Palpation, the process of assessing physical issues through touch is a crucial part of massage therapy. While registered massage therapists receive extensive training in anatomy and physiology, the vast differences in the body makeup of patients can sometimes make it difficult to locate and assess injured areas. Palpation can provide a vital tool to help RMTs make better assessments.
Nonetheless, the process takes a lot of skill and practice, and students enrolled in massage therapy courses need to work hard to develop their abilities. Knowledge of various muscles and their connected muscle groups and nerves is essential, as well as good physical technique.
Read on to find out more about how palpation works, and some of the basic protocols RMTs must follow throughout the process.
Massage therapists use a series of palpation protocols to help them identify and locate injured soft tissue and joint structures. Palpation is carried out in the areas between the muscle’s attachments, ligamentous attachments as well as boney surfaces and joint structures. Students in massage therapist training need to ensure they are identifying the targeted landmark, rather than moving to an adjacent structure by mistake. Confirmation of soft tissue landmarks involves asking the patient to contract the muscle in order to make it “pop” up under a therapists fingers. If the therapist cannot feel the tissue change, they are off the structure in questions and need to re-position.
In some cases where there are a number of adjacent muscles that work when the target muscle contracts, an RMT may need to ask a client to perform a further action. For instance, the anterior deltoid is easier to identify by performing flexion of the arm at the shoulder joint, as it engages the other deltoid muscles to a notably lesser degree. Occasionally, it will also be necessary to add resistance to the patient’s contraction if the targeted muscle is not easily palpable.
When performing palpation on soft tissue, most students are usually taught to evaluate any inconsistencies using the ‘4 Ts’: Tone, Texture, Temperature, and Tenderness. Each of these elements can potentially serve as an indicator for a therapist’s assessment:
Palpation can be incredibly useful for massage therapy school students when looking to assess whether a complaint from a patient is ‘referred pain.’ Damaged tissues can send sensory signals through the spinal cord from the nerve root, causing pain and discomfort in other muscles in the body. This can result in patients erroneously perceiving their injuries as originating from a different area. Viceral problmes for instance, can often result in pain in the chest, upper back, and shoulder.
If palpating the area of complaint reveals no inconsistencies, a skilled RMT will often continue their assessment by palpating other areas of the body which share the same nerve root, helping them to better identify the root cause of the issue. Through assessment and differential diagnosis of soft tissue concerns, RMT’s know when to refer if the originating cause seems to lay elsewhere.
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