Let's Talk Minutes
With most sessions lasting from 45 minutes to 90 minutes, massage and bodywork practitioners are allotted sufficient hands-on time to develop a strong awareness of the clients ability to function in physical, emotional and spiritual planes. It is unfortunate for both client and therapist when time constraints (common in many manual medicine practices) become a primary determinant in the success or failure of the therapeutic intervention. Fear of "running late" and anxiety intensified by rushing from one client to another often disrupt the rhythm, preventing the development of physical and mental rapport. Clock-watching is the enemy of attunement, focus, and intent as the therapist unconsciously drifts from being totally "present" with the client to suddenly worrying about getting enough "techniques" completed in the allotted time frame.
"Minutes" allows the therapist time to observe, assimilate, and record such things as postural abnormalities, present state of mind, painful past experiences (both physical and mental), positive or negative attitudes about their condition, and preconceived ideas about their recovery.
In a relaxed pain management practice, therapists can practice sharpening such skills as visual screening evaluations, anatomical landmark comparisons, injury assessments, and history intakes. This physical examination process can be completed with clients clothed, in bathing suits, sportswear, etc. Make it a custom to observe clients as they enter your therapy room. Look for clues by noting how they sit, remove a jacket, lean forward to untie a shoe, or get up from a stool. Clients often reveal more information when performing typical unconscious movement patterns than when asked to actually execute such tasks as walking, forward bending, range-of-motion maneuvers, etc. More truthful patterns often surface if the clients are unaware that they are being observed.
Since our ultimate therapeutic goal is to establish pain-free movement during the walking cycle, gait evaluations rank high in every assessment protocol. By making mental notes during gait observations and comparing them with anatomical landmark findings, valuable information can be recorded and stored for future reference. Always check for obvious dysfunctions such as short legs, pelvic tilts, low shoulders, cocked heads, scoliotic patterns, etc. With practice, visual and physical assessments can be performed quickly and efficiently, even with the client fully dressed. The following is a laundry list of some things to look for during a usual client evaluation:
When therapists take time to focus, relax, and carefully listen to the history of a client during a standard intake session, a clear picture often emerges. Alas, the picture frequently changes from visit to visit as the client recounts past events. So, what is the best way to arrive at a true pain portrait of this individual?
- Holding patterns during gait
- Asymmetrical anatomic landmarks
- Presence of upper and lower crossed syndromes
- Abnormal front-to-back (A/P) and side-to-side (scoliotic) curvatures
- Aberrant muscle-firing order patterns
- Arthritic hands
- Pronated/supinated feet
- Excessive wear patterns on the client's shoes
- Emotional states (extreme anxiety, "bug-eyed," withdrawn, angry, etc.)
Medical history-taking often is unreliable, according to psychiatrist Arthur Barsky, MD.1"Patients frequently fail to recall (and therefore under-report) the incidence of previous symptoms and events, tend to combine separate, similar occurrences into a single generic memory, and falsely recall medical events and symptoms that did in fact occur," Barsky explains.
In both acute and chronic neck/back pain clients, history often relates to individual personality characteristics, state of health and mind at the time of recall, and preformed beliefs about symptoms and prognosis. Nearly all manual therapists would also agree that clients are far less likely to recount distant events accurately. Therefore, it behooves today's manual therapist to consider the following factors when interpreting a client's history...
Erik Dalton, Ph.D., Certified Advanced Rolfer, started the Freedom From Pain Institute and created Myoskeletal Alignment Techniques to share his passion for massage, Rolfing, and manipulative osteopathy. Go to the Erik Dalton website for information on workshops, conferences, and CE home study courses.
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