Accompanied by her mother, my newest client (a young girl of 14 years) carefully described her symptoms.
“This pain began several months ago—actually more of a deep ache than a pain. It was gentle at first, then increased over time. Starting first in my calves, it spread to my ankles.”
“Was it more on one side than the other?” I inquired.
“It started on the left, but quickly spread to the right as well. The pain has kept me from doing many of my favorite activities. Now, my knees hurt and I cannot play soccer, basketball, or any other serious athletic activity. In fact, just going for a walk is hard. The longer this goes on, the more limited I am.”
I informed Miss D. that, using my hands, I wanted to explore the musculature of her legs. The moment I pressed on her tibialis anterior, she recoiled in obvious discomfort. Pressure on the posterior calf created the same reaction, as did any pressure near the ankle. Sensing that further palpation in this area was unwise, I decided to go elsewhere.
I cautiously palpated the rectus femoris about mid-thigh and again Miss D. recoiled, but slightly less than when I palpated her lower leg. With so much widespread pain, I began to think about other possible mechanisms and explanations. Turning to her mother, I asked whether they had consulted a physician.
“That is part of what makes this situation so perplexing,” her mother said. “My daughter does not seem to fit into any of the traditional boxes, and no one seems to want to pursue treating her pain because it isn’t life threatening. It is, however, life altering. We are at our wits’ end.”
The mother went on to describe the copious number of health-care providers they had seen. All of the medical conditions I would be concerned about had already been explored. With these eliminated, I could explore the soft-tissue possibilities safely.
After speaking to the mother for perhaps five minutes, I happened to notice that Miss D., while lying on my table, had been applying pressure to her throat the whole time. Her mother, aware that I noticed her daughter’s rather peculiar action, felt compelled to explain.
“My daughter often applies pressure to the front of her neck. Whenever there is a moment, especially when she lies down, she presses her throat.”
Miss D. looked rather embarrassed at having
this revealed to me, but she did not take her hand off her throat.
“Generally, we do what we do for a reason,” I assured her. “There must be some reason you find pressing on your throat helpful.”
“I don’t know why, but pressing here seems to help me feel more relaxed,” she said, gesturing to her throat. “It just quiets me.”
“If I am gentle, may I explore the muscles in the front of your neck?” I asked. “Perhaps there is a reason that pressing on them is helpful.”
I began with a mobility test of her hyoid bone and discovered it did not move symmetrically. Movement to the left was restricted, implicating the omohyoid and digastric on the right. After releasing these muscles, I retested the mobility, finding it much improved. I showed Miss D. how to move her own hyoid to relax and mobilize the muscles attached to it. This movement gave her both a measure of comfort and validation. The sternohyoid and sternothyroid were very sensitive bilaterally, as was the sternal head of the sternocleidomastoid. I showed Miss D. how to self-treat these muscles as well.
Returning to her quadriceps muscles, I replicated the exact pressure used earlier in the session and Miss D. did not react or recoil. Increasing my pressure, I was able to thoroughly explore and treat the quadriceps, locating and isolating selected areas of restriction—a far more normal reaction. I could see that Miss D. and her mother were astonished at how quickly the leg sensitivity had diminished after treating the girl’s neck; an explanation was in order.
“The reason the neck treatment affected the lower body so dramatically has to do with central sensitization, an overexcitement of the central nervous system. You could think of the central nervous system as a master volume switch: if it is overexcited, everything below it will also be excited. Conversely, turn down the volume in the central nervous system and everything below quiets down in response. Research has shown that certain areas of the body, such as your neck, can cause central sensitization much more quickly than other areas. By quieting a powerful source of input like your neck, the rest of your body also relaxed, making it possible for me to massage your legs more precisely. Pretty cool, huh?”
“Very cool!” Miss D. exclaimed.
“That seems like magic,” her mom said.
“Just the magic of our incredible nervous system,” I responded.

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.