Excellent Questions

Honestly Answering Clients is the Best Policy

By Douglas Nelson
[Table Lessons ]

“June? Really?” As soon it came out of my mouth, I realized my response was a bit forward. (OK, maybe a lot forward.)

“Yes, that was the first available appointment I could get with the hand specialist,” she replied, while I tried to walk back my reaction.

The context? My client, Ms. M., is enrolled in a master’s program in flute performance. She is likely to pursue a doctorate as well; playing the flute is both her passion and her future livelihood. How is it that a musician of her caliber must wait four months for an appointment? Given my experience in treating collegiate athletes—who have access to treatment immediately—this made no sense. This fact only strengthened my determination to help her recover as quickly as possible.

As I began to address the musculature in her forearms, I could sense a question brewing from the concerned look in her eyes.

“Is this something that will pass, or is this a problem I will have to deal with my entire career?” Ms. M. asked.

Her question cuts to the heart of the struggle that affects most everyone in pain. It isn’t just what you feel, it is what you think it might mean for the future. For anyone to experience arm pain is unpleasant. For Ms. M., the thought that this pain could alter her life path is potentially devastating. Playing the flute since age 6, her arm pain is now also a threat to her personal identity.

It is here that pain and stress share particularly important attributes. One of the factors that can increase the experience of both pain and stress is a sense of uncertainty. Pain (and stress) that is predictable or knowingly short-lived is much easier to tolerate than pain that may be chronic. In the research arena, unpredictable pain is experienced as more unpleasant, harmful, and intense. Even more, losing control over pain is worse than having never had control over it in the first place. Ms. M.’s question expresses her desire to have a sense of what to expect in the future, so that she appropriately might address it.

Addressing a question such as this is never easy. We therapists are often understandably hesitant to predict possible outcomes. Yet, responses like “every person is different” is of little help to the client. How do we respond honestly and accurately to such a difficult but important question? After pondering her question, I answered in the best way I knew how.

“Here is what I can tell you, based on many years of treating musicians with problems such as yours,” I said. “In a modest percentage of people, when an episode such as this is resolved, it does not return. A much smaller percentage of musicians have the opposite response—an ongoing problem that they must be constantly vigilant about addressing. The largest percentage experience a resolution of the initial problem but do have occasional episodes when under substantial stress or intense and erratic playing schedules. It is hard to know which category you will fall into at this time, but there are two factors that will be helpful to determine the future course of events.

“The first factor is your body’s response to treatment. If you notice, each time I find a sensitive area, the intensity seems to abate rather quickly. In my experience, this is an excellent sign for the future and speaks volumes about the health of your tissue and your body in general.

“The second factor involves playing technique and underlying factors. Whenever I am treating a musician, I must consider the possibility that faulty technique is ultimately the problem. If it is, soft-tissue treatment is not likely to succeed and the issue will keep resurfacing. I know your professor and he is extremely knowledgeable about ergonomically sound technique. In addition, you are also seeing a physical therapist for strengthening and an Alexander instructor for more efficient body usage.

“When you add these factors together, there is no guarantee, but I’d say your outcomes are likely to be very positive. In fact, you may even come out of this with a more efficient playing technique that will benefit you for years to come. How you are handling this says a lot about your resilience and desire to learn and grow, both as a person and as a musician. I’m happy to be a part of this journey and look forward to sitting in a concert hall and hearing you play someday. That day will come.”

“Not soon enough,” she replied. “I miss performing.”

And I miss attending live concerts due to COVID restrictions. When that day comes, attending hers will be especially gratifying.


Addendum: I just saw Ms. M. for her fourth appointment. The previous evening, she performed an hour-long master’s recital on the piccolo and was elated about how well it went. She was able to transcend from focusing on playing mistake-free to conveying the deep emotion embedded in the music. It was a transformative experience for her. She has already canceled that appointment in June.

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 nmtmidwest.com, or email him at doug@nmtmidwest.com.