Massage assessment is not a single technique, but a systemic process by which information is gathered, analyzed, examined and communicated.
Whenever a client arrives at the office, our objective is to open a clear line of communication, establish the intent and goals of the therapeutic relationship, and use our skills and experience to deliver the appropriate level of care. Assessment is the process through which we evaluate a client and make logical, reasoned choices on how to achieve these objectives.
A comprehensive assessment allows treatment to be targeted and specific, and is an ongoing process throughout the therapeutic relationship. As therapists, it is our responsibility to be actively involved in the assessment process by listening, examining, analyzing, communicating, writing and learning.
Read Parts 1 and 2 in this series, “Brick by Brick: 3 Ways Professional Communication Helps You Build Your Practice” and “Brick by Brick: This is How Knowledge of Pathology, Movement, Anatomy & Medication Improves Your Massage.”
When a client talks, we listen. We listen not to respond, but to understand. What story is the client trying to tell us? Do their words and body language align with the symptoms being described? Are there gaps in the history? If there is pain, have they described it thoroughly and accurately?
When it is our turn to ask questions, we are trying to fill those gaps in the story. We are adding details to the picture that the client is painting, gathering what may be relevant to inform our decisions.
In The Clinic
Something about my client’s story was not adding up. She had indicated her pain was a 3/10, but her body language told a different story. She was fidgety. Beads of sweat rolled down her forehead. After a few additional questions I discovered that her pain was really an 8/10, but she had been afraid to answer honestly after she had been turned away by two other therapists the previous day.
A massage therapist uses many senses to examine a client. We observe the client visually from the moment they enter the clinic. We hear their voice as they describe their symptoms. We touch and palpate them to evaluate the quality of their soft tissues. We observe their reactions to movement and pressure.
Whether we choose a gait analysis or a postural assessment will depend on what information we are seeking. A runner with hip pain may benefit more from the former. However, if that client’s hip pain only occurs at work and not while running, a movement assessment that relates to their daily tasks would be appropriate. Choosing the proper assessment is as critical as performing it properly.
Palpation and range-of-motion assessments are the most universally familiar to massage therapists. With these tools we evaluate the quality of the tissues, the fluidity of motion at the joints, and note asymmetries that we find. Special orthopedic tests, to rule in or out specific musculoskeletal conditions, are used to further refine the list of possible relevant therapeutic interventions.
After conducting a thorough history and exam, we now have a collection of data in front of us. But what does it all mean? How does this raw material become distilled into a comprehensive and tailored treatment plan? Both the short and long answers are the same: critical thinking.
Starting from a place of great care, and perhaps some humility, we must take that information and ask a few key questions: Is massage safe for this client? Would this client benefit from a physician’s examination and diagnosis? Am I the right person to help the client at this time? No therapist enjoys turning a client away, but neither does any therapist want to be the one who causes undue harm.
Once we decide that massage is an appropriate intervention, the next step is determining how we will proceed. The treatment planning stage is where we determine the answers to the what/how/why questions:
• What intervention(s) is/are therapeutically appropriate? How often do we need to treat?
• How long will the treatments last?
• How will effectiveness be measured?
• Why is this treatment approach appropriate?
The critical thinking and informed clinical decision making applied at this phase sets tone for the remainder of the therapeutic process.
In The Clinic
I was nearing the end of my exam on an elderly man with a complaint of neck pain and headaches over the last several months. His medical history was unremarkable and the complaints were not due to any recent trauma. He had a few additional complaints that he attributed to his age, namely fatigue, occasional dizziness, and tinnitus.
When I positioned his head and neck for one last set of assessments, he announced that he was dizzy to the point of nausea and that the headache was back. As I brought him to a neutral position I told him that I would not be treating him and that I would like to talk with his physician.
He called his doctor right on the spot and handed me the phone. After a brief conversation he agreed to see the patient immediately. Two days later the man’s wife called and thanked me for sending him to the doctor where they discovered an 80% blockage in one of his carotid arteries.
As massage therapists we do more than just provide manual therapy. We are also educators. A large part of being an educator is the ability to communicate effectively. Explaining your findings and treatment plan to a client is meant to be a conversation, not a mandate.
The most effective therapeutic relationships are built upon clear two-way communication. Listening to and discussing feedback from the client about the clinical findings, making any necessary adjustments to the treatment plan to reflect the client’s expectations and values, and gaining full informed consent of the client serve to deepen the level of trust in the therapeutic process.
“If it is not in the chart, it didn’t happen.” This adage is taught to just about every student in every healthcare profession. For massage therapists it means that we must be adept at not only verbal communication, but we must also be able to communicate clearly via the written word.
While the abbreviations used and the format of the documentation may change between clinics, the ability to write clearly and accurately improves the efficiency delivering top-quality care.
Short of having an eidetic memory, no therapist will remember all the details of every session with every client in their care. Having concise and accurate notes allows us to look back at a client’s course of treatment and quickly ascertain their progress and what the next step of the treatment plan is. Moreover, having clear documentation allows for efficient and meaningful communication with other healthcare professionals who may work with the client as well.
One of the first things I tell each and every one of my clients is that I will unashamedly use the phrase “I don’t know” when I do not have answers for their questions. An honest admittance of one’s own limits is a fundamental step on the path to learning. Our initial education in massage school covers many common conditions, and continuing education offerings expose us to an even wider menu of knowledge and skills.
In the clinic, however, clients will present with a myriad of complex conditions, tales of unfamiliar surgical procedures, and a list of medications sometimes pages long.
Our opportunities for expanding our knowledge and skills are vast. Taking classes on specific conditions or assessment skills, reading our trade journals, and engaging with scientific research are some of the ways we can enhance ourselves to better serve our clients and the profession as a whole.
By being active learners we better prepare ourselves to not only serve in our capacities as therapists, we also train ourselves to be more engaged critical thinkers. In this way we hone our ability to ask meaningful questions and attain significant answers.
In The Clinic
Every so often I encounter a condition in a client’s chart that is completely unfamiliar. And one day it came with the additional note, “non-typical.” A quick internet search did not help me with the symptoms my client was describing. I probed a bit deeper into the research on PubMed and still could not find what I needed.
I finally found answers by reaching out to the individual physicians involved with the research. Sometimes you get answers from the published papers, and sometimes you have to go to the source!
But What Is It All For?
Assessment, much like the scientific method, is a process of information gathering, analysis, communication and refinement. In essence, the assessment of a client never ends. Each session brings about opportunities for more inquiry, more critical thinking, more clinical decision making, and more opportunities to learn.
A good client assessment guides treatment decisions to be specific, targeted and appropriate. When those criteria are met, the client will experience superior results and be satisfied with the investment they have made in their health. That, to me, is the greatest value of assessment: happy, satisfied clients.
About the Author:
Christopher Jones is a National Certification Board for Therapeutic Massage & Bodywork Board Certified massage therapist in professional practice for 14 years. He holds a master’s degree in kinesiology and is an approved continuing education provider for the National Academy of Sports Medicine. Jones has served as a subject matter expert for the NCBTMB on a number of committees. Listen to a conversation on Assessment between Christopher Jones and Donna Sarvello, NCBTMB’s VP of Educational Support.