Rom: Where we begin to compare the subjective to the objective

If you are looking to be a little more thorough in your technique for massage assessment but don’t really know where to start, simple range of motion is a great place. During your interview process with a client you should have covered such topics as: Where does it hurt? What is the quality of the pain? When did it start? How did it start? Does it radiate? What is the pain on a scale of 1-10? Is there any compensatory issues? Aggravators?  Relievers? This is your subjective information.  Some of us cover a little more, some of us cover a little less, but this is how your client ‘feels’ about his or her pain/condition.

It is very important information, but keep in mind the body is not cut and dry.  Injury is not always where the pain is, nor does structural abnormality add up to pain either. It is only by combining the different tools that we have, that we can begin to scrape the surface and make educated guesses about what is really going on in the body.

Range of motion is a huge assessment tool that is really undervalued. For the most part, when we think of range of motion, we think of boring dry numeric assessment of how many degrees of motion is normal or abnormal, and while that information is important, for most therapists, it matters little if the arm has 3 degrees less rotation, or 8 degrees.  Once we know something is limited, whether normal or over-mobile, it is in comparing that information with the rest of the data we have learned that ROM really becomes a valuable tool.

You will want to divide your range of motion up into two categories. Normal ROM for an average person, and normal ROM for ‘that’ person.  In your first assessment you will compare their ROM with what you know to be normal for others. Recording this information will give you a baseline by which to measure your client.  As time progresses and you learn how their body works, you will begin to measure them by what is ‘normal’ for them.  It is important to understand the distinction between these two things, because for your client, normal may not be normal at all. . Lack of moment or over-mobility may also be completely normal for a client and not add up to any relevant pain. In the case of injuries, however, it often can be.

Once you have made both a verbal assessment and a physical one you will start to overlay the two sets of information and compare what you have learned.  Comparing what the client ‘feels’ to what we observe is where the real value is. The more areas of assessment we have to compare, such as ROM, palpation, verbal assessment, passive ROM, and special test etc…the more likely we are to gain an accurate picture of what is going on in a particular body.

I will give you a brief example of how it works:

A client comes in complaining of low back pain. It is chronic and constant, and he has been receiving 30 minutes of massage on his low back for 3 weeks, once a week with no change. He has been to his doctor and been cleared to see you. He is a runner, in good physical health and has no history of back injury.  He is now afraid he has a disk problem, and has stopped activity for fear of seriously hurting himself, which has aggravated the pain.  Because he has come to your clinic, you do a full assessment, including ROM of the surrounding area (low back and legs) Even though he complains that he has low back pain, he has no limited movement in any direction of his lumbar spine. If anything, he is over -mobile. Now you think to yourself, “that does not seem right, someone with low back pain should be tight and trigger pointy”. So you perform the ROM for his legs and while you find most things pretty normal, you realize that he has almost no mobility in his IT bands and gluts.

By comparing the two sets of data we can start to build a picture of the probable cause for the client. If you had just had the one set of verbal information to go on, you would have massaged his lower back like everyone else. If you had just done the ROM with no verbal information, you would likely assume that perhaps the limited mobility is normal for that client, but since we know he stopped running recently, and we know exercise warms the tissue, we can draw the conclusion that the symptoms were aggravated by withdrawing from activity.  Because you draw from the compared data, you treat both the lower back and the legs with massage, stretching and fascia work, which eases the symptoms for your client.  As you learn more tools you can add them in, such as tests for disc problems as a rule out, but remember, this is an educated guess, not a diagnosis. 

Sometimes things are not so clear but the more you practice the more you will realize how complex the body is and the rules you were taught often do not apply at all, as biology is not rule based, but biology based. There are, however, patterns in many of the things you will encounter. Getting familiar with ROM and using it as an assessment tool is just one step forward in giving you a tiny peek under the hood.  Good luck building your tool box!

For more information on Orthopedic Massage please see  Orthopedic Massage NYC
by Beret Kirkeby