Before hands on treatment can begin some time is spent just looking at the patient/client. Its important to observe how he or she walks, stands, sits, breathes, holds their hands, crosses his legs, reads intake forms, rubs his neck, carries a purse, backpack, or briefcase. These and myriad other behaviours provide clues regarding the nature of the problem. While some patients will have difficulty identifying the sites or patterns of their pain and sometimes even the severity, the observant clinician can learn a great deal by paying close attention to this person who has come for help. It is rare that muscular constrictions and trigger points exist in an isolated, single muscle. Careful attention to these details can reveal a great deal about the unique and often complex pattern presented by each patient. Watching how the patient rises from a chair, gets on or off a treatment table, removes a coat, or wears out his shoes can provide valuable information leading to the effective treatment of his complaint. As in many medical therapies the clinician must be part detective, developing an ability to pick up on these clues, since they can be as important as any diagnostic testing procedure.
Of course a complete history and will completed after this. Which involves medical history, medication and any other issues the client may have.
The next step after observation and a full history has been taken would be palpation. Through touch the patient discovers much about the nature of the practitioner. That first touch tells the patient whether you are gentle or rough, respectful or invasive, careful or careless, and most importantly, if you know what you are doing. It is a good idea to first palpate the area where the patient is complaining of pain, since it demonstrates, in a matter of seconds, that you understand that he or she has pain and that the pain is there, where you are palpating. So often patients will exclaim, “That’s it,” or “exactly” and with those two words they have begun to accept and trust you as a practitioner. As the practitioner explores related areas the patient will often remember pains or injuries that were not mentioned in his medical history. This is a very common occurrence. It is as if the palpation examination opens new doors in the patient’s understanding of his own problem and encourages him to come to some insight regarding the direction of treatment.
Palpation is an art and a skill. It requires work, practice, and the constant awareness that you are touching a person, not just a muscle. As most myofascial problems involve sequences of numerous associated muscles, effective examination will generally involve extensive palpation around the area of most acute presentation. In acupuncture, a common assessment principle has the practitioner examine left and right, up and down, and front and back relative to the presenting region. This simply means that if a patient is complaining of pain in the left lumbar region, examination should include the right lumbar region, the upper back and shoulders, which would include the rotator cuff muscles, the buttocks and legs, and the abdomen. Such wide examination not only renders significant information but also respects the patient as a whole person.
Learning to touch another person includes awareness that the body will often tense to “guard” itself against invasive touch, particularly in painful areas. Such responses mitigate effective palpation, so the practitioner must learn how to touch, gradually applying pressure and earning the trust of his patients to allow for accurate palpation.
Regardless of the particular method of treatment employed, skillful palpation is the defining factor differentiating highly successful practitioners from those who obtain erratic results. Regardless of theory, method, or amount of treatment, skilful palpation is without doubt the singular most important component of any treatment. This is one of the most important things that I practice at my massage Cardiff
Listen closely. First, the patient has direct experience of the problem. His descriptions of what he feels and when and how he feels it are extremely important pieces of data. Second, many patients with chronic pain have suffered the experience of being told that the pain is “in their head” or “isn’t real.” They will often feel they have to convince you of the reality of their experience. Listening and confirming their
“Educating patients about the nature of myofascial pain syndromes, showing them wall charts of pain patterns, describing postures and movements that can trigger pain patterns as well as what kinds of organic dysfunctions might be associated with such syndromes is important. We have seen patients lose their tension and anxiety as soon as they saw their pattern on a wall chart; many have exclaimed, “I’m not crazy!” This kind of confirmation and education goes a long way in establishing a relationship that leads to effective treatment.
Additionally, it is important to remember and respect the subjective nature of the experience of pain. What might seem to be a mildly constricted area to your touch can in fact be a source of considerable pain to the patient. As you listen to your patient, listen them closely and embrace their reality.
Treat with precision and attention. The following approach to patient care is designed to help to focus in on the problem at hand and its resolution.
Clearly define the areas of pain and restrictions of movement that the patient is experiencing. Have him delineate, and perhaps draw, the areas of the body that feel painful. Have him demonstrate the movements that cause pain. Be certain that you understand, to the best of your ability, what he is experiencing.
Determine the various muscles that might be the source of your patient’s pain and restriction. Utilising the pain pattern and symptom indices will be useful in this determination.
Palpate for constrictions and taut bands in the individual muscles that you have hypothesized to be the source of the difficulty.
Palpate associated regions for additional constrictions and taut bands. It is important to palpate the entire body, anterior and posterior, to determine associated constrictions. Additionally, awareness of the pathways of meridians and cutaneous zones will provide a guide for identifying restrictions that might lie outside of the affected quadrant.
Locate individual taut bands in the involved muscles. “Capture” the band with precise palpation and compression. Define the specific trigger point along the taut band through focused palpation.
Apply treatment to the trigger points. Once the bands and trigger points are captured, maintain pressure through ischemic compression until softening of the point occurs. This can be used for treatment in and of itself; however, if acupuncture needling is used or dry needling, lightly peck the point until you feel a softening of the band under the hand that is compressing the muscle. Palpation of the region after treatment will provide feedback as to whether or not there has been a complete release of the muscle.
Repeat this process of treatment with each area of constriction in each region that you identified as having restrictions. This is an essential component in obtaining complete release.
Apply moist heat. Whether in the office or at home, moist heat should be applied to the treated regions to increase blood flow to the areas. This should be done for at least twenty minutes each day for three days following treatment.
Provide a stretching program. Once the patient has had moderate release of muscular constrictions, instruct him in appropriate stretching exercises to maintain the release of the muscle. These should be done several times a day. Performance of the stretch should not produce pain.
Provide a strengthening program. When the patient has been pain free for seven to ten days, instruct him in appropriate strengthening activities, if the muscle needs reconditioning.
Teach your patient how to breathe.
These are all key factors in treating trigger points within muscles.
To read more about sports massage please read my post on there benefits and reasons for having one.