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Chapter 8 / Treatment Plan 331
relatively easy for clients to commit to this kind of time
frame, considering finances, transportation, schedules,
and child care.
Techniques and Areas to Include or Avoid
During the massage, you may try specific strokes or techniques that are ineffective or disliked by a client. On the
other hand, you may find techniques that are especially
effective on a particular client or techniques that a client enjoys. Some clients do not want to be touched in
certain areas, such as their abdomen, feet, or face. For a
client who does not want abdominal massage, but likes
trigger point techniques and responds well to them, you
couldwrite:
Cl–avoid abdomen, likes TP work. Use TP next session.
It is a good idea to ask clients prior to their massage session if there is any area of their body that they prefer not to
have touched.
There are occasions when you do not have enough
time during the session to use all of the techniques you
want or you think of a technique that might be good to try
during the next session. Sometimes the massage is almost
finished when you discover an area of restricted fascia that
you suspect could be the primary imbalance causing the client’s compensation patterns. Rather than start therapeutic
techniques on that area at the end of the massage, you can
recommend that these techniques be incorporated into the
next session.
Reevaluation
Reevaluation is performed when the original treatment goal
has been reached, and it is also important for determining
the progress toward STGs and LTGs. You may want a particular area or joint movement reevaluated before the next
massage session, especially if the self-care activities were
focused on that area. For example, your plan might include a
suggestion to reevaluate right shoulder flexion for hesitation
upon active range of motion (AROM). While you are continually reevaluating clients during each session, you might
use some of the general assessments you performed in their
initial visit. Any new assessment findings are documented in
the “O” portion of the SOAP note.
You typically treat clients for 30 to 90 minutes at a time,
which is enough time to make progress. Between massage
sessions, clients can help to maintain and advance the progress by using self-care, which is simply homework to support
the treatment goals and reduce physical tension. This is not
to say that clients will not benefit from the massage treatment alone, but that the benefits usually increase and goals
can be reached sooner if clients participate between sessions
with self-care techniques. Self-care gives clients an opportunity to participate in the maintenance and improvement of
their health. Using the concept that healing input influences
healing output, you can educate your clients about participating in their healthcare and following self-care recommendations to progress toward their goals faster.
It is not in the massage therapy scope of practice to
prescribe, but there are clients who assume that massage
therapists have the same responsibilities and capabilities
as medical professionals who are allowed to diagnose and
prescribe. Emphasize to clients that self-care activities
are suggestions for enhancing the effects of the massage
session and improving the health of the soft tissues and
not in any way a prescription. Clarify that you treat only
soft tissue conditions via massage and emphasize that any
other conditions should be diagnosed and treated by the
appropriate healthcare professional. It is your responsibility to ensure that clients experience no confusion regarding diagnosis, prescription, or treatment. To avoid any
misconceptions, you can offer handouts and a suggested
reading list with information about self-care activities you
recommend.
Self-care is recorded in the Plan section of the SOAP
note. Try to be specific but brief and refer to the specific
activities, frequencies, durations, and amounts you recommend. For instance, you recommend a client increase water
intake to 60 ounces per day and stretch the left triceps twice
a day, five times a week. You demonstrate the stretch by flexing the left shoulder and elbow and, using your right hand
to slowly push upward on the distal humerus, increase flexion of the left shoulder. Your notes could say:
rec: H
O to 60 oz/day, perform (L) triceps stretch
2X/day, 5X/wk, as demonstrated
2
332 INTRODUCTION TO MASSAGE THERAPY
Considerations for Self-Care
Consider your client’s lifestyle and time constraints
when making self-care recommendations. If your
recommendations do not fit within either of these, clients are not likely to comply or, even worse, their confidence in the treatment process may be diminished.
Clients can feel empowered to take responsibility for
their health and well-being when they are comfortable
added gradually.
Many clients feel burdened with self-care, as if it
were a dreaded homework assignment. Limit the number
of activities you recommend to minimize the number of
things they have to remember and the amount of time
and energy they have to commit. Too much too soon can
overwhelm the body and even lengthen the healing process. For example, it is beneficial for a client to receive
massage treatment, increase water intake, and use one
or two stretches for the connective tissue in the affected
area. However, adding a vigorous exercise program, using
heat and ice therapy, radically changing the diet, and adding five specific stretches on a daily basis could overwhelm
the body. The combination of all these activities could add
more stress, the body might not be able to distinguish or
integrate so many changes, and the client’s initial condition
could be aggravated.
Nevertheless, massage therapists often see clients
resist self-care and resist progress toward their goals.
This situation can be very frustrating and you must be
aware of this behavior. Many persons have suffered from
chronic conditions for so long that they stop paying attention to the discomfort. Their compensation patterns, pain
patterns, and coping skills become part of their everyday
routine and can even become part of a person’s identity.
The clients’ goals for moving toward a better and more
balanced state of health may effectively take away a part
of their identity. Life without pain and discomfort may
be unknown territory for a person with a chronic condition. Most people are somewhat uncomfortable about
change and unfamiliar experiences. This is exactly the situation that may occur when clients start making progress
toward their goals. It may seem strange, but it will make
sense as you see it occur in your practice. For example,
clients who have had a chronic pain condition for years
can get attention and concern from friends and family.
Losing this attention may deter them from letting go of
their pain and from participating in their healing process.
You have a professional obligation to support clients in
making progress toward their goals, but you must not
judge or harbor negative feelings toward a client who is
hesitant or does not want to participate in the healing
process.
Making self-care recommendations is the massage thera-
pist’s responsibility, whether clients choose to participate
Some self-care topics include internal and external
or not.
hydrotherapy, rest and sleep, nutritional awareness, specific
stretches for the areas of concern, physical awareness, and
ergonomics.
Hydrotherapy
Hydrotherapy is the use of water as a treatment. It can be
used internally to support cells and organs, and it can be
used externally. Water, the universal solvent, is so inexpensive and readily available that it is often overlooked as a valid
therapeutic approach. Because of its simplicity and availability, water is excellent for self-care.
Internal Hydrotherapy
Water has many functions in the body: elimination of waste,
delivery of nutrients and oxygen to the cells, maintenance
of tissue pliability and function, cushioning of joints, and
regulation of body temperature. The muscles are composed
of about 75% water, and blood about 90%, and those percentages must be maintained with sufficient water intake or
the health of those tissues will suffer. Muscle tissue and fascia can get stuck together and cause fascial adhesions, muscle contractions can become less efficient, blood becomes
more viscous, blood volume decreases, the ability of blood
to flow decreases, and thus the delivery of oxygen to cells
isreduced.
One of the most common self-care recommendations is for clients to drink enough water to stay hydrated.
After a massage session, adequate water intake helps flush
the waste out of the body that would otherwise sit in the
tissues, impeding healing and restoration of function.
Hydration further enhances relaxation of the muscles
and surrounding soft tissue during the massage session.
Encourage clients to drink enough water after a massage
and in between sessions as an important self-care activity. Recommendations vary widely, but a general rule is
to drink ½ ounce per pound of body weight. The intake
should be increased with physical exercise, salty food,
alcoholic beverages, exposure to sun or heat, and illness.
Any time you discuss or suggest hydrotherapy, provide
safe guidelines rather than simply telling clients to drink
more water.
To avoid this, find several references for water consumption and create handouts for your clients. Insufficient
water intake leads to diminished cellular function, which in
Chapter 8 / Treatment Plan 333
turn reduces the body’s ability to recover from injury and
maintain a healthful state. It makes tissues sticky and more
difficult to heal. It is harder to attain STGs when tissues are
dehydrated, and it requires more time to reach the LTGs.
Dehydration occurs when the body does not get enough
water or loses too much fluid, which can result in diminished soft tissue function, muscle cramps, fatigue, headaches, and dizziness.
The average person is typically dehydrated because of
insufficient water intake and substances that rob the body
of water, such as alcohol and salt. Instead of judging clients’ habits and tendencies, you can teach them about the
effects of alcohol and salt. Alcohol is a diuretic, meaning
that it causes excess amounts of water to be eliminated
from the body, and it can actually cause dehydration. As
alcohol is consumed, the tissues are prone to dehydration
and may require more time to heal. Consuming excessive
amounts of salt makes the body shed extra amounts of
water in an effort to maintain homeostasis. The negative
effects of alcohol and salt can be counteracted to some
extent by additional water intake. A common misconception is that caffeine contributes to dehydration, but
numerous scientific studies have shown that caffeine has
no effect on dehydration. You can educate clients about
hydration and health, but it is up to them to decide what
they will and will not consume.
The color of urine is a simple and sometimes useful
indicator of hydration. Generally, pale yellow or clear urine
usually indicates adequate hydration. Although deep yellow
or dark coloring can indicate concentrated urine and dehydration, it can also reflect chemicals, vitamins, and minerals
that are being eliminated.
Persons who are retaining water tend to drink insufficient amounts of water. They falsely believe that the less
water they consume, the less water they retain. Actually, the
opposite is true. As a cactus in the desert retains all of its
water because of minimal rain, the body retains its precious
supply of water when insufficient water is consumed. This is
one of the many homeostatic mechanisms that protect and
maintain our health. Drinking more than the generally recommended amount of water makes the homeostatic mechanisms eliminate any excess water that was being retained,
thus reducing water retention.
Alert
Ice should be avoided for persons with circulatory
Ice
problems.
Ice and cold applications reduce circulation and nervous system activity. Ice is typically used in acute conditions in which
inflammation, spasms, and pain are present. Any time you use
deep-fiber friction techniques, you can recommend ice to prevent inflammation and promote healing. Ice, or an equally cold
substitute, should be applied for a maximum of 20 minutes.
A plastic bag filled with ice works, and crushed ice
conforms nicely to the body. Ice can be used directly on the
skin, but a washcloth or towel helps to hold onto the melting ice, and it soaks up the resulting water. Chemical gel
packs are available that also conform to the body, and many
people have them in their freezers at home. They must be
used cautiously because they are colder than 32°F and can
damage the skin.
Alert
Use a layer of fabric between a chemical gel pack
and the skin.
Heat applications enhance circulation, which can
increase healing.
Alert
Heat should be avoided if there are signs of
inflammation, heat, or redness.
Heat relaxes people and may be used for acute conditions in
the muscles surrounding an injury, muscle spasms, or other
forms of pain. For chronic conditions in which techniques
other than friction are used, heat may be applied for up to
20 minutes to increase circulation in the affected muscles.
Heat may also be used concurrently while the client is
applying ice to help maintain the body’s core temperature
and to distract the client from the unpleasant effects of ice.
External Hydrotherapy
External hydrotherapy refers to applications of cold and
heat, because those treatments were initially only provided
by water in its solid (ice), liquid (water), and gaseous (steam)
states. Today, there are chemical forms of cold and heat, but
the original term remains. Hydrotherapy is covered extensively in the Complementary Modalities chapter, but selfcare information for clients is summarized here.
Stretches
Stretching the muscles and surrounding connective tissue
in the clients’ affected areas may be the second most common self-care recommendation. Although massage lengthens muscles and stretches tissues, the body will adapt to the
mechanical changes and new positions faster when clients
334 INTRODUCTION TO MASSAGE THERAPY
reinforce those changes between massage sessions with additional stretches. Remember, massage therapists do not diagnose nor prescribe treatment, so be careful to educate clients
only about how stretches affect soft tissues and enhance the
massage treatments. Clients must understand that stretches
are not a substitute for treatment from other healthcare
professionals that may be necessary. If you recommend
stretches to clients for self-care, you should have books and
handouts in your office that illustrate specific stretches (see
Suggested Readings). To keep from overwhelming clients
with “homework,” suggest one or two stretches at most.
As with all self-care, thoroughly explain effective stretching to clients. They should understand how to do the stretch
properly, the possible contraindications, and the expected
results. Ideally, take time to demonstrate the stretch for clients and let them try it while you observe. This way you
can ensure that they are stretching the correct area with a
safe technique. You can describe the end feel of a stretch and
make sure they are not compromising any anatomical structures or triggering the stretch reflex. Always provide specific
information about the frequency and duration of stretches
and techniques to use.
Rest
Most people underestimate the value of rest for promoting
healing and regeneration. Essentially, rest is a period when
mental, physical, sensory, and emotional activity slows or
ceases, allowing the body to redirect its energy to restoration. People lead very busy lives, often moving from one
event to another and taking little time for rest until they fall
into bed in the evening, exhausted from the day’s events.
Taking time for a massage is one way for people to slow
down and rest; however, it is most likely not enough to completely rejuvenate the body and mind. Clients should be told
that it is good to take time for massage and that adequate
rest can maximize the benefits of massage.
Sleep
Sleep is a deep state of rest when tissues regenerate, repair,
and prepare the body for new activity. Oftentimes, sleep
positions are the cause of pain and discomfort, which may
include stiff necks, aching backs, and numbness and tingling in the arms or hands. It can be difficult for people
to change their sleep positions, but you can educate clients about sleep positions and leave it up to them to try
to incorporate the changes. Sleep positions can cause pain
and discomfort, and yet sometimes pain and discomfort
cause problems with sleep.
Stomach sleepers tend to develop stiff necks because
they have to turn their heads to the side to breathe.
Additionally, stomach sleepers may hyperextend their lumbar spine, which may create pain. They can benefit from
sleeping in a different position. Persons who sleep on their
side sometimes complain of back pain, which can result
from the torque and tension on the pelvis and hip when
the top leg drops down to the bed. You can suggest a body
pillow to support the top leg and relieve the torque on the
pelvis. Sometimes side sleepers complain of numbness and
tingling in their arms and hands, which can be caused by
nerve impingement from compression on the shoulder they
sleep on. They can be relieved by sleeping on their backs.
Persons who sleep on their backs sometimes complain of
back pain, which can be caused by the lordotic curve of the
spine. Supporting the knees with a pillow reduces the lordotic curve and sometimes relieves pain.
Sleep disruption can cause irritability, concentration difficulty, poor muscle coordination, increased sensitivity to
pain, fatigue, sluggishness, a diminished sense of well-being,
an inability to cope with the physical and mental challenges
of life, and, in some cases, depression. Too little sleep creates
“sleep debt,” which is similar to being overdrawn at a bank.
In time, the body will demand that the debt be repaid. Our
bodies do not adapt well to getting less sleep than required,
and while we may get used to a sleep-depriving schedule,
our judgment, reaction time, and other functions are still
impaired.
When massage clients discuss their lack of sleep, you
can educate them about the importance of sleep for health
and healing and offer some self-care recommendations.
Sleep can be affected by a number of factors, and you can
recommend that clients examine their daily habits to see if
any of them are affecting their sleep patterns:
• Eating or drinking too close to bedtime
• Eating or drinking too much caffeine
• Eating or drinking too much sugar
• Smoking cigarettes with nicotine
• Medications or medication schedules
• Lack of physical activity
• Temperature of the bedroom
• Insufficient body support
• Bedtime schedules
• Amount of sleep necessary for optimal daily
function
• Other individuals who might be keeping them awake
Clients who are chronically sleep deprived and cannot
seem to change their sleep pattern may need to be referred
to a medical doctor, who can look for a diagnosis and make
a prescription. If you do refer your clients to other healthcare practitioners, you should document the referral in the
Plan portion of the SOAP note and follow up by writing a
letter to that practitioner.
Chapter 8 / Treatment Plan 335
In addition, clients can be encouraged to take “minibreaks” during the workday to stretch or walk for a few minutes once every other hour or so. Our body rhythms create
a dip in brain activity in the middle of the afternoon, which
creates a natural naptime. A short, 15- to 20-minute nap
sometime between 1 and 4 pm can be refreshing and is least
likely to affect that night’s sleep.
Nutrition
Nutritional awareness is another form of self-care a therapist
may encourage in a client. Unless you are a properly trained
dietitian or nutritionist, you should be very careful not to
offer professional advice in this area. With this in mind, massage therapists can make nutritional recommendations from
an educational standpoint as they pertain to soft tissue health.
Have nutritional references on hand for clients who are
interested. Vitamin C is required for tissue repair and thus is
important to include in the diet. Nerve cells and muscle cells
require sodium and potassium to conduct electrical charges
properly, so it is generally recommended that these electrolytes be included in a balanced diet. Calcium and magnesium
are critical for proper muscle contraction, making them necessary dietary elements. Nutritional recommendations generally accepted by the public are usually valid, but myths and
false information are widespread. Massage therapists can
demonstrate professionalism by sorting through nutritional
information and guiding clients toward scientifically proven,
valid facts with reasonable explanations. There are a number
of herbal and “natural” remedies on the market that claim all
kinds of benefits, but because many of them have not been
scientifically proven, it is best to refer clients with questions
about these products to a nutritional or herbal specialist. For
specific dietary and nutritional recommendations, however,
therapists should practice the rule “When in doubt, refer out.”
Body Awareness
Increasing a client’s physical awareness is not only a benefit
of massage; it can also be recommended to clients as a selfcare activity. As mentioned above, many persons with chronic
conditions do not remember what it is like to be without pain
or to have unlimited function. Some get used to gauging their
days by the amount of pain they experience, or they regularly
describe their pain to friends and family. Sometimes the pain
and discomfort become so much a part of their identity that
they do not know how to let go of it. Having lived with tension or pain in an area for so long, they get used to it being
there and are generally unaware of times when they do not
feel pain. You may encourage clients to shift their focus to
times when the tension or pain is absent, even if it is just for
a few moments a day. Another approach is to get clients to
periodically check for pain at mealtimes or at other regular
intervals during their day. It can help them realize that being
without pain is acceptable and can help them look forward to
less pain and discomfort and encourage them to participate in
the progress toward their goals. You could write:
rec: Cl record (P) every day at mealtimes
Massage therapy can be compared to peeling layers of an
onion—the layers of compensation are treated with a series
of massage sessions. You must inform clients that the tension
or pain may get worse as these layers are removed, that you
are addressing the core of their condition, and that this is a
normal part of the progress. The old adage “Change is good”
applies in this context. Massage treatment that increases or
decreases the client’s pain and ROM indicates that the body
is responding to the work. If significant therapeutic work was
done, the mechanical effects can be uncomfortable but not
extremely painful. Discomfort resulting from massage usually
decreases within 2 to 3 days as the body accommodates the
mechanical changes. If it does not, it is possible that you overtreated the client, and you should adjust the massage techniques for the next session. If this is the case, you must look
over your documentation notes and reevaluate:
• The client’s condition
• Contraindications
• Your treatment
• Possible referral to another healthcare practitioner
You have a responsibility to address your clients’
responses to your treatment. A thorough general assessment may be necessary, and you may need to ask more
leading questions to elicit information that might suggest
contraindications that you did not identify before the previous session. The techniques you used might have been too
aggressive or inappropriate for the client’s condition and relative tissue health. If you cannot determine how pain resulted and why it did not go away, you may need to refer the
client for further evaluation by another healthcare practitioner to maintain a client-centered practice. It is in the client’s
best interest to be referred out for conditions that you do
not understand, which means it is also in your best interest.
When no change occurs after a massage, it suggests
that the massage treatments are ineffective. If no change
occurs, you should reevaluate the above factors and make
adjustments to your treatment.
Ergonomics
Ergonomics is the science that designs and coordinates people’s activities with the equipment they use and the conditions
E
336 INTRODUCTION TO MASSAGE THERAPY
of their working environment. Ergonomics focuses on minimizing the mechanical stress placed on the body and soft
tissues, which is usually accomplished by maintaining body
positions that are as close to our natural and relaxed standing
position as possible. For example, chairs with a flat seat and
a flat back provide no support for our natural spinal curves.
After sitting in that kind of chair for extended periods of time,
we tend to slump, which puts mechanical stress on the spine
and the nerves that exit the spine, and some persons can suffer
nerve impingement as a result. Ergonomic chairs are designed
to provide support for our natural spinal curves to reduce
the mechanical stress on our body. There are computer keyboards that are ergonomically designed to accommodate the
natural resting position of our wrists and hands to reduce
With a few exceptions, massage is a good form of treatment
for soft tissue dysfunction, injury recovery, and stress reduction, but it is not a cure for everything.
require the care of other healthcare professionals, and
as a professional massage therapist, you have an ethical
responsibility to refer clients to the appropriate healthcare practitioner. You should also be aware of professional
etiquette when contacting that practitioner regarding the
referral.
Whether you suspect a problem with the client’s skin,
nervous system, teeth, body temperature, feet, emotional
instability, joints, or skeletal structure, if it is not soft tissue,
massage therapists do not treat it. Generally, you refer clients
to their primary caregiver, who further evaluates or diagnoses the condition.
Some conditions
compression of the carpal tunnel in the wrist. This compression is sometimes responsible for impinging the radial nerve
and causing neurological symptoms of numbness and tingling in the first few phalanges.
Special equipment is not required to make ergonomic changes. Instead of looking at a computer screen that
is above or below your head, which forces your neck into
hyperextension or flexion, you can position the screen at eye
level. Instead of carrying a purse or backpack on the same
shoulder all the time, which can create chronically hypertonic muscles and fascial restrictions, you can occasionally
switch the shoulder you carry the bag on. These kinds of
ergonomic changes are a good source for self-care recommendations and they tie into body awareness.
but also with other healthcare professionals. The key to the
ripple effect is your ability to recognize when a condition
is out of your scope of practice and needs to be addressed
by another professional. This is essential for upholding the
standards of practice and ethical codes of the massage therapy profession as well as preserving client-centered care.
Document your recommendations for referral to other
healthcare professionals in the Plan section of the SOAP
chart. If you recommend that a client see his or her primary
care physician (PCP) for further evaluation of the left shoulder, you could write:
rec: Cl see PCP for further evaluation of (L) shoulder
Follow-up
Alert
Even if you feel confident of a diagnosis, it is not
in your scope of practice to share that diagnosis in
any form of communication, verbal or written.
Again, clients often see their massage therapist as a
healthcare professional who can diagnose medical conditions. As a massage professional, you must ethically and
legally educate clients that diagnosing medical conditions is in no way a part of a massage therapist’s scope
of practice.
By referring clients to other healthcare professionals
when it is appropriate, you maintain the core principle of
client-centered care. Maintaining this principle creates a
ripple effect of respect and trust not only with your client
Communication
Professional communication skills and a command of the
common professional language facilitate effective communication between you and other healthcare practitioners.
Correct pronunciation of anatomical and physiological
words, scientific terms, and techniques is required to
convey true knowledge. Proper spelling, grammar, and
use of terminology are also critical for communicating
a sense of understanding, especially when you are trying
to develop a respectful working relationship with other
healthcare professionals. Working with other profes-
sionals is always better than working apart from them,
because clients generally feel better when everyone is
working together, toward the same goal—their health
and well-being.
Chapter 8 / Treatment Plan 337
Once a referral is made, you can ask clients to keep
you in the communication loop, which makes you part
of their cooperative team of healthcare professionals.
You should request copies of medical reports and medical updates so you are aware of any medical diagnoses,
treatments, and test results. The client-centered focus
encourages determination of whether massage treatment
is appropriate for the client. Without team communication, you cannot make the best decisions for soft tissue
treatment, which can result in over- or undertreating the
soft tissues. Conversely, if a healthcare practitioner refers
a client to you, you should contact the practitioner to
complete the communication loop and start creating a
healthcare team.
Keeping the above in mind, there is a protocol for
communication between you and other healthcare practitioners. You should keep all communication simple and to
the point. Rarely do other healthcare providers have time
to sort through pages of information to ascertain what you
are requesting or communicating. Essentially, you should
summarize the details and state the progress of the client’s
condition. Familiarize yourself with how to make a written
or verbal request for copies of medical reports and updates,
how to discuss a client’s condition, how the referral process
with another healthcare professional works, and how to
communicate with insurance companies so you can be reimbursed for massage treatments.
Requesting Copies of
Medical Records
You can request copies of medical reports and updates
either formally or informally. To request copies of medical information formally, your client must fill out a records
release form (see Chapter 2, Fig. 2-3), and you must send
a copy to the practitioner along with a cover letter stating
your request. Figure 8-1 shows an example of a cover letter.
Informally, you can ask clients to request copies from their
healthcare practitioner and bring them to you. These forms
are kept in the client’s file.
Discussing a Client’s
Conditions
On occasion, you may need to discuss a client’s condition
with another healthcare practitioner. For example, the
healthcare practitioner may need some information about
your soft tissue treatment before writing a prescription.
Before contacting the healthcare practitioner, you must first
get written permission from the client to share the information in the massage treatment records. You can include
such a statement in your client history forms rather than use
a separate permission form. (See Chapter 2, Fig. 2-3 for a
health information form that asks for the client’s permission
to consult with the referring healthcare professional.)
Communication for Referral
and Insurance Reimbursement
Insurance laws vary from state to state, so if you are seeking
insurance reimbursement, you must be aware of the insurance laws in your state and research how those laws affect
reimbursement for massage. The information presented
here is very general and is intended to give you a basic idea
of how communication flows in this process.
Currently, clients have direct access to massage therapy,
meaning they can seek treatment without a formal referral or prescription from another healthcare practitioner. In
spite of direct access, most insurance companies will not
reimburse without a medical prescription or formal referral
for treatment as well as treatment notes. A prescription is
a written order from a medical professional who is legally
allowed to prescribe, and it pertains to treatment for a specific condition. A prescription typically includes the referring healthcare practitioner’s name and contact information,
date, patient’s name, diagnosis, diagnosis code, and the prescribed treatment with frequency and duration parameters.
Since massage therapists cannot write prescriptions,
you can use a referral form to get a prescription from the
physician for initial or additional massage treatment. The
form should include space for your contact information
and the client’s name, and it should be clear that you need
to have the physician write the diagnosis, precautions, body
areas to treat, frequency and duration of massage treatment, and whether progress updates are requested as well
as how the physician wishes to receive them, a reevaluation date, and the physician’s signature and contact information. Figure 8-2 is an example of a prescription and
referral form. Fill out your contact information and the
client’s (patient’s) name and send the form to the client’s
physician. The physician can then fill in the treatment protocols and return the form to you. Make a copy to send to
the insurance company and keep a copy in the client’s file.
Notice whether an initial treatment report and/or progress notes are requested in return. Your initial treatment
report should include a note of thanks to the physician for
referring the client to you for massage in addition to your
initial findings and massage treatment plan. Essentially, it
summarizes the SOAP notes and general assessment form
information. Figure 8-3 shows an example of an initial
treatment report. A progress report, basically a summary
of the Subjective and Objective sections of the SOAP notes,
is often requested by the referring physician. If you are recommending further care, specify the new duration and frequency parameters. Generally, a progress report is sent to
the healthcare provider every 30 days or for the length of
the prescription (see Fig. 8-4) .
338 INTRODUCTION TO MASSAGE THERAPY
Figure 8-1. Cover letter.
Chapter 8 / Treatment Plan
339
Figure 8-2. Prescription and referral form.
340 INTRODUCTION TO MASSAGE THERAPY
Figure 8-3. Initial treatment report.