My client Mr. R. entered my treatment room wearing a smile from ear to ear and said, “My back hasn’t felt this good in a long time.”
“Any spasms since our last session?” I asked.
“Not since before my last visit, even with the longer time span between appointments. Actually, I felt good enough that I considered canceling, but decided to come in anyway. I felt a significant difference after both sessions, but the effect tended to wear off after about three days,” Mr. R. said.
“In the last session, we focused on your back muscles, but we need to spend some time with your hips today,” I said, laying out the game plan. “The more restricted your hips are, the more your low back tries to compensate by moving more. That can be disastrous for the back, which seeks stability, not excessive mobility.”
I asked Mr. R. to lie prone on the table while I gently assessed femoral internal and external rotation. Finding his internal rotation quite restricted, I targeted the quadratus femoris and the piriformis, looking for tight and tender areas.
Suddenly, I heard muffled laughter through the face rest.
“Are you OK?” I asked.  
“I don’t understand how you seem to know right where the problem is, but maybe more importantly, how can I be so unaware of something that hurts so much? Wouldn’t you think I would know about muscles that are that painful?”
“That is a fabulous question, and one I hear from a lot of people. In a way, it’s similar to what you mentioned earlier about having the beneficial effect of a session wear off in two or three days.”
“How are they related? They seem opposite,” Mr. R. asked.
“The principle revolves around the concept of what you perceive as normal. How does your brain decide what to pay attention to and what to ignore? As it turns out, this is an important question and one that the brain assigns a lot of bandwidth to trying to solve. Much of the physical sense of ‘normal’ happens in an area of the brain called the cerebellum. While the cerebellum is just 10 percent of brain volume, it contains about 50 percent of the neurons of the brain. A big part of its job is discerning the expected from the unexpected. For instance, soon after putting on a shirt in the morning, you no longer notice the shirt sleeve rubbing against your arm while you move. Why not? With the myriad of sensations the brain has the capability to sense, it has to prioritize.”
“That makes sense, but where you were pressing is really painful. You’d think that kind of pain would have gotten my attention earlier.”
“The brain generally asks three questions of every new sensation: What is it? What does it mean? What do I do? It is highly likely that at one time, you were aware of some pain or restriction in your hips. As time went on, however, the sensation of restriction didn’t change significantly in either direction, signaling to your brain that this discomfort is not a severe threat and can be ignored until further review. It became your new normal. It is important to realize that the new normal doesn’t feel any different than the old normal. In fact, time dulls the memory of the old normal. Only when you can contrast them within a tight time frame is there any possibility of a true comparison.”
“You said that is connected to my improvements after the earlier sessions. How so?”
“After our first two sessions, your body experienced a remarkable difference. Since this change happened so fast, you could really compare and contrast the changes immediately, making the difference abundantly clear,” I explained. “The increase in painless movement was dramatic, but the novelty of that change fades over time as the increased range becomes the new normal. Most people only notice these differences when they can observe changes in the ease of a familiar daily activity utilizing that range. Many other people have also stated that the benefits they initially noticed faded after three days. It is only when I point out the increase in their activity level that they realize how much they have improved.”
“So it seems like the perception of normal can work in both directions: it explains how we get worse without noticing or how small improvements can be overlooked. What we call normal is a constantly moving target,” Mr. R. said.
“Our perception of self depends on consistent, accurate, and timely information about the state of our body, and massage is excellent at revealing the nervous system to itself.”
“Well, the message I am getting from my body is that my hips are way too tight,” Mr. R. reported.
“Let’s see what we can do about that,” I replied, exploring the muscular anatomy of the hip with renewed focus.  

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.