Walking into my waiting room, I greeted Ms. K., a client I had not seen for several years. I noticed she was wearing a surgical boot on her right foot and was also in possession of a pair of crutches, which had seen extensive use.
I closely watched her gait as we walked the hallway to my treatment room; nothing about using crutches is easy. After entering my treatment room, we sat down to talk.

What struck me now—as I remember it did when I first met Ms. K.—was her quiet confidence.
Ms. K. was clearly comfortable in her own skin—so comfortable that it seemed all her energy and focus could be directed to the person with whom she was speaking. I admit feeling the need to elevate my level of attention to match her singular focus.
“How can I help you?” I asked, thinking this was assuredly about back pain from wearing the boot.
“My neck hurts,” she answered. (So much for my assumptions.) “I thought it would get better on its own, but over the past three weeks the discomfort has been increasing, not decreasing.”
 “Where and when do you feel the most pain?” I inquired.
“I feel a deep ache around here,” she replied, pointing to C6–C7 on the left. “The discomfort varies in intensity, but it never completely goes away. And then there is this place,” she said, pointing to the C1 transverse process on the left.

“This pain happens when I turn my head to the left. When I do, there is a sharp pain, very point-specific. I feel it in the same place when turning right, but the pain has a different quality, more of an ache.”
Thinking through her explanation in my head, I started making a list of all the muscles that attach to C1 and their roles in ipsilateral and contralateral rotation. Of that list, which muscle might also explain the lower cervical pain?

Also, which muscles on the list would be irritated by her use of crutches? Remembering her gait, she had a pronounced forward-head position at the moment her crutches hit the ground. How might that play into this scenario?

After populating my list of potentially involved muscles, I began to explore her tissue via palpation. While several muscles were tender, the levator scapula and the obliquus capitis inferior were extremely sensitive. Since both of these muscles are ipsilateral rotators, they could play a role in pain during left rotation and aching during right rotation. Observing how she recoiled in response to very gentle palpation, I decided to pursue a more indirect approach, addressing other ipsilateral rotators (synergists) that were not as tender.
Usually, when I discover the epicenter of a client’s pain and move to other muscles, the client tries to redirect me to the original area of discomfort. In their mind, I am on the “right spot” and have now wandered away from what is most important. This usually requires an explanation of what I am doing and why. Not only did Ms. K. not ask that question, I had no sense she was concerned about my choice of strategy.

Because I have always needed to explain myself in the past, I did so again. “You might be wondering why I am treating areas that aren’t as painful as the one we initially found,” I said. “Very often, when the offending muscle is hypersensitive to intervention, it is best to address other muscles in its relative ecosystem, hoping to indirectly downregulate the super-sensitive muscle.”

Ms. K. did not respond verbally; she just gave me an understanding nod. Slightly surprised, I still felt the need to continue explaining.

“As an example, imagine a volatile situation,” I said. “Let’s say, perhaps, involving a crime. There might be one main instigator, but they are so agitated that any direct negotiation carries a high risk of escalating the problem.
“One strategy is to use the influence of others who may be more amenable to intervention. In this case, I am addressing other muscles that have the same function as our original culprit. If we are successful, then direct intervention will be possible.”
Again, Ms. K. gave me a smile and a nod that revealed deep understanding. I probably looked a little confused at her complete acceptance of the approach, and she noticed my perplexity.
“I’m a retired FBI agent,” she replied. “One of my main roles was hostage negotiation.”
“OK then,” I replied, sheepishly. “I guess you pretty much understand the strategy.”
“Very much so,” she replied. “It’s an approach we employed to great advantage in volatile situations. It makes sense to apply it now.”

There are two lessons here. First, principles of great problem-solving span multiple disciplines, and we can learn much from the experience of others. Second, never underestimate the depth and breadth of understanding clients may bring to the table!