Issue link: https://www.massageandbodyworkdigital.com/i/1358392
66 m a s s a g e & b o d y wo r k m ay/ j u n e 2 0 2 1 he did have a broken ankle. He thanked me for pressing him to do the right thing. HAVE YOU HAD ANY SURGERIES I SHOULD KNOW ABOUT? Clients may have metal plates, screws, or other surgical hardware in their neck, back, lower arm, wrist, lower leg, ankle, etc. that you will need to use care and caution with when addressing. For instance, I currently have a client who broke her radius at the wrist and has screws in her lower arm. I've also treated a man who has anterior shoulder pain, but also has a pacemaker with wires that need to be avoided near the surface of his upper chest and shoulder. Knowing this, I've adjusted my work with both accordingly. DO YOU HAVE ANY OTHER MEDICAL CONDITIONS I SHOULD BE AWARE OF? It is always important to know what other issues, conditions, or injuries a client may be experiencing aside from the specific reason for their visit. While a concurrent medical condition may not be the focus of your treatment, it can't be ignored. Be sure to factor in any necessary adjustments, modifications, or needed positioning. If you need to know more about the condition to feel confident in addressing your own work, ask more questions and seek out additional resources or even referrals. For instance, one of my recent clients who came to me for back pain also had a history of blood clots and phlebitis, which put him at risk for conditions like deep vein thrombosis (DVT) or, at worst, a pulmonary embolism. So, I focused my work on his low back and used only light pressure when working his legs. A colleague of mine was treating a woman who was undergoing chemotherapy for cancer. You'll need to rethink and modify your use of pressure when working with clients who have or have had cancer. Familiarizing yourself with Tracy Walton's Massage Therapy Pressure Scale is a good starting point. 1 the body. If there has been an injury, compare the client's left and right sides to evaluate the difference in flexibility. HAVE YOU EVER DISLOCATED YOUR SHOULDER? If this has happened in the client's past, one or more of the rotator cuff tendons have likely become weakened and distended. Follow up to find out if there are any positions the client avoids out of fear of another dislocation. For example, a client may say: "I avoid putting my arm behind my back and reaching up because I'm afraid it might dislocate again." Now you know one thing not to do. IS THERE ANY PART OF YOUR BODY YOU DON'T WANT TO RECEIVE WORK ON? There are many reasons a client may not want you to work on particular parts of their bodies. It may be as simple as wanting more focus on specific areas, or they may be self-conscious about their body, or even associate emotional trauma with specific areas. A client may also know that an area of their body is sensitive or painful to the touch, which could indicate there is some injured tissue in that region that has never been effectively addressed, or it could simply be an area where they hold tension. Ask a couple more questions to find out if it is an injury. Regardless of the reason, always avoid any area a client tells you they do not want touched or treated. IF THE CLIENT HAS A SPRAINED ANKLE, ALWAYS ASK, "HAVE YOU HAD AN X²RAY OR MRI?" You don't want to work on a broken ankle. I once had a client almost beg me to work on his sprained ankle, as he was sure it wasn't broken and wanted to still do a particular physical activity the following week. I insisted he get an X-ray from his doctor or an emergency room before I would consider treating the ankle. Unfortunately for him, imaging confirmed ARE YOU UNDERGOING ANY MEDICAL TREATMENTS, OR DO YOU TAKE ANY MEDICATIONS REGULARLY THAT MIGHT MAKE YOUR BODY TISSUES MORE UNSTABLE, WEAK, OR EASILY BRUISED? If the client says yes, ask follow-up questions about the medical treatments and also the affected area(s) to inform your pressure and technique. It's important to be aware of the common side effects associated with medications, including, but not limited to, aspirin, Coumadin, ibuprofen, or Plavix (also called clopidogrel). DO YOU TAKE ANY MEDICATIONS THAT INTERFERE WITH SENSATION OR PAIN PERCEPTION? When clients are taking medications like Celebrex, Oxycontin, Dilantin, Disulfiram, or Cisplatin regularly, any injury assessment may not be completely accurate, as sensation and pain are diminished; an injury you think is mild might be quite severe. For the same reason, client perception and sensitivity of pressure are also diminished. If you are seeing this person once, work very gently. If they are to become a regular client, ask them to schedule an appointment with you before they take their medication so you can retest and re-palpate the injured structure without the medication at full strength in their system. STAY UPDATED It's important to take a detailed and thorough health history when working with a new client, yet it is also necessary to periodically update those intakes for long-standing clients. This ensures you are staying current with each client's health history and not missing important information like new signs or symptoms related to their condition or other significant health changes. In some cases, continued manual therapy and treatment could actually be detrimental to your client and require attention from their