HEMME APPROACH TO SOFT-TISSUE THERAPY

may or may not be clinically significant. It is common for the shoulder on the
dominant side to be lower than on the opposite side and the hip on the same
side to be higher than the opposite side and slightly rotated posteriorly. The
upper extremity muscles on the strong side (normally the right side) are almost
always larger than muscles on the weak side (normally the left side).
Functional leg length is seldom equal, and the cervical spine tends to show
lateral flexion in one direction more than the other. Even though deviations
from the ideal should always be noted, they are not always symptomatic.
Of the four classic methods of physical evaluation, palpation and
inspection are used more in soft-tissue therapy than either percussion or
auscultation. Even though palpation is probably more important in soft-tissue
therapy than inspection, many forms of orthopedic and neurologic testing use
both. Inspection is normally the first method of evaluation used.
Even though active motion testing is mainly inspection, passive motion
testing uses both inspection and palpation. In determining the five classic
signs of inflammation—heat, redness, swelling, pain, and loss of function—
heat is determined by palpation; redness by inspection; swelling by either
palpation or inspection; pain by seeing, hearing, or feeling indications of pain
during palpation; and loss of function by inspection and palpation.
Although pain is more of a symptom than a sign, painful areas can be
identified by using (1) palpation to induce the pain and (2) inspection to note
the patient's response to palpation. If trigger points are located by palpation,
heavy pressure may cause the trigger point to become insensitive in the same
way that ischemic pressure neutralizes a trigger point. To avoid combining
palpation with treatment, trigger points should be located with light pressure
and then treated with heavier pressure.
The combination of inspection and palpation can also be used to locate
landmarks that help to identify specific parts of the body such as muscles,
tendons, and bones. Specific vertebrae can be located as follows.
• The most prominent cervical vertebra is C-7.
• The vertebra level with the inferior angles of the scapulae is T-7.
• The vertebra level with the lower insertion of the trapezius muscle is T-12.
• The vertebra level with the iliac crests is L-4.
• The vertebra level with the posterior superior iliac spines is S-2.
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HEMME Approach to Soft-Tissue Therapy