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MT101 Introduction to Massage Therapy
Spa Vargas University
MT101 Introduction to Massage Therapy
Chapter 6: Assessment
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Introduction
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General Assessments
Postural Assessment
Gait Assessment
Range-of-Motion Assessment
Appearance of Tissues
Palpation Assessment
Functional Assessments
Post Treatment Assessment
Copyright © 2010 Spa Vargas University
Spa Vargas University
MT101 Introduction to Massage Therapy
Chapter 6: Assessment
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General Assessments
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Does not need to be extensive or time-consuming for
nonspecific relaxation massage for wellness
Gives better idea about contraindications, which soft tissues
to address, and how to address them
Fascia and Fascial adhesions
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Understanding key to massage
Can cause the location of client’s pain to differ from where the pain
originates
fascial adhesions
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adhere to near by tissue
been crumpled or kinked
Caused by
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dehydration
accumulated scar tissue
Repetitive motion
Spa Vargas University
MT101 Introduction to Massage Therapy
Chapter 6: Assessment
Copyright © 2010 Spa Vargas University
Spa Vargas University
MT101 Introduction to Massage Therapy
Chapter 6: Assessment
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General Assessments
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Compensation patterns
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Offset to injury or other imbalance
Registered in muscles and nerves
Implications for massage
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Helps determine treatment focus
Facial lines of tension that radiate from facial restriction
Assessment documentation
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Initial observations can be recorded in “O” section of SOAP
Copyright © 2010 Spa Vargas University
Spa Vargas University
MT101 Introduction to Massage Therapy
Chapter 6: Assessment
Postural Assessment
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Posture can affect a person’s health
Evaluate client’s stance
Ideal posture
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Minimizes stress and strain
Maximizes efficiency
Anterior aspect
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Nose and chin
Sternum
Spine and navel
Shoulders and ears
Pelvis, hands, feet, knees
Spa Vargas University
MT101 Introduction to Massage Therapy
Chapter 6: Assessment
Postural Assessment
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Ideal posture
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Posterior aspect
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Cranium and shoulders
Pelvis and spine
Hands and scapula
Lateral aspect
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Cranium and shoulders
Hands
Pelvis
Knee
Spa Vargas University
MT101 Introduction to Massage Therapy
Chapter 6: Assessment
Copyright © 2010 Spa Vargas University
Spa Vargas University
MT101 Introduction to Massage Therapy
Chapter 6: Assessment
Postural Deviations
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Can add to or cause
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soft-tissue dysfunction
Stress
Exhaustion
Incorrect posture can be learned and reinforced
Abnormal spinal curvature
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Swayback posture
Flat-back posture
Scoliosis (lateral curvature of spine)
Excessive kyphosis, lordosis
Rotation (appearance of turned shoulders)
Copyright © 2010 Spa Vargas University
Spa Vargas University
MT101 Introduction to Massage Therapy
Chapter 6: Assessment
Copyright © 2010 Spa Vargas University
Spa Vargas University
MT101 Introduction to Massage Therapy
Chapter 6: Assessment
Feet
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Foundation of balance
Imbalance can lead to multiple compensation
patterns
Postural assessment performed without shoes
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Check height of arches
Determine if feet deviate medially (toes point in)
Determine if feet deviate laterally (toes point out)
Observe wear patterns on shoe soles
Refer to other healthcare professionals when
appropriate
Copyright © 2010 Spa Vargas University
Spa Vargas University
MT101 Introduction to Massage Therapy
Chapter 6: Assessment
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Gait Assessment
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Observe client’s walking pattern
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Quantity, quality, fluidity, evenness of steps
Alignment of head over spine
Position of shoulders
Arm swing is equal from side to side
Medial or lateral deviation of feet
Extent of knee flexion, amount of bounce
Hip movement is even and fluid
Copyright © 2010 Spa Vargas University
Spa Vargas University
MT101 Introduction to Massage Therapy
Chapter 6: Assessment
Copyright © 2010 Spa Vargas University
Spa Vargas University
MT101 Introduction to Massage Therapy
Chapter 6: Assessment
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Range of Motion
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Focus on client’s area of concern
Determine which joint movements are
affected, how they are affected, and which
soft tissues are involved
Specific joint determines direction and
amount
Measured in quality and restriction
May determine contraindication for
massage
Copyright © 2010 Spa Vargas University
Spa Vargas University
MT101 Introduction to Massage Therapy
Chapter 6: Assessment
Range of Motion
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Two kinds of range of motion
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Active (AROM): client moves joint to demonstrate
how much of the full range can be completed
comfortably and without restriction
Passive (PROM): therapist moves relaxed client
through a ROM to determine full-range limitation
Pain and discomfort caused by PROM can suggest
problems with ligaments and joint structures
which are outside the massage scope of practice
Copyright © 2010 Spa Vargas University
Spa Vargas University
MT101 Introduction to Massage Therapy
Chapter 6: Assessment
Active Range of Motion
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Assesses the muscles and tendons actively involved
in the joint movement
Movement should be slow
Movement performed at steady speed
Movement must be isolated, rest of body still
Movement continues to point of restriction
Therapist should demonstrate movement before
client performs the movement
Watch for nonverbal clues
Copyright © 2010 Spa Vargas University
Spa Vargas University
MT101 Introduction to Massage Therapy
Chapter 6: Assessment
Passive Range of Motion
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Evaluates passive tissues (ligaments, joints, and
joint capsules)
Active range of motion should be performed first
Requires client to be relaxed
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Client must trust therapist
Use gentle, knowledgeable tone of voice
Better determination of indication or contraindication
for massage
Perform carefully to avoid injury
If pain, massage is contraindicated
If no pain, massage indicated
Copyright © 2010 Spa Vargas University
Spa Vargas University
MT101 Introduction to Massage Therapy
Chapter 6: Assessment
Copyright © 2010 Spa Vargas University
Spa Vargas University
MT101 Introduction to Massage Therapy
Chapter 6: Assessment
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End Feels
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Resistance sensation at end of joint range
Specific to structure
Normal end feels classified as hard, soft,
firm
Abnormal end feels classified as hard, soft,
firm, springy block, empty, spasm
Work on recognizing normal versus
abnormal end feels before identifying
specific abnormal end feels
Copyright © 2010 Spa Vargas University
Spa Vargas University
MT101 Introduction to Massage Therapy
Chapter 6: Assessment
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Direction of Ease
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Good tool when clients cannot relax
Uses the direction in which the tissues
move with least resistance
Client’s body position helps determine
starting point
Apply when client continues to tense his
muscles during PROM
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Client pushes or pulls against resistance
Hold for 5 seconds
Muscle naturally relaxes
Copyright © 2010 Spa Vargas University
Spa Vargas University
MT101 Introduction to Massage Therapy
Chapter 6: Assessment
Appearance of Tissues
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Visual assessment
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Skin coloration
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Redness may indicate increased circulation
Paler skin may indicate reduced blood supply
Bilateral symmetry
Marks (moles, varicose veins, scars)
Wounds (sores, rashes, bruises)
Fullness and thickness of soft tissues can point out
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Hypertonicity
Difference in muscle mass
Edema (swelling from accumulated interstitial fluid)
Copyright © 2010 Spa Vargas University
Spa Vargas University
MT101 Introduction to Massage Therapy
Chapter 6: Assessment
Palpation Assessment
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Good palpation skills are critical for massage therapy
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Touching and exploring the body, locating different
structures, and assessing the quality of structural
characteristics
Massage Therapists need to have relaxed hands
“Less is more” is a guideline for palpation and
treatment of soft tissues
Evaluate soft tissues for
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Temperature (local hot or cold)
Textures (hypertonic muscles, scar tissue, restricted
fascia, trigger points, tissue edema)
Movement (fascial adhesions and restrictions)
Rhythm (breathing, pulse, craniosacral)
Copyright © 2010 Spa Vargas University
Spa Vargas University
MT101 Introduction to Massage Therapy
Chapter 6: Assessment
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Assessment of Skin Temperature
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Temperature can be circulation indicator
Excessive heat can be caused by
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Fever: systemic contraindication
Inflammation response to injury
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Determine how long
Less than 72 hours in local area contraindicates
massage
Cold skin can indicate decreased
circulation
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Ischemia (reduced blood supply)
Massage indicated
Copyright © 2010 Spa Vargas University
Spa Vargas University
MT101 Introduction to Massage Therapy
Chapter 6: Assessment
Texture and Movement of Soft Tissues
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Scar tissue and restricted fascia feel bound and stuck
together
Hypertonic muscles feel tight and resistant
Trigger points feel like knots; pain radiates to another
body part
Tissue edema feels spongy or full and squishy
Copyright © 2010 Spa Vargas University
Spa Vargas University
MT101 Introduction to Massage Therapy
Chapter 6: Assessment
Textures and Movements of Muscles
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Normal, healthy muscles feel warm and pliable
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Muscles lacking nutrition feel deteriorated and
insubstantial (dissolving)
Injured muscle tissue
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Open up to receive additional pressure
Slip smoothly past neighboring tissues
Not painful
Feels ropelike
Massage stroke may slow down or bounce over
Repetitive motion muscles feel resistant, tough,
inelastic, and sticky
Copyright © 2010 Spa Vargas University
Spa Vargas University
MT101 Introduction to Massage Therapy
Chapter 6: Assessment
Rhythms
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Body rhythms can provide information about client
Breathing rhythm
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Check rib cage movement for
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Good topic for self-care
Cardiac pulse
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Slow, deep breathing
Fast, shallow breathing
Upper chest breathing
Check for difference in strength of pulse, side to side
Craniosacral rhythm
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Ebb and flow of cerebrospinal fluid
Evaluated for quality, quantity, fluidity
Copyright © 2010 Spa Vargas University
Spa Vargas University
MT101 Introduction to Massage Therapy
Chapter 6: Assessment
Functional Assessments
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Evaluate the client’s area of concern to discover the
likelihood of dysfunctions
Manual muscle tests
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Manual resistive tests
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Clients perform isometric muscle contractions against
counterforce
Determine where muscles have abnormal function because
they are shortened, overstretched, or weak
Active isometric muscle contractions
Determine problem with muscle or tendon
Could possibly indicate more severe neurological condition*
Special orthopedic tests
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Find conditions related to fascia, ligaments, nerves, joints
*Caution: Do not diagnose; refer to healthcare practitioner
Copyright © 2010 Spa Vargas University
Spa Vargas University
MT101 Introduction to Massage Therapy
Chapter 6: Assessment
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Post Treatment Assessment
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Reevaluate original findings
Example:
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Client complained about tight left shoulder before
session
Hypertonicity can be assessed during massage
Shoulder elevation and range of motion assessed
after client is off table and dressed
Document changes in activity and analysis
section of SOAP note
Copyright © 2010 Spa Vargas University
Spa Vargas University
MT101 Introduction to Massage Therapy
Chapter 6: Assessment
Summary
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Assessment is a critical first step to massage therapy
Determining underlying cause is more beneficial and
produces longer-lasting results than just giving a
massage
Suspect compensation patterns; treat them to
restore optimal function
Treat where it hurts, where it is compensated, and
at the ends of fascial restriction
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