Palpation Hints

Replies to This Discussion

Permalink Reply by Darcy Neibaur on November 7, 2009 at 8:11pm

Not a problem about the email Tina. We were taught in school to take a strand of hair and rub it under neither a page in the telephone book. That is how we were taught palpation.

Permalink Reply by Darcy Neibaur on November 7, 2009 at 8:51pm

No questions are silly. We had a skeleton in our class and learned them that way. Also Trail Guide has flash cards that you can purchase as well.

Permalink Reply by Keith Eric Grant on November 7, 2009 at 8:53pm

Hi Tina,

Often, it's a process of refinement -- starting with what's big and obvious and, over time, progressing on to what's deeper, subtler, and harder to to discern. Comparing what you can sense with your fingers to what books or videos tell you is there. With muscles, just a hint of muscle effort against a resistance is enough to make the muscle stand out from surrounding tissues.

One of the benefits of massage school is that it provides other people to work on and palpate and you also get the sensation of being palpated and can give feedback. Any willing subjects you can recruit as you go are also helpful. A lot comes from just getting the miles (or meters) of work under your hands, as you reflect on what you are sensing. Which way do the fibers seem to run? Where's the edge between this and that? Is it the same on the other side? What's the texture? Is it fibrous like a rope? Is it squishy like a wet lawn under a plastic bag?

Leon Chaitow wrote one of the more thorough books that I'm aware of, specifically on palpation skills. On the more general level of awareness of one's body and movement in space, I've drawn a lot on Constance Schrader's A Sense of Dance.

I've written a couple of articles you might find helpful, Skills of Touch and a longer one on Intuition. Learning palpation skills is very much like learning a sport, dancing, or playing an instrument. The only way to begin is to start where you are, as awkward as that might feel. As you practice, you try for the next goal and practice the hard parts until they come, being aware of what works and what doesn't. It's this awareness that makes the difference -- simply repeating errors without awareness only reinforces them.

The results are often nonlinear. You practice, get some level of skill. Then it seems like things don't change. Until they do, all at once. While it seemed like nothing was happening, your unconscious mind was learning patterns of skill and perception. When you gain expertise, you often can't easily describe what you do. You simply sense things that you couldn't sense before and can move your hands without consciously thinking about the details. It becomes as easy as riding a bike. Gary Klein goes into the cognitive aspects of such expertise in his recent book Streetlights and Shadows, while keeping it highly readable, by the way.

Hope that helps a bit. Enjoy the journey.

Permalink Reply by Bert Davich on November 7, 2009 at 9:51pm

Hi Tina,
I bought the flash cards when I was in school but found them to be impractical when it came to relating them to the student clinic massage work. I found the book "Basic Clinical Massage Therapy" by James H. Clay and David Pounds much better material that was easy to relate to the actual practice of massage in school. It allows for easy quick reference to use while you complete your SOAP notes in student clinic. It presents muscle groups (such as Vertebral Column) by chapter with illustrations of the skeletal and muscle structure with an overview followed by specific muscles (with clear and easy to understand illustrations). Each muscle is listed with ATTACHMENTS, ACTION, REFERRAL AREA, OTHER MUSCLES TO EXAMINE (palpate) followed by 1 to 3 specific clinical methods of palpating/treating that specific muscle (with illustrations). The most important thing is it is easy to understand and use. Using this book to complete SOAP notes after each student clinic massage will result in a giant leap for your knowledge of anatomy and massage. I still use it for reference because it is so fast to use.

Regarding palpation, nothing replaces a real human body.

Permalink Reply by Carl W. Brown on November 8, 2009 at 12:01pm

Tina, I started by taking a series of classes that was taught one joint at a time starting with the knee. I used Netter’s as a reference and the teacher provided others such as trail guide and Clemente’s plus handouts for each muscle group. We also had skeletons and joints. We studied each muscle group and then used it to build a clay model of the joint. First bones and then muscles. The clay model gives you a better three dimensional idea of how the muscles fit together and it is also tactile sense of positioning. We then worked on each other palpating muscle by group and seeing differences, positioning and issues. The teacher also brought in models with specific problems for the class to feel and learn how to work. We learned techniques for each specific muscle as well as proper positioning and misalignment. We also learned about anatomical variations. For things like the pelvis where you can not build a model with clay bones we each purchased a full sized skeletal model of the pelvis to attach the muscles.

When you we through with the course you works on that joint for a while before taking the next course. When you were through with the series you took it again and learned more now that you had a reference to learn by.

Permalink Reply by Carl W. Brown on November 8, 2009 at 6:20pm

Frank H. Netter M.D. Atlas of Human Anatomy A lot of our training delt with feeling for myofacial adheasions. These we most difficult for deeper muscles. You should also learn ligaments and joint positionaing so the clay models also help learn some of the more difficult joints like the talus/calcaneus joint. Many of the techniques did not fit in well with Swedish for example the easiest way to put the ITB back into place is have the person stand faceing you sidways between your legs while you are sitting and you reach around and work the ITB facing away from you. Nerves are even harder to palpate especially the deep ones.