I often think of the individual lesson as a dialogue between two people. It is, by definition, a constant communicative exchange. In shaping this dialogue, perception on both sides is of utmost importance. People differ widely in their ability to perceive movement and touch, and a key element of our communication lies in my ongoing effort to adjust my actions to the student’s perceptual capacity—and, when possible, to help develop it.

At times, despite my efforts, a student’s responses remain limited, without an apparent reason. When trauma of any kind is involved, one often senses an underlying hindrance, something lurking beneath the surface.

In this case study, I explore how the complexity of this dialogue unfolds over a long series of lessons, and how my understanding of the student’s overall and physical organization evolves as changes occur and new perspectives emerge. Throughout the process, there were many moments when I shook my head in disbelief, wondering how it was possible that I only understood one aspect or another at that particular moment.

Since I worked with Jorge for over a year, I will remain relatively general and refrain from describing the specific manipulations used in each session. I hope that by organizing the process around broad themes—perhaps better described as strategies—the ongoing correspondence between detailed bodily changes and a broader, integrative framework will become clearer. This organization is primarily heuristic: the dynamics of my work are not linear, and elements of each theme are present at multiple stages throughout the process.

I was surprised when I saw Jordi standing at the door of my office. A few days earlier, we had spoken briefly on the phone about what he referred to as “my lack of balance.” As often happens, I had formed a mental image of him based on his tone of voice and manner of speaking—an image that bore little resemblance to the man now entering the room.

I already knew his situation was complex. He had been referred to me by another practitioner who did not know how to help him. On the phone, Jordi sounded confident and terse, offering few details. Later, I learned that he had founded and managed a successful business, which perhaps explained his managerial tone. Physically, he was an imposing man—around 100 kilograms, taller than me, with broad shoulders and a round face.

Yet when he stepped inside, he swayed from side to side, limped in an unusual way, and appeared exhausted and weak. When I asked him to sit and describe his situation, he collapsed into the chair like a sack of potatoes. He told me he “walked like a duck” due to two hip replacements: the left hip five years earlier, and the right two years after that. His voice was hoarse, and his breathing labored.

He then added that ten years earlier, at the age of fifty-five, he had been diagnosed with lung cancer that had metastasized to the brain—and that he had been miraculously cured. As he said this, his face lit up with pride. I sensed that this pride extended to many of his life achievements, although I would only recognize this fully later. When I asked about any after-effects of the cancer, he said that officially there were none. I was unconvinced; one side of his face appeared slightly paralyzed. Still, I chose not to pursue the matter. I generally avoid medical discussions at the outset, as they can frame the work too narrowly within a pathological model and limit the scope of our dialogue.

After a few minutes, I asked him to walk so I could observe his gait. He walked with flat feet, leaning forward, his body rigid. His head swayed from side to side, his arms hung stiffly without swinging, and his limp was difficult to decipher. Overall, he appeared to be struggling to maintain his balance.

When he lay down on the table, he moved rigidly from sitting to lying. As I supported his legs and head, he actively participated in the movement, arresting his breath. I gently flexed his foot and was astonished to see the ankle remain bent long after I released it, until I actively returned it to neutral. Palpating his legs and neck, I encountered a degree of rigidity I could not recall having felt before. Was this solely the result of his surgeries? Had he always been like this? Or perhaps the brain cancer had left residual effects after all?

Adding to my confusion, he described himself as having always been physically active—playing tennis, skiing, and hiking extensively during summer vacations.

When he asked whether I thought I could help him, I replied that I would need a few sessions to understand his situation more fully. During our first lesson, I felt doubtful and struggled to make sense of his organization. To my surprise, however, at the end of the session he declared—without any suggestion from me—that he felt different, lighter, and immediately asked to schedule the next appointment.

This confidence in his own sensation contrasted sharply with his rigidity and forceful, jerky reactions. Yet it gave me hope that we could work together. When he returned the following week, I could sense that the effects of the first lesson were still present. “You’re full of surprises,” I told him.

Initially, I understood Jordi’s spatial organization primarily as a consequence of his double hip replacement and focused on addressing his limp. A limp often emerges as a compensatory walking pattern following a limitation in the original gait. Traces of the original pattern are usually still discernible beneath it.

Given Jordi’s fragile balance, I knew that changes would have to occur slowly, by establishing additional references within his existing framework. Limping involves a marked asymmetry between the two sides. Typically, when one leg is shorter, the person uses the opposite hip joint as a hinge, lifting the shorter leg and then “falling” onto it—similar to the movement explored in AY 268 (hip joints through lengthening), but in standing.

My initial hypothesis was that improving the dynamics of his limp might reveal aspects of his original organization. If there were more space around the right hip joint, the pelvis could rise and sink more freely around the femoral head. Thinking in terms of the necessary conditions—mobility, force transmission, and relative movement—has always been a helpful strategy for me.

The surgeries had left Jordi with a 1.5 cm shortening of the left femur. Even with an orthotic or raised sole, the left knee sat closer to the pelvis, creating an inherent asymmetry that was difficult to manage. The tissue around the left hip was tight and painful. Although a shorter leg often invites falling onto that side, Jordi avoided stepping on it altogether. When stepping left, he tilted his torso to the right, minimizing weight-bearing on the left leg. He swung from side to side, using the spine as a rigid rod, with little rotation or flexion.

This pattern may have originated in pain around the left hip, but it could also have had a different source. He relied heavily on the right leg for both support and propulsion. I wondered which leg had been his dominant support leg before the surgeries. Tracing pre-trauma patterns often provides access to deeper organizational resources. Pelvic rotation suggested the left side, yet he reported having kicked a ball with his left foot.

Although his head appeared better organized above the left foot, rigidity along the right side prevented effective testing of force transmission between head and foot. Holding this question in mind, I decided to focus on improving mobility around both hip joints and observe how this affected his limp.

Early on, working on the right side seemed more promising. I began with side bending to the right while he lay supine, envisioning how this might later translate into spinal rotation. As mobility increased—especially in the right hip—it became easier to roll the pelvis to the left, fostering communication between the two sides.

It took time to realize that part of his rightward tilt stemmed from poor differentiation between the right leg and the back, caused by rigidity in the lower ribs and lumbar region. Over several sessions, I placed small rubber balls under different areas of his back to facilitate differentiation and mobility. As pelvic rolling improved, it became clear that further local work was needed to reduce pelvic tension and improve coordination between the two hip joints.

Early in the process, it became clear that moving Jordi passively on the table—supporting him or pushing through his skeleton—was insufficient. Gentle work elicited little response; stronger force was exhausting for me and ineffective given his rigidity and weight.

Trying to accelerate progress, I attempted to guide him toward greater self-awareness: moving more slowly, breathing more freely, exerting less force. This language did not resonate with him. His movements remained forceful and jerky, and his tendency to arrest his breath persisted.

In the delicate balance between action and perception, it was evident that perception was lacking. I began to understand this as a communication problem between the central nervous system and the musculature. When soft touch, support, and movement fail to modulate muscle tone, the issue may lie at one or both ends of this communication loop.

From my experience with children with cerebral palsy and adults post-stroke, I knew that long-standing spasticity and fascial adhesions can render such strategies insufficient. When soft tissue remains stiff for extended periods, it often ceases to provide meaningful afferent input. Without more direct local intervention, the cycle of contraction and relaxation cannot be re-established.

Although this work may resemble massage or Rolfing from the outside, its context is fundamentally different: the aim is learning. By separating tissue layers, muscle bundles, and fascial sheaths, we seek to restore both proprioceptive function and structural integrity.

Jordi had extensive scar tissue around his left hip and admitted that the first surgery had been “lousy.” Almost any change in the angle between pelvis and leg caused pain. Each session required careful negotiation around what constituted acceptable versus unacceptable pain.

Rather than resisting Jordi’s tendency to exert force, I decided to use it. I frequently asked him to move against my resistance. For example, I would have him slide a leg sideways while I leaned into the table, limiting his movement so he pressed against me.

This produced two effects: activating a muscle encouraged relaxation of its antagonist, and elevating muscle tone above habitual levels often resulted in a subsequent drop—sometimes even below baseline. Combined with soft tissue work, this approach helped mobilize scar tissue, increase flexibility, and strengthen the reciprocal relationship between movement and perception. Gradually, he gained more mobility and control around the hip joints.

Despite these improvements, I remained concerned by the lack of overall integration. From the beginning, I worked with Jordi in multiple positions—lying, sitting, standing, and walking—often within a single session. This served several purposes.

First, I wanted to avoid reinforcing a passive patient role. Despite his pride and managerial background, he seemed inclined toward passivity, perhaps due to exhaustion or prior medical experiences. Active collaboration was essential for learning.

Second, the transition from the safety of the table to the demands of walking was too abrupt to process all at once. Large changes risked destabilizing him and increasing fear. Third, I wanted to observe how table-based changes translated into functional movement.

We worked on weight shifts, head tilts, and various walking constraints—altering foot contact, knee lift, or head position. While these interventions produced small improvements, the overall walking pattern remained largely unchanged. I began to wonder whether my expectations were unrealistic, or whether I was missing something essential.

The growing gap between local improvements and global integration made me suspect a neurological issue. Perhaps fear of falling was inhibiting integration, or perhaps neural processing itself was compromised. I felt frustrated, as though we were circling without progress.

A breakthrough occurred when, after several sessions, I supported Jordi in a slow, controlled “fall” to his right while seated. His startle response was immediate—breath held, tone increased—but through repetition, his reactions softened. When he stood and walked afterward, he noticed his pelvis moving side to side, which reminded him of skiing.

When I asked him to show me how he skied, his movement became fluid and confident. He smiled, animated, and began recounting his skiing experiences. For the first time, I glimpsed the person he had been before the trauma.

This moment marked a turning point. Skiing became a functional, positive goal that awakened a dormant skill. I encouraged him to practice the movement at home, and he became more engaged—following exercises and even hiring a personal trainer.

Although the skiing movement improved upright integration, Jordi’s gait remained largely confined to side bending. This highlighted the complexity of spinal rotation in walking—a pattern that develops later in childhood with contralateral arm swing. Its absence initially made his gait seem primitive.

Rotation gradually became a goal, a means, and a marker of integration. We worked on rotational patterns on the table, combining them with side bending, progressing through sitting, standing, and walking. As confidence grew, I introduced constraints—wide stance, head rotation, weights, rollers—to challenge coordination.

Eventually, I asked him to run. Though awkward at first, this too awakened latent patterns and increased overall fluidity.

Despite improved rotation and spinal mobility, his head continued to sway. Ideally, the head remains relatively centered during walking, providing a stable sensory reference. When I held his head steady, however, the rest of his body could not coordinate.

Neck stiffness played a role. Throughout our work, I addressed differentiation between head and body—using rollers, eye movements, and gentle mobilization. Still, progress was limited.

I increasingly suspected residual brain damage—perhaps affecting vestibular processing. We intensified work around the neck, incorporating increasingly unstable environments, including a trampoline. Although enjoyable for him, these interventions did not fundamentally alter the pattern.

By the time summer arrived and we parted ways, I was convinced that neurological damage was limiting his capacity for integration. I was prepared to tell him I could no longer help.

When Jordi returned after the summer, I immediately noticed a change. He was thinner, lighter, more agile. He told me that a new doctor had diagnosed him with Lambert–Eaton Myasthenic Syndrome—a rare autoimmune disorder affecting neuromuscular transmission. He had been taken off his previous medication and placed on cortisone.

Although he still swayed slightly while walking, his movements were smoother, his reactions faster, and integration more apparent. The correspondence between changes in muscle tone, movement quality, and functional walking was unmistakable.

This explained my frustration. The disconnect between local change and global integration had been rooted in impaired neural transmission. Yet knowing the diagnosis would not have changed how I worked. Our task remains the same: creating conditions in which perception, movement, and integration can emerge.

When learning does not unfold as expected, we must imagine who the student was—and who they might yet become. Challenging their relationship with gravity can awaken latent skills. The gap between present limitations and past or future possibilities generates the questions that fuel learning.

Sometimes, a student’s learning capacity does not meet the teacher’s expectations. Sometimes there is a medical reason, and a name for it. And sometimes, there is not.