“That’s my killer stroke,” my client said emphatically. “Every player has a power move, and mine is the backhand. For many tennis players, the backhand is their weaker stroke. Knowing that, opposing players will aim the ball to the backhand side. When they do that to me, they are unknowingly playing to my strength.”
From Mr. H.’s facial expression and the intensity of his gaze, it was obvious he was closely observing me for confirmation that I “got” what he was saying and how important it was. As a high-level tennis player, he was used to reading an opponent’s body language. He was using the same skills of observation on me now. In my experience, high-performance clients, such as athletes, dancers, and musicians, want assurance that their health-care provider understands the specific demands of their chosen field. Without that specific understanding, broadly applied strategies more appropriate for the general population are likely to fail. (I remember one client who, while he was getting a doctorate degree in the viola, was told by a doctor that he might think of switching instruments. Without hesitation, he asked the doctor if he ever thought about becoming a veterinarian. It would have taken me two weeks to think of a comeback line that clever.)
“May I ask you where you feel the pain?” I inquired.
“Right here,” replied Mr. H., pointing to his lower ribs on the left side. “It started about four months ago. At first, I could shake it off. When it persisted, my trainer suggested that I take some time off, but when I returned to the court, I had lost my edge and the pain was there anyway. Upping the intensity of my training, the pain became much more focused. During the second set of a tournament in Florida, it just seized on me. That was it; I had to withdraw.”
“Do you feel pain at the point of full backswing, the point of contact, or the follow-through?” I asked.  
“Good question,” Mr. H. said, getting in position to demonstrate. “It actually affects all three. During the full backswing, I feel it at the furthest point of the range. I know that I do not go back as far as I usually do. That leads to a change in the point of contact for the ball as I am coming forward. Of course, changing the point of contact affects my accuracy and power. In some ways, the worst pain is during the follow-through, and sometimes I feel a little click in the ribs at the furthest point of the motion. I do not have full range in the follow-through, which affects my accuracy.”
“Everything seems to point to one muscle,” I suggested. I got an anatomy book and showed Mr. H. a picture of the left internal oblique muscle.
“This muscle is what contracts to rotate you to the left, creating the backswing motion. If it has a problem, it will falter at full contraction, which will be at end range. That is the point of maximal contraction and shortness of the muscle fibers. Once you reach the endpoint of motion, the opposite muscle contracts to powerfully propel you into right rotation.”
“If other muscles propel me forward, then why does it hurt the left internal oblique during follow-through?” Mr. H. asked.
“The force of the forward movement has to be decelerated. Guess who does that? The same left internal oblique! Actually, stopping the momentum going forward is much harder to do, which is why the follow-through is painful.”
“What about the clicking?” he asked.
“Here is one likely possibility,” I said. “If you look at the picture of this muscle again, notice the individual attachments to each rib. It is possible that select fibers of the muscle are not letting go at the same speed, which will cause a discrepancy in rib movement. That could account for the click. If that is true, we will find one section of the muscle sensitive to the exclusion of others.”
That is indeed what we found during our session. Very specific fibers of the internal oblique were exquisitely tender, others not so much. Locating and neutralizing these isolated areas was engaging for Mr. H., and for myself as well—his somatic awareness and control was amazing.
At the end of the session, Mr. H. and I reviewed what we did, why we did it, and what the next steps would be. It was clear that he was all-in with the process. I have since heard from his coach that the improvement has been substantial and progressive. It is my strong belief that these results would not be possible without demonstrating a deep understanding of the specific needs of his sport. A deeper physiological understanding can facilitate a deeper emotional understanding, and the sense that someone “gets me.” Both are essential to excellent outcomes.

Douglas Nelson is the founder and principal instructor for Precision Neuromuscular Therapy Seminars, president of the 16-therapist clinic BodyWork Associates in Champaign, Illinois, and president of the Massage Therapy Foundation. His clinic, seminars, and research endeavors explore the science behind this work. Visit www.nmtmidwest.com, or email him at doug@nmtmidwest.com.