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 Fourth edition

LEON
CHAITOW
Palpation and Assessment in
Manual Therapy
Learning the art and refining your
skills
Foreword
Jerrilyn Cambron, LMT, DC, MPH, PhD
Chair, School of Allied Health Sciences and Distance Education; Chair
of the Massage Therapy Program; Professor, Department of
Research, National University of Health Sciences (NUHS), USA;
President, Massage Therapy Foundation, USA

Contributors
Sasha Chaitow
Whitney Lowe
Warrick McNeill
Sarah Mottram
Thomas W. Myers
Michael Seffinger
HANDSPRING PUBLISHING LIMITED
The Old Manse, Fountainhall,
Pencaitland, East Lothian
EH34 5EY, Scotland
Tel: +44 1875 341 859
Website: www.handspringpublishing.com

First published 2017 in the United Kingdom by Handspring Publishing

Copyright ©Handspring Publishing Limited 2017

All rights reserved. No parts of this publication may be reproduced or transmitted in any
form or by any means, electronic or mechanical, including photocopying, recording, or any
information storage and retrieval system, without either the prior written permission of the
publisher or a licence permitting restricted copying in the United Kingdom issued by the
Copyright Licensing Agency Ltd, Saffron House, 6–10 Kirby Street, London EC1N 8TS.

The right of Leon Chaitow, Sasha Chaitow, Whitney Lowe, Warrick Mcneill, Sarah Mottram,
Thomas W. Myers and Michael Seffinger to be identified as the Authors of this text has been
asserted in accordance with the Copyright, Designs and Patents Acts 1988.

First edition 1997, Churchill Livingstone

Second edition 2003, Churchill Livingstone
Third edition 2010, Churchill Livingstone

ISBN 978-1-909141-34-6

British Library Cataloguing in Publication Data

A catalogue record for this book is available from the British Library

Library of Congress Cataloguing in Publication Data

A catalog record for this book is available from the Library of Congress

Notice
Neither the Publisher nor the Authors assume any responsibility for any loss or injury and/or
damage to persons or property arising out of or relating to any use of the material
contained in this book. It is the responsibility of the treating practitioner, relying on
independent expertise and knowledge of the patient, to determine the best treatment and
method of application for the patient.

Commissioning Editor Mary Law

Copy-editor Stephanie Pickering
Designer Bruce Hogarth
Indexer Aptara
Typesetter DiTech Process Solutions
Printer Bell and Bain
The
Publisher’s
policy is to use
paper manufactured
from sustainable forests
|
 CONTENTS

Contributors
Foreword
Preface
Chapter 1 Objective: palpatory literacy Leon Chaitow
Chapter 2 Palpation reliability and validity Michael
Seffinger
Special 1 Using appropriate pressure (and the myofascial
topic pain index) Leon Chaitow
Special 2 Structure and function: are they inseparable?
topic Leon Chaitow
Chapter 3 Fundamentals of palpation Leon Chaitow
Special 3 Visual assessment, the dominant eye, and other
topic issues Leon Chaitow
Chapter 4 Palpating and assessing the skin Leon
Chaitow
Special 4 Source of pain: is it reflex or local? Leon Chaitow
topic
Special 5 The morphology of reflex and acupuncture
topic points Leon Chaitow
 Special 6 Is it a muscle or a joint problem? Leon Chaitow
topic
Chapter 5 Palpating for changes in muscle
structure Leon Chaitow
Chapter 6 Fascial palpation Thomas W. Myers
Chapter 7 Assessment of “abnormal mechanical
tension” in the nervous system Leon Chaitow
Special 7 Red, white and black reaction Leon Chaitow
topic
Special 8 Percussion palpation and treatment Leon Chaitow
topic
Special 9 Joint play/“end-feel”/ range of motion: what are
topic they? Leon Chaitow
Chapter 8 Palpation and assessment of joints (including
spine and pelvis) Leon Chaitow
Chapter 9 Accurately identifying musculoskeletal
dysfunction Whitney Lowe
Chapter 10 Evaluating movement Warrick McNeill and
Sarah Mottram
Special 10 Fibromyalgia palpation assessment Leon Chaitow
topic
Chapter 11 Palpating for functional “ease” Leon Chaitow
Special 11 About hyperventilation Leon Chaitow
topic
Chapter 12 Visceral palpation and respiratory function
assessment Leon Chaitow
 Special 12 Synesthesia Sasha Chaitow
topic
Chapter 13 Understanding and using intuitive
faculties Sasha Chaitow
Special 13 Palpating the traditional Chinese pulses Leon
topic Chaitow
Chapter 14 Subtle palpation Leon Chaitow
Chapter 15 Palpation and emotional states Leon Chaitow
Appendix: Location of Chapman’s neurolymphatic
reflexes
Index
 CONTRIBUTORS

Sasha Chaitow PhD

Independent Researcher
Corfu, Greece

Whitney Lowe LMT

Director, Academy of Clinical Massage
Sisters, OR, USA

Warrick McNeill Grad Dip Phyty (NZ), MCSP

Director, Physioworks
Associate Editor, Journal of Bodywork and Movement
Therapies
London, UK

Sarah Mottram MSc MCSP

Director, Movement Performance Solutions
Bristol, UK

Thomas W. Myers LMT NCTMB CSI

Director, Anatomy Trains
Walpole, ME, USA
Michael A. Seffinger, DO
Professor
Department of Neuromusculoskeletal
Medicine/Osteopathic
Manipulative Medicine (NMM/OMM)
College of Osteopathic Medicine of the Pacific
Western University of Health Sciences
Pomona, CA, USA
 FOREWORD

The university at which I teach encourages students to frequently

practice their palpation and assessment skills on fellow students and
instructors. Some students have a natural ability to feel the
structures they are palpating, while others are going through the
motion of poking and prodding without understanding what their
fingers should be experiencing. I am willing to let students practice
these exercises on me because I was once at their level of
inexperience. We all must start at the beginning of the path.
One of the exercises I was taught as a student in palpation class
was to move my fingers over a sheet of paper until I could locate a
single human hair hidden underneath the page by a fellow student.
Over time, we would increase the number of pages to challenge
each other and to continue improving our skills. We initially
struggled to find the hair under one sheet of paper, but with practice
we improved our sense of touch and could feel the minor shift in
paper height even through many pages.
As such, palpation and assessment skills improve over time. As
we learn to trust our abilities and instincts, we stop being concerned
about our body mechanics during the assessment and start focusing
on what we are feeling under our fingertips including the incredible
variations in tissue height, density, temperature, and movement. We
are continually learning the nuances of touch throughout our journey
as manual medicine practitioners, fluidly moving between
assessment and treatment of human structures and finding new
variations with each patient we see.
 Leon Chaitow has been my mentor and friend for many years. I
have always been impressed by his ease at describing even the most
complex issues in understandable terms. After dozens of publications
on manual therapy, he has brought forward a revision of another
incredible text. Palpation and Assessment in Manual Therapy brings
our attention towards the most important aspect of everyday
practice in manual medicine-the art, science, and intuition of
palpation and assessment. This text poses many interesting
questions about how and what we feel, bringing us back to the
beginning of our education to rethink our own method of palpation.
After many years in manual medicine, palpation and assessment
become second nature but include our own biases and expectations.
Refocusing on the process and relearning different aspects of
thought discussed in this text was educational, interesting, and
exciting.
Leon Chaitow has many suggestions on how to focus on different
aspects of palpation such as the external feel and temperature of the
skin and moving from the superficial layers to the subcutaneous fat,
fascia, vessels, and eventually muscle tissues and joint complexes,
as well as the potential reasons for variability in the feel of these
structures. Multiple exercises are included throughout the book that
encourage refinement of the described techniques, which range from
basic (such as the “hair through paper” exercise - see page 43) to
advanced, making this text ideal for improving the skills of seasoned
practitioners and students alike. Illustrated orthopedic tests, postural
observation methods, and functional movement tests are all
revisited, accompanied by commentary and discussion regarding
variations that we may encounter in clinical practice.
The chapter on reliability and validity of palpation by contributing
author Professor Michael (Mickey) Seffinger was particularly
interesting, and includes research that describes the consistency of
physical findings within practice. What he presents is that many
manual medicine assessment techniques are neither accurate nor
consistent; however, recommendations for improvement are offered
along with quotes from experts such as Craig Liebenson and David
Simons, providing suggestions as to how best to improve the
reliability of our palpation assessments.
Contributions from other authors add a blend of different
viewpoints to the text, including chapters on fascial palpation by Tom
Myers, accurately identifying musculoskeletal dysfunction by Whitney
Lowe, evaluating movement by Warrick McNeill and Sarah Mottram,
and understanding and using intuitive faculties by Sasha Chaitow.
Each chapter offers insight for contemplation by both new and
experienced health care providers, supplementing and enhancing the
chapters and discussions presented by the editor.
Of great interest to more advanced practitioners are chapters on
visceral palpation, assessment of respiratory function, using intuition
during palpation, and the effect of emotional states on palpatory
findings. In practice, we all encounter patients who do not fully
respond to treatment. Learning to reassess through different means
may benefit our patients’ overall outcomes. This text provides us
with some novel thoughts to consider when that difficult patient
once again comes for an appointment.
Congratulations to Leon Chaitow and the contributing authors on
an intriguing book about manual therapies that encourages us to
improve our palpation and assessment skills no matter how much
experience we may have. Through this book, he is challenging us to
continue to learn and to add even more pages over that strand of
hair, to see what we feel.
Jerrilyn Cambron
Lombard, Illinois
December 2016
 PREFACE

As Frymann (1963) noted: “Palpation cannot be learned by reading

or listening; it can only be learned by palpation.” Learning palpation
should not be just about effort – it should be fun and it should be
rewarding. Skillful palpation can be seen to represent “knowing in
action” (Schön 1983), in which apparently spontaneous therapeutic
skills emerge from a background of deep understanding and refined
actions, acquired by diligent practice.
If manual treatment is to have an optimal therapeutic effect, it
needs to relate to the requirements of the tissues, region, or person
concerned. Haphazard or unstructured manual approaches are
unlikely to achieve good results. The clinical decisions made as to
what type, degree, and duration of treatment to offer will always
depend on the training and belief system of the
practitioner/therapist, responding to information gathered and
interpreted, through history-taking, palpation, observation, and
assessment.
Whether the therapeutic objective is to mobilize a joint, restore
range of motion, release hypertonic, shortened soft-tissues, modify
fibrosis, enhance circulation or drainage, or to tone weak or inhibited
musculature, deactivate trigger points, or ease pain, or any of a
range of other “bodywork” objectives, an adequate degree of
appreciation of the nature and current level of dysfunction, as well
as an ability to compare the current state with whatever is conceived
of as “normal,” before treatment commences, is desirable.
The ability of a practitioner seamlessly to switch from
palpation/assessment to treatment, and back again, marks the truly
skilled individual. Whether palpation and assessment are used to
build a clinical picture from which treatment flows, or whether
assessment/palpation and treatment are simultaneous, what is
evaluated offers the basis for the intervention, a yardstick by means
of which to measure progress, a documentable, ideally measurable,
foundational (to the therapeutic endeavor) record of the current
state of the target tissues.
It is true to say that much evaluation can now be performed
using technology. Patients can be photographed, scanned, X-rayed,
and in a multitude of other ways investigated as to the current state
of their structures, functions, and dysfunctions. Biotechnology is
advancing rapidly, and tools and equipment previously only available
in hospital and major clinic settings are increasingly available to the
individual practitioner and therapist, to assist in the clinical
application of such methods.
• Does this make the ancient art of palpation redundant?
• Are assessments involving subjective judgment old-fashioned and
inaccurate?
In recent years the value of palpation has been challenged, with
research studies suggesting that reproducible results cannot always
be demonstrated when the accuracy of palpation is tested. The
reliability of palpation performed by individuals, as well as the
degree of agreement between experts palpating the same patient, or
tissues, is increasingly questioned. These issues have been diligently
explored in Chapter 2.
The truth is that as with the acquisition of any skill there are a
number of variables that can determine whether palpation is skilled,
or not. These include:
• the quality of the teaching of the skill, particularly involving
methods used in hands-on practice
• the degree of application and practice given to skill acquisition by
the student of palpation – however experienced – involving the
amount of time, number of repetitions, as well as the degree of
focus and thought, applied to particular exercises, tasks, and
methods
• the underlying depth of knowledge of anatomy, physiology and
pathophysiology to which the findings can be applied, and from
which interpretations and conclusions can be drawn.
This book contains a distillation of the methods and thoughts of
hundreds of skilled individuals, from diverse therapeutic
backgrounds. The commonality that emerges is that there is no
equivalent in technology to replace what can be gleaned from truly
skilful hands-on touch and assessment methods.
You are recommended to work through this book, chapter by
chapter, exercise by exercise (more than once), recording your
findings and refining your skills. This is as relevant to the student as
to the person currently in active practice, for we should never cease
striving for even better subtlety of palpation. I am immensely
grateful to the gifted chapter authors for their insights and input that
have helped to make the book less of a dry “how to” text, and more
of an immersion in subtle skill refinement.
Whether palpating skin, muscle, fascia, neural structures or
joints, the same message applies: repeat and repeat again, until
what is observed, and what is perceived makes sense.
In the very first incarnation of this book, before it adopted its
current title, the book was titled Palpatory Literacy, a phrase that
emphasizes the ultimate goal of the reader (and the author and
chapter contributors) that – like learning to read – this subtle art
would become automatic, with the multiple sensory impulses
reaching the brain being accurately interpreted.
Please enjoy the exploration of “what you feel.”

Leon Chaitow ND, DO

Honorary Fellow, University of Westminster
Corfu, November 2016

References
Frymann V (1963) Palpation. Its study in the workshop.
In: Yearbook of the Academy of Applied Osteopathy, pp 16–31.
Carmel, California: Academy of Applied Osteopathy.
Schön D (1983) The Reflective Practitioner, London:
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