them and subsequently feel that you need to tell them so as to not waste any more of their resources or time, but that you have given it considerable thought and have someone else in mind that you feel may be able to help them and the next logical step in their journey to obtaining an answer, they will more than appreciate it!

In my experiences in doing this, it has paid huge dividends, although certainly not my intention initially. If the patient has not come back themselves they told people of their experience and referred new patients in my direction.

The message here for patients is to not let anyone tell you that this is as good as it gets!

Yours in Health,

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    Ryan is a Registered Massage Therapist, Sport Massage certification candidate and Fascia Enthusiast!


    February 2013