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Inside-Out Paradigm

By Dale G. Alexander, LMT, MA, PhD

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The Clinical Experience & Your Clients

Participants in my courses are encouraged to understand and accept that when one works with clients experiencing degenerative progressions they must be prepared to fail. This is a sobering and humbling reality for those of us in our profession who clinically serve clients with chronic somatic difficulties, which so often slip through the cracks of conventional medical diagnoses and treatments.

It is important to realize that our best efforts may fall short of assisting our clients to fully regain their quality of life. A client may genuinely need medical care or surgical intervention. And, the fullness of one's compassion and common sense is required when people come to us with terminal illnesses.

Yet often, on the other side of humility can be a discovery that allows us to serve other clients with more knowledge, empathy, and skill. It simply requires awareness and a willingness to learn. We cannot help all, but we can assist many more than we ever imagined.

Here are short versions of some past lessons and subsequent discoveries.

The Clinical Experience & Your Clients - Copyright – Stock Photo / Register Mark Lesson One

Don't assume that the medical care a client has received is completely thorough. A male client came to me with chronic foot pain. Though I was able to assist to some extent, over a 10-year period his problems shifted to sciatica, generalized low back pain, cervical difficulties, groin symptoms, and pain returning to his feet between these other episodes.

What had never occurred to me was that the treatment he was receiving from his physician had allowed his blood pressure to trend higher to the point where systemic pressure was literally destroying the functional filters within his kidneys, the nephrons.1

The discovery portion of this client story is that the lumen of the arteriole blood vessels in the kidneys are quite narrow and thus are more susceptible to damage from sustained high blood pressure.2 The ongoing progression and loss of function of this condition is silent and painless because the kidneys have no internal sensory neurons within their capsules.3 Unless self-testing of urine protein and blood is checked with appropriate test strips, a change in protein content or color wouldn't have been noticed by the average person.4

The Clinical Experience & Your Clients - Copyright – Stock Photo / Register Mark My encouragement is that when a client presents to you with recurring low back, groin, knee, or foot dysfunction or pain, consider their kidneys. Ask about their blood pressure. Suggest they have it taken in both arms, each time. Also, recommend that they have different medically trained people check their pressure from time to time. And, most importantly, if they had a parent or grandparent who had a stroke or degenerative kidney problem we need to regard them differently, with enhanced care and inquiry.

Checking with a former client, a kidney specialist, he further expanded my understanding that uncontrolled high blood pressure may speed the deterioration within one's retinal blood vessels; within the vessels related to coronary microvascular disease and vascular dementia; and with even more stealth — ischemic gut vessel disease.

Lesson Two

If you are unable to help a client, refer them on. We are their "early detection team." This lesson covers a great deal of territory so I will endeavor to highlight these examples in a couple of categories but please be aware that additional categories do exist.

It can be clear during the initial interview with a client that medical testing or additional alternative therapy is needed, however it is not always apparent. As a rule,  I use a three to six session threshold of allowing a client's body intelligence and my perceptual matrix and skill sets as an opportunity to synchronize toward a level of therapeutic communication, which produces positive shifts for them. If there has been little or no progress after that interval, then something more or different is needed.

One category is that clients can present with problems we have never seen, read or heard about. I worked with a female who had precipitously lost thirty pounds. She had seen three different physicians and various other alternative practitioners before seeing me. Cancer and endocarditis had been ruled out. In her case, I had just one session to make a difference, as I was on a short teaching trip to Ohio. The responses of her body were atypical; yet, her immediate responses to my treatment seemed to center around her gastrointestinal function. My instinct was that she had a problem that produced a recognizable symptomatic profile infrequently, so I recommended that she seek the opinion of a physician with at least 30 to 40 years of experience.

Her next physician immediately diagnosed the problem as mesenteric artery stenosis, which is a atherosclerotic narrowing within the lumen of the arterial system supplying the small intestine. With reduced blood supply to the small intestine, nutrients cannot be adequately absorbed, and weight loss follows. The condition usually requires medication or varying levels of surgical intervention. Chronic mesenteric ischemia affects only about one per one hundred thousand people. 5, 6

Another category relates to subclinical infections that "fly under the radar" of standard blood screenings. My clinical experience consistently evidences that such infections contribute to all varieties of chronic somatic dysfunctions. Chronic subclinical infections involving one's ears, sinuses, gums and teeth, tonsils, throat, lungs, stomach, liver, small and large intestines, prostate, ovaries, uterus, and fallopian tubes plus stealth sexually transmitted diseases are most common. Others do exist as well. I believe that bacteria, mold, fungus, parasites, and cancer have all learned to hide within our bodies and are consistent contributors to chronic somatic dysfunction.7

Case #1

A young female client, 29 years of age, presented with joint dysfunction and pain throughout her body. She reported that she felt like a 98 year old woman. It wasn't until our third session when I palpated an area in her abdomen that hadn't shown itself before, which felt like a fairly specific area of adhesive tissue. When asked about the abnormality, she responded, "Oh, I forgot, I had a Mersa staph infection there five years ago." I immediately referred her to her physician. With appropriate antibiotic treatment, her extreme and chronic joint related symptoms vanished and morphed into more normal stress related musculoskeletal difficulties experienced by a professional dog walker and trainer.

Case #2

A female, 64 years of age, presented with chronic right hip and low back symptoms. As she was a yoga enthusiast, very careful with her diet, and practiced a health-conscious life style, I was lulled into imagining that internal infection was less probable. Four hours after her third session, while on a plane to NYC, she experienced severe abdominal cramping and was rushed to the hospital upon landing. She was diagnosed with a moderately severe colitis infection. The discovery here is that even apparently healthy clients may harbor subclinical infections.

Case # 3

A male client, 54 years of age, presented with lower back pain and intermittent right sided sciatica. During his second session, because there was a tenderness associated with the lower margin of his ileocecal valve that was exceptionally sensitive to even the lightest palpation, I inquired whether anyone in his family had had appendicitis. He acknowledged that his father and his brother both had had appendectomies. I encouraged him to see a physician as soon as possible to rule out any congenital anomaly that might predispose him. I heard from him a week later that 72 hours after his session he had gone to the ER and subsequently had his appendix removed. Gratefully, it had not ruptured. He had not sought medical care or testing. We are the hired help. It is a client's choice to follow our guidance or not.

Case Summaries

For over three decades now, my discovery has been to engage clients in an ongoing dialogue similar to a continuing intake interview so as to elicit the clues and cues that might reveal stealth infections or potential genetic predispositions.

A third category, which often requires a referral, includes many clients who come to see us in such desperation that they are resistant to seek care from other sources. We are ethically charged to hold their projected faith with a professional perspective if we perceive a better path for them.

This happens frequently with clients experiencing joint degenerations (hip, knee, shoulder) and spinal disc disease. In these situations, I often extend the upper range of the session threshold described earlier to six or beyond, if the client agrees to seek out advanced evaluation and treatment with their personal physician, an orthopedist, a chiropractor or an acupuncturist.

These joint degenerative conditions can have many cross-currents, including subclinical infections, as described above. Or may involve progressions of visceral organ dysfunction piggy-backing the viscero-somatic reflex arc system that may be present, which confuses what appears to be a clear structural problem, when in fact other sources, including the emergence of pathological changes, are contributing to their joint dysfunction, functional difficulties, and pain.8

The key factor in treatment is whether or not we can assist in improvement of our clients' functional capacity toward resuming a more normal life as they perceive it. If such progress happens, regardless of how slow or halting, there is hope and we can feel confident that our ministrations are contributing to their progress.

When none of these markers of chronic dysfunction and pain shift toward resolution or improvement, we are obligated to help our clients explore additional options and find qualified care. There are now a host of reputable treatment regimes including injections of all types that serve to stabilize joint function and reduce pain for many before a surgical option is fully explored. What is important to consider is that most clients who you refer to other alternative care practitioners or to medical care will thank you for it later.

Lesson Three

When working with people who have been diagnosed with terminal illnesses, we can assist more than we might envision. To date, I have had fewer client deaths than I might have imagined by this point in my career, yet a few examples stand out.

A male client who had been a "regular" for 30 years developed lung cancer that metastasized to his brain. Over time he was unable to come to my office or even to receive treatments in his home. He mentally regressed into a paranoid fantasy involving his family members which eventually led to his being committed to a psychiatric hospital. His daughter sought my counsel, fearing that he would die without having the support of his family during his final days, as the hospital was four hours away from where they lived.

Acting upon a mixture of instinct, meditation, and prayer, I suggested that we drive to the hospital. As it had been quite some time since he had seen me, I theorized that possibly he would recognize me and that my face, voice, and presence would break the delusional state of the paranoid fantasy. It was a long shot. Yet, ironically I felt confident. When I walked into his hospital room and he turned toward me, my appearance and voice speaking his name did startle him into present time reality. I will always remember his heartfelt embrace. His daughter entered the room immediately and gratefully he was able to recognize her and subsequently his son-in-law, grand-daughter, and former wife who had remained a dear friend and proud grandma. His final days were filled with their love and support for his mind, body, and spirit.

Most recently, I had the honor to serve a family whose mother had the devastating neurological disease ALS, Amyotrophic Lateral Sclerosis, also known as Lou Gehrig's disease. Initially, I was able to regularly mobilize her shoulders, arms, and hands to maintain some degree of normal function and to reduce her painful edema. As her speech was affected, it was rather amazing how she could speak more clearly after releasing the tensions of her jaw and tongue. Then the disease progressed faster than anything I had previously witnessed. Her capacity for speech, swallowing, sleep, appetite, bowel and bladder function had maintained themselves reasonably for many months even as her upper extremity motor capacities diminished completely. But eventually, nothing seemed to be of assistance except being compassionate and loving with her. Her husband and daughter began to see me professionally around this transition time. Last weekend, I received a text that she passed away peacefully with her family by her side.

The discovery here has been that it is not what we do, but rather who we are in the embodiment of our hearts that matters during a client's final passage.

Summarizing for our collective consideration; the most expansive arena for our profession is to develop the clinical knowledge, compassion, and skill sets to serve those with chronic somatic dysfunction and pain. It seems to me that this is where the greatest need is within our nation's health care delivery system. With a willingness to learn from each and every experience, we can assist more than we ever imagined. And, if you feel the calling to serve at this level of dedication, my experience suggests you will feel an enhanced daily sense of personal and professional satisfaction.


  1. NIH. "High Blood Pressure and Kidney Disease." National  Kidney Urologic Diseases Information Clearinghouse, Feb 2014; 14-4572.
  2. "Efferent Atreriole." Inner Body
  3. McMahon SB. "Are there Fundamental Differences in the Peripheral Mechanisms of Visceral and Somatic Pain ?" Dept. of Physiology, St. Thomas Medical School, London, England, Behavioral and Brain Sciences, 1997; 20:381-391.
  4. "Efferent Arteriole." Wikipedia
  5. "Mesenteric Ischemia." Wikipedia
  6. Tendler DA, Lamont JT. "Chronic Mesenteric Ischemia."
  7. Alexander D. "Additional Stealth Factors in Chronic Somatic Dysfunction." Massage Today, September 2015; 15(9).
  8. Alexander D. "The Aspiration to Prevent Hip, Knee and Shoulder Replacements." Massage Today, November, 2014, (14)11 and January, 2015 (15)1.


  • Rothchild J., Retired Kidney Specialist.
  • Gresham LB., Founder of Integrated Awareness®.
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