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