Issue link: https://www.massageandbodyworkdigital.com/i/1488451
L i s te n to T h e A B M P Po d c a s t a t a b m p.co m /p o d c a s t s o r w h e reve r yo u a cce s s yo u r favo r i te p o d c a s t s 27 ASSESSMENT PROPS OFFER IMPORTANT CLUES Since the pain game rules prevented us from performing a history intake or questioning the models about their primary pain complaints, we quickly realized we needed props to gather basic information. Fortunately, Aubrey's classroom already had a mounted postural grid chart, and I remembered I had packed two matching digital scales for use in the workshop to demonstrate weight-differential effects on postural compensations. In Image 1, Aubrey and I are observing for posturofunctional deviations and weight- distribution differences using the two scales and comparing the findings with what we were seeing on the postural grid chart. Researchers say most people exhibit a right motor-dominant pattern and bear more weight on that side, which causes the right leg to be 4.6 percent larger in volume, and we found this to be generally true. 1 The props helped pinpoint the model's gross defects and offered important clues to possible areas of excessive weight-bearing that might trigger soft-tissue and joint strain. Yet, with two therapy detectives attempting to perform orthopedic, postural, and pain provocation assessments, we soon recognized the need for a more simplified screening method. ART TO THE RESCUE We decided to streamline using a method discussed in my last Massage & Bodywork column, "Put ART to Work in Your Practice" (November/December 2022, page 27). ART is an osteopathic acronym that stands for asymmetry, restriction of motion, and tissue texture abnormalities. Focusing on ART allowed us to more quickly identify how one side of the model's body was moving in relation to the other and to then test if the movement restrictions were related to the tenderness they may be feeling during palpation. When assessing for tenderness, Aubrey and I typically began by performing digital pain provocation tests of suspected muscles, tendons, ligaments, joint capsules, bursa, and joints. These tests offered clues as to whether the palpated tissue might be under load, but without verbal feedback, we weren't always able to determine if the tender area was one of their three primary complaints or just compensations due to tension, trauma, or weak posture. That's when ART really came in handy. By observing, palpating, and motion testing the whole person rather than chasing the pain, we were able to better trace the effects back to the originating cause—and gain context as to how and why the tissues were under load in the first place. L i s te n to T h e A B M P Po d c a s t a t a b m p.co m /p o d c a s t s o r w h e reve r yo u a cce s s yo u r favo r i te p o d c a s t s 27 1 2 Aubrey Gowing and I observe for weight-distribution differences using the two scales and compare our findings to a grid chart. A sample list of pain and injury issues one of our participants submitted. SUMMARY Although Aubrey and I weren't always able to identify a key lesion that may have been at the root of their problems, we were surprised and delighted that we correctly identified 12 areas that matched the list of pain complaints the four subjects had recorded. Image 2 is a sample list of pain complaints one of our participants submitted. This pain detective game turned out to be fun for all, and it really helped sharpen our palpation assessments and clinical- reasoning skills. I suggest trying it either in your private bodywork practice or with a fellow therapist. I believe it will greatly empower you to move through the body with more confidence and with greater therapeutic outcomes. Note 1. J. P. Chapman, L. J. Chapman, and J. J. Allen, "The Measurement of Foot Preference," Neuropsychologia 25, no. 3 (1987): 579–84, http:// doi.org/10.1016/0028-3932(87)90082-0. Erik Dalton, PhD, is the executive director of the Freedom from Pain Institute. Educated in massage, osteopathy, and Rolfing, he has maintained a practice in Oklahoma City, Oklahoma, for over three decades. For more information, visit erikdalton.com.