Tricks for Ticklish Patients

Every year there’s always a few really ticklish patients that struggle to get through their ultrasounds. They squirm, they huff, they squeeze their eyes shut really tight and they tense up every muscle in their body. It’s alarming to a tech doing an ultrasound. And its a difficult exam to complete. You worry about hurting your patient and their involuntary movements or laughter make it difficult to find clear windows for imaging.

Recently I learned two great tricks that make working with a ticklish patient much easier from a massage therapist friend. I liked them so much that I had to share.  

Being a ticklish person, I have always disliked being tickled. It tends to trigger a mild panic response that leaves me gasping for breath, my heart beating uncomfortably fast. I feel helpless and oddly threatened and it turns out that my response is quite normal. It’s an evolutionary response to a perceived attack on some of our weakest areas, which stimulates a part of our brain that controls instinctive reactions of fight or flight.

Although tickling is often perceived by the giver as fun, it is often uncomfortable, tiring or nauseating for the ticklish recipient. Tickling occurs when unmyelinated nerve fibers in the skin, the same nerves that react to pain, are stimulated, which activates a part of our brain that controls instinctive reactions – such as fight or flight – which is why someone being tickled may accidentally lash out at the person who is tickling them.

Our most ticklish zones are also our weakest spots, such as the stomach and neck, and evolutionary biologists believe that we laugh when these areas are touched as a defense mechanism to show that we are not a threat and are trying to show submissiveness.

So now that you know way too much about tickling and it’s frustrations, here are my tricks to minimize tickling:

Part of the tickling reaction occurs because we aren’t expecting it. And when we try to tickle ourselves we’re unable to because our cerebellum can predict the sensation and use this to cancel out the response of the other brain areas to the tickle. This is a necessary process to allow us to do things like put on our socks without activating the tickle response each time.
We can use this handy evolutionary process to prevent tickling during an ultrasound by having the patient place their hand on top of ours as we scan the ticklish area. Their brain will perceive that it’s just their own hand causing the stimulation and their reaction will be much less, or they may not even react at all.

Another way to prevent the tickle reaction is to distract your patient. Really distract them. The distraction needs to be a mental one, not a physical one, in order to prevent the brain from activating the instinctive response. This can be done by asking the patient to do something relatively complex such as count backwards from 100 by 3s, or spell their name backwards or recite the alphabet backwards. These are challenging mental tasks that will distract them from their tickle anticipation and response, giving you the time you need to scan and take your pictures.

Although I don’t run into really ticklish patients very often, I see enough of them that it’s been a relief to have a couple of methods to use to help make the scan go easier. We usually end up sharing a laugh together then I explain that laughter is really disruptive to the imaging process so I’m going to have them try a distraction method while I finish the scan. It almost always works and both me and patient are much relieved.
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Happy Scanning!