Client Assessment

1. Client Assessment Posture and Range of Motion

2. Reasons for Assessment • To define the most appropriate massage session. • To refer the client to another health care or medical professional when necessary.

3. Gravity and Posture • Gravity is a constant force that ‘can’ work against proper body posture. • Many postural disorders (kyphosis, anterior head carriage, etc.) occur because something has decreased the body’s ability to overcome the force of gravity.

4. Gravity in Massage • Bodywork practitioners can use gravity to their advantage. • It is important to position the client correctly to minimize the amount of unnecessary bodywork on the part of the practitioner. • Standing • When a person stands up, gravity draws blood from the upper portions of the body down to the lower extremities. If the body does not adapt quickly enough, the person may become light-headed, dizzy, or faint. • Stroking • When using massage strokes to reduce inflammation, the inflamed part of the body can be elevated above the heart so that gravity will help draw fluid out of the extremity.

5. Palpation • Palpation requires the ability to differentiate, compare, and assess many qualities of the body through touch. • Palpation can help us to detect the following: • Tension • Temperature • Texture • Movements • Pulses • Adhesions • Energy flows and blocks

6. Postural Analysis • Correct posture is best described using a plumb line as a reference point. • A plumb line is a cord suspended from a fixed point with a plumb bob or other weight attached at the bottom. • As the client stands by the plumb line, distortions and faulty alignments are easily seen. • From the anterior view, all structures front and back should ideally be symmetrical about the plumb line. • From the lateral view, certain bony landmarks can be compared with the reference line to assess proper alignment.

7. Lateral View Landmarks • From the lateral view, the reference line should be positioned as follows: • Slightly anterior to the lateral malleolus. • Slightly anterior to the midline of the knee joint. • Approximately through the greater trochanter (posterior to the axis of the hip joint). • Midline of the trunk (through the bodies of the lumbar vertebrae). • Through the shoulder joint. • Through the bodies of the cervical vertebrae. • Through the lobe of the ear (external auditory meatus).

8. Range of Motion • Active Range of Motion • The client moves a part of his body using his own power. • Passive Range of Motion • The client relaxes and the practitioner moves his body.

9. Active Range of Motion • Ask the client to move his body part and joint in the direction you wish to measure. • Let the client move himself without any help from you. • Measure the degrees of motion the client achieves in the joint with a measurement tool such as an inclinometer or a goniometer.

10. Passive Range of Motion • Ask the client to relax the body part or joint you wish to move. • As you move the joint in the direction you wish to measure, notice any resistance the client is giving back. • Notice any resistance from the client’s muscles. • Once you have moved the joint through as much motion as it will go, notice the end-feel of the joint. • Hard end-feel – two bones come together. • Firm end-feel – a tendon or tight ligament has stretched. • Soft end-feel – a muscle is tight or the joint is swollen. • Measure the degrees of motion the client achieves in the joint with a goniometer or inclinometer.

11. Strength • You can learn muscle testing and muscle screening techniques to assess muscle strength. • To test a specific muscle strength, place the muscle in a shortened position and press gently, but firmly in the opposite direction that the muscle would normally move in. Gradually increase your pressure until the patient’s strength gives out or the arm starts to move.

12. Visual Assessment • Gait or walking pattern • Is each movement smooth, balanced, and symmetric? • Posture • What kind of posture does the client assume? • Basic body structure • What kind of basic body structure does the client have? Does he have any deformities (uneven shoulders, uneven hips, lordosis, kyphosis, scoliosis) • Movement patterns or restrictions • Does the client exhibit any range of motion deficits that involve a joint or the surrounding muscles, tendons, or ligaments? • Eyes • Does the client maintain good eye contact?

13. Visual Assessment • Visible pathologic conditions • Are there any visible pathologies (i.e. varicose veins, bruises, inflammation)? • Breathing • Is the client’s respiration normal? (rhythm and depth) • Sympathetic or parasympathetic condition • Is the client anxious, angry, excited, agitated, or restless (sympathetic condition)? Is the client relaxed, calm, content, or depressed (parasympathetic condition)? • Emotional condition • Can you deduce any more about how the client is feeling by how he looks? • Physical condition • How much energy does the client display? Does he appear energetic or tired?

14. Structural Compensatory Patterns • The body has many structural compensatory patterns for musculoskeletal disorders. • Alignment – the natural position of a bone or limb as it relates to gravity. Joints required to function out of their normal position often become misaligned.

15. Structural Compensatory Patterns • Hyper-mobility – a condition in which a joint has more range of motion than would normally be permitted. This is usually associated with lax ligaments. • Hypo-mobility – a condition in which a joint has less range of motion than would normally be permitted. This is usually associated with tight ligaments or contractures (shortening of soft tissue structures around a joint). • Substitution – an attempt of one muscle to function in place of another muscle that fails to perform because of pain or weakness. This often results in faulty movement patterns and can lead to unbalanced or strained muscles.