Palpation of skeletal muscle and tendons
Palpation of skeletal muscle
Muscle is made up of contractile fibers that are embedded in connective tissue. The direction of the muscle fibers is usually distinctly palpable, although the palpation of muscle fiber direction is much easier when pathology exists. The area of the muscle that becomes the largest when the muscle is concentrically contracted is the belly of the muscle.
Normal muscle tissue is firm and pliable. In areas where more than one layer of muscle exists, the layers should slide freely over one another. To palpate deeper layers, additional compressive pressure must be applied. Muscle fibers in adjacent layers do not usually run in the same direction. Identification of the appropriate layer may be helped by the client engaging the muscular layer with an appropriate active or resisted movement.
Soft, spongy muscle tissue indicates a lack of muscular tone.
Firm, dense muscle may indicate increased muscular tone, or a build-up of metabolic wastes.
Hard, dense misaligned fibres which are palpated within the muscle may be scar-tissue (evidence of a muscular injury).
Muscle atrophy may indicate neurological dysfunction, a chronic trigger point, or compensation.
Muscle hypertrophy may indicate increased strain on the muscle due to musculo-skeletal imbalance, or muscular compensation. It may also indicate that the client engages in some repetitive activity (occupational, sporting, hobby) which requires the use of this muscle.
Local muscle tension may indicate muscular imbalance. Either…
- The muscle is hard, bunched and is in a shortened position (i.e. concentrically short).
- Muscle is in a lengthened position (i.e. eccentrically long)
- Repetitive overwork of that muscle related to work or recreational activities
Generalised muscle tension may indicate a high level of sympathetic arousal, or stress.
A taut band within the muscle may indicate the presence of an active or latent trigger point.
Lack of movement between muscular layers indicates myofascial adhesion or scar-tissue.
Resistance to palpation may indicate tenderness, a trigger point, muscle guarding or muscular tension. It may also indicate that you are using too much pressure, or are moving into the tissue too quickly.
Tenderness on palpation may indicate an injury, inflammatory process, or trigger point.
- Trigger points are exquisitely tender at one specific point.
- Injuries or inflammatory processes are generally tender at the location of the injury when palpated.
- If pain is referred from somewhere else on the body it will tend to manifest as generalized regional aching. You will not be able to locate the exact location of the pain when palpating the area.
Palpation of tendons
Tendons feel more pliable and less ribbed than muscle tissue. Normal tendon tissue should be elastic and mobile.
Adhesion to bone or tendon sheath indicates scarring or fibrosis from an inflammatory process (e.g. tendonitis / tenosynovitis)
Hard, dense misaligned fibres which are palpated within a section of the tendon may be scar-tissue – evidence of a tendionous injury.