Subjective assessment protocol for massage therapy

Contributors

David McQuillan (2008). Otago Polytechnic: Massage Therapy

Following is a subjective assessment protocol based on one described by Hertling & Kessler (1996). It is by no means comprehensive. You may find over time that you add other questions, or change the ones that are here, but it’s a good starting point at least.

Tell me about your problem / Why have you come for a massage?

Beginning with an open question like this provides your client with the opportunity to tell you all of the details that they consider to be important regarding their reasons for coming to you. Often there may be several important elements involved in their condition, so it's important to allow them the time to discuss these issues (Lowe, 2006).

While you should be careful to allow them enough time to inform you, you should feel free to interrupt when you feel you have a picture of what is happening. This can be done by saying something like…

I think I’m getting an idea of the nature of your problem. Now I would like to ask you some more specific questions regarding it

Show me with one finger where your pain is

Then draw the area of pain on a body map. Ask your client to confirm that this is where they feel the pain. Make any modifications that are needed.

If the client and/or therapist can reproduce the pain by pressing on the area in which they feel it, the pain is likely to be caused by the structure being palpated. If not then the pain is likely to be referred. (Lowe, 2006)

How does it feel?

Sharp, localized, hot pain suggests an acute inflammatory process (e.g. muscular strain).

Sharp, burning, radiating pain suggests a neurological disorder (Lowe, 2006), however it's important to realise that any altered sensations (paresthesia) can be caused by neurological disorders including numbness, tingling, hypersensitivity, burning, shooting pains, or virtually any alteration in normal sensation.

Dull, aching, regional, poorly localized pain suggests referred pain. (e.g. trigger point, viscero-somatic, nerve pain)

Regional pain with an intense central spot suggests a trigger point which refers locally.

Was there a sudden or gradual onset? Were any unusual activities involved?

A sudden onset suggests acute trauma (e.g. muscle strain, or trigger point activation). The client is likely to be aware of what they were doing when the trauma occurred, and this activity will generally provide a useful indication as to the current condition.

A gradual onset suggests a gradual process injury, or other non musculo-skeletal causes. If the cause is musculoskeletal, the client must be experiencing some repetitive cause of muscular strain (e.g. poor posture, static work posture, sports, factory process work).

What causes it to feel better/worse?

Pain of musculoskeletal origin is usually aggravated by activity and relieved by rest. If this is not the case, the pain may have another origin. The particular activity that aggravates the condition is often a useful indicator of muscular involvement.

Pain which wakes the client in the night is commonly related to the client irritating a trigger point or other lesion by lying on it.

Is it better or worse in the morning or afternoon?

Morning stiffness may indicate trigger point dysfunction or an inflammatory joint condition.

Is pain constant or intermittent?

Is there any loss of function, or any other related symptoms?

What do they think caused the pain?

Often the client has a useful perspective on their condition.

Has the problem occurred previously, or is it the first time that it has affected them? If it has occurred previously, did you get treatment for it? What was the result of the treatment?

Recurring problems are often the result of trigger points moving between latent and active states. They are often related to stress.

Previous treatments can provide useful information on what kind of approach may (or may not) be effective in working with the condition

If the client consents, access to the client records of other healthcare professions with which they have had treatment can be very helpful especially when you are dealing with a difficult case.

Are they currently having any treatment or taking any medication for the current problem?

References

Hertling, D., Kessler, R. (1996). Management of common musculo-skeletal disorders – physical therapy principles and methods. Pennsylvania, USA: Lippincott-Raven publishers.

Lowe, W. (2006). Orthopedic assessment in massage therapy. Oregon, USA: Daviau Scott Publishers.