Geeking Out on the Basics: What makes for Good Treatment
Words like “massage” and “bodywork” are umbrella terms, meaning the potential client has no idea what they’re signing up for prior to receiving. This fact in and of itself can often be prohibitive to an individual seeking manual therapy because it’s a toss up as to whether they are investing in their own wellness or simply throwing money away as they seek to have a more optimized embodied experience. The industry of therapeutic touch is so nuanced, with each practitioner delivering their own understanding of approach, principles, and beliefs about how the body works and how best to apply their individual insight and skillset. The reasoning for people seeking bodywork is no less complex because of the differences and complications from one body to the next as well as the client’s personal agenda, goals, expectations, and needs. If we boil it way down to simplicity, we can say that most clients fall into one of two categories or a hybrid of the two. One is pain/tension remediation, and the other is relaxation/stress reduction. This is a conundrum for a lot of therapists because it means the practitioner must wear multiple hats in order to facilitate an experience that both meets or exceeds the expectations of the receiver, while also having the professional know how to address underlying issues that the client may or may not be aware of. The thing is that discomfort of any kind in the body influences the mind, emotions, and kinesthetic physiology of the whole and the inverse of that is also true, so if someone is under abundant stress, dealing with emotional overwhelm, or psycho-emotive trauma of any kind, then the body will manifest pain and/or limited performance. So it begs the overarching question:
“What makes for good treatment?”
Simply put, good treatment is that which imposes demand on the body to change while simultaneously opening the flow of energy and cultivating an awareness within the receiver of the inherent flow and vitality that has been impeded. Without getting into the technical aspects, the main benefit of good treatment is neurological rather than muscular. Bodywork results in an alchemical brewing of endorphins, hormones, and neuro-chemicals. The body itself is the cauldron and the mind and emotions are the fire so to speak. Feelings, be they proprioceptive or otherwise are what provide the relief, the reset, or the remediation. This being so, it is too reductionist to state that good bodywork is only derived from the understanding of applied neurology because touch itself is therapeutic stand alone, and of course a good bodyworker will have a practical understanding of structure and function and how to apply techniques that are beneficial to the body under their care. This is why if someone comes in with a complaint of headaches or sore and tight shoulders for example that a therapist wants to work parts of the body distal from the area that is being noticed, because more often than not the causative factors in the issue someone is aware of are not the things being noticed by the client. Even though each person is different and the reasons for their individual states of being are complex, there are also overarching truths that pertain to everybody’s body. Awareness and understanding go a long way towards supporting someone’s ability to self correct, so as an example the following is a somewhat simplified breakdown of what I commonly see and treat in session:
First off, it is the feet that have the main proprioceptive relationship to the head. This means that the head and neck’s position are directly influenced by the feet. I could write volumes on the complexity and importance of the feet, but suffice to say when the feet are under inhibited conditions, the response is to lock the legs for back up stability. When the legs are locked, the abdominal muscles can’t work properly. Long term dormancy in abdominal performance creates a whole host of issues. The most common being low back pain or tension, sore hips and glutes, and restricted quads and hamstrings. All of which will manifest their condition in the felt experience of the head, neck, and shoulders and put the spine into disfunction. Furthermore, when the abdominal muscles are underperforming, the psoas and other hip flexors are also underperforming, creating deep tension and restriction in the upper glutes (medius), as well as piriformis ( muscle from the sacrum to the hip/head of the femur), and TFL ( muscle at the top of the thigh that becomes the IT band). All this tension changes gait, performance, and one’s ability to have optimal reflex throughout their body. Over time any external stimuli is perceived as a threat to safety by the nervous system because it is over tasked with maintaining limited function instead of responding to the demands we place upon our body.
The psoas is wrapped in a sheet of connective tissue that anchors itself on the diaphragm, essentially making your hip flexors a respiratory muscle. If psoas is not firing properly, diaphragmatic breath is limited, making the muscles of the ribcage work harder so that the body can breathe. In order to do so, the neck muscles are working harder and more frequently to raise the upper ribs in order to gain more upper inspiration, or “top of the lung breathing” in order to compensate for the underperforming respiratory diaphragm. But as we have already stated, the feet influence the position of the head and neck, so the added work load placed upon that area to just simply breathe passively quickly becomes too much of a task for the building tension in the neck muscles and upper traps as a result of these conditions, essentially compressing the 11th accessory nerve when the head rolls forward and the shoulders follow. By proxy, when the head posture is forward, the chest drops creating a loss of at least 25% of upper body range of motion.
So, now the neck is locked up, the head feels stuck, the shoulders are sore, the low back hurts, the legs are tight, and overall movement becomes uncomfortable. Over time, the body collapses towards the core, the belly, in an effort to protect its vulnerable areas, add this to the fact that the learned breathing pattern is now to inhale quickly and shallowly in the center of the chest between lots of holding of the breath every time effort or endurance is called for, things become pretty dire pretty quick. All of this is tied to the condition and dysfunctional positions of the feet and ankles, which are also the main communicator of overall posture. So, when our posture is collapsed and we are breathing shallowly, we are sending the message to our nervous system that we are experiencing a threat. This is the classic trauma response as well, so essentially, even if we do not think we are dealing with a “trauma” of any kind per say, our limbic brain cannot tell the difference and we begin to exhibit indicators of being trapped in a loop of “fight, flight, or freeze” as well as the inability to think clearly, experience feeling “energized”, or sleep well in some cases. These conditions influence our circadian rhythm, our digestive responses and bowel function, our sexual performance or ability, our circulation, our lymphatic system, our immune system, our respiratory system, and our mental health. Add to that the fact that there is a reciprocal relationship of position/posture to emotion/thought, all this structural stuff is directly influential on how we feel emotionally and how we think, and/or what we believe about ourselves, which can contribute to states of depression and anxiety and also significantly lower metabolism which often results in the storage of fat and by default, weight gain. Now it is not as simple as working the feet to “fix” all of this, nor is it as simple as only working the areas of discomfort to “fix” the causative factors, in fact it’s not about “fixing” at all. I am not saying that all these conditions can be remedied by receiving bodywork, but I am saying that without the embodied self awareness and making choices to support the biological process of flow, one cannot experience themselves from a place of true wellness in spite of whatever other necessary interventions are being sought. The structural positions of the spine, ribs, and pelvis must be addressed, the muscles and other tissues must be addressed, and the nervous system must be calmed in order to create conditions that are conducive to reeducating the body and restoring an optimal sense of being and objective perspective must be supported which is often the domain of mental health professions. Things like physical therapy are sometimes necessary, chiropractic care is essential, and exercise and diet are key factors. Yet, practitioners cannot achieve lasting results or deliver relief if the position of the head and neck are not remedied, which means that the shoulders and chest must also be released, however that cannot happen until the position of the pelvis and issues of the low back and abdomen are not met first, which as discussed cannot be maintained if the feet and ankles are not restored to optimal function. As true as all of that is, “healing” is only made up of about 20% structural change (therapeutically influenced posture and performance). The remaining 80% is a matter of allowing yourself, the client, to feel, to let go of your story and beliefs or reasons about why you think you feel the way you do, to put on hold all the factors of life that perpetuate stress, grief, or difficulty, and to choose to align your energies with being present for your time on the table and instituting a practice of “ Be Here Now” whenever you catch yourself escaping into a drama or distraction that takes you away from the present moment. If you do so, the flow of energy produced by your body is then beneficially employed rather than stagnating, creating a positive association with those behaviors and their reward. If you focus on breathing and observing stimuli, you train yourself to come out of “defense” mode and begin to experience flow once again, which to bring it full circle is a self love potion of endorphins, hormones and other neuro-chemicals. So a good treatment is at its roots a partnership with your therapist, built upon trust and informed by your own volition to act in your best interest, essentially hacking your feel good states and making them available to you any time you choose to breathe consciously, think positively, and allow yourself to feel the fullness of the present moment.