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Chapter 6 / Communication and Documentation
271
Figure 6-2. Pertinent information for SOAP notes.
272 INTRODUCTION TO MASSAGE THERAPY
information is documented as subjective data on the SOAP
note. Information from the client history form provides
many clues about the condition of a client’s structures and
soft tissues even before your formal assessment. The history form should include the following client data: personal identification and contact information; current health
information, health concerns, and goals for health; goals
for treatment; history of injuries, illnesses, and surgeries;
and consent to exchange health information with other
healthcare providers as well as consent for care. Finally, clients should sign and date the form as acknowledgment and
proof that they had the opportunity to discuss anything
on the form with you and gave their consent for massage
treatment. (See Figs. 6-6 and 6-9 for examples of health history forms.)
Some intake forms include body diagrams, which can
be a helpful tool for clients because verbalizing their symptoms and physical sensations of discomfort may be difficult.
Additionally, when the client is given the opportunity to
draw on the body diagram before the interview, it can simplify and expedite the interview process. Figure 6-3 is a sample
health report form indicating a client’s current symptoms.
Know that clients almost always have more information than
they initially write down.
about accidents and injuries. The muscular and nervous systems, however, do not forget. In fact, soft tissue condition
and postural compensations directly reflect their cumulative
stresses. Any one accident, injury, condition, hobby, or activity may not seem stressful for the body, but cumulatively or
unresolved, individual stressors will manifest in the body as
postural compensation patterns and physical symptoms in
soft tissues.
More often than not, people forget
Interview
After the client has filled out the history form and indicated
symptoms on the body diagram, you begin sorting through
the information. Leading questions help clarify the client’s
input, allowing you to identify contraindications, set appropriate session goals, and develop an effective treatment plan.
Daily activities, hobbies, and environmental factors such
as climbing stairs or long commutes to and from work are
often the culprit behind muscular tension and pain. Some
categories that are commonly covered when interviewing
massage clients 1 :
• General: allergies, fatigue, fever, function, illness,
pain, stress
• Circulatory: cold extremities, cramps, edema,
inflammation, swollen lymph nodes, varicose veins
• Musculoskeletal: aches, joint pain, muscle pain, stiffness, swelling, tension, weakness
• Neurological: numbness, radiating pain, tingling,
localized weakness
• Psychosocial: lifestyle, important experiences, personal life, social life, work situation
The history is your first and perhaps most important
assessment tool to understand the condition of the client and whether massage is the safest and most effective
treatment.
Functional Stress Assessment
Stress can be anything that takes a person out of homeostasis or balance or it can be defined as a state of bodily or
mental tension resulting from factors that hinder the body
from maintaining homeostasis. Stress is not necessarily a bad
thing and, in fact, small doses of stress can encourage the
body to become stronger. Antigens that are incompatible
with our own tissues are a form of stress because they jeopardize homeostasis, but the only way our bodies can develop the appropriate antibodies is by being exposed to those
antigens. The resulting antibodies effectively strengthen the
immune system. Bones remodel and become stronger in
response to mechanical forces, or forms of stress that push,
pull, twist, or compress them.
Stress may cause problems when it is prolonged or when
many individual stress factors accumulate and the body is
challenged to maintain homeostasis. For example, people
who work long hours and have to stay intense and alert for
weeks on end overwork their sympathetic nervous systems.
Without enough rest, the activities of the sympathetic and
parasympathetic nervous systems become imbalanced, creating internal stress that threatens the ability to maintain
homeostasis. Mechanical forms of stress can be caused by
overusing one set of muscles on one side of the body without
using the antagonists or the same set of muscles on the other
side of the body as much. To maintain balance and homeostasis, the body adopts an abnormal posture that compensates
for the imbalance. Another form of mechanical stress is pain,
which may force the body to accommodate for the pain with
an abnormal posture and compensation patterns.
Massage therapists consider the effects of stress from
a functional perspective, evaluating the extent to which a
client is out of balance and how the imbalance affects the
client’s soft tissue and postural compensation patterns as
well as everyday activities. When assessing a client, you
must consider specific sources of stress, such as dysfunctions or pathology, previous accidents or surgeries, activities, and nutritional habits and the overall effect of the
accumulated stress factors. Several types of stress may
affect the client in many areas of life, and you must recognize how each source of stress affects soft tissues and postural compensation patterns so you can develop the most
Chapter 6 / Communication and Documentation
273
Figure 6-3 Health report, filled out. (Reprinted with permission from Thompson DL. Hands Heal: Communication, Documentation, and
Insurance Billing for Manual Therapists. 3rd ed. Baltimore: Lippincott Williams & Wilkins, 2006.)
274 INTRODUCTION TO MASSAGE THERAPY
effective treatment plan for each client. You should evaluate, using leading questions, if necessary, the following
stress factors:
Health Conditions
• What current soft tissue or pathological conditions
is the client experiencing?
• Are the client’s conditions acute or chronic? (This
provides information about the condition of soft
tissues.)
• Are the conditions genetic?
• Has the client seen any other healthcare practitioner or
had other forms of treatment for the condition? If so,
what did the other healthcare practitioner conclude?
What kind of treatment is currently being given?
Accidents and Surgeries
• How many and what kinds of accidents or surgeries
has the client had?
• What kind of treatment, if any, has the client had for
the accidents?
• What are the residual soft tissue injuries or
compensations?
• How many and what kinds of surgeries has the client
had? Does the client have residual scarring in the area?
Age Considerations
• Tissue changes at different ages
• The effects of gravity over time on postural compensation patterns
Lifestyle
• Are there any activities the client does daily that use
repetitive movements or positions that are held for
extended periods of time? What postures or positions is the client in and for how many hours a day?
• What exercise activities does the client participate
in? What muscles are used most in those particular
activities?
Postural Factors
• Are there any daily postures or positions that the client holds for extended periods of time?
• How many hours does the client work per day?
• What position does the client sleep in?
• How many hours does the client sleep per night?
Nutrition and Medication
• What are the client’s nutritional habits?
• How much water does the client drink per day?
• How much caffeine does the client consume per day?
• What vitamins or nutritional supplements does the
client take?
• Does the client take any medication, prescription or
over-the-counter? If so, what does the client take it for?
Emotional and Psychological Factors
• As stated above, treating emotional and psychological factors is not within the massage therapist’s scope
of practice, but any increase in stress level because of
these factors can weaken the body’s ability to maintain homeostasis or balance. In turn, this can affect
the client’s soft tissues or postural compensation
patterns. Although specific psychological conditions
should not be documented, you can make notes
regarding general emotions to consider when creating a treatment plan.
Generally, the higher the client’s stress level, the longer
it will take to return to balance or homeostasis.
Cumulative Effects of Stress
After discussing the client’s history, you can educate the client about how stress has accumulated and describe your
plan for the current and future massage sessions. The client
may be seeking relief from current pain or discomfort, but
an effective therapist will also consider past and potential
stressors. All past, present, and potential or perceived future
stressors can affect the client’s condition. Explain to the client that if it took years to develop a muscular or soft tissue condition, it could take numerous sessions to reduce the
severity of the condition. Again, the number and accumulation of stressors influence the length of time it will take soft
tissues and postural compensation patterns to return to balance or homeostasis. Although there are general principles
regarding soft tissue rehabilitation and recovery time, each
client is affected by a unique set of accumulated stressors.
Some clients may think that one massage will miraculously
cure them of their aches and pains. Unless they understand
how the cumulative effects of stress relate to the development of a chronic condition, clients may be quickly discouraged or decide that massage is not helpful after only one
session. (See Box 6-1, Procedure: Client Interview.)
Objective Information
Objective information includes your assessments of a client’s body and the condition of the soft tissues. Any observations and evaluations you make before, during, or after
the actual massage treatment are documented in this section of the SOAP note. Visual observations to record might
include areas of swelling or inflammation, unevenness of
bilateral bony landmarks or muscles, postural abnormalities, compensation patterns, gait (walking) assessments,
and localized areas of abnormal skin coloration, especially
Chapter 6 / Communication and Documentation 275
BOX 6.1
1. Greet first-time clients with good eye contact and a friendly, confident handshake.
2. Explain your policies and intake form(s) and offer reasons for documentation.
3. Ask clients to fill out forms. Meanwhile, start filling out their SOAP note.
4. Interview clients:
a. Clarify their purpose for coming to you for a massage.
i. Is there any area in particular they want you to address or avoid?
ii. Are there any techniques they prefer or dislike?
b. Clarify their chief complaint, if there is one. This helps you better understand the client’s current condition to
know if any progress was made when you perform the posttreatment assessment.
i. Is there anything that makes the pain worse or better?
ii. Do they notice the discomfort all of the time, only during certain activities, or only after certain activities?
iii. How long have they had this condition?
iv. Ask them to try to rate the discomfort, using a scale of 1 to 10 or on a scale of mild to severe.
v. Ask them to try to describe the discomfort (sharp, achy, numb, tingling, heavy, throbbing,etc.).
c. Question any conditions on the history form that might present contraindications—injuries, illness, surgeries,
bruises, circulatory problems.
d. Inquire about daily activities, hobbies, and environmental factors, looking for repetitive movements or sustained
positions to try to identify the soft tissues that might be involved.
i. Do they drive/sit/stand/type/carry an infant a lot during a typical workday?
ii. Do they garden/knit/ride horses/drive a race car most of the weekend?
iii. Do they hold an instrument/walk a lot of stairs/breathe smoke-filled air/shift a manual transmission/look up
at a screen high on the wall repeatedly?
e. Discuss the general, circulatory, musculoskeletal, neurological, and psychosocial aspects of their health to find
out if there is anything that might influence the treatment you give or the results of the treatment.
5. Evaluate their functional stress:
a. Health conditions
b. Accidents and surgeries
c. Nutrition and medication
d. Age, lifestyle, postural factors, emotional and psychological factors
6. Explain that the uniqueness of individuals, especially their stress factors, can affect the length of time it takes to
restore function or create a noticeable change.
redness. Palpation observations are noticed when you touch
the client’s body and feel the soft tissues. Some pertinent
palpation observations to record include hypertonic muscles, atrophied muscles, and abnormal skin temperatures,
either localized or over the entire body.
You may also evaluate the client’s range of motion
(ROM) at one or more joints, especially if he or she complains of restricted movement, normal activities that
cannot be performed, or “tightness.” A goniometer
(GOH-nee-AH-meh-ter) is a specific device that measures
the ROM in degrees. With specific training, some massage
therapists use this device; however, most massage therapists
evaluate ROM as a relative difference. Usually, clients explain
that they have difficulty moving a specific joint or difficulty
performing an activity that they normally do without any
trouble. You can easily compare the ROM of the affected
joint to the ROM of the same joint on the opposite side of
the body. Likewise, you can consider the ROM of the joints
276 INTRODUCTION TO MASSAGE THERAPY
involved in the activities that they cannot perform or have
difficulty performing and compare the client’s normal ROM
to the now limited function and its associated limited ROM.
With additional training, you can use functional assessment
tests such as manual resisted (manual muscle) and special
orthopedic tests to help determine any potential contraindications or the need for referral to another healthcare practitioner. The information you need to document in the “O”
section of the SOAP note is covered in Chapter 7.
Activity and Analysis Information
Activity and analysis information covers the massage activity
and an analysis of the session. The “A” portion of the SOAP
note includes information about which techniques were used,
where they were applied, and what the results were. You can
also include effective or ineffective techniques, techniques the
client preferred or disliked, and any changes you might have
made during the session. Massage strokes, the flow of the massage, therapeutic techniques, complementary therapies, and
special techniques are covered later in Chapters 9 through 12.
The analysis of the session requires that you perform
a posttreatment assessment to determine if there are any
changes following the massage, including increased or
reduced pain levels, ROMs, stress levels, muscular tension,
and progress toward the client’s goals. These assessment
skills are detailed in Chapter 7.
The next two steps of the analysis of the session, prioritizing functional limitations and setting treatment goals,
apply to both therapeutic and wellness massage sessions.
Try to avoid categorizing clients as either wellness massage
clients or therapeutic massage clients, because in actuality,
there is overlap. Even though wellness massage does not
address any specific soft tissue conditions or limitations, you
should document the functional limitations and treatment
goals. People who go to spas for wellness massage on a regular basis may occasionally have soft tissue injuries. When
that happens, a massage therapist can perform a therapeutic
massage and establish the necessary treatment goals on the
basis of the prioritized functional limitations.
Prioritizing Functional
Limitations
After you have performed the posttreatment assessment,
you can review all of the subjective, objective, and activity and analysis information to help clients prioritize their
functional limitations, which are normal daily activities
limited by muscular or connective tissue conditions. Using
the information gathered from the intake forms, interview,
and general assessments, you can help clients prioritize
their functional limitations, deciding which activity is most
important to restore. Consider a client who has trouble flexing his left hip. Functional limitations may include a struggle
to get in and out of his car without severe pain, an inability
to go running, and difficulty getting in and out of his bed.
His main concern might be getting in and out of the car
because his job, which requires a lot of driving, is significantly affected. The secondary concerns might be running
and climbing in and out of bed. You may have some information about the client’s past and present involvement with
these limited activities: how much the client ran before the
limitation or how the lack of running has affected him. All
of this information will help you devise the treatment goals
and treatment plan.
Setting Treatment Goals
When clients come to you for massage treatment, they typically want to relax, reduce pain, reduce stress, reduce muscular tension, and/or increase movement. These pretreatment
requests, sometimes considered goals, are subjective input
that can be documented in the “S” portion of the SOAP
note. After the massage and posttreatment assessment, however, you and your client will integrate the client’s goals with
the analysis of the session to determine short- and long-term
treatment goals. These treatment goals are functional goals
that clarify a client’s progress toward overcoming functional
limitations. Although not necessary, client participation in
goal setting is helpful because it gets them involved in their
healing and treatment process. When establishing goals, the
following components must be included:
• Identify a specific activity.
• Include results that can be easily recognized or are
quantifiable.
• Include measurable tasks that can be accomplished
by the client.
• Include a functional limitation that is pertinent to
the client’s lifestyle.
• Set a limited amount of time in which to accomplish
the goal.
The most important quality of these goals is that you
and your clients can recognize when the goals are met
and the outcome has been achieved. Specifying measurable quantities and identifiable qualities makes it easy for
clients to see that the goal has been accomplished. Make
sure the goals are reasonable and attainable. Otherwise,
clients might feel too discouraged to participate in their
healthcare or could be disappointed when the goals are not
quickly reached. If the client is not convinced that a goal
will lead to lifestyle improvements, and there is no distinguishable way to know if the goal is achievable or when it
has been achieved, then that goal is useless for the therapeutic process. Creating effective and useful goals takes
some practice but is important for the therapeutic process.
Chapter 6 / Communication and Documentation 277
When clients have a solid goal before them that is attainable
and easily recognized, they are usually more motivated to participate in their healthcare .
Long- and Short-term Goals
Long-term goals (LTGs) are set up for clients to achieve within
1 to 2 months and are based on their primary areas of concern.
This time frame varies with functional stress, chronic conditions that require time to heal, and a client’s desire to return
to the most functional state of health over time. With time
frames longer than 2 months, clients can easily lose sight of the
goal and may discontinue treatment. An LTG for the above client with hip problems might be being able to run 3 miles, three
times a week without pain after 2 months of treatment.
To keep clients from becoming discouraged with slow
progress or from doubting progress altogether, you assign shortterm goals (STGs). STGs are those that can be accomplished in
1 to 2 weeks. They are a good source of motivation for clients
to continue treatment and continue working toward overcoming functional limitations. They focus on the client’s primary
area of concern, overcoming functional limitations that are
top priority, or getting clients out of an acute phase of an injury. Each STG should support the LTG, and they are typically
designed to be progressive so the client is aware of the progress.
For instance, consider a dog groomer who experiences shoulder
pain when lifting dogs onto the grooming table. You and the
client can decide on the LTG of being able to lift a 20-pound
dog onto the grooming table, four times a day, 5 days a week
without pain. A series of STGs to support this LTG might be:
1. Within 10 days, be able to lift a dog of less than
5pounds onto the grooming table, twice a day, 3 days a
week without pain.
2. Within 10 days, be able to lift a dog of between 5 and
10 pounds onto the grooming table, twice a day, 5 days
a week without pain.
3. Within 10 days, be able to lift a 10-pound dog onto the
grooming table, four times a day, 5 days a week without
pain.
Following are some effective STGs to support LTGs:
• STG: Climb in and out of a car three times a day
with mild pain within 2 weeks
• LTG: Run 3 miles, three times a week without
pain after 2 months
• STG: Drive the car for 10 minutes, 3 days in a row,
without pain within 1 week
• LTG: Drive the car for the 1-hour commute to
work, 5 days a week without pain within 2 months
• STG: Sleep for 3 hours in a row, without back pain
upon waking, 3 days a week within 2 weeks
• LTG: Sleep for 6 hours in a row and wake up
without back pain, 3 days a week within 2 months
• STG: Talk on the phone for 15 minutes without getting a headache, 3 days in a row, within 12 days
• LTG: Talk on the phone for 30 minutes, five times
a day, 5 days a week without getting a headache,
within 6 weeks
• STG: Carry the baby for 10 minutes at a time, once a
day without neck and shoulder pain, 3 days in a row,
within 1 week
• LTG: Carry the baby for 15 minutes at a time,
five times a day without neck and shoulder pain,
7days a week within 2 months
Recall the effects of cumulative stress. Healing time
and the length of time improvements will last depend on
the accumulated stress and stress factors, the amount of
self-care a client performs, and the client’s physical activity.
You must explain to clients that accomplishing their treatment goals depends on a number of factors: the uniqueness
of the individual plays a large part in restoring normal function, and although the treatment goals are reasonable and
attainable, client participation with self-care activities will be
helpful.
Examples of the activity and analysis of massage sessions are shown in Box 6-2.
Plan Information
The plan information of the SOAP note includes a plan for
future treatment and recommendations for self-care. This
future treatment refers to the frequency of future treatments, duration of those treatments, techniques to try, and
techniques to avoid. If you refer clients to any other healthcare practitioners, you can document it in this section.
The plan section identifies the specific self-care activities that you assign and how often clients are supposed to do
the activities. You can check the SOAP note from the client’s
previous session to know what kind of self-care the client
might have used between sessions and ask whether it was
used. Many clients are only interested in receiving massage
to feel better and are not interested in participating in their
own healthcare, so try to not get frustrated with clients who
do not use the self-care activities you recommend. You can
gently remind clients that self-care activities will help reduce
the time it takes to accomplish goals and will increase the
length of time the benefits of the massage last. One form of
self-care is to redirect clients’ focus from illness and pain to
health and absence of pain. When clients start paying attention to how much better they feel, they better appreciate the
benefits of massage and may be more likely to participate
in their own healthcare. Treatment goals that focus on the
absence of pain or discomfort support this redirected pattern of thinking. The treatment plan is further discussed in
Chapter 8.
278 INTRODUCTION TO MASSAGE THERAPY
Examples of Activity and Analysis
complains that her neck and shoulders hurt all the time, but these
Andy begins the session by wanting to minimize his right-sided
neck tension and pain. He has difficulty looking over his shoulder
to check his blind spot when he drives, and he states that he drives
in city traffic all day long for his job. Aspirin seems to reduce the
pain temporarily, and as the day wears on, he can move his neck
more. You observe limited range of motion (ROM) of the neck
upon rotation and lateral flexion, especially to the left.
During the session, you notice that the muscles for neck
rotation and lateral flexion are hypertonic, and you find some
trigger points that radiate pain in his levator scapula muscles.
You apply some light friction and trigger point release along
with general massage techniques.
The posttreatment assessment shows several improvements.
Andy reports reduced pain and expresses relief and gratitude.
With palpation and retesting, you notice that the tension in the
neck has decreased and the ROM has increased when tested for
lateral flexion. Andy says that his only concern is to be able to
check his blind spot without wincing in pain, which becomes
his top priority functional limitation. Together, you determine
his long-term goal to be to be able to check his blind spot
throughout the entire day, 5 days a week without pain. Some
short-term goals you set from session to session might be to
1. Check his blind spot for the first hour of driving without
pain at least 3 days a week, within the next week.
2. Check his blind spot all morning without pain at least
3days a week, within 10 days.
3. Check his blind spot all day without pain at least 3 days a
week, within 10 days.
Sara comes to you for massage. She says she is having trouble
lifting her baby in and out of the crib, car, swing, and high chair. She
particular movements create so much pain in her shoulders that she
is afraid she will drop the baby. She says she suffers the same pain
when doing laundry and trying to wash her hair. Before the massage,
your general assessments reveal bilateral limited shoulder flexion
and bilateral shoulder abduction, although worse on the right side.
During the massage, you detect hypertonic areas anterior to
her glenohumeral joints, hypertonic upper trapezius muscles,
and hypertonic levator scapula muscles. Adding therapeutic
techniques to your typical relaxation massage flow, you feel the
hypertonic tissues soften with massage.
Following the massage, Sara admits that the pain that she felt
all the time is gone. You reevaluate the affected ROMs and find
that she can flex and abduct both shoulders much farther than
before treatment and barely notices the pain at the end of the ROM.
Verbally summarizing the subjective, objective, activity and analysis
information, you can then review Sara’s functional limitations: lifting
the baby in and out of different things, doing laundry, and washing
her hair. She states that it is most important that she be able to
lift the baby in and out of the crib confidently because people are
usually around to help her with the other things, such as getting the
baby out of the car and doing the laundry.
Together, you determine her long-term goal to be to lift the baby
in and out of the crib three times a day for a week without pain. Over
a series of sessions, you establish the following short-term goals:
1. Within a week, be able to place four dishes on the top shelf
of the kitchen cabinet daily, one at a time, without pain
2. Within a week, be able to place eight dishes on the top shelf
of the kitchen cabinet daily, two at a time, without pain
3. Within 2 weeks, be able to lift the baby out of the high chair
twice a day, every day, without pain
4. Within 2 weeks, be able to lift the baby out of the crib once
a day, every day, without pain
Putting the SOAP Together
The massage treatment record you use does not have to
be the SOAP format included in this text; however, it is
commonly used in many healthcare fields, and it can be
helpful for sharing information with other healthcare practitioners. There are several guidelines for documenting in
your practice to ensure validity and dependability of the
records:
• Information should be pertinent to the client’s chief
complaint/s or massage treatment.
• Information should be clear but brief.
• Abbreviations used should be generally accepted
industry standards.
• Writing should be in pen, neat, and legible.
• Only correct a mistake by drawing a single line
through it and writing your initials and date near or
over the line. Never use an eraser or correction fluid.
• Records should be kept in a safe place and away from
public access.
When you first start writing SOAP notes, you may
find it challenging to write all the necessary information in
a limited space and within the limited time for every massage session. There are times when you might have 15 minutes between clients to clean the table, wash your hands, put
new sheets on the table for the next client, and document
the session you just finished. Although it is tempting to skip
the documentation for some sessions, it is important to your
clients, your financial success, and the profession that each
session is recorded. Brief statements, body diagrams, abbreviations, and symbols can speed up the documentation process and make SOAP notes easier to interpret. SOAP notes
can be preprinted forms or blank documents that you fillout.
Chapter 6 / Communication and Documentation
279
Some preprinted massage treatment records include a
body diagram to indicate where on the body the client feels
symptoms. (See Fig. 6-4 for an example SOAP note for a client from Box 6-2.) Symbols are often used on these diagrams,
and a key to the symbols is typically at the bottom of the page.
These diagrams and symbols can be useful for visually tracking
changes on the body, and they eliminate the need to use words
to describe an area on the body or a change that occurred.
Many abbreviations and symbols are used for efficient
and effective documentation. (Table 6-6 lists abbreviations
Figure 6-4. SOAP with body diagram filled out for sample client in Box 6-2. (Reprinted with permission from
Thompson DL. Hands Heal: Communication, Documentation, and Insurance Billing for Manual Therapists. 3rd ed.
Baltimore: Lippincott Williams & Wilkins, 2006.)
280 INTRODUCTION TO MASSAGE THERAPY
( common ones in bold)
TERM SYMBOL
Massage Terms, Modalities, Findings
client Cl
connective tissue CT
contraindication CI
craniosacral therapy CST
cross-fiber friction XFF
deep tissue DT
direct manipulation DM
direct pressure DP
effleurage eff
energy work EW
friction Fx
ice, compression, elevation, support ICES
manual lymphatic drainage MLD
massage M
TERM SYMBOL
tension tens
treatment Tx
Symbols
adhesion X
after p, post
and
approximate
&, ⫹
艐, ⬃
at @
before a, pre
change
down, decrease
elevation
equals
female
greater than
⌬
↓
Ⲑ
⫽
⬎
massage therapist MT
muscle energy technique MET
myofascial release MFR
neuromuscular therapy NMT
not applicable N/A
palpation palp
pétrissage pet
physical therapy PT
positional release PR
proprioceptive neuromuscular facilitation PNF
reciprocal inhibition RI
reflexology reflex
somatoemotional release SER
tense and relax T&R
hypertonic, tension
leading to, resulting
less than
longer than normal
male
numbness, tingling
⬅
→
⬍
↔
么
⬎⬍⬎
⬍
pain P, P
rotation
shorter than normal
spasm
swelling, inflammation
tender point
哷, 哭哬, 哶
⬎–⬍
艐
?
•
trigger point
times, repetitions X
continues on following page