Like “stressed” and “traumatized” before it, “burnout” has become the new repository for all manner of presenting symptoms, both physical and mental. As we pick up our tools and get back to work, this particular time in history calls us to our deepest motivations: to set a straight course into an uncertain future.

Your deepest purpose can often be found by rummaging around in your origins: What got you involved in this work? No matter what form of manual or movement therapy you practice, 9 out of 10 of us arrived here through our own wounding. In my own case, it was not a direct injury that was healed by bodywork, but rather the curse of being the awkward kid, never “fitting in my skin,” as the French say. Deep touch brought me into myself, and (re)started a long and joyful relationship with my movement and my emotional, sexual, and spiritual self these last 50 years.

After many years of practice, my mature work has returned me to my wounded roots: As we come progressively out of the pandemic and back into touch with each other, I want every child to get the kinesthetic life skills I missed out on. I was stuck in a little metal desk in front of a blackboard. Our kids are jacked into a beanbag chair in front of a screen.

As a career therapist, I can say this with assurance: An updated version of physical education—a real education in how their body works for our kids—would go far to alleviate a lot of the problems we deal with daily. Instead of a bright focus only on athletics, we need a User’s Guide to the Human Body course for this generation of electronified children. Anyway, that’s my own personal crusade based on my particular wounding.

We all have wounds, and they are the key to healing—if not to full healing, at least to finding your true purpose in this lifetime. “Freedom is resting easy in the harness,” said my teacher Peter, his little chuckle hinting at how difficult this simple task might be. Parents learn this lesson early (or don’t, and then struggle with their children).

Regardless, if you can find a harness that fits your shoulders and a load you can bear—well, there are worse lives than service. But we were talking about burnout (I promise, we will come back to the part about wounding again at the end).

As we return to work (or maybe you have been working full time all along, but here comes a new world anyway), some of you—and a lot of your clients—are burned out. People often compare this physiological state to running out of gas, but the more proper analogy for burnout is lack of lubrication.

For most of us this past year, parts of our motors have been running on overdrive, while other parts have turned over only lethargically, so burnout is the screaming of those loose belts and ungreased gears turning too fast for long-term health. Is it fair to say that “tired” is low imbalance at the end of the day or the week, “stressed out” is the same deficit at the end of the month, and “burnout” is the same process after a year? Depends on your innate resilience, and the words blur into each other, but it’s something like that.

What to Do with Client Burnout

The rest of our discussion applies to clients, but hey, you are smart enough to see where it might apply to you as well. Beyond the usual bromides we’re all doing our best with already—diet, sleep, exercise, and personal connection (tell me about it)—what can you do as a bodyworker to help restore an integrated purr in a client’s physiological motor?

To wring the last bit of fuel out of this body-as-machine metaphor, we want the engine to be capable of dropping to a low idle when there’s a chance to rest and repair, while still being capable of revving up when power or speed are needed.

Stress—or, more properly, continual unresolved stress, which science calls “distress”—revs our motors up to a high idle, preventing parasympathetic self-repair and the restoration our organism needs regularly to self-maintain. This past year has been a transparent model of what continual stress does to us all.

Consider the balancing act your body performs—to so many different rhythms. Your eyes recreate the visual world many times per second, constantly reconciling what’s seen now with what’s been seen before. Your heart rebalances, spinning out a gout of blood about once a second. A relaxed breath balances your blood every five seconds. The fluid in your head waxes and wanes several times a minute. Peristalsis moves your food. Every few hours, your kidneys force you to find a place to pee. Once or twice a day, you rebalance by defecating. Every 28 days, you shed the lining of your fruit. And so on, with a hundred fluctuating waves that constitute our minute-to-minute high-wire act. When the idle runs high, repair runs low, and it is a matter of time until whatever part is weak starts to whine or just seizes and quits.

The chemistry of stress is well documented, so follow your own lights with supplements or medications or vagal stimulation—not my bailiwick. But can we change our chemistry by other than chemical means? Yes, with hands-on work, by working in from the other end of the equation.

What do I mean? Instead of approaching burnout from an emotional or chemical vantage, what happens to the movement system? First, sensory data from the tissues—principally but not exclusively from the fascia—up to the brain gets distorted. Any bodywork or movement work can help return accurate reporting up the proprioceptive and interoceptive tracts—you accomplish that every day. No matter how you practice, greater awareness is our most important offering. And sure, getting into the sore places is great, but better yet, see if you can find a way to touch or move the silent but short areas that will free clients to resolve the strain patterns that led to the pain patterns in the first place. So, first, some places in the sensory body image get lost.

Second—and this relates more to the burnout part—an anxious brain with unfulfilled needs (“You can never get enough of what you don’t really need”) is constantly pumping out extra signals down the motor nerves to the muscles. The motor nerves are the only way “out” of the brain. You get input from eyes, ears, body, and the rest, but all the output goes to your muscles—striated and smooth. Thus, we are all carrying a muscular “set” with which we confront the world. It might be open and easy, or it might be shut down and protected in the front and thus breathless. Or it may dramatize, scampering away from the back with a sucked in and pushed forward pelvis. Or the spine curls in on itself in grief—we all have a complex “set” built up over years.

The Neuromyofascial “Set” and Habitual Responses

The neuromotor set can be coupled with a lot of emotional force or only a little—it varies by person—but we are all somewhat controlled by our habitual responses. This habitual response is “noise” in the motor output of the brain. Burnout increases the neural noise, and the resulting muscle tension leads to more holding and more pain. Our job is to break that cycle.

So, our second job—and it is a higher calling than simple awareness, as powerful as that can be—is to facilitate client resolution of this noisy overdrive.Unfortunately, there is always some “noise”—the anxiety that we’re not moving fast enough, that “somebody might be gaining,” as Satchel Paige said, may produce constant underlying tension in the hamstrings, tension we are not aware of.

These tensions accumulate over a lifetime, and gradually both mind (habit patterns) and body (your fascial fabric) take on that pattern as a permanent fixture of your posture. The amount of change we all needed to adjust to this past year—and likely for more years to come—has either temporarily or more seriously overcome the habitual responses in some of us.

Burnout, on the other hand, denotes a particular kind of tired. “I can’t go another step,” complained my 8-year-old friend on a hike. Stop for a few minutes, and she’s soon happily ranging on ahead again. Tired—no matter how tired—can be fixed with sleep or rest. Burnout, however, is still there in the morning, or comes on quickly as the day progresses. Burnout occurs when the requirements outstrip the resources over a sustained period of time, and the body switches to a defensive maintenance mode.

These days, I feel the fierce urgency of more touch connection—just to sit down and laugh over a meal, for crying out loud—as an ongoing tension in my low belly and low back. This constant output into our muscles costs energy, and in turn stifles sensation, so opening up your clients to these neuromuscular patterns becomes the doorway out of burnout.

Resilience—“things may be bad, but I can cope”—implies more fuel in the spiritual tank, even if it comes from reserves. True burnout—what used to be called a nervous breakdown—implies all the usual spark is gone. We’re all aware that we’re running faster than we are being restored, especially for anyone on the front lines: nurses, mothers, and check-out clerks.

How do we restore resilience? When you feel resilient, you feel inside that you can muster the resources to stay centered, whether it is to keep yourself safe or keep moving toward a goal. Increase your resilience and you’ll reduce your burnout.

I will leave it to your own training and skill set as to how you tackle this in a session of your chosen modality. All modalities, practiced with awareness, can be helpful in this regard. A coordinated program of deep-touch sessions can definitely help such a “whole-person” event as burnout. Proceed with confidence and be patient—results usually do not appear until six sessions or so. The remainder of this piece discusses some global concerns in building a self-care component into your clients’ daily activities.

“Homework” Framework

No matter how good your work is, it will be more effective if the clients live into the new space and make it their own—we all know this. And the resources for generating a wide spectrum of self-care are legion, available all over the internet or indeed in recent issues of this magazine. (See Heath and Nicole Reed’s feature article, “Tending to Our Hands,” on page 44 of this issue, and their Savvy Self-Care column in past issues of Massage & Bodywork magazine for more self-care practices for massage therapists and bodyworkers.)

Having made every frustrating mistake in the book trying to inspire my clients during my nearly 50-year career allows me to share some overarching concepts I find useful, and I hope you will find them helpful too (but, please, interpret all of the following into your own practice as you see fit).

With a few clients, especially if I have not started in on “homework” from our first session, broaching the subject of support work is difficult. I usually go for the direct approach: “You know, you’ll get more bang for your buck if you do a little support work between sessions.”

Regardless of the actual homework you assign your clients, you are inducting them into a self-care routine, which is also an attitude. So many people have lost this attribute—many in the pre-COVID, “easy” days before the world shut down. Now, the long-term lack is clear, and the need is urgent: Care for the self, from the self, is important, since outside stimulus has not been forthcoming this year. Treat yourself as a person worth cultivating.

Make It a Project

As you introduce any homework/self-care practice to a client, think ahead. What is your goal? What is your goal for your client? I look for a “We’ll be done with this exercise when you can . . .” statement, and get the client’s agreement for the goal. If you hear the question, “How long should I do this?” you should have an answer ready—a definable state they can achieve. Corrective homework that is open-ended and does not have a specific goal tends to spend its energy and fade all too quickly in the client’s mind.

After that project is done, you may have another goal to set with them. Or the first project may have been in service of a larger goal. Either way, keep the goals project-oriented with an end in sight. Too many times I get an exercise from a therapist without a goal, so the whole experience becomes endless and discouraging when I am at home.

A client can handle missing a benchmark, but without them, it’s harder to keep the inner child interested. “OK, we’re going to try these deep calf raises for a month—if we don’t see improvement in your arches by then, we’ll look for another strategy.” That statement falls very differently on the ears of the client than: “Do these calf raises to strengthen your arches.” Be as specific as you can about how or when the project reaches its sell-by date. Set and monitor reachable goals. Think about how much you like to hear, “Good, you got that, now let’s go on to the next thing.”

Start Small

Even with the athletes and everyday mat yogis, I start small. “How many minutes a day will you give to this project?” If they answer an eager “15,” I give them something under five. If they say “five,” I give them something under one minute.

Also among my arsenal of homework assignments are items to be remembered moment-to-moment. Like, “Every hour you’re at work, I want you to drop those scapulae down your back about 80 times—any time you think of it.” Or “Every time you’re waiting for something, take a few seconds to center your pelvis back over your feet.”

If they come back and they haven’t done the homework (all too common), make the assignment smaller. No shame, no blame—we’re all busy and distracted. Say, “Well, how about we try this then?” And then go for something shorter and easier, which leads you to the fruitful meditation: What is the minimum change this client could make that would have the maximum benefit? More is not better; more is much worse. If your client doesn’t take it, all the good advice in the world you can think of is not just useless, it’s damaging. It puts you in a parent position, which is a bad place for a therapist to stand—and a hard one to get out of once you have put yourself in it. Guard against “good” advice. Instead, look out for effective cueing.

Cue to the Change*

*This is a phrase I believe I “stole” from Judith Aston (astonkinetics.com), but it is an especially important concept when you want to change a common body habit that a client’s “set” makes them prone to. (Make sure they know the “bad” place, as well as the “good.”)

For the office worker prone to lifting her shoulders to her ears when stressed, it is not a winning strategy to say, “OK, now your shoulders are down in a good place—keep them that way.” She won’t. It’s a habit. Despite your good work—especially at the beginning—those shoulders will go up again as soon as the boss is around or she’s tired.

A better way to approach this is as they are ready to leave the session (after they’ve dressed), give homework. This is the time when they are as close to the condition they will be in when the habit strikes again. Discuss the process of getting from A to B by saying,  “Here’s what it feels like with your shoulders up—feel that? Now drop them down your back, as if you’re putting them in your back pockets—feel that? Now up. Now down. What do you do to drop them?” And so on, until they can easily go from their “bad” to your “better.” Take your clients through these homework exercises several times, so they really know the difference. I do this commonly with shoulder position, or taking a breath for those who freeze, or centering the pelvis over the ankles for those who are “ahead of themselves,” and a bunch of other little corrections that can be done to make deep pattern change more likely for your clients. Other times, I really am giving them a strengthening exercise to do, rather than a postural awareness, but the same principles apply.

In each case, I reserve a few minutes before they go out the door to cue to the change. “Here’s what you feel like when you hold your breath. Got that? Not very fun, is it? When you feel like that—and you likely will—just swing into an inhale, letting your upper ribs lift. Yup, just like that,” or whatever it is.

Prepare to be patient. When the client comes in complaining they have to cue themselves multiple times an hour (or per day, depending on the cue), you’ve won. They are on the verge of dropping the compensatory pattern—persevere a little more, and suddenly it is just gone, and they are not complaining anymore. You can then go on to the next challenge.

Anchor the Cue

For cueing the change to work well, you need to know a little about your client’s activities. Some cues work well anchored to exercise or another daily practice the client does already. The woman in the office likely needs to cue to interactions: “Every time you listen to someone talk, take a second to drop those shoulders.” Does the guy with the forward pelvis use the ATM a lot? Cue him to remember about centering his pelvis every time he’s waiting in line.

Find some concrete moment in their lives you can link to the cue that will make both your lives easier. Phrases like “When you get out of bed . . .” or “Last thing before you sleep . . .” can be good cues to jog their memory. Exception: Do not cue moms to their kids’ behavior. Moms (OK, some dads too) have a special state that is so totally unselfish, so focused on their child, that this is not a time for them to think and make a self-correction. Lots of my cues to parents start with, “When you feel their breathing finally drop into sleep, and before you go clean up the mess, just stand up for a minute and (insert body cue here).”

Build Strength by Exercising the Mental Muscle

These mental cues—however you couch them, and however the client receives them—are the basis for your clients to build a practice of self-attention and self-care. In my own case, my mother’s attempt to teach me ethics—“You should think of other people”—got translated as “It’s a sin to pay attention to yourself.” By the time I got to bodywork in my 20s, I could feel almost nothing and had little control over my inner workings. It took a while to build up that skill of being able to scan and read myself, a skill that is second nature to some, but I had it bred out of me.

True self-care is a muscle that most of us must exercise, or it gets lax. As we build strength in this muscle, it can take heavier loads. So, just like training, start small, do many reps, get some successes, and then (and only then) increase the load.

Do not mistake self-care for self-regard, which is altogether less attractive. It is easy to tell the difference: Self-care asks questions arising from inner feeling, while self-regard asks questions about how things look from the outside. People with high self-regard are often so empty in the middle, it is very hard for them to go there. Acts of service, if they ever get around to it, are good cues for those narcissists like me. When building a mental muscle of self-care, clients should start small with doable projects and avoid “injury” (too much homework). Soon you will have a client capable of taking on the bigger issues in their lives and bodies.

Resolve Stressors

Much of our contemporary stress handling devolves into displacement behavior. My older brother rags on me. He’s too big and powerful for me to confront directly, so I rag on my younger sister to disperse the feelings and chemistry within me. Continued unresolved stress induces displacement on the way to becoming endemic distress.

Displacement is often accompanied by the words “So I . . .” as in, “Work is crazy, so I ease it off with a drink as soon as I get home,” or “School is stressful, so I smoke a bowl to make it bearable.” Of all the possible avenues to relieve mental pressure—like drugging, overeating, playing for power—physical exercise and truly consensual sex are the least harmful to the body. 

Better to smash a squash ball than to yell or strike at your employees, as exercise dissipates most of that chemistry as well.

On this planet, at least, no one gets all their wishes fulfilled. So we all have to deal with at least some frustration of our id.

The only response that is not some form of displacement is to resolve the stressor itself. Eventually I grew enough that my older brother could not dominate me, and I stopped having to dominate my sister. Of course, not all stressors are so easily resolved, and not all stressors are resolvable. When my dad died, I watched my mom like a hawk for the year after. They had been together 60 years, and there is no resolving the stress of a lost mate. She weathered it and lived a full life for another 20 years.

If you get to a place with the client where they have built their inner sensing muscle, you can start moving them toward the resolution of the actual stressor. This is not easy, and sometimes requires outside psychological expertise, since the obvious stressor is not always the actual one. You know this: The problem with the boss may be built on a much deeper original problem with the father figure, for example. The hunger for a mate is built on a hunger for attachment that was thwarted starting on day one. No one is asking you to be a psychologist, but all these knots have body components, and your bodywork can help expose them for resolution. In fact, I would say absent a change in the body, psychological insights and victories tend to fall flat.

Without being a psychotherapist, you can point your client in the direction of the real stressor, the real disparity between how they construct their inner world and how the outer world appears to them. When the two coincide, you live happily. To the extent that they diverge—boy howdy, haven’t our expectations and reality parted company this past year—there will be stress, the gears will whine, and eventually something will break.

Some stress is resolvable; some is not. My mother could not bring her husband back. We cannot wish COVID away. What we can do—for ourselves and our clients—is expose the (minimum) two conflicting urges inside the stress. One of those urges is to move against the stressor, and that movement is highly specific to each client. Another inner urge inhibits movement because the original move was too risky. For most, once the two urges are exposed and cleared emotionally, the outer stress, whatever it is, can be borne more easily. Ultimately it comes down to the old prayer, “God, grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference.”

Your Neuromyofascial “Set” of Posture in Action

To feel how your neuromyofascial set works, lie on your back on a floor or a mat, legs out straight. Put your attention in your spine. Notice where it touches the floor, where it doesn’t, and note any tension you feel there. Everything I want you to notice is going to happen in the first half-second—I am inviting you to look at what happens when you prepare to move.

Now lift one heel off the floor. An inch will suffice—your spinal muscles, joints, and fascia “set” themselves to handle the weight just before and just as you make the movement. Do this a number of times, relaxing in between and watching what happens when you just start to think about beginning to lift your leg. The “set” of your spine and hips as you take the load is a combination—honed over many years—of neural messages to muscles, the muscles strengthening as they can, and the fascia providing the force transmission. Failure or deficit in either the muscles or the coordinated messages will result in gradual densification and stiffening of the fascia to make up for the loss in stability.

For comparison, calm yourself and pay attention again as you lift the other leg an inch or so. Do that a few times. Can you feel a difference between how the two sides handle the added strain? Remember to take a little rest between changing sides, so you can perceive the differences clearly.

If you are not feeling it, put a finger lightly on each anterior superior iliac spine on the front of your hip bone, and then do the test. It’s dollars to doughnuts that one side of your pelvis twists more than the other, one finger moves up more than the other. Almost no one (but the most balanced athletes) have a bilaterally symmetrical response to load.

Can you create one? Can you create a “set” that allows both sides to remain in place (which a dancer would appreciate) or at least move the same (which your low back will appreciate)?

Make Meaning

If we resolve all our stressors, will life make total sense?

No, it will not. We humans are sense-makers, meaning-makers. It’s our job as humans. And it’s never done.

Achieving a fully upright posture, or a strong core, or a perfect wheel (backbend), or a four-minute ice bath, or a fully open breath are not ends in themselves. They are signposts on the way to a body cleared of the “noise” that accompanies burnout. Finding meaning is a complicated and subtle assessment that requires the lack of noise to even get close to.

For many of us, faith in God or a credo provides the matrix of meaning. For some, the matrix has been transferred onto another spiritual path. For most people, though, there is a middle layer of personal meaning to their lives, which is there to be discovered and then hopefully lived through.

In my own case, finding Ida Rolf and structural bodywork has given meaning to my life, a meaning that was at first only sensed dimly (though firmly) but couldn’t be articulated. At this far end of my career, with my dedication to a new program of somatic education, that meaning (which was present all along) is now coming to fruition. Maybe it will turn out well, maybe badly, but the meaning to me is clear: Sensing + Doing = Meaning. Meaning is both the sensory side (getting accurate signals from the body) and the doing side (being able to translate the sensory data to effective movement) that translates into deep and emotionally satisfying meaning.

Understanding “meaning” in itself does not spell success or failure in the outer world. It is possible to understand your inner meaning and still fail in an attempt to love, or to act on creativity or ambition.

To return to our beginning, though, is in the act of facing that inner wounding where we find the deepest resolution to our human dilemma—win or lose. There is no great satisfaction to winning at the wrong thing—you just feel like you fooled ’em again. But it is surprisingly satisfying when we lose if we are barking up the right tree. Building the muscle to face our wounds is something we can build into our homework. It is a call to the self-care we so desperately need right now.