Why are anatomy palpation skills so important to manual practitioners?

With recent advances in manual medicine, treatment options for practitioners are growing in number. Various new techniques have emerged both in the literature and in the everyday practice of chiropractors, physiotherapists, massage therapists, osteopaths, and athletic therapists. Each of these particular techniques including Active Release Techniques ART®, Trigenics®, Graston®), electro-acupuncture, Kinesiotaping©, myofascial release, muscle energy techniques, laser therapy, etc. offers a particular approach to dealing with specific tissue pathology, and/or mechanical dysfunction. For example, ART® acts to remove soft tissue fibrosis or scarring, whereas electroacupuncture is utilized for neuro-modulation and reduction of pain and inflammation.

As with other more established forms of therapy, such as spinal manipulation, mobilization, and stretching, even the best management techniques will fall short if the evaluation is not thorough enough to delineate the exact deficits. But are our methods of tissue evaluation and examination specific enough to correctly select the right technique to accomplish its intended purpose?

Most manual practitioners have limited access to diagnostic advances in imaging methods. In terms of orthopedic examination, most procedures are designed to determine the extent of ‘macro’ injuries to tissues (ruptures, fractures, tears, etc.); however, a large majority of conditions seen in a manual practitioner’s office are ‘micro’ tissue injuries such as repetitive strain disorders or fascial adhesions which are often not detected with these tests. Even in situations where an orthopedic test elicits a patient’s symptoms, little information is forthcoming to assist in the selection of appropriate treatment.

As an example, positive shoulder impingement signs do not delineate the exact structures that are causing the pain. These signs simply indicate that the location of the painful structure is the subacromial region, which can represent various diagnoses, including: