Clinical Massage

A Delicate Dance
Dialoguing with the Body through Massage

By Roger Byrd, BS in Ed, NCTMB

“I feel like I’ve had a dagger in my back for four years!” That was almost the first sentence this client (I’ll call her Anita), an accomplished professional, told me when she came into my treatment room in December 2003. Attempting to get a handle on her pervasive chronic pain, she had already spent years working with several very reputable physicians (surgery was seriously considered). Physical therapists had set up exercise and stretching programs for her which she carefully and faithfully did, but with minimal benefit at best; at times they actually seemed to aggravate her pain. These specialists seemed to agree that the pain was coming from her well-documented scoliosis, a lateral curvature of the spine. If that was the case, I told her, it was a real question whether my work could help.
 

"However, as a Clinical Massage Therapist, my approach to pain is fairly straightforward: find and release muscular tightness and imbalance, and myofascial trigger points (irritable spots in muscle or connective tissue that can trigger pain sensations in other locations). So I was willing to see if any of these conditions might play some role in her pain, and she agreed. We were both surprised when, after just 2 or 3 sessions, a very tight hip muscle, piriformis, began emerging as the source of nearly all her pain.
 

"Instead of launching an assault on this locked-up muscle, my approach was, as usual, to slowly and sensitively engage it, actually to dialogue with it through my hands, encouraging - rather than demanding - release. This involved taking the time to patiently listen. Just how resistant is this muscle? At what rate can it release? When the muscle was first contacted in this way, it would just sit there like a rock, inert and unmoving, or at times fibers would start twitching nervously. Then, possibly after several seconds, slowly and grudgingly, sometimes a millimeter at a time (sometimes a micron at a time), it would begin to yield, to melt the tiniest little bit... then another bit... then another... As I took the time to partner with it in this slow and sensitive way, it was able to start releasing at it’s own pace. I was co-creating with this long-suffering muscle, and with my client’s body as a whole, a clear feeling of respect and trust rather than invasion and domination. At the end of most sessions we did a specific type of stretch to help “set” the benefits gained.
 

"Deep pressure was certainly an important ingredient in this extended process, but it need not, and should not, cause pain in order to be effective (“Use the minimum amount of pressure necessary to gain a release.” — Earle Timberlake, my clinical massage instructor). By avoiding or at least minimizing pain and discomfort, a larger, more comprehensive release seems to be gained. This typically includes whole groups of muscles, more effectively utilizes the client’s own innate movement intelligence, and therefore yields a more complete and longer-lasting improvement. That might involve more than just physical aspects, too, easily the subject of another whole article. I am convinced that, in using any bodywork technique, the quality of intention and interaction with the client, and the conscious participation of the client as a partner in this process, add substantially to the work’s effectiveness. The basic elements of this whole-person focus, of sensing and dialoguing with the body in a personal way, were a significant part of my first massage certification at Esalen Institute in Big Sur, California, where this whole orientation to doing bodywork originated.¹

"Blending this kind of sensitivity and awareness with the detailed, well-researched and specifically targeted techniques of clinical massage can be quite rewarding. For Anita, within 3 or 4 more weekly sessions, her level of pain (on a scale of 1–10, with 1 being barely noticeable and 10 being the worst pain imaginable) decreased from a 7 all day every day, to 2 to 3 all through the week, with periods when there was no pain at all. As we continued to work, this benefit extended into multiple weeks, and with only occasional exceptions, that improvement continues still. She now enjoys taking long walks, plays more easily with her young grandchildren, and spends much less time on pain management exercises.
 

"Anita does not conclude from all this that clinical massage is the whole answer. She still continues with exercises a particularly helpful physical therapist had recommended, but writes that those “strengthening regimens seem to require the critical complement of relaxing and lengthening muscles, the massage therapy ‘puzzle piece’ that completes this picture... [It is] this combined therapeutic approach... [that] has proven effective in helping me cope with nearly ten years of chronic, often debilitating, lower back pain.”

"It’s moving for me to play a part in helping unravel such deep and long-standing knots and blockages. At times it seems almost magical, a delicate dance with bound up tissues that yearn for release but have completely forgotten how. I can’t make them release, but by simply giving them a proper invitation, they gratefully do it themselves...

"Roger Byrd was certified in Clinical Massage in 1992, and has been with Borgess Medical Center’s Integrative Medicine department in Kalamazoo Michigan since it was created. He can be reached at wellnessgrows@yahoo.com.
 

1 Coughlan, Brian: “Esalen: Where It All Began,” Massage Therapy Journal, Millennium 2000 Issue, vol. 38, no. 5."
 
(Note: the person in these pictures is not "Anita," but a model helping me demonstrate my work.)