Issue link: https://www.massageandbodyworkdigital.com/i/1501042
Interactions between medications and massage therapy treatments also warrant precautions. While massage therapy is generally safe, certain medications may affect how the body responds to massage. For example, blood-thinning medications can increase the client's risk of bruising or internal bleeding. Nonsteroidal anti-inf lammatory drugs (NSAIDs) or prescription pain medications can sometimes mask pain during a massage, making it difficult to gauge the appropriate pressure. Conditions like diabetes can change how someone perceives sensations in their feet or hands. Also, a client may seek massage for side effects from a medication, used for symptoms such as headaches or discomfort, that massage treatment cannot address. Uncovering contraindications to massage treatment is another important reason for an effective history. Clients are unlikely to know what these contraindications would be; it is the practitioner's responsibility to be informed. As a practitioner, you might recognize a potential contraindication only if you explore the nature of the client's current situation in greater detail. For example, suppose a client came in complaining of pain in their leg. You might think massage is warranted if you only perform a cursory history and minimal physical evaluation. However, a more detailed history might uncover symptoms such as leg swelling, sensations of heat, cramping in the calves, and generalized aching in the leg. These significant symptoms are all common indicators of deep vein thrombosis. WHAT MAKES A GOOD HISTORY? For clients with potential injuries or pain complaints, the history should be more than just asking questions about their current symptoms, recent surgeries, or medications. The first place to start is with the chief complaint. Exploring the main complaint is the primary way to delve into relevant factors. For many people, there may be more than one issue, but usually, it's a primary complaint that has brought them to the clinic. Knowing what questions to ask can be intimidating if you are unaccustomed to pursuing detailed histories. However, practice makes you more comfortable and savvier at choosing questions. Four main categories of investigation to pursue are: how, what, when, and why. • How: At a minimum, a history will include information about how the complaint occurred. Did the pain have an acute or chronic onset? Was there a specific incident that caused the complaint, or was the pain slow to develop, getting worse over time? • What: What behaviors could have led to the injury event or chronic complaint? Are there other factors that may have been or are present to create or aggravate the condition? What other symptoms might the client be experiencing? Now or in the past? • When: When did the complaint start? How long has the client been experiencing the issue? Similarly, has this complaint happened before? • Why: Learning why the client is suffering and what tissues may be involved are revealed as you investigate other aspects of the assessment. For example, why is there pain with a particular movement? What tissues seem to be involved? With any of your questions, listen carefully to what the client says. Good listening skills are paramount. Pursue greater details when you think they are relevant. Knowing what information to delve into is partly experience, but having a working knowledge of the most common musculoskeletal issues can help develop your investigation strategy. When you know more about various problems, you can recognize patterns and pursue that line of inquiry. 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 23 TECHNIQUES FOR AN EFFECTIVE HISTORY There are several important factors in good interviewing skills. The following are the most common. Active Listening It may be tempting to continue taking notes while the client is talking, but it's more effective if you are actively listening. Active listening is a communication technique that is a valuable skill set for a massage therapist. It involves paying attention to the client, reflecting on what they say, asking for clarification, avoiding assumptions, empathizing, exploring further details, and offering an appropriate response. Active listening is a handy skill in all relationships—work or personal. Your body language and eye contact are giveaways as to whether a client is being heard. However, eye contact can be substantially different based on culture and community. Whether to maintain eye contact, the level of direct eye contact, and speaking while looking at your partner can be different for different people. If you have a diverse clientele, learn the common communicative practices for your clients. Then, pay attention to your clients' cues when speaking to them. Do not judge those who have different ways of communicating. And be aware enough to adapt your communication style to fit the client. Open-Ended Questions Sometimes a simple yes or no answer question is appropriate. However, in most cases, open-ended questions are more valuable. Open-ended questions encourage your client to provide detailed information. These questions begin with words such as "what," "how," "why," "tell me about," or "describe." You can then explore aspects of the answers more thoroughly to better understand what is happening for your client.