Let’s commit spasm/twang and empty feeling to the backs of our minds for the time being as they are on the rarer and extremer range of things for massage therapists. We will recognise them when we see them.
And let’s also combine hard endfeel with springy block, both of them indicating a joint problem.
We further combine the soft tissue compression (to which we add the stretch of soft tissue structures as in for example antagonist muscles and joint capsule on the antagonist muscle side of the joint) and the tougher yet still soft leathery feel.
A hard endfeel we generally relate to joints and it is thus intracapsular, a soft endfeel we generally relate to soft tissues like muscles, tendons, ligaments and joint capsule and it is thus extracapsular.
So to distinguish between intra-articular and extra-articular blockage, we check the quality and feel of the blockage within the joint.
If the blockage has a rubbery feel and gives slightly under pressure, it is likely to be an extra-articular (soft tissue) blockage.
If the blockage seems inflexible and range of motion ends abruptly, there is probably an intra-articular (bony) blockage.
If a soft restriction is found on the closing side of a joint (usually the agonist side) we are likely to look at a compression of tissues.
If the restriction is found on the side where the joint opens (usually the antagonist side) we most likely encounter (over) stretched tissue, for example the antagonist muscle or its tendon or the fascia on the antagonist side of the joint. More
|Pain on Traction
(when pulling structures apart)
|Pain on Compression
(when pushing structures together)
|If there is pain on traction the problem is likely to be soft tissue as in muscle tendon or nerve.
|If there is pain associated with compression the problem is usually joint related, or a nerve is compressed.|
In cases where there is multiple joint involvement one has to be careful to differentiate and find out where the movement really occurs as the endfeel varies.
In Horizontal Flexion of the Shoulder for example there should be a tougher, leathery endfeel stemming from the stretching of the posterior jopint capsule. The shoulder joint will lock at the end of this movement. The way one normally tests for this movement by bringing the arm horizontally across the chest, will encourage to allow the shoulder blade to move into protraction as soon as the shoulder joint locks and is unable to move any furter. This way it might get a bit blurry as to which is the endfeel. The leathery feel of the joint capsule or the more likely soft endfeel stemming form the stretch of the rhomboid muscles which will eventually put a stop to that movement.
In such cases it pays to fixate one joint (in this case the scapulothoracic articulation) to isolate the (shoulder) joint.