How do we fix something that can’t be fixed? We can’t. But a good look at the levator scapulae gives us some insights into how we perceive pain, how our clients might perceive pain, and what, exactly, we can do with all that perception. Join Allison in pondering this powerful muscle and the lessons it might teach us if we begin to pivot how we listen.
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We have invited a powerful line-up of all female authors, Physicians, therapists and clinicians to share their passion and life's work. Visit anatomytrains.com for details. [music] 0:01:29.1 Allison Denney: Hi, my name is Allison Denney and this is The Rebel MT podcast, where you'll hear me forcibly colliding the worlds of anatomical jargon and humor. I believe that when you know your anatomy, the what, and you know your physiology, the how, the techniques will follow. But the loads of Latin and the gobs of Greek can make a cranium convulse. It is a little overwhelming to dip your toe into the sea of anatomical knowledge, only to find that it is a bottomless ocean. You are smart, but this is intimidating. You will get there eventually. In the meantime, let's look at things differently so that you will actually want to take a swim or at least hop on a boat and take a peak at what's under the surface. [music] 0:02:15.3 AD: I had a client once who called and demanded a promise that I would fix her if she came in to see me, a relative newbie in the field at the time with an over-inflated sense of confidence, I promised. I said, "I got you, I have a couple of tricks up my sleeve." What? Needless to say, I became immediately bogged down with a grip of emotions spanning from a deep desire to rise to the occasion and an inflated ego telling me that I actually could, to total confusion about how I would manage this, and then of course, the humiliation in realizing that they experienced a momentary lapse of reason. Fixing someone is not a thing. Everyone seems to want to be fixed. But it is, in reality, just not a thing. And there are many layers to this. A heap of philosophers will debate for days, weeks, months and years around this topic. But for today, I'm going to explore two of the main layers that are integral to the work we do as massage therapists. 0:03:21.6 AD: First, there is the client and their perception of fixing pain and then there is us and our desire to do the fixing. The very curious and complicated subject of pain and suffering is one that circles the work we do constantly. How do we get a client to express what they feel? How do we know what they think is normal? And how do we know if we are doing the right work, the work they need in that moment? We don't, really. There are lots of great indicators to help us determine if our work is productive or not, but there are also a lot of factors that we have no control over. Whether or not a client is doing the necessary steps to help themselves when they are not in our office is out of our hands. Whether or not the work we do will last an hour or a day or a week is difficult to predict. And whether or not a client is just really nice and thanks us for the amazing job we just did because they want us to feel good for working so hard that they complement our work, even though they wince and find bruises once they get home, might be the actual reality. 0:04:30.1 AD: So pain, and a client's perception of pain, is a lot more convoluted than a chart that indicates which face emoji they most relate to in that moment. A client, like the one I mentioned in the beginning who demanded to be fixed, has a set notion of expectations and the lens through which they experienced life that dictates how our interaction with them lands. Then there is our perception. Most of us got into this field out of a desire to help others, we know people experience pain and we want to help. But even that simple momentum is convoluted, it is noble indeed to want to help, but helping others often appeases a deeper desire to be the hero, so to speak, and this complicates things. To be the person who comes to the rescue is something that feeds our ego on some deep level, whether we like to admit it or not. 0:05:29.3 AD: Just like our client who is doing who knows what when we are not directly influencing their issue or dysfunction, we are equally as bogged down with cognitive and emotional lenses that shift how or why we do what we do. Many of us grow attached to the outcome, many of us feel some version of pain or suffering when we are not fixing our clients, and many of us have a difficult time separating our true purpose from these sticky layers of perception. Psychologists, neurologists, Buddhists, and many, many others have written timelessly about the intrinsic relationship between suffering and happiness. Without going too far down that road, I want to explore the actual techniques of what to do when a person is in pain or suffering and how to navigate all the lenses of our interactions. The Levator Scapula is the perfect muscle for this topic. It is one that causes both clients and body workers a frustrating amount of irritation. It commonly holds a chronic contraction, it cramps up and sends referring pain throughout the head and neck, and it doesn't seem to want to let go. 0:06:42.2 AD: The client is upset because they feel the grip this muscle has and they want to sometimes literally rip it out of their necks, and the massage therapist is frustrated because it does not appear to respond very well to the work. All the trigger point therapy, pin and stretches and positional releases in the world only scratch the surface. That damn muscle invariably fires back and make everyone mad, it seems to have a mind of its own. Let's look at the details. A skeletal muscle is made of muscle fibers. We sometimes even call a skeletal muscle striated because of what the fibers look like under a microscope. Looking even deeper, each of those fires has little tiny micro-filaments inside of them called actin and myosin that want to grab on to each other and hug each other really tightly. When they do, they squeeze so tight that they actually pull the ends of the muscle closer together, and the ends, being attached to two different bones, start to move. Hence, the bones themselves shift positions and voila! We have joint movement. Human Anatomy really is a spectacular thing. 0:07:52.7 AD: Anyway, for the Levator Scapula, the bones this muscle brings closer together are the neck bone and the shoulder bone, more specifically, the first through fourth transverse processes of the cervical vertebrae and the medial border of the scapula, between the superior angle and the spine and the scapula. So yeah, the neck bone and the shoulder bone. So when those little actin and myosin filaments start hugging, the shoulder starts to move closer to the neck and the neck starts to move closer to the shoulder. Mostly the former, but it's never really just one or the other. In broader terms, though, the Levator Scapula wants to shrug the shoulder up to the ears, it's what it was born to do. It also wants, very badly, thank you very much, to pull the ear to the shoulder. It's purpose in life, so to speak, is to help you keep your phone in place, so you can talk to your friends while cooking dinner, and you don't have the time to find your earbuds. It's got a serious job, and it takes that job very seriously. The problem is this, the Levator Scapula is so good at what it does that it does it way more than we really need it to. Kind of like when a kid learns a new task, like tying his shoe, and now all of a sudden everyone needs their shoes tied and he's gonna be the one doing it. 0:09:06.6 AD: Not really the most efficient activity, but that kid is a shoe tying machine, there is no stopping him. And there is, in a sense, no stopping the Levator Scapula either. Which brings me to my bottom line, how do we stop something which can't be stopped? We don't, we just choose a different lens of perception. Remember how we really wanna fix things? Maybe that's not the end goal. Maybe the end goal is to find new methods of management. If the client is frustrated because this muscle is creating chronic pain issues, and you're frustrated because your client doesn't seem to be listening to when you're telling him or her to let go, hanging out in your frustration is not productive for either one of you. Trying to fix that which can't be fixed is not a path lined with flowers and rainbows, it is solid concrete and not very fun. 0:10:03.1 AD: Fixing a Levator Scapula is a lot like fixing anger. We are born with this ability, and it serves a purpose. Anger, as angering as it may be, helps us to defend that which needs defending. Anger rises to the occasion when a muffled voice needs to speak or a cog in the chain is broken and is preventing us from moving forward. But anger, much like the fibers of the Levator Scapula, isn't aware that it can be problematic, so getting angry at anger is futile. Try this, next time you've got a client in your office with a rogue Levator Scapula, start by honoring it for doing exactly what it's supposed to do. However you wanna do this is up to you. Silently, in your own head, speaking directly to it and risking the chance that your client thinks you've lost your marbles or a candle lit seance with your client and all of his or her loved ones holding hands in a circle, it doesn't matter how you do it. What's important is that you shift your perspective. 0:11:06.6 AD: Once you've pivoted, your work becomes more about moving with this muscle as opposed to against it. Find the position it feels most at ease in and go from there, if the shoulder is being hiked up to an ear, try holding that Levator Scapula with one hand and using your other hand to hike that shoulder up even higher and then see how it reacts. Maybe it goes into spasm because it didn't really think you were gonna do that and you just called its bluff. Maybe it locks up even more and stubbornly refuses to show any signs of weakness, or maybe it actually starts to soften because, dang, if that muscle isn't exhausted. The point is, not every Levator Scapula is going to act the same from client to client and how you handle yourself in each session is going to be equally as different. 0:11:56.6 AD: Remember that the complicated layers to what defines pain is going to present uniquely with each client. Remember also that your role here is not necessarily one of the hero, it is one of observing. Watch how this muscle responds, listen to what your client is telling you and feel for what technique might be appropriate for right now. You don't need to be the fixer. Your client want space to just be, more than anything else. And this powerhouse of a neck muscle just wants to do what it's supposed to do, you can't blame it for that. This new mindset might even be the thing that breaks the code. You and your client might actually be able to hop off that chronic pain and frustration cycle and start something new. 0:12:48.3 AD: And here we are, the end of the episode. Thank you to the extraordinary crew over at ABMP for helping me get my words into your ears. And if you wanna get any of your words into my ears or, more accurately, into my brain via my eyeballs from a computer screen, drop me a line at firstname.lastname@example.org. That's R-E-B-E-L-M-T@ambp.com. I always wanna hear your questions, comments, suggestions or salutations. Also, if you're interested in checking out anything else I'm doing, head over to rebelmassage.com where you will find all sorts of fun things to click on, like homemade organic products for your practice, cool links to continuing education classes, thoughts I have typed up and posted here and there and other rebel massage dabblings. [music] 0:13:37.7 S1: Members are loving ABMP five-minute muscles and ABMP Pocket Pathology, two Quick Reference web apps included with ABMP membership. ABMP five-minute muscles delivers muscle specific palpation and technique videos plus origins insertions and actions for the 83 muscles most commonly addressed by body workers. ABMP Pocket Pathology, created in conjunction with Ruth Werner, puts key information for nearly 200 common pathologies at your fingertips and provides the knowledge you need to help you make informed treatment decisions. Start learning today. ABMP members log in at abmp.com and look for the links in the Featured Benefits section of your Member Home Page. Not a member? Learn about these exciting member benefits at abmp.com/more.