Early on in my massage career I cut my massage teeth in chiropractors’ offices. Over the years, chiros have become colleagues, and I’ve learned two very important things from them: 1. Don’t be afraid to work the muscles/ligaments on and around the spine, 2. Palpate the spine (and around the spine) for tight and tender areas. Now I palpate like a chiropractor but with a different purpose in mind.

Squirting Massage Lotion

There are differences between how MTs approach a body and how chiros approach a body. Once when taking a neuromuscular seminar I partnered up with a chiroprctor during the practice sessions. When it was his turn to work on me, he literally took the bottle of massage lotion, held it above my back and squeezed, as if he were squirting ketchup on a bun.

Granted, most chiros wouldn’t squirt massage lotion on a patient. However, this example does illustrate that massage clients and chiropractic patients have different therapeutic touch expectations.

A chiro can get away with being abrupt and mechanical with her touch because the expectation is primarily about correcting an issue, not relaxing the body. However, we need to maintain a sensitive touch and keep connectivity with the client in order to fulfill an expectation of relaxation.

Though different in some ways, we’re similar in other ways. A big one is that we both deal with back pain. That means that both chiros and MTs need to know how to palpate back muscles and the spine.

How to Palpate Like a Chiropractor

Lesson #1: Don’t be afraid of the spine.

The first hurdle to palpating the spine is to understand that we’re not going to hurt someone if we touch their spinuous processes. Chiros do it all the time. In fact, they are experts at palpating the spine.

Becoming comfortable with palpating the spine simply comes down to getting reps in. I’ll show you how to do that in a minute.

Lesson #2: Palpate the spine (and around the spine) for tight/tender areas.

Palpating the spine can give us clues as to where we might want to work. For example, if I’m palpating the spinous processes and one is tender or seems off center from the spinous process above and below it, I would investigate for tenderness and/or tightness in the paraspinal muscles on either side of the misaligned and/or sensitive spinous process.

When I investigate, I often find tight or tender spots in the paraspinal muscles, and in my experience, clients get pain relief when I work these areas.

Two Ways to Palpate Like a Chiropractor

Here are two ways that I palpate like a chiropractor but in a relaxing way. One is with fingers on top of the spinous processes and the other is with fingers around the spinous processes.

You don’t need to apply a lot of pressure with either technique, just enough to feel the spinous processes. When I apply pressure I also do a gentle and relaxing back and forth (perpendicular to the spine) motion.

If I find a spinous process that is “off” and an area to either side of the spine that is tight and/or tender, I will apply focused and appropriate pressure. Check out this pain scale video for establishing appropriate pressure.

I’ll use combination body parts (barred thumbs, thumb and fist of same hand, knuckle and thumb) and massage tools (specifically the T-bar and L-bar) to apply pressure.

In this video I demonstrate the 2 spine palpation techniques: Massage Palpation Techniques for the Spine. (My massage model got sick. So the camera person is on the table and I’m filming myself doing the massage palpation techniques—so it’s a little shaky.)

Small and Big Picture 

Palpating the spine can give you a big picture and a detailed view of the client’s back. Go up and down the spine for a big picture view (e.g., reveal a scoliotic pattern) and when you find a spinous process irregularity, zero in on that area. By working the paraspinal muscles near the irregularity, you might just address that one area that has never been worked before. And you might give your client greater pain relief.

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Research has shown that most people diagnosed with conditions like plantar fasciitis actually don’t have inflammation (-itis) anymore. Instead they have a condition (-osis), like tissue degeneration.

The medical treatments for tissue inflammation and degeneration are different and may negatively impact treatment outcomes if misapplied. By understanding the difference between the two diagnoses, you can not only fine-tune your massage, but you can also help your client get the correct diagnosis and find the best medical treatment.

The Past

It’s a common misconception that inflammation is always associated with tendon/fascia problems. But when researchers examined the tissue of people with conditions diagnosed as plantar fascittis (research study), they didn’t find a lot of inflammation. Instead they primarily found collagen degeneration.

[bctt tweet=”Most plantar fasciitis cases are degenerative not inflammatory. This changes treatment.” username=”Mark LiskeyMarkLiskey”]

So What?

This is big. For one, if a tendon/fascia condition is not an inflammatory condition, then “corticosteroid injections and nonsteroidal antiinflammatory medications (NSAIDS) may not be the most effective options”.

This could mean that your client who has persistent plantar fasciitis may never have had the appropriate treatment plan.

What May Help?

Preliminary research (plantar fasciitis study, hamstring tendinopathy study) suggests that eccentric strengthening exercises may be helpful with -osis conditions (which is what most people have).

But since many doctors still bundle the terms tendinitis and tendinosis together, they may not appreciate what this can mean for the person in terms of treatment and treatment outcome.

What’s It Mean for Us?

Knowing the difference between –isis and –osis changes how I work with a client before, during and after the massage.

Pre-Massage

For example, let’s say Sabrina is a runner and she comes to my office with a diagnosis of tibialis posterior tendinitis. First, I’m going to check for visual evidence of inflammation. Is there swelling in the tendon/attachment areas and are they warm?

During the intake, I will find out if her condition has been persistent (staying the same or getting worse over a course of many weeks). What treatments has she had? Did she have injections that gave her temporary relief? Typically, the positive effects from injections are short lived when it’s a tendinosis condition (Treatment of Tendinopathy: What Works, What Doesn’t and What’s on the Horizon).

If there are no visible signs of inflammation and Sabrina has had the condition for a while, I’m going to treat her condition as an –osis.

During the Massage

This means that I’m going to massage the tendon and foot attachments, rather than avoid them. However, using a 1 – 10 pain scale, I will only work within a 3 – 4 to reduce the pain in these areas. In the surrounding area and the body of the tibialis posterior, I will work in a 4 – 5.

For a quick tutorial on the pain scale system I use, check out this Pain Relief Massage: How to Find the Right Pressure video.

Post-Massage Recommendations

Here comes the tricky part. If you suspect that your client is misdiagnosed and she should get rechecked, you’re going to want to put that bug in her ear. Here’s how I do it.

First, I lay the groundwork during the intake. After I look for inflammation and consider my client’s injury history, I explain my treatment plan. This is the perfect time to mention the research around “-itis” versus “-osis”.

Next, since I use a pain scale approach when working tendon/fascia conditions, I’m regularly interacting with the client throughout the massage. This would be another opportunity to talk about “-isis” versus “-osis”.

I’ve found that during this time the client will often circle back to the pre-massage conversation of finding a solution for her condition. At this point, I go deeper into the topic of “-isis” versus “-osis”.

After the massage, I do a wrap up. In the wrap up, I tell the client what I did and what I think might be helpful going forward, like getting rechecked to make sure she has the correct diagnosis. It’s not uncommon for me to start by saying, “If it were me…” or “If it were my (fill in the body part)…”.

Follow-Up

Finally, I follow up 2 to 3 days after the massage. In this conversation, I don’t press the client about going back to make sure the diagnosis is accurate, but I will give her my opinion if she asks for it.

Ultimately, my goal is to provide my client with the most current information so that she can make an informed decision about her tendon/fascia condition.

Getting it Done In 3 Steps

If you think your client has an “-osis” condition instead of an “-isis”, help her this way:

1. Tailor your massage to reduce her pain by using a pain scale system and appropriate pressure.
2. Make her aware of the symptom and treatment differences between “-osis” and “-isis”.
3. Follow up and answer her questions.

At times, you may feel like an outsider because you’re operating with the most current information which, in this case, challenges conventional thinking. But your client will thank you for your effort—especially if you can help her get out of pain.

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