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Therapeutic Kinesiology:Musculoskeletal Systems, Palpation, and Body Mechanics
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Description
Chapter 9 Notes
Transcript
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
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