You might wonder, “I received good training in my massage-school program.

Is it necessary for me to learn additional assessment skills?” Yes, absolutely!

If you work in a medical or clinical environment with your massage practice, assessment skills are vitally important — however, even if your massage practice emphasizes the personal care aspect of massage, such as in a spa or general relaxation/stress reduction massage, some assessment skills are crucial to provide safe and effective care.

The question really becomes: How extensive will your use of those assessment skills be?

What is Assessment?

Assessment is a systematic process of gathering information that continues throughout the duration of the treatment(s). It provides the practitioner with the information necessary to determine appropriate strategies for care. Assessment reveals important aspects of the client’s health, including the tissues most likely involved and the status of those tissues.

Why is Assessment Necessary?

The most important reason for the massage practitioner to perform assessment is to determine if massage therapy is appropriate. Massage can produce significant tissue changes, which is why it is functional as a form of soft-tissue treatment. Ordinarily, these changes are positive. However, massage can be contraindicated and the practitioner must be able to apply clinical reasoning to determine the effect that massage is likely to have on the client.

It is the responsibility of the practitioner to know their therapeutic limitations and capabilities. Practitioners should refer clients whose pain or injuries need more significant investigation than can be offered by the practitioner. It is through assessment that you make those decisions. Even when a client is referred with a physician’s diagnosis, the individual characteristics of the client’s condition must be explored with assessment so appropriate treatment can be offered.

Massage as an Alternative

Clients increasingly turn to soft-tissue treatment for musculoskeletal pain and injuries as an alternative to mainstream interventions because of value and effectiveness. The majority of these problems are minor musculoskeletal disorders or pain conditions that do not require surgery.

From everyday aches and pain to soft-tissue disorders and injuries, massage is an effective method of treatment. Massage therapy is also proving to be a valuable complement to traditional treatment methods that focus on rest, exercise, rehabilitation and activity modification.

Yet for massage to truly provide the beneficial effects it can, the practitioner must be adequately trained. That is why it is important to learn assessment skills.

Assessment Skills Are Not Diagnosis

There is often misunderstanding about the definition and role of assessment. Many people confuse the concepts of assessment and diagnosis and for that reason shy away from learning about it. Assessment skills are a systematic method for gathering information in order to make informed decisions about treatment.

Since assessment is really an information-gathering process, you can’t really do any kind of massage without doing some level of assessment. When your hands feel a tight area in your client’s muscle tissue, you naturally focus your attention on reducing the tension in that area. You have performed assessment through palpation and then chosen a particular course of action as a result of your assessment of the client’s tissue state.

Diagnosis, on the other hand, is the assigning of a name or a label to a certain group of signs or symptoms. In order to arrive at a diagnosis, the physician performs several assessment strategies, and based on the findings she will assign a name or a label to the problem.

When you assign a name or label to the problem and state to the person they have “x” condition, you have given them a diagnosis. However, the process of gathering information about their condition in order to determine if massage is appropriate is assessment and not diagnosis.

Palpation vs. Assessment

Sometimes I’ll hear practitioners make comments like, “I don’t really need to learn assessment skills because I let my hands tell me what the client needs.” Actually, you are using assessment when you let your hands tell you what is going on for your client. Palpation is only one aspect of the assessment process, though. I would caution any practitioner against relying on just one type of assessment to identify their client’s needs most appropriately.

A problem such as muscle tightness can be effectively identified with palpation. However, you can’t rely on palpation alone to identify many conditions the client might have. For example, numbness and pain in the hand could be the result of a nerve entrapment syndrome such as carpal tunnel syndrome, but could just as easily be from median nerve entrapment near the elbow, or a symptom of diabetes. You can’t identify these problems with palpation alone.

Assessment skills would be crucial in that situation to help identify if massage was an appropriate treatment for that client, and if so, what types of massage would be beneficial or harmful. That client with hand pain could easily be coming for a relaxation massage at a spa, so it is in every massage therapist’s best interest to have some basic assessment skills to evaluate the safety and appropriateness of massage.

Causes of Dysfunction

Massage treatment aims at reducing symptoms by addressing the causes. In the simplest terms, the practitioner should know whether the tissues involved are muscle, fascia, tendon, ligament, capsular, etc. In addition, the practitioner will evaluate the type of dysfunction in the tissue (tear, hypertonicity, myofascial trigger point, nerve-conduction impairment, etc.).

Identifying what specific musculoskeletal dysfunction is impairing your client is essential for proper treatment. It often takes a comprehensive investigation and thorough physical examination to accurately identify the client’s primary problem(s). Unfortunately very few practitioners in our current health care system do this with the appropriate level of detail.

Very often I have had clients remark, “How come nobody ever did this [detailed assessment] with me before?” The massage therapist is in a position to give the client great care they are not receiving anywhere else. An integral part of that care is properly assessing what they need so you can identify how massage could help.

Limitations of Assessment

An important caveat with massage therapy assessment is that it is not an exact science. There are no specific evaluation techniques that provide 100 percent positive results in establishing the tissues and dysfunction involved.

In some cases the nature of the client’s pain is fairly straightforward. In other cases, the client’s condition is far more complex. However, having assessment skills gives you tools with which to conduct this investigation. Without assessment skills you are left guessing about your client’s condition.

Guessing about your client’s condition leads to a lower quality experience for your client or in a worst-case scenario could end up injuring them. Learning more assessment skills is a critical part of your professional development. Assessment skills are a valuable adjunct to your massage practice no matter what method, technique or approach you practice.

About the Author:

Whitney Lowe, LMT, directs the Academy of Clinical Massage. He teaches continuing education in advanced clinical massage through the academy, and offers an online training program in orthopedic massage. He is a regular contributor to MASSAGE Magazine and is a MASSAGE Magazine All-Star.

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