To complement the MASSAGE Magazine article, “Expert Advice,” by Jennifer Soames, in the September 2013 issue. Article summary: Recurring pain might not be due to stress or repetitive activities; instead, muscle pain and tension might be recurring due to the client’s postural patterns.

Take Time to Assess Clients, MASSAGE Magazine

Failing to develop effective treatment plans can lead to prolonged pain for your clients, decreased client satisfaction and reduced referrals.

Avoiding the following common behaviors will help your massage therapy practice prosper:

1. Applying a routine treatment. A specific massage routine may be effective for a certain percentage of people with an ailment, but it is not an individualized approach to your client’s concern. As such, your treatment success rates will not be as high as they could be.

If we take low-back pain, as an example, how could one standard massage routine adequately address individuals with hyperlordosis vs. a flat back vs. a lateral pelvic tilt vs. a pelvic rotation vs. decreased sacroiliac joint mobility? It can’t.

Instead of relying on one standard routine, take the time to assess your clients and develop individualized treatment plans.

2. Assuming all sore muscles are locked short. Think of how many hyperkyphotic people come in to see you with pain in their rhomboids. Overstretched rhomboids get sore all the time, and the same thing can happen to any muscle of the body.

Assess any painful structure to determine if it is locked short or locked long. Do not assume all sore structures need lengthening and stretching. You may inadvertently exasperate your client’s issue by stretching an already overstretched muscle.

3. Relying on palpation as your only assessment tool. We all know our clients want as much time on the massage table as possible. It is so tempting to think, “I can just assess them while I am palpating them during the massage.”

The danger of this approach is you are not going to have an understanding of how to adequately address the issue once you palpate it. Palpation can tell us where an issue is, but it does not tell us what is going on or what is needed to fix it.

It is difficult, for example, to palpate the difference between a muscle that is locked long vs. a muscle that is locked short. They will both feel tight, and they will both have trigger points. How do you know if you should be lengthening this structure or not if you did not assess it?

4. Not understanding how to formulate treatment goals. Formulating relevant treatment goals is dependent on a thorough orthopedic assessment. Ideally, your assessment will reveal the following information:

  • Restrictions in range of motion
  • Hypomobile joints
  • Structures that are locked long
  • Structures that are locked short
  • Postural deviations

Once you have collected this data, you can use it to formulate specific treatment goals. Take this information as an example of a client with neck pain:

Assessment results: Decreased lateral flexion to the right.

Treatment goals: Increase lateral flexion, and decrease hypertonicity located in the left lateral neck.

Assessment results: Hypomobility in C3, C4, C5.

Treatment goals: Increase joint play in hypomobile joints.

Assessment results: Hyperkyphosis noted.

Treatment goals: Lengthen pectorals, upper fibers of the trapezius, levators, sternocleidomastoid muscles and suboccipitals. Shorten rhomboids and mid trapezius muscles.

Once you have a clear idea of the goals you want to accomplish with a client, every stroke you apply will have a focused intention. This type of focused intent yields more powerful results.

5. Not understanding when to apply which techniques. We all have our favorite go-to techniques; however, not all techniques are appropriate for all situations.

What techniques in your toolbox would you use to accomplish these goals? What techniques should you avoid when trying to accomplish each of these goals?

  • Increase range of motion
  • Lengthen a muscle that is locked short
  • Treat a painful muscle that is locked long
  • Decrease swelling
  • Increase the function of scar tissue
  • Decrease hypomobility of a joint

If we return to our aforementioned example of neck pain, we may chose to use the following techniques to accomplish our stated goals:

Assessment results: Decreased lateral flexion to the right.

Treatment goals: Increase lateral flexion and decrease hypertonicity of left lateral neck.

Techniques: Trigger-point therapy, neuromuscular techniques, myofascial release, applied to any hypertonic structures of the left lateral neck.

Assessment results: Decreased rotation to the right.

Treatment goals: Increase rotation and decrease hypertonicity in the sternocleidomastoid muscle and levator scapula.

Techniques: Same lengthening techniques as above, applied to the sternocleidomastoid muscle and levator scapula.

Assessment results: Hypomobility in C3, C4, C5.

Treatment goals: Increase joint play of C3 to C5.

Techniques: Joint mobilizations, muscle energy technique (MET), positional release (applied to C3 to C5).

Assessment results: Hyperkyphosis noted.

Treatment goals: Lengthen pectorals, upper fibers of the trapezius muscle, levators, suboccipitals, sternocleidomastoid muscle. Shorten rhomboids and mid trapezius.

Techniques: For structures that need lengthening, apply the same lengthening techniques as above. For the rhomboids and mid trapezius muscles, work from insertion to origin, apply positional release therapy and assign strengthening home care.

There is no one technique out there that is appropriate for all your goals. Knowing when to draw on particular techniques will make you a more effective therapist.

This approach will allow you to yield better therapeutic results, improve your client satisfaction and increase client referrals. What massage therapist doesn’t want that?

Rebecca Henry is a registered massage therapist practicing in Stoney Creek, Ontario. Canada (www.bodhimassage.ca). She is passionate about restoring balance and function through the application of massage therapy.

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