Mastering Palpation is vital to being proficient
in our profession. Not only is it important
for correct goniometric measurement, it is also important for the diagnosis and
treatment of restrictions in the tissues which result in patient pain, lack of
motion or inappropriate muscular recruitment. I term these as Structural Dysfunctions.
According to Wikipedia “Palpation is used by various therapists
such as medical doctors, practitioners of chiropractic, osteopathic
medicine, physical
therapists, occupational
therapists, and massage therapists, to assess the texture of a patient's tissue (such as
swelling or muscle tone), to locate the spatial coordinates of particular
anatomical landmarks (e.g., to assess range and quality of joint motion), and assess tenderness through tissue deformation
(e.g. provoking pain with pressure or stretching). In summary, palpation might
be used either to determine painful areas and to qualify pain felt by patients,
or to locate three-dimensional coordinates of anatomical landmarks to quantify
some aspects of the palpated subject.”
Easier said than done…
In my PT school training, I was taught
to palpate anatomical landmarks by using a book that showed pictures and gave a
verbal description of where a condyle, tubercle, tendon etc….should be, I was
never taught to feel.
While your other four
senses (sight, hearing, smell, and taste) are located in specific parts of the
body, your sense of touch is found all over. This is because your sense of
touch originates in the bottom layer of your skin called the dermis. The dermis
is filled with many tiny nerve endings which give you information about the
things with which your body comes in contact. They do this by carrying the
information to the spinal cord, which sends messages to the brain where the
feeling is registered.
The
epidermis also contains very sensitive cells called touch receptors that give
the brain a variety of information about the environment the body is in.
There are about 100 touch
receptors in each of your fingertips. These receptors perceive sensations such as pressure, vibrations, and texture.
There are four known types of mechanoreceptors whose only function is to
perceive indentions and vibrations of the skin: Merkel's disks, Meissner's
corpuscles, Ruffini's corpuscles, and Pacinian corpuscles.
The most sensitive mechanoreceptors, Merkel's disks and
Meissner's corpuscles, are found in the very top layers of the dermis and
epidermis and are generally found in non-hairy skin such as the palms, lips,
tongue, soles of feet, fingertips, eyelids, and the face. Merkel's disks are
slowly adapting receptors and Meissner's corpuscles are rapidly adapting
receptors so your skin can perceive both when you are touching something and
how long the object is touching the skin. Your brain gets an enormous amount of
information about the texture of objects through your fingertips because the
ridges that make up your fingerprints are full of these sensitive mechanoreceptors.
Located deeper in the dermis and along joints, tendons, and
muscles are Ruffini's corpuscles and Pacinian corpuscles. These
mechanoreceptors can feel sensations such as vibrations traveling down bones
and tendons, rotational movement of limbs, and the stretching of skin. This
greatly aids your ability to do physical activities such as walking and playing
ball.
Some of the techniques which are used by individuals to improve
their sense of touch include the following:
- 1. Putting yourself in a position where you have the best mechanical advantage. Putting myself in a position where I can use my body weight to sink into tissue has made the biggest difference in my ability feel. I believe that if you are exerting force from your fingers and upper extremities, you asking your neurological system in those areas to multitask. Like texting and driving it is impossible to do more than one thing optimally at a time.
- 2. Close your eyes. We know that when you take away one sense the others will become more sensitive.
- 3. Relaxing in your own body. I recall being tested in Manual Therapy and was stressed in my body about something that happened earlier that day. At that moment, I would have trouble discerning a porcupine from a kitten.
- 4. Take a cleansing deep breath and put your intention to feel into your fingertips.
Here are some links to websites that
have exercises to help improve your tactile sense.
