A – Assess, Assess, Assess
We would all love to be like Mary Poppins pulling something out of the bag when necessary.
Like Mary we carry everything with us and metaphorically speaking we need to pull the right tool or hand-skill out when required. But perhaps more fitting is the Sound of Music song ‘Do-Re-Mi’ – ‘let's start at the very beginning a very good place to start, when we sing we begin with ‘‘Do-Re-Mi’’ and when we read we begin with A,B,C. Whereas when we massage, it seems we start with "E" for Effleurage! Starting here is forgetting all that comes before so I’ll be writing the Massage Alphabet and there is no better place to start than "A" for Assessment. Assess, Assess, Assess! Sorry was I shouting, forgive me, so often I see massage commenced without any sort of basic assessment or understanding of the clients, patients, athletes, friends, or family members needs being taken into account before "E" is administered liberally!
I have three rules of thumb, forgive the pun, to ensure that when delivering massage it meets the need of the moment:
Rule 1 - Use assessment to rule people out not in
Rule 2 - Your failure to ask a question is not the clients failure to notify you of something important
Rule 3 - The devil is always in the detail, so be attentive
If you are receiving a massage and no assessment or questioning is undertaken before the massage begins then I would seriously consider another therapist. Understanding individuals needs and therefore the appropriate massage method or hand-skill to meet them comes from an appropriate assessment. Understand what is required in order to justify your actions and to be safe and effective.
You will need to have an appropriate recording system that is clear, concise, repeatable and legible. Whether you record on paper or computer remember to register for data protection purposes and if placing personal information on a computer that it is properly encrypted and password protected. Records must be retained for a minimum of 8 years by the regulated professions and as you are a professional healthcare practitioner/ therapist you should follow the same protocols. I know many therapists don't keep records so why make one? The simple answer is to protect yourself in the event of a claim as without any written evidence you cannot justify your actions. This is regardless of where you are delivering your massage, clinic, house or sports venue. The following are the basics and by no means the maximum depending on your situation, but the minimum for safe and effective practice:
Name, address, gender, DOB, occupation, doctor and other healthcare practitioners and consultants. Remember rule 3, if you don't have a DOB or age of the individual your actions could be inappropriate. For example a client who is unaccompanied and under 16. Alternatively without a Dr the person may not be eligible for healthcare in the UK which could mean your insurance will not support you in the event of a claim or your massage intervention is inappropriate in the light of their other treatments by specialists or consultants.
Reason for Visit
Ascertaining early the reason they have sought your style of massage is important. Remember rule 1, the sooner you determine their suitability for massage the better so as not to waste your time and theirs. If the reason for their visit is not soft tissue based or likely to have soft tissue as the problem then refer them early to a more appropriate practitioner.
Don't use yes/no or tick box, it's important that you ask the questions and write the answers, not the individual. Why? Remember rule 2 your failure to ask a question is not the individuals failure to answer and therefore if you don't have a system to ensure all the main reasons not to massage are covered then you may place yourself or the individual at risk. Individuals are not expected to understand the consequences of yes/no and tick box systems so often the therapist is left without the most important information. Consider 7 areas of questioning in determining who not to massage, all with appropriate detail and dates:
General health/health on the day they present
Blood pressure. When last taken, by whom and the reading if known (rule 3)
Medication. Name, dosage, frequency & duration (rule 3)
I always find it useful to ask "is there anything else you think I should know?" These areas of questioning are all starting or open questions and should lead to secondary or further questions to clarify exactly the health status of the individual before proceeding. It's important to stop as soon as a contraindication is recognised and the appropriate advice or referral made. To continue in the knowledge that the individual is not suitable puts you at risk of a claim for potentially exacerbating their problem unnecessarily. If it's safe to proceed then you will need as much detail of their presenting issues as possible.
Current Medical History
When only using massage as the modality or intervention then this should be detail of their reason for visiting you (rule 3), the more you know about the how, when, where, symptoms, what makes it better or worse and training if appropriate the better.
Past Medical History
Past medical history of their reason for visit should include previous episodes of the presenting problem along with any investigations, blood tests X-Ray's etc and past interventions and healthcare professionals consulted (rule 2).
In collecting the information above, it often helps to use a body chart to record areas, objective and subjective information, a picture says a thousand words! Take care when using a body chart to ensure that a key is used so that the lines, dots, crosses etc are understood and consistently used (rule 3).
Observation, Palpations and Movement
Now you have the history and presenting issues it's important not to jump to massage without a clinical assessment. This should be a combination of Observation, Palpations and Movement and your findings recorded in detail (rule 3) To follow as O, P & M in our Massage Matters alphabet. Once this is concluded you can decide on the appropriate management/massage to use and on your aims and objectives. These should be conveyed to the individual in order to gain informed consent prior to the delivery of the massage. The individual would normally sign and date their consent at this point on the record. We will cover this in I for informed consent in our alphabet later on.
Your records should show the massage delivered in terms of the area massaged, the position of the client and the methods, hand skills etc delivered to each area separately. Reassessment on conclusion helps to determine the efficacy of your massage both objectively and subjectively and should also include the individuals feedback. This helps you to reflect on your choice of method/skill and informs your future practice. Advice is important to ensure that your good work is not undone but should always remain within the therapists scope of practice and any exercise, stretch or other suggestion should be quantified and recorded.
The final signature on the record is that of the therapist along with the date and if necessary the time of the massage. Please note that it is also advisable to write notes immediately after intervention or within 12 hours in certain situations and not to change records at a later date or to erase parts so that the information is illegible. If notes need to be changed then strike with a single line, date and initial the change or add to notes with a clear date, time and initials along with the reason for the addition after the event. Assessment is always necessary but assessment skills are accrued over time through education and experience. If you need help in this area then get in touch and make an appointment for a one-to-one session.
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