The Health History Conundrum

By Ruth Werner
[Pathology Perspectives]

One of the things many of us love about the massage and bodywork profession is its amazing versatility. Here is a skill that can be developed in infinite directions and a vocation that can be practiced in myriad settings, from chemotherapy clinics to cruise ships.

At one time, a perceived schism existed between bodywork that was conducted primarily for general recreation and relaxation and bodywork that was intended to address specific weaknesses with the goal of improving health or function in a particular direction. It is safe to say that “clinical” therapists had a tendency to look down on their colleagues who were performing primarily “fluff and buff” types of bodywork with a healthy clientele and often in a spa or resort setting. This division in our profession was self-destructive and fundamentally false. Of course relaxation massage is therapeutic—in some cases much more so than many other interventions. And if clinical massage isn’t relaxing at some level, it is unlikely to be highly therapeutic.

Our profession has, with mixed success, begun to integrate these divergent approaches so that clinical massage is no longer automatically assumed to be purely technical and relaxation-based or recreational massage is no longer assumed to be appropriate only for people with no health problems.

Client Safety

This is a pathology column, so the main focus in this discussion is on how pathology issues impact or influence massage therapists working in spa settings. In this context, the challenge of the client health history intake form rises quickly to the top.

The target market for massage in spa settings has traditionally focused on healthy clients who are indulging in a recreational treat. Not surprisingly, taking a thorough health history has historically seemed unnecessary. At $125 per hour and up, it may feel ridiculous to spend time on a lengthy introductory interview for a healthy person on a relaxing vacation.

But these days many spas market services to people who live with chronic or even life-threatening conditions. And why shouldn’t they? Even people with fibromyalgia or rheumatoid arthritis can be pampered. Retreats for current cancer patients and cancer survivors are held at luxurious resort getaways. Spas offering treatments to help with diabetes, heart disease, lupus, and many other chronic conditions are a search engine click away. With this shift of the target market from theoretically healthy people to people who live with illness, but who still want to experience bodywork in a spa setting, it is more important than ever that bodyworkers be well educated about how to work safely with clients who are not fundamentally healthy.

A highly unscientific survey of spas and spa-based practitioners reveals enormous inconsistencies in how—or even if—client intakes are managed. Some facilities are thorough—even intrusively so, according to some feedback. Others require no health histories at all; indeed, massage therapists are actively discouraged from “wasting time” with this pursuit. Some collect a minimum of information at the reception desk, but the therapist never looks at it. Perhaps most facilities function somewhere in the middle, collecting some information that may be particularly pertinent to the type of work offered.

The most obvious reason to conduct a client history interview is of course to protect the client and the therapist (and by extension the spa facility) from any harm that might occur as a result of the bodywork session. Massage therapists who haven’t or couldn’t get a thorough client health history in the past have always run the risk of working with someone with an invisible-but-serious disorder: remember that heart disease and cancer, two classes of conditions that typically don’t create symptoms until they are very advanced, are the two leading causes of death in this country. But because spas and resorts now openly cater to clients with known chronic health challenges, under-informed spa practitioners have an even greater chance of inadvertently contributing to a problem, either through not recognizing warning signs or by not bringing warning signs to their clients’ attentions.

The whole proof-of-harm debate is an open one, but while fully litigated examples are sparse, many malpractice cases have been brought against massage therapists and settled privately. This is not proof of harm per se, but it is proof of a need to protect all the parties involved in a business that offers massage or bodywork.

A Sample Health History Form

As a pathology educator and someone who is highly invested in the gathering of as much information as possible in order to make decisions about what kinds of bodywork are most appropriate, it is almost physically painful to create an abbreviated health history form. Still, it is clear that such a thing is needed in order for any of this vital information to be shared at all. Therefore, I offer the following, from which enough information can be gleaned in order to work safely, but which can probably be accomplished within a very few minutes.


1. What do you do?

2. What hurts today?

     A.          What makes that pain worse?

     B.          Better?

3. Are you under a doctor’s care?

     A.          Why?

     B.          Does your doctor recommend that you exercise?

4. Do you take any medications?

5. Do you have any allergies?

6. Have you had any injuries or surgeries that affect your ability to get through your day?

7. Do you have any rashes or open blisters or sores today?

8. (Most importantly) What would you like to accomplish today?


It is important to point out that a client history is only useful when it is filled out accurately and read carefully. Therapists sometimes never look at the form, in which case, what’s the point? And it is always surprising how often clients withhold important information until mid-session (“Oh, you mean that rash?”).

the Intake Gauge

Ultimately, it is not a realistic or even useful suggestion to require that every spa that offers massage or bodywork conducts the same client health history procedure. But doesn’t this topic reveal how invested a facility is in its bodywork program? The willingness to devote even just a few minutes to gather the most perfunctory information shows that a spa considers it important to …

•  Be professional and serious about the work that is conducted.

•  Create a safe working environment for the client and the practitioner.

•  Establish a personal connection between the client and the practitioner that invites the possibility of a longer-term relationship, with return visits and client referrals.

•  Meet the client’s needs as an individual, as opposed to treating him/her as just another body on the table. 

The spa industry is crowded and competitive. People considering where to spend their money for this kind of self-care need some way to judge which facility will give them the best possible experience. A quick look at a spa’s health history form can reveal a lot about that organization’s dedication to comfort, individuality, and well-being.

  Ruth Werner is a writer and educator for massage therapists and serves as chair of the Massage Therapy Foundation’s education committee. She teaches several courses at the Myotherapy College of Utah and is approved by the NCBTMB as a provider of continuing education. She wrote A Massage Therapist’s Guide to Pathology (Lippincott, Williams & Wilkins, 2008), now in its fourth edition, which is used in massage schools worldwide. Werner is available at or