Tech 534

Muscle Palpation

Dr. Ron Castellucci

Professor
Sherman College of Chiropractic
 The Fine Art of Muscle Palpation

The innate intelligence of the body is constantly striving to adapt to its external and internal environment. This
includes a striving toward the self-correction of vertebral subluxations. The means used by the body to correct
vertebral subluxations is the para-spinal musculature, more specifically, the intersegmental muscles most
closely associated to the function of the posterior motor units of the spinal column. The nerve system through
a complex interplay of afferent proprioception and efferent motor impulses causes para-spinal muscles to
engage in “tone” adjustments which attempt to right the aberrant position of the subluxated segment(s).

Muscles that are “working” to correct spinal subluxations can be distinguished from non-working muscles by
their hyper-tonicity and evaluated, giving the doctor insight into the innate normal position of any vertebra.
Description: The para-spinal musculature is palpated in the relaxed patient in the prone position for the lower
spine and in the seated position for the cervical spine.

Objective: To observe and document the tone, size and quality of each para-spinal muscle comparing it to its
contralateral antagonist. To determine which muscle are working and which are not working to correct
vertebral subluxation.

Results: Using knowledge of the spinal anatomy, spinal bio-dynamics and the information gained from the
muscle palpation exam, the doctor will form a clinical impression regarding the location (level) and nature
(listing) of vertebral subluxations.

Pattern Analysis: Muscle palpation findings can be patterned. A subluxation will cause the muscles involved
with the segment to show a persistent pattern of findings which will also indicate a listing. These findings
should reduce following the correct adjustment.

Dysafferentation: Abnormal afferent input as a result of joint restriction that involves a functional decrease in
the activity of large diameter mechanoreceptor afferent fibers and a simultaneous functional increases in the
activity of nociceptive afferent nerve fibers

Proprioception: The ability to sense stimuli arising within the body regarding position, motion, and
equilibrium. The awareness of the alignment or position of a joint is also known as joint position sense.
Receptors provide constant information on limb position and muscle action for appropriate coordination of
limb movements. Proprioception is perceived in four places:

 the semicircular canals in the inner ear

 the eyes through sight
 through receptors in the skin which sense pain, temperature and pressure
 through receptors in the muscles, tendons and joints known as mechanoreceptors

2
Muscle Palpation

A unique feature of the Sherman System is our specific style of paraspinal muscle palpation. Muscles serve the
body with the function of postural maintenance and motion. A spinal column that is balanced and in
alignment will have muscle activity/tone that is also balanced. When the normal position of a vertebra in the
spinal column is lost the muscles innately respond by contracting in order to regain balance. This muscle
activity will be imbalanced due to the fact that they are contracting on one side more than the other in order
to bring things back to center. In the case of a vertebral subluxation, the muscles are working to make the
correction but are not always able to. In the analysis of a vertebral subluxation we can assess the activity of
the muscles that are innately working to correct the subluxation and determine what adjustment that body
needs in order to help facilitate the correction. As the chiropractor introduces a force into the spine that the
body uses to correct the vertebral subluxation, these same muscles become the tool for correcting and
maintaining spinal alignment.

Muscle Palpation Guidelines

Sherman Muscle Palpation is an extremely useful tool, but its effectiveness can diminish rapidly unless certain
rules are observed by the practitioner. If one will learn and apply the following rules, muscle palpation will be
a reliable part of the analysis system.

1. Get the patient to relax; even in the relaxed state, the subluxation will still be present in the patients
spine; therefore the muscles will still be attempting to make a correction. There are several ways that one
can achieve relaxation in the patient. Performing palpation in the supine and prone position is certainly one
way to remove the paraspinal muscle activity due to gravity, thus increasing the contrast between the sill
active working muscle and the now relaxed non-working muscle. At Sherman we perform our thoraco-
lumbo-pelvic palpation in the prone position. We do all of our cervical palpation in the seated position with
a knife edge contact on the patient’s forehead. The patient is encouraged to relax the head as much as
possible into the doctor’s forehead stabilization hand. This reduces the effect of gravity on the cervical
spine.
2. Compare the patient to the patient: Because people have variable resting muscle tone it is essential that
one first compare antagonistic muscles to each other in the same patient’s spine in order to determine the
working muscle. Whether someone has high tone or low tone, we are palpating for segmental imbalances
between antagonistic muscle pairs. For example, the 60 year old bricklayer will have very high tone with a
dense feel to his muscle mass, while the 12 year old child will have a very soft, pliable tone. In either case,
the overall tone for any given patient will be the base line and the doctor will be palpating for the
comparative imbalances from the patient’s own base line comparing left from right. The examiner also
looks for changes in tone from top to bottom. Several muscles of the back work in relays, therefore finding
sharp changes in regional or segmental tone will indicate regions or segments that the body is attempting
to “keep in line.”
3. Tracing: It is important to always trace a muscle between its attachments. Tracing the muscle will identify
the segmental level and listing. It will also allow the examiner to identify which muscle is in question. An
understanding of the anatomy of the musculoskeletal system is essential for good palpation. Although
there is validity in simply palpating for segmental muscle imbalance, this will not yield a line of drive
3
 required for the proper correction of the vertebral subluxation. You may find that the muscles on the left
side of the C5 are much tighter than the muscles on the right side. This tells you that perhaps C5 is
subluxated, but if you do not know where the muscle attaches to C5 then you do not know whether to
adjust the segment as a PL or a PR (body left). This is what separates an adjustment from a manipulation. It
is necessary to trace a working muscle in order to determine the listing and subsequently, line of drive for
correction.
4. Do not press too hard: A light palpatory touch will give the doctor the best ability to sense and gather
valuable information from muscle activity. A vigorous muscle palpation exam can be similar to a massage.
Kneading of the muscles, or massage, will change the physiology of the muscles and make them useless for
analysis. Lastly, a patient’s muscles will function better and hold the adjustments more efficiently if they are
not massaged into a state of relation after the adjustment as well.
5. Go against the grain: Palpating the muscles across the belly of the muscle (or against the grain) aids the
doctor in detecting specific muscle location and imbalance of activity.
6. Stay local: Use the muscles with the fewest attachments and the most direct influence at each segment
level. For example, the muscles of the Layer V, known as the sacrospinalis muscles, run in relays from the
top to the bottom of the spine. They often overlap and under lap each other, and have attachments that
are 5-6 segments apart. These muscles are not useful indicators for locating the level and listing of vertebral
subluxation. But, because their primary responsibility in the spine is to maintain an overall balanced
structure, this muscle grouping is very useful for determining global/regional distortions, such as scoliosis.
7. Never analyze a muscle during an isolation test: Isolation tests are tools to aid the doctor in locating each
individual muscle and distinguish it from the surrounding musculature. Remember, muscle palpation is
performed during the resting state, so if a muscle isolation test is used, give the muscle a few seconds to
relax again before you make your assessment. We are not measuring muscle strength.
8. Go from least invasive to most invasive: Always perform muscle palpation prior to motion palpation.
During the motion palpation exam forces will be put into the spine that the body may use to correct the
subluxation. Muscle physiology may change during the motion exam, so we recommend that motion be
done last.
9. Pattern your findings: Look for patterns of findings as opposed to general muscle tightness. Doctors
pattern physiological measurements in order to establish when a patient is subluxated. This principle is
useful when applied to muscle palpation. For example, if a patient is subluxated ASRP, then he should have
certain finding that indicate this. These finding would be consistent and persistent over the course of
several visits. The muscle palpation pattern for this type of subluxation might be as follows:
Active: RCP Minor, Left Superior Oblique, Right Splenius Capitis & Right Levator Scapulae
By doing pattern analysis, the doctor establishes a baseline of consistent and persistent findings. These
findings are monitored and should change after the adjustment is delivered and the subluxation begins to
be corrected. As the subluxation resolves, the pattern of findings should also resolve.

4
 CERVICAL MUSCLE PALPATION

MUSCLES THAT INDICATE C1 LATERALITY:

Levator Scapulae
When atlas misaligns laterally the transverse process on that side will move superior toward the mastoid due
to the slope angle of the a/o joint, and it will drop inferiorly away from the mastoid on the side opposite
laterality. Because of this superior movement, the distance between C1 and the scapula increases, which
causes the Levator scapula to stretch, and in turn, respond by contracting. Therefore the Levator scapula will
palpate more active on the side of atlas laterality.
The Levator is palpated specifically for atlas in the intertransverse space between atlas and axis. It can be
isolated by having the patient gently elevate and anteriorly rotate their shoulders.

Levator Scapulae: attaches

to C1-C4 transverse
processes and then into the
superior medial border of the
scapulae.

Intertransversarii
The Intertransversarii is a small muscle between vertebral transverse processes. Since the atlas transverse
process moves superior toward the mastoid when it goes lateral, the space between the atlas and axis
transverse process become increased and stretches this muscle, which causes the muscle to contract in
response. This muscle will be active on the side of atlas laterality. When active, it will feel like a firm nodule
that only occupies that space between the C1/C2 inter-transverse space.

Intertransversarii:
attaches to the transverse
processes of C1 and C2

5
Superior Oblique
The superior oblique muscle is a high value muscle when determining atlas subluxation and listing. This muscle
has dual roles due to its orientation between occiput and atlas. This muscle will be found active on the side
opposite of atlas laterality because the atlas transverse process moves superior toward the mastoid on the
side of laterality, and inferior away from the mastoid on the side opposite laterality. This increase in distance
between occiput and the C1 transverse process stretches the superior oblique muscle, and in response the
muscle contracts.
The best location to palpate this muscle is immediately posterior to the mastoid where it meets with the
occipital shelf. To isolate this muscle, the doctor can offer a gentle resistance to rotation toward the side being
palpated.

Superior
Oblique:
attaches to the
occiput and the
C1 transverse
process

_____________________________________________________________________________
MUSCLES THAT INDICATE C1 ANTERIOR ROTATION

Superior Oblique
Due to the superior oblique’s orientation between occiput and atlas, it is also useful in indicating anterior
rotation of atlas. When the transverse process rotates anterior, it will increase the distance between the
attachments of the superior oblique, which stretches the muscle, and in response the muscle will contract.

Superior Oblique:
attaches to the
occiput and the C1
transverse process

6
SCM (Sternocleidomastoid)
This muscle is very active during daily routine of pulling the head into lateral flexion and contralateral rotation.
Since it is not directly connected to the atlas, it is limited in its usefulness in determining the atlas listing.
However since it is the A/O joint that we are analyzing, it is logical that if the occiput is rotated posterior
relative to the atlas that is anteriorly rotated, the SCM would be active unilaterally working to bring that
articulation back into its proper relationship.
To locate the SCM, start at the inferior tip of the mastoid and move inferior and ever so slightly anterior. If you
need to isolate to confirm you are in fact on the SCM, you can laterally flex the patient’s head toward the side
you are palpating and rotate it away from the side that is being palpated.

SCM: attaches to
the mastoid process
and the
sternoclavicular
junction

Inferior Oblique
This muscle is attaches to both atlas and axis; therefore, activity in the muscle will give us information about
atlas or axis or both. The inferior oblique muscle attaches to the C1 transverse process and the C2 spinous.
When the atlas transverse process is rotated anterior, the distance increases between these two points,
stretches the muscle and in turn it responds with contraction. Thus, the inferior oblique is found to be active
on the side of atlas anterior rotation. It is also used to analyze C2 and is active on the side opposite spinous
rotation. To locate the inferior oblique, mark the C2 spinous with your thumb and the atlas transverse process
with your chiropractic index finger. Split the difference between these two points, making sure to be in the
laminar gutter just inferior to the occipital shelf. Turn your palpating hand so that you will be palpating
superiorly to inferiorly across the belly of the muscle. An added note, due to the attachments of the inferior
oblique, this muscle is very useful in identifying when there are variable listings (meaning they are subluxated
in opposite rotational directions) between C1 and C2.

7
 Inferior Oblique:
attaches to C1
transverse process and
C2 spinous process.

Splenius Cervicis
The splenius cervicis is one of the most useful muscles for upper cervical subluxation analysis. This muscle can
be found very easily in the intertransverse space between C1 and C2. This muscle can be isolated by offering a
light resistance to rotation toward the side being palpated. Splenius cervicis will be found active on the side of
anterior rotation of atlas.

Splenius Cervicis:
Splenius attaches to C1-C3
Capitis transverse processes and
T3-6 Spinous processes

MUSCLES THAT INDICATE C1 POSTERIOR ROTATION

Splenius Capitis & Semi-Spinalis Capitis

These muscles will be palpated together on the occipital shelf half way between the mastoid and the EOP,
where the two muscles overlap. When locating them it is important stay near their occipital attachment and
not trace too far inferior from that point. These muscles originate from many different locations in the lower
neck, but it is the common attachment to the occiput that is of interest. This muscle can be isolated with
extension of the head. These Capitis muscles will be active, attempting to correct the position of the occiput
with A/O joint subluxations. For example, if the atlas is subluxated AILP, then relative to the occiput, atlas is
posterior on the left and the occiput is anterior. Therefore, these Capitis muscles will be active on the left side
attempting to bring the occiput posterior to be in a proper relationship with atlas.
8
 Capitis muscles
overlap
Semi-Spinalis Capitis: attaches to
the Occiput and C4-6 articulations &
T1-8 transverse processes

Splenius Capitis: attaches to the

Occiput and C7-T4 spinous
processes

RCP Major
This muscle originates on the sub-occiput and inserts on the C2 spinous process. It will be active in conjunction
with the other Capitis muscles attempting to correct the position of the occiput with A/O joint subluxations. If
it is active independently of the Splenius Capitis and Semi-Spinalis Capitis, then it is most likely working to
correct a C2 misalignment. This muscle is palpated across its belly, half the distance between its attachments,
just superolateral to the C2 spinous process.

RCP Major: attaches

to the Occiput and C2
spinous process

9
MUSCLE THAT INDICATES C1 SUPERIORITY

RCP Minor
This is a difficult muscle to palpate and may be inaccessible on some patients, but is rewarding when
accessible. This muscle attaches to the sub-occiput and the posterior tubercle of C1. When the atlas has
subluxated superiorly, this muscle will be active bilaterally, working to pull the posterior tubercle of the atlas
toward the occiput. This muscle is palpated right on the midline of the sub-occiput. The doctor’s fingers must
be turned upward in order to access the occipital shelf. Be careful not to allow the head to fall into too much
flexion, as this will cause the nuchal ligament to tighten up and push your finger away from the RCP minor.
This muscle can be isolated by having the patient forcefully sniff. The RCP minor muscle also has special
significance because it is often found to directly attach to the spinal dura mater.

RCP Minor: attaches

to the Sub-Occiput and
to the C1 Posterior
tubercle

__________________________________________________________________________________________
MUSCLES USED TO ANALYZE C2-7

Scalene Group
The scalene group has individual muscle bands attaching to each of the transverse processes of C2-7 and from
there they attach to the first and second ribs. This muscle will be active on the side of the posterior transverse
process misalignment. When a cervical vertebra, let’s say C4, misaligns PR the spinous process is rotated to
the right, the body is rotated to the left. Also on that left side the transverse process has rotated posteriorly.
If the transverse process is misaligned posterior, the scalene muscle band that is attached to that PR C4 will be
active on the left, working to bring it back anterior. Due to the specialized listings for C2, we limit our
interpretation to noting that the body of C2 will be misaligned on the same side as the working scalene
muscle. This muscle can be isolated by having the patient take a deep breath in and hold it.

10
 Scalene:
attach to the
anterior
aspect of the
C2-7 TP’s
and to
Ribs 1 & 2

11
__________________________________________________________________________________________
THORACO-LUMBO-PELVIC MUSCLE AND LIGAMENTOUS PALPATION

Rotatores & Multifidi Muscles

The Rotatores and Multifidi muscles are located deep in the laminar gutter. Individually, they are probably too
deep to be palpated, yet when they are working in conjunction to correct a subluxation at a specific segmental
level, they can easily be discerned as a tight mass of muscle located just lateral to the spinous processes. There
is no isolation test for these muscles. These muscles will be “working” or active on the side opposite spinous
process misalignment.

Multifidi Muscles: attach Rotatores Muscles: attaches from

from spinous processes of the thoracic lamina to the transverse
C3-L5 to the transverse process of the segment below.
processes of segments 3-
5 segments below.

12
Serratus Posterior Superior & Inferior
These muscles are extremely useful in regions in which they are found. Often, the Serratus Posterior Superior
is confused with the trapezius, but will still yield the same analytical conclusions. These muscles, as with the
Rotatores and Multifidi, will be palpated near their attachments to the spinous processes. The Serratus
Posterior Superior & Inferior will be active with respiration and therefore, can be easily isolated with forced
inhalation and exhalation. These muscles will be “working” or active on the side opposite spinous process
misalignment. While these muscles help in breathing they are thought to function primarily in proprioception.

Serratus Posterior
Superior: attaches to the
spinous processes of C7-
T3 and to Ribs 2-5.

Longissimus Muscle:
attaches to the posterior
sacrum and to various
transverse processes up the
spine
Serratus Posterior
Inferior: attaches to the
spinous processes of
T11-L2 and to Ribs 9-12.

Iliocostalis Muscle:
attaches to the superior
medial crest of the ilium
and to the ribs

Erector Spinae
Due to the multi-segmental overlapping relays, it is difficult to isolate these muscles to a specific segment level.
Consequently, they are not used to identify intersegmental subluxation, but only for gross misalignment of the pelvis
and spinal column. The Erector Spinae muscles are important postural muscles, often hypertonic on the convex side of a
spinal curvature (scoliosis). They may be useful as indicators of an inferior sacrum misalignment or a PI ilium
misalignment when found working through long relays into the said structures. For example, finding the Iliocostalis
muscle more active laterally in the lumbar region extending down into the crest of the ilium would indicate a PI ilium. If
the Longissimus muscle is working and traced more medially to the sacral base then it is likely to indicate an inferior
sacrum (PI-L/ PI-R, AI-L/ AI-R).

13
Ligamentous Palpation
Premise: The job of spinal ligaments is to maintain the proper juxtaposition of one or several bones to each other within
a specific range. When a subluxation occurs, it may cause a tightening or relaxing of these ligaments. When Ligaments
are adversely tensioned, the innate intelligence of the body reacts physiologically with swelling, edema and/or tension,
which can be palpated.

Description: Paraspinal ligaments are palpated in the relaxed patient in the prone position.

Objective: To observe and make note of tight, swollen ligaments or areas of edema associated with these ligaments.

Result: Using knowledge of spinal anatomy, spinal kinematics, as well as the information gained from palpation of
ligaments, the doctor will form a clinical impression as the location and nature of vertebral /ilia subluxations.

Sacrotuberous Ligament
The sacrotuberous is probably the most important pelvic ligament from a biomechanical perspective. It is the
thickest ligament in the human body and it essentially supports the entire weight of the upper body. It
attaches to the lateral inferior border of the sacrum and the ischial tuberosity. When these two points
misalign away from each other, the sacrotuberous ligament will become tight and edematous. There are a few
listings that tend to cause this pattern of findings. One is a Posterior and Inferior Ilium (PI), another is an apex
posterior sacrum and lastly, an inferior sacrum with lateral deviation of the sacral apex. When palpating this
ligament, care should be taken as there are important neurovascular structures near it and the sciatic nerve
runs directly beneath it.

14
Sacroiliac Ligament
The sacroiliac joint ligament is comprised of several layers of tough fibrous tissue originating on the ilium and
inserting medially and inferiorly along the posterior lateral sacrum. When there is a bony misalignment of any
sort between the ilium and sacrum this ligament is likely to be tight and/or edematous. The SI Ligament should
be palpated from top to bottom and the location of tightness or edema noted. The location and extent of the
finding will determine the possible listing that is indicated.

Sacrospinous Liament
The sacrospinous ligament attaches at the sacral notch and the ischial spine. This ligament is difficult to locate
because it is deep to the gluteus maximus and medius. It is most often tight on the side of an inferior sacrum
(PI-L/PI-R, AI-L/AI-R). It is important to visualize the location of this ligament, as it is not connected to any
easily palpated osseous landmarks.

References:
1. Basic and Clinical Anatomy of the Spine, Spinal Cord and ANS, 2nd ed.
Cramer & Darby, Elsevier Mosby 2005
2. Spinal Palpation, 5th ed.
Gates, D., Westwood, NJ, 1995
3. Correlative Spinal Anatomy, 4th ed.
Gates, D., Westwood, NJ, 1995
4. The Physiology of the Joints, Volume Three, 2nd ed.
Kapandji, I. A., Churchill Livingston, 1998
5. Chiropractic Technique principles and procedures, 3rd ed
Bergmann & Peterson, Elsevier Mosby 2005

15
16
17