Palpation: An Art of Not Knowing

Learning palpation, to feel what we need to feel in order to intervene, is a source of frustration for newcomers to the manual therapy field. As I teach my Foundations in Manual Therapy: Voice and Swallowing Disorders course to SLP and others, many of who’ve yet to be exposed to touch-based work, I find a general hesitancy and frustration with this part of learning. During one of the early seminar hands-on labs, I vividly recall an SLP in a recent class shouting out, “Walt, what exactly are we looking for?” Their frustration was legitimate, as I am rather vague about this concept. Vague, at least, from the tissue or pathology we are seeking. I teach that we are not seeking high muscle tension, myofascial restrictions, trigger points, postural faults, or other perceived problems, but we are seeking frozen chicken. Huh? While the mentioned problems may exist and may be a problem, palpation findings vary based on someone’s training rather than a result of confirmed pathology. What is excessive laryngeal muscle tension? What created it? Is it a sole factor of local muscle action, or are their behavioral, perceptual, environmental, or nervous system drivers causing the increase in peripheral tension? Locating the tension via palpation is not about finding the problem but is an attempt to connect your touch and the possible ability to help with the awareness and perception of the client. The frozen chicken concept is simply a reminder not to label the tissue or pathology as the problem.

Not knowing is difficult, as our clients expect us to understand what is wrong and what needs to be done. But I know enough that I don’t know it all…until my client becomes a partner in their care.

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Walt Fritz, PT

Foundations in Manual Therapy Seminars