Therapeutic Presence
In physical therapy, we use our hands to help patients and client progress toward treatment goals. Manual contact is an essential part of our practice and the burden is on the practitioner to maintain professionalism.
Massage is rendered through direct skin contact. Patients and clients are in some state of undress during massage treatments. The treatment environment should be warm and quiet and there should be adequate blankets, pillows and sheets to allow for self-draping and additional draping as needed during the treatment.
A PTA implements skills in hygiene (short, trimmed nails, jewelry removed, clean hands and body, minimize hand perspiration), communication (informed consent/choice, open and neutral body language), positioning (self and patient/client), privacy and draping prior to initiating massage.
If the PTA can maintain themselves in a relaxed, comfortable state, their hands become their "eyes" into the soft tissues. With practice, PTAs can distinguish normal from restricted tissue mobility, therefore optimizing treatment outcome by working with the most appropriate timing, direction, and pressure during massage and mobilization.
Manual work can be tiring. A PTA should modify their positions and techniques to minimize overuse. Correct techniques includes total body movements which are well coordinated with the hands. Hand flexibility, stretching, using other body parts (palms, thumb, ulnar border of wrist), proper body mechanics, and good upper body strength and endurance will help protect the PTA from overuse injury.
Summary of Therapeutic Technique
- Position patient/client for maximum support and comfort to encourage relaxation
- Relaxed, appropriate body mechanics
- Relaxed hands which can contour around targeted body parts
- Adjusting rate, pressure, and rhythm of massage according to meet treatment goal