171: The Most Skipped Step in Assessment and Why It Matters Most (with Whitney Lowe)

And I wanted to focus on some key aspects of treating pain and injury conditions and look specifically about the role of the history, the role of that intake that we have with our clients, because this is so critically important.

So we're gonna take kind of a deep dive on some key issues related to how do you take a really effective history, why the different parts of it matter so much, and what kind of excellent information we can get for this that's gonna help us become a lot more effective with our treatments when we're working with our clients.

And one of the things that gets overlooked a lot is how important and detailed that history needs to be.

There are various parts of our assessment process, and sometimes I see some practitioners focusing, uh, almost exclusively on the physical examination components of the assessment and, and even speaking about assessment as if saying like, uh, "Oh, I've done my assessments with my, with this client." Meaning what they're really talking about is they've done a bunch of tests or physical examination tests with them.

But the reality is the most important part of that assessment process is really the subjective information that you get from your client, that initial history.

And so this is what we wanna zero in on is like, how do we take a good history? What kind of information do we get from that? And where can we really use this to benefit ourselves much more effectively as we make our clinical practice, uh, aimed at treating these various people who are coming with so many pain and injury complaints for us to address? So here's where we see one of the problems kind of getting started.

A lot of the therapists will sort of begin treating their clients just, you know, maybe focusing, just asking some basic questions at the beginning, and maybe your client says they've got shoulder pain, or maybe they say they got a pain down their upper extremity into their hand.

And so then your attention goes to those places, and you just start working on where it hurts.

But really we wanna be asking a different question, not so much just where it hurts, but why it hurts.

What's the reason going on there? Because this can make a big difference in where the problem is really originating from.

What is the nature of that problem? How is it gonna respond to the work that we do? How might we actually aggravate that problem with the work that we're doing also? These are all critically important questions that we're gonna try to identify here.

So with the various parts of that assessment process, again, um, as I mentioned, I wanna, I want to sort of zero in on the history-taking process, and we're gonna use a framework or introduce a framework today called the OPQRS-T model.

So this is taking a big, uh, sort of alphabet soup, [smacks lips] chunk of letters of the alphabet, but this is an acronym, and we're gonna look at each of these different, uh, component parts of the OPQRS-T framework.

And one of the reasons I like this framework so much is, um, you know, oftentimes I would talk t- to, uh, students about, uh, the critical importance of history-taking, and they would say like, "Well, uh, you know, I don't know what kind of questions to ask.

I don't know what kind of things I should be asking my clients." And then the other really important part of this is like, what do their answers mean? So if they say, for example, "I've got a, uh, you know, a dull, throbbing ache that just wakes me up at night in my shoulder," what does that tell us? What kind of thing does that mean versus something that might be a, a real sharp kind of sensation that they would feel? So we're gonna zero in on what this framework tells us and how this helps us design and implement a much more effective history-taking process that will then guide our treatment most effectively.

So one of the big things that this history tells us is a lot about red flags, and what that means is, you know, some safety things that we need to be aware of.

There are often, um, very concerning, uh, conditions or problems that somebody might present with that they might not realize is a concern or a caution or possibly even a significant contraindication to the things that we might be doing with massage.

And if you just kind of glance over and skip over a few things in the history, you might miss some of these really important red flags that would indicate the necessity for a referral for somebody to be seen by another particular practitioner.

So this is a, a really distinct advantage of having a, a bit more of a structural framework to your, your history-taking because it, it helps you zero in on some of those things that might be critically important here.

So let's take a look at this, um, this whole, uh, history-taking process.

Uh, one other thing I want to just emphasize first off, though, is, um, we talk so often about the therapeutic alliance and the ability to connect with your client and how critically important that is, and this is one of the things that happens by building, uh, a really comprehensive history-taking framework is you have a great opportunity to really enhance that therapeutic alliance and develop a great deal of confidence and communication with your client, and that hasTremendous therapeutic power.

So there's a tremendous amount of benefit that comes from, uh, developing that, uh, communication and rapport with your client that happens just through a well-taken history.

So let's look at that OPQRST framework here.

We're gonna start with the letter O, and this is for onset.

So this tells us how, hmm, how did that condition come about? Was it a sharp, sudden, acute injury, or was it a gradual, um, condition over time, and maybe there was a...