Skip to main content

Ep 483 – Language and Teaching: “I Have a Client Who . . .” Pathology Conversations with Ruth Werner

01/28/2025
Image of letters floating in the foreground and background.

For nearly 30 years, Rob Kelly has taught anatomy, physiology, pathology, lymphatic work, and orthopedic massage. Recently, Kelly reached out to “I Have a Client Who . . .” host Ruth Werner to share his observations on how easy it is to misunderstand how the body works and how these stories we tell ourselves can have negative consequences.

Kelly and Werner turned their conversation into an episode about the power of language and the responsibility we have to elevate our profession by using words carefully.

Author Images
Image of Ruth Werner
Author Bio

 

Ruth Werner is a former massage therapist, a writer, and an NCBTMB-approved continuing education provider. She wrote A Massage Therapist’s Guide to Pathology, now in its seventh edition, which is used in massage schools worldwide. Werner is also a long-time Massage & Bodywork columnist, most notably of the Pathology Perspectives column. 

 

Werner is also ABMP’s partner on Pocket Pathology, a web-based app and quick reference program that puts key information for nearly 200 common pathologies at your fingertips. Werner’s books are available at www.booksofdiscovery.com. And more information about her is available at www.ruthwerner.com.   

 

Sponsors

 

Anatomy Trains: www.anatomytrains.com

 

Anatomy Trains is a global leader in online anatomy education and also provides in-classroom certification programs for structural integration in the US, Canada, Australia, Europe, Japan, and China, as well as fresh-tissue cadaver dissection labs and weekend courses. The work of Anatomy Trains originated with founder Tom Myers, who mapped the human body into 13 myofascial meridians in his original book, currently in its fourth edition and translated into 12 languages. The principles of Anatomy Trains are used by osteopaths, physical therapists, bodyworkers, massage therapists, personal trainers, yoga, Pilates, Gyrotonics, and other body-minded manual therapists and movement professionals. Anatomy Trains inspires these practitioners to work with holistic anatomy in treating system-wide patterns to provide improved client outcomes in terms of structure and function.    

                

Website: anatomytrains.com    

                  

Email: info@anatomytrains.com          

 

Facebook: facebook.com/AnatomyTrains

                    

Instagram: www.instagram.com/anatomytrainsofficial

 

YouTube: https://www.youtube.com/channel/UC2g6TOEFrX4b-CigknssKHA  

Full Transcript

0:02:29.6 Ruth Werner: Well, listeners, today we have a special treat we are not doing. And I have a client whose story, in terms of one specific pathology, what we're going to do today is to have a conversation about when we hear things that are being taught that we think are probably not correct. And what do we do with that in terms of other professionals and in terms of clients who come to us with their stories about what they have been told before about their situations. And joining me today is my friend and colleague, Rob Kelly. Rob has been a teacher and practitioner with more than 29 years of experience. He works at Irene's Myomassology Institute, which is really an iconic school in our profession. And he reached out to me because, as a teacher of anatomy and physiology and pathology, plus someone who is certified in lymphatic drainage and who teaches lymphatic drainage and orthopedic massage, he hears things from his students, from clients, from people, when he goes on the road to teach continuing education classes about things that are being taught that just make our teeth itch. And so he contacted me to have a little chat about this, and I thought it would make a great topic for a podcast.

 

0:03:56.2 RW: So here we are. Rob, do you want to add anything to how I introduced or described you? 

 

0:04:02.0 Rob Kelly: No, that was a very kind introduction. Thank you very much. I absolutely possibly love anatomy and physiology and pathology. And the more I learn about it, the more I learn it's not as simple as people try and make it. And so it's just, everything is complex. And so even if we look at a blood cell and how complex a red blood cell is, and I can spend hours learning about the complexity of red blood cells, and that's only one cell.

 

0:04:36.3 RW: And always one of the great challenges in being a teacher or an educator in any form is simplifying things to the point where they are accessible without simplifying things to the point that it's no longer true. Here we are trying to convey the glories and wonders of human function, and what a miracle it is that when we get ill, we often get better in ways that are both simple and nuanced. And I think when that goes wrong, then we hear weird stories, like some of the things that you sent me. For instance.

 

0:05:08.1 RK: Someone who said tension headaches are very commonly caused by muscle tension, which is an accurate statement. But then they went next to with that and said, well, excessive tension in the muscles will limit blood flow to the brain. And that's just not accurate.

 

0:05:27.4 RW: Yeah, how skeletal muscles are going to clamp down on the vertebral artery, that's going up through the transverse processes.

 

0:05:36.5 RK: And the internal carotid, because the internal carotid also goes up there. So it's got four arteries going up that way. So I understand someone saying muscle tension and this and then taking it to that point, but having a little bit of just knowledge about anatomy and how the blood gets up to the brain.

 

0:05:56.0 RW: Well, we can imagine the client who hears this, you're having headaches because your muscles are cutting off blood supply to your brain. And think about the weird directions that could send someone as they have a relationship with their body.

 

0:06:13.0 RK: Exactly. Yeah. And I talk about how successful you are at life. You've been successful up to X amount of years. You may have had some bumps or something along the road, but you're still successful. And the human body is just so ridiculously complex, but also so ridiculously good at dealing with different stresses that we put on it.

 

0:06:37.5 RW: The compensation patterns we create are so functional a lot of the times.

 

0:06:43.0 RK: Yeah. I remember Dr. Chateau talking about functional dysfunction, and I love that concept of, yes, things are dysfunctional, but we're working our way through it, and the human body is resilient.

 

0:06:56.7 RW: Wait, tell me some of the misconceptions you've heard from people coming from the lymphatic drainage world.

 

0:07:05.9 RK: I've heard instructors and then also therapists who said they've heard this from instructors, that if lymph drainage isn't done in a very, very specific way, it can cause tremendous dysfunction in the client. And when I teach lymph drainage, I talk about movement of tissues. Movement of tissues are going to move fluids. Okay, that's a simple concept. Lymph drainage can be done in numerous different ways. There's so many different types of lymph drainage, and it's wonderful. I choose the one that I think it works best for me, and that's the one I teach. But I say go out and get some other lymph drainage education, but it doesn't have to be done exactly like this, or if you put your hand here and not here, if you put someone on their belly, then their lymph flow is going to be so impeded and I don't know if it's social media or fear or sales tactics or any of that, but it just seems like people are just making it seem like there's going to be detrimental harm if we do one thing wrong. And one student said that they heard this in a class that you cannot put your hands on the abdomen or the inguinals because the instructor said that is genitals, and you cannot touch genitals.

 

0:08:29.9 RK: And I don't think that's an accurate statement.

 

0:08:34.6 RW: That would come as a big surprise to people who work, for instance, with athletes who have groin poles. I think there's a lot of, I'm not sure. I don't think I'm qualified to use the word mythology in the context of lymphatic work. I will tell you that I did one level of training in Vodder work many, many years ago, and I suRWed at it. I was so bad at it. This poor teacher was beside himself trying to help me understand how to do this. But very much the message that I got was, if you get this wrong, you're going to tear the little collagen fibers that are holding the lymphatics open and never petrissage. Because that'll just tear up the lymphatic system. And it just makes me really wonder what happens when these people, do physical labor or squeeze their elbow after they've bumped it on a door jamb or something.

 

0:09:32.9 RK: Exactly. I don't know if it's just to make them different than other people who are talking about how anatomy and physiology really does work and how resilient the body is. And I don't want to demonize people. Sometimes it's just ignorance and education and learning how to say, I don't know, let me find out, or, boy, that's new information. I've got to integrate that into how I'm thinking. And when people get stuRW in the, massage flushes out toxins and all of that stuff. If we're still hearing that in 2024, almost 2025, people need to catch up with where science is at the moment.

 

0:10:18.5 RW: Well, that will never not be true. There's always a lag, especially in a practice that is taught so much from tradition as ours is. And I think there are cultural things around this is the way to do this that we find with some techniques that I think might be a little looser around some others. So that we don't get a bunch of hate mail, Rob, can we talk about situations where inappropriately applied lymphatic work might actually cause harm? The first one that pops into my head is if there's an infection present.

 

0:10:57.8 RK: Yeah, no, we obviously, people say if I've got an infected lymph node, should I do lymph drainage? And I say, no, let the body do what it's designed to do. Let the body heal. If that person's on antibiotics, let the antibiotics take their course, but let the body go through its normal process. There are times that lymph drainage can be a contraindication with, if someone is trained to work with lymphedema or someone's not trained to work with lymphedema, we need that training because those people, it's just so much more complex. And so we need to be careful because we can cause some dysfunction. I don't think any real ill harm.

 

0:11:38.9 RW: Maybe not serious or life threatening damage most of the time, but if someone is dealing with lymphedema, which can be silent and then flare up again, let's not be part of that dysfunction.

 

0:11:52.5 RK: Exactly. And so sometimes with people who've got venous insufficiency, there can be some problems with that also. So we just have to look at the condition and respect the condition, but also respect the client who has that condition and be able to treat that person safely and effectively. And saying, no, I'm not trained well enough to work with this person. And having that confidence in what you know and what you don't know is, I think, a really important part.

 

0:12:22.8 RW: I want to talk a little bit more about this idea of catastrophizing things, right? So let's say you have a student in one of your CE classes who says, oh no, I learned that you cannot be face down on the table because that will wreRW it and you won't be able to do, whatever you do is not going to work. Right. What are some communication hints or clues that might help people let go of some of those myths? 

 

0:12:54.2 RK: I would just say, did that person provide evidence for this or a good reason why that would be. So if someone provides a solid reason in some sort of evidence based or some sort of anatomy, physiology thing, then yes. But I would also try and work with them to say, okay, when we are in this position or when we do this or that, what is actually happening to the tissue? How much is the tissue being compressed? Are you compressed at other times of your day with that tissue, laying on your belly, getting massage or doing whatever. What is happening? And looking a little bit deeper into what's going in the tissues.

 

0:13:41.5 RW: To me there's a little bit of an elephant in the room, which is that sometimes people will say, I was taught this or that, that you might really strongly disagree with based on some good thinking processes. Do we go baRW to the origin of that information, the person who taught them incorrectly, or do we let it slide? I mean, this is a very small community. That person might be a colleague. Right. And it doesn't seem appropriate to go to that other person and say, hey, here I think you, I hear you've been teaching this. That's wrong. That's not going to get us very far.

 

0:14:20.6 RK: No, I may and I have done it just a few times, of emailed someone and then asked about this and ask where they got their information from. Because I have been wrong. I have said all kinds of things that I said 25 years ago that I don't say now, because I was corrected, which I have no problem with. I am perfectly okay. Students will correct me on a regular basis because something I don't know about, and I'm okay with that. But I will go to them and just say, where did you get this information from? Well, I heard it from this or that. Okay. Do you know where they got that information from? No, they just told me. I said, did you take a look at this? Because I have some information that is a little bit different than that. And this is the information that I'm going by, and this is where my sources are for this information.

 

0:15:10.9 RW: But having a private conversation in the spirit of honest inquiry I think is the best way we can possibly elevate the information that gets out to our students. And it's so important, and it's also really slow. It's a very slow process, and people will oversimplify on their own behalf. I certainly have been guilty of that. Reading something fairly complex, creating my own picture of it in my mind, which is 85% correct. But that 15% that I misunderstood can sometimes really trip me up down the road. So as my friend Diana Thompson would say, take that as another swear word learning opportunity. She didn't say swear word.

 

0:16:00.6 RK: Okay. She said a swear word. It just is having the ability to learn or having the zeal to learn, I think is just such a big thing and being okay with not knowing everything.

 

0:16:15.4 RW: Well, and the thing about teaching anything about health is it is always a moving target. What I learned about, here's another sort of myth that turns up even around lymphatic work. When I was early in my career and learning about orthopedic massage, I was taught that I was breaking down scar tissue, right. With cross fiber friction. You're ripping it up and then setting it up so it'll heal better. And with all respect, that was a story that we were told and that we told ourselves and that we told our clients to explain. That didn't change the effectiveness of the work. The work, the way it was done got good results. But the story we were telling about what's happening at the rotator cuff or the extensor compartment or whatever was wrong. And I think we have an obligation to be as correct as it's possible for us to be in the way we communicate to students and to clients about what we're doing. And so you sent me a story about how one thing that you heard from someone was that manual lymph drainage breaks down fat cells.

 

0:17:30.0 RW: And I have seen people talk about MLD breaking down scar tissue. And I'm sorry, but if you're breaking the collagen fibers, if you're breaking open the fat cells, this is tissue damage. And there's going to be bleeding and bruising and adverse events that are not the things that our clients are looking for from us.

 

0:17:55.8 RK: No, I think it's just like we said, just a simplification of things and trying to define what we don't know. And so sometimes people will jump at the first thing. The longer that I've been teaching, the more that I'm saying about some things with anatomy and physiology is we just don't know. We don't know exactly, to my knowledge, at least. And what I know of what's happening to try and mobilize tissues, what physiologically is happening? To my knowledge, we don't know. And you may know more than I do about that.

 

0:18:28.4 RW: Actually, I have a client who episode that will air before this one was an interview with a scar tissue expert named Kathy Ryan, who certainly opened my eyes to some things about the interface between manual therapy and the quality of scar tissue. We are, in fact, learning more about this every single day. And it's exciting. It's exciting not necessarily to know the answers, but if you're a student or if you're a teacher who feels responsible to students, saying something like, we're pretty sure massage has some kind of impact on circulation, but we're not really sure what it is, does not make people feel confident about passing the MBLEx.

 

0:19:11.2 RK: No.

 

0:19:12.0 RW: It's okay to have some nuance and to go baRW on those sayings like massage boosts circulation 300%. That is a dual quote from something I was taught and it took years, decades really for me to go baRW and say, what does circulation mean in this context? Are we talking about blood or lymph or venous blood, arterial or venous? Are we talking about locally or systemically? Are we talking about duration of effect? What in the world do you mean? Where did 300% come from? Yesterday in a social media place that I follow about using the word knot in reference to myofascial trigger points. Right. People actually think that there are knots, like literal knots in their muscles.

 

0:20:00.3 RK: A student just asked me last night about it.

 

0:20:03.0 RW: Yeah. How does that muscle get into a knot? Right? 

 

0:20:07.4 RK: You cut it off, you tie it into a knot and you reattach it to the bone.

 

0:20:12.5 RW: Language is a blunt tool.

 

0:20:14.5 RK: Yeah.

 

0:20:15.6 RW: We have to use it with some precision. But that can be triRWy to do when we want to cut to the chase and share information really, really effectively. But it's not effective if we're giving wrong ideas.

 

0:20:28.8 RK: Exactly.

 

0:20:29.6 RW: Wrong ideas can sometimes lead to catastrophizing when people think that they're going to have brain damage because their muscles are tight or that their muscles are in knots or that, I'm cutting open their scar tissue with cross, all these things. So.

 

0:20:46.8 RK: And I can lose weight by my fat cells getting broken open and things like that.

 

0:20:52.6 RW: Reduced cellulite. Yeah.

 

0:20:54.3 RK: Yeah. And I think it is a language thing. And if we as a profession, I know this is a difficult thing to do, but if we were to agree on a common language like of someone I know said deep tissue massage should be everything from deep fascia deeper and base it on anatomy. But it just is, that's just, that's just an idea of just if we have some consistency.

 

0:21:16.6 RW: Yeah, no, and we finally have some good nomenclature around definitions of massage, massage therapy and massage therapy practice. Those are three different entities that I think have been really, really beautifully defined by the work of Ambler Kennedy and her team. But we don't have great definitions for a lot of other things like deep tissue or. Here's a word I would like to eradicate from massage therapy language altogether is release.

 

0:21:46.2 RK: Oh yeah.

 

0:21:47.1 RW: Which is hard because natural release is a whole effective approach. But we've taught ourselves this story about releasing things, and that's probably not happening. All right, so this has been a fun opportunity, Rob, to talk with you about some of the challenges of being a teacher and being a citizen of our community of massage therapists and elevating the way we talk about our work so that we can really emphasize the success story that it is when someone shows up.

 

0:22:21.7 RK: Yes. Thank you so very much. It's been very, very, very enjoyable.

 

0:22:24.9 RW: Thank you, Rob. I really enjoyed this time as well. We'll be in touch.

 

0:22:28.0 RK: Okay, bye-bye.