Clinical Techniques: Therapeutic Palpation

Clinical Techniques: Therapeutic Palpation

TABLE OF CONTENTS

Clinical Palpation Skills

Therapeutic Touch and palpation are clinical techniques the canine therapist works to progress and advance over their canine career. Working with the dog's consent and not applying a technique onto the dog, will significantly improve the accuracy and validity of canine palpation skills.

Therapeutic Handling and Touch techniques are part of Canine Movement Enrichment Techniques, leading to the therapist and dog building a professional mutual trust and confidence.

We now know this empowers the efficacy of canine clinical approach and treatment strategies.

Owners always prefers to see their dog trust and choose to work together with the therapist in a confident and focused manner. The scientific evidence for this choice of practice is overwhelmingly strong as Therapeutic Handling techniques are incredibly proprioceptively enriched and are mindful therapeutic techniques which achieve great results.

Why does this matter?

We now know that this engaged and focused canine - therapist communication as part of both active movement patterns and compliant participation, with applied manual therapies leads to amazing outcomes and improves dogs lives.

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Clinical Tip: Developing breed knowledge and canine functional anatomy is important in advancing Therapeutic Palpation clinical skills and canine practice.

Connections that count!

Therapeutic Palpation is used to build trusted connections with each dog, analyse and evaluate soft tissue changes, muscle tension and tone, identify texture and temperature changes, detect damage in soft tissues and muscle spasm.

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Clinical Tip: Therapeutic Palpation is a communication skill using Therapeutic Touch and is a "two way process".

With dogs you rely on your skills to watch an analyse their constant stream of feedback signals in clinic. Feedback signals are also known as social signalling or calming signals, which are in response to a wide variety of different stimuli. These stimuli include your Therapeutic Palpation skills, the clinic environment, any pain issues, their previous clinical experiences, as well as part of their breed temperament and own personality.

Canine therapists need to constantly read the facial and body expressions and posturing of the dog throughout the session, responding to it with their own considered and mindful Therapeutic Handling.

Guide to Effective Therapeutic Palpation

  • Consider the difference between different skin thickness and amount of loose skin in certain areas and specific breeds
  • Palpation skills will develop over time and with increasing experience, so be patient and practice
  • Use visual references; K9HS Bitesize Canine Anatomy videos, canine anatomy colouring-in atlas, your own devised resources, structured reading, canine anatomy apps and charts, canine skeleton and coloured string
  • Palpate with mindful, flat finger tips / hands / thumbs, use calm and gentle considered sweeping movements that maintain contact with the dog. Do not prod or poke the dog. To ensure your accuracy, go lighter when you explore to find the specific structure
  • If you are unsure what you are feeling under your finger tips, try a lighter touch, as using a “light and soft hand, thumb or finger pad” to palpate with, will achieve the best results
  • Refer to your anatomy pictures / charts / videos as you practice and progress your skills

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Clinical Tip: Use as much pressure as you would if you were palpating your own closed upper lid of your eye or cheek bone, no heavier, as less is always more.

  • Always use bony landmarks to orientate yourself. This is particularly important in certain breeds and particular areas that have excessive skin movement
  • Always begin your palpation examination away from any known area of pain or discomfort
  • Develop your own methodical approach to examine all areas to ensure a systematic holistic approach that is mindful, considered and responsive to the feedback signals from the dog
  • Explore depths of tissue with care and do not automatically palpate more deeply. When electing to palpate more deeply, consider why you are doing this, and keep your other hand in gentle but consistent contact with the dog

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  • The thumb or fingers are most commonly used for therapeutic palpation and with repeated use they may develop problems or chronic inflammation of certain joints. Use your hands as passive tools and keep them relaxed to protect your digits. This will also assist your thumbs and fingers to become more sensitised and effective palpation tools
  • Take great care if you have wrist, thumb or finger joints with hypermobility and make sure you palpate with these joints in a neutral plane
  • Always carefully consider your posture, stance and back care throughout your therapeutic sessions and your hands are your working tools so take great care of them, pace your work and other manual activities to prevent overuse injuries
  • Carry out your sessions in a quiet, warm and well ventilated room
  • Practice techniques on humans first as the target tissue is larger and you can get verbal feedback. Please remember to re-adjust your palpation pressure when moving onto dogs

Standard Canine Palpation List

Palpate using your Therapeutic Touch skills to identify and analyse bony landmarks, joint lines, muscles and other soft tissue structures on a range of different sized breeds. Compare left to right.

Extrinsic muscles

  • Pectoral muscles evaluating Superficial Pectorals and Deep Pectorals
  • Brachiocephalicus muscle
  • Sternocephalicus muscle
  • Trapezius muscle
  • Rhomboid muscle
  • Omotransversarius muscle
  • Latissimus Dorsi muscle
  • Gently grasp the skin in several areas of the dog and consider the variation of thickness. Note where the skin is thicker and where the looser skin lies on your breed

Forelimbs:

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  • Brachium, antebrachium and manus
  • Cranial and dorsal borders of the scapula
  • Spine of scapula
  • Acromium
  • Greater tubercle of humerus (point of shoulder)
  • Lying medial to greater tubercle is intertubercular groove housing tendon of origin of Biceps brachii (this is a deep palpation, be mindful and take care!)
  • Crest of greater tuberosity of humerus
  • Locate spine of scapula and locate where the deep Supraspinatus (cranial) and Infraspinatus (caudal) muscles lie and describe what structures cover them
  • Scapular part of Deltoideus muscle caudal to the spine of scapula
  • Find the acromium and palpate the acromial part of the Deltoideus muscle
  • Tricipital line of humerus
  • Deltoid tuberosity on lateral aspect of humerus
  • Shaft of humerus
  • Triceps brachii muscle caudal to brachium and identify its tendinous insertion on the olecranon of the ulna (point of elbow)
  • Identify lateral and long heads of Triceps Brachii
  • Lateral epicondyle of humerus and follow down the extensor muscles of the antebrachium
  • Medial epicondyle of humerus and palpate the flexor group of muscles of antebrachium
  • Head of radius
  • Tendons of insertions of Biceps brachii muscle (medially) and Brachialis muscle (laterally) at cranial aspect of the cubital fossa of the elbow
  • Follow the shaft of the ulna from proximal to distal and note where it lays in relation to the radius
  • Radius shaft medially
  • Extensor Carpi Radialis muscle
  • Styloid processes of ulna laterally and radius medially
  • Superficial Digital Flexor (SDF) muscle under skin
  • Radial carpal bone
  • Ulna carpal bone
  • Accessory carpal bone and palpate the insertions of Flexor Carpi Ulnaris and Ulnaris Lateralis muscles
  • Tendon of SDF at the carpal canal
  • Examine the paw
    • Small pad that protrudes palmar to carpus is the carpal pad
    • The largest pad of the paw is the triangular metacarpal pad (palmar aspect of MCP joints)
    • Digital pads are flat and oval (on the palmar aspect of the distal IP joints)

Hindlimbs:

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  • Iliac crests beside sacrum at the cranial aspect of the pelvis
  • Tuber sacrale
  • Tuber ischii
  • Ischiatic arch between these two tuberosities (with great care)
  • Greater trochanter of femur, lateral to the hip
  • Gluteal mass
  • Sartorius muscle, cranial and caudal parts
  • Quadriceps femoris muscle (deep and take great care not to damage its fascial covering)
  • Biceps femoris muscle
  • Semitendinosus muscle
  • Semimembranosus muscle
  • Tensor Fascia Lata (TFL) muscle
  • At the distal end of femur palpate the trochlea ridges of the femur
  • Femoral epicondyles
  • Tibial condyles
  • Tibial tuberosity and straight patella ligament
  • Gracilis muscle (medial and caudal)
  • Pectineus muscle on medial aspect of thigh
  • Find and count the femoral pulse
  • Cranial Tibial muscle
  • Common calcaneal tendon and follow proximally to medial and lateral heads of Gastrocnemius muscle
  • Fibula along entire length
  • Head of fibula
  • Identify the lateral saphenous vein where it crosses the shaft of fibula
  • Medial and lateral malleoli, identify which bones of the crus you are palpating
  • Central tarsal bone
  • On dorsal aspect palpate the ridges of the trochlea of talus
  • Lateral border of fifth metatarsal
  • Length from base to head (or vice versa) of all metacarpals and metatarsals
  • Tuber calcanei
  • Distal interphalangeal joint of third digit of the left hindlimb
  • Proximal interphalangeal joint of second digit of the right forelimb

Axial skeleton:

  • Occipital protuberance
  • Zygomatic arch
  • Sagittal crest of the skull
  • Wings of atlas
  • Ridge of axis (spinous process)
  • Transverse processes of cervical vertebrae (Cx). Which can you reliably palpate?
  • Thoracic (Tx) spinous processes
  • Anticlinal vertebra
  • Lumbar (Lx) spinous processes
  • Lumbosacral junction
  • Sacrum
  • Ribs
  • Manubrium (first sternebrae)
  • Sternum

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Activity: Found out what the canine vertebral formula is and build your own Skills Work Log of structures you can reliably palpate on at least 3 different breeds using Therapeutic Palpation.

Practice, practice, practice on a wide range of breeds, of different ages and fitness levels. Keep a Skills Work Log to record your therapeutic palpation sessions.

References

Evans, H.E. & deLahunta, A. Guide to the Dissection of the Dog (6th Ed.).

Evans, H.E.; Miller’s Anatomy of the Dog (5th Ed.).

Goody, P.C.; Dog Anatomy: A pictorial approach to canine structure (1997).

This Bitesize Resource was produced for you and is owned by K9HS Courses