Always On

By Douglas Nelson
[Table Lessons]

“First, I want to tell you my leg has been better ever since you treated it last month. I haven’t given it a thought for weeks. That’s not the pressing issue for today,” Mrs. M. said, taking off her coat. “I have a new issue—this muscle right here,” she said, pointing to her upper trapezius muscle. “I can’t shut it off. It’s like there’s a switch somewhere stuck in the on position, and I can’t find the off switch.”
I had Mrs. M. lie supine on my massage table as I began to examine her right upper trapezius with very slow and careful pressure, using flat palpation. Almost immediately, Mrs. M. said the tissue I was touching was tender and likely the source of her tension. After a bit, her sensitivity began to subside. Moving just a few centimeters distally, I immediately happened on another spot Mrs. M. declared to be important. After that also released, I again moved just slightly, only to discover another tender area. At this point, my alarm bell went off.
“I’d like to briefly explore the whole area a bit more, if you don’t mind,” I told Mrs. M. Doing so, I found almost everything was quite tender, each one about the same as the last.
“I don’t like this,” I told her. “It seems there are too many sensitive points in your shoulder. My experience in the past has been, ‘If everything is it, nothing is it.’ It’s like playing whack-a-mole with pain. I’d like to try something. Would you please lie on your left side?”
With Mrs. M. on her left side, I sat behind her and wrapped my right hand around the front of her shoulder while placing my left hand over her scapula. I began to slowly move her whole shoulder into elevation, depression, protraction, and retraction. The point of this movement was to sense resistance and assess which movements were easy and which movements were difficult. Moving her shoulder into depression was smooth and effortless, while elevation was rather difficult, and, for lack of a better word, ratchety.
“Can you feel what I’m doing with your shoulder?” I asked. “What do you notice?”
“Nothing hurts when you do that, if that’s what you’re asking,” she responded.
“I didn’t expect it to be painful, but I am curious about what you perceive about the quality of the movement. Does each direction feel the same? Do they all have the same ease?”
As I performed the movements with her shoulder again, Mrs. M. paid closer attention. “It seems when you push my shoulder upward, I have a difficult time just letting you do that. I can feel myself somehow resisting the motion.”
“This is what is so interesting,” I responded. “If I pull your shoulder downward toward your feet, which muscles have to let go?”
“The muscles above,” Mrs. M. replied without hesitation.
“And if I push your shoulder upward?”
“The muscles from below. Which is curious, since I feel tension in the muscles above,” she said, pointing to her upper trapezius.
“I have an idea,” I said. “Let’s fully treat the muscles from below, and then see what happens.”
For the next 10 or 15 minutes, I treated the latissimus and lower trapezius muscles thoroughly with flat and pincer palpation, finding and treating several sensitive areas. After finishing, I repeated moving her shoulder superiorly and inferiorly. This time, the movement was effortless and easy.
“What a change,” Mrs. M. observed. “It seems easy now.”
“Let’s check the muscle again,” I said, as I had her return to the supine position. Reexamining the previously sensitive areas, there was a substantial improvement. Most of the sensitive spots were gone and those left were far less tender than before. Mrs. M. looked a bit perplexed.
“How did treating the muscles below quiet the muscles above?” she asked.
“Muscles work in opposing pairs during movement. When one pulls upward, it is opposed by another muscle pulling downward. If one muscle contracts, the opposing muscle must turn off. These relationships allow us to move with ease and grace. However, when one muscle has unrelenting low-level tension without movement, it causes the opposing muscle to respond in kind with a low-level contraction of its own. In your case, the muscles from below keep sending a message that they are contracting, necessitating the other side—your upper trapezius—to counter that contraction.”
“So that was what caused my feeling that the muscles were always on?” she asked.
“Exactly,” I responded. “When we shut down the tension from below, the tension from above also receded.”
“Muscles are kind of like people in that regard, I suppose: they respond to what they sense around them,” Mrs. M. observed.
“Indeed,” I concurred. “Indeed.”

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