Added: Siri Holt - Date: 27.09.2021 04:14 - Views: 25941 - Clicks: 2844
The profession of massage therapy has grown tremendously in recent years as the value of therapeutic touch has become increasingly recognized. Therapeutic touch can bring general emotional, psychological and physical relaxation to clients, as well as improve local fluid circulation. Certainly, knowledge of anatomy, physiology, kinesiology and pathology is always appropriate and helpful for all massage therapy. A foundational understanding of science arms the therapist not only with a base of knowledge,but also with the critical reasoning skills necessary to be able to accurately assess and treat a client who presents with a specific musculoskeletal condition.
It is largely the expansion of massage therapy into clinical orthopedic work that has solidified the role of massage therapy in the world of complementary alternative medicine, also known as integrative health. In the world of medicine, there is an adage that states that treatment should never be administered without a diagnosis. Similarly, clinical orthopedic massage should never be done unless an accurate assessment has first been made.
Of all assessment tools available to the massage therapist, palpation, especially palpation of the musculature, is the Massage 4t com important. However, in the context of muscular assessment,palpation involves much more than simply touching the muscle. Muscular palpation has two major objectives. The first is to locate the Massage 4t com muscle that is being palpated. Once it has been located, the second objective is to assess its health by feeling for its tone and texture: Is it tight or loose? Are there trigger points located within it?
Is it inflamed or Massage 4t com to touch? Are fascial adhesions present? Assessing the health of the muscle is the most important aspect of palpation because the integrity of the tissues is what informs our decisions regarding treatment. However, if we do not first locate and discern the muscles of the region, we will not even know what musculature we are assessing. Further, effective massage therapy often involves working the entirety of the muscle, from attachment to attachment,which can only be done if we know the exact borders of the muscle.
For these reasons, accurate location of target musculature is supremely important, and is the basis for clinical orthopedic massage. For each target muscle, there is a Massage 4t com protocol that can be carried out to identify and locate it at times there may be a of possible protocols that work equally well for a muscle. Muscle palpation is often presented as protocols to be memorized with little understanding of why each step is done.
As with most things that are memorized, they are often forgotten or in time become fuzzy, leaving us with weak palpation skills. Further, the protocols are often passed along without being critically examined, setting Massage 4t com stage for massage therapists to learn less-than-ideal technique. In other words, we need to learn an approach to muscle palpation that allows us to figure out how to palpate the muscles of the body.
This can be accomplished with a set of guidelines that addresses the science and art of palpation. To thoroughly Massage 4t com this topic, a fairly long list could be given; however, this list can be pared down to the most important guidelines that, when followed, allow us to accurately and easily figure out how to palpate most every muscle of the body.
These guidelines are presented in a straightforward and commonsense manner that facilitates critical reasoning. Critical reasoning skills not only inform and improve our ability to palpate; they also inform and improve our hands-on clinical treatment technique, making us more effective clinical therapists.
Together, these guidelines comprise the science and art of muscle palpation. The first guideline is to know the attachments of the target muscle that is being palpated. Knowing the attachments is the first necessary step because it gives us the general location of where to place out palpating fingers. More specifically, if we want to palpate the anterior deltoid, we place our palpating fingers just distal to the lateral clavicle. If we want to palpate the middle deltoid, we place our fingers just distal to the acromion process.
And if we want to palpate the posterior deltoid, we place our fingers just inferior to the spine of the scapula. Hence, knowing the attachments of the target muscle is the first necessary step for successful palpation. Each muscle palpation protocol should begin here.
The protocol should not end here, however. Unfortunately, this is often the case. Often, the student is told Massage 4t com attachments of the target muscle and instructed to simply palpate from Massage 4t com to attachment. The Massage 4t com is that although this approach may work well when palpating the center of a superficial muscle, once we continue to palpate that muscle toward its borders, how do we know if we have strayed off it and onto an adjacent muscle? The problem is that this guideline does not help us discern the borders of the target muscle from the adjacent muscles and other soft tissues.
For deeper muscles, approaching palpation just by palpating from attachment to attachment is even more problematic because we can never be sure whether we are feeling our target muscle or a more superficial muscle that overlies it. When the target muscle contracts, it hardens and becomes palpably clearer. The deltoid contracts and becomes palpably harder, allowing us to palpate its entirety and more easily discern it from the adjacent musculature. Adding contraction of the target muscle to knowing where to place our palpating fingers guidelines No.
However, there are many times when simply choosing any action of the target muscle will not be sufficient for a successful palpation. This is another place where some palpation protocols are less than ideal. The purpose of guideline No. However, if the chosen action also causes other muscles to engage and contract, then discerning the target muscle from these other muscles will be difficult, and our palpation will not be clear. Always keep in mind that our goal is not just to feel the target muscle, but to be able to know when we are on it and when we are not.
In other words, we must clearly discern the target muscle from all other tissues.
This means that we need to find an action that engages the target muscle but does not engage the adjacent muscles. In effect, we want an isolated contraction of the target muscle. Although this is not always perfectly possible, most of the time it can be achieved quite well. Here, guideline No. In a sense, this guideline is a refinement of guideline No.
Choosing the best action to create an isolated contraction of the target muscle requires knowledge of not just the actions of the target muscle, but also the actions of all the adjacent muscles. This is where our foundation of science knowledge and critical thinking skills truly become important.
What we need to do is think through all of the actions of the target muscle to find the action that is most different from the actions of the adjacent muscles. For example, continuing with the deltoid as our example, glenohumeral abduction will engage anterior, middle and posterior fibers of the deltoid. However, if we want to palpate and discern only the anterior deltoid, flexion of the arm at the glenohumeral t is a better t action because it engages the anterior deltoid without also engaging the middle deltoid.
In fact, an even better action for palpation of the anterior deltoid is horizontal flexion of Massage 4t com arm at the glenohumeral t because it creates a more powerful contraction, and engages fewer adjacent muscles.
Similarly, if we want to palpate the posterior deltoid, glenohumeral t extension is better than abduction because it engages the posterior deltoid without engaging the middle deltoid. And horizontal extension of the arm at the glenohumeral t is the very best t action to have the client perform because it creates the most powerful and isolated contraction of the posterior deltoid. Another example Massage 4t com palpation of the fl exor carpi radialis FCR of the wrist flexor group.
If we ask the client to flex the hand at the wrist t, the FCR engages, but so will many other muscles of the anterior forearm, including the adjacent palmaris longus PL. In this case, a better action is to have the client radially deviate abduct the hand at the wrist t. So, when palpating the FCR, guideline No. Flexion of the hand accomplishes this goal, but is also a common action of other adjacent muscles.
Guideline No. In this instance, the best action is radial deviation of Massage 4t com hand at the wrist t. In these cases, choosing the best action depends upon which aspect of the target muscle we are palpating. An excellent example is the fibularis longus FL please note, the FL was formerly called the peroneus longus of the leg.
The FL everts and plantarflexes the foot. What action would be the best one to use?
The answer depends upon whether we are palpating the anterior or posterior aspect of the muscle. If we had chosen eversion, both the FL and EDL would engage, making discerning the border between them difficult. Eversion engages the FL, but not the soleus the soleus plantarfl exes and inverts the foot. If we had asked the client to plantarfl ex Massage 4t com this case, both the FL and the soleus would have contracted, making it difficult to discern the border between them.
Science informs the practice of massage therapy, raising the competence of the therapist and allowing the therapist to do more effective orthopedic assessment and treatment. The most competent clinical therapist is the one who marries the science of knowledge with the art of hands-on skills.
The next step is to pay attention to how hard the client contracts the target muscle. The reason that we ask clients to actively contract the target muscle is to make it palpably harder so it stands out among the adjacent soft tissues. This action often causes the muscle to pop out under your palpating fingers when it first contracts. However, simply asking the client to perform the t action does not always cause a Massage 4t com enough contraction to make the target muscle easily palpable.
So, if the client contracts the target muscle and you still cannot feel it contract, add resistance. If necessary, continue to add more resistance until you feel the muscle contract. Of course, more contraction strength is not always better. The ideal degree of target muscle contraction can vary from muscle to muscle within the same client, and from client to client for the same muscle.
If more resistance does not work, Massage 4t com less. Be prepared Massage 4t com be creative with the resistance that you add. Adding resistance to the contraction of the target muscle is where palpation protocol errors are most often made. For this reason, the following addendum to guideline No. The problem with contacting the client across a t that does need to be crossed is that it causes the client to recruit and contract additional muscles.
Remember, out goal is to create an isolated contraction of the target muscles so that it is the only hard tissue among a sea of soft tissue. An example from the lower extremity is palpation of the tensor fasciae latae TFL. The TFL flexes, abducts and medially rotates the thigh at the hip t. Therefore, when adding resistance to its contraction, contact should be on the distal thigh.
Massage therapists should not cross the knee t to contact the leg. If the leg is contacted, the vastus lateralis of the quadriceps femoris group will also contract, making it difficult to discern the TFL. Assessment lies at the heart of clinical orthopedic massage, and no assessment technique is more valuable to the world of massage therapy than muscular palpation.
The science of muscle palpation involves understanding and applying a set of guidelines that allows us to critically reason how to approach the muscles of the body instead of memorizing rote palpation Massage 4t com. The art of muscle palpation involves the quality of our touch and how we seamlessly weave together these guidelines as we work with our clients. The guidelines presented in this article form the foundation of palpatory literacy. Working with these guidelines can improve not only our assessment skills, but also help us to become more effective clinical orthopedic therapists.
Discover how assessments can help to improve client safety and provide you with the information you need to best meet client needs. By Joseph E. Muscolino, November 17, Necessity of Assessment In the world of medicine, there is an adage that states that treatment should never be administered without a diagnosis. Palpation Protocols For these reasons, accurate location of target musculature is supremely important, and is the basis for clinical orthopedic massage.
The Science of Palpation Guideline No. Related Resources. Continuing Education Integrating Assessments Massage 4t com Intake Discover how assessments can help to improve client safety and provide you with the information you need to best meet client needs.Massage 4t com
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