Client Assessment and Treatment Flashcards

A client presents with a history of systemic lupus erythematosus (SLE) and reports a recent flare-up with joint inflammation. During the intake, they mention their rheumatologist has not cleared them for massage. What is the most appropriate course of action?

Answer: Postpone the session and request written medical clearance before proceeding

When a client with an active autoimmune flare has not received medical clearance, the therapist must postpone the session and obtain written clearance from the treating physician. SLE flares involve systemic inflammation that can be exacerbated by massage, and proceeding without physician approval—even with modified techniques—places the client at risk and exposes the therapist to liability. Verbal consent from the client does not substitute for medical clearance.

During a postural assessment, a massage therapist observes that a client's right shoulder is elevated and the head is laterally flexed toward the left. Which muscle is most likely adaptively shortened on the RIGHT side?

Answer: Right upper trapezius

An elevated right shoulder combined with lateral cervical flexion toward the left indicates that the right upper trapezius is adaptively shortened. This muscle both elevates the scapula and laterally flexes the head to the ipsilateral side when shortened. The head's leftward tilt is a compensatory response to the right-side elevation, not a primary shortening of the left-side muscles. The SCM would produce ipsilateral lateral flexion and contralateral rotation, which is not the primary finding here.

A client discloses they are taking warfarin (an anticoagulant) following a recent deep vein thrombosis (DVT) in the left calf, diagnosed 10 days ago. They say their physician has cleared them for 'light activity.' What is the therapist's most appropriate response?

Answer: Contact the physician directly to clarify what 'light activity' means in the context of massage therapy before proceeding

A recent DVT (10 days ago) is an absolute local contraindication, and the client is on anticoagulants, which increase bleeding risk systemically. A physician's clearance for 'light activity' likely refers to ambulation, not massage therapy. The therapist must contact the physician to confirm whether massage is specifically approved, what regions are safe, and what pressure is appropriate. Proceeding based on a general clearance without massage-specific guidance is a clinical and ethical error. Anticoagulants alone are not an absolute contraindication, but the active DVT history within 10 days is a major red flag requiring direct physician consultation.

A therapist is assessing range of motion (ROM) and notes that passive ROM is significantly greater than active ROM in a client's right shoulder abduction, with pain only during active movement. This finding most strongly suggests:

Answer: A contractile tissue lesion, such as a rotator cuff strain or tendinopathy

When passive ROM exceeds active ROM and pain is present only during active movement, it indicates a lesion in a contractile tissue—muscles or tendons—because passive movement does not stress contractile structures the same way. This pattern is a hallmark finding for muscle strain, rotator cuff pathology, or tendinopathy. Joint capsule restrictions would limit both passive and active ROM proportionally. Ligamentous laxity would increase passive ROM without significant pain during active movement. Central sensitization typically presents with widespread, non-mechanical pain patterns.

A client with Type 1 diabetes arrives for a 90-minute deep tissue session. Midway through the session, they become disoriented, sweaty, and report feeling shaky. What is the MOST immediate and appropriate action?

Answer: Stop the massage immediately, have the client consume fast-acting carbohydrates, and monitor them before allowing them to leave

The client is exhibiting classic signs of hypoglycemia (low blood sugar): disorientation, diaphoresis, and shakiness. Massage increases glucose uptake by muscles, which can precipitate hypoglycemia in insulin-dependent diabetics. The correct response is to stop the session immediately and provide fast-acting carbohydrates (juice, glucose tablets) if the client is conscious and able to swallow. The therapist should monitor the client and not allow them to drive or leave until stable. Elevating legs is appropriate for vasovagal syncope, not hypoglycemia. A therapist must never administer insulin—that would worsen hypoglycemia. Calling 911 is appropriate if the client loses consciousness or does not respond to oral glucose.

During a client intake, a therapist reviews a health history form and notes the client has a diagnosis of 'peripheral neuropathy' with reduced sensation in both feet. When planning the session, which clinical concern is MOST specific to this condition that the therapist must address?

Answer: The client's inability to provide accurate pressure feedback, increasing risk of undetected tissue damage

Peripheral neuropathy causes reduced sensation, which means the client cannot reliably report pain or discomfort from excessive pressure—removing the therapist's primary real-time safety feedback mechanism. This creates a significant risk of tissue damage (bruising, nerve compression, ischemia) without the client's awareness. The therapist must use lighter, carefully monitored pressure and rely on visual tissue assessment rather than client feedback alone. Peripheral neuropathy does not contraindicate all lower extremity work, and cross-fiber friction is not a treatment for nerve regeneration. Effleurage direction is unrelated to this specific concern.