This past weekend I taught an SMRT: Shoulder, Axilla, Ribcage, & Upper Back course in Moorhead, MN. We had a woman in class, I will call her May, who presented us with an opportunity to see what SMRT can do with lymphedema. The morning of the second day I wrote this on facebook:
We had the most amazing experience in class yesterday. We were working on the lateral shoulder and axilla. One of the students told us she had a single mastectomy with axillary node dissection on the right a few years ago. She partnered with a young woman in her first CE course who has only been practicing 4 months. During the demo, I spoke to the students about guarding due to trauma, how we can create guarding (which we do not want to do), and how we can alleviate existing guarding. While this young woman worked on her partner’s right axilla, I checked in, coached mildly, but she was completely engaged with her “client.” From the table, the student told us that she had not let another therapist really work on her shoulder or axilla since the surgery. She had tried several times and had to make the therapists stop due to pain and a feeling that she was not fully listened to. By the end, several things happened, not the least of which was that the woman was physically transformed from the work. The student working on her, the young woman, was filled with confidence, gratitude, and a sense of where she wants her career to go. While the woman who had been worked on let go of layers of held trauma.
At the beginning of the second day, Patti and I talked about May and decided she should stay with the partner she had the first day. They had a connection, and we wanted to keep her safe. May came into class and said her shoulder and arm had not felt this good in years, and she felt her lymphedema had decreased. May receives consistent MLD treatments, which control the lymphedema. The SMRT shoulder work had actually lessened it, which, for May, was fairly amazing.
The second day of our class was ribcage. When she got on the table, May informed me that she had been kicked by a horse in the right anterior aspect of her ribcage when she was 6, 56 years ago. Because she was not supposed to be with the horses, and was afraid of getting into trouble, she never told anyone. There was no medical intervention and no knowledge of what had been damaged. Through palpation, we could tell that her ribcage had sustained damage, but was it from the long ago injury, the mastectomy, the reconstruction of her right breast. Many things could have happened and there was no way to tell what had caused the immobility and tension we felt.
As May’s partner worked and her ribcage slowly unlocked, May’s right hip began to ache and throb. We worked on it while she was on the table. The next morning May told Patti and I that the dorsal surface of her right foot had begun to cramp the night before. The cramp then moved into tibialis anterior, then into the plantar aspect of her foot, and finally into her calf. The work had, apparently, unlocked a systemic compensation pattern.
But, along with what was happening to her leg, she also noticed that the lymphedema in her right arm was again lessened by the work she had received. While all of this was happening, I posted a story to facebook about another client of mine who had breast cancer, a double mastectomy with reconstruction, a diep flap, and axillary node dissection. I use a combination of SMRT and dry fascial work similar to rolfing to open up her right shoulder. I received the following comment:
I just returned from the 10’th Annual Integrated Oncology Training Conference for Massage Therapists at M D Anderson Hospital in Houston. According to their guidelines this client would be at risk for lymphedema on her affected side and should not be receiving deep work on her entire right upper quadrant, front and BACK.
In answer to this I would say two things: First, SMRT when used alone is amazingly gentle. The comments we heard from students in this course were, “I hardly see you doing anything,” “the movement is so small,” “for being such a gentle, small movement, there is a lot going on in my body,” “this is really powerful, I thought we would have to do soooo much more to get these results.” In class I repeat the same thing over and over, “do that less,” “don’t work so hard,” “do not force it,” “lighten up.” If a client is at risk for lymphedema or is currently having lymphedema, SMRT has the added benefit of being effective in an area without having to directly contact the tissue of that area. SMRT can be combined with deeper modalities, and fully enhances the depth gained, but when it come to lymphedema, SMRT should be used alone or with lighter modalites such as MLD.
Second, I have personally found that accessing the area that is affected can decrease lymphedema. What do I mean by accessing? That depends on the client. In the case of my personal client, the only relief she gets is with a combination of SMRT and fascia work. I do not believe in deep work for the sake of deep work, and I use the SMRT to unlock the fascia, which allows me to facilitate movement in the connective tissue of her right shoulder. This not only gives her pain relief, but it decreases her existing lymphedema.
For May, it was the combination of the gentleness of SMRT and light palpation, along with a therapist that helped her feel safe by moving slowly and listening to her needs, that finally gave her relief from the lymphedema and tissue binding in her right upper quadrant.
If May teaches us anything, it is the need to work on each client as an individual, listen throughout the session, and the importance of referring clients to others while seeking out additional training if needed.