Working with Nerves and the Cold Laser

Author
Translator
Pages: 73-77
Year: 2019
Dr. Ida Rolf Institute

Structure, Function, Integration Journal – Vol. 47 – Nº 2

Volume: 47
ABSTRACT James Schwartz discusses manual work for the nerves and the use of the cold laser in his Rolfing® Structural Integration (SI) practice, and how both have dramatically increased the effectiveness of his work.

 

 

 

Editor’s Note: this interview was conducted in spring 2018.

Anne Hoff:

James, I first met you in a class Jon Martine was teaching on nerve work, and you were already pretty deeply into it. Would you share your story of how you got interested in  this and  decided  it was an important piece to bring into your Rolfing practice?

James Schwartz:

By the time of that class, I had already done the Rolfing Advanced Training twice, and had explored craniosacral work   and   Somatic    Experiencing® and found them interesting and  useful but knew that they would not  be  a  major focus for me. I did the visceral manipulation training, which eventually became an important part of my work, but it took me quite a while to feel like I was getting the hang of it. I decided to take the nerve work classes that Don Hazen was offering in part just because they were so close and convenient as I live near Berkeley.

I still remember the first time Don was demonstrating working on someone’s hamstrings and explaining that the muscles were tight but that the posterior femoral nerve was inflamed and tethered – and that this was in fact causing the strain  and  tightening  of  the  muscles.   I distinctly remember realizing I knew exactly what he was feeling under his fingers, that I had felt that many times and that I had just never  realized  that the taut cord was separate from the tight muscle  fibers  it  was  traveling  over  or

through. I somehow knew that quickly that this changed everything for me. I went home after three days and realized  I had been feeling these all over the body without making the connection. I soon found out that I could not only untether and calm these nerves down and relieve chronic and acute pain, but that when I did, I saw dramatic structural changes in some of the most resistant patterns  in my clients’ bodies.

I slowly began to learn how to use this new information  more  skillfully.  At  first  I realized I could find nerves all over the body, could  even  become  obsessed with working on nerves, but then started to differentiate between nerves that are tender but are more background noise and other times when they were so painful or tethered that the body was organizing around avoiding pain or preventing further strain or even injury to the nerve. When this was the case, if I could release and calm down a painful nerve, it would often release a whole pattern of myofascial guarding since it was no longer needed. Whereas learning craniosacral or visceral work felt like they would involve a long learning curve, somehow  the  nerve  work just seemed like an exciting new playground for me.

AH: I think you bring up an important point about how you could become obsessed with nerves. Sometimes when we learn something new we tend to want to play with it all the time, but you differentiated when it was appropriate to do that for the overall structural goals of your work.

JS: It’s not like I was just doing nerve work and not ‘real’ Rolfing SI anymore – I have always thought that another way of putting Jeff Maitland’s question of “What do I do first?” is “What, at this point in time, is the biggest barrier to progress and how can I release that barrier?” One of the things that has made us much more effective as Rolfers over the years is that we have become better at deciding what kind of barrier we are dealing with (joint or visceral or cranial fixations, nerve issues, and even emotional or trauma- related patterns) and have developed our skills enough to deal with these and have the very powerful organizing principles of Rolfing SI to tie all of these together.

AH: Well said. So what was the trajectory from first learning the nerve work to it becoming such a key part of your practice?

JS: I have always liked working with interesting challenges, with clients who took me to the edge or a little beyond my skill level. Learning to work with nerve problems and acute and chronic pain issues certainly kept me challenged. Every time I thought I was getting pretty good at it, my clients kept presenting me with ever more complex problems that I would learn over time to resolve, and before long I was getting a chain of referrals of people with these kind of problems.

AH: Yes, I find that with acute and  chronic pain issues there often seem to be tethered or inflamed nerves involved. Can you  talk  a  bit  about  nerve  work  in terms of pain, and also in terms of numbness and muscle weakness from nerve compression issues? Can you work effectively with all of these?

JS: Let me give a couple of examples that might help answer these questions. Sometimes the main issue is a painful and tethered nerve that is at the heart of a whole pattern of guarding and shifting weight to avoid this pain, like in what is generally referred to as plantar fasciitis and often manifests in  heel  pain.  Most of the time I find this is a nerve issue, namely the tibial nerve and less often the sural nerve, both of which come down the lower leg and have a branch that wraps behind the malleoli and under the heel. Most of the work I would do for this would be to release any tethering along the length of the calf and behind the malleoli, particularly where they turn the corner on the calcaneus (motion-restricted nerves often get inflamed where they cross hard, bony surfaces). I would use the laser on nerve inflammation and adhesion settings to facilitate this.

Figure 1: James Schwartz in 2019 working on a client with pelvic asymmetries, muscle contraction, and muscle atrophy from a history of injury and surgical recovery. Here he is using a percussor on soft tissue while the Erchonia FX-365 Laser (FDA approved for low back pain and plantar fasciitis based on clinical trials) is running programs on the client’s low back and pelvis. Meanwhile units from the Erchonia Base Station Laser are held in a stand at the client’s right heel, as shown in closeup in Figure 2. (The FX-365 Laser is not discussed in the text, as Schwartz did not have it at the time the interview was conducted.)

 

I had a session with a woman who had    a chronic pain in the groin area that had caused her no end of problems since having surgery for endometriosis several years earlier. It caused sharp pain when climbing steps or getting up from sitting. She had tried a number of different treatments for it to no avail. It seemed to radiate out from the center of the inguinal ligament but extended to the ASIS and along the crest of the ilium. As it turns out, there is a nerve that follows that exact trajectory and its name describes it well – the ilioinguinal nerve – and everywhere I touched it made her jump. Because she has a history of PTSD and anxiety I had to contact each hot spot very carefully and wait for her nervous system to get used  to the idea and respond to the input of  the laser and gradually calm down. Within ten minutes the pain and her fear of it was dramatically reduced. There were secondary issues with the obturator and femoral nerves to adductors and quads, and some work to help her let go of the rest of the guarding pattern in her upper leg and groin, but these resolved easily. Most of the work I did not was not standard Rolfing SI, but the dramatic change in her structure and movement patterns were typical of the goals of Rolfing SI.

AH: I’m glad you are mentioning  the  cold laser because I know that’s been important for your work in recent years.

JS: I have had a number of clients recently with pain, motion restriction, weakness, and numbness in their arms and hands. The laser has been invaluable for this. One of the ways the laser works is by entrainment – in other words, when a  nerve  or  organ  or  system  is  over-  or under-active, the laser will bring it towards the mean. You can use it to calm down a nerve that won’t stop firing or to up-regulate nerves where signals are not flowing properly, causing numbness, lack of proprioception, or weakness because the muscles are not getting a strong signal from the brain. In most cases, clients will have a steady improvement from the laser with these, and sometimes the change is stunning, even when an area has been completely numb or a muscle very weak for years.

My father had  serious  neuropathy  in  the bottoms  of  both  feet  that  made him cautious  about  walking  and  put him at greater risk of falling from losing his balance. Mayo Clinic said they had nothing to offer him for this and I  had tried nerve work and Rolfing SI, which helped his mobility but did  nothing  for the numbness. Then I started using the numbness setting on the laser on  his  feet when I saw him, and each time he improved. Within six months he told me that most of the time his feet were not numb at all – if he stood or walked too long they would tend to go a little numb, but if he got off his feet this would quickly go away. Another problem was weakness in his left leg – he showed me that he could cross his right foot over his left knee easily, but could only do this with his left foot with great difficulty, and not without using his hands to drag it into place. So I tested the major muscles of that leg, and for each one that tested weak I used an up-regulation setting on the opposite-side motor cortex and same-side cerebellum to get them to send a stronger signal, and they would test stronger. When finished he was able to do the motion more easily, although still using his hands to help. An hour later, he wanted to show me that he could do it just as well as the other side. Two months later when I saw him again,  I asked him how it was doing and he showed me that he could still do it just   as well.

AH: That is wonderful, and something we’ve not necessarily had  good  tools for before.

JS: Another fascinating use of the laser is for healing bone breaks and fractures. My father caught his big toe on the carpet one night when I was there and fell, rolling over it with his full weight. It was broken in two places and the doctor said he would need to wear a boot for eight weeks. I was concerned this would really set him back so I left the laser with him for an extra week. My mother called to say that ten days after the break they had it X-rayed again and the doctor told him it was healed and he could get rid of the boot. I also used it on my cousin nine days after she had her second knee replacement. Her knee was still so swollen that she had no more than 5° of movement, but after a single treatment of twenty minutes with the laser setting for postoperative wound and scar healing, the swelling was visibly down, the pain was decreased, and her range increased to 30° – which totally shocked her surgeon the next time he saw her, he said he had never seen a change like that. She ended up healing faster than anyone in her group. Last year I worked with a colleague before and after the double hip replacement surgery she had after twenty years of dealing with increasingly severe pain and dysfunction resulting from reconstructive surgery to her femur after a major car accident. I managed to find a laser for her to rent for two weeks. I was convinced it would get her back to work a couple of weeks earlier than she would have been able to do without it, and she reported  that she had an excellent recovery and felt good enough to go back to work within four weeks, but gave it an extra week to be sure. Within a couple of weeks, she was back to her full-practice workload. She is thrilled with her progress and has been  doing  Bikram  yoga  and  stretches she could not even do before the accident. She felt her surgeon was excellent  but felt that combining his work with the laser made a real difference in her recovery. In my experience, using the cold laser before and after this type of surgery significantly reduces swelling, discomfort, and healing time of soft tissues, incisions, and bone.

AH: This is all fascinating. We are used to our work being impactful, but it seems like the addition of the nerve work and the laser has added further dimensions for you.

JS: If you had interviewed me five years ago when I was doing pretty standard Rolfing SI (although outside the Ten- Series format) and doing the nerve work as a tool that enhanced and sometimes expanded my work, it would have been pretty simple. Since I have added the laser work, though, my work has expanded in so many directions that I don’t know where to start. I am doing a lot of health-related work on asthma/allergies/sinus problems, anxiety and depression, gut problems, and immune enhancement and postoperative healing – not because I had any great need to go there, but because I can and if it is  a value-added proposition and helps my clients while enhancing their experience, then why not? Particularly when it helps resolve problems that nothing else has.

I have been thinking of some of the articles and interviews I’ve read recently in the Journal. Michael Salveson wrote about how careful we have to be about narrowly focusing on ‘techniques’ like visceral, cranial, and nerve work, and in so doing losing sight of the larger integrative goals of Rolfing SI. It is a pertinent question, but then in another article Peter Schwind went on at length about working with [Jean-Pierre] Barral and even doing brain work, and Stanley Rosenberg is  taking his exploration in all kinds of different directions. I say this as a prelude to my own realization that despite my contention that most of what I do with nerves and with visceral and trauma work still fits within the context of the Rolfing goals, I have some clients where my work could almost be considered a prelude to Rolfing SI.

A good example is a client who was sent to me by a doctor I worked on once. This client had been in escalating levels of pain in her jaw; it had gone from sporadic to constant acute pain. In our first session I spent less than twenty minutes working on this with the laser and manual nerve work and typical Rolfing work on her jaw, and the pain reduced by 80% and never came back as a significant issue. (Oh that it could always be that easy . . .) As her case sounded complicated, I had asked her to send me some of her medical history, which turned out to be three long paragraphs about life-threatening asthma with one or more hospitalizations every year of her life, periods of severe depression and anxiety, and a list of medications for these that was quite impressive. There are protocols for the laser that I thought might  help,  so  in  that first session I decided to try some   of them. (Most of the time I just put the laser on the stand on these settings while I do my Rolfing work.) She responded well to the anxiety and parasympathetic facilitation settings, and this and the asthma and lung settings seemed  to  help her breathing. We made a second appointment to check on the jaw and do more work with the neck and shoulders, and I decided to continue exploring what the laser could do for her asthma and also her immune system, which was very vulnerable to catching anything that was going around, which would go to her lungs and necessitate  hospitalization and heavy antibiotics, prednisone, etc.  To make a long story shorter, I  have  been working with  her  almost  weekly  for eighteen months, in conjunction with her psychiatrist and doctors, and  she  has made it through two winters without being hospitalized, the second without even taking antibiotics, and her asthma and anxiety are mostly under control. All of this has been life-changing for her.

Working with clients like this was not something I had planned when I decided to add the laser to my toolkit, but sometimes life takes you in surprising directions  . . .  I don’t think these are Rolfing sessions, although I do some Rolfing work in them. Sometimes people come to us with serious problems that need to be dealt with before anything like a standard Rolfing series is even relevant, so we refer them out. But when it is something I can help them with, particularly, as has often been the case, when they have not had results with other medical or alternative practitioners, I am happy to work with them. They can tell quickly if I can help them, and if I can they are often profoundly grateful and become long-term regular clients. I have always loved new challenges when a new client’s needs match my skill set, and some of these people need almost every skill I have. It’s one way to never get bored doing this work. I only have a few of these types of client at any given time, but I learn so much from working with them.

AH: How do you frame what you offer for them? They are presumably coming to you as a Rolfer, so what is the dialogue when they mention something health- related and you have curiosity to offer work with the laser in conjunction with hands-on work?

JS: Whenever I see new clients I assess what brought them to my practice and what expectations they have coming in.   It varies a lot, from “I have always heard Rolfing work is great,” or “My friend says you helped her with  her  chronic  pain,” or “My friend had the same complicated problem as me that no one has been able to help or resolve and you helped her so much I want to try it too,” and so on. The ones who come in for Rolfing SI (but may or may not know much about it), I try to update them on how our conception of Rolfing SI has changed, how like many Advanced Rolfers I don’t follow the ten- session format anymore and have added new skills, like nerve and visceral work. Depending on their issues I may or may not even talk about the laser for a while unless there is something I think it will help them with.

Some clients clearly come to me hoping to deal with distressing chronic or acute pain problems that in some cases have taken over their lives. With all clients I feel it is important that they feel heard in terms of their goals or worries so I try to make it clear that I am addressing their priorities right from the start. If they are dealing with a lot of pain or mechanical dysfunction I try to get my hands on that right away and may talk about the laser and nerve work more at first, although I am also working and thinking strategically in terms of structure  and my Rolfing goals. I will talk about Rolfing goals more and more as they start to get some relief from their distress,  saying that it is essential  to getting long-term relief from their problems and taking them past getting out of crisis-management mode to a sense of possibility and active management of their physical health and well-being.

Some people come  into  my  practice  not even knowing I am a Rolfer or even caring, but I do a lot of educating about it. It just comes at different times in our work depending on their needs.

AH: Tell us a bit more about the laser. How did you decide to check that out?

JS: I had heard of cold lasers for a few years but it seemed like they were very expensive and I had no particular interest in them. I first saw a cold laser in one of Jon Martine’s nerve trainings, when he brought it out to work on a particularly inflamed nerve. I had been working with many clients with serious acute and chronic pain conditions – one of them had had a rare and severe reaction to back surgery that left him in severe pain. He was taking much more pain medication than anyone I had ever worked with, including methadone, Lyrica®, lidocaine patches, and Percocet® as needed. The nerve work had made a real difference, reducing his pain by 40%-50% but I was having trouble helping him beyond that. I decided to look into what the cold laser could do for him and other clients. Jon told me if I wanted to understand this better  I  should  talk  to Mark Hutton in Alaska who was very experienced with laser work. Mark invited me to come spend three days in his office so that I could see what it could do. I was mostly convinced already that I wanted to do a ninety-day trial of it, and what I saw Mark do sealed the deal for me.

AH: What kind of laser do you have, and how did you figure out how to bring it into your practice?

JS: My first laser was a model made by Erchonia that is now called the PL Touch, and cost about $13,000, but Mark  told me if I got serious about using it, I would probably want to upgrade to the Base Station, a set of three lasers (two  red and one with a violet beam), which was $27,000, a very serious investment.

AH: Talk a bit about learning to use it and incorporating it into your practice.

JS: You know when I took my first class from  Don Hazen on nerve work, I took   to it immediately – I know this is not the case for a lot of people but somehow I knew that this was my new leading edge. I felt I could use it almost immediately as I realized I had been feeling inflamed nerves for years without identifying what they were or knowing what to do with them. The cold laser, on the other hand, was a whole new paradigm, but I quickly started getting good – and sometimes astonishing – results just using it in what I call a point- and-shoot kind of way, i.e., using nerve inflammation protocols for nerve pain, numbness protocols for neuropathy, etc.

In my spare time I would look through the protocol book and saw settings for sinusitis and allergies, post-operative  wound healing, and scar revision, and started trying them out. I felt it was essential to buy the stand that holds the lasers because I could try many different settings with the laser on the stand while I went on with my Rolfing work. It has become an important value- added proposition for some of my clients that I can help them with their allergies, post-nasal drip, neuropathies, vertigo, and even anxiety. It has been invaluable for several clients after major joint-replacement surgeries, skin-reduction surgery, and even stroke recovery (one colleague was very impressed that he recovered strength and balance that he had lost thirty years ago, after a series of mini-strokes, in each of three sessions with the laser).

I am sometimes hesitant to talk too much about this kind of result as I would have found them hard to believe had someone told me about them earlier, and I know that others have found a cold laser to be useful but not this dramatic. Partly this stems from the fact that I almost immediately got some dramatic results and was intrigued enough to keep experimenting with it a great deal. I also had a few clients with severe problems with nerve pain, asthma, and anxiety who found the laser work so helpful that they became once-a-week clients, for a year or two now, and they continue to improve beyond anything they thought was possible when we started. They constantly challenged me to become more proficient with the laser. The sessions with these clients alone more than paid for the cost of the laser and they felt it saved them money compared to the cost of the medical bills and missed work they had to pay for before.

Another important benefit to the laser is that it is great for self-care and to use on your family and loved ones and even your pets. It is one of the things that keeps me in good enough shape to still see twenty- five or more clients per week.

Figure 2: The  red  and  violet  units  of the Erchonia Base Station Laser set to numbness settings and held in a stand to point the beams at the client’s right heel.

 

I have always loved a quote by Rilke: “Winning does not tempt that man. This  is how he grows: by being defeated, decisively, by constantly greater beings.” Every time a new client comes in with a problem I have never dealt with before, it can seem difficult at first, but I love to rise to that challenge, and work with it until I can get predictably good results. Inevitably some of these people know other people who have been searching for solutions to their even-more-complicated problems and the process starts again . . .

AH: This has been very intriguing. Thanks so much, James.

James Schwartz first experienced Rolfing SI over forty years ago. Before becoming a Rolfer, he worked as a technical translator and English teacher for ten years in France, before coming back to the US to live in Marin County, California near San Francisco. Ten years after getting his first Rolfing series, he was finally able to complete his Basic Training in 1987. He has since done two Advanced Trainings and extended studies in nerve work, visceral work, Somatic Experiencing, and in using the cold laser.

Anne Hoff is a Certified Advanced Rolfer in Seattle, Washington. She considers Rolfing SI the overarching umbrella for her work but includes craniosacral and visceral work, nerve work, and body- related inquiry as appropriate for a given client. She also brings in the cold laser, especially for nerve inflammation.Working with Nerves and the Cold Laser[:]

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