ADVANCED MASSAGE DEPENDS ON ASSESSMENT NOT METHODS

CLINICAL REASONING

 

Assessment is a learned skill that collects and interprets information provided by the client, the client's consent advocates (parent or guardian), and the referring medical professionals, in addition to information gathered by the massage practitioner.* In reality, the assessment and the application of massage t are almost the same thing. Often massage manipulations and techniques are used during a massage first to evaluate the tissue; then, altered slightly in intensity, to support tissue-appropriate change; and finally to reassess for tissue changes.

Keep in mind that:

·         Assessment does not change a condition; rather, it is an attempt to understand it.

·         Interventions (e.g., massage applications) address the abnormal findings revealed by the assessment

Components of the Assessment

For the massage practitioner, the information gathered during a pre-massage assessment has four purposes:

•           To determine whether the client should be referred to a medical professional

•           To discover any cautions that would modify the massage application

•           To obtain input from the client that is used to help develop the massage care/treatment plan

•           To design the best massage for the client; specifically, the types of methods used and the mechanical forces generated by those methods, in addition to the proper application of depth of pressure, drag, direction, speed, rhythm, frequency, and duration of each method, to achieve the desired physiologic outcome.

Compensation Patterns

Compensation patterns are the result of the body's adjustment to some sort of dysfunction. Assessment identifies what is functioning normally, what is abnormal, and whether the abnormal condition is problematic (maladaptive), requiring attention, or is a resourceful and successful adaptive compensation. Patterns of resourceful compensation develop when the body has been required to adapt to some sort of trauma or repetitive use pattern. Permanent resourceful adaptive changes, although not as efficient as optimum functioning, are the best pattern the body can develop in response to an irreversible change in the system. Resourceful compensation must be supported, not eliminated, because determining whether the changes in the body are helpful or harmful can be difficult.

HISTORY-

The history interview provides subjective information pertaining to the client’s health history, the reasons for massage, a history of the current condition, a history of past illness and health, and a history of any family illnesses that may be pertinent. It also contains an account of the client’s current health practices.  Information you need from the history includes but not limited to:

Surgery or medical procedures

Medications and supplements

Therapeutic exercise activities

Sleep patterns

Breathing patterns

Mood

Previous massage experience

Use of alternative therapies (essential oils, magnets)

What was the nature of the condition to be addressed? Some questions to ask include:

How much does it hurt?

Where does it hurt?

What is the nature of the pain——hot, pokey, sharp?

Does it hurt to the touch?

Does it hurt when you move?

What are the details of onset?

Did the condition arise suddenly or gradually?

Was there a specific injury?

Where is the location of the area? Show me.

What were the prior treatments——medication, surgery?

What was the outcome?

What diagnostic studies have been performed——radiography, magnetic resonance imaging?

What were the results?

What is the nature of the progress?

 Abbreviated Physical Assessment Protocol

Begin by viewing the client from three standing positions: front, back, and side. Note any areas of asymmetry. Then proceed according to the following outline.

Back

Instruct the client to reach (they do not have to touch the toes) for the toes, keeping the knees straight.

Observe for:

•     Scoliosis

•     Kyphosis

•     Asymmetry

Instruct the client to side-bend by sliding the hand down the side of the leg; compare the two sides.

Instruct the client to twist the torso left and right; compare the two sides.

Cervical Spine Range of Motion

Instruct the client to do the following:

•     Look at ceiling (extension)

•     Look at floor (flexion)

•     Look over each shoulder (rotation)

•     Bend the ear to each shoulder (abduction/lateral flexion)

Shoulder Range of Motion

Instruct the client to do the following:

•     Scratch the back with each hand from over the shoulder (external rotation and abduction)

•     Scratch the back with each hand from under the shoulder (internal rotation and adduction)

Muscle Tests—Instruct the client to do the following:

•     Shrug the shoulders

•     Flex the shoulders to 90 degrees

•     Abduct the shoulders to 90 degrees

•     Rotate each shoulder internally and externally

Upper Extremity Range of Motion

Instruct the client to do the following:

•     Flex and extend the elbows

•     Pronate and supinate the wrists with the arms at the sides and the elbows flexed to 90 degrees

•     Spread the fingers

•     Make a fist

Muscle Tests—Instruct the client to do the following:

•     Flex and extend the elbows

•     Pronate and supinate the wrists with the arms at the sides and the elbows flexed to 90 degrees

•     Spread the fingers

•     Make a fist

Lower Extremity—Hip Motion

Instruct the client to bend forward at the hip joints to touch the toes.

•     Observe for hamstring shortening at the hip and the knee.

Instruct the client to do the following:

•     Contract and relax the quadriceps; observe for symmetry

•     Contract and relax the quadriceps; observe for patellar tracking

Next:

•     Observe for knee effusion

•     Observe for ankle effusion

Instruct the client to do the following:

•     Rise up on toes; observe for calf strength

•     Rise up on heels; observe for leg strength

Instruct the client to perform the one leg standing balance test:

•     Have the client stand first on one foot and then on the other; compare the two sides and observe for balance and coordination

Instruct the client to perform the squat test:

•     Have the client raise the arms over the head and then squat by pretending to sit down in a chair; observe for symmetry and reduced or excessive movement, core strength, hip, knee ankle flexion, hip adduction, shoulder abduction, and latissimus shortening

When performing the following assessments, remember that pain is the indication of a pathologic condition—do not cause an increase in pain; only locate the source of the pain.

Palpation

1       Perform palpation on the uninvolved side first. The uninvolved area is “normal.”

2       Palpate all bony landmarks.

3       Palpate all ligament and tendon attachments.

4       Palpate all muscles that act on the area.

5       Palpate for edema and effusion.

Range of Motion

1       Perform active joint movement assessments to evaluate for changes in range of motion.

2       Perform a passive joint movement assessment and compare the range of motion to that seen with active movement assessment.

Manual Muscle Testing

1       Perform strength testing on the normal side.

2       Perform strength testing on the affected area. Do not cause additional pain or strain the injured area.

Intervention Guidelines

If the practitioner notes no pain, stiffness, mobility issues, or other concerns during the assessment, the joint can be considered normal. General massage for the jointed area is indicated to support normal function.

If the practitioner notes pain with movement or on palpation, discoloration, indications of inflammation, unusual stiffness, exaggerated hypermobility or hypomobility, weakness caution is indicated. If no logical cause exists for the finding (e.g., recent unusual activity or a fall) or if the client does not have pertinent information or is being treated by a physician, referral may be necessary to determine the cause. Once the cause has been identified, massage treatment plans can be developed.

 

FINIAL IMPORTANT NOTE:

EFFECTIVE HISTORY ASSESSMENT REQUIRES COMMUNICATION SKILLS

EFFECTIVE PHYICAL ASSESSMENT REQUIRES THAT YOU KNOW YOUR ANATOMY AND PHYSIOLOGY INSIDE OUT.

BIGGESTPROBLEMS I SEE IN ASSESSMENT PROCEEDURES IS ---GUESS WHAT?

COMMUNICATION SKILLS, ANATOMY AND PHYIOLOGY KNOWEDGE AND CLINICAL REASONING ABILITY.

 

Fritz. Mosby's Fundamentals of Therapeutic Massage, 5th Edition. Mosby,

*Although the massage professional observes, interprets, and makes decisions based on information gathered during assessment procedures, it is important to remember that the massage professional is not equipped to diagnose any specific medical condition or to treat one except under the direct supervision of a licensed medical professional.