Core Skill: Palpation

Palpation is a core skill that allows therapists to assess and gather valuable information about the condition and integrity of soft tissues. It involves the application of pressure and touch to various areas of the body to evaluate tissue texture, tenderness, mobility, and fluid pressure pockets. Our unique method of palpation provides greater detail about fluid pressure pockets in soft tissue, helping us identify areas that require specific interventions for pain resolution and improved mobility. Let’s explore the key aspects of our palpation technique and how it enhances our understanding of fluid pressure pockets.

Palpation Technique for Fluid Pressure Pockets:

Our method of palpation focuses on precise evaluation and identification of fluid pressure pockets within the soft tissue. The following principles guide our approach:

Pressing for Contrast:

We press our fingers against the skin to detect differences between normal tissue and areas with increased fluid pressure. This allows us to identify regions where fluid pressure pockets may be present.

  • Tuning Fork Placement: To aid in our palpation, we utilize a tuning fork for vibration therapy. This frees up the opposite hand for palpation and provides real-time feedback on tissue quality while maintaining contact with the patient.
  • Layered Fluid Pockets: Fluid pockets can be found in different layers of tissue. Our palpation technique allows us to explore these layers, identify hidden pockets beneath larger fluid-filled areas, and assess their impact on pain and mobility restrictions.
  • Proper Positioning and Sensing: Through proper palpation, we ensure accurate positioning and assessment of fluid pressure pockets. This enables us to target specific areas for intervention and deliver effective treatments.

Palpation Techniques and Guidelines:

Our palpation technique employs specific methods and guidelines to optimize the assessment of fluid pressure pockets and tissue quality:

Finger Pad Sensitivity: The specialized Merkel cells in the finger pads provide fine texture sensitivity, making them ideal for detecting subtle tissue variations.

Merkel cells are a type of skin cell that function as touch receptors, also known as mechanoreceptors, in the skin of vertebrates. Named after Friedrich Sigmund Merkel, a German anatomist who first described them in 1875, these cells are particularly important for light touch sensation.

Merkel cells are found in the skin and hair follicles in mammals. They are most densely packed in areas of the skin that are highly sensitive to touch, like the fingertips and lips. Each Merkel cell is associated with a nerve ending, and together, they form what is known as a Merkel cell-neurite complex.

When the skin is pressed or touched, it causes a deformation of the Merkel cell, which opens ion channels in the cell membrane, resulting in an influx of ions. This triggers an electrical signal which is sent along the associated nerve to the spinal cord and then onto the brain. This process is how we sense touch.

Merkel cells are classified as slowly adapting type I mechanoreceptors because they generate a sustained response as long as the touch or pressure continues. This characteristic allows them to play a vital role in our ability to perceive continuous touch sensations, including shapes, edges, and textures.

  • Finger Selection: We primarily use the index, middle, and ring fingers to palpate, as they offer the best tactile sensitivity and control. Avoid using the finger tip, side of the finger, or palm of the hand for optimal assessment.
  • Positioning of fingers for placement: Part of the Palpation Core Skill is preparing for the placement of the tuning fork with the sensing fingers positioned where the fingernails of the first and middle finger are on either side of the placement site.

Continue to palpate with pads of the fingers to locate exact position of placement using sensing fingers for feedback during the placement.

Palpation is for perfect positioning, but it is also for effective feedback which is a skill we will discuss after the placement of the tuning fork.

  • Pain as a Guide: Pain is often directly connected to the presence of fluid pressure pockets. We emphasize the importance of “trying a little tenderness” and ensuring that the palpation process does not cause excessive discomfort.
  • Nail Length: Keeping the fingernails short is essential to maintain proper palpation technique and prevent discomfort or injury to the patient.
  • Press & Slide (gliding or sliding palpation): Gliding, also known as sliding palpation, involves the therapist pressing their hand or fingers into the skin and then moving or sliding it across the surface. The objective of this technique is to evaluate the mobility and elasticity of the skin and underlying tissues. It is especially useful for detecting areas of fluid buildup or edema and areas of muscle tension or adhesion. By observing the way the skin moves and stretches under the sliding hand, the therapist can gain insights into the health and function of the skin and subcutaneous tissues.
  • Press & Press (compression palpation): In compression palpation, the therapist uses their hands to apply downward pressure onto a particular area of the body. The main goal of this technique is to assess the state of the underlying tissues and structures, which may include muscles, tendons, ligaments, and other soft tissues. By applying varying degrees of pressure, the therapist can gauge the tissue’s firmness, elasticity, and the presence of any unusual lumps, or areas of tenderness or pain. For instance, a region that causes pain upon compression may indicate a muscle strain or inflammation. This technique is also commonly used to identify and address ‘trigger points’, which are tight knots of muscle fibers that can be particularly sensitive and can cause pain in other parts of the body when compressed.
  • Press & Roll (rolling palpation): In rolling palpation, the therapist applies a downward force and simultaneously rolls their fingers or hands over the patient’s skin. This technique allows for a broader and more dynamic assessment of the tissue beneath the skin. As the therapist rolls over the skin, they can feel for any abnormalities, such as bumps, swellings, or areas of increased muscle tension. The rolling motion can also help to stimulate blood flow to the area and may be used to gently mobilize the skin and superficial tissues, potentially improving their elasticity and function.
  • Starting Wide and Narrowing In: Beginning with a broader search and gradually focusing on specific areas helps identify fluid pressure pockets and locate their edges.
  • Identifying Hidden Gems: Fluid pressure pockets can be concealed within larger fluid-filled areas. We carefully explore these regions to uncover hidden pockets and understand their significance.

Palpation for Joint Dysfunction:

In addition to assessing fluid pressure pockets, palpation plays a vital role in evaluating joint dysfunction. The following considerations guide our approach:

  • Palpation during Movement: We palpate the affected area while observing the changes that occur during specific movements. This helps identify muscles involved in compensatory patterns and provides insights into the underlying dysfunction.
  • Palpation Away from the Joint: Often, the pain experienced is not directly related to the joint itself. By palpating surrounding tissues away from the joint, we can identify referred pain patterns and differentiate between joint and soft tissue issues.

By adhering to our unique method of palpation, therapists can gain valuable insights into fluid pressure pockets, tissue quality, and joint dysfunction.