Walking down the hallway to my waiting room, I was thinking about how much I enjoy seeing new clients. Each one is an unfolding story, with both a mystery to be solved and lessons to be learned for my client and me; a session is truly a collaborative experience. In my waiting room, I was greeted by two vivacious women—a mother and daughter—whose smiles lit up the room. Their delightful presence was all the more amazing given the sad story that was to follow.
Sitting in my office, the daughter, Ms. P., relayed to me the story of her painful odyssey over the last two years. Ms. P. had been a fairly active person who radically changed her diet and exercise regimen during her second year of college, hoping to get in better shape. For about seven months, she followed a strict schedule of running a few miles on a treadmill six to seven times a week (with the treadmill set to a very high incline), supplemented by stretching and an occasional hot yoga class.
After about eight months, she began to feel a buildup of knee pain on the underside of her patella. A few days after she noticed it, her knee pain went from annoying to severe. Since then, she has experienced constant knee discomfort and, at times, excruciating pain in the patellar region of both knees.
Her mother added to the history by listing all the health-care providers her daughter had consulted. The list was long and included primary care physicians, four physical therapists, and several orthopedic doctors. On the good-news side, there was nothing obvious in the X-ray findings or on any other test that had been conducted. She had been seeing a physical therapist for over a year, but the treatments (stretching and strengthening) hadn’t made an appreciable difference.
“What an ordeal you have been through,” I said, leaning back in my chair. “I’m sure it has been very difficult for you, and your parents as well.”
“I just want you to know that I have been proactively and religiously following the physical therapy program. My physical therapist can vouch for my commitment, as I see her regularly and she continues to monitor my progress. A year later, I am still forced to make concessions in my daily life to accommodate my knee injury, even recently having to break my lease to transfer to an apartment that is on the first floor.”
Something in the tone of her voice struck me, as if her commitment and dedication to the therapy had at some point been in doubt.
“Has anyone done specific soft-tissue work on your legs?” I asked.
“The physical therapist has been doing stretching and strengthening,” Ms. P. replied.
“No, I mean focused massage strategies.”
“She has done a little massage on my quads.”
Not knowing what exactly “a little massage” meant, I decided to start right in. Examining first the vastus lateralis, then the rectus femoris, I sunk into the tissue with my fingers, moving slowly and methodically with deep friction in the fiber direction of the muscle.
“Whoa,” Ms. P. said, as I found an exquisitely sensitive area. “No one has done that before.”
Moving the rectus femoris aside to address the vastus medialis, I could feel Ms. P.’s body react.
“I can feel that right under my patella,” she said incredulously. “That is the pain I feel under my kneecap.”  
“Perfect,” I replied. “I am going to hold the pressure as long as this is tolerable, until there is a substantial reduction in the pain at your knee. Tell me when that happens.”
At one point, I looked up to notice that Ms. P.’s eyes had filled with tears. Starting to pull back, I was about to admonish her for not telling me the pressure was too much.
Sensing my reaction, she shook her head. “The pressure isn’t too much,” she said. “This is so confirming. If you can press on my leg and recreate my knee pain, it means that my pain is real and that I am not making this up.”
Now Ms. P.’s remark concerning her dedication to the physical therapy program made sense. Her defensive reaction is reflective of so many people who have suffered chronic pain. They often feel invalidated by health-care providers and even family and friends. If no observable pathology can been seen, or if typical treatments don’t work, the validity of the patient’s experience may be called into question.
Those of us in the massage therapy profession should celebrate how confirming touch can be for our clients. If we can directly replicate a presenting symptom, the relationship between the area being touched and the pain is obvious to everyone. Whatever the beneficial physical mechanisms are, the emotional effect is just as powerful.

Douglas Nelson is the founder and principal 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.nmtmidwest.com, or email him at doug@nmtmidwest.com.

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