● Methods by which to assess improvement during and after the massage. ● The need for special bolstering or propping. ● The need for tools or a hot- or cold-compress ● Observations of the client’s reaction to treatments. ● Post-massage self-care suggestions. ● The need for a referral to another health practitioner (e.g. an acupuncturist or nutritionist). As therapists who possess medical knowledge, there is a broad range of techniques, applications and tools a therapist can use. Exactly what a massage therapist can do in a session is discussed in our next section, Scope of Practice.
techniques to apply during the time allotted so that the client can have a satisfactory outcome for their massage. Along with an understanding of massage techniques, anatomy and physiology leads to what is called clinical reasoning . This is the process of applying skills and knowledge in order to obtain the client’s goals. Since no two clients are the same, clinical reasoning must be used in order to customize a treatment plan for each individual. Overall, the elements of a treatment plan will include but may not be limited to: ● Techniques that may be used during the massage. ● Length of the massage. ● Length of time on a particular area of the body.
SCOPE OF PRACTICE
● A therapist may stretch, mobilize or conduct range-of-motion of the joints of a client. ● A therapist can offer suggestions for the client’s home care such as recommended stretches, self-massage, hot or cold therapy, and methods to help reduce stress such as visualization, breathing or meditative techniques. ● Refer clients to another or more appropriate health care practitioner. The following is a list of things a therapist may not do because they typically lie outside the legal definition of massage therapist in most states. In general, any skill or technique that requires a separate license to practice may not be used in a massage session: ● Acupuncture. ● Use ultrasound machines, use electrotherapy, use laser therapy, inject substances or apply medicated skin patches. ● Conduct nutritional counseling nor recommend any type of nutritional supplements. ● Practice cosmetology or esthetics in an effort to treat the skin for cosmetic purposes. ● No depilating, waxing, electrolysis, or cutting hair in any fashion. ● No conducting colonics or any other kind of internal medicine. ● No ear candling, herbalism, homeopathy or naturopathy. ● No surgery, hypnotherapy or emotional counseling. ● No prescribing, recommending or giving medicines or supplements. A therapist may not aid in giving prescriptions given to a client by a physician. ● No diagnosing of any disease or pathology. ● Intentionally evoke an emotional response from a client. ● Touch, contact or manipulate the genitals in any way. A good rule of thumb is that if there is some doubt as to what cannot be done during a massage, it is best to avoid that technique or application until it is certain that a therapist remains within their scope of practice. To do otherwise may invite legal ramifications.
A massage therapist’s scope of practice details what a therapist may and may not do as far as massage therapy is concerned. A therapist’s scope of practice is defined at the state level as almost all states have a regulatory committee governing massage. Depending upon the state, a therapist’s scope of practice are those things that legally define a practitioner as belonging to a particular practice. Even if a therapist possesses training or certification in an adjunct therapy to massage such as acupuncture or psychotherapy, they cannot legally include techniques used in those therapies in a massage session in most states that govern massage therapy. What follows are the most common statements regarding of a therapist’s scope of practice: ● A therapist may collect and survey a client’s medical information and interview them to create a treatment plan. ● A therapist can assess findings and treatment outcomes. ● Observe a client’s posture standing and walking and test the client’s range-of-motion. ● Determine if a massage should be conducted or not by screening for contraindications. ● Inform a client of the benefits and risks of particular treatment plans. A therapist can obtain informed consent, the permission to treat a client after the treatment plan has been explained. ● Use massage strokes with or without pressure such as effleurage (gliding), petrissage (kneading), tapotement (percussion), traction (pulling of the limbs) holding, jostling, vibration, friction, and use hands, forearms, elbows, knees and feet or other tools to help in the application of massage strokes. ● Reeducate or strengthen weak muscles through the use of active assisted or active resisted exercise. ● Use lubricants to reduce friction on the skin such as lotions, creams, butters, oils, gels and powder, as well as apply ointments, balms, antiseptics or rubbing alcohol. ● Use hot and cold applications such as hot stones, hot towels, heat packs, heat lamps, ice, cold stones, cold towels, use hot and cold contrast therapy, apply muds, clays and salts or sugars to moisturize or exfoliate the skin, do body wraps, use essential oils, and apply sports wraps or tape.
ASSESSMENT FOR TREATMENT PLANNING
In order to plan a treatment information is gathered during the interview. This facilitates long-term solutions to dysfunctions and/or injuries and requires knowing what tissues are at fault or involved and how. While this might seem simple and obvious (ex: pain in the neck is due to some neck muscle dysfunction) cause can be more complex. While it may not always be possible to know exactly what tissues are the primary fault, the more a therapist understands about the causes of dysfunction and injury, the higher the therapist’s success in treating dysfunctions or injuries. This level of treatment planning requires critical thinking skills which are rarely taught in massage school. Before conducting soft tissue assessments, a knowledge of kinesiology – muscles and their actions – is as is a solid grounding in anatomy and physiology. Working knowledge, that is, being able to identify tissues accurately and immediately in a clinical setting takes a commitment to learning and experience.
Effective treatment also relies on applications of massage techniques that fit the goals expressed by the client. Not all massage techniques are beneficial for some injuries. Massage itself can be a contraindication and poorly thought out. Improper treatment plans can be ineffective for the client at the least, and at worst, make the condition or pain worse. Effective massage techniques come from multiple massage modalities. These techniques include but are not limited to the previously listed methods. The point of these assessment tests that are commonly used by physicians and physical therapists is to narrow the focus of treatment so as to treat dysfunctions and injuries more quickly. Although massage therapists cannot diagnose, therapists can pinpoint soft-tissue dysfunctions in planning treatments for clients or even insurance patients in a more clinical setting. This
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Book Code: MLA1224
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