There are about as many categories of soft-tissue dysfunctions as there are types of nut butters in the grocery store, so we cannot expect to know them all when we walk out the door of massage school—or perhaps ever. It can get a tad overwhelming.

There is the sports injury, the car accident injury, the work injury, the overdoing it injury, the underdoing it injury, the poor nutrition injury, the under-hydrated injury, the no-sleep injury, the yelling-at-kids injury, and, most recently, the quarantine injury. (This last one includes gray hair and wrinkles, which I only wish could be treated with massage.) Thankfully, though, we can narrow this down a little and talk about a subcategory that falls under all these headings—the persistent injury.

As bodyworkers, we know our work is not a one-visit-and-done type of situation; the work we do involves changing the way tissues operate, and this is no quick fix. Receiving bodywork is like going to the gym. You are not going to get buff after one visit. You are also not going to be a good artist or writer or musician or ostrich farmer after one attempt either. These things take practice. And so does healing.

Plantar Fasciitis, For example

Let’s take a hard look at plantar fasciitis, which is something we see quite often in our clinics and on our tables. Plantar fasciitis is a soft-tissue injury that typically comes from overuse or improper footwear, and it is theoretically treatable with the right techniques. Why, then, does it persist?

Like the skin from a clove of garlic that insists on sticking to the garlic, then the knife, and then to your finger, plantar fasciitis stays clinging to your client’s foot like it’s on a mission, with the tenacity of a child on Christmas morning. Like this child, when we are dealing with a tenacious tormentor, it takes an equal amount of tenacity to confront it.

If you think about it, plantar fasciitis is the combination of muscle tissue pulling in one direction and connective tissue straining to give us some sort of stability—kind of like a magician trying to yank a tablecloth out from under some dishes, except we are the dishes, and the tablecloth is glued to our feet. There are a lot of things happening here that are screaming dysfunction, but the main focus is that the muscles won’t stop yanking, and the connective tissue won’t stop sticking. This is a good thing in the end—they are doing what they are supposed to do—but how do we deal with them when they just don’t know when to stop? The answer lies in the simple truth that, to be good at anything in life, consistency is everything. In healing, this is especially true.

The Practice of Healing

We commonly talk about the importance of practice when learning a new skill, but we don’t often experience this in how we heal. We are used to the quick fixes of modern medicine—the shots and pills that numb the pain. This makes learning how to move through pain a little like trying to speak Russian after only watching a few Russian TV shows. If we are given the tools but are not taught how to use them, giving up becomes awfully appealing.

A massage therapist might be technically gifted and able to utilize incredible skills to work through plantar fasciitis with a client. There might be intricate detail in the muscles of the calf and steadfast patience when manipulating the various elements of the foot. There might even be fancy tools or soothing oils handled like a chef at a Japanese steak house. But, unless we teach that client how to incorporate these tricks into their lives, they will just end up where they started—in pain and unhappy.

Giving a client homework has never been a strong suit for bodyworkers. The idea of telling someone what to do seems to go against the very grain of everything holistic. The reality is, though, that we are responsible for teaching self-care. Walking clients through the details that will keep their tension at bay is more beneficial than any extravagant technique. Assuming they know what to do—and they will actually do it—is on par with feeding your 8-year-old macaroni and cheese and then believing they can make it for themselves next time.

Consistency Creates Results

Allow time at the end of every session to sit with your client and walk them through exactly how to work on their own calf and stretch their own foot. Offer them options of how to stretch, like hanging their heel off a step, and choices of how to self-massage, like using their knuckles if it is too difficult with their thumbs. Be sure, though, not to allow too much leeway when it comes to how often—and how long—these stretches and self-massages should take place. These need to be set in stone.

Lay out a regimen your clients can follow, including how often, how long, times of day, and frequency. Emphasize, in each of these layers, the importance of consistency. And then, be sure to schedule a follow-up session. Make sure clients feel you are on this journey with them—that you are as invested in their health as they are.

Once your client leaves your office, set a couple of reminders to check in with them before they return. Exemplify what consistency means. This will reinforce all the work you ignited. Remind them that their practice and energy are the missing elements in what it truly takes to heal.

Dr. Strange: How do I get from here to there?

Ancient One: How did you get to reattach severed nerves and put a human spine back together bone by bone?

Dr. Strange: Study and practice. Years of it.

—Marvel’s Dr. Strange