Client Assessment and Treatment Flashcards

During a postural assessment, you observe that a client presents with an elevated right iliac crest, a right lateral lumbar curve, and a depressed right shoulder. Which of the following muscle imbalance patterns BEST explains this combination of findings?

Answer: Shortened right quadratus lumborum with lengthened left lateral trunk flexors and shortened right upper trapezius

An elevated right iliac crest is produced by a shortened right quadratus lumborum (QL) pulling the pelvis superiorly. The resulting right lateral lumbar curve reflects lengthened left lateral trunk flexors. To compensate, the right shoulder depresses — a pattern consistent with a shortened right upper trapezius pulling the shoulder girdle down on the same side as the elevated hip. This crossed-lateral compensation is a hallmark of Janda's lower crossed/upper crossed hybrid patterning.

A client with a history of well-controlled Type 2 diabetes reports peripheral neuropathy in both feet. During the intake, they mention their physician has not cleared specific massage modalities. Which of the following treatment decisions reflects the MOST appropriate clinical reasoning?

Answer: Perform light, superficial effleurage on the feet with careful post-session skin inspection, and obtain physician clearance before advancing pressure

Peripheral neuropathy reduces the client's ability to accurately report pain or discomfort, making deep or aggressive techniques risky due to undetected tissue damage. Light effleurage is appropriate to maintain boundary and provide benefit, while skin inspection after treatment helps detect any adverse response the client may not feel. Physician clearance should be obtained before progressing treatment intensity. Heat packs are contraindicated because impaired sensation prevents the client from detecting burns.

A massage therapist is treating a client who experienced a myocardial infarction 6 weeks ago and has been medically cleared for light activity. The client complains of persistent chest tightness and fatigue. Which assessment finding would be the MOST critical indicator to POSTPONE the session and refer the client back to their physician?

Answer: Resting heart rate of 98 bpm with new-onset shortness of breath at rest and jugular venous distension

Resting tachycardia (98 bpm), new-onset dyspnea at rest, and jugular venous distension are cardinal signs of acute decompensated heart failure — a potentially life-threatening condition that requires immediate medical evaluation. Even with a prior medical clearance, developing these signs post-MI indicates the client's cardiac status has changed. The other options may warrant monitoring but do not represent the same level of acute clinical urgency.

When performing a range-of-motion assessment for cervical rotation, you find that active ROM is limited to 45° bilaterally, but passive ROM reaches 60° bilaterally with an abrupt, hard end-feel on both sides. Which clinical interpretation is MOST accurate?

Answer: The hard end-feel is consistent with capsular or bony restriction; the active-passive discrepancy suggests muscular weakness or pain inhibition, not solely muscle tightness

A hard end-feel at the end of passive cervical rotation is abnormal and suggests bony or severely contracted capsular pathology rather than simple muscle tightness (which would produce a soft or firm end-feel). The 15° gap between active (45°) and passive (60°) ROM indicates the muscle-driven movement is further restricted by weakness, pain inhibition, or neuromuscular factors — not just tissue shortness. This combination warrants referral for imaging and medical evaluation before aggressive manual therapy.

A client presents with anterior knee pain that worsens when descending stairs and after prolonged sitting. Palpation reveals tenderness along the medial patellar facet. Resisted knee extension is painful, but passive knee flexion to 130° is pain-free. Which condition does this presentation MOST closely suggest, and what is the primary massage therapy consideration?

Answer: Patellofemoral pain syndrome; address quadriceps and hip abductor/external rotator imbalances rather than directly compressing the patella

The clinical triad of anterior knee pain worsened by stair descent, prolonged sitting (movie sign), tenderness at the medial patellar facet, and painful resisted extension with pain-free passive flexion is classic for patellofemoral pain syndrome (PFPS). Massage therapy should target the quadriceps (especially vastus lateralis), hip abductors, and external rotators to reduce lateral patellar tracking stress. Direct patellar compression or aggressive local work is avoided because it can exacerbate joint irritation.

A client discloses during intake that they are currently undergoing chemotherapy for breast cancer. They have no open wounds or active infection sites. Their oncologist has provided written approval for massage. Which of the following treatment modifications reflects ADVANCED best practice for this client population?

Answer: Limit the session to light Swedish techniques only, avoid the affected breast quadrant and ipsilateral axilla, position for comfort over standard draping, and monitor for fatigue response during and after treatment

Oncology massage requires significant modification even with physician clearance. Light pressure is indicated systemically due to thrombocytopenia risk (reduced platelet counts from chemotherapy), compromised skin integrity, and immunosuppression. The ipsilateral axilla and affected breast quadrant must be avoided to prevent lymphedema risk and local tissue trauma. Positioning must prioritize comfort due to port placements, surgical sites, or fatigue. Monitoring for post-massage fatigue is critical because chemotherapy clients can have exaggerated responses. Deep tissue work to any area during active chemotherapy ignores systemic physiological compromise.