7 - the essential '7'
What are the nuts and bolts of good basic assessment for massage/soft tissue therapists?
All therapists have a duty of care to rule clients out not in!
It is often the view that when a client, patient or athlete attends a session, that the therapist ‘must’ deliver their skills. This is often a ‘hands-on’ session accompanied by advice. How do we rule out those for whom massage/soft tissue intervention isn’t appropriate?
It is only through assessment that we can determine whether or not ‘hands-on’ is appropriate? To start any assessment it is important to understand the nature of someones underlying health as well as the reason they have made an appointment with you.
After you have recorded their personal details and general practitioner/consultant information there are 7 ‘open’ questions you should ask followed by multiple additional questions which stem from those initial 7 open questions. What are the essential 7?
General Health? This requires more than just the ‘fine/ok’ response often recorded! Especially during the age of Covid you want to delve deeper. Are they well today? Do they have a cough or cold? Have they experienced any unusual symptoms in recent days?…..
Blood Pressure? The usual question is have you had your BP taken recently? To which many will reply ‘No’. To record this alone without exploring whether they have ever had a reading? The date of the last check? or the last reading?, means any decision is not taking in to account the risk factors associated with age, activity and general health of not knowing the BP status on the day they see you. This will affect any justification for actions taken at your session .
Medication? Don’t forget that records should state the name of the medication, its dosage, frequency & duration. All these depending on the type of medication will influence your clinical reasoning and again actions taken being justifiable. Don’t forget that many individuals ‘self medicate’ with over the counter products and that also supplements can affect your decisions.
Surgery? Knowing types of surgery, dates of surgery and any follow up interventions will also elude to someones general health. Often not mentioned when asked about general health!
Conditions? After questions about medication and surgery it is often clear that the person has underlying health issues which will impact on your decision making process and whether or not an intervention is appropriate. However, some people have either never sought help for an underlying condition or never been investigated or have chosen not to take medication for their condition. It is therefor very important to pursue a full conversation about any issues that concern the client but for which there are no formal management strategies.
Allergies? We are all familiar with the need to ensure that any product or medium we use, with ‘hands on’ skills, does not cause an allergic reaction to our client. The common ones of nut, latex and other food products such as shell fish are often discussed. However, not all clients disclose they carry an Epipen or where to find it should it be required? Do you know how to use one? It is important that these discussions take place early in an assessment to ensure that any ‘risk’ to the client either from products or environment are eliminated and a strategy for management in the event of an anaphylaxis reaction.
Anything Else I Should Know? Giving clients an opportunity to disclose other issues, situations or circumstances which might impact your decision to proceed or not is important. The earlier you understand any other ‘factors’ that can change your intention to proceed to ‘hands-on’ or soft tissue skills the better.
Remember your failure to ask a question is not the client/patients failure to tell you something important. As autonomous practitioners we have a duty of care to explore in sufficient detail and depth all those areas of information we know can impact whether an intervention is safe and effective.
No Client/patient ever ‘signs away’ their rights! They can only ‘sign’ to an understanding of what you want to ‘deliver’ and that they ‘agree’ - informed consent. Generalised statements that give the responsibility to a client to inform you of changes/important information do not protect you. A client is not expected to understand the implications of circumstances, situations and health which might make your intervention inappropriate at best and potentially damaging at worst. You are the professional person and your duty of care is to explore through questioning and clinical assessment anything that might inform your practice. This might be treatment, referral or information. Your records should justify your actions.
We are also responsible for maintaining adequate records of any appointment / treatment session. Both for the clients’ to access should they require the detail of any treatment, but also to protect the therapist in the event of a claim. We are only protected by what we record not by things we think we remember. Therefore, if anything unusual or untoward happens or is discussed it is in everyones interest that the information is recorded in detail along with the standard record of the session. I often hear from therapists, particularly when working as a volunteer or at events where large numbers of Athletes present for ‘massage/treatment’, that they don’t have time to make records or notes are not necessary in these situations. A failure to keep accurate records can lead to regulated professionals being ‘struck off’ the register which allows them to practice. Non regulated therapists might feel they are ‘safe’ as no legal register exists in the UK. However, these failures might lead to civil proceedings or in the most serious cases criminal proceedings for which they will have no defence if no records of the occasion / incident exist.
If you feel your ability to investigate a problem or injury through assessment is limited or needs updating then coming soon are our ‘New Generation’ Education Programmes. One or more will suit your needs.
If you need help to better record your findings or increase the range of assessment skills you currently use, then we can help you gain the necessary knowledge.
If you need to better integrate your skills to address sports injury, conditions or general health and well being issues then our ‘New Generation’ Education Programmes will provide a route to development.
If you want to give better advice and integrate your soft tissue skill/massage interventions with appropriate exercise and activity information then our ‘New Generation’ Education Programmes will help your decision making process.
‘Do the Basics Well’, was advice I heard a consultant tell his new intensive care doctors and you will save and improve the quality of life of more people. Better than being able to spot a rare condition for which we don’t yet have the answers!
We may not be able to help everyone, nor should we treat everyone, as we may not be the best therapist for their needs. Recognising our limitations through doing the basics well - listen, look, feel & move (History, Observation, Palpation & Movement), will mean we identify those for whom our skills are relevant, safe and effective and those who we should refer to more appropriate professionals able to meet their needs.
All of the above requires a professional approach to Ruling People OUT not IN and recording the process in detail.
The New Generation Eduction Programmes from SPS Ltd are coming this Autumn. While we are saying goodbye to our old courses and hello to the new, we are definitely keeping the baby just changing the water!! For those of you who don’t know the expression “throwing away the baby with the bath water” . It means quite often people discard what is good about something for a new route but in doing so loose what was the essential part of their ‘good’ process/product or concept. I often think that the obsession with having research evidence, before delivering any intervention, runs the risk of not delivering an intervention we know is effective. Just because the research isn’t there to back it up yet doesn’t mean its not a valid approach to client management. Research based evidence and evidence based practice, don’t need to be at odds with each other. An acceptance that we don’t always know why something ‘works’ isn’t poor practice, its merely an indicator that we still have much to learn. Research may get there in the future, but to discard an intervention due to a lack of it is ‘throwing the baby away with the bathwater’
We are definitely keeping the (baby) great content just applying it to a greater range of clients/patients and adding the integration of those skills to a broader massage and movement concept.
We look forward to seeing you again soon.
If you need help and support a friendly ear or just to know you are not alone then contact us. admin@spslearn.co.uk Stronger together, more insight through shared experience and a collective desire to improve the health & well being of our clients, family & friends. Not forgetting your own mental & physical wellbeing.
If you need any further help, support or guidance then contact us to arrange a One to One or join a “New Generation” education programme to expand your knowledge and skills at THE Centre in Cardiff. There will be many opportunities in the next few months so keep in touch! Follow on Twitter & Instagram