I have a little jar of "blog topic ideas" sitting on my desk, relatively neglected until now. I find it funny that this title was the first one I pulled out because assessment is one of the fundamental parts of my treatment, and the treatments of other health care professionals. Why else would there be so many types of specialists but to look more closely at the details to answer that constant question.... Why?
Assessment is the back bone of a reasonable and rational treatment. In school, I'd suspected this would be true, but, finding assessment difficult, I tried to avoid it; circumstance and ambition would see it otherwise. I attended a seminar given by Rob Johnston DOMTP, principal and one of the head instructors at the Canadian Academy Averland Denis of Osteopathy, here in Hamilton Ontario. It would be impressed upon me that not only is assessment important, it is the only way to truly find and correct the dysfunctions found in the people who come to my office.
So what makes assessment so important? It is the difference between walking into a dark room and crashing into everything to find the one small item you needed, and walking into the same dark room and turning on the light before you begin to search. Massage Therapists have great hands and can feel a great many lumps, bumps, cold spots and textures on the bodies of our clients. But without an assessment, none of that really means anything more than lumps, bumps, cold spots and textures. My first true experience with this was in the seminar I attended. We were asked to palpate (feel) the bony prominences called Transverse Processes of the lumbar vertebrae. Once found our partners were instructed to bend from side to side. It became very obvious that when one bends to one side (say the right), the vertebrae involved in that motion will rotate to the opposite (left). This small bit of information radically changed my treatment. For, that lump I'd been feeling on so many left sides that I dug and dug at to no avail, was a poor little transverse process, right where it should be. This is the power of understanding assessment.
When we assess, we are looking at the expression or symptom, of the dysfunction. This is what makes assessment such a challenge. As assessors, we are interpreting the expression, tracing it back to the root cause in order to discover what is truly at dis-ease. We all know cough medicine doesn't make the sickness go away, it makes the symptoms/expression of it more tolerable. Manual therapy can be very much the same; it can be symptom management, like cough medicine. But unlike cough medicine, when a solid assessment is done, it can identify the root cause of the dis-ease, and, if treatment is within the scope of practice of the practitioner, it can be corrected.
Another reason assessment is so important is investment involved in treatment. Treatment can take a lot of time, and can be costly; more so if the practitioner has a poor idea of what is going on with his client's body. Not knowing why a person has pain means spending a lit of treatment time playing "hit or miss." This is a wasteful use of time for both the practitioner and the client, and a waste of the client's money. Not only is a single treatment spent mostly trying things that likely fail, but the next appointment is another session of trial and error, and the client has lower chances of actually getting better. And note there is a difference between feeling better and getting better. Certainly getting a massage can make that chronic back pain go away for a few days, maybe a week or two, but it probably will be back. So many of my clients want Trigger Point Therapy. They say "oh you can go deeper" or "dig at that!" but all that pressure really does is release natural pain killers, called endorphins. These will last for most of the day, and may even remain for a few days, but these, like cough medicine, are only managing the symptoms. In short time the back pain has returned, and you're once again at the mercy of your therapist and the Pain Scale system.
By doing very simple postural exams, I have learned to identify and correct problems of vertebral alignment, fixation of sacroiliac joints, sciatic nerve compression, rib and thorax immobility, carpal tunnel like syndromes and other joint or limb pains. Every client presents new challenges and new puzzles with all their own unique alignments to investigate. Assessment is an ongoing process, as you change throughout your treatments, and as I change throughout my career, revealing more and more information about your body, and my role in bringing it to the best health it can have. Though it is not always easy, assessment is always necessary. Next time you visit any professional, whether he or she is a Doctor, Nutritionist, Personal Trainer, or Accountant, make sure your investment is protected and respected by having your concern properly assessed, so the prescribed treatment is reasonable and rational.
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