Client Assessment and Planning Flashcards

A client with a history of deep vein thrombosis (DVT) three years ago presents for massage and reports no current symptoms or anticoagulant use. Which approach to the affected limb is MOST appropriate?

Answer: Perform only light effleurage distal to the site, avoiding any directional pressure toward the heart

A resolved DVT still warrants caution because post-thrombotic syndrome can leave valvular damage and increased clot risk in the area. Light effleurage avoiding directional pressure toward the heart minimizes the risk of dislodging any residual thrombus or stressing compromised venous valves. Blanket avoidance (B) is overly restrictive, and standard full massage (C) ignores ongoing vascular vulnerability. Proximal-to-distal strokes (D) push venous blood the wrong direction.

During intake, a client discloses they are currently undergoing chemotherapy and presents with mild peripheral neuropathy in both feet. Which assessment finding would most significantly alter your session planning beyond the neuropathy alone?

Answer: Platelet count below 50,000/μL reported at their last oncology visit

A platelet count below 50,000/μL indicates severe thrombocytopenia, which substantially increases bleeding and bruising risk and requires significant pressure modification — often limiting work to only very light touch. Fatigue (B) is common and manageable with session length and pressure adjustments. A port-a-cath (C) requires local avoidance but does not globally alter the session. Trace edema (D) is minor and does not carry the same systemic risk as critically low platelets.

A therapist reviews a new client's health history form and notes a diagnosis of Marfan syndrome. Which assessment consideration is MOST critical when planning soft tissue work?

Answer: The potential for aortic root dilation requiring avoidance of deep anterior thoracic and abdominal pressure

Marfan syndrome involves connective tissue abnormalities that predispose clients to aortic aneurysm and dissection. Deep pressure over the anterior thorax and abdomen near the aorta carries real risk of catastrophic vascular injury. Joint hypermobility in Marfan syndrome contraindicates aggressive stretching (B) rather than encouraging it. Positioning (C) and lubricant choice (D) are logistical, not safety-critical, considerations.

A licensed massage therapist is assessing a client who reports intermittent 'clicking' in the temporomandibular joint (TMJ), occasional jaw locking, and pain radiating to the ipsilateral temple. The client asks for intraoral TMJ work. What is the therapist's MOST appropriate next step before proceeding?

Answer: Obtain written physician or dentist clearance given the locking episodes before performing intraoral techniques

Jaw locking episodes suggest possible disc displacement with reduction, a condition that may require co-management with a dentist or oral surgeon. Physician or dentist clearance protects the client from harm and the therapist from liability. Proceeding without clearance (B) when locking is present is risky even within scope. Deferring all work until clicking stops (C) is overly restrictive and misstates the contraindication. An arbitrary three-session extraoral trial (D) substitutes protocol for clinical reasoning.

A massage therapist is conducting a postural assessment and observes that a client's right iliac crest is elevated, the right shoulder is depressed, and the head is laterally flexed toward the right. Which assessment interpretation is MOST accurate?

Answer: The findings are consistent with a functional right lumbar lateral shift compensated by a left thoracic curve and right cervical flexion

Elevated right iliac crest with depressed right shoulder and right cervical lateral flexion represents a classic compensatory postural chain: a right lumbar shift creates an apparent right low back curve, which is compensated by a left mid-thoracic curve, then a right cervical curve — all to keep the eyes level. This is functional patterning, not necessarily structural scoliosis (C). A structural leg length discrepancy (B) would need radiographic confirmation, and the postural chain here involves multiple segments. A depressed shoulder does not indicate hypertonic trapezius on the same side (D) — it often indicates stretch weakness.

A therapist's client discloses a diagnosis of complex regional pain syndrome (CRPS) Type I in the left forearm following a wrist fracture six months ago. The skin appears shiny and mottled, and the client reports allodynia. Which session modification BEST reflects evidence-informed practice for this condition?

Answer: Begin with extremely light touch proximal to the affected area and integrate graded exposure techniques only with the client's real-time feedback

CRPS involves central sensitization and autonomic dysregulation; allodynia means even light touch can trigger severe pain. Graded exposure with proximal, extremely light touch and real-time client feedback respects the nervous system's hypersensitivity while working toward desensitization. Total avoidance of the limb (B) may reinforce fear-avoidance patterns and is overly restrictive. Deep cross-fiber friction (C) would intensely aggravate allodynic tissue. Standard effleurage and petrissage (D) is inappropriate for allodynic skin, which cannot tolerate normal mechanical input.