“Good morning,” I said as I greeted Mrs. S. in my waiting room. “It’s wonderful to meet you. Thank you for being here. If you would like, you can bring your things with you back to the room.”
Observing the guarded way Mrs. S. turned to pick up her coat and purse, I had a pretty good idea of the problem at hand. This was confirmed as we settled into my treatment room. I could see Mrs. S. hesitate, looking for the right words to convey what she felt.
“Essentially, no one knows what to do with me,” she began in a rather exasperated voice. “I have seen many health-care providers over the last several years, but I get the sense they do not understand my situation. Everyone tries to treat my neck, but I think my muscles don’t know how to respond appropriately anymore. Most often, the intervention leaves me worse off than before. Exercises often make me worse. The effect isn’t always immediate—it might take two or three days—but I am in much more pain after doing them.
“But if I don’t do anything, I will never get better. It’s like my neck is excessively weak and sensitive, but I suffer when I try to do the exercises. It’s a damned-if-you-do, damned-if-you-don’t situation.
“Honestly, I am not even sure what I am asking of you. In the past, massage has made me worse, but several people suggested you might approach this differently. I am wondering how different your treatment could possibly be, but I am willing to explore this with you.”
 “Any presenting symptom, such as your neck pain, is the end product of a whole system of underlying factors,” I responded. “If we change the underlying context, we will affect the outcome. The direct approach is to treat the symptom; the indirect approach is to change the context that created the symptom.”
“How do we do that?” Mrs. S. inquired. “One more thing to complicate the issue is that I don’t do well lying on a massage table.”
“Have a seat in front of me and let’s explore some possibilities,” I instructed. “First, I am going to ask you to rotate to look to the left.”
As she rotated to the left, the protective guarding of her musculature was amazing to observe and palpate. The image that comes to mind is stepping on the gas and then immediately hitting the brakes.
“Let’s try something,” I suggested. “Rotate as though you were going to look to your left, but do it with no movement in your neck at all. I want you to feel all the movement coming from right here,” I said, placing my hand over her thoracic spine.
Using my hands on her thoracic spine to enhance her proprioception of the thoracic spine in rotation, I had Mrs. S. look to her left again. It took her several times before she was able to differentiate cervical motion from thoracic motion. Once this was clear, I asked her to move only from her cervical spine, inhibiting movement in her thoracic spine. She was clearly hesitant to do this, fearing that it would cause pain. Assuring her that she should only rotate as many degrees as was comfortable, I guided her through this process multiple times.
During all of these movements, my palpation of her tissue was key. At first, the role of the palpation was simply to listen, not intervene. My hands told me which muscles were engaging and when. Once I knew what was happening, my hands could then either enhance or inhibit movement. This information, in turn, was communicated to her nervous system via my touch, revealing that muscles work in concert—that looking to the left is an experience of the whole spine, not just the neck. My hands acted like a mirror, revealing Mrs. S.’s nervous system to itself.  
 We continued to explore rotation in three ways: cervical only, thoracic only, and a combination of both.
“That’s pretty cool,” Mrs. S. said. “I never knew I had so many choices in how I move.”
“You only have a choice when you know what you are doing,” I replied. “My hands and directive instructions have helped your nervous system experience what it is presently doing and explore other possible options for movement. When your body has choices, you can move by design, not by default. Touch can be a way to learn as well as to treat.”
In the ensuing weeks, Mrs. S.’s muscles became much less hyper-reactive, allowing me to work more directly. She is now slowly incorporating some stretching and strengthening exercises into her daily routine. Most importantly, Mrs. S. is gaining confidence that there is a way out of the pain—perhaps the best outcome of all.

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.