Palpatory Diagnosis^16,17,18,19
One of the most successful initial methods of palpatory diagnosis is to run the pads of a finger or several fingers extremely lightly over the area being checked, assessing changes in the skin and thereby the tissues below it. After localising any changes in this way, deeper periaxial structures can be evaluated by means of the application of greater pressure. There are a number of specific changes to be sought in light palpatory examination which apply to both acute and chronic dysfunction. Among these are:

1. Skin changes.²⁰ The skin overlying reflexively active areas such as trigger points (or active acupuncture points) tends to produce a sensation of 'drag' as it is lightly stroked - due to increased sympathetic activity and hydrosis. The skin will lose some elastic quality, so that on light stretching (taking an area of skin to its easy resistance barrier on stretching) it will test as less elastic than neighbouring skin. The skin above reflexively active structures will be more adherent to the underlying fascia, evident in any attempt to glide or roll it.

2. Induration. A slight increase in diagnostic pressure will ascertain whether or not the superficial musculature has an increased indurated feeling, a tension and immobility indicating chronic fibrotic changes within and below these structures.

3. Temperature changes. In acute dysfunction a localised increase in temperature may be evident. In chronic conditions there may, because of relative ischaemia, be a reduced temperature of the tissues.

4. Oedema. An impression of swelling, fullness and congestion can often be palpated in the overlying tissues in acute dysfunction. In chronic dysfunction this is usually absent having been replaced by fibrotic changes.

The questions which need to be asked include:

• 'What am I feeling?'

• 'What significance does it have in relation to the patient's condition/symptoms?'

• 'How does this relate to any other areas of dysfunction I have noted?'

• 'Is this a local problem or part of a larger pattern of dysfunction?'

• 'What does this mean?'

In deep palpation the pressure of the palpating fingers or thumb needs to increase sufficiently to make contact with deeper structures such as the periaxial (paravertebral) musculature without provoking a defensive response. Amongst the changes which might be noted may be immobility, tenderness, oedema, deep muscle tension, fibrotic and interosseous changes. Apart from the fibrotic changes, which are indicative of chronic dysfunctions, all these changes can be found in either acute or chronic problems.

In the next article a variety of palpation and evaluation skills, as well as exercises to practice these will be outlined.

References
1. Korr I The physiological basis of osteopathic medicine. Postgraduate Institute of Osteopathic Medicine and Surgery New York 1970

2. Korr I Spinal cord as organiser of disease process. Academy of Applied Osteopathy Yearbook 1976

3. Korr I op cit

4. Selye, H., The Stress of Life, (McGraw Hill, 1956).

5. Chaitow L Soft Tissue manipulation Thorsons London 1989

6. Wall P Melzack R Textbook of Pain Churchill Livingstone London 1989