Empowering patients

THE SCENARIO

I used to work in a rehabilitation facility where most of our patients were motor vehicle accident victims and their treatments were on lien.  The clinic offered physical therapists, Pilates and manual therapy.  When patients  first came in, they were often in the early stages of dealing with trauma. Although their minds may know that the accident was in the past and they are safe now, their bodies still needed to learn this.

This is how it looks when your body exhibits body armor or guarding:  muscles that are puffed out, as if constantly flexing, rigidity instead of natural movement (arms don’t swing when walking), strained voice, unaware or disconnected  from what their bodies are going through.

Before placing my hands on anyone, I would get an assessment of how they were feeling, what they are noticing. A person who is guarding will often say they are fine and only this one area bothers them.  When they are on the table, usually face down to start, their backs often have a light shimmer to the surface of the skin. The skin looks taught around their muscles, like a well-fitting glove. When my hand moves across their skin (without lotion), the surface layers of the skin are firmly adhered to the tissues beneath so that there is no free movement. This is also known as fascia that is beyond bound (an Ashley Black term).

The tendency for most massage therapists at this point is to prepare an elbow and go in deep.  Now, most people expect or believe that it has to hurt to be effective or the deeper you go, the faster you’ll see results.  You know the slogan, of gain only being possible through pain.  Usually as this happens, they patient on the table will try to grit their teeth and hold their breath through it.  Some patients will try to escape to their happy place or any place by talking non-stop about something else.

In my opinion, the problem with this approach is that it is disempowering. Patients perceive this work as “being done to them” and their role as simply “showing up and going through the motions”.  I used to do this too, until over the years dealing my own injuries, the process of recovery taught me something different.  This whole dynamic can be so different once the patient/client is empowered through knowledge and tools. When they can once again feel in control, there is a real shift in their recovery.  They no longer feel like victims.

THE PARTNERSHIP APPROACH

This is how I approach patients: First I have them take a seat and review what I know of their history and condition so far.  I ask them to tell me how they feel their recovery is going, what seems to be working and what they need help with. Then I ask them to close their eyes and just tune in to their bodies, what is calling their attention the most right now.

After hearing them out, I begin to explain what I will need to work on given what they have told me. For example, if their low back is the issue, I will need to work on everything from their  mid-back down to their knees, front and back. I explain how the muscles which support your low back run underneath the gluteal muscles, how the legs support them and how some wrap around your hip bones and need to be accessed in the front, through the abdomen.

Then I give them my 3 rules:

  1. Number one: you are encouraged to complain and ask questions often. I want you to be comfortable and understand what and why I’m doing certain things and how this will help you.
  2. Number two: never hold your breath, exhaling will allow your muscles to move more easily and decrease the likelihood of spasm as well as alleviate pain.  For this same reason, leave your joints unlocked.
  3. Number three: Please let me know if we ever cross the 7 out of 10 mark on the pain scale.

This makes them part of the process, rather than an observer. It also makes them present to the moment rather than getting lost in their heads. It helps to educate them, not only to build trust, but also to help them understand how they can help themselves.

Anything I do; the position I put them in physically, the type of therapy I decide to use (ie. trigger point, lymphatic drainage or working with the fascia), I explain it to them and ask them if it is alright, so that they know that their voice matters. This allows them to feel in control and an active participant in their own healing process, rather than escaping mentally.

Recently, I’ve been fortunate enough to find out about the FasciaBlaster and Ashley Black. Using this tool has helped me add another layer to my treatment of post trauma patients.  As I mentioned earlier, oftentimes right after an accident a patient is too sore, sensitive and bound by fear, pain and fascia. Sometimes, it is too painful for them to even receive regular Swedish strokes. Now, I know that there are many therapists out there who would just continue applying traditional massage strokes even with a patient this guarded, maybe hoping that as time goes by they will relax.  I don’t do that because I feel that having them recoil in fear with my touch even for just a little while will not facilitate a trusting relationship with me or with their bodies. I wouldn’t want them to think on any level that fearing pain and enduring pain inflicted by another (regardless of intention) is necessary. In the past, my response to this would be to begin with lymph drainage, which helps decongest the area where the muscles and fascia are most congested in a gentle, non-invasive way. The usual reaction for them is relief, a feeling of the pressure decreasing in their aching bodies. Then, I would attempt to introduce deeper strokes. Sadly, this process is slow, very slow but effective.

After discovering the FasciaBlaster, and learning how to use it with this population I had a wonderful new way to help them. I still begin with lymph drainage at the clavicular, axillary and abdominal nodes but then I follow up with the FasciaBlaster. Using an essential oil blend, (grapeseed or coconut oil works well too) I gently but rapidly scrub the area with only enough pressure to sink into the first few layers of the skin, just above the muscles. I do this to bring more blood flow to the surface and follow it up with flat handed smooth gliding strokes, towards the lymphatic drainage nodes for that area. Scrub in the direction of the fascial lines always asking how they are feeling and if the pressure is bothering them in any way. Almost 99% of the time, there is no pain, they are even surprised by how it feels, soothing, relaxing, rhythmic. In a few minutes, their guarded tissues let go and relax enough for me to work without having them recoil or want to escape. It is amazing. I go very light, gently going one layer at a time until their body lets me in to the next layer. No trauma.

Their relief and amazement usually leads to questions about this tool and often times further education on how they can obtain this FasciaBlaster and use it at home. I make sure to educate them on the proper way to use it for their condition and health, letting them know that as more circulation reaches the area and the tight, painful adhesions break down, they may see bruising. This is a good, healthy and temporary thing. Of course, I also direct them to the source of all this knowledge by pointing them towards the product’s inventor, Ashley Black.


 

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