Complete Your CE Test Online - Click Here possible to do both unless the session is extended for a longer time period (if available in your schedule). Another factor in formulating a treatment plan is to retain the flexibility to make changes and adaptations during your session when palpation findings provide more information on soft tissue conditions and as you receive feedback from the client. Upon client approval of your treatment plan, explain where you will begin on the person’s body, where you will subsequently transition to, and where you will finish the session. Ideally, your session protocol will be performed by moving from one body area to another in a sequential, systematic order, providing continuity and flow throughout the session. Whether relaxation or pain relief is the goal, explaining the details of how you will proceed can ease any potential anxiety or fear, especially with new clients. If applicable, explain when you may ask client to turn over, how you want the person to turn over, and that you will adjust the face cradle, support bolsters and draping. Body positioning If your interviews take place in the waiting room of your establishment, once it’s finished, take clients to the treatment room. Whether you normally begin your sessions with clients in the supine or prone position, your explanation of your approved treatment plan format will have established the position you prefer. However, a client’s past massage experiences may have begun with an opposite starting position. As a gesture of concern for this client’s preferences, you may offer to begin in the position most comfortable to the person. Being flexible in your approach may mean reversing the order of your proposed plan of treatment. In such cases, explain your new protocol and again ask for the client’s approval. If you feel the session would have greater effectiveness by not following a client’s preference, discuss your rationale after the session and ask whether the client would be willing to try your proposed method in the next session. If the client agrees, then after that next session, ask how the person feels to determine how future sessions will be performed. There are differing points of view among therapists on which position to begin a session, and both have merits. But the ultimate decision should rest upon the client’s comfort. Supine position If the session is to begin in the supine position, place your hand on the table to show clients exactly where to position their head. Be sure to emphasize that the head should be completely on the table rather than extending over the edge. Next, illustrate the position of the legs centered over the bolster. Let clients know you will adjust the bolster if necessary. Explain that the bolster support can alleviate any lumbar back discomfort, and emphasize you will check on their comfort level with the bolster and add additional support if necessary to achieve comfort in the supine position. When clients have neck pain complaints, offer a pillow support under the head and check to whether they are more comfortable with or without the support. Ask people who prefer pillow support whether they can comfortably tolerate not having it while you perform any cervical treatment techniques and note that you will replace the pillow when you complete that area. If removal is uncomfortable, be flexible and treat the neck while on the pillow. If the treatment plan dictates changing body positioning, tell clients that just before having them turn over, you will remove the support and replace it in an appropriate position after they’ve turned over. Explain that you will set up the face cradle before having them turn over as well and how it may be adjusted. Lastly, when it comes time to transition their body position, describe how you will lift the draping just enough for them to roll over away from your side of the table. Show them how you will perform this so that their body will be unseen during the process, which will emphasize that your respect the client’s privacy. This same method should be described when clients transition from the prone position. Prone position For clients beginning in the prone position, explain that you can adjust the face cradle for their comfort. In describing the bolster support for this position, physically illustrate where the placement of the pillow/ bolster should be to support the front of the foot/ankle area. Ensure when you return to begin treatment that toes are positioned at the edge of the pillow for maximum client comfort and not on the table, bent in a flexed position. Also let them know where the bolster will be positioned in the supine position when changing from prone to supine during the session. Explain that in either body position, you will remove the bolster by sliding your hand under the ankle area and gently lifting their legs to remove and replace the support bolster. Another consideration for females with large breasts is to place pillow support under the abdominal area to ease pressure on the chest in the prone position. This same pillow/bolster positioning may also be more comfortable for any client with lumbar back discomfort. Side lying position For clients unable to receive a comfortable massage in the supine or prone position because of pain or for a pregnancy massage, an effective session can be achieved in a side lying position. The knees may be brought up enough to flex the hip area with a pillow placed between them. Give clients a pillow to hug in front of them and place a pillow under their head. Explain how you will remove the pillow between the knees and the one they are holding when it is time to roll over to their other side and that you will replace the pillows in the same positions as before. It is wise to keep a supply of several pillows to accomplish any type of body positioning. Arm positioning Client should be instructed to have their arms at their sides on the table in the supine position. This is not always possible, depending on the size of the client or width of the table. If a client’s hands only slightly dangle off the table and do not impede your ability to perform your treatment comfortably and without incurring contact with your body, you may proceed in this position. If this is not the case or the arms or hands extend substantially off the table, it will be prudent to use the draping to wrap around the hands and tuck gently under the body to secure them on the table. In the prone position, it is essential to tell clients the best suitable position for their arms. First, explain it is not desirable to place their arms forward with their hands resting on the face cradle or dangling off the front of the table. Explain that in this position, their upper back muscles, especially the trapeziums, will be in a contracted position that will not allow you to use your techniques as efficiently to relax them. Ask them to place their arms at their sides on the table as a position of preference or dangling off either side of the table. You can always use the tuck draping of the hands next to their body if needed. Acknowledge that ultimately, though, whatever position is most comfortable for them is OK, even if it means resting their hands on the face cradle. Draping Your description of draping can be done before or after you explain body positioning. Most clients prefer draping that covers their entire body. While sheets are the most common material for draping, full body towels are at times preferred because they provide a more secure feeling of coverage and additional warmth for the client. Be sure to have blankets available for client comfort as well. For clients who feel overheated with full body draping, you can tuck the draping between the legs exposing the legs as long as genital areas are covered as well as the breast area for females. Adjusting the room temperature to a cooler setting is also an option. Be explicit when you point to and tell clients to cover themselves with the draping upon getting on the table. Let them know you have additional sheets, towels and blankets if needed for their comfort. Finally, tell them you will only uncover each body part being treated and recover them when finished as you move around their body while always respecting their privacy. If you tuck the draping under their legs Page 14 Massage.EliteCME.com