Question:
Hello everyone,
I recently qualified with a Sports massage diploma and am currently trying to get work in a Physio's or Osteopaths which I think will be a great way to build up my experience. It's going quite well but I want to understand more about sports injuries so I don't have to seem gormless in front of clients & employer. My course drummed it into us that we aren't there to diagnose but what happens if somebody has a pain in their elbow which appears to be soft tissue related and not a joint problem? I want to say something informed but don't feel that way at present.
I feel like I've got oodles of enthusiasm but want to build on my knowledge without having to blag it in front of people.
Did anyone else feel like this when they first qualified? How did you get over it?
Any ideas of how to deal with this would be much appreciated.
Thanks KW
Hi and congrats on passing your Diploma (with?)
IMHO the simplest way to think about treating pain / dysfunction is to use ROM assessment (Active,Passive,Resisted) of affected joints. This will point toward the primary cause (eg: what muscles are affected). Once you 'know' which muscle(s) are a potential 'problem', treat them (using whatever techniques you have learnt) finishing off with stretching or (pref) MET
Re-assess to see if the 'problem' has been resolved or improved.
Appologies to all (who know 'better') for this grossly simplified explaination but in my 12yrs practice (and teaching) it is extremely effective, it's major weakness however is that it my just result in treating symtoms rather than cause (so problem may return)
The one thing YOU DO NOT NEED TO KNOW in order to treat a problem is what it's called [sm=soapbox.gif]. for example
Version 1
Client: I've got a pain on the inside of my elbow
Therapist: I know what that is :D
Client: What?
Therapist: Golfers elbow (or if I want to be flash...medial epicondylitis)
Client: Oooo that sound bad what can I do about it?
Therapist: Rest it and put some ice on it..........£30 please
Client: errrr Ok then..........thanks [sm=eeeK.gif][sm=banghead.gif]
Version 2
Client: I've got a pain on the inside of my elbow
Therapist: (thinks... I didn't do elbows. [sm=confused-smiley-012.gif]....... what should I do?) I know .........a ROM [sm=idea.gif]
Client: Flexing my wrist is ok unless you resist it. Extending my wrist is painful unless you resist it.
Therapist: It seems like your wrist flexors are the source of your problem since contracting them hurts and stretching them also hurts.(thinks still don't know what it 'is' though)
Client: Oooo that sound bad what can I do about it?
Therapist: I'll show you some stretches / exercises you can do to help, but before them, let me 'massage /paplate' it to see if I can free up the muscles which might be restricting / affecting the 'quality' of the movement.
Client: Sounds good
Therapist: Right, now I've freed up the muscles see how it feels now
Client: Feels much better [sm=jump1.gif]how much do I owe you?
Therapist: £30 please, but what I'd also like you to do is these stretches / strengthening exercises
Client: Bargain
[sm=food-smiley-004.gif]
what about asking folks to post or send you case studies with treatment to give you an idea of what has been done.....might helo you....
Get a good medical intake form with diagrams and special test protocols... keep it simple... but it will look effective and profcient.... not just the one you got in school... make your own up so as you can follow a treatment with the form giving you handy hints....
see you
hi kw,
i'm a relatively new remedial massage therapist so i understand where you are coming from. trying to remember your training whilst being professional in front of a client is really difficult... there have been times i've wanted to throw myself on the ground in front of the client and scream "i'm a fraud, i don't know anything, please forgive me! aaargh!"
i'm a big fan of tests. if you know your rom and strength tests then you can always fall back on them with presented with something unfamiliar. it's a good way of drilling down by a process of elimination. they also help you track progress in a client. and i agree with ruth, a good screening form is essential.
also get some books on injury and treatment, but to echo dfnu's comments... try not to assume or pigeon-hole.
most importantly, listen to the client. i would say that most of the time they subconciously know what the cause is, you just need to give the room to talk about it. i've given trying to find the one-stop-shop solution to whatever condition they might have. i'm only human after all.
i try and use language like "because of this [restriction/lack of rom etc]and the type of pain you are experiencing, there's a suggestion that it might be related to this [muscle/condition etc]. i suggest we do this and this and this and see if we can get some relief for you. how does that sound?" i'm not telling them i know what it is, i'm just refering them to the results of my tests, suggesting what those tests and the type of pain could be related to and asking them if they would agree to a particular line of treatment.
does that help at all?
x
henry
p.s. hi ruth, when/where's your course?
i meant "...given up trying..."
:eek:
You have to remember that you arent trained to diagnose, and as such you need to know your limitations. GP's and Physiotherapists diagnose, but with your training you should be able to assess what the problem is, whether it be muscular, ligament or skeletal. The problem starts when people misdiagnose, and try to complicate things by finding a 'named' sports injury....look at the symptoms and the outcome of your examination, and treat as you find.
You arent a fraud, you are just working within your own limitations, which we all have to do, whatever the level of our training.
Believe me there are so many mistakes made by the medical profession 'misdiagnosing', and thankfully this is not a problem that this industry suffers with.
More and more clients are turning to sports & remedial therapists because they feel they get a more effective treatment, because the majority will treat the cause and not just the symptoms.
by the way, the advice given by DFNU is spot on :D
Thank you so much for all your replies! They were really useful. I especially like DFNU's theoretical conversation with a client - it's been really good to get an idea of good language to use.
Since I posted this thread I've got a job in a physio's and an Osteopaths! I'm really loving it and feel much more confident dealing with different problems. My first day was hugely nerve racking but I've really settled into it.
I love doing massage and am so happy that I don't have to spend every day in an office!!
Thanks again,
KW
I recently qualified with a Sports massage diploma and am currently trying to get work in a Physio's or Osteopaths which I think will be a great way to build up my experience. It's going quite well but I want to understand more about sports injuries so I don't have to seem gormless in front of clients & employer. My course drummed it into us that we aren't there to diagnose but what happens if somebody has a pain in their elbow which appears to be soft tissue related and not a joint problem? I want to say something informed but don't feel that way at present.
I feel like I've got oodles of enthusiasm but want to build on my knowledge without having to blag it in front of people.
Did anyone else feel like this when they first qualified? How did you get over it?
Any ideas of how to deal with this would be much appreciated.
Thanks KW
Answers:
Hi and congrats on passing your Diploma (with?)
IMHO the simplest way to think about treating pain / dysfunction is to use ROM assessment (Active,Passive,Resisted) of affected joints. This will point toward the primary cause (eg: what muscles are affected). Once you 'know' which muscle(s) are a potential 'problem', treat them (using whatever techniques you have learnt) finishing off with stretching or (pref) MET
Re-assess to see if the 'problem' has been resolved or improved.
Appologies to all (who know 'better') for this grossly simplified explaination but in my 12yrs practice (and teaching) it is extremely effective, it's major weakness however is that it my just result in treating symtoms rather than cause (so problem may return)
The one thing YOU DO NOT NEED TO KNOW in order to treat a problem is what it's called [sm=soapbox.gif]. for example
Version 1
Client: I've got a pain on the inside of my elbow
Therapist: I know what that is :D
Client: What?
Therapist: Golfers elbow (or if I want to be flash...medial epicondylitis)
Client: Oooo that sound bad what can I do about it?
Therapist: Rest it and put some ice on it..........£30 please
Client: errrr Ok then..........thanks [sm=eeeK.gif][sm=banghead.gif]
Version 2
Client: I've got a pain on the inside of my elbow
Therapist: (thinks... I didn't do elbows. [sm=confused-smiley-012.gif]....... what should I do?) I know .........a ROM [sm=idea.gif]
Client: Flexing my wrist is ok unless you resist it. Extending my wrist is painful unless you resist it.
Therapist: It seems like your wrist flexors are the source of your problem since contracting them hurts and stretching them also hurts.(thinks still don't know what it 'is' though)
Client: Oooo that sound bad what can I do about it?
Therapist: I'll show you some stretches / exercises you can do to help, but before them, let me 'massage /paplate' it to see if I can free up the muscles which might be restricting / affecting the 'quality' of the movement.
Client: Sounds good
Therapist: Right, now I've freed up the muscles see how it feels now
Client: Feels much better [sm=jump1.gif]how much do I owe you?
Therapist: £30 please, but what I'd also like you to do is these stretches / strengthening exercises
Client: Bargain
[sm=food-smiley-004.gif]
Answers:
what about asking folks to post or send you case studies with treatment to give you an idea of what has been done.....might helo you....
Get a good medical intake form with diagrams and special test protocols... keep it simple... but it will look effective and profcient.... not just the one you got in school... make your own up so as you can follow a treatment with the form giving you handy hints....
see you
Answers:
hi kw,
i'm a relatively new remedial massage therapist so i understand where you are coming from. trying to remember your training whilst being professional in front of a client is really difficult... there have been times i've wanted to throw myself on the ground in front of the client and scream "i'm a fraud, i don't know anything, please forgive me! aaargh!"
i'm a big fan of tests. if you know your rom and strength tests then you can always fall back on them with presented with something unfamiliar. it's a good way of drilling down by a process of elimination. they also help you track progress in a client. and i agree with ruth, a good screening form is essential.
also get some books on injury and treatment, but to echo dfnu's comments... try not to assume or pigeon-hole.
most importantly, listen to the client. i would say that most of the time they subconciously know what the cause is, you just need to give the room to talk about it. i've given trying to find the one-stop-shop solution to whatever condition they might have. i'm only human after all.
i try and use language like "because of this [restriction/lack of rom etc]and the type of pain you are experiencing, there's a suggestion that it might be related to this [muscle/condition etc]. i suggest we do this and this and this and see if we can get some relief for you. how does that sound?" i'm not telling them i know what it is, i'm just refering them to the results of my tests, suggesting what those tests and the type of pain could be related to and asking them if they would agree to a particular line of treatment.
does that help at all?
x
henry
p.s. hi ruth, when/where's your course?
Answers:
i meant "...given up trying..."
:eek:
Answers:
You have to remember that you arent trained to diagnose, and as such you need to know your limitations. GP's and Physiotherapists diagnose, but with your training you should be able to assess what the problem is, whether it be muscular, ligament or skeletal. The problem starts when people misdiagnose, and try to complicate things by finding a 'named' sports injury....look at the symptoms and the outcome of your examination, and treat as you find.
You arent a fraud, you are just working within your own limitations, which we all have to do, whatever the level of our training.
Believe me there are so many mistakes made by the medical profession 'misdiagnosing', and thankfully this is not a problem that this industry suffers with.
More and more clients are turning to sports & remedial therapists because they feel they get a more effective treatment, because the majority will treat the cause and not just the symptoms.
Answers:
by the way, the advice given by DFNU is spot on :D
Answers:
Thank you so much for all your replies! They were really useful. I especially like DFNU's theoretical conversation with a client - it's been really good to get an idea of good language to use.
Since I posted this thread I've got a job in a physio's and an Osteopaths! I'm really loving it and feel much more confident dealing with different problems. My first day was hugely nerve racking but I've really settled into it.
I love doing massage and am so happy that I don't have to spend every day in an office!!
Thanks again,
KW
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