Client Assessment and Planning Flashcards

During a client intake, a new client discloses they are taking warfarin for atrial fibrillation and have recently had a pulmonary embolism. Which assessment finding would be the MOST critical contraindication to proceeding with deep tissue massage to the lower extremities?

Answer: Bilateral ankle edema with pitting greater than 2+ and unilateral calf warmth

Unilateral calf warmth combined with pitting edema greater than 2+ are clinical signs consistent with deep vein thrombosis (DVT). In a client already on anticoagulants with a history of pulmonary embolism, this presentation represents an absolute contraindication to lower extremity massage. Mobilizing a thrombus could cause a life-threatening embolism. The other findings (mild DOMS, slightly elevated BP, or a therapeutic INR from weeks ago) do not present an immediate threat requiring session cancellation.

A massage therapist is reviewing intake forms and notices a client has a history of non-Hodgkin's lymphoma in remission for two years, with a current complaint of chronic low back pain. The client's oncologist has provided written clearance for massage. Which planning decision BEST reflects evidence-informed practice?

Answer: Adapt pressure and avoid direct work over lymph node clusters while monitoring for fatigue response post-session

Evidence-informed oncology massage practice requires adapting — not eliminating — massage based on individual assessment. Physician clearance authorizes massage but does not dictate technique; the therapist must still apply clinical reasoning. Avoiding direct pressure over lymph node clusters (axillary, inguinal, cervical) and monitoring for post-session fatigue are appropriate modifications. Full restriction to effleurage on the upper extremities is overly conservative given two years of remission and oncologist clearance. Refusing care contradicts the clearance and ethical responsibility.

A therapist conducts a postural assessment and observes a client with an anterior pelvic tilt, hyperlordosis of the lumbar spine, and hyperextended knees. Using a muscle imbalance framework, which planning approach is MOST clinically appropriate?

Answer: Apply inhibitory techniques to the rectus femoris and lumbar erectors while facilitating the deep abdominals and hamstrings

Anterior pelvic tilt in a lower crossed syndrome pattern involves overactive/short hip flexors (including rectus femoris), overactive lumbar erectors, and underactive/inhibited deep abdominals and hamstrings. Correct planning targets the tight, overactive muscles with inhibitory techniques (e.g., sustained compression, stretching) and supports the weak, inhibited muscles with facilitation or activation. Strengthening hip flexors (option A) or facilitating lumbar erectors (option B) would worsen the imbalance. Option C incorrectly includes the hamstrings as needing facilitation when they are typically shortened (not lengthened) in anterior pelvic tilt patterns.

A client arrives reporting they were diagnosed with fibromyalgia six months ago and rates their current pain at 7/10. They express frustration that previous therapists used 'too light' pressure and request deep, firm work. How should the therapist BEST navigate this clinical and ethical situation?

Answer: Begin with moderate, tolerable pressure, explain the sensitized nervous system rationale, and reassess pressure tolerance throughout the session

Fibromyalgia involves central sensitization, where the nervous system amplifies pain signals. Deep pressure can trigger post-session pain flares even when the client reports tolerating it during the session. The correct approach balances client autonomy with evidence-informed clinical judgment: start at a tolerable pressure level, explain the central sensitization mechanism (education is part of the therapeutic plan), and continuously reassess. Simply deferring to client preference (options A or D) neglects the therapist's professional responsibility. Refusing all deeper work (option B) is overly restrictive and not supported by evidence.

When completing a SOAP note after a session, a therapist documents: 'Client appeared anxious during intake, shoulders were elevated, and reported headaches three to four times per week for six months.' In SOAP format, which section does MOST of this information belong to?

Answer: Subjective and Objective, split based on whether the data is self-reported or directly observed

In the SOAP framework, Subjective (S) captures what the client reports — in this case, headache frequency and duration. Objective (O) captures what the therapist directly observes or measures — in this case, elevated shoulder posture and observed anxiety behaviors. The appearance of anxiety and shoulder elevation are therapist observations (O), while the headache history is client self-report (S). Placing all data in one section (options A, B, or C) misapplies the SOAP structure. Accurate documentation requires splitting this data across S and O appropriately.

A client with a history of uncontrolled Type 2 diabetes presents with peripheral neuropathy in both feet, complaints of numbness, and reports a non-healing ulcer on the plantar surface of the left foot that is currently bandaged. Which is the MOST appropriate planning decision for this session?

Answer: Avoid all work distal to the knees, obtain physician clearance before any future lower extremity work, and document the referral

A non-healing ulcer in a client with uncontrolled diabetes and peripheral neuropathy represents a serious local and systemic contraindication. Diabetic ulcers carry high risk for infection, poor healing, and osteomyelitis. Neuropathy means the client cannot accurately report pain or discomfort, making pressure-based feedback unreliable. Any massage distal to the knees — including reflexology or 'gentle' effleurage — risks disrupting the wound environment or increasing circulation in a compromised vascular bed. The appropriate action is to avoid the area, refer to the physician, and document clearly. Options A, C, and D all involve working in the contraindicated zone.