Referred pain... getting clients to understand.

[Pompal 09.]

I have a fairly new client, I ended up with her as my client after my partner left the practice. This will be my 4th time seeing her. Honestly, she has so many issues that she really needs to be a weekly client, and I work on her for 1 1/2 hours on a monthly basis, which I end up going over every single time. I don't know how my former partner worked on her in 1 hours time.

Anyway, she has been complaining about her posterior lower legs for some time, and I don't get the classic TP sensation that I would normally get in these areas, but she tells me that she can feel them... I believe that these are tender points that are referred pain coming from her glutes, which today was the first time I approached that area as a hunch. I would have grazed over them in the past, but not actually did an in depth TP work in that area. And no matter how much time I would spend on them, she would say that it wasn't enough that she still had pain. She refuses to go to the doctor or get evaluated to see if it is nerve related, and believes in Holistic treatment only (mainly that yoga is the solution to everything). She didn't say anything negative about me working on her glutes, and Glute Medius was a mess... which was classic to the area that she is referring to the pain pattern.

I suggested during the session that it is most likely the glutes and not the gastroc/soleus itself, that is most likely secondary... She insists it is not, and insists that I spend a ton of time in that area anyway. I then showed her the charts to back up my theory and she just brushed it off, saying that isn't the problem.

I am so drained after working on her, both physically and energetically, that I don't know what to do, and it isn't as if I see her enough to really see improvement. At least I have convinced her that I can't physically do the work in an hours time, and I know she used to be on the schedule more fequently when she was seeing my former partner.

But mainly, how do you get the clients to open up their mind and realize that these are true facts of anatomy, and that it isn't just what they initially feel is the actual problem... This is the first client that I have had this issue with, and I am at the point of telling her that I can't see her anymore unless she lets me do my job. I am so frustrated... I can't speak with my former partner because she left on a very bad note... I have tried contacting her for other issues, and she won't return the calls... so that solution is out.

Thanks for letting me vent...

 

[Hippy chick]

Referred pain... getting clients to understand.

I am so drained after working on her, both physically and energetically, that I don't know what to do, and it isn't as if I see her enough to really see improvement. ... This is the first client that I have had this issue with, and I am at the point of telling her that I can't see her anymore unless she lets me do my job.

Quote says it all imo. You have to set a boundary at some point - if there is a mismatch between client and therapist, if you don't foresee any future improvement in the client's condition with things going as they are, then it's in your best interest (and your client's) to get a referral going. Especially if you are becoming drained - indeed, I'd be frustrated in your shoes - I'd have to sit down with the client and explain my position. Understandable, given that western medicine can be kinda narrowminded, that the client wants to continue with holistic treatment; however, if you are trying to help her and she doesn't want to cooperate with your treatment plan, then I'd encourage her to look elsewhere - after all, you want her to find the best fit in treatment. :?

My two cents

The last thing you'd want is to drain yourself, especially if the client isn't benefitting from current treatment. That'll only leak into other clients' sessions :shock:

 

[MGSA]

Depends what the client's goals are (and her stated goals may be different from her actual internal ones). Is she as determined as you that she be pain-free and clean up the "mess" in her glutes? Or does she just want her post. legs worked on once a month, feeling cared for and in charge of her tx? I have clients who want different work than what I think might help them, but as long as they feel satisfied that they are getting what they want *how* they can accept it, it doesn't bother me to do it their way. I'm not a big referrer -- either I keep them generally, or they drift away on their own.

I see your frustration when a client doesn't like your suggestions, especially if they can harm your reputation by claiming you didn't help them.

 

[meshmesh]

I can understand your frustration.
You are the practitioner here, and the one with the knowledge of anatomy & skillset. But, she is in charge of her body and her time with you. Sounds like you guys could actually come to a great understanding, and sounds like it might be the appropriate time to go for that.
Maybe ask her to come in a little early for her next appointment so you guys can discuss an effective plan of treatment? Or leave extra time in your schedule so the session can run longer if you *can* have that conversation beforehand?
i would advise *not* having the conversation while you are doing the work - there you have the complete upperhand and she is diminished of power psychologically whole on the table.
Find a way to address the issues without ego. Meaning, let it be a marriage of both of your plans, not talking the other into accepting your way, etc.
Bottom line: if you spend time working on her lower legs but can also do work that you *know* will stop the cycle of referring sensations, you both win. She gets what she wants - you get the satifaction of addressing problem with a solution instead of a panacea (sp??).

Good luck!
jill/sagetherapist

 

[Kelly P]

I think you need to detach yourself from the outcome. This is stressed very strongly in the MFR that I'm learning. They say to soften your focus and work where the body guides you to work.

By being emotionally attached to the outcome of the session, you (subconsciously) are stifiling the results. Ego gets in the way. For more examples, subscribe to the MFR email chat. http://www.myofascialrelease.com/mfrtalk/join_list.asp?wss=1943033CD9DE457DBBA726D0B449E03

 

[Belie]

Thank you all for your advise... I really appreciate it

Yes, she is benifiting from the session temporarily, but doesn't come often enough to see real progress. She returns when she can't stand it anymore, and needs another session. I probably could get to everything within the hour if she came on a weekly basis. She definitely says that it feels better after I work on it, and that is why she comes back. I have no reference as to what worked with her in the past since my former partner refused to take notes on her clients, and what info she did have she took with her.

I definitely plan on continuing working on her glutes, since I wouldn't want to be walking around with glutes like that, and she never mentioned pain in that area or any low back pain, just points to the lateral aspect of her gastroc/soleus, and has tenderness when I go up the tendon through the 2 halves. I definitely spend a lot of time on her lower legs, more than I do on any other client to make her happy... but truthfully I get the impression if I spent the whole session on her calves she wouldn't be happy enough... there is only so much I can do in that area. I effleurage, I pettrisage, I strip it, use Neuro, Myo, TP, ring and roll it... implement stretching... you name it, I do it... Yet she insists that she feels these TP's in there, which I don't at all...

I literally cringe when I see her on the schedule, and wrack my brain to think of what else I can possibly do. I am almost tempted to start cryo therapy on her, for that area... I don't book my own appointments (although I wish I did) so sometimes I don't have the ability to leave time for discussion, and she expects me to be early and start working right away, that my earliest appointment isn't early enough for her, and is on the table before I have time to turn my back... so she is a little controling (by 9:30 she has already swam, gone in the hot tub and steam room, and sometimes has taken a yoga class!!!) so I am leaning towards that as the issue, that it is psychological, and she needs to mentally let go.

I only bring up the issues during the session if I know they are still awake and giving me feedback anyway, I ask them if it is too much pressure, what the sensation they are feeling is, and to keep breathing, etc. And believe me she is very vocal about the areas that she believes aren't getting enough attention. I hear it as soon as I efflerage... and tell her I will be getting to that area shortly!!! I am not joking that she really would need to have 3 hour sessions to make my life easier!!!

 

[Coleen]

I think you need to detach yourself from the outcome. This is stressed very strongly in the MFR that I'm learning. They say to soften your focus and work where the body guides you to work.

By being emotionally attached to the outcome of the session, you (subconsciously) are stifiling the results. Ego gets in the way. For more examples, subscribe to the MFR email chat. http://www.myofascialrelease.com/mfrtalk/join_list.asp?wss=1943033CD9DE457DBBA726D0B449E03

 

[Leanatan]

I think that Mick has hit the nail on the head. Truly.
Mick, I'm glad you repeated the post.
jill/sagetherapist

 

[ali.a.j]

I subscribed... I didn't study under Barnes, I studied under an instructor of the Robert King method... so after reading their agreement, hopefully they will let me participate!!!

Anyway, I think you are right, and that is why the lightbulb went off in my head after I worked on her the last time... since I was listening, but not thinking. I have been tempted to call her to see what the outcome of the session was after working on her glutes. But I really do think she is holding onto her pain for some reason...

 

[Chelcie]

I think that Mick has hit the nail on the head. Truly.
Mick, I'm glad you repeated the post.
jill/sagetherapist

It was being problematic in the submission seforum.xxxe. I didn't mean to double post. Didn't realize that I had, either! Glad you like it though! mk

 

[priv828]

how about an analogy

I think because the massage therapy feild is not very good at upholding educational standards many clients have NO RESPECT for a massage therapists knowledge...

Here is a useful analogy
Say your car is making a funny noise that you think is the brake pads getting old. You take your car into a mechanic he says the breaks are fine but you need a new ball joint....how many people would say "nope I know better just change the break pads" and drive off...very few I would guesss. This exact thing happens to massage therapists all the time....

 

[DIESEL]

I agree... they want us to fix them, but they don't want to listen or respect what will really be helpful.

I just don't want to see myself getting burned out dealing with other peoples issues, but don't want to sound as if I am not caring and have an ego trip.

 

[Turtle]

Scope of practice

I have found many massage therapists very concerned about preforming stretches or refering client's out that have symptoms that should be diagnosed...

But in my experience massage therapists rarely cross the line into diagnosis of physical illness or preforming chiropractic or pt

But

They often cross the line into psychotherapy..people go through ten or more years of training before they are able to competently "diagnose" mental disorders like neurosis like hypochondria...

just somthing to think about...

if you really think the client "needs their pain" in my state you would be required to refer to a psychologist...otherwise you would not be fufilling your professional requirement of refering to other medical professionals when appropriate...

BS
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