Palpation/Skin and body surface

Introduction
Palpation at the surface of the body is typically used to detect changes in temperature, hydration, and underlying pathological conditions. A range of techniques may be used for this purpose including scanning, drag technique, the pinch-technique and skin rolling.

Scanning
The back of the hand is very sensitive to temperature variations. To detect these move your hand in fairly quick sweeping motions over the areas being assessed (this is called scanning). Heat sensors adapt quickly.

Heat may indicate inflammation, muscle spasm or hyperactivity or increased circulation. It may indicate an acute lesion.

Coolness may indicate reduced circulation, scar-tissue, or muscle flaccidity. It may indicate a chronic lesion.

Please note that someone who has recently exercised will have a higher body temperature than someone who has not. Also because your sense of temperature indicates the temperature of what is being sensed relative to your body temperature, if you have recently exercised their body temperature will feel cooler.

Drag technique
Very light surface stroking of the skin may be used to assess dryness or dampness. Your fingers should ‘drag’ on any areas of dampness. Areas of increased hydration have an increased thermal conductivity coefficient, which means that they will palpate as more hot or more cold than other areas.

Dampness/’drag’ may indicate an underlying myofascial trigger point, oedema or local sympathetic nervous system over-activation.

Dryness may indicate lack of circulation, or prolonged stress.

Observation
The time that a therapist spends scanning and applying drag technique can be also used to observe the condition of the skin. Does stroking over an area produces more goosebumps (pilimotor action) than other areas? Are there any changes in skin color, moles, skin growths and/or condition of the skin and fingernails?

Goose-bumps may indicate neuro-muscular hyperactivity in the muscles beneath the surface (e.g. trigger point)

Skin Discoloration


 * Pale skin may indicate lack of circulation
 * Yellow skin may indicate liver dysfunction (e.g. jaundice)
 * Blue skin may indicate lack of oxygen
 * Redness may indicate fever, alcohol intake, trauma, or inflammation
 * Hot redness or streaking may indicate possible infection, blood poisoning or thrombosis

Fingernails


 * Vertical ridges may indicate nutritional difficulties
 * Horizontal ridges may indicate stress caused by changes in circulation that affect nail growth

Moles or Lumps – A massage therapist should pay attention to their client’s moles, and should refer them to a doctor if any moles undergo changes, or if any lumps or skin growths develop.

Skin Condition (all of the following may indicate prolonged stress, medication side-effects or other pathological conditions)


 * Skin split around the lips and nails
 * Mouth sores
 * Dry, scaly skin
 * Excessively oily skin

Stretching, pinching and skin rolling
Various techniques may be used to assess the elasticity of the skin, and the existence or lack of fascial adhesions between the skin and the superficial fascia. These techniques include the pinch test, skin stretching, skin-on-fascia pushes, and skin rolling.

The Pinch Test - If the skin does not spring back into it’s original position after a slight pinch, dehydration is indicated.

Skin may be stretched to assess it's elasticity.

Loss of elasticity and resilience may indicate underlying myofascial adhesion, dehydration, myofascial trigger point activity, or reflex activity. The reflex activity may be due to segmental facilitation, or if it occurs in the area of visceral pain referral, the reflex activity may be due to visceral dysfunction. Where there is a loss of elasticity, skin may feel abnormally thick.

Skin-on fascia pushes, or skin rolling may be used to assess the existence of adhesions between the skin and the superficial fascia.

Lack of movement relative to the underlying tissues may indicate superficial connective tissue adhesions, or swelling.

Redness after massage or skin rolling can indicate a previous lack of circulation due to connective tissue changes, or may indicate the existence of a hyperactive muscle beneath the surface or a trigger point. This can be confirmed by eliciting tenderness with deeper pressure.

Palpation of the superficial connective tissue
The superficial connective tissue separates the skin and the underlying muscle tissue, and allows the skin to glide over muscles during movement. This layer is palpated by increasing compressive pressure until the fibers of the underlying muscle are felt. If pressure is reduced so that the muscle cannot be felt the layer that you are engaging will be the superficial fascia. The tissue holds fluid, and should feel soft & springy like gelatin. If surface oedema is present it will be in the superficial fascia.

Oedema may indicate a lack of lymphatic return, or swelling secondary to an injury or inflammatory process. It may indicate an acute lesion.