Finding the root cause

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.

Sally’s Story

I love teaching other therapists.
Let me introduce Sally Pearce. Sally found me in the summer of 2014 at the LCSP Register annual general meeting.
Sally sat herself next to me and asked if she could come along to my workshops. I answered. Of course! I was curious to know why she wanted to come, so I inquired. Sally’s answer was special.
“I know you’ll be able enable me to become the therapist I want to be. I know you will teach me my anatomy of physiology, the parts I don’t already know, and help me inform my treatment plans. I want to know a gentler approach of how to reach people. So that they will feel safe. And I want to develop as a person through my hands on treatment. I think that you will teach me to see the whole body, the whole person.”
Sally went on to become a Hendrickson Method practitioner. Her never ending curious mind is pure joy to be around, and her commitment to help those with long term pain takes my breath away.
The work Sally has done on herself has been courageous! She has devoloped embracing softness through her own body.
I’m also amazed by her reflection on herself as a therapist. When I ask what’s driving your treatment, is it coming from your ego? How desperate are you feeling to be successful? And what can lead to over treating? I see in her eyes, Sally takes this on board, reflects, asks more questions. Then I see in class how soft and deep her hands are becoming, losing all nervousness, shining her unique Sally brightness.

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.


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.


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.


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)


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.


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.


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.