Ep 220 – Ruth Werner: Life Is An Open Book Test: “The Rebel MT” with Allison Denney

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0:00:48.8 Allison Denney: Ruth Werner is a household name when it comes to pathology in the field of bodywork and massage. Her book, The Massage Therapist's Guide to Pathology is currently in its seventh edition and is a staple for schools, clinics and private practices worldwide. She is a wealth of knowledge, a meticulous researcher and a doting grandmother, but what you may not know is that Ruth forged her way into writing about pathologies after not doing so well on the contraindications exam while she was in massage school.

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0:01:25.2 Ruth Werner: I don't know if I failed it, I did not do well. Certainly that part of the test I bombed. And I don't do that, I don't fail tests, and it became very clear to me that something was interfering with my ability to make sense out of this information, and what it was, was trying to memorize, well this indicates, this contraindicates. That's ridiculous. It is not a useful way to think about working with people who have health challenges.

0:01:55.1 AD: Looking back now, this seems to have paved the way and cultivated the Ruth Werner we all know and love today. But it was not as clear to her in the moment. As a matter of fact, becoming a massage therapist at all was a side thought, it only came to her in the form of an ad in the back of a weekly publication.

0:02:14.9 RW: Basically, I was sort of bashing around trying to figure out what to do to make some money that did not involve computers or restaurants, because that is not my gift, and I was a nanny for a young family, and I was at their house one afternoon waiting for the girls to get home and I saw in the Seattle Weekly, which I think is still published, a little ad on the back saying Go to massage school, call... And I still... I remember the name and I remember the phone number, it was that obvious that that's what I was supposed to be doing, and I ended up in massage school at a time when there was no education requirement. My first course, my first massage diploma says, I'm the graduate of 125-hour program, and I got my Washington license and I thought I would work with actors because that was my family. That was my tribe. The problem with that plan was that actors don't have any money, and so I ended up working instead with my friends' parents, so now with a 125 hours of experience, I am offering massage therapy to people with knee replacements and osteoporosis and diabetes, and a lot of age related things that I was not prepared for.

0:03:29.7 AD: Alongside her new practice, Ruth remained involved with the school she had graduated from, and a teacher asked her to help tutor some of the students. It quickly became clear to her what her own strengths and weaknesses were.

0:03:45.6 RW: As I progressed and continued with the school and learned more, and I was doing mainly injury rehabilitation work, which I liked because it has... It's goal-oriented, I really became convinced that I was much better off as a teacher than as a massage therapist, I really was... My least favorite part of my week was doing massage. And I didn't hurt people, I didn't do anything that was dangerous or unethical, but I was just not into it, and so when I was pregnant with my second child and too big to work anymore, I closed my practice, and I just decided I would not re-open it, and that is a decision that I have never regretted. My skills and my talents lie elsewhere. I am very, very good at managing the clock, which makes me great in a classroom, but not great in a session room where you really have to step out of time and just let things happen. I'm a much better doer than I am a be-er. And that's a discipline that I work on all the time. But at the same time, I have some strengths and I decided to just to go toward my strengths.

0:04:55.3 AD: Knowing her strengths, as these things tend to do in life, opened quite a few doors for Ruth.

0:05:01.8 RW: Not much later after that actually, my husband had a job move and of course, you follow the health insurance, so we left Seattle, I left that school, but my teacher asked me to write a document about contraindications. He said basically, he said, You keep telling us we don't have enough information, so now you're gonna be an at-home mom and you're gonna have all this time on your hands. My kids were like five and three or something like that, four and two, and he said, Why don't you write us a thing we can use. Now, this is pre-Google, this is really for most people, pre-internet. So I had the AMA Family Medical Guide and a handful of college textbooks, but I created a document for the school that then later became my first book proposal or my first writing sample for them for a book proposal, and ultimately, that was the seed that became, A Massage Therapist's Guide to Pathology.

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0:06:00.6 AD: So Ruth started writing, she dove in and decided that her own experience was one she wanted to draw from. Having not aced a test in school herself, writing about pathologies took a new twist.

0:06:13.0 RW: I don't know if I failed it, I did not do well. Certainly that part of the test I bombed. And I don't do that, I don't fail tests, and it became very clear to me that something was interfering with my ability to make sense out of this information, and what it was, was trying to memorize, well this indicates, this contraindicates. That's ridiculous. It is not a useful way to think about working with people who have health challenges. And so people who are learners know that it's the things you miss, it's the things you don't get the first time around that really stick with you.

0:06:56.7 AD: Now, I have read a lot of Ruth's work, I had studied her books, read her articles, and I currently am a big fan of her podcasts, but I wanted to hear her explain the approach that has allowed her to help all of us understand pathologies better.

0:07:13.4 RW: So the end goal is to figure out what are the possible risks. If you're uneducated and insensitive and not paying attention, what are the worst things that could happen as a result of your work with this client who has whatever spectrum of health challenges. And then to figure out what are the possible benefits if you are skilled and sensitive and paying attention and invested in their well-being. And then what do you have to do to minimize the risks and maximize the benefits, and there are very few cases where there's really nothing to do. There are very few cases where we have to say, I'm sorry, you have to go home, I can't work with you today. I mean, it can happen. And I wrote about that, especially around the beginning of COVID, when we had no idea, really no clear ideas about communicability or about blood clotting risk or about all those things, where the safest, but also the most ethical thing to do was to defer, was to wait and get more information. So how do you do that? How do you figure out what are the risks and what are the benefits? Well, you do that by understanding a little bit about this disease process, about how it changes the way people function, how that...

0:08:26.7 RW: That's called Pathophysiology, what this thing does to change the way things are working in the body, and then it's the pathophysiology that gives rise to signs and symptoms, so if you can figure out that a sprained ankle hurts because of these frayed fibers and a great big inflammatory process, that gives you some ideas about risks and benefits. I know. Let's not fray more fibers, let's not make inflammation worse. Is there a way we can work safely and effectively to help people feel better and not worse after the end of the... By the time we're done with the massage. So that's really for me, that's really what it comes down to, is risks and benefits, and then appropriate accommodations, and those accommodations will look completely different whether you specialize in manual lymphatic drainage or myofascial release or cross fiber friction, rehab kind of work or whatever kind of work you do, you know, the thing I like about that, that structure, that risk benefit accommodation structure is it makes room for everybody who touches.

0:09:27.9 AD: If you listen to Ruth's podcast, you'll note that at the end when she talks about what the possibilities are for work, she will say it depends. Well, it turns out I'm not the only one who has noticed this.

0:09:40.3 AD: And I feel like...

0:09:42.0 RW: It always depends.

0:09:43.2 AD: It always depends. I feel like that's always...

0:09:43.9 RW: People give me depends because that's my byline. They give me...

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0:09:50.6 RW: Yeah, please don't send me... Please don't send me underwear. That would be good.

0:09:54.0 AD: Oh my gosh. That's the funniest thing I've ever heard. Oh gosh, I will be sure not to send you any underwear. I promise.

0:10:01.0 RW: Thank you.

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0:10:04.8 AD: Back to pathologies, strengths and weaknesses, and Ruth's story. I know a lot of body workers, myself included, who feel frustrated when we can't help a client, and sometimes this sends us into a tailspin of shame and regret. Ruth quite literally took a "failure" and turned it into a looking glass through which she discovered her strengths. I asked her to talk to me about that.

0:10:30.1 RW: We're always on the brink of impostor syndrome, aren't we? And that's... I'm here to tell you that that doesn't go away. What you can do is, is step back from it and say, Yep, I'm feeling imposter syndrome, and just let that be for a bit while you continue to try to do your best, because I guarantee you your best is good, your best might not be what your client needs in this moment, and that's okay. You gave me a little warning that you were gonna ask me about a failure that worked out well for me, and as you pointed out clearly, I've had a number of them. I was a theater major, didn't end up in theater, although I use it every single day. Moved to Seattle to get involved in theater, didn't work out. Thought about grad school in education, didn't work out, but I ended up being a teacher. But for me, I put some thought into this and a lot of it went back to 11th grade math.

0:11:38.3 RW: So I did not struggle in school, school was not difficult for me until I got moved to a very intense sort of high pressure Prep School in Boston, which is where I finished high school, and it was the first time I had to really scramble to perform in the way I felt I was... That really pushed my limits, and I like that, that's fun for me, I'm happy to do that, except for in math. And I had a math teacher, I just don't remember his... Bruce Male was his name, and I got a C in 11th grade math, and I worked harder for that C than I have ever worked for any other grade in my life, and I was proud of it, and I never told my parents.

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0:12:27.9 RW: I never told my parents about that grade on my report card and they didn't really look. But I think that that experience of not having the outcome that I could have other... Could have expected, but still feeling really satisfied and proud of myself for having worked hard at that was probably a more important moment in my early formation than many, and I've had as a massage teacher, I've had a number of students come through massage school, who sailed through massage school through the book stuff, but did not thrive with the hands-on stuff, 'cause they're so in their head, and that certainly describes me as well. And I would encourage them to think about maybe in this class, maybe get a B and give yourself permission to not be perfect here, so that you can maybe give yourself permission to be a little more bold and exploratory and present in your hands, and I don't know if they connect particularly, but I think that getting out of your head and into your hands is one of the most important skills massage therapists can develop. I'm not good at that, which is why I stayed over here.

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0:13:42.1 AD: Such amazing advice from someone who has created a career that did not even exist when she was in school, but it seems like she always knew her next step. I asked Ruth if she ever doubted herself along the way.

0:13:57.0 RW: I just went along for the ride, truly, Allison. My success, and I will call it success, and we can define that if you want, that's a different, a little bit different topic, but my path of to me, has felt like the path of least resistance. It might not look like that to other people, but for me, the key decision points in my life, if I was able to sort of step back and survey, there was always a strong draw in a particular direction, it didn't feel to me like I was bushwhacking a new trail, it felt to me like I was following this obvious path. I was gonna say, I love writing. That's not really true.

0:14:40.8 RW: I love having written. But what I really love, and I think that makes me an effective writer and a teacher is wrapping my head around very complex concepts and then deconstructing them in a way that other people can re-build them into your version of this very complex concept, and I just I get a huge kick out of that, I get... I love when I was in Core curriculum, which I did up until the right before we moved here, where I am a long way from any massage school, but I taught in a massage school in Salt Lake City for years and years, my favorite days where when people would trudge into my classroom absolutely convinced that they were never gonna get this and leave the classroom going, Wow, I get it, I understand how this works now, and feeling some ownership of their intellect and their skills and their ability to manage new information.

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0:15:43.0 AD: So she figured out what she really loved and she went with that. I would argue that as easier said than done. As she reflected, she doesn't necessarily love to write, but she loves having written. In the web of all that she has written, I asked Ruth if there is anything she wishes everyone knew about the world of pathologies.

0:16:03.0 RW: I hate when massage therapists say, get a doctor's note. I hate the idea that a doctor's note gives anybody enough information to do anything.

0:16:14.3 AD: Interesting.

0:16:15.4 RW: It is not a doctor's job to know if your work is safe, not the doctor's job to know if your work is safe.

0:16:21.0 AD: Why? Tell me why.

0:16:22.7 RW: Why does a doctor need to know about your version of massage.

0:16:25.8 AD: Okay. So you're not saying that they need to be cleared for massage, you're saying...

0:16:32.1 RW: If the doctor clears you for massage, what does that mean? The people who have to give permission for a massage to take place is the client and the massage therapist. Now, I did not say, don't include a healthcare team in your decision-making process.

0:16:47.5 AD: Right.

0:16:48.2 RW: That's not at all what I said, but there's a really different tone to conversation when you say, Dear Dr. Martinez, your patient, Mrs. Lee, who has peripheral artery disease wants me to massage her legs. Is that okay with you? And what should I do? Versus Dear Dr. Martinez, your patient, Mrs. Lee, who has peripheral artery disease wants me to massage her legs. I have some concerns and here they are X, Y and Z. Can you please give me some feedback about this?

0:17:16.0 AD: Which is such a different sentence all together.

0:17:18.4 RW: Totally different. That's a consultation.

0:17:21.7 AD: Right.

0:17:22.3 RW: Right? Where the first one is asking permission. It's scary. It seems much simpler just to say to your client, please get doctor's, please get your doctor's clearance before we work together, but I am here to tell you that a doctor's clearance doesn't mean anything unless the doctor knows what you're doing, and if God forbid, you hurt somebody, and you have a doctor's note, that doctor's note will not provide you with any kind of litigious safety. I have had people come to our student clinic in the school where I taught in Utah, diagnosed with blood clots in their legs, bringing in a doctor's note saying, I think Mrs. Smith should get massage because she needs improved circulation, and my response was like, Does your doctor hate you? Because that would be a terrible, terrible, terrible idea. It's our job.

0:18:11.5 AD: It's our job.

0:18:12.5 RW: It's our job. And so, alright, so we talked about risk benefits, accommodations, we talked about the power of collaboration over asking permission with people's healthcare teams, and then the third is to understand that no matter what setting you're working in, you could be taking people in your home, you could be working at a ski resort, you could be working in a medical clinic, people who are ill, people who struggle with their health may come see you, and so saying, Well, I just work in a beauty salon, I don't get complicated healthcare clients... That's not true. People with diabetes get their hair done, and then they would like to go for a massage. People with cancer go on vacation, and they'd like to get a massage.

0:19:00.7 RW: I had a letter once from a woman in England who had read an article that I wrote on Lou Gehrig's disease, on amyotrophic lateral sclerosis and she wrote me saying, "My mother, who has this... In England, they call it motor neuron disease. And she gets massage at the spa and she just loves her massage therapist. Is there any reason that we should stop this?" And motor neuron disease is terminal, and it can change a lot of things about the way people work, and this massage therapist might be absolutely wonderful but I bet they haven't had a lot of training in working with neurological degeneration. And so you, no matter where you work, you won't be in a silo where people who struggle with diseases and disorders aren't going to come see you. Diabetes is everywhere. So baseline knowledge about pathology or the ability to look stuff up about pathology, it's a necessary skill for every massage therapist, no matter what setting they're working in.

0:20:06.3 AD: This was the perfect segue to my last question for Ruth. I asked her for insights on how to handle the inevitable feeling of overwhelm that hits all of us when we graduate from massage school and realize that we can't possibly know it all.

0:20:21.0 RW: The first thing I say is, Life is an open book test. The second thing is, clients like it and appreciate it and trust you more, when you say, Wow, this is new to me. Tell me more about your situation. One of the great things about working with clients who have health challenges is they probably know a lot about their health challenges, and so if you have someone with a colostomy bag and you've never worked with someone with a colostomy bag before, you don't have be perfect without having any experience, you can say, Gosh, I've never worked with someone who has a colostomy bag before. How can we make you really comfortable? And the other advantage that that gives us when we have a client who has health challenges, is that re-establishes our relationship as a team, so we are working with people, not on people.

0:21:12.5 RW: I hate that pronoun. We don't work on people, we work with people and to work with... One of the ways we do that is to ask this question. I wanna make you as comfortable and as happy as possible that you came to see me today. What are some ideas about how I can do that for you? And so most of your clients are not gonna have serious enough issues that require huge changes. Sandy Fritz says a thing that I really love. She says, The more complicated someone's health picture is, the more simple the massage needs to be. And that's a decent sort of general rule, although there are nuances and ways to work with that, the more you learn about people's health situations. But it's a safe way to start until you get more information, and then I think having a good pathology book or a good pathology app or both is probably a decent idea.

0:22:05.3 AD: Ruth Warner's unexpected career path from massage therapist to teacher, to author, to Queen of pathology, is not one she could have predicted, but in the same way that she asks us to be okay with not knowing everything yet diving in and doing our best, she has done exactly that in her own life. Her work reflects the woman she is, grounded, ethical and wise, and gives all of us a foundation on which we can build something great for ourselves.

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0:22:40.4 S1: Members are loving ABMP Five-Minute Muscles and ABMP Pocket Pathology to quick reference web apps included with ABMP membership. ABMP Five-Minute Muscles delivers muscle-specific palpation and technique videos plus origins insertions and actions for the 83 muscles most commonly addressed by bodyworkers. ABMP Pocket Pathology created in conjunction with Ruth Werner, puts key information for nearly 200 common pathologies at your fingertips and provides the knowledge you need to help you make informed treatment decisions. Start learning today, ABMP members log in at abmp.com and look for the links in the featured benefits section of your Member Homepage. Not a member, learn about these exciting member benefits at abmp.com/more.