1. Spa Vargas University MT101 Introduction to Massage Therapy

2. Spa Vargas University MT101 Introduction to Massage Therapy Chapter 6: Assessment Introduction General Assessments Postural Assessment Gait Assessment Range-of-Motion Assessment Appearance of Tissues Palpation Assessment Functional Assessments Post Treatment Assessment Copyright © 2010 Spa Vargas University

3. Spa Vargas University MT101 Introduction to Massage Therapy Chapter 6: Assessment General Assessments Does not need to be extensive or time-consuming for nonspecific relaxation massage for wellness Gives better idea about contraindications, which soft tissues to address, and how to address them Fascia and Fascial adhesions Understanding key to massage Can cause the location of client’s pain to differ from where the pain originates fascial adhesions adhere to near by tissue been crumpled or kinked Caused by dehydration accumulated scar tissue Repetitive motion Copyright © 2010 Spa Vargas University

4. Spa Vargas University MT101 Introduction to Massage Therapy Chapter 6: Assessment Copyright © 2010 Spa Vargas University

5. Spa Vargas University MT101 Introduction to Massage Therapy Chapter 6: Assessment General Assessments Compensation patterns Offset to injury or other imbalance Registered in muscles and nerves Implications for massage Helps determine treatment focus Facial lines of tension that radiate from facial restriction Assessment documentation Initial observations can be recorded in “O” section of SOAP Copyright © 2010 Spa Vargas University

6. Spa Vargas University MT101 Introduction to Massage Therapy Chapter 6: Assessment Postural Assessment Posture can affect a person’s health Evaluate client’s stance Ideal posture Minimizes stress and strain Maximizes efficiency Anterior aspect Nose and chin Sternum Spine and navel Shoulders and ears Pelvis, hands, feet, knees Copyright © 2010 Spa Vargas University

7. Spa Vargas University MT101 Introduction to Massage Therapy Chapter 6: Assessment Postural Assessment Ideal posture Posterior aspect Cranium and shoulders Pelvis and spine Hands and scapula Lateral aspect Cranium and shoulders Hands Pelvis Knee Copyright © 2010 Spa Vargas University

8. Spa Vargas University MT101 Introduction to Massage Therapy Chapter 6: Assessment Copyright © 2010 Spa Vargas University

9. Spa Vargas University MT101 Introduction to Massage Therapy Chapter 6: Assessment Postural Deviations Can add to or cause soft-tissue dysfunction Stress Exhaustion Incorrect posture can be learned and reinforced Abnormal spinal curvature Swayback posture Flat-back posture Scoliosis (lateral curvature of spine) Excessive kyphosis, lordosis Rotation (appearance of turned shoulders) Copyright © 2010 Spa Vargas University

10. Spa Vargas University MT101 Introduction to Massage Therapy Chapter 6: Assessment Copyright © 2010 Spa Vargas University

11. Spa Vargas University MT101 Introduction to Massage Therapy Chapter 6: Assessment Feet Foundation of balance Imbalance can lead to multiple compensation patterns Postural assessment performed without shoes Check height of arches Determine if feet deviate medially (toes point in) Determine if feet deviate laterally (toes point out) Observe wear patterns on shoe soles Refer to other healthcare professionals when appropriate Copyright © 2010 Spa Vargas University

12. Spa Vargas University MT101 Introduction to Massage Therapy Chapter 6: Assessment Gait Assessment Observe client’s walking pattern Quantity, quality, fluidity, evenness of steps Alignment of head over spine Position of shoulders Arm swing is equal from side to side Medial or lateral deviation of feet Extent of knee flexion, amount of bounce Hip movement is even and fluid Copyright © 2010 Spa Vargas University

13. Spa Vargas University MT101 Introduction to Massage Therapy Chapter 6: Assessment Copyright © 2010 Spa Vargas University

14. Spa Vargas University MT101 Introduction to Massage Therapy Chapter 6: Assessment Range of Motion Focus on client’s area of concern Determine which joint movements are affected, how they are affected, and which soft tissues are involved Specific joint determines direction and amount Measured in quality and restriction May determine contraindication for massage Copyright © 2010 Spa Vargas University

15. Spa Vargas University MT101 Introduction to Massage Therapy Chapter 6: Assessment Range of Motion Two kinds of range of motion Active (AROM): client moves joint to demonstrate how much of the full range can be completed comfortably and without restriction Passive (PROM): therapist moves relaxed client through a ROM to determine full-range limitation Pain and discomfort caused by PROM can suggest problems with ligaments and joint structures which are outside the massage scope of practice Copyright © 2010 Spa Vargas University

16. Spa Vargas University MT101 Introduction to Massage Therapy Chapter 6: Assessment Active Range of Motion Assesses the muscles and tendons actively involved in the joint movement Movement should be slow Movement performed at steady speed Movement must be isolated, rest of body still Movement continues to point of restriction Therapist should demonstrate movement before client performs the movement Watch for nonverbal clues Copyright © 2010 Spa Vargas University

17. Spa Vargas University MT101 Introduction to Massage Therapy Chapter 6: Assessment Passive Range of Motion Evaluates passive tissues (ligaments, joints, and joint capsules) Active range of motion should be performed first Requires client to be relaxed Client must trust therapist Use gentle, knowledgeable tone of voice Better determination of indication or contraindication for massage Perform carefully to avoid injury If pain, massage is contraindicated If no pain, massage indicated Copyright © 2010 Spa Vargas University

18. Spa Vargas University MT101 Introduction to Massage Therapy Chapter 6: Assessment Copyright © 2010 Spa Vargas University

19. Spa Vargas University MT101 Introduction to Massage Therapy Chapter 6: Assessment End Feels Resistance sensation at end of joint range Specific to structure Normal end feels classified as hard, soft, firm Abnormal end feels classified as hard, soft, firm, springy block, empty, spasm Work on recognizing normal versus abnormal end feels before identifying specific abnormal end feels Copyright © 2010 Spa Vargas University

20. Spa Vargas University MT101 Introduction to Massage Therapy Chapter 6: Assessment Direction of Ease Good tool when clients cannot relax Uses the direction in which the tissues move with least resistance Client’s body position helps determine starting point Apply when client continues to tense his muscles during PROM Client pushes or pulls against resistance Hold for 5 seconds Muscle naturally relaxes Copyright © 2010 Spa Vargas University

21. Spa Vargas University MT101 Introduction to Massage Therapy Chapter 6: Assessment Appearance of Tissues Visual assessment Skin coloration Redness may indicate increased circulation Paler skin may indicate reduced blood supply Bilateral symmetry Marks (moles, varicose veins, scars) Wounds (sores, rashes, bruises) Fullness and thickness of soft tissues can point out Hypertonicity Difference in muscle mass Edema (swelling from accumulated interstitial fluid) Copyright © 2010 Spa Vargas University

22. Spa Vargas University MT101 Introduction to Massage Therapy Chapter 6: Assessment Palpation Assessment Good palpation skills are critical for massage therapy Touching and exploring the body, locating different structures, and assessing the quality of structural characteristics Massage Therapists need to have relaxed hands “Less is more” is a guideline for palpation and treatment of soft tissues Evaluate soft tissues for Temperature (local hot or cold) Textures (hypertonic muscles, scar tissue, restricted fascia, trigger points, tissue edema) Movement (fascial adhesions and restrictions) Rhythm (breathing, pulse, craniosacral) Copyright © 2010 Spa Vargas University

23. Spa Vargas University MT101 Introduction to Massage Therapy Chapter 6: Assessment Assessment of Skin Temperature Temperature can be circulation indicator Excessive heat can be caused by Fever: systemic contraindication Inflammation response to injury Determine how long Less than 72 hours in local area contraindicates massage Cold skin can indicate decreased circulation Ischemia (reduced blood supply) Massage indicated Copyright © 2010 Spa Vargas University

24. Spa Vargas University MT101 Introduction to Massage Therapy Chapter 6: Assessment Texture and Movement of Soft Tissues Scar tissue and restricted fascia feel bound and stuck together Hypertonic muscles feel tight and resistant Trigger points feel like knots; pain radiates to another body part Tissue edema feels spongy or full and squishy Copyright © 2010 Spa Vargas University

25. Spa Vargas University MT101 Introduction to Massage Therapy Chapter 6: Assessment Textures and Movements of Muscles Normal, healthy muscles feel warm and pliable Open up to receive additional pressure Slip smoothly past neighboring tissues Not painful Muscles lacking nutrition feel deteriorated and insubstantial (dissolving) Injured muscle tissue Feels ropelike Massage stroke may slow down or bounce over Repetitive motion muscles feel resistant, tough, inelastic, and sticky Copyright © 2010 Spa Vargas University

26. Spa Vargas University MT101 Introduction to Massage Therapy Chapter 6: Assessment Rhythms Body rhythms can provide information about client Breathing rhythm Check rib cage movement for Slow, deep breathing Fast, shallow breathing Upper chest breathing Good topic for self-care Cardiac pulse Check for difference in strength of pulse, side to side Craniosacral rhythm Ebb and flow of cerebrospinal fluid Evaluated for quality, quantity, fluidity Copyright © 2010 Spa Vargas University

27. Spa Vargas University MT101 Introduction to Massage Therapy Chapter 6: Assessment Functional Assessments Evaluate the client’s area of concern to discover the likelihood of dysfunctions Manual muscle tests Clients perform isometric muscle contractions against counterforce Determine where muscles have abnormal function because they are shortened, overstretched, or weak Manual resistive tests Active isometric muscle contractions Determine problem with muscle or tendon Could possibly indicate more severe neurological condition* Special orthopedic tests Find conditions related to fascia, ligaments, nerves, joints *Caution: Do not diagnose; refer to healthcare practitioner Copyright © 2010 Spa Vargas University

28. Spa Vargas University MT101 Introduction to Massage Therapy Chapter 6: Assessment Post Treatment Assessment Reevaluate original findings Example: Client complained about tight left shoulder before session Hypertonicity can be assessed during massage Shoulder elevation and range of motion assessed after client is off table and dressed Document changes in activity and analysis section of SOAP note Copyright © 2010 Spa Vargas University

29. Spa Vargas University MT101 Introduction to Massage Therapy Chapter 6: Assessment Summary Assessment is a critical first step to massage therapy Determining underlying cause is more beneficial and produces longer-lasting results than just giving a massage Suspect compensation patterns; treat them to restore optimal function Treat where it hurts, where it is compensated, and at the ends of fascial restriction Copyright © 2010 Spa Vargas University