Protocols of Palpation: Basic Methodology to Guide Your Practice

Palpation techniques, which allow massage practitioners to perform a baseline assessment of a client’s body, make up the cornerstone of any massage therapy practice. Though specific palpation techniques may differ depending on the therapist and on the client’s areas of concern, all typically rely on the extreme sensitivity of a therapist’s hands to analyze tissue and begin development of a personalized treatment plan.

Therapists usually begin treatment with palpation in order to identify soreness and tightness of muscles, skeletal alignment, spasms, trigger points on the body, fibrosis, and more.

After beginning a bodywork session with palpation, a therapist may repeat it throughout the session to ensure the therapeutic approach is always in line with the concerns presented during the initial evaluation. Throughout the course of treatment, the therapist will likely continue palpation to monitor changes occurring in the tissue as a result of the manipulation during massage sessions.

Almost any bodily structure can be palpated—skin, tissues just below the surface of the skin, lymph nodes, tendons, joints, bone, deep tissue, ligaments, and more. Through palpation a therapist is likely to be able to identify almost any abnormality or malady that may be present.

What Is the PALPATE Approach?

In order to use palpation techniques effectively a therapist must have developed a thorough knowledge of anatomy and physiology and must also be attentive, both objectively and subjectively, to the qualities of a body. Again, actual palpation methods will likely differ somewhat between therapists, but some standard procedures have evolved. In 2013, a research team detailed a seven-step approach to palpation that uses the acronym PALPATE:

• Position: Make sure the client is comfortably positioned.
• Anatomy: Visualize a 3-D anatomic model.
• Level: Determine the appropriate depth of tissue contact.
• Purpose: Set a clear intention for initiating the healing process.
• Ascertain: Keep a relative point of reference while initiating motion.
• Tweaking: Continue perpetual exploration of the tissue while fine-tuning the previous steps.
• Evaluate: Adjust techniques according to findings from palpation.

This method can help practitioners prepare for and demonstrate the most basic and universal way to initiate palpation with a client. It does not address specific techniques a therapist may use or aid in the specific analysis of tissue.

When it comes to developing a comprehensive screening for pathology in the body, tissue abnormalities, and conditions of the body’s structure, some therapists agree the process calls for some intuition. Dr. Leon Chaitow, an osteopath and naturopath who teaches around the world, warns, however, that the label of “intuition” would be mistaken.

Skilled therapists will be able to recognize both normality and deviations from it, according to Chaitow, and they may need to act whether or not they are able to fully articulate an abstract understanding of something that does not “feel right.” Rather than calling this intuition, Chaitow says skilled people demonstrate know-how as they become able to perform more complex forms of bodywork, even those they may not necessarily be able to describe.

STAR Palpation for Assessing Bodily Abnormalities

Four principles are used to help massage therapists evaluate somatic dysfunction. Chaitow refers to these as STAR palpation, and others have called it the TART method (substituting “tenderness” for “sensitivity”). Regardless of the acronym, the general principles remain the same:

• Sensitivity: Soft tissue dysfunction will almost always present in tenderness or pain.
• Tissue texture change: The therapist might feel that tissues are hot, cold, tense, swollen, or fibrous.
• Asymmetry: The tissue may vary between sides of the body. Asymmetry on its own may not necessarily be cause for concern, but a massage therapist will use their best judgment in each situation to determine whether it is normal or abnormal.
• Range of motion: Movement is restricted and/or muscles are very tight, inhibiting normal motion.

When these indicators occur alone, they might point to a type of pathology, discomfort, or dysfunction in the body, but a combination of two or three factors are usually enough to confirm a problem. After an initial assessment, the therapist can use this information to determine more about why a problem exists and develop a treatment plan.

The most important element in diagnosing a potential issue and beginning to treat it, however, is communication with the client. A therapist cannot begin to provide adequate treatment without understanding a client’s level of pain or discomfort during palpation, history of injury or illness, and any habits possibly affecting areas of the body that are presenting problems.

Though palpation methods may be taught, the true skill and art of palpation is learned through experience. Over time, a good bodywork practitioner will generally be able to detect subtleties in texture, density, moisture, and temperature variations in target tissue. Chaitow says experts “have the ability to observe, recognize, interpret, judge, decide, and act appropriately in a split second – not based on planned decision-making, but more on a foundation of sound knowledge and practiced skills.”

References:

1. Aubin, A., Gagnon, K., & Morin, C. (2013, February 18). The seven-step palpation method: A proposal to improve palpation skills. International Journal of Osteopathic Medicine, 17, 66-72. Retrieved from http://www.journalofosteopathicmedicine.com/article/S1746-0689(13)00048-5/pdf
2. Beck, M. F. (2011). Theory & practice of therapeutic massage (5th ed.), 646-652. Clifton Park, NY: Milady.
3. Chaitow, L. & Fritz, S. (2006). A massage therapist’s guide to understanding, locating and treating myofascial trigger points, 70. London: Churchill Livingstone.
4. Chaitow, L. (2013). Muscle energy techniques (4th ed.), 305. London: Churchill Livingstone.
5. Chaitow, L. (2017). Palpation skills in clinical practice? Massage Today, 1(17): 13. Retrieved from http://www.massagetoday.com/digital/index.php?i=644&r=t#13