Kinesthesia and palpatory awareness

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One of the hardest things about giving someone a massage is you can’t feel what the client is feeling so you can’t feel what hurts.

Treating clients in a pain free way is something all bodyworkers grapple with. Even more so when trying to address complicated neuromusculoskeletal dysfunction. You don’t want to increase the level of pain that someone is currently in whether acute or chronic. Pain is personal and differs from person to person depending on whether the brain has down regulated the intensity of the pain or not. Time may or may not help. Some people have higher thresholds based on their perception of this pain. Despite peoples differences, there are some interesting commonalities I have seen over the years specifically when people have come to accept their pain as something to live with. One paradoxical behavior that accompanies some chronic pain sufferers I have come across is that one is more open to pain provocation as a means to pain relief. No pain no gain is their motto. The person who has lived with chronic pain for a while has usually seen people who provided aggressive or painful therapy in the form of a painful deep tissue massage, physical or manual therapy. Whatever provided a temporary but welcome respite from the pain encountered during the activities of daily life was appreciated. Pain and discomfort induced by a well intentioned therapist however is almost completely unnecessary. Often moving something the opposite direction of what hurts (regardless of what the therapist thinks), working slower, more superficially and or working with the nervous system to “turn off” the pain signals prior to deep work can decrease the level of pain in a session is the most productive thing to do. As an attentive therapist, one can develop a kind of visual kinesthetic awareness looking at the client’s cues. Breathing patterns such as breath holding and rapid breathing, muscle bracing, flinching, retreats and anything opposite of calm slow breathing and releasing are signs that you are increasing the clients pain level from feeling pressure or stretch to discomfort and pain. I recently had a client say “you feel what I feel” based on how I could tell when something hurt. While it would be extremely helpful to me to know exactly what was going on, it’s just not true. Attentive listening hands are trained through years of experience. There is no short cut. The careful observer uses their awareness to guide pressure in the session.

Words to touch by

Kinesthesia / Proprioception

Awareness of the position and movement of the parts of the body by means of sensory organs (proprioceptors) in the muscles and joints.

Palpation

The act of feeling with the hand; the application of the fingers with light pressure to the surface of the body for the purpose of determining the condition of the parts beneath in physical diagnosis

End feel

The sensation imparted to the examiner’s hands at the end point of the available range of motion. It varies according to the limiting structure or tissue. Types of end-feel include capsular, bone-on-bone, spasm, and springy block. Empty end-feel is the absence of an end-feel during a range of motion examination when the patient stops further movement of a joint before the examiner senses any organic resistance to the movement. These are usually neurological interventions such as fear of pain reproduction, muscle guarding and reflexive protective spasm.

What I CAN feel:

Tissue texture and end feel are dependable tools I use when palpating muscular dysfunction. Here are some different  things one can palpate during assessment.

Fascial adhesions

Fascia when normative feels smooth and almost like a thin sheet of plastic wrap over a muscle. The more hydrated it is, the less you can feel it except at the sinews where Fascial bags of separate muscles meet. Adhesions feel like runs in a slightly denser plastic and releasing them is akin to pulling off a bandaid. I learned about fascia from Tom Myers.

Muscle strain

As I was taught to discern by James Waslaski, these fibers feel like frayed rope in an otherwise smooth continuous muscle. This is because the fibers have become disorganized and the reparative fibrin and collagen deposited actually lie in a multidirectional orientation. Fibrosis has a similar feel but isn’t painful. It actually feels good when addressed manually.

Trigger points

These are hyper facilitated nodules in a taught band of muscle that refer pain in a predictable pattern that have been charted and put in numerous books. Janet Travell made these points popular when she treated JFK in the 60’s. Some doctors use injections on these sites to relieve symptomatic pain but many have found that manual compression works just fine.

Facilitated muscle

Is a new one for me. I learned to locate and palpate this from David Weinstock as it is the palpatory basis for Neurokinetic Therapy. Facilitated muscle feels like a trigger point for the most part but it is usually a larger surface area.

Joint compression VS tight muscles

Another thing introduced by James Waslaski and Erik Dalton and expounded on by Jerry Hesch was the idea of joint compression changing muscle end feel and range of motion. Often when a client’s joint is compressed, the full range is shortened and the client feels “tight” and inflexible. When the joint is decompressed (tractioned) and range increases, the muscle has full range of motion and the joint and tissue receptors release any inhibition and facilitation reflexively keeping the client in a dysfunctional pattern.

Lastly, I want to mention, it is often best when scanning for dysfunction to begin centered and go slow and soft to meet the level of restriction and follow the body’s release to guide tissues rather than pushing through the resistance barrier.

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