At a social event, a client requested that I speak to a friend of hers. As I was introduced to Mrs. L., I could see she had her left arm in a brace and was holding that arm close to her chest. The level of protective behavior immediately got my attention.
Mrs. L. said, “I fell, fracturing my arm, which was then surgically repaired with plates and screws. When I complained about my pain, however, the doctor kept telling me how good the X-ray looked and how everything was healing well. If it was healing so well, why am I in so much pain?”
“If there was enough force to break your arm, what do you think it did to the muscles and nerves around the trauma site?” I asked. “Has anything been done to address the soft-tissue trauma?”
I could see that Mrs. L. was reflecting on the role of soft tissue and her pain, something overshadowed by the overt trauma of the fracture. We agreed to meet the following day for an appointment.

Sensitivity Map
At the beginning of our session, I watched Mrs. L. remove her long-sleeve shirt, being careful to let the fabric make as little contact with her skin as possible. Lying on the table, the apprehension in her face was remarkable.
“Can you tell me where and when you feel the most pain?” I inquired.
“There is a deep aching all the time in my arm,” she said, pointing to the brachioradialis area, “but I also feel a lot of pain here in my hand,” she said as she pointed to the ulnar area. “The skin itself seems sensitive, yet the pain also seems deep inside. The discomfort is relentless; it is hard for me to get any rest at night.”
I began by very lightly stroking the skin of her arm above the elbow and slowly approaching her hand. I did this in several different ways, to vary the sensation. We created a map of her sensitivity, which revealed that specific regions of her arm were involved, but others were not. This clarification of her proprioceptive map was extremely important. Once the map was identified, I could feel Mrs. L. tense as she assumed I was going to do something more aggressive.
“What are you going to do?” she asked. “I’m sorry—that didn’t sound great, but I am nervous about you treating my arm because it is so painful.”
“No need to apologize,” I replied. “I understand your reticence. Let’s see if we can decrease the sensitivity using an indirect approach.”
Pressing lightly into a sensitive spot in her arm, I asked Mrs. L. to remember the discomfort level, which we would use as a reference point later. I then began examining the left side of her neck from C5 to C7.
“Wow, that is surprisingly tender!” Mrs. L. remarked. “Is it sensitive because of the way I am holding my arm?”
“Possibly, but if you don’t mind, I’d like to explore something else as well,” I answered. “Is this area sensitive?” I asked, pressing on a specific area of her infraspinatus.
“Wow, it certainly is,” she said. “What the heck?”
After calming both her neck and infraspinatus, I returned to the sensitive reference area on her arm that we initially explored.
“Is that really the same spot?” Mrs. L. asked. “That is far less tender. That’s amazing.”
“The nerves that serve this area of your arm come from the area of your neck I was touching. Additionally, research has shown a connection between that tender muscle in your shoulder and this area of your arm. Addressing one affected the other.”
Her arm was now much more amenable to touch. I was careful to address the tissue in an exploratory way, inviting her nervous system into the area. I was careful with both the intensity and duration, keeping both at low levels.

Practical Partnerships
When Mrs. L. returned for her second session, my eyes widened when she gently pushed open my office door with her injured arm.
“I’ve been trying to use my arm more this week,” she said, noticing my startled reaction. “I went to physical therapy, and the exercises weren’t as bad as I feared. I also notice that from combing my hair to using the mouse, I am reincorporating my left arm back into my daily life. Could all this improvement really come from one session?”
It is difficult to exercise if you are in pain, or fear being touched. My job was to make physical therapy and an increase of daily activities possible. Massage can be a great catalyst, opening the door to help other therapies work better.

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