Massage & Bodywork

September/October 2011

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CLIENT ASSESSMENTS Basic orthopedic testing will be as beneficial in assessing a client with fibromyalgia as it is with any other client. It is important to note, however, that the results of these tests should not necessarily be integrated into the initial treatment plan while the client is in flare-up. The pain experienced during a flare-up often occurs in a specific, predictable area that the client will be aware of and will have little difficulty in pinpointing for the MT. These areas of pain and inflammation are often unrelated to areas of chronic hypertension, shortening, or other muscular concerns discovered during orthopedic testing. Postural evaluation can be particularly important to perform and track as the client moves from the initial visit to ongoing treatment for chronic pain and maintenance. Many clients will have noticeable postural changes before, during, and after flare-ups that, over time, can help predict and possibly avoid or minimize future recurrences. APPROACHING TREATMENT When fibromyalgia is discussed in texts and the classroom, the point of sensitivity to pain and pressure is stressed repeatedly. For many MTs, this creates anxiety in performing anything but a light treatment, which many of these clients find frustrating. Like any other clients, fibromyalgia sufferers vary in their sensitivity, pain threshold, and treatment preferences. Although it is true many sufferers are hypersensitive to pain and pressure during treatment, there are just as many clients who will find greater benefit from a moderate pressure, and some who will even request and benefit from deeper treatment. For the inexperienced MT, determining just how much pressure to use and how to weigh client preferences against professional judgment and Like any other clients, fibromyalgia sufferers vary in their sensitivity, pain threshold, and treatment preferences. training can be tricky. Working with a fibromyalgia client for the first time can make this decision even more difficult, since there is a lack of reference available on which to base decisions. There is often a greater temptation to make decisions based on the experiences and requests of clients, since they have more knowledge of their condition. Many clients who come in for an initial visit will use their previous MTs as a reference point for ongoing treatments. This can be both positive and negative. A client who has had a number of treatments with one or more MTs in the past will most likely be very aware of what she needs, and what does or doesn't work for her. She will likely be aware of her pain tolerance during a treatment and can direct you accordingly. Unfortunately, this can also create problems during treatments. Clients who have been with one—or very few—MTs in the past may not be aware that pressure, to a certain degree, is subjective. For example, her previous MT may have been a "lightweight," whose deep pressure is only considered moderate by her new MT's standards. She may come in requesting a deep treatment, insisting that it is the type of treatment she is accustomed to, only to discover that the pressure is too much for her to bear. It is an experience that can cause frustration and irritation for both the client and the MT, and one that can create an unpleasant environment during the client's next visit. Avoid this experience by implementing specific treatment guidelines for all fibromyalgia clients and using it consistently. When treating a client with fibromyalgia, be upfront and explain to her that the initial visit will be a learning experience for both of you, and that you will be working cautiously, using light to moderate pressure, and that no deep techniques—such as trigger-point release—will be used at any point. Clients will be much more understanding about necessary adjustments to their treatment plan when their MT is upfront about the fact that they will be learning together. Make it clear to the client that each therapist and each client is different, and new treatment plans cannot be based on experiences with past MTs. Clients who are accustomed to deeper treatments or specific techniques may not be happy, but most will understand your reasoning once it is explained to them that this will help ensure that the appropriate amount of pressure and specific techniques will be effectively adjusted and applied in future sessions based on the client's reaction to their initial treatment. tune in to your practice at ABMPtv 45

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