This article is for you if you…

• Found schools over-emphasis on consent annoying or confusing
• Want to deepen your understanding of what quality consent entails in the wellness industry
• Are worried about clients accusing you of inappropriacy
• Are a client anxious about getting a massage but really really want one

Part 1 Here

When is Consent needed during Massage and Rehab

Consent must be obtained whenever an activity is introduced in every appointment. Yes, that means at subsequent appointments reaffirming consent is necessary even if you’re performing the same treatment again. This can be done at the beginning of treatment for all planned modalities and activities. It is also important to also obtain consent when the practitioner sees either physical or verbal cues indicating emotional or physical discomfort for any reason.

How to negotiate Consent in the Context of Massage and Rehab

Consent requires clear goals. If you’re in the “I don’t know what I’m going to do until I put my hands on the body” camp, you are not obtaining consent, and are providing an inadequate assessment. Clients can not consent to being touched in ways invented as they occur. This means consent start with intent, and intent requires assessment.

Assessment does not have to be complicated. There is little evidence that ‘special tests’ (the ones either named after people or with goofy titles) help inform treatment. Assessment can be a short, simple conversation, such as the following example.

Obtaining Consent When the Client Wants to Feel Good/Relaxed

Consent and Assessment can be as simple as the following.

Client: I’m just here to relax

RMT: Oh, is work really stressful right now

Client: No, I just had the day off so booked in

RMT: ok, so you’re treating yourself to a nice massage

Client: Yeah, haha. So just do your thing

RMT: We could do a full body relaxation massage, back, neck, shoulders, glutes, legs, feet, arms. How does that sound?

Client: No feet, but could you massage my hands too, they’re really tired from work.

RMT: Sure, so no feet, but add hands. Do you prefer to stay face down for our time, or do you want the front worked on as wellness

Client: face down so I can fall asleep

RMT: OK great. I’ll stick to long, slow strokes then so you can just melt into the bed. But please, during the massage let me know if the pressure is to firm, or to soft, or if you just don’t like what I’m doing and I’ll change it up. I’ll do my best to get it right, but I’m not perfect and we want you to feel relaxed after all.

With just this short interaction both the client and the practitioner have a clear idea of what the treatment will entail and what the clients goals are. A massage that feels relaxing, and a silent RMT so the client can fall asleep on the table. No physical assessment needed. Consent, intent and client power are all clearly established.

Obtaining Consent When the Client Wants to Recover

When the client is symptomatic and wants to resolve those symptoms consent becomes more complicated. Gaining a verbal understanding of intent and verbal consent, like above, is still necessary, but now, so is physically demonstrating how the clients symptoms will be reduced and managed. The client can not provide informed consent if they do not understand the feelings of recovery. Practitioners need to show they can be trusted to navigate the clients kinesiophobia and respect the clients feelings (both their pain and emotions). People generally don’t trust their bodies to people they don’t trust.

Establishing Intent While Obtaining Consent

Consent is not a procedural formality executed to satisfy regulatory boards; it is the foundational framework that makes effective manual therapy and rehabilitation possible. When practitioners establish clear intent they should rely on straightforward functional assessments rather than outdated diagnostic rituals. This means they do not rely on postural assessment, perform useless special tests and perform AROM, PROM, RROM for every movement of every affected joint.

Instead they should aim to actively honour client agency. Respect their capacity to know which movements, which functions, are limited. Doing sot transforms assessment from a guessing game and institutional obligation into a collaborative, empowering guided experience for the client. When our goal is to ilistrate and increase clients awareness of their functional deficiencies (or to illuminate a clients skill issues, or where their mind-body connection is falling short) they immediately see the value of both the home-care and the assessment. If the intent of both the therapy, both short term, and long term is clear, then consent is clear.

Functional Assessment is Consent

Because a rehab professionals goal is to help clients restore functionality and reduce symptoms. Movements that are tolerable, but a little scary for the client must be suggested and then adapted to the clients individual symptoms for both assessment and home-care. State the intent of the assessment, gain consent, modify based on client feedback, and repeat as necessary.

Doing so while frequently checking in on the clients perception, physical sensations while assessing movement quality gives the practitioner the information they need to help the client decide which activities they are ready to consent too doing. This might mean the client does cat cows daily for back pain, or that they dead-lift 225lbs twice a week.

Conclusion

True consent protects both parties, mitigates kinesiophobia, and builds the baseline trust necessary for genuine physical recovery. Whether a client seeks pure relaxation or complex functional restoration, explicit communication ensures that every touch and movement serves a shared, agreed-upon goal.

Read more about here, in our article on special tests. Functional tests, ROM and basic neurological tests are sufficient for all conditions. If you want to learn more about how to provide functional tests that encourage client buy in and significantly improve home-care adherence and home-care value sign up for the Really Simple Rehab CE here. (release date TBD)

Hopefully this 2 posts (part 1 here) have helped make clear that consent is not a procedure executed robotically to satisfy regulatory boards. It is not simply a tick-box added to treatment notes to satisfy regulators. Consent is a part of the foundations to effectively and safely performing manual therapy and provide rehabilitation and obtain client buy in. Practitioners must establish clear intent, rely on straightforward functional assessments, and actively facilitate client agency. The practitioner must ensure both they and the client agree upon clear steps that explicitly move treatment towards achieving a shared goal. When they do this consent becomes an integrated part of the treatment process, making things.. rather simple.

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