Ep 559 – Skull Fractures and Failures in Communication: "I Have a Client Who . . ." Pathology Conversations with Ruth Werner

A client asks for a specific technique on their face. They have a bad reaction. Then they say they didn't want work in that area anyway, and by the way, they had a skull fracture four years ago. Now they're leaving because they feel a migraine coming on.

The therapist is left wondering what just happened.

In this episode of I Have a Client Who . . ., Ruth unpacks this interaction, what may have been going on for the client and their bones, and takes a closer look at where things started to break down.

Has this ever happened to you? You're not alone.

Resources:

Cheatham, S.W. et al. (2025) "International Expert Consensus on Instrument-Assisted Soft-Tissue Mobilization Precautions and Contraindications: A Modified Delphi Study," Healthcare, 13(6), p. 642. Available at: https://doi.org/10.3390/healthcare13060642.

Instrument Assisted Soft Tissue Mobilization (no date) Physiopedia. Available at: https://www.physio-pedia.com/Instrument_Assisted_Soft_Tissue_Mobilization (Accessed: March 13, 2026).

Skull Fractures: Types, Treatment and Prevention (no date) Cleveland Clinic. Available at: https://my.clevelandclinic.org/health/diseases/skull-fracture (Accessed: March 13, 2026).

Handling Head Trauma | ABMP (no date). Available at: https://www.abmp.com/massage-and-bodywork-magazine/issues/winter-2025/handling-head-trauma (Accessed: March 13, 2026).

Host Bio:

Ruth Werner is a former massage therapist, a writer, and an NCBTMB-approved continuing education provider. She wrote A Massage Therapist's Guide to Pathology, now in its seventh edition, which is used in massage schools worldwide. Werner is also a long-time Massage & Bodywork columnist, most notably of the Pathology Perspectives column. Werner is also ABMP's partner on Pocket Pathology, a web-based app and quick reference program that puts key information for nearly 200 common pathologies at your fingertips. Werner's books are available at www.booksofdiscovery.com. And more information about her is available at www.ruthwerner.com.

Sponsors:

Anatomy Trains is a global leader in online anatomy education and also provides in-classroom certification programs for structural integration in the US, Canada, Australia, Europe, Japan, and China, as well as fresh-tissue cadaver dissection labs and weekend courses. The work of Anatomy Trains originated with founder Tom Myers, who mapped the human body into 13 myofascial meridians in his original book, currently in its fourth edition and translated into 12 languages. The principles of Anatomy Trains are used by osteopaths, physical therapists, bodyworkers, massage therapists, personal trainers, yoga, Pilates, Gyrotonics, and other body-minded manual therapists and movement professionals. Anatomy Trains inspires these practitioners to work with holistic anatomy in treating system-wide patterns to provide improved client outcomes in terms of structure and function.

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Precision Neuromuscular Therapy seminars (www.pnmt.org) have been teaching high-quality seminars for more than 20 years. Doug Nelson and the PNMT teaching staff help you to practice with the confidence and creativity that comes from deep understanding, rather than the adherence to one treatment approach or technique.

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