Complete Your CE Test Online - Click Here Pain scales and client feedback Whether the type of massage you perform is for relaxation and stress release or for pain reduction, every client must have an understanding of pain scales in relation to his or her existing pain complaints and your palpation pressure. The client seeking a relaxation massage who has no pain complaints quite often will recognize tender or painful areas as you perform your session. Discussing this possibility before the relaxation massage will ensure the client does not think you are creating the tenderness or pain with your palpation. Skillful application using progressive deepening of palpation pressure rather than starting your session with immediate deep pressure will ensure you do not cause or create pain for your client.
 Knowing how to describe what pain scale level the client feels when any such area is located helps the therapist assess the severity of any dysfunction and determine proper palpation pressure. Making clients aware of and able to identify possible sensitive areas that are not consciously evident to them helps them provide accurate feedback to guide their session and to trust your palpation methods. Explain that such a situation is actually beneficial because it helps find any problem areas and allows you to give focused treatment attention to them either during the session or in a future appointment. Further explain that recognizing and treating these areas now may eliminate or prevent any soft tissue problems from developing later. However, let clients decide before the session whether they want to address any sensitive areas found during the session. Some clients may not want pain relief techniques used, preferring to issue as little feedback as possible to maximize the relaxation component of their massage session. Any soft tissue conditions evaluated during a treatment can be discussed after the massage and a determination made whether the client wants attention given to them in future sessions. If a client does want you to spend extra time with any given area during a relaxation massage, discuss the need to extend the massage session. This will require acceptance and approval to charge a higher rate for a longer session. You may also offer to stay within the initially approved appointment time by working less time on other parts of the body or removing some body areas from treatment completely. If the client wishes to do that, let the person determine what adjustments he or she prefers to accomplish the session. A widely accepted pain scale ranks it from zero to 10, with 8 as the first sensation of actual pain. Explain to clients that 9 is extreme pain and 10 is excruciating pain. Tell them to just say the appropriate number anytime during the session when they feel pain and that you will immediately adjust your pressure to a level where pain is not evident and then try to find a comfortable level of palpation pressure. Instruct clients to provide verbal feedback when they feel the first sensation of pain as you reapply your technique of choice gently and slowly deepen your pressure. Tell them when they rate the pain as No. 8, you will ease your pressure slightly until they no longer feel pain from palpation. Tell them your goal is to only use palpation pressure they can tolerate comfortably, which would be from a 5 to a 7 on the pain scale. To describe the appropriate feeling, tell clients the area may feel sensitive as it is palpated but it will feel like a “good” hurt, not a painful hurt. Explain that the pain scale is also used to describe palpation pressure and that your goal is to palpate to between a 5-7 on the pain scale to achieve effective changes in any soft tissue condition. Be sure to ask them to let you know if your pressure drops below a 5 on the scale because too little pressure may not noticeably reduce the pain. It is a good rule of thumb to remind returning clients about the pain scale and need for feedback before beginning each subsequent session until you are satisfied they will provide you with accurate and appropriate feedback. Palpation application Many clients erroneously believe that unless a massage is deep enough to cause pain, they aren’t getting a “good” massage. This false belief might stem from previous therapists who improperly applied deep pressure too quickly, were incorrectly trained, or never learned how to communicate sound massage therapy practices to their clients. The result has been far too many members of the public expecting pain as a measure of whether they are receiving a “good” deep tissue massage. Take the time to re-educate these clients by explaining that deep tissue massage can be accomplished without pain. If your client expects or insists on pressure that causes pain during your sessions, it may be time to re-examine your technique or your ability to communicate how you perform your sessions. It may also require a clearer explanation of how to receive pain-free deep tissue massage. Aggressive palpation in a hurried manner as matter of practice may frequently hurt new clients who don’t provide feedback on their pain – and who instead choose not to return for massage treatment again and spread word about their negative experience to others. It is not uncommon for a client to say, “You can go deeper than that” as you begin to massage any particular area of the body. This usually occurs before you have completed a body area where you are systematically applying pressure from light to medium to deep. Such a statement indicates the need to explain your palpation methods before beginning the session. Inform the client that with each new body area, you will initially apply light pressure to assess the condition of the tissue and progressively increase your pressure deeper and deeper as the tissue allows. Explain that you will not work any deeper than can the client can comfortably tolerate and that you will apply your deepest pressure last on each area treated. Let the person know that if you encounter any dysfunctional conditions, such as tight muscle fibers, or they tell you they have pain, you won’t increase pressure until the tissue softens and releases. Tell the client if softening and release does occur, you will then continue to increase your pressure deeper and deeper accordingly. If the soft tissue does not release or pain is not eased, explain that the dysfunction may require repetitive session treatments to eliminate before you can safely go deeper without causing injury to the tissue or exacerbating the problem. Ask the client to be mindful of any improvement or worsening of the muscles involved between now and the person’s next scheduled session and to tell you about it. After following the protocol of progressively deeper palpation pressure, you will be able to provide deep tissue massage with no discomfort to the client and allow you to comfortably sink down all the way to the bone of a given area. If a client suggests you still can go deeper, press against the bone to show the person you can go no further. He or she usually will be amazed and surprised because this accomplishment came without any pain. This provides an opportunity to reinforce your earlier explanations that it is possible to receive the deepest of pressure without feeling pain when proper palpation methods are applied. Re-educating clients who improperly endured pain from previous therapists heightens your credibility as a knowledgeable, skilled massage therapist. Treatment plan and session protocol Once clients have an understanding of the characteristics of a massage therapy session and you understand their reasons for seeking a session, it is time to discuss your proposed treatment plan for their approval. Determining your plan is based on your interview, clients’ medical history, any stated pain complaints, pre-massage palpation, and any range of motion tests or muscle strength/weakness testing when appropriate. Your plan is also dictated by what your clients are seeking in their session. They may have pain complaints but wish to have a stress release/ relaxation massage rather than a pain relief-focused session. After assessment of all the information you have, choose the techniques within your knowledge base that may bring you the best results. Determine whether to focus on certain body areas or provide a full body session. Ask clients whether there are any areas of their body they prefer not to have treated and remain mindful of avoiding theses areas during the session. Advise them of your evaluations, how you wish to proceed, and ask for their approval. If they wish for focused pain-relief treatment but also want a full body massage, it may be necessary to explain it is not Massage.EliteCME.com Page 13