Having completed this lesson, you will be able to:

• Match these general palpation skills to their written descriptions: cognitive skills (e.g., the knowledge that informs touch such as the ability to name body landmarks in a particular region), kinesthetic discrimination skills (e.g., the ability to sense, feel and interpret normal and altered qualities of the body’s tissues such as temperature, texture, fiber direction, density, depth, hydration, and tone, etc.), communication skills (e.g., the ability to use correct terminology and name sensations so that perceptions of tissue can be categorized and analyzed more easily, etc.).
• Match these specific palpation skills to examples of each skill in action:
  • Locate a specific structure through touch (e.g., find the gastrocnemius).
  • Differentiate between two structures in the same region (e.g., “I know that I am on the teres minor and not on the infraspinatus because…”, etc.).
  • Differentiate layers of tissue through touch (e.g., “I know I have sunk through the gluteus maximus to palpate the piriformis because…”, etc.).
  • Assess the quality or condition of soft-tissue structures through touch (e.g., the ability to recognize if a muscle is hypertonic, hypotonic, or healthy).
  • Make comparisons between tissues bilaterally, before and after sessions, or from one session to another through touch (e.g. “the right scalene feels like X while the left scalene feels like Y”).
  • Verbally describe palpable findings using the correct pronunciation of structure names and technical language (e.g., “There is a palpable hypertonicity in the muscle just inferior to the proximal attachment site”).
  • Verbally describe palpable findings using a rich vocabulary of personal descriptive words (e.g., “This tendon feels bound, ropy, and grainy”).

All highly skilled massage therapists palpate continuously, on an almost subconscious level, gathering, interpreting, and responding to data received through their fingers, palms, knuckles, forearms, and elbows. This intense listening through touch allows you to make moment-by-moment adjustments in the pressure and speed of the stroke to best create positive change in soft-tissue or note changes that occur in the tissue as a result of the session. Palpation skills require the integration of broader skills that could be broken into four categories titled cognitive skills, kinesthetic skills, communication skills, and persistence skills.

Cognitive Skills

Cognitive skills refer to the knowledge the therapist possesses that informs touch. Without good cognitive skills a therapist might feel every nuance in the tissue and not be able to interpret these feelings in order to understand the client’s condition or make appropriate treatment decisions. Cognitive skills include knowledge of the skeleton and the names and locations of boney landmarks. An in-depth understanding of muscle names, muscle locations, attachment sites, movement patterns, function, and fiber direction is especially important. It is also helpful to have general information about all of the body’s organs, their function, and their locations. This includes the position of major arteries, veins, and nerves, which may be superficial in some areas. Build your palpation skills by learning about the structure of the human body. Visualize the structures that reside under the skin, and then find the structures with your hands.

Kinesthetic Skills

Kinesthetic skills refer to the ability to feel nuances in tissue temperature, texture, hydration, tone, and depth. As a student you may notice that some of your classmates naturally palpate better than others. Some seem to sink into the tissue at just the right depth, while others are either too light or too deep to engage the tissue effectively. Some locate the edges of a muscle effortlessly, while others feel blind to distinguishing features that identify tissue types. Why is this? While all of the skills (cognitive, kinesthetic, communication, and persistence) come into play, one reason may be variations in anatomy.

In the study of both humans and animals there are noticeable differences in the size, number, or position of almost all structures when comparisons are made. Students with naturally advanced palpatory ability are likely to have higher numbers of sensory receptors per square centimeter of skin leading to greater perceptual ability.¹ Students without natural ability can still build exceptional skills but it will take more effort and practice.

Another factor is the allocation of attention. Students with strong palpation skills are able to put their attention directly into their hands (or forearms, elbows, knuckles, etc.), and focus specifically on what they feel without being distracted. It also makes a difference if you use slow movement and slow sinking through the layers of tissue. Sometimes novice therapists make the mistake of poking around with their fingers hoping to suddenly feel something that makes sense. This is irritating to the client as well as being an inefficient method for palpation.

When building your basic kinesthetic skills it is helpful to feel the same structure on numerous bodies. Start with a superficial muscle like the deltoid and feel it on both sides of the first body. Move to another body and feel the deltoid again, and then onto a third body, and a forth, and even on a fifth. Each person is likely to express different tissue textures, temperatures, hydration, and tone. By feeling these differences in relationship to one specific muscle, you build your tactile sensitivity.

Communication Skills

Communication skills allow the therapist to name sensations so that perceptions of tissue can be categorized easily. In topic 12-4 (Introduction to Documentation) you will learn how to quantify and qualify data as part of documentation. For now, begin to label what you experience in a client’s tissue with adjectives like crackly, springy, dry, grainy, pliable, soft, yielding, melting, resistant, and other descriptive words. Don’t worry that these terms are not “official”. The important thing is to refine your personal language of tissue so that you can describe what you feel without hesitation. When you start to label what you feel you are better able to recognize differences in tissue and correlate palpation findings with visual observations.

One way to build your palpation vocabulary is to use comparative description pairs such as plump versus thin, full versus empty, moist versus dry, smooth versus crunchy, painful versus pain-free, concentrated versus diffuse, rigid versus fluid, warm or hot versus cold, taut versus loose, and so on. Go back to the exercise where you palpated many different deltoid muscles. This time describe what you feel in the tissue aloud as you palpate. Ask a second student to palpate and describe aloud what he or she feels. In the early stages you can learn a lot by listening to how others describe what you have just felt.

Persistence Skills

Therapists with excellent palpation skills likely began as students with poor palpation skills and worked hard until their palpation skills improved. All therapists had to go through a blind period when the body felt like a dense, blank landscape of subtle textures and obscure prominences and depressions. It is not uncommon for some students to give into frustration while palpating and fail to persist when palpation exercises become challenging. Give yourself permission to get frustrated, but make a commitment, at the same time, to keep trying. If you can’t feel a particular structure on one client, try to find it on a different client, as the variation in their tissue textures might help you identify what you’re looking for.

<cb12-2>Concept Brief 12-2: Palpation Skills

Your knowledge of the body’s structure and function, the power to place your attention in your hands and differentiate sensations, the capacity to describe what you feel in words and to persist when palpation gets challenging enhance your palpation skills. These skills include the ability to:

• Locate a specific structure through touch (i.e., Can you find the teres minor? Can you find the infraspinatus? How do you know you are on the teres minor verses the infraspinatus?).
• Distinguish between different types of tissue through touch (i.e., Can you tell if you are feeling a muscle verses a tendon or ligament? How do you know it’s a ligament?).
• Differentiate layers of tissue through touch (i.e., Can you feel the difference between the superficial fascia and the muscle that lies below it? Can you push through the gluteus maximus to identify the piriformis? How do you know you’re on the piriformis?).
• Assess the quality or condition of soft-tissue structures through touch (i.e., Can you determine if a muscle is hypertonic, hypotonic, or healthy? Can you tell if a muscle has been under stress for a long period of time or suffered past injury? How do you know?).
• Make comparisons between tissue bilaterally, or session to session through touch (i.e., Can you feel and describe the difference between the scalenes on the right side to the scalenes on the left side? Can you compare and contrast the feeling of the client’s muscle tissue in this session to the same client’s muscle tissue in a previous session?).
• Make a distinction between normal and abnormal body rhythms through touch (i.e., can you determine if the client has a normal or abnormal breathing pattern with your hands? Can you tell if the client’s heart rate is elevated?).
• Adapt techniques based on what is felt in the tissue (i.e., Can you move through the tissue lightening and deepening your stroke so that the tissue is engaged but the client feels no discomfort?).
• Describe and document what is felt in the tissue (i.e., Can you feel a muscle and describe what you feel, “the muscle feels ropey, crackly, and adhered”? Can you translate your palpation language into proper documentation language (this skill is learned later in this chapter).

The development of these skills takes place over the course of your massage training program, and beyond into professional practice.