If we look at medicine honestly, we see it’s based on trial and error. Even when the board-certified specialist prescribes a drug that’s been studied for decades, she won’t know how it affects one particular patient.
We often don’t know why a treatment works, we just hope that it will.
As therapists, we should be well aware of how hard it is to really determine cause and effect, and how much our own brains trick us into seeing causality where there is none.
No matter how great our palpation skills, how finely tuned our hands. We can’t know whether the “knot” is just a tight spot after sleeping in a hotel bed or whether the hypertension is protecting a small injury. Go after the former with your neuromuscular skills and yay! problem solved. Try the same on injured tissue, and you make everything worse.
So should we just admit to clients that we don’t know what’s wrong, and we can’t be sure whether we’ll be able to help?
Yes.
As massage therapists, we’re not allowed to diagnose anyway. As patients, we’re all sick and tired of cocky diagnoses that turn out to be completely wrong. Our clients come to us often after being misdiagnosed several times. They don’t need us to point to trigger point charts while mumbling in Latin.
- Tell your clients what you think about their pain, but make it clear that it’s a theory, you can’t know what exactly is happening in the tissue.
- Just do a short tryout treatment as the first session. Approach the problem how it makes the most sense to you, explain why, and say openly “Now, if this responds like in similar cases I’ve had, you should feel much better tomorrow, you might just be a little sore, but that should pass by the next day. Please let me know how you’re feeling, and we’ll make a plan from there.”
- In the next session you can build on the results–if the tryout helped, do similar work, but make it a full session. Otherwise find a different approach. For example lymphatic drainage can help with healing an injury without irritating the inflamed tissue any further.
Lu, I want to applaud you for the post. I don’t find it controversial at all, but will say this is my pet peeve among therapists. I have my own story to tell of bone tumor INSIDE my fibula requiring surgery/bone graft that a therapist once just knew must have been tendonitis of my overused ankle area from running. Probably delayed my diagnosis by a few months. Good thing it wasn’t rapidly advancing bone cancer. This personal experience has caused me to be always aware of the vast array of medial issues that could lurk from the pain our clients are presenting with. I had a relative die at age 52 of a rapidly advancing brain tumor (from diagnosis to death was 4 months) and her only symptom prior to the actual diagnosis which was done in the ER with a severe migraine as the only symptom, was in fact, previous headaches. However, she had been having headaches for probably a year. One must hope that if a massage client comes to us complaining of headaches, that we will not pretend to be Jesus with our hands and will actually encourage them that they may want to rule out problems with their eyesight, their dental condition (are their crowns level? etc) and will see their own family doctor to make sure further inquiry isn’t suggested. My relative’s case may possibly have been operable if caught a bit earlier. One of the reasons we receive the bit of training we do is to have the sense to know when to refer clients for their own safety, not just to learn how to give a massage.
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Lu, I agree agree with all the content you wrote and give my thanks to your fortitude in saying it publically. My only request is that you change 1 word: in the first paragraph, Change effect to affect. This is an oh-so-common usage error, but the meanings are actually different.
Thanks so very much!!! I hate it when I make common mistakes, and I very much appreciate being corrected.
Thanks for taking the comment constructively and in its original intention, which is wishing the best for you and your writing.
Oh, keep them coming, Barbara! I’m always VERY grateful for critique.