A Q&A about Clinical Somatics with Sarah Warren

Photo by Charlotte Karlsen

Clinical Somatics changed my life and it might yours, too.

When I find something that works, I am not shy about it. That’s why I’ve been shouting from the rooftops about Sarah Warren and her work bringing Thomas Hanna’s clinical somatics to the wider world via through her book and online courses. In this Q&A I get the chance to ask Sarah the questions I’ve had since first starting my clinical somatics practice. Two reasons to be thankful for our digital age: access to new information and the ability to connect with the people who inspire you! Thank you, Sarah, for taking the time to share everything you’ve learned with me and with voyagers everywhere!

Bevoya: Sarah, I am so grateful to you for your work bringing Clinical Somatics to me in an accessible, intuitive, day-by-day format. I have been researching mindbody approaches to healing pain for years and never found an approach to help me reset my nervous system and release muscle tension like yours. Why do you think it is that this kind of healing is so hard to find?

Sarah Warren: I believe the main reason why Clinical Somatics isn't more well-known is that Thomas Hanna, the man who developed the method, died in a car accident at a relatively young age. He had just started teaching his first professional training, so when he passed away there were 38 practitioners who were only partially trained. His widow, Eleanor Criswell, continued to teach, and these 38 practitioners worked with Hanna's long waiting list of clients. Hanna was a passionate, charismatic teacher with a dedicated following. People would travel across the country to have sessions with him and attend his workshops. But when he passed away, the momentum he had created slowed way down. I'm certain that if he had been able to live to old age, Clinical Somatics would be very well-known.

Thinking of Thomas Hanna, pictured here, with gratitude (and some sadness)

Thank you for your pioneering work,Thomas Hanna!

The other reason why Clinical Somatics and other types of self-care aren't more mainstream is that in our society, we've been taught to let doctors and other health professionals make decisions about our health. We grow up thinking that they are the experts in our personal health. Now, Western medicine is truly incredible in some ways, especially in life-threatening situations. But when it comes to chronic health conditions that are caused by lifestyle, visiting a practitioner of Western medicine is fairly useless. We need to make changes in how we're moving, eating, sleeping, dealing with stress, etc. We need to take responsibility for our own health. Most people haven't grown up expecting to have to do this, so it can take a big shift for people to be willing to really take the reins when it comes to their health. And it may take time, patience, and a lot of exploration to find the right solutions for their unique health situation. But, speaking from personal experience, it is so worth it! For any of your readers who aren't familiar with somatic movement, this video and article are a good introduction.

Bevoya: In your years of doing this work, who do you think is most likely to benefit from the Clinical Somatics approach? Is it a coincidence that I am an overthinker with lifelong migraines and neck pain whose back pain really kicked up in the past couple of years? Is this the kind of story you hear frequently?

Sarah Warren: The type of chronic pain that is relieved by Clinical Somatics is musculoskeletal pain caused by chronic muscle tension. The majority of chronic pain cases fall into this category, but certainly not all. Tight muscles themselves are sore and painful. They pull our connective tissues tight, leading to tendinitis and ligament sprains. They pull our skeleton out of alignment, leading to joint degeneration. Misalignment of our skeleton puts pressure on nerves, leading to nerve pain. So, the underlying cause of most musculoskeletal pain is functional—chronically tight muscles—but the end result might be a structural issue, like a herniated disc or cartilage that has worn away.

So, people whose pain falls into that category are those who will benefit from Clinical Somatics. But on top of that, people need to be willing to slow down and take some time each day to lie down and practice the exercises. This is very hard for some people! Some folks really struggle to do the very slow exercises and focus on what they're feeling in their body, because they're used to moving quickly and having an external focus. These tend to be the Type A “go-getters.” I get quite a few emails from these students who report that at the beginning of their learning process they had a really hard time, then as the weeks and months went on, they gradually got comfortable with slowing down and focusing on their internal sensations. And then a whole new world opened up to them. I love getting those emails!

Bevoya: I found and bought your book and online exercises out of desperation after I had tried everything else to improve the iliopsoas tendinopathy I was diagnosed with. So many physical therapist appointments, and my next step was about to be more x rays and a corticosteroid shot to the hip...and none of it was helping. I am three weeks into your program and the improvement is significant. More than that, I am living differently in my body. In particular, I am relaxing my belly muscles more frequently during the day and doing diaphragmatic breathing. What are some of the specific things that other people say they notice about how their body changes after Clinical Somatics?

Sarah Warren: There are so many positive changes that people experience! The most common reason people come to Clinical Somatics is for pain relief, and that's what I focus on in my practice, so that's what I hear about most often from students. Muscle tension relief and improved posture are also inevitable if you practice the exercises regularly. Stress relief, better breathing, better sleep. The ability to return to activities and workouts that they love to do but couldn't because of their pain. A new relationship with their body, with heightened sensation and awareness throughout their body. The ability to quickly and easily get themselves out of pain if a new or old pain arises. Increased empathy, patience, and enjoyment of their daily lives. And, since we hold psychological tension in our bodies as muscle tension, some people report the release of longheld emotional stress and trauma.

Sarah Warren demonstrating the One-sided Arch & Curl. The key to clinical somatics exercises is to move slowly and stay attuned to the muscle group you’re engaging as you go.

Bevoya: What are some things that Clinical Somatics can't help with? For example, I have Achilles tendinitis in my right ankle. I assume that this will not be improved by Clinical Somatics. Is that true? In response to my newsletter, a friend wrote "It looks like the exercises are centered on helping with back and torso pain, which my probs are more in my feet and knees... I wonder if maybe those would be helped residually, though?"

Sarah Warren: Clinical Somatics works with the entire body, and can definitely relieve Achilles tendinitis and other issues in the extremities of the body. Posture and movement patterns begin in the core of the body—our core is like the foundation of a house. If there is muscle tension or misalignment in the core of our body, it affects our entire body. Often, an issue in the core of the body is actually felt in our extremities, so we think that's where the problem is. For example, let's say you're hiking one hip up higher than the other (functional leg length discrepancy). That's an issue in the core of your body: your waist muscles and lower back muscles are tight, hiking your hip up. But you may only feel pain in one of your knees, because your weight is shifted to that side, putting an unnatural amount of pressure and strain on that knee. No amount of therapy focused on that knee is going to solve the underlying problem, which is the fact that your hips are out of alignment. So in Clinical Somatics, we always start by working with the core of the body so that we can address foundational issues. Then as the learning process continues, we introduce more movements that work with the extremities. Regarding your Achilles tendinitis, you can read my article on tendinitis to learn about the full-body patterns of tension that are typically involved. And in answer to the first part of your question: Yes, there are some types of pain that Clinical Somatics doesn't address. Basically, any type of pain that isn't caused by chronic muscle tension or habitual body use. For example, pain resulting from peripheral neuropathy, which is most often caused by diabetes, infections, or exposure to toxins. Another example is painful autoimmune conditions; the pain in these conditions is caused by inflammation, so the cause of the autoimmune condition needs to be addressed. This often involves a combination of factors like diet, stress, infections, and exposure to toxins. Chronic pain can also be neuroplastic in nature, meaning that the nervous system adapts by making your pain increase over time. Pain receptors become more sensitive, the spinal cord becomes more responsive to pain signals, and more neurons in the brain are recruited to respond to pain signals. I write about that type of pain in this article.

Sarah Warren demonstrates the One-sided Arch & Curl from another angle. One of the things I love about her approach is how detailed it is. Sarah shares the level of information I need to understand and learn!

Bevoya: What is your vision for this work in the future? Do you have a dream about how ClinicalSomatics will be incorporated into medical fields or as treatments suggested by doctors? Are there obstacles to that?

Sarah Warren: Yes, in an ideal world, doctors would refer their patients to Clinical Somatics in the same way they currently refer them to physical therapy. That would be amazing! I believe we'll get there, but there are some obstacles. Clinical Somatics isn't currently covered by health insurance, so that's a big obstacle. Before that can happen, the Somatics community (which includes Clinical Somatic Educators and Hanna Somatic Educators) needs to come together to form an organization that includes certified practitioners from all the major training programs. There must be guidelines put in place to ensure that the training programs are all teaching the same basic information. Once this organization is in place, I believe the next step would be introducing licensure for Clinical Somatics and Hanna Somatics practitioners. Once we have this type of regulation in place for how Clinical/Hanna Somatics is practiced, then we could pursue getting covered by insurance. Going back to my answer to your first question: I believe we'd be much farther along in this process if Thomas Hanna hadn't passed away.

Regarding my personal approach: I don't have much patience for dealing with institutions. At the moment, I feel like trying to introduce Clinical Somatics into mainstream medicine would just slow down my efforts. I really enjoy going straight to the people who need it, and making Clinical Somatics accessible for them. I've always felt like this is my role. When I first learned about Clinical Somatics, I felt like most people do—why doesn't everyone know about this? In addition to the reasons I already listed, another reason is that “what Clinical Somatics is” can be a tough thing to communicate. We use words like “pandiculate” and “sensorimotor awareness” that people have never heard. We talk about the stretch reflex (myotatic reflex) and the gamma feedback loop, and tell people not to do static stretching—the opposite of what they've been told their entire life!

My passion has always been: How can I communicate what Clinical Somatics is in a really clear, simple way so that people understand how they can benefit from it? So, that's what I strive to do every day through my website and my courses. I wish that literally every human being could practice Clinical Somatics. Can you imagine what a wonderful world that would be? There would be a dramatic reduction in chronic pain, and associated problems like depression. There would be a reduction in opioid prescription, abuse, and related deaths. There would be a vast reduction in elective orthopedic surgeries, like hip and knee replacements. Not to mention reduced healthcare costs! And, people could be more physically active as they age, would would extend their lives and improve the quality of their lives. It may sound a bit crazy to say that all of these effects would result from everyone practicing Clinical Somatics, but once you do it for yourself and experience the benefits, you know it's true.