I wanted to talk to you about
how to touch people.
In osteopathic medicine, you are going
to be doing manipulation.
You are going to be doing
by touching a person,
and when most people go to medical school,
we know how we touch our family. We
know how to touch our friends.
We don’t know how to touch strangers.
We don’t know how to touch
people who are sick
so it is a privilege we have
to be invited into peoples’ lives
to help make their lives easier
and more comfortable.
It is a privilege to be able
to examine somebody
and to touch them,
but there are things about touch that
we do have to be aware of,
we do have to guard against,
and do have to use to the maximum benefit.
So palpation or touch is the application
of the fingers to the surface of the skin.
It’s touching somebody
in order to get information about
that person’s body,
their functioning, the makeup
of their tissues,
and there are a lot of things
that go into palpation.
It allows you to spend time
with your patient’s body
to get more information about
So where does palpation fit in?
Just about every patient who comes to
the physician expects to be touched.
They expect to be touched to be assessed,
to be evaluated, and sometimes
for treatment as well.
So it is part of the look, listen, feel,
and move your patient
to figure out what’s going on with them.
In osteopathic medicine,
we’re assessing whether or not a
patient has somatic dysfunction.
And again, there’s an ART to it.
You look for asymmetry,
you look for range of motion changes,
and you look for temperature, tenderness,
or tissue texture changes.
That’s the ART of diagnosis
For the tenderness, touch helps.
For tissue texture changes,
touch is essential.
For temperature changes, touch
is incredibly sensitive.
Even asymmetry is better diagnosed
with touching a patient
to see if they move the same amount
on both sides and both ways.
And range of motion changes,
restrictions to motion,
can often be felt better when you’re
trying to move somebody
than by just observing them.
So you have to use the passive and active
motion to see how people move.
Things to know when palpating.
First of all, there’s a mindfulness
that goes into palpation.
Being there with the patient,
focusing on what you’re feeling,
focusing on what’s deeper
and what’s underneath the tissue
that is where your hands are.
So you need to get some background as
to what’s going on with the person,
while they’re there, and know how they’re
going to respond to your palpation,
know how they’re going to respond
to being touched,
and watch the patient
to see how they respond when they’re touched
because you’re going to start
with diseased tissue,
with the area of pain, with the
area of discomfort,
because that’s where the patient
expects to be touched
and that’s where you’re going to start—
typically, trying to find out
how much tenderness, is there
tenderness all the time,
is it worse with touching.
So with tissue finding,
you want to go through the mind,
body, spirit thinking and say,
“Is this just the tissue underneath it?
Could this be referred?”
In osteopathic medicine, we talk a lot about
and viscerosomatic reflexes
where the body may exhibit
an organ being ill
or the body may exhibit dysfunction
in one place,
in another place, which is somato-somatic
or it could be somatovisceral where
affect the functioning of
some of the organs.
And palpation will help you
with all of those.
Just general observations, palpation
is a simple logical process.
It has cognitive and physical pieces to it.
Touching is one thing,
picturing what should be under there
and what it should feel like,
should the muscle fell boggy,
should the skin feel milky,
should you have flaking when
you’re touching somebody—
all go beyond just the touch.
It’s adding a cognitive process
to the touch process,
and it gives you the opportunity
to make observations
about abnormalities and function.
Is it boggy like the patient’s
potassium is too high?
Is it edematous as if they’re third spacing
or leaking fluid from somewhere?
Those are all things you’ll be
able to tell from touch.
It informs us about the tissue structure,
the function, and the overall
health of the patient.
So the body is a physical structure,
touching it is going to help us
understand what’s going on
and the external manifestation of a person
and the internal body functioning
so touching people will help give you some
assemblance of what’s going on.
And again, the structure of the
body reflects the physiology.
What can you tell from palpation?
Obviously temperature and tissue texture.
You can learn about the shape of a muscle,
the size of a muscle. How big is it
compared to how big it should be?
Is there anything underlying the tissue?
Is there tension to the tissue
that’s not moving
or does it move better in certain
ways and not others?
We know that a scar can limit mobility.
t can limit tissue tensegrity or tissue
motion and ability to flow and be used.
One scar can limit activity,
so you need to be aware of those things.
It can also share the body’s motion
possibilities, and again, edema.
The benefits of palpation,
it is part of clinical practice.
It helps you bond to a patient
because the patient is being touched
in a way that they’re not touched
by anybody else.
It is a clinical way of bonding and
linking with a patient,
showing them that you’re not
afraid to touch the areas
that other people might not want to touch
and that’s why it is generally
the unhealthy areas,
the areas that do have abnormalities
or do have pain, where we
usually start touching.
And again, the patients feel a bond
and they feel a connection
and they do expect it.
The key rules to palpation—be present,
this is not a time to do something
other than get information.
So when you touch someone, touch
someone with purpose, be there,
focus on what you’re feeling, and
focus on what’s underneath
what you’re feeling.
Communicate with your patient. Tell
them what you’re touching
and what you’re finding,
sharing results shares that this is medical
and gives the patient an understanding
of why you’re touching,
where you’re touching, and what
you’re trying to get out of that.
Receive permission from the patient.
Some patients may have had
experiences in their past
or feelings about medical care that differ.
They may not want to be touched.
They may not want to be touched extensively.
And we have to communicate
about why we need
certain things exposed, why we might need
a hat taken off or clothes taken off.
You need to share that with your patient
and then you can negotiate, discuss
and figure out what they’re comfortable with
versus what you feel is the best way
for you to get information.
Pay attention to the patient’s body language,
see when they’re uncomfortable.
Make sure that this is concise,
medical, and with purpose.
Start slowly and gently,
visualize the relevant anatomy
both with what you’re touching and
under what you’re touching,
and adjust your approach based
on the patient’s response,
and to continue to communicate
what you’re feeling,
what you’re learning, and why you
continue to palpate the patient.
In OMM Lab, it is important that we do get
access to tissues that are being treated,
that people not wear tight fitting clothes
that would limit palpation
and limit our ability
to comfortably move them, comfortably assess
extremes of motion,
and know when someone is
hitting a physiologic barrier
versus an anatomic barrier.
Can you take them past an anatomic barrier
or are the clothes going to
limit your activity?
These are things that are going to matter.
Visualize the anatomy that you’re touching—
that’s the idea behind it.
Locate the correct tissue levels—if you’re
going for the cervical or thoracic spine,
you can start a level above
or a level below
before you get to the level where
you think the problem is—
just so you don’t jump to where the pain is
but the area is the area of interest
and the area of the complaint.
Note to the tissue texture,
put that in the chart,
and get feedback from the patient
during the process
if there’s anything uncomfortable
or anything that might need explanation.
In preparing for palpation,
you’re a professional—
they’re going to look at your fingers,
they’re going to look at your hands,
and they expect them to be clean,
fingernails kept short,
and make sure that you focus on
what information you want
and you get it directly.
Keep the atmosphere professional
and keep it goal oriented to what you’re
doing, what you’re doing for a reason,
and as a physician, you’re touching
them for more information
that will help you make a diagnosis
or if you’re manipulating them,
you’re treating them
to enhance motion, ease pain,
or make life more comfortable for them.