Your Palpation Tools

Having completed this lesson, you will be able to:

• List three anatomical “tools” massage therapists use to palpate tissue (e.g., fingertips, palms, knuckles, forearms, elbows, etc.).

The tools used to palpate the client’s tissue include the fingertips, palms, knuckles, forearms, elbows, and even the feet (in massage systems that use the feet to apply strokes). These tools provide us with a high degree of palpatory sensitivity because of a number of somatic sensory receptors found in the skin, skeletal muscle, tendons, and joints. These receptors are made up of a single afferent neuron that divides into many fine branches, each ending at a receptor (in a few cases an afferent neuron will terminate in one single receptor). Each sensation like light touch, deep pressure, heat, cold, joint position, and pain is associated with a specific receptor type.

• Light touch: Conveyed by mechanoreceptors (a class of somatic receptor sensitive to mechanical changes) called Meissner’s corpuscles, Merkel’s disks, and hair-root plexuses.
• Deep pressure and rough touch: Conveyed by mechanoreceptors called Pacinian corpuscles, Krause’s end bulbs, and Ruffini’s end organs.
• Warm and cold temperatures: Conveyed by thermoreceptors (a type of somatic receptor made up of free nerve endings that detect changes in temperatures).
• Muscle degree and speed of stretch: Conveyed by proprioceptors (a class of somatic receptor sensitive to movement) called muscle spindles.
• Muscle contraction and load on tendon: Conveyed by proprioceptors called Golgi tendon organs.
• Joint movement and position: Conveyed by proprioceptors called joint receptors, which detect how much of the articular surfaces of joints are touching.
• Pain: Conveyed by nociceptors (the name means “pain receptor”) when tissue damage occurs.

Information from somatic receptors passes to the brainstem and thalamus and from there to the somatosensory cortex, a strip of the cortex that lies in the parietal lobe of the brain that processes sensory information.

Palpation skills rely on the responsiveness developed predominantly in the mechanoreceptors that reside in the skin. These are the receptors that are sensitive to touch and pressure; they are divided into two categories. One category of mechanoreceptor, called rapidly responding receptors, reacts to stimuli with a burst of activity when the stimulus is first felt and again when it is removed. These receptors also respond rapidly to any changes in the stimuli and convey sensations like touch, vibration, movement, and tickle.

The other category of receptor, called slowly adapting receptors, responds to stimuli with continuous unvarying activity throughout the duration of the stimulus. These receptors convey sensations of pressure. Some number of both rapidly responding receptors and slowly adapting receptors are able to provide precise information about the textures and contours of objects that indent the skin. It is not surprising that many of these highly sensitive receptor types are concentrated in the fingertips. Other receptors convey less specific detail and are involved in relaying information about sensations of vibration, skin stretch or movement.

While the fingertips and palms are probably the most sensitive tools the therapist uses to palpate, many therapists also develop finely honed palpation skills with their forearms, elbows, knuckles, and feet. Tools like hot stones used in hot stone massage, or knobs sometimes used with trigger point work, seem to decrease palpation sensitivity initially. Therapists who use these types of tools regularly report that they learn to palpate through the tool and eventually become as responsive to tissue as if there is no tool in their hands.