Number two on my top 10 list of things to be a successful orthopedic massage therapist is to investigate and collect data. Let me take a moment to explain what I mean by being successful. I don’t mean successful monetarily. I mean being productive towards meeting your patients’ goals and needs.
You have to gather information to get a comprehensive idea of what your patient is going through. You need to put together the pieces of the puzzle by asking questions and utilizing existing data.
By now you are probably wondering where do I get my data? Your number one data source will be your patient. Talk to them and ask them lots and lots of questions. Get as much information from their other health care providers as you can and if possible, get physical data in the form of x-rays or other medical reports.
What kind of data do I get? I use three kinds of data in my practice, subjective, objective, and supplementary data. Subjective data is information that you get straight from the patient by asking them questions. Objective data is information that you collect yourself. You gather it using your observations, palpation, and intuition. Supplementary data is information you get from outside sources.
Subjective data Includes:
- Where does it hurt?
- How badly does it hurt?
- Does it hurt intermittently or all the time?
- What causes the pain?
- What makes it feel better?
- What have you tried to treat it?
- What were the results of that treatment?
- What other previous injuries or conditions have you had? Often the pain the patient is dealing with today is from compensating for an injury that happened ten years ago, which occurred while they were compensating for an injury two years before that. I want all these pieces of the puzzle so I can understand how one thing links to another.
- What kind of activities do you in your daily life?
- Are you making any repetitive motions?
- What are your hobbies?
- What do you do for work?
- How often do you get up and walk around?
- How many hours do you spend on the computer?
- How long are you up and walking around?
- How long are you standing still?
- Do you have armrests and a backrest on your chair?
- Do you use them?
- Do they feel high or low?
- Do you use a keyboard or mouse more?
- Are you on the phone all the time?
- How are your monitors positioned?
- Where are your eyes in comparison to the middle of the monitor?
- How is your sleep?
- What position do you sleep in?
- How stressed are you?
- Tell me about your stressors.
All these specifics will differ for each patient. Most people who work at a computer all day will have issues in their neck and shoulders, but these issues will be different for each. They are going to use their arms and shoulders and sit in their chair uniquely. Their previous conditions will affect how their current ergonomics are impacting them. There are a ton of details that the patient might not even think to tell you because they don’t understand how they are contributing to their current condition. It is your responsibility to ask these questions to find out.
Objective data includes:
- Postural imbalances
- Range of motion limitations
- Muscle strength or weaknesses
- Gait dysfunctions
Using palpation, you can feel for muscle guarding, muscle spasticity or myofascial adhesions. Don’t discount the power of your intuition. It’s often more subtle information and can be as simple as noticing that the patient is not comfortable with what you are doing and therefore you are not being effective
Supplementary data includes:
- MRI Reports
- Lab Reports
- Surgical Reports
You will see different things on an x-ray than what you can see on an MRI. One isn’t better than the other; they give you different pieces of information. An x-ray does not show the soft tissue. It will show you the bone structure and if bones are in the correct location. It will show you vertebra and joint spacing, and it can also show conditions such as osteophytes (bone spurs) or bone fraying. An MRI will show a muscle or tendon tear and a disk herniation.
You can palpate with your hands, and test for conditions, but you can’t feel a disk bulge. You can’t tell its size or if it’s going medial or lateral. You can’t feel hypertrophy of spinal vertebral ligaments. You can’t always feel scar tissue inside the glenohumeral joint. You might be able to feel or see that a patient’s spine is out of alignment but looking at an x-ray will give you a much more detailed idea of what is happening beneath the skin.
A lot of times, an MRI or an X-ray is just as useful for ruling things out as they are for seeing problems. Many conditions present with the same symptoms but have different causes and require completely different treatments. If you use an x-ray to rule out pain being caused by a bone spur, and then look at an MRI and rule out muscle and tendon tears, you have significantly narrowed your window of possible conditions. Getting the supplemental data from MRI reports and x-rays is very helpful.
I can look at x-rays and get a lot of information, but I can’t read MRI films. So, the reports from the radiologists are beneficial. Radiologists are trained to look at the films and write down what they see or don’t see. A regular radiologist is very different than a chiropractic radiologist. A regular radiologist might write a three-sentence report where a chiropractic radiologist will write five paragraphs. But, no matter what type of report you receive you will still be able to gain information about your client. If possible, I like to actually communicate with an expert to explain to me what I am seeing in the films so I can build a comprehensive mental picture of what is going on in the patient’s body.
Another form of supplemental data is surgical reports. A patient can tell you what surgery they had and why, but you don’t get the details of what went on in the person’s body unless you read their surgical report. As the surgical field continues to advance, more and more procedures are being used. Each procedure has a different effect on the patient’s body. Ten years ago, if somebody had a full discectomy, we knew their spine was going to be fused with rods. Now, they can have rods or flexible connectors, or every prosthetic discs, and partial discectomies are much more common. There are also many options for how surgeries are performed. A surgeon may use laparoscopic techniques, a laser, or a scalpel and each one of these techniques will affect the patient differently.
The number one thing needed to collect data for your patients is time. It’s so uncommon for massage therapists to take the time to collect data. They are trained to book patients on the hour. Fifty minutes of table time and 10 minutes for your patient to dress, undress, and tell you what is bothering them. You can’t get enough information to understand what is going on with your patient for orthopedic purposes in under 10 minutes.
In my practice, especially with my newer patients, I try to spend at least 30 minutes just investigating their situation prior to the session. After the session, I talk to them again after to get an understanding of how they are feeling after the treatment. I also spend time following up hours after the session to see how they feel well after I treated them. Sometimes I ask questions that are delicate and direct, and I make sure to do this tactfully with a caring tone.
Being able to speak directly with my clients’ other health care providers is huge. I work directly with a few chiropractors and I have learned that patients will tell different doctors different things. If you can speak with other people who have treated your client, you can pull information together to best treat them. Often times patients are embarrassed to tell you that they were not happy with the treatment you provided but they might tell another practitioner about their experience. So, if the other practitioner is willing to talk to you, you can gain invaluable knowledge about how your treatment is affecting your patients.
As massage therapists, we can’t order x-rays, MRIs or lab work. However, we can request that the patient see someone who can. I have personally developed relationships with referring physicians that trust my opinion. If I call them up and explain what I think they can recommend diagnostics and we can collaborate over the results.
The biggest obstacle when it comes to collecting data is often you, the massage therapist. You don’t feel qualified to ask for more information, and you feel uncomfortable having the conversation with your client, you don’t have the time to follow up or call other practitioners. You don’t know what to do with the information.
A lot of your information will come from other practitioners. As a whole, massage therapy is not respected in the health care industry. To be honest, I don’t blame other health care professionals for thinking this way. There are very few massage therapy schools that teach their students how to understand information from the medical field. Doctors have gone to school much longer than you and paid a lot more money for their education than you have. Many of them see you asking for information on their patients as something similar to a nail artist asking for medical information on one of their clients. They don’t think we have the experience, skills, or training to know what to do with medical information or the expertise on how to understand it.
We often have to use our patients as a middleman for data because health care providers will not talk directly with us. This can introduce even more problems because it’s like playing a game of telephone. You are asking someone unfamiliar with technical healthcare terms to translate what their doctor told them and often information is lost in translation.
We have to overcome lots of obstacles to get data about our patients, but it is always worth it. There have been countless times that I have been pushing for data that has helped figure out something that no one else has been able to figure out because I put all of the data together. This is a critical part of being a successful orthopedic massage therapist. I hope this post inspired you to get out there and get the information you need to help your patients!
I would love to connect with you! Listen to my podcast, Bodywork Therapists, or join in on the conversation in my Facebook community: Bodywork Therapists Group, a forum for therapists to ask questions, start discussions, and help each other.