1. Spa Vargas University MT101 Introduction to Massage Therapy

2. Spa Vargas University MT101 Introduction to Massage Therapy Chapter 7: Treatment Plan Introduction Planning Process Future Treatment Self-care Recommendations Presenting the Treatment Plan Copyright © 2010 Spa Vargas University

3. Spa Vargas University MT101 Introduction to Massage Therapy Chapter 7: Treatment Plan The Planning Process Flexible guide to adapt to client’s condition Components Duration of sessions Frequency of sessions Length of treatment Techniques and areas to incorporate or avoid Self-care recommendations Referrals to other healthcare practitioners Ask leading questions to clarify information with client Use information to determine treatment plan and referrals to other healthcare providers if necessary Discuss with client before recording the treatment plan Document in SOAP note Copyright © 2010 Spa Vargas University

4. Spa Vargas University MT101 Introduction to Massage Therapy Chapter 7: Treatment Plan Treatment Plan Intended path massage therapist recommended for clients to reach clients’ treatment goals Should reflect how to continue progressing toward the prioritized goals Plan needs to be reasonable and recognizable for clients’ to be successful and follow plans Needs to be flexible and adaptable Components 1. Suggestions for Future Treatment 2. Suggestions for Self Care 3. Referrals to other Healthcare Professionals Copyright © 2010 Spa Vargas University

5. Spa Vargas University MT101 Introduction to Massage Therapy Chapter 7: Treatment Plan Initial Session First session is educated guess based on Client’s health history Client interview General assessments Willingness to participate Engage clients in conversation to determine How they handle stress How long it takes to recover from illness How physically active they are Often collaborate with client to ensure plan is reasonable Copyright © 2010 Spa Vargas University

6. Spa Vargas University MT101 Introduction to Massage Therapy Chapter 7: Treatment Plan Subsequent Sessions Ask questions to reevaluate previous plan Answers recorded in subjective part of SOAP Make necessary changes New assessments recorded in objective part of SOAP New techniques marked in activity and analysis part of SOAP Copyright © 2010 Spa Vargas University

7. Spa Vargas University MT101 Introduction to Massage Therapy Chapter 7: Treatment Plan Future Treatment Decide Healing time Duration Frequency Length Techniques Specific suggestions for reevaluation Determined by amount of time client’s body needs to change condition of soft tissue Document in plan section of SOAP Notes help track progress and design next session Copyright © 2010 Spa Vargas University

8. Spa Vargas University MT101 Introduction to Massage Therapy Chapter 7: Treatment Plan Healing Time Affected by client’s internal healing environment Evaluated by learning about client stressors More stressors necessitate longer healing time Healing time is unique to an individual so one should not compare the healing time of one client to another Stronger healing environment allows more aggressive plan (longer or more frequent massages) Weaker healing environment suggests more conservative plan (shorter or less frequent massages) Copyright © 2010 Spa Vargas University

9. Spa Vargas University MT101 Introduction to Massage Therapy Chapter 7: Treatment Plan Duration of Future Sessions Can be 15, 30, 60, or 90 minutes long Most are 60 minutes long Shorter sessions for uncomfortable clients Shorter sessions can prevent over treating 90-minute massage may benefit clients with multiple compensation patterns and can provide good internal healing environments Copyright © 2010 Spa Vargas University

10. Spa Vargas University MT101 Introduction to Massage Therapy Chapter 7: Treatment Plan Frequency of Future Sessions Healing input influences healing output Mainly determined by Condition of client’s soft tissue Client’s lifestyle Financial situation Schedule Transportation Child care As frequent as twice a week, at least one every few months Seeing clients at least once every few months establishes a regular and dependable client base Must balance the frequency of sessions so that steady progress is made and over treating is avoided Copyright © 2010 Spa Vargas University

11. Spa Vargas University MT101 Introduction to Massage Therapy Chapter 7: Treatment Plan Future Treatment Length of treatment Should not exceed time frame of long-term goals Techniques and areas to include or avoid Ask clients prior to massage session where on their bodies they prefer not to be touched Reevaluation Performed when original treatment goal is reached and helps determine the progress toward short- and long-term goals Copyright © 2010 Spa Vargas University

12. Spa Vargas University MT101 Introduction to Massage Therapy Chapter 7: Treatment Plan Self-care Recommendations Support treatment goals Provide client the opportunity to improve own health Suggestions only, not prescriptions Reinforce scope of massage therapy Recorded in plan section of SOAP Try to be specific and brief Copyright © 2010 Spa Vargas University

13. Spa Vargas University MT101 Introduction to Massage Therapy Chapter 7: Treatment Plan Considerations for Self-care Consider client’s lifestyle and time constraints Don’t burden client Expect some clients to resist Compensation patterns can become part of client’s identity Don’t judge clients that hesitate or do not want to participate Copyright © 2010 Spa Vargas University

14. Spa Vargas University MT101 Introduction to Massage Therapy Chapter 7: Treatment Plan Self-care Topics Hydrotherapy Rest and sleep Nutritional awareness Specific stretches for areas of concern Physical awareness Ergonomics Copyright © 2010 Spa Vargas University

15. Spa Vargas University MT101 Introduction to Massage Therapy Chapter 7: Treatment Plan Internal Hydrotherapy – water consumption Water has many functions in body: Elimination of waste Delivery of nutrients and oxygen to cells Tissue maintenance Joint cushioning Temperature regulation Hydration further enhances relaxation of muscles and surrounding soft tissue during the massage session Recommend intake of 0.5 ounce per pound of body weight per day Educate clients on insufficient water intake Can reduce the body’s ability to recover and maintain health Makes tissues sticky and more difficult to heal Color of urine can indicate level of hydration Need to drink more water when retaining water Alcohol and salt can dehydrate an individual Dehydrated tissues may feel “sticky” Copyright © 2010 Spa Vargas University

16. Spa Vargas University MT101 Introduction to Massage Therapy Chapter 7: Treatment Plan External Hydrotherapy Ice and cold applications Reduce circulation and nervous system activity Do not use for circulatory problems Prevent inflammation Promote healing Apply for maximum of 20 minutes Chemical gel packs Colder than 32 degrees Need layer of fabric between gel pack and skin for protection Heat applications Enhance circulation, increase healing Avoid if signs of inflammation, heat, or redness Used for Muscles surrounding injury Muscle spasms Other forms of pain Maximum of 20 minutes Balancing body’s core temperature Copyright © 2010 Spa Vargas University

17. Spa Vargas University MT101 Introduction to Massage Therapy Chapter 7: Treatment Plan Stretches Reinforce mechanical changes and new positions from massage sessions Not a substitute for treatment from healthcare professional To avoid stretch reflex – stretches should be done slowly and steadily Explain to client: Demonstration of stretch Expected results Possible contraindications Specifics regarding frequency and duration Copyright © 2010 Spa Vargas University

18. Spa Vargas University MT101 Introduction to Massage Therapy Chapter 7: Treatment Plan Rest and Sleep Rest Period when mental, physical, sensory, emotional activity slows or stops Allows body to restore energy Sleep Deep state of rest Tissues regenerate, repair, and prepare the body for new activity Copyright © 2010 Spa Vargas University

19. Spa Vargas University MT101 Introduction to Massage Therapy Chapter 7: Treatment Plan Sleep Positions Stomach May develop stiff neck May hyperextend lumbar spine Side May complain of back pain Suggest body pillow for support May also have numbness and tingling in arms and hands Back May have back pain (lordotic curve of spine) Sleep pattern can be disrupted by numerous factors: Eating habits Lack of physical activity Medication Insufficient body support May need to refer client to other healthcare provider Document referral in the plan section of SOAP Copyright © 2010 Spa Vargas University

20. Spa Vargas University MT101 Introduction to Massage Therapy Chapter 7: Treatment Plan Nutrition Stick to education as it pertains to soft- tissue health Hand out nutritional references if client is interested Myths and false information about nutrition are widespread Sort through available information and guide client toward scientifically proven, valid facts Refer to nutritionist as necessary Copyright © 2010 Spa Vargas University

21. Spa Vargas University MT101 Introduction to Massage Therapy Chapter 7: Treatment Plan Body Awareness Clients may be use to pain Try to get them to recognize when pain is absent Massage may make pain or tension temporarily worse before it gets better Reevaluate and reassess as appropriate Refer elsewhere if condition is not understood Copyright © 2010 Spa Vargas University

22. Spa Vargas University MT101 Introduction to Massage Therapy Chapter 7: Treatment Plan Ergonomics Equipment design for person’s activities Chairs Computer keyboards Focuses on minimizing the mechanical stress placed on the body and soft tissues Should be as close to natural as possible Special equipment is not necessary Slight changes can make big difference Copyright © 2010 Spa Vargas University

23. Spa Vargas University MT101 Introduction to Massage Therapy Chapter 7: Treatment Plan Referral to Other Healthcare Professionals Ethical responsibility to refer clients to appropriate healthcare practitioner Keeps professional image intact Key is knowing what is and isn’t in scope Record referrals in plan part of SOAP Follow-up communication Ask client to keep you informed Keep any communication simple and to the point Requesting copies of medical records (formally or informally) Formally: client must complete records-release form, and a copy must be sent to practitioner along with cover letter stating your request Informally: ask clients to request copies from their healthcare practitioner Discussing a client’s condition Must get written permission from client to share information with other healthcare practitioner Copyright © 2010 Spa Vargas University

24. Spa Vargas University MT101 Introduction to Massage Therapy Chapter 7: Treatment Plan Communication for Referral and Insurance Reimbursement Most insurance companies require prescription Need prescription from client’s physician Referral form requesting prescription Contact information (you and client) Diagnosis Precautions Body areas under treatment Frequency and duration Whether progress reports are requested Reevaluation date Physician’s signature, contact information Copyright © 2010 Spa Vargas University

25. Spa Vargas University MT101 Introduction to Massage Therapy Chapter 7: Treatment Plan Presenting the Treatment Plan Treatment recommendations Explain to client that healing times vary widely Document in plan part of SOAP Referral recommendations Be careful not to alarm client Do not diagnose or prescribe! Refer to appropriate healthcare professional if Massage is contraindicated Outside scope of massage therapy Copyright © 2010 Spa Vargas University

26. Spa Vargas University MT101 Introduction to Massage Therapy Chapter 7: Treatment Plan Copyright © 2010 Spa Vargas University

27. Spa Vargas University MT101 Introduction to Massage Therapy Chapter 7: Treatment Plan Summary Treatment plans are client-centered and therefore not an exact science Self-care recommendations involve the client and may speed up healing process Documentation is critical to tracking progress Be careful to stay within scope of massage therapy when developing and implementing treatment plans Copyright © 2010 Spa Vargas University