Injured clients are easy targets for creating goals, since they have limited function—and lots of pain. As practitioners, we’re motivated to check in on these clients and update their goals when doctor referrals or insurance company reimbursements depend on it. Unfortunately, retaining these clients is difficult once they’re well. Sure, they may thank us profusely, but they often don’t come back for wellness visits. Setting some wellness goals near the end of their care may help transition injury clients into wellness clients who adhere to a massage program for life.

Goals Related to Wellness

Identifying constructive goals that motivate clients to commit to staying and paying out of pocket (once they’re free of pain or functional limitations) may sound challenging, but we can surmount that challenge by promoting the advantages of well-being, discussing the effects of stress on health and touting the benefits of massage and bodywork. Once clients are educated about the well-being effects of massage, it will be easy to create goals and plan a series of bodywork sessions they can get excited about.

Well-Being

There are multiple components that describe—and tools that measure—a person’s well-being. Health is defined as the absence of disease and includes more than just the physical wellness we commonly think of when we think of health. Well-being also includes psychological, emotional, spiritual, social, and economic health. All of these are fundamental to overall well-being and may include happiness, vitality, calmness, and optimism.
Tools that measure well-being include value statements such as being hopeful, being in touch with how you feel, being engaged in activities, being highly effective, and being connected with the people around you. It’s also important to like and trust yourself; to do things that are worthwhile and consistent with who you are; and to constantly be improving, developing, and advancing.1 Each of these components of well-being can provide a sense of purpose for massage and bodywork. It can become a goal that validates wellness massage as ongoing care.
Remember, all goals must have a measurement component in order to track progress and judge the success of the treatment plan, and mood is an easy thing to measure. Also, measuring mood keeps us in our scope of practice, allowing us to avoid more diagnostic terms like depression and anxiety.

Long-Term Client Goal Example

Improve my mood in the evening after work so I enjoy spending time with my family, with my mood rating no more than 3 out of 10, 4–5 nights a week within four sessions.

Stress

Some clients think well-being is elusive and find it difficult to make goals around awareness and feelings. To set concrete goals with these clients, it’s helpful to identify their issues related to stress.
Routine stressors can include daily responsibilities like money, work, and relationships. They could also include sudden or negative changes (such as losing a job or experiencing a divorce or death) or stress resulting from traumatic events (like abuse, war, or an environmental catastrophe). All of these stressors can result in physical and mental health risks.2
Stress impacts health in many ways and may be a more tangible example of the benefits of bodywork as a well-being tool when setting goals with your client. Stress is something everyone wrestles with, but it’s how we handle stress that’s most important.

Some people use stress as motivation and recover quickly. For example, my 14-year-old client once rated her stress very high on a 0–10 scale. I was worried, and I asked her about it. She wisely said, “Not all stress is bad. I like school. Basketball is fun. But grades and winning are stressful.”
Others dwell on their problems and are consumed by stress. Stress can be dangerous when the source becomes relentless, chronic, or feels like an attack. That’s when health problems can occur. Some known problems associated with stress include:3
• Accelerated aging
• Alzheimer’s disease
• Asthma (which triggers shallow breathing)
• Depression and anxiety
• Diabetes
• Gastrointestinal problems (heartburn, reflux, and irritable bowel syndrome; worsens ulcers)
• Headaches
• Heart disease (high blood pressure, high cholesterol, and heart attacks)
• Obesity
• Premature death
Clients with a family history or early sign of these conditions may be motivated to keep those conditions at bay and will commit to a series of sessions.

Short-Term Client Goal Example

Increase my ability to recognize when I hold my breath or breathe shallowly as a stress response every day and implement my deep breathing homework exercise at least once a day within two sessions.

Exacerbating Old Injuries

In addition to striving for well-being and reducing the risks of stress-related illness, goals can be centered around chronic limitations or potential exacerbations of a client’s injury you originally treated. To limit future reoccurrences, encourage your clients to maintain their pain-free experience by coming in bimonthly or monthly for massage.

Long-Term Client Goal Example

Avoid exacerbations of injury by receiving massage every 2–3 weeks and stretching legs and low back 4–7 days a week, keeping pain no higher than a 2 out of 10 for the next 60 days.

Benefits of Massage and Bodywork

There is a strong association between stress and disease. Psychosocial stressors influence both mental and physical disease and, interestingly, psychosocial treatments can ameliorate both mental and physical disorders.4 (Note: While the research referenced does not define psychosocial treatment modalities or mention massage therapy, we can consider how massage and bodywork might affect stress. One way to measure our success is by setting goals and documenting outcomes.)
There are many benefits of massage and bodywork beyond pain reduction and increased function. In a retrospective study, results of dozens of research papers on a variety of complementary and alternative (CAM) therapies were combined. In particular, the researchers studied comments collected in a short-answer format that were not reported in the primary research articles published.
Upon review of the comments, the researchers began noticing a common thread in the answers to the open questions placed at the end of each feedback form. Questions such as “Have you changed the way you think about your back pain as a result of having received (massage, acupuncture, chiropractic)?” and “What effect, if any, has (massage, acupuncture, chiropractic) had on you?” were asked.5 In general, the most common responses included:
• Dramatic improvements in health or well-being
• Improvements in physical conditions unrelated to pain
• Increased ability to cope with pain
• Increased ability to relax
• Increased body awareness
• Increased connection of mind, body, and spirit
• Increased energy
• Increased sense of control over health
• Increased sense of well-being
• Positive changes in emotional state
Given the beautiful litany of benefits directly out of the mouths of research participants, we can safely focus goals on the outcomes listed above—the outcomes that matter most to people.6
We are often tempted to talk about the benefits of massage therapy in terms of how it works. The truth is, we don’t really know. As Tracy Walton wrote in her article  “Myths and Truths About Massage Therapy: Letting Go Without Losing Heart,” there isn’t enough research to tell us that massage elevates endorphins or increases circulation. There is enough research to say massage doesn’t decrease lactic acid, however. So, when enrolling clients in a series of sessions, avoid promising results we may not be able to prove—like detoxifying their system—and stick to outcomes we can speak confidently about.

Long-Term Client Goal Example

I will be able to get into a relaxed state of mind at least once per day, 5–7 days per week, and I will maintain it for at least 30 minutes within six sessions.

Setting Goals

Communication

Every client is different, with unique perceptions of wellness and goals for health. Engage each by asking questions about their life now that they have their health back. You’re familiar with what they couldn’t do; now ask what they want to do and work with them to integrate new activities without exacerbating their injury.
People who can do everything with little or no pain may still have issues they want to address. Identify goals by exploring what they want to get out of massage. Prompt them with ideas about more restorative sleep, skills for coping with stress, increased awareness regarding posture, or noticing when stress begins rather than just dealing with the aftermath of stress. I often hear clients say they didn’t know massage would work for reducing nerve pain, or that working on their feet could help their hips loosen up, or that massage would improve their attitude and self-esteem. As people’s self-esteem rises, they tend to make healthier choices about their eating habits and activities.
When setting goals with a client, consider the types of activities they enjoy and their values regarding family and community. Encourage clients to participate in social activities. They may discover they’re not alone in striving for a healthier life. Teaming up with friends and finding classes to attend between massages will keep them on track.

Functional Outcomes

There are several measurement tools for charting progress over time. Progress motivates clients to commit to ongoing care. The one that’s already been used in the examples above is called functional outcomes reporting. This is common throughout health care, most often used by physical and occupational therapists. It’s simple, measurable, and can be modified to fit any individual. The structure used to ensure functional goals are useful is called SMART goal setting (see chart below). A common mistake in setting functional goals is not setting homework goals. These are distinctly different. You can weave homework into a functional goal, but the goal itself should focus on a specific daily activity, such as sitting at the computer working, standing on the sideline at the soccer game, walking up stairs to bed, getting into the car, working on a project under a deadline, fixing the kids’ bicycles, etc. We want the goal to center around something the client really wants to enjoy—and homework is often just a means to an end.
Always define success through a measure and a feeling. For example, reading two hours in a row, 3–5 days per week with no headache; waking only two times per night, 5–7 nights per week with no more than mild fatigue upon waking; or running three miles a day, three times per week with no more than 24 hours of muscle soreness afterward. Remember that measures usually involve numbers; feelings usually describe soreness or fatigue.
Be careful to set goals that will be attained within 60 days or less. People need to feel successful to stay motivated. Short-term goals should be attainable within 2–3 weeks, long-term goals within 1–2 months.
Help your client choose an activity they do frequently. You want to be able to measure progress on a regular basis. If they are training for a marathon, set multiple short-term goals around walk-running first, and then add mileage as you go.
Always include a time-based goal. If the goal is not accomplished within the time frame selected, you can always modify it. Knowing when to celebrate is important. When each goal is accomplished, praise your client and move on to the next goal.

Numerical Scales

Numerical scales are easy to use. Choose a number system that starts with zero. You want to state when there is no pain as well as the presence of pain. The most commonly used scale is 0–10 and can be used for most anything. I recommend using 0–10 scales for pain, function (activities of daily living), and mood.
In addition to numerical scales, there are value scales comprised of statements that describe the activities limited by pain. The smiley face is a visual scale helpful for children and those for whom English is not their first language. The Defense and Veterans Pain Rating Scale is an excellent example of combining a numerical scale, value scale (words), and a visual scale to best assist people in scoring how they feel at a point in time.7
Most scales produce outcome measures that can be graphed over time. This is a good visual to demonstrate progress and keep clients motivated. With electronic health records more widely available, choose one that automatically graphs progress before and after each session and over time (electronic health records charts). Some systems allow clients access to their health record, and they can check on their progress anytime.
Function seems to improve quickly compared to pain. Most people try to increase their activities—pushing pain to their threshold. In the beginning, getting through a workday may raise their pain level. As their condition improves, they may start doing more after work and on weekends before they hit their threshold. If you only track pain levels, especially when the client is fairly healthy, you may never see progress. Always track function when setting goals and tracking outcomes, for both treatment and wellness sessions.
Research has shown that massage improves anxiety, depression, mood, and bothersomeness. While anxiety and depression can be considered diagnoses, mood is an all-encompassing term that stays away from diagnostic language and is more common than bothersomeness. How someone feels about their condition can have a large impact on their ability to get better. When a person is feeling hopeless, the same level of pain can be more debilitating than someone who’s hopeful about getting better.

Assessments and Findings

Posture, range of motion, gait, and palpation findings can be used to measure progress. The 0–10 scale can be used to measure deviations from normal with most findings. Normal, good, fair, and poor can also be used and may seem easier when measuring multiple findings.
Some electronic health records allow you to upload photos and videos and attach them to a client’s chart, making progress more real. This is especially helpful with images of scars, photos of posture against a grid, and videos of range of motion and gait.

Ongoing Care

Plan out a series of sessions to engage clients in committing to long-term wellness care. Here’s some easy steps:
1. Identify their goals for wellness.
2. List potential blocks they have to achieving the goals.
3. Identify massage techniques that support those goals and help remove blocks.
4. Discuss a treatment frequency they are willing
to commit to.
5. Support the sessions with homework and self-care education for in-between times.
6. Revisit the plan every few sessions and modify if needed.
7. Celebrate accomplishments!

Remember, measured results (goals) encourage repeat clientele. And while you’re focused on retaining the clients you have, your happy clients will be busy referring their friends and family to you!

Why is the information in this article so important for massage therapists and bodyworkers? Because it can absolutely impact your business today!

The 2019 ABMP National Consumer Survey, conducted by Harstad Strategic Research, confirms that consumers enjoy massage and appreciate its therapeutic benefits, but sometimes don’t understand that its value goes beyond the “fix-it” stage. Of the survey respondents who had ever received massage, 31 percent said they had not been back for a massage in the past year because “they don’t need a massage” right now. With comments like “what was broke got fixed” and “I got better so I don’t need it anymore,” these consumers only saw massage through a very narrow remedial window. Do your acute pain/injury clients know the ongoing value of massage beyond the targeted, reparative role?

Notes

1. Ylenio Longo et al., “The Scales of General Well-Being (SGWB),” Personality and Individual Differences 109 (2017): 148–59, https://doi.org/10.1016/j.paid.2017.01.005.
2. “5 Things You Should Know About Stress,” National Institute of Mental Health, accessed July 17, 2019, www.nimh.nih.gov/health/publications/stress/index.shtml.
3. R. Morgan Griffen, “10 Health Problems Related to Stress That You Can Fix,” WebMD, accessed July 17, 2019, www.webmd.com/balance/stress-management/features/10-fixable-stress-related-health-problems#1.
4. Neil Scheiderman et al., “Stress and Health: Psychological, Behavioral, and Biological Determinants,” Annual Review of Clinical Psychology 1 (April 2005): 607–28, https://doi.org/10.1146/annurev.clinpsy.1.102803.144141.
5. C. Hsu et al., “Unanticipated Benefits of CAM Therapies for Back Pain: An Exploration of Patient Experiences,” Journal of Complementary and Alternative Medicine 16, no. 2 (2010): 157–63, https://doi.org/10.1089/acm.2009.0188.
6. Tracy Walton, “5 Myths and Truths about Massage Therapy: Letting Go Without Losing Heart,” Massage Therapy Foundation, accessed July 17, 2019, www.massagetherapyfoundation.org/resources/e-books.
7. Rosemary Carol Polomano et al., “Psychometric Testing of the Defense and Veterans Pain Rating Scale (DVPRS): A New Pain Scale for Military Populations,” Pain Medicine 17, no. 8 (2016): 1,505–19, https://doi.org/10.1093/pm/pnw105.