Why Should I Learn Assessment?

Musculoskeletal disorders (MSDs) are one of the most pervasive health care issues in the United States. These conditions include a wide array of soft-tissue problems such as strains, tendinosis, sprains, myofascial trigger points, nerve entrapment, and the ever-present host of biomechanical problems resulting from chronic muscle tightness. MSDs are the second most common reason for seeing a family practice physician, with infectious conditions like the common cold being  first.¹ It is interesting that even with the high incidence of MSDs in our medical system their importance as a health care concern seems undervalued.

Many different medical disciplines are involved in the treatment of MSDs. Orthopedists are the specialists whose primary focus is on disorders of the musculoskeletal system. However, most orthopedists’ practices are limited to more serious conditions, such as those that may require surgical intervention. Consequently, the large majority of physician visits for MSDs are handled by family practice physicians.

MSDs account for millions of office visits with physicians each year. Yet most people would be astonished to realize that medical school training for most physicians does not prepare them to address these disorders at all. In fact, almost half of the medical schools in the United States do not require any clinical or basic musculoskeletal course prior to graduation.²

The lack of training in musculoskeletal medicine has been reflected in physician knowledge in several other studies as well. Dr. Elizabeth Matzkin and her colleagues administered a basic cognitive examination on musculoskeletal medicine to 334 medical students, residents, and staff physicians.³  Seventy-nine percent of the participants failed the exam. The most common reason given for the lack of confidence in performance by the participants was that their training in musculoskeletal medicine was inadequate.

Adding to the problem of training deficiencies in musculoskeletal medicine, traditional Western medical care has not had a great track record when it comes to effectiveness in treating the plethora of MSDs. The ineffectiveness of many treatments could result from the deficiencies in training and preparation. However, it is more likely due to the fact that these conditions are largely functional soft-tissue disorders that do not respond well to drugs or surgery, the two primary treatment tools of most physicians.

Ineffective results in traditional medical treatment for MSDs has driven millions of Americans to seek better care through complementary and alternative medicine (CAM) approaches, such as massage therapy. In their comprehensive 1998 study on alternative medicine use in the United States, Eisenberg noted that there were an estimated 114 million visits to massage therapists each year.⁴ This number is likely to rise with the growing popularity of massage. A study on the practice patterns of massage therapists in 2005 found that about 60% of visits to massage therapists each year were for musculoskeletal symptoms.⁵ That means a conservative estimate would suggest over 68 million office visits to massage therapists each year to address MSDs! This number is also likely to increase significantly with the aging of the baby boomer population.

Like our physician counterparts we have gaps and deficiencies in our basic training related to MSDs. While there are a host of continuing education opportunities available for massage therapists that teach advanced skills and techniques, the large majority of these courses focus on treatment techniques. Consequently we have all kinds of opportunities to learn how to manipulate the soft-tissues in various different ways to improve our outcomes. Yet there are few training opportunities that help us develop the cognitive evaluation and reasoning skills that help us figure out the nature of our client’s complaint. Wouldn’t it make sense to expend appropriate effort properly identifying the nature of these MSDs?

Assessment is the systematic process of gathering information in order to make informed decisions about treatment. We must be able to tell if the client’s condition is something that should be referred to another health professional or if it is something we can address. If we decide the client’s condition is something that can be treated with massage, our use of all those treatment techniques we have learned will be far more effective if we understand why we are doing what we are doing. That is what assessment is all about. With over 68 million office visits to massage therapists each year to address MSDs, shouldn’t we also be looking at what we can do to best serve our clients? Massage therapy has tremendous potential to fill this critical gap of care for MSDs in the U.S. health care system, but as responsible health care providers we really must know what we are doing. Learning and practicing effective client assessment is a key step in this process.

1. McCaig LF, Burt CW. National Hospital Ambulatory Medical Care Survey: 2001 emergency department summary. Adv Data. 2003(335):1-29.
2. DiCaprio MR, Covey A, Bernstein J. Curricular requirements for musculoskeletal medicine in American medical schools. J Bone Joint Surg Am. 2003;85-A(3):565-567.
3. Matzkin E, Smith EL, Freccero D, Richardson AB. Adequacy of education in musculoskeletal medicine. J Bone Joint Surg Am. Feb 2005;87-A(2):310-314.
4. Eisenberg DM, Davis RB, Ettner SL, et al. Trends in alternative medicine use in the United States, 1990-1997: results of a follow-up national survey. Jama. 1998;280(18):1569-1575.
5. Sherman KJ, Cherkin DC, Kahn J, et al. A survey of training and practice patterns of massage therapists in two US states. BMC Complement Altern Med. 2005;5:13.