need help with client big time

[Kristin Durbin]

need some serious advice here guys.

ive had a client this week who has neck problem very limited ROM pain when turning head to left, client gets pins and needles when turning to the left also, they had an MRI 18mths ago and the outcome was degeneration of discs, they contantly wear a scarf to help keep the neck warm, there is not much strength in the muscles, left shoulder is elevated, scapular is ant rotated, on L side, teres major also very tight. there are signs of scar tissue at the proximal end of trapezius around the around the C2 area, there is also a slight curve of the spine from right to left when sitting. client did say they had a fall and banged there head on the floor a few weeks ago, client added that he has had this neck problem for several years, posture is all over the place so i wont explain for now

i performed gentle MFR to neck and traps, a little DF on TM and a little MET to neck, but all was very difficult due to pain, client did gain a little more ROM from treatment.

my question is, with the suspected nerve (pins and needles) problem i think i'd much perfer to refer client on to some one else but who is best? or should i stick to treating him myself for the muscular problems?

oh yes the client is 81 and not looking the picture of health either if you get my drift so very frail and not able to take deep work well

 

[ragsScarkinia]

Hi beagle.

Usually I'd refer to chiro/osteopath but can they do much to "fix" degenerative discs? You have found muscular tightness around the shoulder area so your sports massage will be of benefit for sure.

Personally I would continue massage for a few weeks then refer to chiro/osteo if no improvement to general client comfort then see what the client believes is working best.

Just my thoughts- human body isn't half complex

 

[CNICOLE]

Hi Beagle,
by this age most of us will be experiencing a multitude of degenerative changes so I would not be using anything but gentle techniques for short periods.(if at all).
My prefered choice for referall would be to a cranial osteopath because of the gentle natue of this therapy.

Regards steve

 

[Romanceistheway]

If you decide to treat I suggest general maassage using aloe vera heat cream as a mediummet using eye direction to contract muscles (not a vountary muscle contraction)positional release / scsand avoid any form of frictions

From the info you have given that's what i would do anyway

 

[Joe E]

not sure what an osteo or chiro would do, as neck manipulations would be contra-indicated here.

IMO a softly softly approach is best here, and I would use heat (in the form of a decent warming cream, which you can buy online, with ingredients that actually work such aloe, msm, essential oils). Maybe just using light 'melting' pressure.

I would agree with the referall if the paresthesia is constant, rather than intermittent, however, best to refer back to his GP as opposed to another comp health practitioner.

 

[varun]

As long as there are no apparent contraindications, why not try nerve gliding techniques?

I have found this is good for clients with 'pins and needles'

 

[1234]

Reading this thread, I'm slightly surprised that a frail 81-year-old has booked himself in for 'sports massage'. I would be inclined to do some very gentle MFR, or refer the client on to an osteo or chiro.

Alan

 

[syahir sephiroth]

well i have explained what sports massage is all about and what other therapies might be able to offer, i also said he should go back to the Dr and get an xray on his neck and get referred to a physio via NHS as the Dr said physio would help his problems, He went to Doc's again after several questions the Dr said there was no need for xray and do what he thinks is best

before asecond treatment i asked if there was any benefit he felt after the first treatment, he said there was and he wanted to continue, his son was there also to listen to what i had to say, his son also had a treatment while he was there and was very impressed with my service

the client has now booked a course of 5 treatments, i am only doing gentle massage and added what you guys have surgested, i do see a much better ROM after the second treatment, but i think that his problems will never go as it has been to long before treatment

but it has been interesting to hear you thoughts on dealing with an older client, and i was suprised that they chose a SM for treatment

 

[ahmad]

I regularly see an 80 year old who has a full body sports massage as well as other soft tissue techniques, he attends the gym 5 times a week ,cycles 10 miles a day and walks 5 miles a day, both he and I dont see his age as an issue regarding treatment, as a therapist you just need to be aware that you may need to use varying pressure but the outcomes can be very beneficial. Contrary to some of the opinions on this thread, I see osteopathy and ( particularly) chiropractic as more aggressive and inappropriate for a client of this nature. I also for the record, do not extol the virtues of other therapies whilst I am appropriatley trained, qualified and able to assist the client in meeting their goal.

I have to say that on my original training course, this type of scenario was covered, we had access to treating older clients and in the summative assessments there was questioning of how we would adapt our treatment to facilitate treatment of older or frail clients.

Myofascial relase can be very gentle and effective and greatly assists in the primary goal to restore range of movement, after all a muscle cannot work properly with limited activity whilst held in a mid range position.
kind regards
BGFL

 

[WilliamAspeplyHili]

Hi Gary

I agree that there are some very fit 80-year-olds who are still active enough to need regular sports massage : there were some very impressive performances in the over-80 category at the recent World Masters Championships ! But Beagle did specifically say that his client was 'very frail' and didn't appear to be in the best of health !

Regards

Alan

 

[kteuducaipsibfesb]

Hello Alan,
I did read the OP, my point was that perhaps the training course didnt adequately prepare the student for either working with frail clients or referring to a more appropriately trained therapist.
for the record my oldest client is a frail 94 year old great grandmother of another client
kind regards
Gary