Reflecting on Early Training

When I think about ‘beyond assessment’, my mind returns to my initial experiences and early training. In bodywork disciplines—be it physiotherapy, massage therapy, or osteopathy—the foundational skills involve assessing individual muscles or groups of muscles to identify sources of pain or restricted movement.

Chronic Pain and the Assessment Process

Throughout my remedial massage education, I learned how to assess both rotator cuff injuries and issues with bicep function.  We also learned the importance of measuring the range of motion when investigating joint pain, as well as how to assess for restriction and discomfort in both the lumbar and cervical spine.

While curiosity was supported, I frequently questioned how many individuals genuinely adopted this mindset, developed confidence in their professional responsibilities, and prioritized sustained growth over short-term results.

Curiosity in Practice

Take, for example, a rotator cuff injury. Sometimes, the underlying issue might be that the ribs are not moving as they should. This required us to nurture our own curiosity and question why the rotator cuff was presenting problems. Our focus was on repairing the rotator cuff, not necessarily on exploring the broader context.

Expanding Understanding Through Practice

After qualifying and starting my practice, I attended workshops to broaden my technique repertoire. This journey led me to a deeper appreciation of what assessment truly entails, moving beyond just the basics. Developing a deeper understanding of my anatomy and connections within the body, that muscles can function as synergists, antagonists and agonists, as well as solo action and combined action.

The Four Guidelines of Assessment

• Subjective
• Objective
• Assessment
• Plan

These four pillars formed the basis of my assessment approach. They provided a guiding framework—an anchor—for evaluating and treating the person before me. The plan I developed often felt adaptable, changing rapidly based on the patient’s response. Over time, I began to cultivate skills that extended beyond the assessment itself.

Skills Beyond Assessment

• Silencing the critical inner voice
• Listening to subtle cues in the subjective assessment
• Tuning into the body’s rhythm and energy
• Recognizing when the body signals that treatment is sufficient or when an innovative approach is needed

Assessment as an Anchor

My assessments and plans became my anchor. The initial plan, shaped by the assessment, might evolve depending on how the individual responded to treatment and their neurological functioning. This anchor often pointed to a deeper narrative behind injury or chronic pain.

Questioning and Adapting

It is essential to remain open to challenging our own findings and determining the next steps. Adapting is part of the process; I do not charge for changes in my understanding, as these are natural components of effective practice.

The Broader Context of Pain and Injury

Pain and injury rarely exist in a vacuum. These factors frequently intersect with emotional stress, lifestyle decisions, and social conditions, each of which can significantly influence an individual’s experience of discomfort or recovery. Understanding pain means looking beyond the surface symptoms and appreciating the impact of daily routines, work demands, sleep quality, and even the person’s support network.

By placing each case within its broader context, I am better able to appreciate the complex interplay between physical symptoms and external influences. This holistic perspective enables more effective, empathetic care, ensuring that treatment plans are responsive to the whole person rather than just the immediate injury.

Chronic Pain and the Assessment Process

When treating someone with persistent pain, headaches, or shoulder issues that have resisted previous interventions, I share with the patient that their pain signals dysfunction or a need for healing. We must find a way in—assessing neck pain or headaches physically, then drawing on the confidence to consider neurological and historical factors. The assessments reveal restricted movements and provide insight into what is happening.

Variety in Injuries

In certain cases, the concern may involve a routine running injury or an issue related to the back.  Others may have sustained injuries by lifting heavy objects, tripping, or being involved in accidents. Each case is unique, and assessment must adapt accordingly.

In conclusion assessment is not a static process; it serves as a foundation from which meaningful treatment can evolve. As practitioners, we must continually reflect on the underlying causes and remain attentive to the subtle cues each patient provides. This approach fosters a deeper understanding and builds trust, allowing for more targeted interventions that address both physical and psychological aspects of pain.

Teaching workshops for 20yrs.

This last March will be almost the weekend, in March 2005 the first time I held a cpd workshop in my name Sue Bennett, which then became Flexible Healing workshops,

I had an invitation to organize, lead and recruit other teachers to present cpd workshops for members of my professional body at the LCSP register, the LCSP at the time was made up of remedial massage therapists, physiotherapist and osteopaths.

At the time it felt like a huge honor, I did wonder to myself what do I have to offer other therapists do I really have knowledge that is broad and deep to share of any meaning. I do believe there was a little impostor syndrome occurring.

The workshops were and still reflect my own practice they are reflection of my growth as a therapist over the last 20 years.

Over the years the workshops have covered subject matters:

• Muscle energy technique
• positional release
• studying the thoracic spine
• headaches and TMJ
• working with people with chronic pain states
• hip and shoulder dysfunction l!
• Hendrickson Method with Tom Hendrickson in San Francisco bringing the knowledge and technique back to the UK.

However, within the content of whatever subject matter been taught. There has always reflection, how do we teach adults.

Often therapist in my experience,  people within my sphere of practice, other colleagues like me have not always had an enjoyable experience of education as a child.

I learnt quite quickly. That sometimes people were visual, audible, or kinaesthetic learners, my delivery would change in style to the group before me. Some people needed to record or film technique being shown, I grew confident creating boundaries and been clear it was okay to record for personal use, not to be shared on ‘social’.

What became clear over the years, that often therapist attending the workshops were often working in isolation. Whist they were there to learn a new technique, we would also end up reviewing patients’ treatment plans, clinical reasoning, how to help those patients stuck in patterns of dysfunction, how to look after ourselves in the face a patients seeking emotional support as well as healing from their injury.

The workshops have evolved over the years, to include NLP skills, to support clearer understanding of ourselves, giving therapist clearer communication skills, setting compassionate boundaries.

The workshops have become, more seminar in nature, over one day, feedback tells me therapist are enjoying the smaller groups, whilst new skills are being developed there is always space for questions, inquiry and self-development.

Watching therapist grow in skills, confidence, knowledge and insight has been an absolute joy over the years of sharing insights and knowledge. There has also been friendships made, laughter, smiles and giggles, sometimes tears wonderful memoirs never to be forgotten.

 

 

 

 

 

When I first qualified 30 years ago, like many just starting out, I had a little impostor syndrome. I would ask myself – do I know enough? As new patients arrived there would be huge butterflies in my tummy. 

I hadn’t expected it, but this sense of being an imposter started to lessen as I found my place within the practice – treating people with long term chronic pain. I was finding I could help people who had struggled to find help elsewhere, with anything from back pain and shoulder issues to long-standing neck pain. This was going so well that I started to develop a reputation for being the person to see when noone else could help.

It was from this point curiosity kicked in. I had started to see how I could help people, and now I wanted to know more. I have always questioned the way things are the way they are, and this curiosity was key to my developing practice. 

As I started to seek more information, some key books I read were:

Atlas of Human Anatomy by Frank Netter

Leon Chaitow’s Positional Release and Muscle Energy Technique manuals 

Rene Cailliet’s series on pain and soft tissue

Where does curiosity come from? 

For me, it came from a deep sense of needing courage to find the right teacher, the right books to build and deepen my knowledge of anatomy and physiology, to gain the ability to treat all sorts of conditions and people in long term pain states.

Soon into this journey I found Tom Hendrickson with his own eponymous method, The Hendrickson Method, and embarked on a three-year journey to fly out to San Francisco three times a year to complete the training with him.

Whilst training with Tom there was a comfortable realisation that the journey to deepen our knowledge of anatomy and physiology is never ending. It then gave me the confidence to be curious again. Question why a condition was the way it was, why the injuries are the way they are. The confidence to question and be curious about other people’s opinions and diagnosis.

Knowing that courage and curiosity go hand in hand, as I continued the work I discovered Gary Carter’s Natural Bodies, and fascia focused anatomy approach. The Noigroup gave me a deeper understanding of neurological processes within pain patterns, looking at how we can enable the people we treat to create change and acceptance.

It took courage and curiosity to say yes when invited to teach both by the Northern Institute of Massage and my professional body the LCSP.

When I began teaching, impostor syndrome naturally struck again, and I had to find courage to stand in front of a class and own “this is what I know, this is what I think, this is what I feel”. It was worth it to start sharing what I had learnt so far, whether it was positional release muscle energy technique or Tom Hendrickson’s method.

The curiosity kicked in again – this time I was questioning how do adults learn? Was their experience of education healthy and empowering – or was it a little like mine, that had been a struggle and diminishing until I found out I was dyslexic. 

I began to see that some people are visual learners, some people a learn by feel, some people learn by seeing a demonstration then feeling it. Some people see the demonstration immediately and have to practice it. I began creating space in the classroom so that everybody could learn on their own terms, to empower them to embed the knowledge within themselves to enhance their practise

Most recently, it was one of my patients that encouraged me to reflect on my own curiosity and courage. This patient is now into their 80th decade and has osteoporosis, MS and has recently had heart surgery. 

One day she turned up as we were piling out of the church after a Pilates class asking me she could join in. At that time she was in a motorised scooter and was barely able to stand. Jose was curious whether the Pilates would help her to gain a little strength and a little more coordination and help her move a little more. I was both curious and needed to be courageous to invite her to a little 1-2-1 session after next week’s class.

Jose came full of curiosity and courage – wondering whether she could create the movement, and have enough in her to give it a go . Jose comes to class each week and occasionally comes to the clinic to use my spring wall for one to one.

It was that one of these one to ones I asked her what kept her going, as conversation with Jose is always interesting and lively. Jose replied, the courage to be always curious and I smiled and said I had been thinking very much the same way about myself on my journey as a therapist.

We also chatted about the courage needed to know things may not always work out how we imagined and be okay with that, and the curiosity needed to have the confidence in knowing there will always be unique ways of seeing and being.

We agreed that these things are what keeps us lively as we progress through the decades, that have kept our humour and our ability to see the whole of the world, not through a small tunnel. Courage and curiosity are something that we encourage within our practice when we’re working with those learning to live with a condition that will last for a lifetime. We need them to investigate ways of living well, and have the courage to make changes and do things differently. And most of all to try to have fun with it, safe and secure in the knowledge that things might not always work out the way they thought we would – but with courage and curiosity we can keep trying.

Can you be curious?

When people with chronic issues come for treatment, often they are those who have been around a number of therapists without much success.  Then they come to check out what we do. In these instances, our focus is simple: find the ‘root cause’.

My very first teacher, Ken Woodward, taught me to be curious. Ken maintained it was the key to being successful in enabling patients back to wellness, and emphasised that we had to ask the right questions – and sometimes the hard questions. I did not realise at the time quite what this meant.

After a while in practice in my clinic, Ken’s words evolved into a clearer, more thought-out process. 

My four main points:

• Always see the whole body, the whole person.
• Always be genuinely curious – treat it like a case to be solved!
• Always remember how far back it can go: what was their childhood like? How did they study, what sport did they play? Have they had any falls? Any head injuries? Have they ever ridden horses or done a bungee jump?
• Always work on your anatomy and physiology and make friends with it. It is a lifelong journey of exploration. Really take time in understanding connections.

When I began training with the Tom Hendrickson in 2006, Tom likened my four points to SOAP notes.

Subjective: This is all about the reason for treatment and history, which may go back a long way, so get curious and ask! It’s at this point the treatment may touch onto general well-being, which is great to know too.

Objective: This is about our observations, it’s where we can assess active range of movement (ROM), passive movement, isometric testing and at times gentle palpation. We will be assessing their standing, their walking and how they hold their body.

Assessment/Action: Making notes on any treatment given through your assessment process. Noting what structures or condition could be responsible for your persons condition/pain.

Plan: Outline goals, aims, and how many treatments you might recommend. I always share my plan. I do explain this could change, sometime as we unravel a painful area, the response is not what we anticipate, so it may change. This is never a worry if you have always worked on your anatomy and physiology, but it needs communicating to the patient.

Here is an example case study relating to this process:

A young woman of 22yrs came to see me with long term chronic headache which were debilitating. She had her hairdressing exams coming up and needed help quickly. 

We started by looking at food that could be triggering her, and I gently asked her if there were any stresses in her life? We sat there chatting, me asking and questioning to get an idea of her world. 

I was observing the way she sat. There was a little anterior rotation through her upper ribs, with tension through the anterior neck. As well as that, the right GH joint just looked a little tense and seemed to be sitting higher than the other.

I enquired whether she had ever had a fall, or an accident with significant impact.

She smiled and said she had fallen over a rope swing when she was 14yrs and fractured her collar bone. I asked if she had had treatment, and it turned out she hadn’t, due to small size of the fracture. She said it had just been very sore and painful for quite a while.

On assessment, there was considerable tension in splenius capitus and cervices, scalenus, upper trap, multifidi, pec minor, subclavius. 

I suggested that we treated her as if she had just fallen off the rope swing, unravelling the old injury. I had a feeling the headaches would clear up.

It took just four treatments, in which I mostly employed the Hendrickson Method with precise strokes, for the headaches to clear.

It was all about getting curious. Instead of leaping into probing around the neck and head, as she told me previous therapists had done, our conversation revealed where I should focus her treatment. It is often this way; by taking the time to understand and acknowledge a patient’s history, we can reveal the path forward to their wellness.