How do you feel such subtle things?
When I was a little baby medical student, I knew in my deepest heart that osteopathy was my calling, and I was terrified that I wouldn’t have the necessary gifts to be able to succeed at it.
I went to a conference on manual osteopathy my first year of med school and attended one session that continues to keep me going on days where I start to slip into anxiety and self-doubt. So for all the baby osteopaths or other bodyworkers out there, and for all the people wondering “What can you really diagnose just by feeling someone with your hands?” this is for you:
If, with your eyes closed, you were given a writing utensil and start writing with it, you would (if you are a person who has been using such things over your lifetime) probably be able to tell immediately and if it was a crayon, a pencil, a marker, a ball point pen, a gel pen, or any of a number of other types of writing utensils you’re familiar with. You would also be able to guess at the thickness and texture of the paper and the texture of the surface underneath it. And none of this would be from feeling the thing itself, but from feeling through a tool to the tiny point of contact where it meets another material and the subtle variations in friction and resistance there.
That is the degree of sensory discrimination you have in your hands. And it’s not a gift or a magic trick. It’s just a skill gained from many years of writing. You can develop that level of perception for any task that you commit yourself to*
Osteopathic manual specialists are people who have devoted their lives to honing that level of perception when working with the human body. Every type of tissue in the body has its own texture and motion. We learn layer-by-layer palpation: placing a hand to feel the skin and then sense the subcutaneous tissue below that, the muscle, the cortical outer bone, the spongy inner bone, the difference in texture between blood vessels and nerves running through all these layers. Each organ can be known and differentiated by its location, its density or slipperiness, the way it moves with breathing. Touch a few thousand people (while studying anatomy and physiology) and you develop a “palpatory database” for what these tissues feel like and you can learn to identify what they feel like in health compared to dysfunction.
I have many patients who have had every conceivable test: blood work, X-ray, CT scan, MRI, ultrasound, colonoscopy, etc, but because everything comes back normal, they keep being told (ie gaslit) that “Nothing is wrong” or (my absolute favorite) “It’s all in your head.” Our current medical training has made physicians so dependent on these tests, that the idea that there could be a disease state outside their scope of perception is inconceivable to them. And this does patients a massive disservice.
There are conditions for which the human hand is actually the most precise diagnostic tool we have. One such issue I often see is disorders involving fascia, a part of the human body long revered by the osteopaths, and recently “discovered” by allopathic medicine and re-categorized as one of the body’s “organ systems” (along with digestive, nervous, circulatory, etc). An MRI is an incredible and potentially life-saving device, but it will not tell you anything about this complex web of connective tissue that envelopes and interposes every single tissue and structure in the body. And that’s just one example. Conditions that impact motion, like the fluid motion of the lymphatic system or the quality of a joint’s range of motion, will be invisible in snapshot images like X-rays.
So why would we deprive ourselves of one of our most finely tuned senses when gathering information about our patients? And why would we not use the elegant precise tools of our hands to help treat those dysfunctional tissues when we find them?
*This is adapted with minor edits from a presentation given by Dan Shadoan, DO at the 2013 American Academy of Osteopathy Convocation.
