Originally published in Massage Bodywork magazine, May/June 2011. Copyright 2011. Associated Bodywork and Massage Professionals. All rights reserved.
"These fingers," she said, pointing to her little finger and ring finger on her left hand. "These fingers feel weird."
"When you say weird, what do you mean exactly? Numb? Painful?"
"I guess I mean that they are kind of numb and kind of fat. They don't feel like my other fingers. It has been this way for almost two years, getting progressively worse over the last several months. I have recently been going to yoga class and getting massages regularly, but the problem continues to worsen. I also saw a neurologist and she did a nerve conduction test. My ulnar nerve shows some sort of a problem. Does that make sense to you?"
"It certainly does and we need to figure out what is impeding the nerve. Since no obvious trauma started this, there must be some constant, low-level trauma irritating the nerve. Would you stand up and let me look at your structure?"
Miss D. stood up and I placed my hands on the spine of her scapula to assess shoulder height.
"Right there. You knew right where to place your hands."
A little startled, I recoiled a bit. She was thinking I was addressing the tissue, but I was simply assessing shoulder height.
"Here? Is this what you mean?" I asked as I pressed on her trapezius.
"Yes, right there. I have been stretching that area for weeks and it isn't improving even after lots of stretching and some pretty intense massage."
Standing back, I looked carefully at Miss D.'s structure. Tall and rather slim, she presents as a woman with a long and elegant neck. With that as a clue, I looked carefully at her scapular alignment. As I suspected, the lower apex of her scapula was much closer to her thoracic spine than the upper angle. This was true bilaterally, meaning both scapulae were downwardly rotated. Interestingly, this gives the illusion of having a long neck.
"I am hoping that the particular technique you do will have some lasting results. Based on my experience with the other massages, I am sure it is going to be painful, but I am fine with that. This tightness has got to stop so that the numbness in my hand will improve. You think my shoulder tightness and the hands are connected, right?"
Before I could answer, she continued.
"Everyone keeps telling me to keep my shoulders back and down. I must not be doing it often enough to make a difference, because the neural symptoms in my hand haven't improved at all. If you have any tricks to help me remember to drop my shoulders, I would love to hear them."
"Oh boy, this could get interesting," I thought to myself.
"First, can we try something? I want to you to sense your feeling in your ring and little finger. OK, now pull your shoulders back (posterior) and down. What is the effect on your hand from doing that?"
"It is, umm, worse. That's weird. I can feel it go numb when I bring my shoulder back and down. Am I doing something wrong?"
"Well, I wouldn't suggest pulling your shoulders back and down anymore. Your shoulders are already downwardly rotated, which compresses the clavicle against the first rib. The nerve that serves your fingers goes between the clavicle and your first rib. When you pull your shoulders back and down, you compress these nerves."
"But it feels tight!" she said emphatically, pointing to the upper trapezius.
"The sensation of tightness is actually deceiving. When your shoulder blades downwardly rotate, the upper trapezius muscle is pulled taut, like a rubber band being stretched. If you ran your finger over a stretched rubber band, it would feel stiff and hard. That stiffness is not tightness, but too much stretch. Getting it to relax won't work, as it needs to shorten, not lengthen. Feel what happens to the upper trapezius when I rotate your shoulder blades into a more neutral position. Also, place your finger behind the clavicle and feel the increase in space for the nerve when your shoulders are in a neutral position."
"Oh my gosh. That is amazing," Miss D. exclaimed as she felt the softening in the trapezius and the increase in clavicular space. "The massage therapists and I were mistaking tautness for tightness, trying to lengthen and relax an already overstretched muscle."
"Right you are. I doubt many therapists can feel the difference between tightness and tautness by palpation alone. Hands can feel tissue texture differences, but only knowledge and understanding can correctly interpret the meaning of what is felt. Good therapy not only treats soft tissue, but helps you, the client, understand what you feel and why."
With a new approach and different understanding, Miss D. was symptom-free in about six weeks. The ulnar nerve symptoms are gone, and her trapezius "tightness" is a distant memory. Douglas Nelson is the founder and principal instructor for Precision Neuromuscular Therapy Seminars and president of the 16-therapist clinic BodyWork Associates in Champaign, Illinois. His clinic, seminars, and research endeavors explore the science behind this work. Visit www.nmtmidwest.com or email him at firstname.lastname@example.org.