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A Discussion with Special Guest, Whitney Lowe and the Results of the Assessment Survey
Introduction
When it comes to client assessment, what should schools teach? What knowledge and skills should graduates demonstrate, and what resources do instructors need? Are robust assessment skills still necessary in the current massage therapy environment and what about all these special tests?
These are some of the questions we explore through a video conversation with Whitney Lowe and the results from the Assessment Survey. Whitney shares his unique perspective as an expert in orthopedic assessment and advanced therapeutic treatments for over three decades, while the survey provides insights into national educator attitudes. Together we explore a little of the past, the present, and next steps for the massage profession related to assessment in massage education.
Please note that we broke the interview into sections to make it easy for busy instructors to zero in on topics of particular interest. Watch the videos in order or jump around. Also notice that we pulled the survey responses outlined in the conversation with Whitney two weeks before we closed the survey causing minor discrepancies between the percentages we discuss in the video and the final results.
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Can you share a little about your personal journey with assessment?
Transcript
Anne: Hi, Whitney. Thank you so much for being here today to talk about assessment in foundational training programs and beyond.
Whitney: Well, thank you so much for having me. It’s a topic I certainly love talking about and actually any topic that I get to have a chat with you about is a great topic. So I’m looking forward to that.
Anne: Thanks, Whitney. All right. My first question for you is can you share a little bit about your personal journey with assessment?
Whitney: Yeah. So I’ve been a massage therapist for about 36 years now. And initially I got interested in some of the aspects of pain and injury treatment, working in a couple of sort of clinical and medical type of environments with massage. And one of the things that I realized early on was that so many of the CE courses that I was taking were teaching me all kinds of great things about techniques, but they weren’t teaching me what to do or how to figure out when to deal with somebody in a certain way. And there was one day in particular where a client came to me that had been referred by a physician because I had put in my office in this medical office building.
Whitney: And she came in and she was obviously in a great deal of pain. And I was thinking, well, the doctor sent her here, so it must be okay. But I also realized I have no idea what’s wrong with this woman and I’m supposed to help her. And that’s when it really dawned on me that just knowing a lot of techniques and a lot of treatment strategies is not the answer. I have to also be able to figure out the nature of what somebody’s problem is so I can choose the best treatment strategy to deal with them.
Whitney: So that started me on this long, long journey of focusing a great deal on assessment And then also trying to teach and share that with other practitioners through books and training materials and other resources I’ve been producing since that time.
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What was assessment training like when you entered the massage profession?
Transcript
Anne: I’m curious about the state of assessment training in foundational education when you entered the profession. I went to Seattle Massage School in 1996, and we learned a lot about assessment, probably because Washington state is still 1 of those states where insurance covers massage therapy. So therapists have to know how to assess at least to some degree and then document their findings in order to get paid. But what about you? What was that very early assessment training like for you?
Whitney: I’m not going to, well, I shouldn’t say zero because as soon as you touch somebody, you are assessing them because you’re making decisions about what you feel with your hands. But in terms of structured assessment training, I honestly can’t remember getting much at all in massage school. I mean, we were sort of given cursory information about how to take a history, But what we’re really given is like, here’s a bunch of questions to ask, but not like, what do you do when they answer a certain thing a certain way? What does that mean? How does that change your opinion?
Whitney: What are you going to ask them next? You know, and so it really was left off. And, you know, my training was a little earlier, so there’s, we give a little bit of credibility for some, the fact that, you know, the profession grew a little bit, but this was 1987 when I went to massage school. But I think what you said about the state of Washington is absolutely true. It was probably better there than anywhere else in the country anyway.
Whitney: So most of the rest of the U.S., at least in entry-level education, was lagging substantially behind with what they covered with assessment in entry-level education. And this, you know, it’s just the nature of education and entry-level training programs in our field, which is that where our education system is really based a lot more on a legacy, or not a legacy, but a lineage education model, which is, you know, I learned from this teacher and that teacher learned from that teacher and so and so. Not so much on an academic curriculum model of here’s the content that we need to cover. Somebody’s got to learn how to do this stuff right and do it well. And So we’re kind of moving a little bit in that direction now, but I think that’s 1 of the things that’s left assessment in particular difficult to teach is that it’s hard to find teachers that know how to do it really well.
Anne: Yeah, we were blessed by having Diana Thompson, who was sort of the lead instructor there at Seattle Massage School in terms of the assessment and documentation program. And of course, you know, her work is just exceptional, and it trickled down to all 5 campuses, which is great.
Whitney: Yeah. There’s also something fascinating, I think, about something I refer to as a talent vortex, which is that when you have a group of really talented people there, all in the same kind of area at the same time, it just explodes the creativity and the power of the things that happen. And Seattle was a talent vortex at that time in the massage world. You know, there were a few other places in the country that were doing that. I think Boulder was very much that way.
Whitney: I think there was a many and smaller talent vortex thing going on in Atlanta where I was working with Benny Vaughn I did and you know all of the CE instructors Paul St. John and Judith Delaney and Upledger and all these folks came through Atlanta because it was the biggest city in the South, but some places like that end up feeding a lot more sort of performance and excelling in all those areas and they create much better practitioners as a result of that.
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What are your thoughts about what's happening with assessment training right now?
Transcript
Anne: What is your general feeling about what’s happening with assessment in massage schools now?
Whitney: Well, I think we’re making headway with it, but I also think that we’re getting off track. And I have to take some responsibility for that also because I wrote a book about assessment that got used in a lot of massage schools. And there became a lot of focus in assessment on learning special orthopedic tests as what assessment was really about. And that kind of became, I mean, I even hear people talk about like, well, they had a client come into their treatment room and then went through their assessments, plural, like it’s a thing to do.
Whitney: You do these techniques and these are your assessments. But assessment is a systematic process of gathering information. It’s not a thing. It’s not a technique or a method. And because a lot of emphasis was placed in a lot of the orthopedic books on learning all of these special orthopedic tests, people kind of glossed over the fundamentals of musculoskeletal assessment, just learning the real basics of active movement and passive movement and manual resistive tests. And the hard part is how to interpret the patterns that emerge out of there. And so they kind of skipped over that stuff and just went to like, oh you got to learn how to do the Phelan’s test and the Hawkins and Kennedy test or whatever. It’s like that actually almost does more harm than good because it makes people oversimplify what assessment is all about and skip some of the really important stuff.
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What's the deal? "Yes" to assessment processes but "no" to assessment for planning!
Transcript
Anne: I used to make the assumption that every school taught assessment the way my school taught it, and that everyone gives assessment a lot of time and attention. And my first hint that this wasn’t true was when I worked on the entry-level analysis project, or ELAP. And when we asked the massage profession to give input on a survey where they could vote in or out learning objectives, a very interesting trend emerged. Many respondents approved of learning objectives related to the process of conducting assessment procedures, but voted out learning objectives for using assessment findings to make treatment or session choices. For example, the learning objective, “having completed a posture assessment on one peer, identified two muscles that are short and tight and two muscles that are long, weak, or adapted.”
Anne: This was voted out. They wanted people to do the posture assessment, but they didn’t want them to identify short, weak, long, adapted, tight. They didn’t want to look at that. Here’s another example. “Plan a one hour massage session based on posture assessment findings and defend the choices for sequencing of body regions or body regions in focus based on compensating structures.”
Anne: Again, voted out. So in the subtopics of posture assessment, range of motion assessment, and functional limitations assessments, this is what we find. Yes, do the assessment. No, don’t apply it to your session planning. So my question is this, what are your thoughts?
Whitney: That’s an exact example demonstration of what I was just talking about a moment ago, which is people viewing assessment as something easy to teach. Like, sure, I can teach people how to do range of motion movements for the shoulder. Sure, I can teach people how to stand upright and look at their posture. Now, take that information and tell me what does it mean and how do you do something with it. Okay, that’s harder.
Whitney: That’s a lot harder and it takes a really skilled clinician and skilled educator to know how to get people going in that direction. And I see this all the time in my continuing education workshops where we start going through basic fundamentals of assessment. And I ask, how many people in the room were taught how to do range of motion assessments? Everybody raises their hand. I said, okay, great.
Whitney: So let’s do this little exercise and I’ll give them a simple little thing. A person has, you know, pain with this motion, pain with this motion, and no pain with that motion. Three things. Tell me what might be causing that pattern. And it’s deer in the headlights.
Whitney: Because they were taught how to go through the motions of range of motion testing. So yeah, I know how to do it. But the real question is, do you know how to interpret it and see what it means? And then how is that going to change what you’re thinking about what you’re doing. So yeah, that’s where we are.
Anne: So we got a lot more work to do.
Whitney: It was right again, and we got a lot more work. But that’s a real interesting example that you gave of how that illustrates what my experience was as an educator in the CE world, seeing this happen over and over again. So yeah, people know how to do the basic procedure. They don’t know how to interpret what it means and how to use it effectively.
Anne: Yeah, and I think it’s because, well, my interpretation would be, we just don’t know enough about biomechanics and we don’t sort of break, but then it does get pretty complicated. Like I think for some joints you could say, when you see this pattern, it means this, and you can do this. And then when you get into like the low back, it could be about 45 million things sort of that’s creating an issue. So it’s really, really challenging.
Whitney: Yeah. one of the ways that I’ve, again, I’ve experimented with a lot of different educational structures over the years to try to solve that problem. And one of the things that I have migrated towards with our, we have a very comprehensive online program that teaches, you know, a lot about orthopedics and biomechanics and pain and injury treatments, but I’ve changed a lot of the structure of that program to be oriented around conditions, common musculoskeletal conditions. With every one of those conditions, We go through the comprehensive assessment process, history, observation, palpation, range of motion testing. What are the questions that somebody would ask if somebody has this condition?
Whitney: What would you see? What would you palpate? To give people some, what you and I were talking about a little bit before the recording, about the foundational knowledge about these different conditions first. Because what I found is the more you know about all of these different potential problems, the better you’re going to get at asking relevant questions. The better you’re going to get at recognizing patterns.
Whitney: This happens a lot with rotator cuff disorders. Yeah, people have night pain. They have problems more with abduction than they do with forward flexion. So you see those patterns emerge and that’s what develops your expertise to be able to then do your own reasoning is because you’ve seen that pattern process before.
Anne: Yeah. And with experience, you then start to figure out what will work and what won’t work.
Whitney: Yeah.
Anne: That’s why doing a continuing education program like yours, is they’re learning from your experience of what you’ve seen work consistently and what you’ve seen really does not work.
Whitney: Yeah. It doesn’t work as an information dump. I promise you this, because I’ve done that. We used to do a lot of this in the workshop environment in the CE world, supposedly, again, once everybody had supposedly known that, and I just would give them a ton of information and just dump it on them. And I saw like, it doesn’t work that way.
Whitney: One of my favorite education strategies to talk about with people is chunking. You gotta take small pieces of information in small parts, reintegrate it, make it your own, and then go back through retrieval practice and pull that back out at a later point. And so that’s what’s gonna make these things gradually sink in with people.
Anne: And it requires sort of a knowledge of content hierarchy and how you set that hierarchy up to sort of lead the learner in a step-by-step process to higher order thinking ability. But it’s such a process and it takes a lot of effort to set up your curriculum that way.
Whitney: Yeah, it does. And it takes some skilled educators to pull it off too, to really understand the complexities of those things and teach people and watch them gradually go through the process of the early stages of pattern recognition. The temptation when we learn a lot is to throw all this stuff at people that we like, well, you got to know this and you got to know this and you got to know this. And it’s like, no, you got to cut back. You got to just slice and dice and cut things out to really just build some fundamentals, some real fundamental skills first.
Anne: That is so true. Like my latest, my mantra now for myself is “teach less better.”
Whitney: Oh yeah, I like that.
Anne: Just stop teaching so much content that will go unused because it’s too much. Like just step by step.
Whitney: You know our mutual friend Rick Garbowsky had a saying that he had said was essentially the mission statement of his school that they were teaching there because people would always ask him, how can you produce such great therapists in such a short program? Because they had a shorter program than a lot of other schools. And he said, “we do the ordinary things extraordinarily well.”
Anne: Oh, that’s brilliant.
Whitney: That was what they did is they got things down and they made them work extremely well. And that serves as a great foundation for the future.
Anne: Yeah. The other one that I remember from this book called What the Best College Teachers Do is the author makes this little quote and he’s like, “just get to the point, the silent plea of your adult learners.”
Whitney: Right, yeah, exactly.
Anne: And I’m like, I think about that whenever I talk about aromatherapy and I’m like off over here and what the Mesopotamians are doing. That’s right.
Whitney: Here’s the Latin term for that aromatherapy thing. I was in an education, I think this is 1 of the ADMP education events I did a number of years ago, and I was talking about this issue of relevance, and so I had a slide up on the screen with a student there looking kind of semi-bored with a name tag that said WIFM, you know, W-I-I-F-M, you know, what’s in it for me? That’s who’s sitting there. Why should I care?
Whitney: That’s right.
Anne: Exactly, tell me why I should care about this.
Whitney: And I know as educators, many of us get really frustrated with students asking this question. Do we have to know this? Why do we have to know this? Why do we have to know this? It’s a good question.
Whitney: It’s actually a really good question.
Anne: Oh, it’s so true. That was one of the things my mom, who’s a curriculum designer and had this beautiful, like amazing career in curriculum design, she would always say, you need to go through every single bit of your content and be able to describe at least 3 reasons why a student should care about it. And when you look at your curriculum or whatever you’re writing through the lens of why should they care? And you get really, really determined to figure that out, you’ll realize how much of your content is superfluous. But when it comes to aromatherapy, you should know about the Mesopotamians!
Anne: So I’ll just leave it at that and move on.
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What belongs in entry level and what belongs in continuing education?
Transcript
Anne: As part of this session, we set up a little informal assessment survey, and we asked massage educators working in foundational massage programs to give us some insights into what they teach at their schools and what they think should be taught in entry-level education. So I’m gonna tell you kind of the percentage of people who responded, yes, this belongs, or no, this doesn’t belong in just a minute. But before I do, I wanna just say, I’m just gonna give you a list of line items and I want you to say, yes, that belongs in entry level or no, it belongs in continuing ed. And then I’m gonna ask you to come back and tell me why.
Whitney: Interesting, okay, great.
So reading a health-
Whitney: Do I get to answer it depends sometimes? Yeah, probably you do.
Anne: I know it’s gonna be hard for you. Let’s see if you can do this. Okay, reading a health form, does it belong in entry level education?
Whitney: Yes.
Anne: Conducting a client interview to plan a session with the client?
Whitney: Yes.
Anne: Palpation assessment?
Whitney: Yes.
Anne: Posture assessment.
Whitney: I’m not sure about that. I know I’ll elaborate on this and cause we’re not gonna talk about this. So I’m gonna say maybe. Okay. When we get to the editing floor, that’s 1 of the ones that I’m going to be feeling okay about cutting and I’ll explain why.
Whitney: Okay.
Anne: Okay. Yeah. Gait assessment. No. So belongs in continuing ed, if at all.
Whitney: If at all, that’s where I am, yeah. If at all, yeah.
Anne: Range of motion assessment. Yes. Pain assessment using analog measures.
Whitney: Meaning like a scale or something like that?
Anne: Yeah, like a scale where they go happy face, painful face.
Whitney: I think that’s helpful in an entry level, yes.
Anne: Okay. Special orthopedic tests?
Whitney No. Beyond entry level.
Anne: Functional limitations assessments.
Whitney: Can I say sort of? Maybe like getting introduced to the idea. Getting introduced to the idea would be good, but I don’t think we need to lean on it heavily. Okay,
Anne: so I’m going to tell you what our respondents said, and then I’m going to ask you to give us some why pieces. So reading a health form, 96%, We had a percentage who said that it wasn’t necessary because they don’t get to do it at, they don’t have the opportunity to read a health form when they’re working for franchise clinics.
Whitney: Yeah.
Anne: And then conducting a client interview, 100%. So gathering information by asking the client questions. Palpation assessment, 91%. Posture assessment, 91%. Gait assessment, 48%. Range of motion assessment, 87% says, these are people saying it belongs in entry level. Okay. Pain assessment using analog measures, 82%. Special orthopedic tests, 65%, and functional limitations assessment, 60%.
Whitney: Okay. So, they were all above half. Some of them very well above half. You didn’t have anything, I don’t think they’re on that list below 60%, right?
Anne: Yeah. And I would say, this is what I would say, people who care about assessment were the people answering this survey. So people who really believe in assessment and really want it in education, we’re doing this survey. That was my general takeaway. So tell us a little bit about your posture assessment.
Whitney: Yeah, my thing about posture assessment is that I think it has gotten abused a lot, first of all. It’s something that has turned into a noceboic model, meaning by that, where you create a nocebo or something, which is, if people aren’t familiar with the term, it’s basically the opposite of a placebo. So you come into me, you see me, I’m like, oh my gosh, and look at your shoulders. You know, you’re like, no wonder your back hurts, you know, because you’re looking at how forward your head posture is, you know, I’m creating an idea in your head about how messed up you are.
Anne: How are you still walking?
Whitney: And here’s the reality. The correlation between posture and pain is really bad in research. So we have had all these things for years that we’ve told people, well, the reason that your neck hurts is because you have this forward head posture, because your shoulder is up, hiked up here like this, that’s why you have pain. That doesn’t pan out in the research. There’s a lot of people with wacky, messed up postures that have no pain whatsoever.
Whitney: And my favorite quote around this is something I saw or heard said on a social media debate forum about this 1 time, and I can’t even remember who said it, but he said, like, posture is not necessarily a cause of pain, except when it is. So it’s not irrelevant. It may be playing a part in this, but when we teach it at entry level, what we do is we simplify it and it becomes almost like an equation or just a formula that people just kind of say like, oh, you’ve got so-and-so posture, you’ve got these tight muscles, I need to work on them, that’s why your back hurts, that’s why your neck hurts, that’s why your feet are messed up or whatever it is. I really think the posture thing requires a much more refined set of subtle understandings about the complexity of pain and dysfunction to understand like when is it relevant and when does it not matter? I have a pretty Significant forward head posture that really develops because I was a scrawny kid when I was growing up Playing tenor saxophone and practicing every day with a 12-pound saxophone hanging on my neck, you know It doesn’t bother me now but if you put me in front of that posture chart with a plumb line, I look really messed up.
Whitney: You know, but so what? It’s like it’s not a thing. So that’s my beef about the posture thing. I actually think it can be absolutely relevant, but I think putting it in an entry level program makes it turn into a formulaic thing that requires less knowledge and less complexity of understanding and it creates noceboic messaging to clients.
Anne: Yeah, I had never really thought about that, but yeah, I can really see what you’re saying there. It makes total sense. And then what about, can you talk a little bit, you said absolutely range of motion assessment belongs. Give us your thoughts on range of motion assessment in entry level.
Whitney: Well, this is where you could start getting people to understand the process of assessment from the physical examination component. So if you teach people how to do a basic range of motion process of active movement, passive movement, what is the difference between active movement and passive movement, and a resisted movement, like what are the… There’s some real simple rules about how to perform a good, you know, resistive movement test. If you teach them how to do those things, then the clinical reasoning process of interpreting those results and the pattern recognition that comes out of it will grow later on, probably after they are out of school, but at least they have the foundational understanding of why do you do range of motion things actively 1 time and passively another thing. Like what difference does it make?
Whitney: If they just got that basic concept down, to me that would suffice at entry level.
Anne: Yeah, that makes a lot of sense. And actually, I’m gonna talk about a comment from one of the respondents to the survey that sort of goes, that talks a little bit about that. So we’re going to come back to that. I just want to touch on functional limitations assessment for a second. And the reason I do this is I learned this from Diana Thompson.
Anne: So obviously, I got an amazing education in this from her. And I found it was sort of like reading Job’s body. It changed my life. It changed my whole approach to how I thought about treatment planning and session planning and it really just changed things for me. Talk a little bit about your thoughts about how it might fit into entry level and where it sort of doesn’t fit in and what works and what doesn’t work about it.
Whitney: I just see it as a gradient scale. And one of the things that I think is great about is it starts to make this stuff a lot more real because you start talking about, and how is this bothering your life? How is this impacting your day-to-day activities? Not just okay a person has a 7 on a 1 to 10 pain scale you know and so does the next person have a 7 on a 1 to 10 pain scale but you know one of them is a Geriatric person who sits all around all day crocheting and the other person is a competitive athlete – Yeah the difference in how those things impact people you have to start looking at the subtleties and the fine points of what makes those things different And that’s starting to treat clients as individuals. And that’s gonna continue to grow throughout the whole rest of your career and professional development.
Whitney: So I think starting those skills first and getting a sense of understanding the context within which each individual has an experience of pain or limited function is a great place to get started growing with that at entry level. And it will never stop, I think. You know, it will continue on, should continue to grow.
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What is the problem with orthopedic tests in entry-level education?
Transcript
Anne: Okay, we’re going to move on to the next question. I’m so loving this.
Whitney: Can I back up to one moment to give a rationale on one of your other questions because I do want to comment about the special orthopedic tests thing?
Anne: Oh, please do. Yes.
Whitney: Because What was the number on that one? I can’t remember what the number was.
Anne: Special orthopedic tests, 65% say yes, it belongs in entry level.
Whitney: I think a lot of this is because people think they’re supposed to know that stuff because that’s what all the orthopedic assessment books focus on, including my own. Again, I take a lot of responsibility for having planted that idea in a lot of people’s minds. But a lot of the recent research on special orthopedic tests has shown a really not so great degree of validity to many of them. They have problems with specificity or sensitivity that make them not so accurate. And I think they become 1 of those things that becomes a cognitive overload Because people are trying to remember the so and so test and this test and that test and they get so caught up in remembering how you do this specific thing.
Whitney: And they really should be focusing more on the fundamental aspects of the assessment process and not so much on all, on memorizing all. They have to memorize so much crap at entry level already. I know. That’s not, you don’t want to keep piling on the cognitive stuff to have to remember. And how many times are they going to use these frequently right off the bat?
Whitney: And there are so many videos, books, resources, free things available now. Somebody comes in, they got shoulder pain, like I can go look up what are the 5 best, you know, special orthopedic tests in the shoulder region to do and relearn them at that time. So get it out of entry level it’s too much.
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Can we talk about chasing pain, orthopedic tests, and scope of practice concerns?
Transcript
Anne: This is interesting because this respondent on the survey, this person made numerous comments on each survey question that echoed what you really just talked about. But I’m going to read you one of their comments and then ask you to share a little bit about your thoughts about this comment. They wrote, “traditional palpation, posture, and dynamic assessments are notoriously inaccurate. Even research in assessments used by licensed physical therapists show that most tests are unreliable. Pain is complex and massage therapists should not chase pain during a session. Orthopedic tests should be avoided as this is outside our scope of practice.” So what are your thoughts about the issues raised in this comment?
Whitney: So let me start with the last piece first. Orthopedic tests are outside of our scope of practice. Wrong. It’s just, it’s not correct. Because assessment is a process of gathering information and an orthopedic test is just a means of gathering information.
Whitney: Giving a diagnosis based on an orthopedic test, yes, outside of scope of practice. But the test itself is not, that would be like saying assessment is outside of our scope of practice, and it’s not. And this is a process of gathering information. So I’m definitely not in agreement with that part of it. Second part of it is that the idea of like chasing pain is something that gets people off down the wrong track.
Whitney: This is one of those things that I see and I hear this phrase frequently and especially in social media discussions and things like that. I think this is one of those pendulum swings that has gone too far out on this side of saying, dismiss with the whole concept and idea of orthopedic assessment because there are problems with validity and reliability, which we talked about, and there are. That doesn’t mean you throw the baby out with the bathwater. When people say, oh, don’t chase the pain, well, if somebody has a particular pattern of pain and dysfunction, they might have something that they need to actually go see somebody else about and they don’t know that and you’re going to help them and you’re gonna make a determination should I even be working on them. Judy Delaney told me a story one time.
Whitney: She had a client that came in and began talking to her about the nature of her pain complaints and she went through some assessment process and she was only like halfway through the assessment. She said, stop, we’re done. You’re on your way to the emergency room right now because you’ve got symptoms, signs and symptoms that are similar with a serious neurological problem. Now, it was called equinas syndrome. She didn’t tell her that so that it wouldn’t be misconstrued as giving a diagnosis, but said, you need to go to the emergency room right now.
Whitney: And that woman, the physician that treated her in the emergency room called Judy back and said, thank you for sending this woman here because you may have saved her very serious injury, possibly saved her life. So this idea about don’t chase the pain, I get where they’re coming from, the saying like, you know, don’t get caught up too much in trying to find always the absolute solution because pain is complex. But this is part of the process of uncovering when is there something that might be based on a particular injury or tissue damage thing or something like that. You can give your client a lot of really helpful information about stuff they can do and things that they should avoid that will keep this from getting worse. But sometimes it’s a complex chronic pain problem that’s got central sensitization involved and the nervous system is completely out of whack and it’s you know there’s bio-psychosocial factors wrapped around this and there’s history of all kinds of other stuff.
Whitney: And yep, that one’s complex and you’re probably not going to find that with a special orthopedic test because it is complex. But that’s like saying, don’t investigate anything because you can’t know all the answers. So yeah, to me that’s like going off the other end of the pendulum that’s taking it too far, I think.
Anne: Yeah. Okay, good. Thank you.
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Let's talk about assessment in school and assessment in work environments.
Transcript
Anne: Many respondents noted that entry-level classrooms provide a foundation for assessment procedures, but that these skills develop as graduates gain experience in a professional practice, which I think we can both agree with. But what works and doesn’t work about this approach to assessment, given the current state of the massage profession, where so many therapists are going into entry-level jobs that put them in situations where they don’t get to continue assessing clients, that they really don’t have time to do that, they’re not given the opportunity to do that?
Whitney: I think part of it is forcing assessment into a particular model, which is that I’m going to go through this comprehensive assessment process with people every time I see them. It’s not really necessary for a lot of people that you’re working with. That general relaxation massage client who comes to see you in more of a standard type of maybe like a franchise type of environment that just wants a really good relaxation treatment or something like that, and there’s nothing that’s immediately coming up as a red flag, you don’t need to do a lot of assessments. So it is not necessarily necessary. But the next person that comes in the door might be in the midst of doing something with you like, oh you know by the way I got this shoulder thing can you kind of like do something about it and like they’re already on the table because you went you didn’t do a comprehensive assessment with them.
Whitney: Okay so now you got to figure out how to do your assessment in the middle of your treatment with them and figure out some things that might tell you or help you determine how to be more effective. So the 1 thing that I would say is that a lot of people make a misplaced perception that assessment isn’t relevant in some of those kind of environments. And I completely disagree. The level of assessment and the nature of it and how much of it you do might vary. But if you remember that assessment is the process of just gathering information, you are doing that with everybody that you work on because you’re making decisions about what you feel underneath your fingers.
Whitney: And you might have clients who come in, because this happens a lot in the franchise situation, where like somebody told them that massage would be helpful for their back pain, and they don’t know massage therapy. So they’re gonna go to the safest place they can think of, which is a store out in the open with a storefront that says Hand and Stone or Massage Envy or whatever it is, the franchise thing. And they think, well, this place looks pretty safe. I’m going to go in there. And they’re going to tell you, oh yeah, I’ve got back pain or something like that.
Whitney: I just want to relax. Somebody in my neighbor said massage will help me. Well, you got to figure out something about whether or not that person might be helped there. So I don’t subscribe to the same idea that assessment is irrelevant in those environments. A different type of assessment is necessary.
Anne: I know I have talked about this before, but I always think that the franchises are missing out here because there’s nothing that clients like better than to be able to share with a knowledgeable person everything that’s happening in their bodies. Yeah. And just being able to say, it hurts right here, it hurts right here, What do you think this could be? That conversation piece is so, can be so supportive. Obviously it requires some nuance. Otherwise we’re gonna be right back in the Nacebo kind of effect. But I always feel like if there was an opportunity for really good assessment on the front end, somebody who’s had a lot of training, who was like a franchise assessment expert, that could then sort of be talking to the therapist and saying, this is what I’m seeing, these are the areas you should work on. I think that could be really powerful.
Whitney: Yeah, I tell practitioners too, this is not only something that, you know, is something that, you know, might be necessary with the skills. This is therapeutic treatment, the assessment itself, because when you go through these things with somebody and enhance their sense of confidence that you know what you’re doing, that has beneficial therapeutic outcomes, and that has been proven in research Significantly that the outcomes and the intended Confidence that somebody places in you it has therapeutic benefit and we need to remember that so Even the you know, I worked in a PT clinic for a while that, you know, I saw people on the half hour, which meant, you know, come in, talk to me, get undressed, get on the table, treat them, do things with them, get out the door, change your sheets, and be ready for somebody else 30 minutes later. So the whole idea that you don’t have time to do this in a 50-minute franchise session like I’m not buying that. You just learn how to get efficient and effective at what you’re doing and if I had a nickel for every time somebody had said to me how come nobody ever asked me this before?
Whitney: How come nobody ever did this with me before? That, I’m telling you, has therapeutic value and power.
Anne: Yeah, I agree.
![](https://massagemastery.online/wp-content/uploads/2024/05/Client-Assessment-Video-Cover-.jpg)
Tuition costs, gainful employment rules, and the value of assessment hours. Where do schools cut?
Transcript
Anne: So one of the respondents said, “depending on employment setting, there may not be much incentives for LMTs to perform comprehensive assessments. It’s not valued in spa settings and even in medical insurance injury treatment world, insurance companies won’t pay for assessment time. They only pay for hands-on time. And they disregard the validity of LMT’s assessment findings anyway. So it’s challenging to justify spending time on a skill that’s useful, but not necessarily valued by employers or other entities in the healthcare profession.”
Anne: And, you know, I think that there’s a lot of conversation that’s happening right now about schools cutting back their hours because of the gainful employment law and trying to figure out what to cut. And, you know, in that sort of conversation, this makes sense to me, like, where do we decide what to cut? So I just thought people are cutting back their programs and assessment is part of that. Not necessarily just about assessment, but where do you think we should, if we need to cut back our curriculum, where do we cut? And what parts of assessment should be on the chopping block and what parts need to stay?
Anne: I know we kind of covered that before, but let’s talk through it again.
Whitney: So I’m gonna answer that with a question. Do massage therapists ever change their work environments? Like where they’re working? Or do they just leave school and only work in one place for their entire career? Okay, you might go to a workplace where something like assessment is not valued so much and it is a little bit problematic.
Whitney: Like you know as what I was talking about earlier I worked in an orthopedic clinic and people came in with a diagnosis from an orthopedist right there already. I didn’t have to do anything except for the fact that I learned that there’s a strong bias in the world of orthopedics towards joint dysfunctions and conditions that end in ITIS and that’s not always the problem. Yeah. And so my issue is like yes I’m in absolute agreement with a lot of people who say, you might be working in certain environments that don’t value that a lot, or maybe they don’t pay you in the insurance model or something like that. Does that mean these are skills that you shouldn’t ever learn?
Whitney: I’m not in agreement with that, because you might find yourself 6 months later saying like I’m over this I’m out of here I’m gonna open my own clinic and now you’re a direct access healthcare provider Who has to make complex clinical decisions about who you should work on not work on treat refer and what you should be doing and? You didn’t have any of that training in school because they didn’t think it was important. So, yep, we’re gonna learn some things in school that you may not use in all different work environments. But if you are, and This goes back to the complexities of the structure of massage therapy currently in our country. We are preparing people to work in certain types of employment environments, but they also have the capability to be a direct access health care provider with extremely inadequate training.
Whitney: And so for the sake of public safety and health, I think it’s essential that we do not drop some of that kind of stuff out because people are in an environment where they have to make some of these kinds of decisions that might be, I’m not gonna say life or death, but they could be serious injury or non-injury kinds of decisions about what you’re doing. And you need to have some background to make those kinds of determinations.
Anne: Yeah, I also think like kind of referencing back to the functional limitations discussion, you never know what’s going to be a spark for a student when you cover a body of knowledge. For me, that was a real game changer for me in terms of how it made me think about the world of massage therapy. And I always think of, you know, even if we’re just introducing certain concepts, we’re sort of creating a framework where they understand the depth and breadth of the profession that they’ve entered. I think that there’s a lot of relevance in saying, we’re not going to cover this here, but I want you to be aware that it exists. So that you have opportunities to explore after school.
Anne: We’re teaching you some assessment, there’s actually more. We’re teaching you some anatomy, there’s actually a lot more. We’re teaching you some massage forms and styles. There’s a lot more. Yeah.
Whitney: Yeah. Yeah.
Whitney: I was just gonna say, there’s just, and I get that there’s complex decisions that people have to make about the curriculum. So if they were to, you know, get any kind of advice from me, it’s like, cut out those things that I talked about earlier that are not supported in research and don’t really, you know, have the potential for being problematic because you’re trying to teach people more comprehensive, complex kinds of skills where that’s not really what’s needed at this point, and get back to teaching those fundamentals really well. You can do that in a lot less time.
![](https://massagemastery.online/wp-content/uploads/2024/05/Client-Assessment-Video-Cover-.jpg)
How can we help schools address the challenges they face with assessment curriculum?
Transcript
Anne: Schools pointed out a variety of challenges when it comes to assessment curriculum, including lack of detailed textbooks, lack of teacher training, and lack of opportunities to apply assessment learning once a student graduates. What do you think we need to create, you know, in the profession broadly to better support schools when it comes to assessment?
Whitney: It is, you know, and I’ve looked at this issue for many years, and you and I have talked about this a good bit too, you know, I do think the lack of good assessment resource materials in the classroom is like one of the starting places because until you have those kinds of things, the teachers don’t have really good resources to go to. And if the teachers don’t understand and know how to really teach some of the greater facets like you know when you’re a teacher you’ve got to know you know this much content about this much that you’re going to deliver. You know, for, again, I don’t know if we’re visual gonna be on the screen, everybody who’s not looking at that, like you gotta teach or know a whole bunch more than you’re actually going to deliver so that you can understand context and answer questions related to those things. So the teachers have to understand a much bigger and wider facet of the world of assessment and then know how to streamline it down into some really basic skill building processes. And We have to get away from trying to teach a lot of specific, do this just like I did it here.
Whitney: Okay, now you know how to do that. And one of the ways I do that a lot in continuing education workshops is that, we do some very, very basic fundamental review of skill sets and then I give all the participants a worksheet of problems to go through and I haven’t told them how to do any of this stuff. You’ve got to figure this out. How do you do a passive range of motion test for the lumbar spine if somebody is supine? I don’t know.
Whitney: Show me. Well, I want you to figure it out because this is what you’re going to have to do in the real world. So there has to be a certain degree of exploratory processes and in learning science, they talk about this as desirable difficulty, which is making the students have to put forth some effort to learn some of these kinds of things. But again, it takes a lot more skillset on the part of the teacher to understand how to facilitate that kind of learning environment as well. So we need a lot more teacher training in addition to those other resources as well.
Anne: Yeah, because teachers then get that pushback from the student of, I can’t handle this. You just, you haven’t taught me this.
Whitney: Just tell me how to do it.
Anne: Is it going to be on the quiz?
Whitney: Just show me how to do it. Yeah. And I have to, you know, honestly say that, granted, I understand this is a lot harder to do at entry level because there’s a certain degree of self-selection of students that I get in a continuing education workshop who really want to learn this and get why it’s important. They’re also struggling with it, but there’s a greater degree of, they got a lot more skin in the game of why they’re doing this. It’s a lot harder to do from a classroom management standpoint and also getting buy-in from students at entry level about some of this kind of stuff.
Whitney: And so that’s a great place for you to give case study context. Let me tell you why we’re doing this today and to give you some examples of why this is relevant. Like Here’s what’s going to happen to you. Paint the picture and don’t be afraid to use fear and bad outcomes as a reason why you need to do this. People love to move towards desirable things and away from undesirable things.
Whitney: So, use both those. The stories about how you changed somebody’s life because you got them out of pain, and they’re powerful, as is the story about the woman with cauda equina who you possibly saved her life because you kept something from really bad happening.
![](https://massagemastery.online/wp-content/uploads/2024/05/Client-Assessment-Video-Cover-.jpg)
What are the next steps for the massage profession related to client assessment?
Transcript
Anne: I want to ask you a couple of questions. Actually, the first is sort of what’s the next step for the massage profession related to client assessment? Where should we be in 10 years time?
Whitney: I would love to see something And you have worked so hard at trying to get standardized curriculum happening through your work with ELAP and the resource materials that you’ve been putting out. I would love to see us getting closer to that where our schools are more focused on a standardized curriculum content and less on that whole lineage education model of like, oh, we got to do it the way at our school the founder did it, because this is how the founder designed this kind of thing. So I think there is movement in that direction because there is increasing degrees of emphasis on evidence-informed practice and things that are backed up by good quality research and things like that. So we need more of that kind of thing. It is challenging because in massage school, we aren’t really trained in an academic model.
Whitney: So we haven’t learned a lot of things about critical analysis of reading material or content or how to make some things better and, you know, how to have good academic debate and not have it degenerate into, you know, personal vitriolic fights and things like that. But that’s where we need to go. We need to do some things where it’s okay to challenge ideas. It’s okay to challenge perspectives and to debate about some of these kind of concepts to make ourselves better. So the big thing, the big takeaway, though, I think is a lot more about standardizing curriculum outcomes and curriculum content to focus on those things that are a necessity.
Whitney: And you know, I’ve done a little bit of work with the NCB and also some of the other organizations that we’re doing scope of practice surveys and professional surveys. Looking at what do people think are really critically important skills at those levels, and we have to kind of continue to do that whole job analysis project and ask ourselves what kinds of things do people really need to know and are important because. Sometimes those things are reflected well by surveying the people who are in practice, but sometimes the educators know better about what we need to teach people under certain circumstances.
Anne: Yeah, and sometimes it’s timing too, because ELAP really had around 35 hours of communication training in the original map that we put out to the profession. Schools said, “no, we don’t want to teach communication skills.” But I bet that if we surveyed them in the same way today, they would say, we need more communication skills. We were right on the brink of when the educators in the room really having the discussions about what should be in ELAP, they were talking about it as a forward leaning, they were leaning into communication. But the general school population wasn’t quite ready for it.
Anne: Probably 10 minutes after ELAP came out, I think people started to contact me and say, there’s not enough communication.
Whitney: Well, what you’re also getting, I think too, and this is a potential bias with people who get involved with some of these kind of projects, which is the underlying message behind that is like, I’m not really good at communication skills, so I’m not going to place a great deal of importance on that in my answers to this survey. But if they were answering anonymously, as the people who wrote back, just like, why isn’t there more emphasis on communication skills? Because, you know, actually it is probably the most important reason why people get therapeutic results from what we do. It’s not because you did the, you know, whatever it is, magical technique of the day on them. It’s because of that interaction process that you engaged in between the client and the therapist and the compassionate therapeutic touch.
Whitney: The communication skills are what made that really work. Yeah,
Anne: Well, I have one more question for you, and if you don’t like it, we can cut it.
Whitney: Okay.
Anne: The question is, why haven’t you written a textbook for entry-level programs and a companion teacher program that solves all of our issues? You’re the only person maybe in our profession who honestly has the skill to do this?
Whitney: Would you be happy to know that I’m working on that? We were having a little bit of a discussion before we got started here about sort of like my focus back to the basics again of what it is that I’m about and what I’m doing. I’ve actually been rekindling this idea of redoing my books and combining together treatment and assessment into 1 book because I think they are both very connected with each other. But teaching assessment in a way that is really pertinent and relevant for people to get started doing this. You know, I wrote my previous assessment book intending for it to be used by practicing professionals out in the field, and So I skipped over a lot of the basic foundational skill building stuff.
Whitney: And then there was just like, it got this kind of momentum and I just, there were so many other things going on and I felt like I didn’t have time to really go back and redo it and make it simpler. And so many schools were using it. It was kind of like, well, okay, they seem to be using it. But the number of times that I had people come to my workshops and say like, oh yeah, we used your book in school and I didn’t understand any of it. Now I’m starting to get this a little bit.
Whitney: That’s the red flag of like, you need to produce a different target with those things. So here’s the answer. I’m working on it and hope to have the answer to that sometime soon. I’m not going to put any kind of dates, but really gonna start working on this hard here to make that happen.
Anne: That is fantastic news, Whitney, because I do feel like you hold a true key to making this better at the entry level. It is like, and I always say, because I work from the ELAP learning taxonomy model, level 1, which is receive and respond to information in the cognitive domain – the psychomotor domain, it’s observe and imitate. And I think at level 1, there’s no harder level to teach. That level where you are offering information for the first time and then working with the response that students have to it and how you move them from receiving information to being able to apply concepts and physical skills in new ways and in new contexts. And that’s that transition from level 1 to level 2 is where we just, well, level 1,we screw up. That transition from level 1 to level 2 is where we just, well, level 1, we screw up. That transition from level 1 to level 2, we annihilate. That’s where we need to be focused.
Whitney: Yeah, absolutely. So now, the thing that excites me about redoing this stuff is that in the interim time period between when I first released the last edition of my assessment book, which was actually 2006, there’s been a good, almost 2 decades now, but certainly a decade and a half of passionate obsession with learning science and learning how to be a better educator, how to be a better writer, and how to be a better person producing educational resources. So I’m really hoping to wrap up and enmesh this learning product in some really good learning science strategies as well that will make it a lot more accessible and a lot more relevant and useful for people that might use it in the entry level curriculum.
Anne: Love it. Well, that is a beautiful place to end. As always, it is such a delight to spend any time with you at all.
Whitney: My pleasure as well. Thank you so much for the invitation. Always love having these chats with you. And I really, again, want to acknowledge all the work that you are doing with pushing the envelope forward of high quality educational resources and materials for people. You know, I’m just, I’m one of your very biggest fans out there as well.
Anne: Oh, thanks Whitney. That means a lot.
Survey Results
Instructor Views on Client Assessment in Massage Education
In March, April, and May of 2024, Massage Mastery Online sent email invitations to the 960 massage schools and approximately 450 foundational educators on its email list, asking them to complete a survey to share their views on client assessment in massage education. Thirty-four educators responded to the survey. Thank you to the participants who took the time to share their views. We are especially grateful to those who took the time to comment, thereby providing invaluable qualitative data. Please note that we’ve lightly edited all comments for grammar and clarification and to remove identifying elements.
Hours of Assessment Curriculum
When respondents described how many hours of curriculum their school dedicated to client assessment topics, 54% taught under 35 hours, and 46% taught more than 35 hours.
- Less than 8 hours: 4.2%
- 8-16 hours: 12.5%
- 17-25 hours: 25%
- 26-34 hours: 12.5%
- 35-43 hours: 20.8%
- More than 43 hours: 25%
Priority of Assessment Curriculum
Sixty-seven percent of respondents stated that teaching client assessment is a high priority at their school.
- Low priority: 4.2%
- Medium priority: 29.2%
- High priority: 66.7%
Health Forms and Client Interviews
Regarding health forms and client interviews, 100% of respondents said that the ability to read a health form to rule out contraindications, conducting client interviews to ensure client safety, and determining client wants and needs for session planning are high priorities. In addition, 100% of respondents said their students exhibit confidence when demonstrating these skills and that instructors teach them competently.
One respondent commented, “We teach documentation, consultation, and SOAP Charting in more detail and at a much higher clinical level than my graduates report is utilized in the field by most chains. This is one reason we get great feedback from clients and employers.”
Palpation Assessment
Regarding palpation assessment, 87% stated that palpation to assess the health and quality of soft-tissue structures is a high priority, while 96% viewed palpation to identify regions and specific structures that would benefit from manual therapy as just as important.
However, only 62% of respondents said that their students feel confident in their palpation findings, while 79% say instructors at their school teach palpation competently. Additionally, 8% of respondents said that palpation assessment does not belong in foundational education.
Several respondents made comments regarding palpation assessment. One suggested that “Palpation assessments provide unreliable information and should not be used as a guide for planning a massage. Research has also shown that relaxation massage is as beneficial as specific musculoskeletal massage for pain relief and improving function.”
Two respondents noted that students need time after graduation to develop palpation skills. One said, “I feel as if students don’t always understand what is under their hands until they have worked on several bodies.” At the same time, the other commented, “I have found that student touch is not advanced enough to make accurate findings through palpation. I feel they need that first 1000 hours of professional work to have that ah-ha moment.”
Posture Assessment
Respondents reported that learning about the normal spinal curves, the benefits of good posture, the drawbacks of poor posture, and the concepts of symmetry, asymmetry, hyperkyphosis, scoliosis, forward head position, and head tilted laterally are concepts taught at their school (99%). All respondents (100%) stated that their students learn to assess posture in anterior, posterior, and lateral views and use bony landmarks as visual and palpatory reference points. Additionally, these schools teach students to identify muscular imbalances through posture assessment. Most respondents (83%) state that their instructors teach assessment competently and that the school’s graduates would report that they feel confident assessing posture and using their findings to plan beneficial client sessions.
However, 17% of the educators surveyed report that their schools teach posture assessment but don’t teach students to use pre-session posture assessment findings to plan sessions and post-session posture assessment findings to determine the efficacy of sessions. Furthermore, 13% say posture assessment does not belong in foundational training programs. Some comments from respondents include:
“Students learn these concepts and then learn that they are limited in value and may even provide completely false information for how to treat. People are different, they move differently, they hold posture differently. Good and bad posture is an overly simplistic concept.”
“Doing posture assessment takes practice, I think after 1000 hours of massage, my graduates would report that they feel confident.”
“We teach assessment thoroughly, but it comes into focus over time and with practice. Confidence comes after graduation with professional practice.”
Range of Motion (ROM) Assessment
When it comes to range of motion assessment (ROM), all respondents (100%) said their schools teach the purpose of ROM assessment, the concept and experience of different types of end feel, and the cautions and contraindications related to ROM assessment. These respondents agree that ROM assessment belongs in foundational education.
Ninety-two percent of respondents teach students about pathological joint restrictions. Similarly, 92% teach the application of active and passive ROM assessment and how to document findings. This percentage drops to 79% when quarried about resisted ROM application and documentation.
Seventy-five percent (75%) say their instructors teach ROM competently, and 62% report their graduates are comfortable moving joints for assessment purposes. Comments about ROM assessment include:
“ROM assessments are of limited value and certainly should not be used to identify a specific issue. But ROM can be used under certain circumstances as a means to measure changes or lack of changes pre and post massage.”
“The logic of ROM assessment take practice. After 1000 hours of professional practice, I think my graduates would report they feel confident and competent using ROM assessment.”
“We introduce students to the concept of ROM assessment and instruct them to seek out Whitney Lowe’s CE courses to learn more.”
“Although my graduates would report they feel confident in assessing ROM, they consistently confuse ROM with stretching. Even with visual reminders in the school that ROM and stretching are completely different. ROM takes time to sink in. Some get it, some don’t. This comes down to who is going to excel as a functional therapist and who is going to work in a spa.”
Pain Assessment
Fewer respondents report that their schools teach pain assessment. When asked if students learn two or more theories of how pain is generated and perceived (e.g., Gate Control Theory, Neuromatrix Theory, Biopsychosocial Model, etc.), 87% responded in the affirmative, while 96% share the purpose of pain assessment methods and 78% teach the use of visual analog measures and pain questionnaires. Seventy-four percent (74%) of respondents said their students would feel confident using pain assessment tools to plan sessions, while 69% reported that their instructors teach pain assessment competently. Comments about pain assessment include:
“Pain assessment can be beneficial and should be introduced in foundational training, but again, I think it should be used judiciously if at all. This is getting very close to outside our scope of practice. The biopsychosocial model seems to have the best body of research backing it and it should be introduced. However, this should be discussed to teach limitations of massage and the complex reason some clients might experience total pain relief while others may notice no change. Pain should not dictate how a massage is applied other than to ensure no harm is done.”
“Pain and pain assessment are presented in different ways and various formats throughout our program but in having to grade ourselves here, we could definitely master this with our students. We discuss how they will learn more about this in CE classes, but I see how this is passing this skill off and students may never really learn it if we don’t tighten up our instruction.”
Functional Limitations Assessment
Regarding functional limitations assessment and functional goal setting, 100% of respondents say that students learn how to identify a client’s activities of daily living, activities that aggravate a client’s condition, and activities that relieve a client’s condition. Students learn how functional limitations impact clients and their quality of life. Many schools teach students how to work with clients to identify functional limitations and appropriate functional goals (92%). Fewer teach students how to write short-term and long-term functional goals and document functional goals on SOAP forms or other forms (71%). Just half of respondents (50%) say that their graduates are confident using functional goals to plan sessions. Sixty-seven percent (67%) report that their instructors teach functional limitations concepts competently, while 8% say these concepts don’t belong in foundational training programs. Respondents shared these comments:
“Functional limitations should be taught and discussed but with an emphasis on the major limitations of these types of assessments.”
“This is an advanced skill. We introduce these concepts, but if students want to go in this direction, they should look to CE classes.”
“We introduce functional limitation assessment and direct students to CE classes if they want to learn more.”
“This assessment model requires therapists to invest in their clients. Not all students want this kind of commitment. Depending on their mindset, some will flourish and those that don’t want to invest in clients will likely work at a spa providing relaxation massages.”
Less Common Assessment Methods
When quarried about less common assessment methods, 21 of 34 respondents reported that their schools taught gait assessment (76%) and special orthopedic tests (71%). Respondents shared these examples of special orthopedic tests taught in their programs (note that these are the names of the tests as stated by respondents and not necessarily the official names of the tests):
- Adson’s test
- Apley scratch test
- Braggard’s test
- Buckling sign
- Carpal tunnel tests
- Costoclavicular maneuver
- Craig’s test
- Drop arm test
- Empty-can test
- Faber test
- FADIR (piriformis) test
- FAIR test
- Foraminal compression test
- Hawkins-Kennedy impingement sign
- Homan’s sign
- Hoover’s sign
- Kemp test
- Lesegue’s test
- Log roll test
- McMurray’s test
- Modified Thomas test
- Neer’s test
- Nerve testing for carpal tunnel
- Ober’s test
- Pace test
- Phalen’s maneuver
- Piriformis length test
- Pronator teres test
- Roos elevated area stress test
- Scapular stabilization test
- Slump test
- Soto-Hall test
- Speed’s test
- Spurling’s test
- Sternal compression test
- Stork’s test
- Straight leg raise test
- Thomas test
- Tinel’s sign assessment
- TOS test
- Turyn’s test
- Valsalva maneuver
- Varus and valgus stress test
- Vastus medialis coordination test
- Waddell’s sign
- Windlass test
- Wright’s test
Schools’ Primary Challenges in Teaching Assessment
When asked about the primary challenges their schools face in teaching client assessment competently, respondents reported:
- There is no explicit national agreement on what massage graduates should know and be able to do regarding client assessment. Schools need more precise guidelines on learning outcomes related to client assessment (75%).
- More hours of the school’s curriculum are now dedicated to preparing students to pass licensing exams, taking hours away from assessment topics (58%).
- Few teachers (83%) have the knowledge, skills, and practical experience necessary to teach a range of assessment topics competently.
- No dedicated teacher training is available to help massage instructors improve their assessment knowledge, skill, and assessment-related teaching methodology (71%).
- Massage schools are unwilling to pay for teacher training to help massage instructors improve their assessment knowledge, skill, and teaching methodology (33%).
- Schools have no problems teaching client assessment topics competently (4%).
- Foundational massage textbooks don’t cover assessment topics in adequate depth. These textbooks need additional detail to illuminate client assessment topics effectively (58%).
Several respondents commented on their view of schools’ challenges in teaching client assessment.
“Most textbooks are extremely lacking in teaching biomechanics properly. Most entry-level and mid-level biomechanics and assessment books are riddled with mistakes.”
“We are a 750-hour program for $9400. We would need to add more hours, moving our entry-level program to over $10,000. As a personal pay school, that is not feasible.”
“The Department of Education’s rule change requiring Title IV eligible schools to match the minimum number of hours for state licensure will likely result in many schools cutting assessment from their foundational massage education curriculum.”
“Employment guidelines will reduce the hours of our program from 720 to 600 hours. The current projection is for those hours to come from clinical and practical hours. This leaves us less time to practice and refine assessment skills. The scope of practice in our state doesn’t clearly allow special orthopedic tests under massage licensure.”
“Depending on the employment setting, there may be little incentive for LMTs to perform comprehensive assessments. It’s not valued in spa settings, and even in the medical, insurance, and injury-treatment world, insurance companies won’t pay for assessment time (only hands-on time), and they disregard the validity of LMTs’ assessment findings anyway. So, it’s challenging to justify spending time on a skill that is useful but not valued by employers or other entities in the healthcare profession.”
Assessment Comments
When asked if they had other comments related to teaching client assessments, respondents shared these views. Note that if you want to share additional comments about assessment, you can email us and we’ll add them to this page. See the form at the bottom of the page.
“Very few massage therapists and instructors have adequate knowledge of biomechanics and assessment techniques. It is better to understand one’s limitations than to falsely believe you have a skill or expertise that you lack. A great massage therapist does not need a deep understanding of biomechanics or physical assessments. Instead, they need enough information to do no harm and know when to refer out. Some of the best massages I have ever had were by practitioners with little understanding of biomechanics.”
“I feel that we need to rethink entry level. I believe that entry level is giving a basic Swedish massage – with light-moderate-to fairly deep (no elbows or major pressure) pressure, and only for relaxation. When we start getting into all of the other techniques and pathologies, and the why we can/can’t give a massage, it gets beyond a basic massage. The amount of knowledge now becomes more technical and much more involved. My school teaches a more advanced approach because when they get out into the population and start working, they will need to know more than just a gentle massage. Most people we encounter in our school clinic and in class want more than just a relaxation massage.”
“We teach assessments based on various modalities/techniques taught (i.e., when teaching Hot Stone Massage, we incorporate an assessment for this technique). We do cover general assessment of the client for Client Intake, SOAP note-taking, and ROM, but keep this more general. We use Sandy Fritz’s Sports Massage for sports classes and use a few of the orthopedic assessments, but we find that introductory students get overwhelmed this early on.”
“I recently attended a CE workshop from a national presenter using many specialized techniques that I (and other attendees)felt were out of the LMT scope of practice. It concerns me that some of the MBLEX questions may also cover assessment topics outside of scope of practice for my state. How do I teach my students what is needed to pass their Boards and not go outside of the state’s scope of practice?”
“I’d love a textbook that focuses on all the areas of the body and assessment – orthopedic assessment testing – and then what comes next after you have all of that information. My students like to see it in black and white. I can say it 1,000 times and they won’t hear me – but they will read something or watch something and take it as LAW! LOL – I think you understand the dilemma. Thank you for this.”
“Teaching quality client assessment begins when first learning basic or relaxation massage techniques; it’s not only for assessing injury or pain. Teaching students to ask for an active ROM of the area of tension, stiffness, or soreness is just as important and helpful to planning a session as when there is an injury, major pain, or limitation. If we begin with that premise, it’s not so hard to expand it as their skills become more specialized and treatment-oriented.”
“We have prepped for client assessment lessons by priming with critical thinking exercises and trying to incorporate real-life scenarios with complex client background info to show the intricacies of treating clients for musculoskeletal issues amongst and around multiple other chronic systemic conditions.”
“In my view, basic assessment skills need to be taught in school, and students should be encouraged to continue advancing those skills with their CEU choices. However, many schools may not have qualified Instructors with experience to teach those skills. Fortunately, we do in our school.”
“I’m involved in massage CE, so I’m not a student or in a school. However, I have benefited from a massage therapist who is exceptionally skilled in advanced functional assessment. Correctly assessing a client’s condition or status, I think, is one of the most important skill sets of a massage therapist who works with people with pain conditions can have. It not only helps the client by making the treatment more efficient and taking guesswork out, but also limits legal liability and prevents injury. Other healthcare professionals can and do misdiagnose conditions. A massage therapist skilled in advanced assessment (functional) can be a life-changer for people in pain. So, I do advocate for entry-level assessment training and then ongoing training once graduated.”
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If you want to make a comment about assessment or a particular type of assessment please send it through this form. I ask that all comments be your views on assessment and not comments on other people’s comments. Let’s share our thoughts without the need to judge others’ thoughts. Thank you!