Why I love teaching therapists

4 Diaphragms

I love to teach, to share what I have learnt over the past 30 years as first a Remedial Massage therapist, physiotherapist, and Hendrickson Method therapist.

I was first invited to teach by the Northern Institute of Massage back in 2003. Eddie Caldwell, the owner, said of me ‘he’d never met such a through, thought though therapist’ and wanted me to pass this on.

In 2005 the LCSP asked me to set up a cpd workshop for the register. It felt very confirming for me as a therapist.

I taught workshops on

  • Muscle Energy Techniques
  • Positional release
  • Upper and lower crossed syndrome

I began training with Tom Hendrickson in 2006 and in 2013 Tom made me one of his teachers.

In those early days, I learnt that a lot of therapists hadn’t always had an amazing time at school, their experience of being taught and learning had often been lacking and at times humiliating.

I am dyslexic, my experiences weren’t great at school. So, I wanted to make my classes accessible, a comfortable place to learn and explore new techniques without judgment. A place where questions can be asked, information delivered in such a way, it didn’t matter if you were a kinesthetic, audio, or visual learner. Which has led to a very open safe learning space with lots of conversation, debate, reflective practice.

My classes can be recorded or filmed with the clear understanding it’s for personal use only, never to be shared on social media.

Attending my NLP practitioner program helped me to be clear, use less words, set boundaries in class.

It gives me such delight to share knowledge in ways that it reaches everyone in the room. Watching therapist flourish makes me feel, this is my place in the world.

Knowing there are patients being treated by therapist that understand that treatment techniques that don’t over challenge the nervous system leading to feeling that coming for treatment is ‘safety’ in mind is essential, precise hands are essential. Making sure we truly see the whole of our patients, by hearing their story well to quote Tarana Bruke ‘if you don’t hear me, you can’t see me’.

Knowing there are therapists that understand treatment can turn on a pin and be able to re-do that plan without thinking they didn’t get it right.

Knowing there are therapists that know how to check their own ego.

Knowing when they are going into over treatment mode, and can self-reflect, asking what driving my thoughts today.

In class we talk about how we enable ourselves, because it’s only when we can help ourselves can we be truly present for others, free of our self-doubt.

All this along with a deep understanding of anatomy and physiology allows therapists to find themselves knowledgeable confident, kind, open honest wholehearted therapists.

Here are a couple of testimonials.

‘To quote- Rudyard Kipling

Words are, of course, the most powerful drug used by mankind.

Your words are not only nurturing but also inspiring and even more so they encourage us to explore where our treatment may lead or what avenue it may lead us down.

Thank you Sue, without your spark/input/guidance I wouldn’t be where I am now in my treatment or life’.

Sally Pearce Hendrickson Method Practitioner LCSP

‘Toms work has allowed me to further my knowledge and grow my confidence when treating clients. Sue delivers the workshops in a way that I feel I can understand the work and confidently take it back to my treatment room and practice, practice, practice. I have found since using the Hendrickson Method, I have much more progress with clients, I am so glad I found Sue who has always supported me through my career as a therapist’.

Natalie Bagnell Massage therapist & Hendrickson Method Practitioner

 

 

 

 

 

 

The Hendrickson Method

Dr Tom Hendrickson began developing his wave mobilization and soft tissue mobilizations back in the 1990s.  Tom’s wave mobilization is a side lying approach to manual therapy.  I began training with Tom in 2006 and the Hendrickson Method became the cornerstone of my practice.

I found that Tom’s wave mobilization supported my approach to treating people with sensitive nervous systems, those dealing with long term trauma and PTSD.  At the heart of Tom’s work there is the wave mobilization, joint mobilization, and a unique way of interweaving muscle energy technique.

WAVE MOBILISATION

At the heart of the Hendrickson method, a unique technique called the wave mobilization the strokes are rounded, scooping strokes performed transverse to the soft tissue and applied as arrhythmic oscillations at a frequency of approximately 60 cycles per minute which matches the resting heart rate.  Performing wave mobilization is akin to ‘moving meditation’ which leads to an energetic opening for the therapist as well as the client.  These strokes are extremely relaxing and profoundly healing.

JOINT MOBILISATIONS

The joints and surrounding soft tissue are often the original source of pain in the body.  Acute injuries often cause swelling, heat and inflammation inhibiting normal muscular function by neurological response.  Chronic joint problems are usually due to either degeneration or dysfunction and are almost always due to misaligned and restricted joints which prevent normal movement.  The Hendrickson method uses specific protocols for treating acute and chronic joint problems that are effective in reducing pain and restoring normal movement.

MUSCLE ENERGY TECHNIQUE

As you may be aware muscle energy technique (MET) can be an extremely effective treatment for dysfunction of the nervous system.  Injury and chronic pain in the joints generate neurological reflexes which tighten or weaken specific muscles around joints.  I have found through Tom’s work, creating whisper-like resistive pressure provides enough neurological input to creating changes in the fibers, creating a pathway to enlighten the people we are treating to enable patients to get to know their body’s function better.  A unique aspect of the Hendrickson Method is that it provides treatment for the joints, the nervous system, the soft tissue, and the fascia because the cross-fiber scooping strokes address the fascia that holds and supports the fibers.

The Hendrickson Method has given my patients long term benefits that have gone beyond when I have used my conventional oil-based massage.  Studying Tom’s work has made my anatomy knowledge grow out of the requirements for precise hand movements.  I have found my treatments for back pain, neck and hip degeneration, headaches and TMJ pain clear up a lot quicker.  Feedback from the people I treat have found the treatments profoundly relaxing and will often say to me, “I feel you have relaxed me from the inside out rather than the outside in.”  Nobody gets up feeling overwhelmed by the treatment they have received. The bonus is that we can work through the patient’s clothing, for some patients this gives them a ‘safe’ feeling especially when dealing with lifelong pain states.

 

 

 

Hypermobility: me and my patients

Over the years I have treated many people including young people, learning to live with chronic pain, because of their hypermobile bodies and accompanying syndromes, Ehlers-Danlos and Postural tachycardia syndrome (PoTS)

I attended a workshop with Jeannie Di Bon, (with Polestar UK), I had gone with the intension of being able to support my patients, however, I discovered while sat there listening to Jeannie, that the things she was saying also related to me!

Within this I further realised that managing my own needs to ensure I functioned well both physically and emotionally, has always been a priority.

Having owned my own hypermobility, I has started to become aware of the looseness from an age of about 11yrs

I became clear on how I have managed it, understanding my pitfalls, and understanding I have a strategy for myself.

I have shared this strategy with the people I treat and those who attend my Pilates classes.

My strategy falls into four groups:

The groups being:

  • movement
  • self-care
  • Check-Check
  • Carefully selected body work (selection being the therapist, do they understand. Do they know when enough is enough)

Movement:

I have always felt stronger and safer with movement.

Younger Sue used to do weightlifting, power training, which built strength and a feeling of safety. This gave me stability to run, cycle and swim, leading to taking part in a sprint triathlon.

Becoming a mother reduced my available time which meant I was left with walking and cycling. However, there was a growing sense of ‘instability’ growing in the joints.

I then found Polestar Pilates, the pre-Pilates movements gave me for the first time interoception proprioception and nociception.

I got to know my own body and began to love it.

Self-care:

I have had to learn this which has been quite a challenge.

Pilates is essential for my stability and strength, it also this includes eating foods that my body can digest. I have found I need a lot of protein and lots and lots of vegetables, fresh fruit. No processed food, low sugar foods.

I have also worked out that a fascial eases stress and tension, however a back massage is too much relaxation, my limbs feel like they are going to fall off my body.

I have also learned when it is good to create pause in my life which as a busy woman was not easy.

It has been useful to notice things and places that have impacted my ability to remain relaxed and calm, which, for want of a better word has ‘jangled’ my nervous system.

Taking a break from the practice every six or seven weeks, finding films and good company that creates laugh aloud moments, have all helped in this respect.

Self-check:

I have learned self-check as a hyper mobile person is beneficial. Sometimes we keep moving as we are worried that if we stopped, we might just collapse. We then would struggle to get back to that positive place. So being mindful and regularly self-checking for me is important.

Mindfulness, this I find quite difficult. Calmness and stillness for me comes from walking, noticing nature which when I am on my own can be relaxing and easing.

I created a system where I remind myself to ‘ check-check’ what I’m doing.

  1. Do I need to keep moving, what does it give me to keep moving?
  2. When moving, is my body feeling it may be doing too much, or just asking is this good for me?
  3. When enjoying Pilates, listening to my body, asking am I doing too much today.
  4. What would rest look like today?
  5. Am I talking too much?….sometimes this happens, I go on repeat and it becomes fatiguing

Choosing the right therapy:

I always tune in to my intuition, asking does the therapist understand that my system can overreact to their treatment.

I always need to ensure that anyone who is going to treat me, share with me their protocol before doing anything. Within my practice I always encourage open honest feedback on the treatment I have provided.

I share the above strategies with people in my treatment room and also take this into my Pilates classes asking:

  • Does this feel useful?
  • Just because we can it does not mean we should
  • Can we feel the movement, with clear description of where they might be feeling any response.
  • Lots of visualizations
  • Inviting clients to feel the length and breadth of a movement, but where they can still feel in control/safe.
  • Exploring what does letting go feel like. What does this even mean
  • The next step is to ask what stops us from seeing and feeling, what is good, helpful, and supportive for our own bodies.

We need to know when things are too much, exploring what does their mind-body tell them when it is enough.

Helping clients to find their strategies is very fulfilling, then working out a treatment plan which could include listening to the body’s rhythm, through the soft tissue mobilisation of the Hendrickson Method treating fibrous tissues and fascia. Then noticing when the rhythm in the tissue changes, knowing when is enough, then lifting the hands off, having an understanding to move at their pace. Sometimes just holding a person with intention is enough. On occasions it is better to under treat rather than push through in a particular moment.

I find making a video for them to use at home is especially useful. It gives them chance to embed the work we have done together at home still hearing my voice.

Each patient is unique, finding strategies which they can understand and find useful is a challenge but is extremely rewarding when you see the patient becoming confident in their new path feeling safer in their own body.

 

Creating space: Mental Health Awareness Week

“Between stimulus and response there is a space. In that space is our power to choose our response. In our response lies our growth and freedom.” —Viktor Frankl

This quote appeared in Brene Brown’s feeds this week and it got me thinking, along with the stories I’ve been seeing around Mental Health Awareness week. 

In the Flexible Healing clinic, we see a lot of patients who are dealing with long-term pain. Of course, as a physio I get stuck in and start working around the physical problem. But I’ve found it helps to discuss a mental coaching step with them too.

For all of us, long-term pain can be really, really hard. You can feel lonely with it. The consistency of it can feel too much, making you think you can’t cope.  

When I encounter people with long term pain, I ask – what do you do when the pain comes? What is your first instinct?

It’s a tough question. Because for all of us, the instinctive response is to feel distress and fear. “What do you mean, what do I do?” they say. It seems a silly question – there is nothing to do but experience the pain, surely?

I then ask: next time this happens, can you create space instead?

As Frankl says, between stimulus and response there is space. And sometimes we forget that when the stimulus is simply too consuming. So I ask: “Can you create space for yourself? To choose how you’re going to respond, and not respond from a place of complete fear?”

In this space there exists a certain kind of freedom, where you can choose to move away from the distress and fear and instead experience something else. 

I’m not saying this is easy. I know it’s hard. I had the good fortune to be told about this and started to practice it in my own life through NLP training.

A way to start is to ask yourself when you pause in that space: what would help me right now? Would a shower change your state? A walk outside? Think about what works for you, and if all else fails, try something research tells us helps. In Deb Dana’s book The Polyvagal Nerve in Therapy, she explains how it’s been proven that something as simple as looking at moving water has a proven calming effect on the nervous system.

Find whatever works for you to break state.

Then I advise patients to check, check, before they make a decision based on how they’re feeling when the pain rears. Is this your decision, or the pain’s? Can I wait to make it until I’m feeling better?

Sometimes when the practice is overwhelming, therapists need to do this too. So it’s not just for patients; I tell every therapist I teach in workshops to check check too!

Whilst I’m not trying to say it’s a choice to have fear or distress when it comes to pain or mental health, I believe that we have the power to claim back space from the difficulties we experience. 

Whether you’re a patient in long-term pain or a therapist with a busy workload, I hope and believe this can help you on your way through our crazy little world.

Happy Mental Health Awareness Week – Sue.

Why use METs and how to make them your own

When I first came across METs I was studying for my Higher Diploma from the Northern institute of Massage; it was an essential requirement to learn this technique. As therapists gathered round to watch demo after demo, I, being a questioner (see Gretchen Rubin, The Four Tendencies), was soon asking “how come”,  “isn’t that a big movement” and  “will these moves be too much for older patients?” But I didn’t feel heard. I found myself not  comprehending how I would incorporate this into my treatment room, especially when reflecting on the type of patients I was treating (in 2000). 

I bought Leon Chaitow’s book to aid understanding, and mindfully began to introduce the technique into my treatment room. Within METs, there are big physical moves that involve a more global movement within the body. I felt the smaller ones i.e., scalene, infraspinatus, would be useful. I quickly started to make the resistance feather like, and experimented with a longer pause in between each contraction. This led me to ending up parking METs for a while as I explored positional release, which felt gentler and more suited to working with long term pain. This also applied to overly sensitive patients, especially those with overly sensitive neurological systems, due to trauma or assault. 

It wouldn’t be for another 6 years that I would re-examine METs. 

There is a lot of debate in literature about how MET works. Some focus on the Golgi tendon organs, whereas some authors focus on the muscle spindle. It is best to have a clear understanding of the essential neurologic role of the muscle spindle.

MET works the conscious, voluntary contraction of isolated muscles. Creating an isolated voluntary contraction is different from the muscle contraction we use in everyday life. The higher brain centres work to isolate muscle contraction, causing a unique neurologic effect, compared to those accomplished in everyday functional activities.

John Gibbon in his book Muscle Energy Techniques breaks it down as:

  • Muscle spindles are sensitive to change in length and speed of change in muscle fibres.
  • Golgi tendon organs (GTOs) detect prolonged change in tension.

In order to really understand this however, I found it was going back my knowledge of anatomy which began to connect the dots. Whilst attending Gary Carter’s Anatomy for Movement Teachers, based on his experience with Julian Baker, he would argue, how do we know?

Often textbooks on Mets never show the people that walk into my treatment room.

They are people who

  • Are often afraid of their pain
  • Are disconnected from their body 
  • Do not feel when muscles contract 
  • Do not believe there are muscles where we say they are
  • Are afraid to move
  • Have become physically and emotionally fragile 
  • Were struggling to be seen and heard with their injury and pain

These people can have painful memories stored within the tissues. When we refer to ‘muscle memory’, we have to remember it goes both ways. It can be a positive experience relating to skill learning – or it can be a negative experience in which the body learns to react a certain way due to trauma (for more on this, see The Body Keeps the Score).  

We must be prepared for the potential release that will follow when working with them. Sensations and feelings can occur in other parts of the body, again, due to the trauma the patient may have experienced. It is at this point we may be required to verbally check in.

Sometimes we can question whether we are really within our scope of practice. We may not be qualified counsellors or coaches. So how can we help when physical pain reveals and raises past traumas?

At the very least, we can do something they might not yet have encountered. We can listen. We can create a situation where maybe for the first time they feel heard, even seen, for the first time. This can be enough for some people or, if you feel necessary, point them in the direction of a good therapist. At the end of the day, it is their choice.

I’ve developed this approach through a number of avenues; from my years as a social worker to NLP training. But it was brought together in 2006 when I went out to San Francisco to train with Dr Tom Hendrickson. Tom Hendrickson had integrated METs into his wave and soft tissue mobilizations as part of his treatment protocol. On the other side of the world, I came back to a technique I’d previously put to one side, and I found space to take the technique apart and gain a deeper understanding. Training with Tom supported my thoughts of making sure the patient understood why this technique was going to be useful.

Here are the ways I have made the technique work for me.

  • Create feather like contractions
  • Make sure they are really pain free before working
  • Check which other muscles they are they recruiting instead 
  • Create imagery, descriptions of the muscle you want them to connect with
  • Enable them to re-create the movement that a particular muscle may make by supporting them with a passive movement

I have found patients enjoy collaborating with me towards their recovery/reconnection. At times they are surprised by the pain free range we are creating together. Then I find if I couple this with pre-Pilates movements to embed the work we have done as homework/rehab, we have formed lasting change within their body, creating pain free functional movement

I have grown to love Muscle Energy Technique, on my personal terms as a therapist that makes it work for the people in my clinic, adapting the moves to suit them and where their bodies are at.