1. Chapter 5: Client Examination for Massage Outcome-Based Massage: From Evidence to Practice

2. Outcome-Based Massage: From Evidence to Practice © 2009 LWW Objectives At the end of this presentation, you will have the information needed to: Describe the unique elements of a client examination for massage Discuss how to perform palpation Identify the impairments that can be assessed using palpation Describe a variety of nonpalpatory approaches to assessing the impairments that are relevant to massage

3. Outcome-Based Massage: From Evidence to Practice © 2009 LWW Focus of the Client Examination for Massage 1. Treatment of Impairments Resulting from Medical Conditions Identification of: –Soft tissue dysfunction related to the client’s clinical condition –Other primary and secondary impairments that therapists can treat with massage techniques –Functional limitations associated with the client’s impairments

4. Outcome-Based Massage: From Evidence to Practice © 2009 LWW Focus of the Client Examination for Massage 2. Wellness Interventions Identification of: –Body structures and functions for client’s wellness goals that therapists can treat with massage techniques

5. Outcome-Based Massage: From Evidence to Practice © 2009 LWW Relevant Clinical Outcomes for Massage See Table 5-1 in Chapter 5.

6. Outcome-Based Massage: From Evidence to Practice © 2009 LWW Issues in a Client History That Suggest Soft Tissue Dysfunction

7. Outcome-Based Massage: From Evidence to Practice © 2009 LWW Using Palpation in the Client Examination Objects of Palpation Contact Surfaces Used for Palpation Force of Palpation Rate of Palpation Pressure of Palpation Direction of Palpation Duration of Palpation Integration of Information from Other Senses

8. Outcome-Based Massage: From Evidence to Practice © 2009 LWW Assessing Objects of Palpation Temperature Contour and Bulk Texture and Consistency Fluid Status Palpating Soft Tissue Layers (“Layer Palpation”)

9. Outcome-Based Massage: From Evidence to Practice © 2009 LWW Tissue Layers

10. Outcome-Based Massage: From Evidence to Practice © 2009 LWW Tissue Layers Skin: epithelium, epidermis, and dermis Superficial fascia: deep to skin, houses fat and water, provides a path for nerves and vessels, and sometimes contains striated muscle Deep fascia: dense connective tissue that lies between the superficial fascia and muscle Muscle Periosteum

11. Outcome-Based Massage: From Evidence to Practice © 2009 LWW Tissue Mobility and Restrictive Barriers: Normal Range of Motion

12. Outcome-Based Massage: From Evidence to Practice © 2009 LWW Tissue Mobility and Restrictive Barriers: Restrictive Barriers

13. Outcome-Based Massage: From Evidence to Practice © 2009 LWW Barrier-Release Phenomenon Tissue barrier: the point at which therapists palpate a resistance to tissue motion. If therapists sustain the pressure on the tissue barrier, a “release” may occur after a latency period. Latency period varies with the nature of the tissue and its state of health. Release results in a reduction of the resistance that enables therapists to move the tissue beyond the original barrier without increasing the pressure of palpation.

14. Outcome-Based Massage: From Evidence to Practice © 2009 LWW Selected Impairments Evaluated through Palpation

15. Outcome-Based Massage: From Evidence to Practice © 2009 LWW Examples of Outcomes and Examination Techniques for Massage See Table 5-1 in Chapter 5.

16. Outcome-Based Massage: From Evidence to Practice © 2009 LWW References The references for the material in this PowerPoint presentation are found in Chapter 5: Client Examination for Massage.