Our clients are smart enough to choose massage therapy to meet their needs when they are stressed or in pain. However, massage therapy is very broad based in what it offers, and often our clients’ needs change from session to session. It is therefore necessary for us to learn to draw the information from our clients that will clarify what their needs are each time they come for a session.

Some massage therapists who do relaxation massage tell me that they always do exactly the same routine even to the point of using the same music and lighting every time. When I asked them if their clients had any health or lifestyle changes, their answer was yes, there were several, but they were coming only for relaxation massage so they had never changed their routine. My suggestion to one of these massage therapists was that she talk with her next client about updating her information so that she could adjust her treatment to more effectively meet her client’s needs. I also suggested the she give her client a new intake form, and have the client choose new music and lighting. When I talked to this massage therapist a short time later, she mentioned that her client had indeed chosen different music and brighter lights, and had listed different goals and health conditions on the intake form. Based on the new information, the therapist gave the client the option of spending the majority of their time working in the head, neck and shoulder area to address the stress headaches that the client had been having for the last four months associated with a job change. This example perfectly illustrates why it is important for us as massage therapists to spend time at the beginning of each session to find out what the client’s needs are for that session, and adjust our room and/or routines to better meet those needs.

When I am teaching therapeutic massage techniques I spend time communicating the necessity of meeting clients’ needs. Frequently, massage therapists who take advanced therapeutic technique classes after several years of applying other massage techniques will report that they are hesitant to try these new techniques on their current clients. They are afraid that they won’t like them since they are used to a pre-established routine. When I ask them if they evaluate their clients before beginning a session, their response is usually "no." They will tell me that they know their clients, and that they will expect their normal full-body routine. After over 30 years of a therapeutic massage practice, my response to this is to have the massage therapist share with the client that they are learning new skills in order to be more effective in their treatment. Most massage therapists find that clients are very interested in at least trying out the new advanced techniques that their therapist has spent time and money to learn. When they ask the client to fill out a new intake form to clarify their present needs and problems, they usually find that their clients’ needs have changed. In addition, clients tend to have more confidence in their massage therapist because the therapist is taking the time to re-evaluate their clients’ health needs, and to offer solutions with advanced massage techniques that could more effectively meet those needs.

Another evaluation tool for massage therapists doing therapeutic work is the SOAP notes. With the SOAP notes you first have the subjective report of your clients’ conditions. If you listen carefully to your clients there is usually a wealth of information about how to proceed with treatment. In addition, there will be the development of trust and report. This is the clients’ chance to be heard by a caring and attentive therapist as compared to other healthcare professionals who will often report coldly from an x-ray or medical test. This builds rapport quickly, and the client will be more willing to cooperate with the massage therapist for their well-being.

The second part of the SOAP notes, the objective findings of the therapists, also helps build rapport. The therapist will be able let the clients know that their findings are providing the information necessary to determine the most effective treatment. Clients who have not been told the parameters for their problems, and what can be done about them, tend to respond less favorably than clients who have been given this information. They will be able to better understand how therapeutic treatments can rehabilitate their conditions.

The next challenge that is also the next step in the SOAP note is the application of a therapeutic protocol. This is simple if a client has a condition that is limited to one area of the body. However, the vast majority of our clients are much more complex than this and so are the problems. Even conditions of the extremities such as plantar fascitis and carpal tunnel syndrome have their roots in the structural imbalances that can be found throughout the client’s body. They are often painful symptoms of a significant imbalance from the basic core distortion. Briefly explained for those of you who are not familiar with the musculoskeletal condition of the core distortion, there is an anterior/posterior rotation of the iliums, an exaggerated scoliotic curvature of the entire spine from the sacrum through the cervical spine, a difference in a leg length resulting in a long/short leg, an internal rotation of the arm and a high/low shoulder relationship. This distortion is found in 99.99% of the population, and every client has a different degree of structural collapse within this core distortion pattern. It is seldom that musculoskeletal problems are not in direct relationship to the structural collapse found within this full body core distortion.

When you take into account the full body involvement of the core distortion and all the resulting compensations, it may be more difficult to determine the optimal treatment application for clients, especially when they only complain of a problem in an extremity. One of the ways you can evaluate the effects of the core distortion in the body for both you and your clients is by using applied kinesiology (muscle testing). With this technique specific muscles will test strong when the bones and musculature are in balance, and will test weak with approximately 30% of normal muscle strength when they are out of balance. If you know applied kinesiology and can use it in your objective evaluation of your clients’ conditions, your clients will quickly understand that their conditions are not limited to just one area of pain. The understanding that is easily communicated to your clients using applied kinesiology is the necessity for you to treat more than just the small specific area of pain and discomfort.

The majority of our clients have more than one area of pain and discomfort. Sometimes these can be as diverse as neck and shoulder pain with ankle and foot pain where both conditions are at the opposite ends of the structure. If we view these conditions within the core distortion, it is obvious that they are related, and that to fully resolve the problem both need to be treated.

Obviously, good communication with our clients is necessary. If the client has been coming for relaxation massage and now has a condition where therapeutic massage is a more appropriate treatment, it is necessary to communicate from our objective evaluation what the condition is and the benefits of therapeutic treatment. We also need to explain to the client that, unlike a relaxation massage where we treat the whole body, a therapeutic protocol will only address the areas that need treatment. The client must also understand that, due to the time spent on the therapeutic treatment to specific areas, the rest of the body most likely will not be treated. Clients will be able to make the choice between therapeutic or relaxation massage after given the above information. If the client is unclear that they are giving up a full body relaxation massage for work on only parts of their body, they are not likely to be happy. In addition, a client who chooses the therapeutic work will be more likely to cooperate with the massage therapist to accomplish the therapeutic goals.

There are times when clients will have a number of challenging conditions, all producing pain and discomfort. As massage therapists we need to have the knowledge of the structural dysfunction relating to the pain. In addition, the client will usually give us the decision making power as to which area it is most important to work for the session. I find it is important to find out from the client where the most pain and discomfort is coming from, and to understand how this area is related to the structural collapse of the core distortion. If the client has several areas of pain and discomfort, it is also necessary to communicate to the client why one area is more important to work than another, and give them information on the criteria that you are using to make your decision. Sometimes just the extent of the client’s pain will override the other structural considerations as to the area that will be treated. However, if you use this as the criteria for making the decision, it will be necessary in another session to include the other areas that will provide structural support to the changes if the improvements are to be maintained. Ultimately within this process we want our clients to be on the most direct road to rehabilitation and to feel that we have been paying close attention to their pains and individual needs. If our clients feel we are ignoring their needs, they are not apt to continue with the treatments necessary for rehabilitation.

The application of therapeutic protocols needs to be the best that we can offer and have a reasonable expectation to produce rehabilitative results. It is your responsibility to continue your education until you have a large enough box of skills to support your clients, or be willing to refer clients when your skills are not up to their needs.

Be sure to note the improvements of each session so the client’s progress can be monitored and tracked. Sharing this information with your clients will also further involve them in their own rehabilitative process, and help them see that their improvements from just one session, even if small, will eventually achieve the primary treatment goals which should include the client being pain free and able to resume normal life activities.

I hope this discussion on meeting your clients’ needs will encourage you to communicate fully with your clients, and to continue to expand your own skills. For more information on how to balance the structural collapse of the core distortion and work deep tissue effectively, please see previous articles of SET TALK, or go to the Publications section of the website for copies of these articles. Keep working to support your clients with the world’s best tools – your knowledge, hands and skills.