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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:

  • Supraspinatus insertional tendonopathy
  • Long head of biceps tendonopathy
  • Long head of biceps tenosynovitis
  • Subacromial bursitis
  • Glenohumeral joint capsular tear or capsulitis
  • Internal impingement (posterior-superior glenohumeral impingement)
  • Subscapularis tendonopathy/ impingementMany of the above possibilities differ in terms of histological causes (inflammation, collagen degeneration, angiogenesis, ligamentous tear, etc.) and symptomatology (pain, swelling, stiffness, etc). Most importantly perhaps, they also differ from a treatment perspective, in terms of structural location. Considering the many current treatment possiblilities in manual care, a diagnosis of subacromial impingement is insufficient for selecting from the most suitable modalities. Such a diagnosis lacks the specificity to determine exactly where the practitioner inserts the acupuncture needle and to what depth, or where a myofascial release technique is performed, or which joints need to be mobilized and in which direction.

    Thus the manual practitioner is often left with just their hands and their knowledge of anatomical structure and soft tissue palpation to determine the cause of a patient’s symptoms. Further, treatments of said problems are often solely guided by the same skill?? anatomy palpation.

    Contrary to popular belief, anatomic palpation is a skill that is mastered through practice and proper instruction. Textbook knowledge of anatomy and anatomic structure is insufficient when dealing with live tissues and hence, soft tissue palpation courses are necessary in order to perfect this skill. Functional Anatomic Palpation Systems© anatomy seminars offer the most advanced soft tissue palpation training for all manual disciplines.

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    One Comment leave one →
    1. Katrina permalink
      June 12, 2013 2:36 am

      I wish I could have more time to do the palpating before the treatment but the clients at the “clinic ” expect to just be rubbed with lotion.

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