Part 1: Keeping Clients Safe
How to Avoid Client Injuries
TASA ID: 4192
Few things are worse than asking a returning client how they feel after a session and having them reply: “I don’t know what you did, but my pain is much, much worse.” Every therapist I know sincerely wants to help their clients feel better, whether the treatment is geared toward relaxation or a specific injury or pain. Unfortunately, in my work as an expert witness, I have seen many cases of well-meaning therapists who have seriously injured their clients.
In one case, a therapist intended to stretch a client’s shoulder, yet pulled on the client’s arm with such force that the client needed two surgeries over the course of one year to fix the damage. In another case, a therapist’s aggressive approach to working an aching forearm left that client needing six months to recover from complete loss of strength due to nerve damage. I also know of several cases where clients presented with broken ribs as a result of overly vigorous massages.
In addition to the horrific experience, pain, disability, and expenses incurred by the clients, these cases also resulted in lawsuits, damage to the therapists’ reputations, and loss of a professional licensure to practice. In some cases, careers were prematurely ended. What might be to blame? A lack of knowledge? An inflated ego? Poor judgment? Low-quality education? Inadequate skill? It’s hard to know, but here are some guidelines to help prevent this from happening to you.
TAKE A THOROUGH HISTORY
Always take a client history, preferably face-to-face. If you are under severe time constraints, have a detailed questionnaire available for clients to fill out in advance; this will give you an opportunity to review the history and ask any necessary follow-up questions. In addition to the client’s preferences for the type of session they want, how much pressure to use, and where they want you to work, find out as much as you can about their injury history. Here are some key questions to ask:
DO YOU CURRENTLY HAVE A PAIN OR INJURY PROBLEM IN YOUR BODY?
Finding out if a client has any present pain or injury lets you know which areas to address with gentle pressure or caution, or to fully avoid. Follow up with questions about the pain or injury issue; the depth, number, and specificity of your questions will depend on and be informed by how extensive your training has been, as well as your experience.
WHERE HAVE YOU HAD PAIN OR INJURIES IN YOUR BODY IN THE PAST?
Areas of previous injury are usually vulnerable places and warrant extra care. If a client has had on-and-off back or neck pain, these areas may need special attention.
HAVE YOU SEEN A PHYSICIAN ABOUT THIS PROBLEM? IF SO, WHAT WAS/IS THE DIAGNOSIS?
If the client has seen a doctor for any pain-related issue, find out what they learned about the injury. If they have not seen a doctor, encourage them to do so. In some cases, require clients to see their physician before continuing treatment; there are serious conditions that can cause back, neck, or headache pain that need immediate medical attention. For example, severe headache pain could be the side effect of either a disk injury in the neck or a cerebral hemorrhage in the brain.
DO YOU CONSIDER YOURSELF VERY FLEXIBLE OR HYPERMOBILE?
When a person is hyperflexible, they are much more vulnerable to injury. Their ligaments are longer than they should be, resulting in unstable joints and hypermobility. If it’s genetic, they may also have a more fragile type of collagen in their connective tissue. This greater range of motion is often referred to as being “double jointed.” Hypermobility can also occur as a result of an accident. In these cases, the extreme range of motion is only present at and around the site of injury, rather than throughout the body. If there has been an injury,compare the client’s left and right sides to evaluate the difference in flexibility.
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