Please help -- client tomorrow - cervical spine fused

[Turkey Man]

Hi there,

I'm having a first-time client tomorrow who has Rheumatoid Arthritis in her neck and spinal fusion from C1-C7 with 0 degrees ROM. I've read up on the condition, and have formulated a bit of a game plan in my head, but I would love some tips/no-no's/additional input.

Has anybody ever encountered this? What procedure would you use?

Thanks in advance.

 

[smmay2]

please help client tomorrow cervical spine fused

Well, take the time to read over the intake form. Start your charting carefully noting what they are coming for, relaxation, pain relief, leg work,etc. Ask client how they feel it's most comfortable for them to be on table. They have lived in this body so they may have some definite don'ts. Make sure you chart how client requests to be /or not be in certain positions. If you get any bad vibes at all, it might be in your best interest to refer the client elsewhere. I usually allow the client to tell me how they can lay on the table and work from there, always checking in frequently, letting them know it's always OK to stop the massage to change position etc. I tell them I never want them gritting their teeth hoping the massage will be over soon. That only makes their muscles more tense and their experience, a bad one. If I feel I cannot safely do what they want, I'll tell them. Probably not much help, but without metting/knowing client for first time assessment, this is the best advice I can give.

 

[julie s]

^ what lovely said

 

[Sweet Cat]

I have a client who has a rod in her neck from her occiput down through her c-spine. She also has no cervical ROM. I was nervous working with her at first, but I asked a lot of questions and she was happy to tell me what worked best for her. After a few sessions, we found that side-lying position works well for her. Her neck is under much less strain in that position, and it allows me to work on the levator scap, which she needs. Good luck!

 

[Dragonsking91]

Thanks for the replies, guys.

I have met this woman before. She's fairly healthy aside from the RA and the cervical spine. She does yoga, keeps herself moving. She's told me about her experiences with previous therapists, and that she can lay prone and supine.

Mostly, I'm worried that I'm going to inadvertantly move her too much and hurt her. Should I be worried about arm rotations/stretches -- will it hurt her neck? Mainly I plan to focus on all the surrounding neck and shoulder muscles (obviously ) for the neck portion, and she also wants pec work done, so I want to be able to stretch her arm over her head and get in there.

Mainly, I guess I'm just nervous. I know her personally, so I definitely feel more invested than usual in helping her, if that makes sense. I should probably just suck it up, feel confident in my abilities, and rely on her responses throughout the massage, right?

 

[karla C]

please help client tomorrow cervical spine fused

Hi I think you'll be just fine if you take it very slow!! Many people have limited ROM esp. in raising arms overhead and it helps to remember we, as CMT's do ROM to client's comfort level, not beyond to a level we think they should go to. That is PT's area. If ROM gradually gets better with each session, big pat on back to you for respecting & honouring your client's tissues. If you know her well, sit down and tell her up front what your plan is: I usually tell clients who present with this type of bodywork: My first session is an assessment of many things, how you relax under touch, how your muscles/fascia respond/relax, your trust in me, your ability to communicate with me during session, where the restrictions lay, etc. People are usually happy to know these things.Good luck!