Defect or Defense?

By Douglas Nelson
[Table Lessons]

“I’m worse. Way worse. This is so discouraging.”
These are not the words you want to hear from a client at the beginning of a session. I tried (probably unsuccessfully) to hide the disappointment I felt. Failure is something I am familiar with, but this turn of events completely surprised me.
“I thought you were doing better after our last session. Wasn’t the pain down the leg receding?” I inquired.
Ms. H. had first visited my office about three weeks before, complaining of back pain that radiated down the right leg. Her pain had the presentation of a classic radicular issue, typical for an L5 nerve root distribution. She had seen her physician for this problem and an MRI did not show anything conclusive. There were some degenerative changes and slight abnormalities, but nothing that would explain the pain she was experiencing. Her physician prescribed physical therapy. Multiple visits resulted in no improvement.
After consulting with some friends, Ms. H. sought my services. I had seen her three times, and during our last communication she informed me that the pain down the leg was better.
But her sudden flare-up of symptoms had me totally perplexed.
“I was doing better,” Ms. H. said. “The symptoms got much worse after my physical therapy appointment last week.”
“What happened at that appointment?” I asked.
“I had the chance to see a physical therapist in Chicago. She did a really thorough assessment and postural evaluation. During the structural examination, she found a significant distortion in my spine, which may ultimately be responsible for my back pain. We did some corrective exercises for the distortion multiple times that day. By the time I left, my back was really hurting. On the way home, my leg pain reappeared and has been there ever since. I am just devastated.”
“Were you having leg pain before your appointment?” I inquired.
“Only occasionally at that point,” she said.
“If your pain had improved before, it is certainly possible to get that improvement back. Let’s see what we can learn from the physical therapy experience and apply that to helping you. There is always something very important to be learned in both failures and successes. I’d like you to show me the distortion the therapist pointed out.”  
As Ms. H. faced away from me, I already knew the distortion the therapist was referring to. Looking at Ms. H. from the back, her spine was laterally shifted to the left, mostly at her lumbar spine. I had seen this during her first visit to my office.
“I do see the lateral distortion in your spine, but I want you to notice something,” I said. “Watch what happens when I move you into a more aligned position.”
Placing my right hand on her right hip and my left hand on her left shoulder, I moved her spine to the right, correcting the shift.
“Ouch,” she exclaimed. “When you move me to the right, the pain shoots down my leg.”
“This is a very important discovery, one that tells us a lot about the role of this distortion in your spine. As you were told by your physician, one of the nerve roots at the base of your spine is probably very inflamed. As a result, the nerve is hypersensitive to any kind of pressure.” I picked up the flexible spine model hanging in my office. “Watch what happens when I shift or laterally flex the spine to the right. What happens to the nerve?”
“It is compressed,” she observed.
“Exactly. Do you see how the nerve is then decompressed when your spine shifts to the left? This is why shifting left gives you relief.”
“But my spine is distorted; that can’t be good,” she countered.
“Yes, it is distorted, but the more important question is why. Is this a defect or is this defense? Is the distortion the cause of the pain, or a response to it? I think the answer is pretty clear in one simple movement: if I put you back into what is supposedly correct posture, it makes your pain worse. Do you remember when you were here last? I was treating your lower back with you lying on your left side, opening up the right side of your lumbar spine. It felt great because I was taking pressure off the irritated nerve.”
“So the distortion in my spine isn’t the problem, it’s actually my body’s answer to the pain,” Ms. H. summarized.
“Exactly,” I agreed. “Temporary distortions like this are called antialgic positions—the words mean ‘against pain.’”
“If we resolve the neural issue, the distortion should disappear on its own, right?” Ms. H. surmised.
In the weeks that followed, that’s exactly what happened. Observing what the body presents is important, but perhaps the more important task is to deeply understand why.

Douglas Nelson is the founder and principal instructor for Precision Neuromuscular Therapy Seminars and president of the 16-therapist clinic BodyWork Associates in Champaign, Illinois. His clinic, seminars, and research endeavors explore the science behind this work. Visit, or email him at