Simple Things First

Soft-Tissue Sources of Discomfort Are Often Overlooked

By Douglas Nelson
[Table Lessons]

“Very few,” she replied. “Just two or three episodes since the last session.”
This was great news. Three months previous, this client had presented with a host of strange neurological symptoms that were perplexing both her and her doctor. None of her physicians had a clear idea as to the genesis of her symptoms or what the appropriate response might be.
Hearing her report, my mind immediately reverted to another client (Ms. B.) who, three years earlier, also presented with unusual neurological symptoms.
An otherwise healthy woman in her mid-40s, Ms. B. was referred to me by her primary care physician, who was at a loss to explain her strange neurological symptoms. Ms. B. described having “sensations on the left side of her face” in the mandibular and maxillary areas. Multiple doctors explored possible diagnoses, from tumors to serious neurological diseases. Perplexing to everyone, these facial sensations were unaccompanied by any other symptoms. Neurological diseases are progressive, but her symptoms were contained to her face and were relatively unchanged in frequency and intensity. Activity and stress seemed to exacerbate her symptoms, but the location remained unchanged.
What was changing was Ms. B.’s emotional and financial health; both were deteriorating in direct relationship to the number of additional tests, providers, and unanswered questions about her future. The long list of providers, plus additional out-of-pocket complementary providers, had depleted her family’s financial resources. Ms. B. was both emotionally and financially exhausted.

Remember Our Bread and Butter

The human brain is wired to want a reason for each experience we encounter. When a reason is ascertained, then a course of action can be pursued. Having no reasonable explanation for one’s symptoms is a completely disempowering experience. While Ms. B. wanted a reason, she also worried that the cause might be life threatening, or at least life changing. Unfortunately, the latest explanation was that she may have multiple sclerosis. This was devastating news.
The one explanation that no one considered was the possibility that her sensations were soft tissue in nature. I am sensitive not to over-apply “soft tissue” as the reason for every symptom, but if palpation could replicate her symptoms, then soft-tissue therapy would be a reasonable approach.  
Asking Ms. B. to show me exactly where on her face she felt these symptoms, I began slowly palpating her zygomaticus, masseter, and temporalis muscles. All were quite sensitive (especially the zygomaticus) and relevant to her symptoms. I could also sense her satisfaction with the careful and thorough palpation, as she confided that no other health-care provider had actually touched her face. I also compared the fascial mobility of her face, finding palpable differences in the left side compared to her right.
After examining her facial muscles, I began slowly and methodically searching her upper trapezius for sensitivity. In my experience, the anterior fibers that attach to the clavicle often refer sensations to the face, in the same pattern Ms. B. described. Indeed, this is what happened. She was astonished that I could replicate her symptoms by compressing a muscle so distant to her problem. Different areas of the trapezius replicated different symptoms in her face, like a map I could trace at will.
Not surprisingly, Ms. B. left the office in a completely different state of mind. She had hope that there might indeed be an answer to this mystery. Calling her three days later, she was thrilled to share that her symptoms were much less frequent, the first change in months. All of this positive news was counterbalanced by a hesitancy in her voice when I mentioned returning for a follow-up session or two. I was perplexed.
Later that day it hit me: her hesitancy was probably embarrassment at not being able to afford the work.

A Helping Hand

One of our wonderful clients has given my office funds to provide treatment to people who could not otherwise afford it. When I called Ms. B. to offer her the opportunity to use these funds for more sessions, she was ecstatic. After three more sessions, her symptoms disappeared. Think of the emotional and financial burden that was lifted using thoughtful and thorough hands-on therapy, all at a cost that was minuscule in comparison.
“I’m thrilled with the progress,” my current client stated, jolting me back to the present moment. “I think my doctor needs to know about the value of this work.”
“Indeed,” I replied. “It could really help someone else who is struggling with similar symptoms.”
And save a lot of money, time, and worry in the process, I thought to myself.  
There is a time and place for everything. Advanced medical testing and imaging can detect unknown problems and save lives, but it is also important not to overlook simpler solutions to symptoms as well. It is my experience, and I bet yours as well, that soft-tissue sources of discomfort are indeed too often overlooked.

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 president of the Massage Therapy Foundation. His clinic, seminars, and research endeavors explore the science behind this work. Visit, or email him at