One of my latest blog posts on “The Feel” generated quite a bit of interest. This is flattering, but not surprising, as I truly feel that teaching the Feel of soft tissue restriction is a lost art, one that is not covered in most schools or continuing education. But the connection that you make with your patient’s pain or dysfunction is key to making changes. What you do with that connection varies widely, depending on your choice of modality.
Since writing that post I’ve thought a lot about what connecting to the Feel means to me. It really is about the hook in therapy; how to move someone from a person with passing interest in your work to one who is deeply invested in the process. I see this every day in my treatment room. The hook is not about tricking someone into coming for treatment, it is about allowing them to know that you are able to feel what they are experiencing. The connection may not be anywhere near where the pain is felt by them, but you are able to connect with it. If you, as the therapist can identify an area in your patient’s body that seems to correspond with their pain and get confirmation from them, you have completed a feedback loop of validation, one that informs them that you truly know what you are doing. Once you’ve identified the tissue that is responsible, treatment via myofascial release follows easily.
Have you given any thought to your hook? Can you find and touch your patient’s pain, even if you are not touching where they feel the pain? If not, find the hook.
For Now,
Walt Fritz, PT
How very true. Often I find that the client has not been “hooked” by another practitioner(s), and is relieved to just have what they feel validated, not to mention having it addressed. Hooking as you put it seems to be lost (or never was there) in some because of a desire in the practitioner to relieve the symptom within the shortest time possible for the highest compensation.
I always make it clear to the client that we are connected beings affected by changes in all forms. I use analogies and some tactile examples to illustrate fascia, and other structures so that they can visualize and “hook in” so to speak. I also demonstrate with their participation on an unrelated body (easy to palpitate) area so that they may experience what I’m feeling. This takes maybe 15min. with a new client, but pays off huge in acceptance, results, and referrals.
I took this approach with an MD client, and it resulted in a stream of referrals from her, including two other MDs, and a potential to speak at their MD peer group meeting.
Darren,
An excellent approach. The Hook is a vital aspect of both my practice, as well as my seminar teachings. Without it, our effectiveness is diminished.
I believe we need to have a connection to the patients pain. When I am able to feel with my hands and pinpoint their pain without their direction the results are amazing. The patient knows that I understand where they are at in their pain. We make a personal connection with them. Most have been told it’s in their head. Yes Walt, validation is very important to those we treat in our practices.
Worked on my most self aware client today. When we got down to the popping in her knee [distal edge of the keel was catching medially with flexion and proximal laterally with extension] she was able to trace the fascia tension all the way up to the popping in the left TMJ.
She is very good at noting the how and why during treatment so that she can relieve the stress daily from her work. As I commented on the bodyworker group I hate unnecessary client visits.
Unfortunately during my training in the Rolfing paradigm, there was not a lot of class time devoted to teach “listening”, of refining our touch to feel not just where, but what hooking-in is all about, how that connection tells us where to go, the body’s story and so on. We were thrown into a complex world in a short time and taught to follow the Rolf recipe and all would be well, but as I have found out after three years of practice that doing a mechanical analysis and pressing firmly into someone’s body without having the client with you, you and they can become lost. In my practice, if someone complains about pain here, I go there, only to have them say, “I feel weird stuff happening way over there”, and I just acknowledge that and move on. An opportunity missed. There is so much more to learn.
Jon,
My myofascial release training tended to herd therapists toward the emotions and unwinding. While unwinding can have merit, it does not replace learning the Feel, which to me is the basic importance of this work.
We learn a lot of very good information through continuing education, but the rest is up to us.
Hi Walt, I loved this post in your blog. I have been teaching courses in Myofascial Release in the UK for the past 10 years and there is one thing that seems vital to Myofascial treatments is that the sessions are collaborative. I find that it is essential that the patient “comes along for the ride” and is not simply a passive recipient of manual therapy. To that end if I am facilitating some release of the upper quadrant, for example, and reach a restriction I ask my patient if they can tune into where I am and allow me to “pass through” that restriction. To some, this is pure gobbledygook to others they can feel how their holding pattern and their restriction is theirs alone and my job in all this is to prompt and facilitate the release….. and Oh when the tissue goes! With barely restrained excitement I ask, “did you feel that?” they reply with descriptions of what they could feel in the various local and non-local parts of their body… There’s the hook! This is the client base with whom I know we will progress along a fruitful journey.
Having your patient connected is not mandatory, as people can heal or improve even if they are not a participant. But, I find the effects are more profound if they are hooked into the process.
Hi Walt,
I totally agree about the hook. If the client know that you know how to make the connection with their pain, they will totally tell all their family, friends and even strangers! I love the referral these clients send me.
Thanks for the great article!
Christine
“The Hook” can have many faces, and future referrals is certainly one of them!
You have found the words to describe what I’ve been doing! Thanks. It certainly helps when the client can connect deeply with what you’re doing! They still receive the benefits of your work if they don’t but they are much more excited about it when they “get it”.