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The palpatory sense that good therapist develops never ceases to amaze. This sense of feeling or seeing inside is the basis of my therapy and my Foundations in Myofascial Release Seminars. I've written about touch frequently, but a revisit is in order.
Many years back a retired professional football player was referred to me for treatment due to knee pain. He had retired from football after his eighth knee surgery. Thirty years had passed and he now described his life as one of pain while standing and needing to use his arms on handrails climb stairs. Still fit at age sixty, he seemed to pride himself in having retained his athletic physique. He made this known to me when I was performing my normal assessment. As I reached his quadriceps, I noticed the remarkable density in both thighs. I mentioned this to him and he made a remark about trying to keep them "in shape". I kept my mouth shut and continued the assessment.
When laying relaxed in supine, the patella should be at its most relaxed state and able to move both medial/lateral and cephalad/caudal with great ease. Needless to say, my client lacked any appreciable movement of either patella. It felt like someone had poured glue under each kneecap. These two signs, increased quadriceps tightness/density and diminished patellar mobility are typically remarkable predictors of knee pain.
As I returned to his quads, I felt around in the depths, finding rather strange scar-like areas. When I quizzed my client a bit, he came to the conclusion that they must have been due to the numerous helmet hits, etc. that he had received over the years. So, I spent a few sessions working away on my findings. After five to six sessions, he came in to tell me that he was doing surprisingly well. His knee pain had greatly diminished, could stand all day without major issues, and could walk up and down stairs without relying on his arm power. He was concerned, though, as he felt that he need to get back into the gym. He was worried that his thighs were getting "flabby"! They lacked the tightness and firmness that he had had for most of his life. What he took for strength was in fact soft tissue restriction. I spent a bit of time trying to explain to him why this "tone" was not a good thing, but I do not believe for one minute he believed me. I am fairly certain that his beliefs got the best of him and he turned to the gym to get back into shape. Despite all, his goals for therapy were met.
Trust what you feel with your hands. Learn to see inside with your hands, as they have much to teach you. Know what "normal" soft tissue feels like, which can only be learned by touching hundreds of people. Seek out those areas of tightness, density, ropy quality, etc. Isolate your pressure into these areas and seek feedback; does palpation here reproduce a portion of your client's pain? Get to know these areas. They have much to teach you.
Walt Fritz, PT