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I work with a dynamic population of seniors that wish to remain active and also continue in the workforce. In today’s reality, most seniors still need to work because pensions are not enough and they have to continue earning an income to support their daily lives and those of their family’s. A RMT needs to consider all aspects of the patient’s life, and how they cope with the physical, emotional, mental and social stressors that they face.


June 16, 2016
By Dwynwyn Droppo


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The health history is fundamental to the next steps of treatment. It is imperative that we delve deep into the life of the client. Seniors have 60 or more years of history behind them, all of which have affected the growth and development of their bodies and the attitude they choose to move forward with. It is vitally important to find out how those years have impacted their body. This is where we start understanding the fascinating life history of fascia.

As RMTs we understand perfect posture, and we know that a postural assessment is fundamental and should be done – even if only providing relaxation treatment. This is an eye opener and should not be taken lightly. As an assessor, we need to see the history unfolding in front of our eyes. We see structures that have been used more than others and less than some, deviations from the norm, atrophy, hypertrophy, joint mechanics, balance and compensation patterns of frequent
activities.

The postural assessment tells a unique story as each individual is very different –  like a fingerprint. For example, a frequent golfer may show a rotational pattern in the direction of his swing or a desk worker shows the slumping posture of a forward head, kyphotic spine and protracted scapulae.

A great aspect of working with the elderly is that the patterns are so well pronounced. The biggest difference between a younger model is the condition of the tissues. With the elder postural assessment, you clearly see the deviations from the norm because there has been a greater time lapse for them to show.

Some of the things an elderly patient hears after an assessment are that they have lost height, that there are degenerative discs, fused vertebrae, and arthritis in their bodies. Muscle structures are weak, or other soft tissue structures show fibrosis and scarring, or connective tissue shortening. Also, that the relationship between agonist, antagonist, synergist and stabilizing muscle structures is out of balance causing the firing sequence to be out of whack. This is the aging population.

During intake and assessment, it is important to include the patient. In fact, they should be uncovering the story of their body with you. I have a skeleton in my practice and I use that skeleton to pull the joints into the posture that I see in my patient. I do this in front of my patient so they can see what I see. I explain exactly what is happening to the joints and soft tissue structures, because if I were to give remedial exercise they now understand what it’s supposed to do. I try to relate what I see to what they have told me during the history intake. By simply explaining how painful patterns develop and form through habitual activities, poor ergonomics and joint mechanics, the patient tends to be much more aware of how they use their body.

So let’s say the patient is suffering from headaches. You get the patient to show you on your trigger point charts the type of referral pattern they are experiencing. If there are trigger points in the SCM muscles causing headaches, and they have a head forward posture, that’s an obvious relationship. I take my skeleton, I show the patient where SCM attaches and then I mimic the action of the SCM muscles and pull the head forward and down towards the clavicles. It’s easy for the patient to see what’s happening in their own body and it’s easy for them to understand how they need to stretch the SCM muscles. Your patient feels very educated and really understands what they are experiencing.

Naturally, the body strives to find balance, and the time spent in a certain posture causes the body to adjust to that posture. For the elderly, it’s even more important because they have likely been repeating a certain habit for a number of years. These holding patterns are typical of the nature and behaviour of fascia.

I have found that when involving a patient in their own assessment, they become a more responsible component of their own outcomes. The great reward in treating seniors is that they have an aptitude for learning new things, they love being involved and in control of themselves. As RMTs, we have unique training about the body, so why should we not teach our patients? When we involve them in their care they are motivated and understand that their input and actions greatly influence their rehabilitation process. It’s not just our assessment of their condition but the way we involve and educated them on their condition. They become excited and an active participant in their own care.

When it comes to the assessment and treatment aspect, RMTs have to be knowledgeable in so many areas – anatomy, physiology and pathology, joint mechanics, ligaments, tendons, muscles, strong and weak, short and long structures, the list goes on. With the senior population, a RMT’s selection of manual muscle tests, special orthopaedic, and neurological tests needs to be even broader because at times there are limitations in the application of some tests.

Once assessment results are established, the selection of massage therapy techniques needs to be very specific.

My focus for the elderly patient is fascia – the system that is the most adaptational in the body, a system that has a memory for habitual patterns, and responds primarily to repetitive stress and strain. The word tensegrity is the best way to describe the nature and behaviour of fascia.

When your patient understands how fascia conforms, adapts and moulds to habitual patterns, they tend to be more aware of themselves and how they behave in everyday life. With elderly patients their patterns are more obvious, and when you bring it to their attention they see it clearly.

You can go one step further and draw their posture on an anatomical posture chart and explain what your assessment findings revealed. They clearly see their deviations from the norm. It’s great to do this because you can explain exactly where you will be treating and why.

Sometimes, patients don’t like what they hear or see with regards to their assesment. It’s a reality check. RMTs have a responsibility to educate and inform, but it needs to be done in a tactful, kind and sensitive manner. We are all habitual beings and everybody has deviations from the norm. That is why setting realistic goals will motivate the patient and they won’t feel so bad about themselves.

As RMTs we have to ask ourselves: “What are the realistic goals for this client?” Take into consideration the health and the condition of the tissues and what this client can realistically achieve. Is the body capable of withstanding change at this age, in this condition? Is the tissue able to undergo a transformation or is this a case where the patient needs to seek a referral? The therapist needs to understand levels of tissue hydration, nutrition, neurological innervation, and chemical influence such as hormone levels. Also, consider the patient’s willingness to change.

How the patient responds to your approach of care and treatment planning is an integral part of their outcomes. Let us teach people about their bodies, let us show the beautiful relationship we have with ourselves.


Dwynwyn Droppo is a registered massage therapist and owner of RMT-MEDIC, a massage therapy clinic based in St Catharine’s, Ont. Her practice focuses on repetitive stress and strain injuries, poor posture and poor ergonomic/habitual compensation patterns. Over the last 10 years Droppo has worked as an independent contractor for multiple clinics and taught for four years in community and private colleges in Ontario.


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