Tenderness to Palpation (TTP) is a fundamental, non-invasive assessment technique used in physical therapy to localize pain and tissue irritation. This procedure involves the therapist applying pressure with their hands to specific anatomical structures. TTP serves as an initial, subjective tool that guides the practitioner toward identifying which muscles, tendons, ligaments, or joints may be generating the patient’s symptoms.
Defining Tenderness to Palpation
Tenderness to Palpation is defined as the subjective report of pain elicited when a therapist presses on a localized area of the body. Because the response relies entirely on the patient’s verbal feedback, it is considered a subjective measure. The presence of TTP suggests localized tissue pathology, such as inflammation, muscle guarding, or increased muscle tone. A heightened TTP response indicates the area is hypersensitive to mechanical pressure, often due to underlying nerve sensitization.
This measure helps the therapist determine if the reported pain originates from a specific, identifiable structure rather than a diffuse source. Comparing the tenderness of an injured area to the corresponding area on the uninjured side provides context for the degree of irritation. While TTP confirms the location of the pain, it does not, by itself, diagnose the specific condition causing the tissue irritation.
The TTP Assessment Process
The TTP assessment requires the physical therapist to apply a standardized, graded amount of pressure to the suspected painful structure, typically using the thumb or fingertip. Pressure must be applied perpendicularly to the tissue to avoid unnecessary shearing. TTP is quantified using standardized tools to ensure objective documentation and tracking of progress.
A common method uses the Numerical Pain Rating Scale (NRS), where the patient rates the tenderness felt during palpation on a scale from zero to ten. More objective quantification uses a pressure pain threshold (PPT) device, also known as a pressure algometer. This handheld instrument measures the minimum amount of pressure required to induce a painful sensation at the site of palpation, typically expressed in kilopascals.
The pressure algometer provides a highly reproducible measurement of the mechanical nociceptive threshold. This device eliminates variability from manual palpation, offering a clear numerical value to monitor improvement during rehabilitation. A simpler, non-instrumented grading scheme may also be used, such as a scale of 0 to 3, where a ‘3’ represents tenderness accompanied by a patient withdrawal or “jump sign.”
Interpreting TTP Findings
Interpreting TTP findings allows the physical therapist to identify the specific anatomical structure generating the patient’s symptoms. A high TTP score or a low PPT reading confirms the area of greatest tissue irritation, guiding the selection of initial treatment interventions. For instance, sharply localized TTP over a tendon insertion may suggest a tendinopathy, while diffuse, rope-like tenderness might indicate myofascial trigger points.
The intensity and location of the tenderness help differentiate between superficial muscle soreness and deeper issues, such as joint capsule involvement or periosteal bruising. Tenderness is always compared bilaterally—assessing the painful side against the non-painful side—to establish a baseline and determine the extent of the pathology.
Tracking changes in TTP over time is an important metric for assessing the effectiveness of the treatment plan. A decrease in the reported tenderness score or an increase in the measured pressure pain threshold suggests a positive response to therapy. This objective data supports the therapist’s clinical reasoning, confirming that interventions, such as manual therapy or exercise, are successfully reducing local tissue sensitivity and inflammation.