Initial Assessment 3) Palpation
After our static and dynamic assessment (discussed in the last few blogs), I will then move onto palpation.
Palpation is a method of feeling with the hands and fingers during physical examination. The veterinary physiotherapist will feel all over the animal’s body to examine the size, consistency, texture and tenderness of different areas of the musculoskeletal system- locating and interpreting muscular injuries or problems. The therapist will then put this map together, analysing it against the findings in our static and dynamic evaluation, to add more layers to the case.
We can pick up so many different states of the muscular tissue. Such as hypertonicity (increased muscle tone-possibly due to over compensation), hypotonicity (reduced muscle tone, possibly due to disuse), hypertrophy and atrophy (increased and decreased muscle size, respectively). I will also look for different tissue states such as inflammation (which is felt by heat and swelling) or oedema. Oedema is fluid retention in the body, often due to injury, and feels like a hot water bottle under the skin!
Symmetry is also very important so I will often compare one limb to the other, or one side to the other. It is often the case that one side is more hypertonic than the other (e.g. the left hamstring muscle compared to the right) and this may be due to pain or lameness on one limb. For example, a knee problem in the left hind will cause less use of the left limb (because it is sore) and more use of the right, causing increased muscle tone in the right hamstring.
Comparisons are also made between the hindlimbs to the forelimbs. For example, many dogs cranial load. This means that they load most of their weight onto forelimbs (think of a bulldog with great big shoulders and a wide forelimb stance, see below!).
Cranial loading can happen for many reason- such as having painful or bad hips or knees, meaning the dog will want to put less weight on the hindlimbs and put more weight on the forelimbs. Therefore, when I palpate the shoulders and arm muscles, they will likely feel tight and sore, due to overcompensating on the forelimbs. In these cases I will work to:
1) Reduce the pain and problems in the hindlimbs which are causing the dog to shift their weight off of the hindlimbs and onto the forelimbs
2) Reduce the hypertonicity and pain in the forelimbs, due to overcompensation
3) Work with the dog using exercises to shift their weight back onto their hindlimbs and strengthen the hindlimbs for further use in the future (see chocolate lab below)
A lovely chocolate lab presenting a step stretch. This works to shift the dog's weight onto the hindlimbs and thus strengthening the hindlimbs.
I really love palpation because my eyes switch off and my hands turn on. I feel like I become one with the animal. Listening, with my hands, to the tissue hinting where it is tight, sore or tense. You can create such a detailed picture of the animal with this technique, and from there (after range of motion assessment), create a bespoke treatment plan from your findings.
This brings me onto the fourth and final step of initial assessment: range of motion, which I will be discussing in my next post!