Therapeutic Kinesiology:Musculoskeletal Systems, Palpation, and Body Mechanics

Therapeutic Kinesiology Instructor Manual: Ch09 p.1 TK INSTRUCTOR MANUAL: CHAPTER 9 Palpation Chapter manuals include: Objectives Lecture Notes Suggested Classroom and Student Development Activities For other chapter-by-chapter resources, see: Key Term Quizzes Muscle Origin and Insertion Worksheets Muscle OIAs List by Chapter MyTest Test Bank For additional resources see “Teaching Tips and Tools”: 7 research-based learning principles for kinesiology courses in massage 5-step self-directed learning cycle for body mechanics courses Tools that build metacognitive skills: e.g., concept (mind) maps, grading rubrics, and self-assessments inventories OBJECTIVES Define palpation and name four reasons a manual therapist uses it. Describe how palpation is approached as a science. List six elements that are observed during palpation. Describe how palpation is approached as an art. Describe the interpersonal skills a practitioner uses during palpation. Contrast the differences between classroom palpation and therapeutic palpation. List five guidelines to keep in mind during palpation. Describe the palpatory qualities of tissue layers, including skin, fascia, muscle, and bone. Define an endangerment site and explain why they should be avoided in palpation. Describe the palpatory quality of peripheral nerves and arteries. LECTURE NOTES THE SCIENCE OF PALPATION Palpation: Clinical examination of the body through touch Reasons to palpate To learn anatomy and kinesiology To locate anatomical structures To recognize what is normal and what is not To develop hands-on skills, quality of touch Connecting what you feel with what you know Requires a knowledge of Anatomy: Body systems and specific structures Kinesiology: How muscles and joints function Physiological rhythms (e.g., breathing, muscle contractions) Palpation as an assessment tool A nonlinear, bodymind process. Three steps: Sensing: Feeling the tissues Assessing: Reflecting on and interpreting Responding: Adjusting touch accordingly Palpation goals Identify injured or pained areas Assess resting tone and symmetry Keep track of where we are working Find and treat tender points in the soft tissues Improve client’s body awareness, bodymind connection Track tissues’ responses in client Prepare client to move during active technique Tracking skills Tracking: Ability to pay attention and follow event Track to gather information about tissues and client Information from tracking are palpation findings Objective findings: What you actually feel Subjective findings: What you imagine you feel Elements to track in palpation Resting tone of tissue Tissue density Changes in tissue temperature Continuity of tone and changes in tone Symmetry or asymmetry Organic/intrinsic physiological rhythms Range and quality of motion Reflex responses Relaxation response Guarding responses, may indicate pain THE ART OF PALPATION The very act of touching another person with focused attention is therapeutic Ability to integrate tactile and interpersonal skills Touch with presence A two-person process Client and you paying attention together Three levels of processing What goes on in you, the practitioner What goes on in the client The synergetic exchange between you Palpation as mindful, body-centered touch Body is living, breathing person Body as psychology in motion Palpation touches the whole person Palpate with pract pracconscious deliberation and sensitivity Build client trust by paying attention Classroom and therapeutic palpation differences Classroom palpation Focuses on finding /assessing specific structures For learning and skill-building Therapeutic palpation A more open focus Feeling what is actually there Focus narrows as structures are assessed Working with rather than on clients Our client's bodies respond to touch Responses can be unconscious Two general types of response: Moving away from and contracting Moving toward, opening, and relaxing Clients often tighten bodies to repress innate responses To elicit client participation and relaxation: Encourage self-awareness and active relaxation Engage your client with active technique Validate any reflexive contractions that occur PALPATION TIPS Palpate a structure on yourself first You can control speed and location of touch You can determine precise location and shape It builds a data bank of personal experience It is experiential learning, which improves memory Tell palpation partner what you're going to do Avoid surprises, like quick moves Encourage palpation partners to actively participate To listen to your touch with their bodies To focus on the area being palpated To provide feedback about discomfort or pain Palpate with open mind and broad focus Trust what you feel; avoid second-guessing Palpate structures on both sides of body to compare Palpate slowly but not too slowly Problems with staying on one place too long Your hands habituate to touch, which dulls sensitivity It can be irritating to class partner or client Your mind can overinterpret what you feel In the classroom, practice round-robin palpation Relax your hands as you sink into tissue The best way to get clients to relax is to relax yourself Make initial contact with static touch Adapt your hands to body with an encompassing, receptive touch Study palpation with anatomical pictures or models It will help you visualize It will improve your accuracy It will improve your memory Types of palpation touch Fingertip palpation A precise, targeted touch For locating specific structures Precursor to trigger point, pressure point techniques Flat-finger palpation To pin slippery, deep fascia on underlying structures For locating thin, tubular muscle bellies Precursor to stripping techniques Cross-fiber strumming To locate taut bands To locate tendons or ligaments Precursor to cross-fiber friction techniques Broad-hand gliding For assessing general tissue tone For exploring general contours For assessing continuity of tone in large muscle groups Precursor to effleurage strokes Pincer palpation Involves grasping muscle belly For tubular muscles, edge of muscle (e.g., sternocleidomastoid) Precurser to petrissage strokes TISSUE LAYERING Tissue is organized in layers Palpation can only touch the skin All palpation occurs through skin, via tissue layers Learn to differentiate/listen to each layer Sense all layers with listening/encompassing touch Skin: Many textures and thicknesses Using broad-hand gliding touch to avoid tickling Avoid compression Imagine touching paper without wrinkling Explore elasticity without overstretching Superficial fascia: Basement membrane directly below skin Thickness can vary depending on adipose deposits Superficial edema will occur in this layer Can feel spongy, depending on composition Deep fascia: Thick, flat layer of dense connective tissue Can feel slippery and nonresponsive Need to penetrate to access underlying muscles Differentiate deep fascia from muscle Muscle: Has many different qualities Match variances on different people Identify general location with muscle tracing Verify location by having partner contract Contains a lot of sensory nerves; can be painful Watch face to track pain responses Tendons and ligaments: Short, fibrous or flat, wide bands or thick bundles Use specific, targeted touch to palpate Locate through attachment sites on bony landmarks Can feel ropy or taut Use cross-fiber strumming to explore and loosen Bone and periosteum Bones are easy to trace Locate bony landmarks to orient location of touch Locate bony landmarks to find muscle attachments Periosteum is fascia covering bone Feels like a slippery layer over bone Often sensitive over previous fracture sites Endangerment sites Location of delicate tissues to avoid touching/massaging Examples: peripheral nerves, blood vessels, easily damaged tissues Learn locations to avoid touch on endangerment sites SUGGESTED LEARNING AND STUDENT DEVELOPMENT ACTIVITIES PROVIDE AN OVERVIEW OF THE CLASS Before class, write a short, schematic overview of the class on the board, then go over it at the beginning of class. For example: Today's class covers: Science of palpation Art of palpation Palpation tips Tissue layering Activities: Review, lecture, palpation lab, recap, and homework GROUP DISCUSSION: The goals of palpation Cover the following three areas in this discussion: Quality of touch Differences between classroom palpation and therapeutic Effective body mechanics TISSUE-LAYERING EXERCISE Static contact (p. 218) Palpating the skin (p. 219) Palpating superficial fascia (p. 219) Palpating deep fascia (p. 220) Palpating muscle (p. 221) Palpating tendons and ligaments (p. 223) Palpating bone and periosteum (p. 223) GOING OVER GUIDELINES EXERCISE Palpation tips summary (p. 215) © 2013 by Education, Inc. Foster, Instructor Resources for Therapeutic Kinesiology