Key Point

• Lessening lifelong chronic pain through bodywork can often require a lifestyle change for clients after the healing begins. 

“I guess I’m having a bit of a hard time with this,” my client said. “I’ve been in pain for so long that the experience of not being in pain when I go to bed is completely new to me. Not only did I think it not possible, I’m surprised at my difficulty in accepting it. Please understand, I’m thrilled, but surprised and almost confused.”

It was so interesting to hear this from her, especially given the circumstances of how she came to my office. She presented with left-sided mid-back pain that had been unrelenting. Her first session was memorable in that her reticence at trying this approach was palpable. She drove over an hour to get to my office, and when people come from a distance, I always want to know how they ended up at my door. 

“My son made me come,” she said. 

“Do you mind explaining?” I asked. 

“Well, I have been in pain for a long time, probably three or four years. I think my son just got tired of me complaining, so he did some research on the internet and came up with your name. I know he means well, but I’ve already seen many doctors and practitioners, and nothing helps. I think it might be time to just accept that this pain is part of aging and nothing is going to help.” (Her son had accompanied her to the appointment. Later, I found out that he did so to make sure she actually came to the appointment!)

“Have you tried other hands-on therapies?” I asked.

“Yes, I have already tried massage therapy a few times and with three therapists,” she said. “I’ve also seen two chiropractors. If I get any relief, nothing lasts longer than a day. I’m not sure how this is going to be any different.”

“Was the work you received very meticulous, thoroughly examining the tissue with a very focused approach?” I asked. 

“I’m not sure what you mean by focused,”
she answered. 

“I think you will see when we start working,” I replied. 

During our first session, I spent little, if any, time verbally explaining what I was doing and why. This was a judgment call, but I felt she would take that as another therapist trying to convince her on the effectiveness of the approach taken. I could sense she had enough of that in the past. Instead, I let the meticulousness of the work do the talking. 

On physical examination, I noticed an anterior and internal rotation to both scapulae and a slight right rotation at the T3–T6 level. Perhaps most importantly, the left upper ribs were restricted during respiration, with an alternating restriction pattern. Treating the muscles involved revealed some progress in rib movement, and I treated muscles around the costovertebral junction as well. 

At the second session, she reported that she felt better for a day, but not longer, about what she expected. Even with these underwhelming results, I could sense she was intrigued by the work, to the point of asking more questions about what I was doing and why. 

At the third session, she seemed to struggle to explain her results. I didn’t push her, but her statements were contradictory. She stated that everything was pretty much the same, but then added that she was moving better and doing more activities than before her first session. I found the tissue we had been addressing to be less sensitive than previously, yet I was concerned that she didn’t report a diminishment of pain. 

It was at the beginning of her fourth session when she relayed her feelings cited at the beginning of this column, her difficulty in accepting that change and improvement were possible. In our conversation that followed, she admitted that she had resigned herself to a life of increasingly limited activity and a daily ritual of dealing with her pain. Having the pain so markedly decreased was a major shift, one that affected multiple aspects of her being in the world. All this was new territory, far more emotionally complex than simply feeling relief and resuming one’s previous life. 

Two points are important here. As to the work, focus matters. Meticulousness matters. Skill matters. We therapists need to hone our skills relentlessly to create real and lasting improvements for our clients. Secondly, for the client, a significant lessening of chronic pain is an adjustment, just as the onset of pain requires an adjustment. Unless thoughtfully integrated, the system is likely to reestablish itself, reverting to the known world of status quo. The work isn’t done when the pain is better—the next phase is just beginning.