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Dealing with Pathologies

By Ruth Werner, LMP, NCTMB

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2017 San Diego Pain Summit: A Conversation Between Practitioners

Editor's Note: This is a conversation between Ruth Werner who attended the 2017 San Diego Pain Summit, and Til Luchau who was not able to attend. Their conversation was a recorded debriefing, with an eye to applying Ruth's take-away ideas into hands-on practice. In this excerpt Ruth and Til focused on how "we" communicate with our clients about pain, and how our words can be either helpful or harmful.


Ruth: Ok, when my client consulted her doctor about her back pain, he said she shouldn't bend over. As a practitioner, I'm a little bit stuck. We have to be very careful about not stepping in between a relationship between a person and their primary care provider.

Til: Absolutely. It's not a helpful for us to cause our clients to question their primary care provider.

Ruth: So, I'd say, "Well let's focus on things you can do, the things that you want to do, in a way that feels safe."

2017 San Diego Pain Summit: A Conversation Between Practitioners - Copyright – Stock Photo / Register Mark Til: I'm the same way. I always say, "I'm not a surgeon, I'm not an orthopedist, I'm not a physician, I would never second-guess any of those practitioners or providers that you have."

"So let's explore a little bit. Let's see what happens if we do this work, or movements. I'm not going to tell you to do something your doctor told you not to do, and I'd never try to second guess what they're telling you. At the same time, I want to help you find a way that you can find out what's okay for your body."

"Let's gently experiment with different options and see what you experience, and so together learn ways you can answer the question for yourself, Does this help, or does this not?"

"And by the way, I do want to gently question your impression that you are broken, damaged, or fragile."

Ruth: Thank you so much for saying that, that's such a huge thing.

Til: Because it's easy to get that impression from what other practitioners tell us, even if they don't mean it that way. It's easy for me as a client to hear that there's something wrong with me, that I'm fragile, so I have to be careful with my body, or it might get worse.

Ruth: That it might break.

Til: Get damaged by something I do.

Ruth: Like it's going to crumble.

Til: Yeah.

Ruth: That's so important — that even people who have been told they have to be very careful with their back can still feel vital, and energetic, and powerful; even if they may have to go about things in a different way than other people.

Til: The other thing I do is I have a lending library with books like Explain Pain1 that lay out the case that although tissue damage can cause pain, pain may not necessarily relate to tissue damage at all.

Ruth: And I think you got to the heart of it when you said that even if someone's been given a diagnosis that looks scary, having the attitude that we are broken, fragile, crumbling people is not a helpful way to move forward. As practitioners, we can be more helpful to clients by helping them experience themselves as vital, and focusing on their strengths, and looking for client-centered functional goals: "What would you like to be able to do that you can't do now?"

Til: I'm just thinking of a client who came in with back pain, and when I asked him what he wanted out of our work, he said, "I don't want my back to hurt."  So to unfold that a little, my response was, "So if your back didn't hurt, what would that allow you to do that's important to you?" He had to think about it for a bit, and then he said, "You know what it is — it's getting down on the floor to play with my grandkids.

Ruth: There you go.

Til: He said, "If I could get down on the floor, that would be something."

So our goal became, "Let's do some hands on work, and then have you pretend like you're getting down on the floor, and see what you run into." And that gave us some ideas to go back to the table with, about new places, new ways, new movements he could do that would help him focus on his goal of getting down on the floor in a comfortable way.

Ruth: That's very much what this is about: it's focusing on what we can do, and setting reasonable goals for working together.

Read the full conversation at goo.gl/OCsFBz. More information about next year's San Diego Pain Summit can be found at sandiegopainsummit.com.

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