Where do I start when treating a new client?

There are many reasons why I love my job but at the heart it is obviously helping to relieve people of their pain and discomfort. 

While it may seem to some that massage is just a benign combination of strokes, pressure and maybe some stretching, for me there is a lot more to it and it begins with some detective work 🕵️‍♀️

Each new treatment begins with a focus on creating a clear treatment path to alleviate the presenting symptoms.

Initially I will ask a series of questions designed to give me a clear picture of the underlying pathology like;

·      Where specifically is the discomfort and the pain radiating? 

·      What type of pain do you have? 

·      Do you have pins and needles?

·      Is it an aching pain or a burning pain? 

·      Do you experience pain at rest, what movements bring on the pain, is there any movement that is restricted? 

·      Have you had a previous history of this pain?

·       Was there a previous accident or injury?

·      Have you had any other treatments?

These are just some of the questions I begin the assessment process with to help me narrow down how best to proceed.

Depending on the tact the questioning takes, I will start to determine if the presenting issue is derived from either functional patterns or structural causes. 

If its functionality then it can be caused by a one or a combination of factors including: lifestyle,

work set ups,

driving,

travel,

sport,

gym to name just a few. 

Also is it their sleeping posture - where people spend up to a third of their lives? It could be their mattress or their pillow.

With functional issues I will try to determine if the cause is muscle over-use or repetitive use, leading perhaps to tendonitis (inflammation of the tendon/bone insertions). 

Or is it from under-use leading to weakening or atrophying of the muscle or muscle group.  Alternatively, it might be from overloading, which leads to muscle tears or strains.

If it’s structural, then I will observe posture and determine if any misalignments are the source of the trouble. 

Structural problems can range from scoliosis (and S or C curve of the spine), kyphosis (excessive curve of the upper back causing rounded or hunched appearance causing rounded or hunched appearance), lordosis (excessive curve of the lower back leading to increased pelvic tilt and forward leaning head), Knock Kness, Flat Feet and Bow-Legs are other examples. 

These issues can lead to the body compensating with areas of tightness, weakness, restricted movement, pain, discomfort and inflammation.

Questioning is vital but equally important is to listen carefully. 

Some of my determinations of a treatment plan are a result of the language and emotion used in describing the presenting issues. 

If the pain or discomfort has become chronic, lasting for weeks, months or maybe years then the emotion of being in constant pain will be evident and this will definitely affect how I move forward in my treatment as the body  might be hypersensitive to touch, meaning I need to start by calming the nervous system down as best I can. 

Quite often the first treatment will be about having the client learn to trust me and to be able to relax during the session.

Once my patient is on the table I can begin assessing the tissues around the affected area. 

I usually begin by laying my hands on different areas to assess any heat which may indicate inflammation.  

I might also do movement tests to check the range of motion (this is often done before the client is on the table) and I will do mobilisations of the skeletal structure to identify any restrictions in those areas.   

I then begin to do a general massage of the area to assess the tissues. 

Are the muscles tight?

Are they weak?  

Are they inflamed?

Have they atrophied?

Is there existing scar tissue?

Are there trigger points or muscle adhesions?

All this information, beginning from when the client first walks in, will help me determine the nature of the presenting issue, whether it be cause of the pain or symptomatic of other underlying issues, and then I can determine a final treatment plan for that session.

From time to time, I will find during a follow up visit that my initial treatment requires modification, and I will make an adjustment to my treatment plan according to the feedback received.

I am also open to recommending a multidisciplinary approach if this suits the individual more.

I love my work and I really enjoy the relationships I develop with my clients. 

I am always looking to learn, and I find self-evaluation is key to helping me improve. 

I want to be the best therapist I can be, continue to push myself and never rest on my laurels.