Takeaway: When the symptoms span a greater area, step back and consider what larger principle could explain it.

We can learn problem-solving skills from our own experiences or from practitioners in other disciplines. In the following case, both. 

A few months ago, I was invited to speak at a conference in the profession. I was honored to be asked and was looking forward to speaking. Travel went flawlessly, and I arrived a day before my presentation. Sitting in my hotel room that afternoon, I was enjoying the unusual experience of having ample time to go over my presentation. That’s when it started.

As I was reading, I began to feel an ache in one of my maxillary molars on the left side. Within the next half hour, the discomfort increased. I explored the area with my tongue, trying to figure out which tooth was involved. Strangely, I couldn’t decide. I pressed with my tongue, then a finger, then flossed to try to identify the tooth, and I still wasn’t sure (Clue No. 1). I decided to do an online search for “dentists near me” to check if someone had time to see me. (OK, the odds of that happening on a Friday afternoon at 3:00 p.m. were slim to none.) I spoke to three dental offices, but none had any openings. The attitude was pretty much, “Thanks for calling and good luck.” 

By the time I went to the banquet hall to do a sound check for the presentation, my concern was growing. I was now feeling a deep aching pain in my mandibular molars directly below the original area (Clue No. 2). The situation was going from bad to worse.  

Trying to hide my discomfort from the conference organizers, I finished the soundcheck and retreated to my room to rest. While lying on the floor and trying to breathe my way to some relief, I began to feel a familiar pain in the upper thoracic spine (Clue No. 3). 

“You must be kidding,” I thought. “Now?” About two months before this conference, I had struggled with a very painful upper thoracic condition that lasted for about three weeks. Ultimately, the source of the pain was due to a nerve root irritation at about T4–5. So now, on top of my dental issues, the upper back pain decided to resurface and join the party, just to make things more interesting.  

At this point, I was deeply concerned about my ability to present in front of hundreds of people the following day. I didn’t want to put the conference organizers in a terrible position by withdrawing. In desperation, I called my personal dentist at home, having no idea what he could possibly do from a distance. Listening patiently as I recounted my symptoms, he then asked some pertinent questions. 

“Exactly which molar is the issue?” he asked. 

I explained that I couldn’t really tell and that I was now getting pain in the mandibular molars as well. 

“That doesn’t make sense,” he said. “An issue with an individual tooth should be easy for you to identify. Any other symptoms?”

After relaying how the thoracic neural pain resurfaced for no apparent reason, he suggested an explanation that incorporated all my symptoms. 

“What makes sense here is that the trigeminal nerve is somehow irritated, and that’s why you are feeling pain across multiple teeth and into the mandibular branch,” he said. “We know that the trigeminal nerve has far-reaching effects, and it likely is the source of reactivation of your upper thoracic pain. I know you are loath to do this, but I think you should follow a regimen of NSAIDs (nonsteroidal anti-inflammatory drugs) that I can suggest. I think you might be surprised at the results.” 

I was skeptical, but to my surprise, I barely noticed the pain during my presentation the next day. The improvement was dramatic. 

The lesson here? Local problems generally have focal presentations. When the symptoms span a greater area, step back and consider what larger principle could explain it. For example, let’s imagine your client has equal sensitivity in multiple areas of the upper cervical spine. If the problem is local, the sensitivity is focal and highly specific. If tenderness is widespread and diffuse, the source is likely to be elsewhere. 

As problem solvers, massage therapists have the capability to organize our clients’ seemingly random symptoms into a model of understanding that incorporates them in a rational and explainable way. From that model, we construct a treatment approach, and the theory is tested by the results attained.