ITEC Level 3 in Sports Massage (SOAP)

Consultation & Assessment (SOAP)

What is SOAP ?

Four phases in assessing the client / injury and deciding what to do:

What is the S in SOAP

S ubjective

What is the O in SOAP

O bjective

What is the A in SOAP

A ssessment

What is the P in SOAP

P lan

In the assesment of clients what do we need to know 6 things ?

• Clients personal details

• The nature of the problem(s)

• Any contraindications or areas to be careful about

• Is continuation of the treatment appropriate?

• Will massage therapy help?

• Should they be referred on to another discipline or a doctor?

Questions to Ask Client (Part 1)

Are they running a temperature?

• Do they have any contagious diseases? (inc cold or flu – even if mild)

• Do they bruise easily?

• Have they had sciatica in the past?

Is there any immediate red flags ?

Questions to Ask Client (Part 2)

• Have they taken any painkillers during the day of treatment?

• Any relevant operations?

• Deliberately vague

• Most interested in things that might affect massage

• Metal/Plastic implants

• Any other issues?

SOAP: Subjective – Reported by Client Current Problem / Injury

• What are the signs and symptoms currently?

• How did it occur / start?

• Did it start quickly or did it build over time?

• When did it start?

• When does it hurt?

• Going down hill? First thing in morning? Getting up from bending?

• What makes it worse or better?

• What's the pain like?

• Sharp, dull, like a knife, constant, intermittent, location, severity

(Perceived Pain Scale 1 to 10)

• Any loss of sensation?

• Taking medication for it?

Paraesthesia

– pressure on/damage to peripheral nerves

Assesment terminology

• Tingling • Numbness • Hypersensitive • Normal

SOAP: Objective – Observed by the Therapist Observations made using three things

• Visual inspection

• Palpation

• Range of movement (ROM)

(Objective) when the client is walking in what are you looking for ?

• Limping?

• Using a walking stick?

How do they hold themselves?

• e.g. Protecting an arm?

Abnormal movement?

Posture ?

(Objective) Palpation and Visual Assessment

• Pain when touched

• Swelling

• Muscle wastage

• Bruising

• Deformity

• Scars

• Standing, Sitting, Lying

Name the three categories of Objective asessment

A symmetry

R ange of Movement (ROM)

T enderness

SOAP: Objective – Asymmetry

Postural Observations • At this stage this is an initial assessment

SOAP: Objective – Asymmetry 2 - what parts of the body do you need to note the position of

Knee

Feet

Head

Shoulders

Arms

When you note the position of the arms what are you looking for ?

• Arms - rotated in/out, elbow flexed

When you note the position of the knee what are you looking for ?

• Knee - rotated in/out, bow legged, knock kneed, hyper extended, flexed

When you note the position of the feet what are you looking for ?

• Feet - toe in/out, pronated, supinated

When you note the position of the head what are you looking for ?

• Head - protracted, retracted, laterally tilted

When you note the position of the shoulders what are you looking for ?

• Shoulders - protracted, retracted, elevated, depressed

Name the three parts fo the range of movement test

Active

Passive

Resisted

Explain ACTIVE in the range of movement test

Active - Client moves joint • Identify what is restricting the movement • Pain, tenderness - Where – which muscle or structure

Explain PASSIVE in the range of movement test

Passive - Therapist moves joint • Explain and ask if they are OK with you doing it • Be careful not to cause further damage • Notice the “End Feel” • Soft landing indicates soft tissue restriction • Bump indicates bony restriction (so possibly a postural problem)

Explain RESISTED in the range of movement test

Resisted - Client moves joint, but resisted by therapist • Looking for weakness, change in pain

What should you use for a comparison in this test ?

Go through all ranges of movement of the joint in question Compare ROM of injured side to uninjured side

Which areas of the body are you palpating ?

• Bony points • Muscles • Tendons • Ligaments

What else are we looking for during the process ?

• Swelling - Observe nature of swelling (soft, hard, boggy)

• Heat - Use back of hand

• Pain / Discomfort

When the objective part of the process is completed whats next ?

The assessment of the findings (S O A P)

What are the three points of the assessment ?

Conclusions, Uncertainty, Decide

What are we not allowed to do as part of the conclusion

We are not allowed to “diagnose”, but can draw conclusions as to what the problem is / may be

Why must we be uncertain in our findings

• Often the conclusions are only a working hypothesis

• There may be more than one underlying problem

• There may be more than one possible explanation

• Sometimes like a detective story

What we must do as a part of the assessment process

Treat

Refer

Or Both

As the last part of the SOAP process what does the *P* stand for ?

Process

What are the three main parts of the Plan ?

Frequency of Treatment Sessions

What can the client do in their own time?

Always respect the client's response to your plan

If there is many treatments what must you check with the client ?

How committed they are

As a part f your plan what can the client do in their own time ?

• ROM Exercises

• Strengthening Exercises

• Postural Exercises

• REST !!!!

Always respect the client's response to your plan, why ?

• You don't know their situation

• It has to fit in with their life

• Time and Money

Most plans have two general phases: What are they ?

• Take away the pain first

• Then look for long term solution

• But be prepared to mix and match

How long do most remedial sessions last ?

1 Hour

• Very rarely someone wants (and can handle) 2 hours

• Occasionally someone will only need 30 minutes

• e.g. they have a specific calf problem only

Why is it hard to predict how many sessions will be needed

• Usually minimum of 3 treatments!, More is uncovered after the first treatment

You will generally find more problems lurking • Or your client will tell you about them when they realise that can probably fix them

What you should explain to the client

• The more the better

• Even if you don't understand something or are puzzled

• Client's appreciate the honesty

SOAP is an integrative process, what does this mean ?

• The client's condition changes with time & treatment • So, re-assess each time you see them • Check progress • You may need to change tack

SOAP: General Advice

Remind the client how they used to feel • We are programmed to forget pain

SOAP: General Advice. When they say “the pain has moved”

• It's usually because you've treated the worst source of pain

• And the next worst place is now the worst

• Sometimes we get knock on effects

• Due to changing patterns of muscle balance

SOAP: General Advice

Sometimes a client says the pain hasn't changed what to do ?

• If so, ask them to point to where it hurts.

You'll often find it's a different place.

• But sometimes we are on the wrong track !!!

• Think again.