Chapter 6 Soft Tissue Manipulation Techniques as an Evaluation Tool

The human hand is, without doubt, a bioengineering marvel. It can rightly be classified as one of the wonders of nature. It is capable of immense dexterity and sensitivity, yet it also possesses tremendous strength and functional ability. Indeed, there is no area of human ability or achievement that does not involve the hands as the center of the activity. Everything made by humans involves the hands. Every activity of daily living and every area of art, music, literature, and sporting ability involves the hands. Indeed, a person who loses both hands, or the use of them, is profoundly disabled and cannot survive without a great deal of assistance. Given the tremendously important role of the hand in all aspects of human existence, it is not surprising that the control of all aspects of hand function is vested in large areas of the sensory and motor cortex of the brain. Unlike any other species, humans have the enormous advantage of an advanced brain that is able to control an amazingly versatile hand.

Two major functions—sensory and motor—can be assigned to the hand. Sensory functions include the gathering of information received by the multitude of sensory receptors in the various parts of the hand. These sensory signals come from receptors in the skin and subcutaneous tissues, ligaments and capsules from each of the many joints in the hands, and a multitude of muscle and tendon afferents associated with every muscle capable of producing movement in the hand. Signals from these afferents are relayed to the brain, synthesized, and eventually interpreted as the experience of touching. A wide variety of functional information can be perceived in this manner, including object recognition, temperature, and texture. Together, they form the important evaluative ability that is known as palpation, and it is a major contributor to the information gathered from the patient concerning his or her movement dysfunction.

A more encompassing sensory experience is also associated with the hands. This may be loosely termed psychic sensitivity. Of course, all sensation is perceived at the cortical level; however, the special sensitivity of the hands may allow some individuals greatly increased awareness and integration of the sensory experience provided by touching. It would not be surprising to find that a person born completely blind would develop extremely sensitive hands. In fact, the history of massage makes it clear that people with serious visual loss were trained in massage, particularly because of their increased sensitivity and manual ability. There can be little doubt that the act of touching can produce significant responses in both parties. The act of touching can communicate many human emotions, and this may be one reason why soft tissue manipulation has proven such a potent therapeutic tool over the millennia and why so many people still have great faith in the “laying on of hands.”

Although palpation is an important part of the examination of a patient, the value of soft tissue manipulation strokes as an evaluation tool has not been sufficiently appreciated. Palpation does play a major role in the examination of most body functions and certainly enjoys a prominent position in the evaluation and treatment of musculoskeletal disorders. The fact that such information gathered by palpation appears to be less objective than that gathered by instruments reflects more on the limitations of the instrumentation than on the powers of human observation. There is clearly great potential for soft tissue massage manipulations in the evaluation of all aspects of musculoskeletal function. This discussion examines the potential value of the sensory information received during the performance of the major groups of massage strokes.

STROKING AND EFFLEURAGE

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