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April 4, 2006

A Reader's Case Study Question

A reader posed this question:

I am a student at PMTI in Washington, DC. As part of our curriculum we are have to consult with a professional outside of our school in regards to our case study project. I would like to get your opinion about what my approach should be for a client who was in an auto accident, what assessments do you use when evaluating clients who have had traumas such as car accidents, what have you found to be most helpful in dealing with clients who have been in vehicle accidents, and how do you address the client's concerns to increase ROM?

My first session with this client is coming up soon and I would like some advice.

Dear Reader,
Concerning your accident case: First, take the time to ask the client about the accident and take a detailed intake of the client's health. Also, ask where they hurt and assess range of motion (it appears you have laid the groundwork for this already.) Unfortunately, I don't have names to give the specific assessment techniques that I use, though I'm sure they all have names.

I rely mostly on my hands to assess and facilitate the body's journey back toward stasis. So, once you get them on the table, trust your hands. They may say they hurt one place, but you will find other areas where they exhibit tension and tenderness. Document this well. I would begin massaging the painful areas with gentle pressure and broad tools while checking in with the client's comfort level and establishing a pain scale for good communication. My scale is generally pain from 1 to 10 with 1 being no pain and 10 being unbearable. 5 is "hurts so good" and I consider this the therapeutic level. You may find some clients in distress with pain in the 3 to 4 range. You will have to work slowly with these clients to establish their trust and confidence in you and the process.

Massage deeper as you feel the muscles starting to relax--still using the pain scale. Keep in mind that with a blow to the vehicle on the left side that the body was jarred sharply to the right. Put yourself in that seat and go through the motions of experiencing the impact. Where do you feel tension, pulling, awkward positioning in your body? Keep those in mind during your palpation process. Okay, think beyond that about the reciprocal action of the body coming back to rest or straining to prevent injury on the opposite (right) side of the neck. Check there for tension.

If you find a particularly tight muscle that doesn't respond well to pressure, try backing off of the pressure until you feel the tissue starting to change or shift. Don't forget the use of heat (I use my hot stones in cases like this) or ice. Or you can work elsewhere and come back to that muscle later--it may need some other muscle to release before it is willing to give up its vigil.

I don't know what classes Potomac offers as part of your core program, but I use craniosacral therapy for all my accident cases. It is, in fact, what cured me of my whiplash and got me interested in becoming a massage therapist in the first place. Cranial base release is one of the most valuable tools, if you have them, and don't forget to release the little hyoid bone in the front of the neck using this technique.

Okay, finally, you may want the client to test their range of motion during the session to see how well you're doing. This way you can immediate feedback from the client about your work and change game plans if things aren't working out. They can also tell you if things are improving where you need to go next if tension is migrating or muscle is only releasing partially-two heads are better than one. Your clients need to be aware that their care is a partnership with you. You are there to facilitate their healing.

Posted by linda at April 4, 2006 12:32 PM