Can We Cut the Charade?

By Table Lessons
[Doug Nelson]

“So painful,” he complained. “My back pain is so frustrating. It can get worse and then somewhat better, but it never completely goes away. I have tried so many different things and still, it hasn’t really changed.”

Sitting across from my new client, I observed his posture, breathing, and general presentation. His frustration was evident, as was an air of impatience.

“How long has your back been an issue?” I asked.

“It’s been almost three years. I really thought it would be resolved by now, but it isn’t. It started when I was stepping off the stage after a gig. I started to slip and caught myself before I actually fell. Within three days, the pain began and hasn’t relented since.”

“Have you seen other practitioners about this?”

As soon as I asked the question, I could sense his unease. What he described was essentially Noah’s Ark for health care; he had seen about two practitioners of every discipline imaginable. Recapping his experience, it was difficult to witness someone so frustrated and hardened by the process of seeking help. And yet, here he was in my office, ready to begin the journey with yet another practitioner.

I began as I always do, asking questions as to what made the pain better or worse, what movements elicited discomfort, and what positions might bring relief. After several questions, I sensed his impatience mounting.

 “Please take this the right way, but could we just cut the charade?”

“I’m sorry, what?” I asked, shocked. “I’m not sure I understand.”

He hesitated and I could tell he was struggling for an answer. The tone he used wasn’t insulting or demeaning, which I found fascinating. His statement didn’t feel condescending, which itself was odd.

“I’ve seen many practitioners and all of them asked me a boatload of questions. I’ve filled out forms, forms to request forms, told the story of my back way too many times, and had diagnostic images taken more than once because everyone wants their own set. Here’s the kicker—in the end, these practitioners did what they were probably going to do in the first place. What’s the point of gathering all this information if you aren’t going to use it anyway?”

The inordinately sad thing is, he is correct, and he isn’t the only person to feel this way. Practitioners often go through the motions, asking questions they are told to ask, with no real plan to integrate that information into forthcoming treatment. It’s like a hotel that sends you a survey that takes longer to fill out than the actual time you spent in the hotel. For all the time spent completing the questions, you are left wondering who is going to read all that, and are they going to fix the noisy heating unit?

“In one way, this is not going to go well for you,” I teased my client, diffusing the situation. “With every question I ask, I will explain what your answer means, what it confirms, and what it disconfirms. I absolutely promise I will change what I do in response to the answers you give. I have no low-back routine or protocol—this is a fluid process. This is much more jazz improvisation than the reading of sheet music. And, as you know, it takes more technical chops to improvise than it does to just read what is written.”

I could see the music reference was something he related to. In the ensuing minutes, for every question asked, I explained what his answer meant and how it influenced my approach. If the answer was positive, I also explained what a negative answer might reveal. To his credit, he went along with the process willingly, even though it took about eight minutes.

After the intake, we began the hands-on portion of the session. After some initial verbal feedback, I settled into the work. After perhaps 10 minutes without speaking, I heard him chuckling to himself.

“May I ask what is so amusing?” I inquired.

“You know, in all the people I have seen, this is perhaps the first time that anyone actually did what I asked. I mean, what I said made a difference—and now, you are addressing areas that I somehow know, deep inside, will help. Someone actually listened to me. Sorry for laughing.”

I know he meant this as a compliment, which it was, but it is a sad commentary on his prior experiences. When we, as providers, listen and then respond, it validates the experience of the client. Few aspects of the session are more important than that. We all struggle to be better listeners. But what we do in response validates whether the client has actually been heard.

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