An Online Palpation Course for Massage Therapists

Read this article and watch the video clips. Reproduce the exercises in the videos with a partner. Relax and take your time. If you are tense your fingers won't be able to feel sensitively. And if you are rushed, you will find it harder to feel things you have never felt before. A sense of playful experimentation is vital in palpation. Stay positive; sometimes it is hard to feel a structure in your partner's body because that particular muscle is not well developed in them, or they may have a little extra adipose tissue that is acting as a buffer between your palpating fingers and the structure you are trying to palpate.

When you are done the tutorial, take the online quiz to test your comprehension of the material. You can take the quiz several times if you need to. When you score 75% or higher, print the quiz result and the continuing education certificate to document your learning! Print your certificate by clicking here.

Study any of the continuing education articles on this web site for free! If you wish to document your learning with a quiz and certificate, then subscribe for a low annual fee for all the content on the web site by clicking here!

Fiber Direction

One of the key ways to know what muscle you are feeling is by feeling the direction of the muscle fibers. The muscle will be most easily felt when your fingers are strumming at right angles to the direction of the muscle fibers. The first video below demonstrates how one can sink through the layers of muscles between the spine and the shoulder blade and pick up each layer of muscle by following the unique fiber directions of each muscle.

Also notice that contracting a muscle with precise instructions, often brings the tone up and makes it more visible and palpable. This is done at the beginning of the video...

This video of palpation of the side of the abdominal wall also uses fiber direction to identify the layers of the abdominal wall. Same principle, different region...

Bony Landmarks

Another way to make sure of the structures you are palpating is to orient yourself with respect to bony landmarks. In the rotator cuff palpation below, I use the bony landmark of the intertubercular groove and work my way around the greater tubercle laterally and then posteriorly to identify the tendons of insertion of the rotator cuff. This bony identification anchors my palpation. Then, it is just a matter of noticing the gaps or thin spots between individual tendons.

A similar approach can be used in other "mysterious" places in the body, such as the medial aspect of the tibia as shown in this video clip below. Toward the end of the clip you can see how it is important to selectively contract muscles sometimes to be sure of what you are palpating!

Palpating Ligaments

Ligaments are important structures to identify and assess as they may be injured from recent or old (sometimes decades old) injuries. A key to palpating ligaments accurately is to orient yourself relative to their bony attachment point. In the video below I follow the joint space between the femur and the tibia to identify various structures in a sequential fashion.

The ankle is a vulnerable site for inversion sprains as the joint is inherently less stable in plantar flexion. In this position, the integrity of the lateral aspect of the joint is dependant on the talofibular ligament. In the video clip below, I trace around the contour of the lateral malleolus and identify the various parts of the talofibular ligament. Notice how a little inversion is required at times to spread the bony attachment points and place the ligament under some tension so that it is more easily differentiated from neighboring structures. The anterior talofibular ligament often needs some soft tissue manipulation to release adhesions within it and from the underlying bones.

The flexor retinaculum is a good example of ligamentous/fascial tissue that one can identify by bony attachments, anatomical landmarks (the distal skin crease) or by differential resistance when flowing along the plane of the deep fascia. The flexor retinaculum is usually a key structure that needs to be released in carpal tunnel syndrome.

Nerve Palpation

Nerves usually travel with blood vessels. They are usually soft, tubular structures with a little bit of turgor (fluid tension) inside them. If you feel a soft tubular structure it is the artery adjacent to the nerve. In many locations, you can learn the fairly constant relationship between where the nerve is usually located relative to the artery. Nerves are sometimes confused with tendons, but if you contract the muscle, the nerve does not tighten like the tendon does. Notice, however, that the nerve may shift as the muscle contracts, or the muscle may bring the nerve closer to the surface as it contracts. One can also gently provoke a nerve by rolling it, compressing it, or tapping it to elicit a tingly feeling that indicates that you are right on the nerve.

In the video below of tibial nerve palpation, I use anatomical land marking, direct palpatory contact and provoking the nerve to identify it. Nerves can be swollen, fibrosed internally and/or externally to adjacent tissues. Manual treatment of nerves is a new and growing niche in the massage profession.

In this video clip (below) bony land marking, and palpating a ligamentous arch helps to identify the location of the ulnar nerve at the entrance to the cubital tunnel (the funny bone!).

Practice!

It is one thing to know academically where structures are, it is another thing to palpate them accurately, with confidence. Practice each of the palpations above with a partner until both of you feel comfortable with them. It is just as important to feel someone identifying with them in your body. This kinesthetic sense will help shape your touch when you are palpating other people.

Once you feel comfortable with these palpations, take the skills on the road and practice palpating every structure in your partner's body (with a good anatomy book close at hand!).

Test Your Knowledge

Print the images for the quiz by clicking on the icon at the right.

Then, take the quiz by clicking on the test icon to the right.

You may take the quiz multiple times if you need to. When you score over 75%, print the quiz and keep it in your continuing education folder.

Print the Certificate

Now that you have successfully taken the quiz and printed it, print the Certificate of Learning that documents the learning outcomes. Coupled with your quiz results it is proof that you have learnt the material!

Print Certificate by clicking on the image!

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