(Excerpted from Osteopathy: A Complete Health Care System )
Diagnosis of somatic dysfunction (impaired or altered function of related components of the body framework) is a relatively simple procedure when the degree of deviation from normal is marked. When, however, there is only a slight deviation, then the diagnostic exercise is more difficult. There are a variety of diagnostic methods used in assessing somatic dysfunction, and diagnostic indications fall into the following three categories:
The tests used to assess these changes usually fall into five classes.
- Changes in symmetry.
- Restrictions in mobility.
- Tissue texture changes.
- General impression. This is a screening, either visual or by palpation (feeling by hand of the whole body or parts of it) for general asymmetries and any obvious abnormalities in structure or function. Other disciplines (physical medicine, orthopaedics etc.) use similar tests. Osteopaths tend to use their palpatory skills to focus on possible problem areas before further consideration.
- Motion testing. A variety of tests to elicit motion, or lack of it, in regions of joint activity (e.g. low back) are utilized. These methods are not confined to osteopaths but are used in general medicine as well. Such factors as ease of movement, range of movement, continuity of movement, degree of discomfort or pain brought about by movement, are all assessed using active (the patient moves himself), passive (the practitioner moves the patient), or resisted movements, whilst the area is palpated and 'visualized'. Restrictions in motion are noted precisely. These might include flexion, extension, sidebending or rotation limitations, for example.
- Positional changes. The practitioner palpates for specific bony landmarks and visually judges these for asymmetry or malposition. Pairs of landmarks (shoulder blades, pelvic bones etc. ) are compared and their relative positions noted. Such tests may be combined with motion tests so that position and motion can be compared simultaneously.
- Soft tissue changes. These are assessed by inspection and palpation. Osteopathic practitioners have developed these methods to a fine art. Tissues such as muscles., ligaments and tendons are assessed for changes in temperature and consistency. The practitioner will quite likely run his hands lightly over the area being checked, seeking changes in the skin and the tissue below it. Having localized any changes in this way he will assess the deeper tissue structure by using greater pressure. He will be looking for a number of specific changes, including:
- Skin changes. Over an area of acute dysfunction the skin will feel tense and will be difficult to move, or glide, over the underlying structures.
- Induration (hardening). A slight increase in diagnostic pressure will ascertain whether or not the superficial musculature has a hardened feeling. When chronic dysfunction exists the skin and superficial musculature will demonstrate a tension and immobility, indicating fibrotic changes within and below these structures.
- Temperature changes. In acute dysfunction a localized increase in temperature may be evident. In chronic lesion conditions there may, because of relative arterial narrowing, be a reduced temperature of the skin. This usually indicates the formation of fibrous tissue in the underlying structures.
- Tenderness. Tenderness can be misleading as it may indicate local or reflex problems in acute or chronic dysfunction. The practitioner will note its presence, but not necessarily consider it as important. In acute joint dysfunction the superficial musculature and skin usually palpate as tender.
- Oedema (excessive fluid). An impression of fullness and congestion is apparent in the overlying tissues in acute dysfunction. In chronic dysfunction this has usually been replaced by fibrotic changes.
These diagnostic methods are used almost exclusively by osteopathic practitioners.
- Local motion testing. As distinct from the testing of a region, this method attempts to assess the local response to a motion demand. The motion might be introduced by the practitioner, or the joint or area might be palpated whilst motion is introduced by the patient. Continuity of motion, tension, resistance and local tissue response are all judged. This class of tests helps to specifically identify areas of resistance to motion, and this leads to the normalizing manipulative procedures used in treatment. This is a purely osteopathic diagnostic procedure.
About The Author
A practicing naturopath, osteopath, and acupuncturist in the United Kingdom, with over forty years clinical experience, Chaitow is Editor-in-Chief, of the Journal of Bodywork and Movement Therapies
. He regularly lectures in the United States as well as Europe where he instructs......more