Monday, May 7, 2012

A Therapeutic Massage Case Study- Mrs. R. Pt.1

One of my ongoing challenges as a Massage Therapist is getting empty vessels (people who need what I have to give) on my table with enough frequency to really meet their needs (transformative, lasting, structural improvement). Read this explanatory post if "empty vessels" seems like a completely random and weird metaphor.

At the beginning of my career I worked primarily on tourists and seasonal guests to Florida's Space Coast, so I rarely saw the same client twice, and never for a series of therapeutic treatments. Later in Tallahassee, I had that opportunity with a few devoted clients at Massage Envy, but I was still a part time LMT with a much larger scale day job which took much more of my time and attention. Now, however; I have a 2 year history with several clients at Massage Envy and find myself in need of some expertise in developing a cohesive treatment plan.

The 5 minute interview, while the meter is ticking, so to speak, at ME is not conducive to an in depth assessment, review of medical history, muscle testing, and range of motion testing. Even bi-weekly clients take about a month for me to get well acquainted with (remembering their face and issues as soon as their name appears on my schedule). As I progress through Erik Dalton's Myoskeletal Alignment home study course, I'm challenging myself to adapt the assessment techniques into the shortest possible intake interview, which will take practice.

Which brings us to Mrs. R. 

She was referred to me by another massage therapist based on my skill set and experience with neck and low back issues, for the times when Mrs. R needs treatment, but the other therapist isn't available. I've worked on her a few times at the clinic, always at least a month between treatments and always to put out the fires- never to make constructive progress. 

Mrs. R is a 27 year old student in law school in Orlando and is also a paralegal at a firm in Tampa. She drives at least 20+ hours a week to get to those computer intensive, seated occupations. Those things alone could cause chronic headaches, neck pain, and low back dysfunction. She has also been in at least 2 car collisions resulting in now chronic back and neck issues. 

She came to me at the clinic- again after more than a month since the last treatment, because she needed to decompress her neck after intensive final exam preparation. We made a noticeable amount of progress by focusing the whole hour just on the neck. We decided to see how far we could get with more, well planned, very specific treatments in a cohesive treatment plan. Our window is small- 3 weeks before classes start again, starting now!

I sat down with Mrs. R at my house the other day and talked through her pertinent history and needs. She was surprised by my thoroughness because she hasn't ever had a clear treatment plan, despite years of different types of therapy for her neck and back pain. I would like to emphasize here that in the name of science and non-compete clauses, no money is changing hands during this experiment.

The top priority is her neck. She has daily, painful, "hot, tingly, nerve numbness" coming down from her levator scapula attachments and flowing down both arms. She has 2 herniated discs: between C 3 and 4 and between C 5 and 6. She also experiences weak grip in both hands and sometimes drops things because of the nerve and muscle miscommunication. One of the car collisions resulted in a Labral Tear in the Left Shoulder which she also suspects causes weak grip, after the surgery to repair it.

She was also diagnosed with Fibromyalgia, which she states she doesn't believe in. I took that to mean that because her pain is so clearly related to spinal alignment, disc herniation, and severely tight soft tissue, slapping an ambiguous label on her does no good. I'm no doctor, but I agree.

Mrs. R really wants to lower and eventually discontinue pain meds, because they seem to be interacting and causing side effects, such as foot cramping. 

She had a Percutaneous Discectomy 2 years and 3 months ago at L5/S1 which is currently mobile (not fused). Her low back and hips are also quite painful on a daily basis. 

She does not exercise at all, aside from walking to and from the car to work and school, because it is too painful. She does no regular stretching. The only current therapy she gets is 1 hour of massage, if she has the time for it, monthly.

During the next 3 weeks, I intend to provide Mrs. R. with 2 hour therapeutic massage treatments, twice a week on Tuesdays and Thursdays- 12 total hours of treatment over 21 days. I will frame my results using Erik Dalton's MAT assessment techniques, range of motion improvement in the neck, shoulders, low back and hips, and finally client reports of pain relief, stress relief and mobility.

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