One evening, about 4 years ago, a patient came in for treatment and told me that her co-worker had been boasting about her chiropractic adjustments for weeks. “She kept telling me to see him, but it made me nervous.”
Apparently, the night before, her friend’s chiropractor finally cracked her neck once too often, causing numbness in her arm and lips. When she told him that “something didn’t feel right,” the chiropractor told her to rest, and assured her that she’d be fine by morning.
While the patient wasn’t entirely convinced that she was safe, the chiropractor closed up for the evening, walked her home and left her to sit with her building’s doorman. Within minutes, her speech became slurred and the doorman had to call her an ambulance. She had suffered a stroke from a cervical manipulation- something that can often be screened for before a neck adjustment, and certainly can be recognized afterward.
A fellow Pilates teacher and colleague of mine, Lisa, told me that she had a private Yoga session with a well-known teacher, who twisted her spine so hard that he ruptured her splenic artery. She told me, “I could have died, and yet his books are still on the shelves of so many New York City Yoga studios.” She told me that she had seen him on various occasions through mutual acquaintances and pleaded for an apology, but he pretended not to know her.
I, too, became injured twice by two different physical therapists who manipulated my spine and neck- the first when I was 26 years old, ironically just before I entered PT school. I suffered with sciatica for nearly 4 years after that. The second time it was for vertigo, I was 41 years old and a trained clinician with my own private practice. I saw, in real-time, my PTs rote attempts to underplay his own mistakes and put the onus on me, the patient. My responses only reminded him that I am actually also a Doctor of Physical Therapy, and that nothing he was saying actually made any sense. I know that it is challenging for a patient to recognize negligence or trust their own perception, because I’ve been there. It doesn’t feel good to call out a practitioner, but it is essential.
The world of manual therapy, or manipulative therapy, seems to have become more sought out with time. So many people consider themselves bodyworkers: massage therapists, myofascial healers, bone setters, visceral mobilizers, cranial sacral therapists, physical trainers, energy healers, Physical therapists, osteopaths… the list goes on and on.
People have really turned to the healing power of the body for so many issues, not only to help with pain and injury, but also for mood disorders, self-regulation, personal insight and sleep recovery. People trust their body workers to heal them so much so that they take their crying babies to cranial sacral therapists (I am one) and sometimes even let bodyworkers tell them to go off their vital medications.
The surge in mind-body healing has confused all of us- patients and providers- so much that patients turn up in my office desperate to find someone who can help calm their anxious teenager, or teach them how to deal with their boss at work. I even had a patient turn up to my office whose psychotherapist taped her sprained ankle!
When I saw the vestibular PT for what turned out to be migraine, he listed everything in the kitchen sink that I was apparently suffering from. Unbeknownst to me, I had a “virus” that caused this (while on lockdown for a year with no exposure). He even gave me a vitamin supplement from his own personal stash that would help me “because that is what helped his wife who had this.” Also, even though I had no neck pain, he was certain that this was coming from the joints in my neck and so it needed to be manipulated. I also had BPPV (benign positional proximal vertigo), even though I didn’t test positive for any of the positions that provoke BPPV, so would need procedures to move my inner ear crystals to “fix it” while I wore fancy goggles. When I told him how much worse my dizziness felt days after these procedures, and that my hands felt weaker after the neck adjustments, somehow the way he shrugged at me made me feeling like I was to blame for my poor response to treatment. I know this game- I’ve seen it plenty. But, like so many other people, I went through this charade for one reason- I was suffering, and I needed the help.
While being twisted under force during her Yoga session, Lisa told me she had moments of hesitation. When she told her teacher, he said she wasn’t ready to go as “deep” as she needed. I’ve heard so many versions of this “blame the victim” story come from patients who trusted and were hurt. I have a patient who is an amazing mother, who wanted the very best care for her baby with cerebral palsy. After thorough research, she came across a well known healer, who swung her baby around by his hip and fractured it. The thing is, that with no license, a practitioner like this has nothing to lose.
It happens. People get hurt at the gym, at movement studios, on massage tables. My own brother got blood clots from overtraining with his boxing coach- This is life. Sometimes people get hurt and it’s no one’s fault. Sometimes people get worse under a clinician’s care before they get better. But let’s never forget that the body doesn’t lie, a patient is always right, and if a patient is not responding well to treatment, there are always ways for the provider to give better treatment and look for better outcomes.
In healthcare, there is a name for how to know what is the right treatment for a person’s issue: It is called “Differential Diagnosis,” and no one should be without one. It means, that before anyone attempts to manipulate your body, he needs to do a series of tests to make sure it’s right for your system. It also means that someone should have a sound explanation of your problem that makes sense before any intervention.
Of course, not all types of bodyworkers need to formulate diagnoses. People intuit amazing things with their hands, hearts and experiences. But, when it comes to applying force– the notion that something is out of place and needs to be forced back- there ought to be a diagnosis and a reason. After all, force, is the only thing that casued something to be “out” in the first place.
A “differential diagnosis” is how a professional knows when it is safe to use one technique over another. It helps to determine if someone is more or less likely to have a poor response if you press on them. It means, if someone doesn’t respond well to treatment, there is a reason. That “something doesn’t feel right” feeling patients get- that is also part of the diagnosis. It is called an apprehension sign, and it is the body’s way of saying, “No, don’t do that!”
When I first met Marty, he had classic Neurological symptoms. He had a shuffling gait, a rigid posture, and a tremor in his hand. I immediately told him to see a neurologist for a work-up, when his Alexander practitioner fought back, and told him that I obviously didn’t understand the subtlety of posture (I very much hold the Alexander Technique in high regard). Today, Marty has a shunt in his brain that has restored his balance, posture, and coordination. He exercises every single day, and has taken up Tai Chi. His progress is his own. He looks younger now than he did when I met him 8 years ago.
If you want to know when bodywork is safe, here is my best advice to you: ask the questions, and if the answers don’t feel right, listen to yourself. If your practitioner lists everything wrong with you, that is a good sign that you are in the wrong hands. If treatment must involves force, let them screen you before and after to see how you do. A good bodyworker should make you feel empowered, not subservient. A good bodyworker should always make you feel like you. They are not there to “fix,” they are there to “listen” and “observe.” And while the world of bodywork can be incredibly vast and incredible- even spiritual for some, for heaven’s sake, don’t let your psychotherapist tape your ankle!