THE ARTT OF PALPATION

Palpation cannot be learned by reading or listening; it can only be learned by palpation - Viola Frymann D.O.

A few days ago, one of my patients asked me: how is it possible that you can determine my illness just by touching my body?

I smiled. And thought: that’s a lovely question to start my blog with.

Yes, it’s true. Practitioners have their own way to treat certain issues and sometimes their tools might look like quiet unusual: we start by asking tons of questions; then, we sometimes approach by making some pressure on the belly or by wrapping the cranium bones during the treatments; frequently we request “breath in; hold it; and release it all out” and so on. With those examples in mind, it may be useful for all the patients to enlighten what is hidden behind of it all.

May I introduce you to Palpation.

During my 5 years studies, I’ve been highly trained in palpating the body’s tissues. In osteopathic medicine the acronym ARTT relates to four, mainly palpable, characteristics of somatic dysfunction, in which A stands for Asymmetry, R stands for Range of motion changes, T stands for Tissue texture changes, and the final T stands for Tenderness.

A: Asymmetry —Absence of symmetry of position or motion; dissimilarity in corresponding parts or organs on opposite sides of the body that are normally alike - or at least they should.

R: Range of motion changes — An abnormality that may be related either to a restricted/altered range or to an increased mobility. It affects the quality of the movement.

T: Tissue texture changes — It concerns all the palpable changes regarding all kind of tissues (from skin to periarticular structures); signs: vasodilatation, edema, hypertonicity, contracture, as well as the following symptoms: itching, pain, tenderness, paresthesias.

T: Tenderness — Discomfort or pain elicited by the practitioner through palpation.

By assessing my patient’s body, I’m seeking those characteristic I’ve been describing. They will get me to understand where the main disfunction of your body is hiding and the way it’s affecting your body. The same happens when you are trying to fix a broken plumping: you will probably easily find many leaks, but not the main issue to solve - that’s why you’ll need to go deeper on the wall to find the real damage.

Executing specific tests (ARTT, Passive or Active Tests, etc.) and conducting a detailed anamnesis, are the keys to understand which path is the disfunction leading throughout the tissues.

Are ARTT parameters scientifically reliable?

Well, studies affirm that Asymmetry is one of the less (1). Although, Range of motion (2), Tissue texture changes (3) and Tenderness (4) are definitely achieving the most acceptable levels of reliability.

Why are these result confirming the reliability of palpation?

First, Asymmetry cannot only be palpated. It’s also a matter of visual prospective - which has a strong subjective impact on the final call. Since every practitioner has a different perception, automatically, this parameter is not reproducible - not all the practitioner would find the same result on the same patient. So, it is not medically reliable.

Instead, high reproducibility is showed among Range of motion, Tissue changes and Tenderness findings. What is the fastest way to find out an inflamed tissue? By touching it! Though palpation more than one practitioner would concord the same findings on the same body. Again, if it’s reproducible then it’s reliable!

Palpation provides sensory information to the brain. It's a bridge between the patients and the practitioner. Swollen, hot and tender? Acute inflammation has recently started. Hard, cold and tight? Chronic inflammation has been there since a long time.

Nonetheless, the brain must be trained in paying attention especially to those characteristics associated with the patient’s symptoms, in order to catch its real source.

With those reassurances that manual palpation can be a reliable method, I strongly encourage the importance of undergoing a high level of training process. Practice, dedication and a degree of focus are the main keys of turning a scientific exploration into an art (or ARTT).