Canadian RMT Fall 2016 Canadian RMT Fall 2016 - Page 19

T ake a look through any of the popular trade publications in our field and you’ll find a wealth of advertising for courses that are teaching you new techniques. The extravagant claims for methods that provide “permanent pain relief” or “immediate results in one or two treatments” can certainly pique your interest and make you think this is something you must have. Clearly, learning new techniques is a great way to give you enhanced skills and abilities and provide more ways to address client problems. However, the emphasis on techniques can be misleading when you are working with rehabilitative massage approaches because technique is only a small piece of the puzzle. Clinical success in treating pain and injury conditions requires a much more comprehensive approach. A comprehensive approach includes technique, but also crucial clinical reasoning skills. Clinical reasoning is at the core of all successful clinical practice in the health care professions. Yet, you don’t hear much about it in massage education because it’s much easier to sell a sexy new technique. Simply put, clinical reasoning is “…the sum of the thinking and decision-making processes associated with clinical practice.”1 The more effective you are at using your clinical reasoning, the more effective and successful you will be as a clinician. Developing effective clinical reasoning is not as simple as just taking a course in it. It is a more complex process that calls upon your skills abilities in a variety of different areas. Researchers examining what separates experts from novices have found that experts develop certain shortcuts by recognizing patterns of information that novices might tend to miss.2 For example, suppose a client comes in complaining of foot pain and reports a recent increase in running on hard pavement and plantar foot pain that is most pronounced first thing in the morning. These are just two clinical factors that have been shared, but someone familiar with plantar fasciitis will immediately recognize them as fitting into the pattern of that pathological problem. It does not mean that we have determined the client’s condition with just those two elements. Yet, the As with many aspects of health care delivery, clinical reasoning relies on both art and science. ability to see that symptom pattern gives us a significant advantage over someone else who may only hear the client rattle off an accumulation of symptoms and not be able to make any sense of them. The practitioner using effective clinical reasoning will then take these recognized information patterns and apply deductive thinking to analyze the clinical problem further. Deductive logic is what occurs with an “if, then…” statement. For example, IF this client reports sharp shooting pain in the upper extremity along with paresthesia on the ulnar aspect of the hand, THEN there is a good chance the pain complaint is originating from some neural pathology, in either the neck or upper extremity. This deductive analysis helps us determine if massage is appropriate and if so, how we should apply it. Clinical re