Key Takeaways
- The health intake form collects medical history, current medications, allergies, surgical history, and treatment goals
- OPQRST is a systematic pain assessment tool: Onset, Provocation/Palliation, Quality, Region/Radiation, Severity, Timing
- Postural assessment should observe the client from anterior, posterior, and lateral views
- Palpation assesses tissue temperature, texture, tone, tenderness, and movement (the "5 Ts")
- Normal tissue temperature is warm and even; hot areas suggest inflammation, cold areas suggest reduced circulation
- Muscle hypertonicity feels dense, rigid, and resistant to deformation; healthy tissue is pliable and resilient
- Crepitus is a grinding or crackling sensation felt or heard during joint movement, often indicating cartilage degeneration
- Always palpate bilaterally to compare affected side with unaffected side for baseline reference
Intake, Assessment & Palpation
Client assessment is the foundation of effective massage therapy. A thorough assessment process ensures safe treatment, identifies contraindications, establishes goals, and guides technique selection.
Health Intake Process
Components of the Health Intake Form
| Category | Information Collected |
|---|---|
| Personal information | Name, date of birth, contact info, emergency contact |
| Medical history | Past and current medical conditions, surgeries, hospitalizations |
| Current medications | Prescription drugs, over-the-counter medications, supplements |
| Allergies | Drug allergies, latex allergies, oil/lotion sensitivities |
| Current complaints | Chief complaint, pain location, duration, intensity |
| Treatment goals | What the client hopes to achieve from massage |
| Lifestyle factors | Occupation, physical activity, sleep habits, stress level |
| Previous treatments | Prior massage experience, physical therapy, chiropractic care |
| Informed consent | Signature acknowledging risks, benefits, and right to refuse |
Verbal Interview
In addition to the written intake form, the therapist should conduct a verbal interview to:
- Clarify or expand on written responses
- Assess the client's communication style and comfort level
- Ask follow-up questions about specific conditions
- Establish rapport and trust
- Confirm informed consent verbally
Pain Assessment — OPQRST
OPQRST is a systematic framework for assessing a client's pain:
| Letter | Question | Purpose |
|---|---|---|
| O — Onset | "When did the pain start?" | Determines acute vs. chronic |
| P — Provocation/Palliation | "What makes it worse? What makes it better?" | Identifies aggravating and alleviating factors |
| Q — Quality | "What does it feel like? (sharp, dull, burning, aching)" | Helps identify the type of tissue involved |
| R — Region/Radiation | "Where exactly is the pain? Does it radiate anywhere?" | Maps pain location and referral patterns |
| S — Severity | "On a scale of 0-10, how bad is it?" | Quantifies pain for tracking progress |
| T — Timing | "Is it constant or intermittent? When is it worst?" | Identifies pain patterns and triggers |
Postural Assessment
Observation Views
Anterior View (Front):
- Head position (tilted, rotated)
- Shoulder height (one higher than the other)
- Arm carry angle
- Hip height (pelvic tilt)
- Knee alignment (valgus/varus)
- Foot position (pronation/supination)
Posterior View (Back):
- Spine alignment (scoliosis)
- Scapular position (protracted, retracted, elevated, winged)
- Gluteal fold symmetry
- Achilles tendon alignment
Lateral View (Side):
- Head position (forward head posture)
- Cervical lordosis
- Thoracic kyphosis
- Lumbar lordosis
- Knee hyperextension (genu recurvatum)
- Pelvic tilt (anterior or posterior)
Palpation Skills
Palpation is the therapist's most important assessment tool. The "5 Ts" of palpation:
Temperature
- Normal: Warm and even throughout the area
- Hot: May indicate inflammation, infection, or increased blood flow
- Cold: May indicate reduced circulation, ischemia, or nerve involvement
- Use the back of the hand (more temperature-sensitive) for initial assessment
Texture
- Normal: Smooth, elastic, pliable
- Abnormal: Grainy, stringy, ropy, boggy, or fibrotic
- Fascial restrictions may feel like thick, inelastic bands
- Scar tissue feels dense and less pliable than surrounding tissue
Tone
- Normal (healthy): Pliable, resilient — returns to shape when released
- Hypertonic: Excessively tight, dense, resistant to deformation
- Hypotonic: Abnormally soft, lacking normal firmness (flaccid)
- Spasm: Involuntary, sustained contraction — painful and resistant
Tenderness
- Use a 0-10 pain scale during palpation
- Note the client's verbal and non-verbal responses (wincing, pulling away)
- Grade tenderness consistently for tracking progress
- Document both location and intensity of tenderness
Movement (Tissue Mobility)
- Assess how well layers of tissue glide over each other
- Restricted movement may indicate adhesions or fascial restrictions
- Compare affected side with unaffected side (bilateral comparison)
- Note end-feel quality during passive movement
Special Considerations
Bilateral Comparison
Always palpate both sides of the body to establish a baseline:
- What is normal for this individual?
- Is the finding unilateral or bilateral?
- How significant is the difference between sides?
Client Communication During Assessment
- Explain what you are doing and why before each assessment step
- Ask permission before palpating sensitive areas
- Encourage the client to provide feedback about pressure and tenderness
- Use open-ended questions: "What do you notice when I press here?"
Orthopedic Assessment Tests (Within Scope)
While massage therapists cannot diagnose conditions, certain assessment tests may be within scope in some states to help guide treatment:
Common Tests
| Test | What It Assesses | Positive Finding |
|---|---|---|
| Shoulder impingement (Neer's) | Supraspinatus impingement | Pain with passive forward flexion of shoulder |
| Empty can test (Jobe's) | Supraspinatus tear/weakness | Weakness or pain when resisting downward force on abducted, internally rotated arm |
| Phalen's test | Carpal tunnel syndrome | Numbness/tingling in median nerve distribution within 60 seconds of wrist flexion |
| Tinel's test | Nerve compression at a specific point | Tingling/electric sensation when tapping over the nerve |
| Straight leg raise | Sciatic nerve involvement, disc herniation | Pain radiating below the knee at 30-70 degrees of hip flexion |
| FABER (Patrick's) test | Hip joint pathology, SI joint dysfunction | Pain in the hip or SI region when hip is Flexed, ABducted, Externally Rotated |
Scope of practice reminder: These tests help guide treatment decisions. A positive finding does NOT constitute a diagnosis. Refer the client to their physician for definitive diagnosis.
In the OPQRST pain assessment framework, what does the "P" stand for?
When palpating tissue, which part of the hand is most sensitive for assessing temperature?
During palpation, tissue that feels excessively tight, dense, and resistant to deformation is described as:
Why should a massage therapist always palpate bilaterally?
Arrange the client assessment steps in the typical order they are performed.
Arrange the items in the correct order
The five components of palpation assessment are temperature, texture, tone, tenderness, and ___ (tissue mobility).
Type your answer below
OPQRST is a framework used to assess:
Hot tissue found during palpation most likely suggests:
Match each orthopedic test to the condition it assesses.
Match each item on the left with the correct item on the right