Written by Lee Jarvis. Editing and proofreading by Taryn Whyte.
Having been in practice for (what feels like a very fast) 10 years I’ve noticed a commonality amongst seasoned practitioners of Osteopathy when discussing manual applications. That commonality is a tendency towards demonstrating treatment while forgetting to explain assessment and structural diagnosis first.
Applying treatment without first having an understanding of the structural findings beneath our hands should always be regarded as an unwise idea. Detailed information about the patient’s body is always necessary for the best understanding of how to change that body in a beneficial way. To apply treatment without structural diagnosis is to paint blindly on a canvas and hope art arises from the mess (granted this technically works sometimes).
I write this specifically because in the articles published in the Osteopathyst I will, and hopefully others will also, be speaking about applied methods, at times called techniques, and not always the structural diagnoses that necessitate those methods.
In my years of school and early years of practice, it could at times be frustrating to have a teacher or visiting lecturer demonstrate a method or technique on an area without any explanation as to the intended goal. The intended goal of the treatment is always to correct the problem, lesion or somatic dysfunction, but without those findings having been explained it could be difficult to understand the full use of the manual method demonstrated. I’ll be first to go on the record to say that I had a great education, and was not frustrated very often with a lack of stated structural findings, though it did happen.
As a teacher myself when demonstrating to students I’ve made it a point to attempt to explain all of the reasons I might choose to do a manual application whenever given the chance. However, speaking now from a point of some experience I understand that I wasn’t wrong to be frustrated in those early years but I have realized that the capacity to determine another practitioner’s diagnosis, or some approximation of it, without an explanation is a hallmark of comprehension that comes with time and experience in addition to being a good exercise in understanding your craft.
The curse of the experienced practitioner or teacher is that they have been practicing so long that often they forget what it is like not to understand things related to their profession inherently and almost immediately. It has been so long since the teacher was a new learner that they often cannot picture a life in which they don’t understand their field of constant practice. This is why some of the most skilled people in any field do not always make good teachers. In fact, sometimes the most skilled practitioners are so out of touch with the new learner that they can neither explain what they do in simple enough terms nor remain patient enough with someone who doesn’t know as much as them for that new learner to obtain anything of value. The reality is that teaching is its own skillset or mastered practice and can exist independently of expertise in another field (but not the conversation of this current article).
The capacity to work from an assessment to a structural diagnosis to the effective treatment for that patient at that time is the most standard process in Osteopathy. A thorough assessment yields findings that build a picture of important areas of the body to be considered. Based on severity and inter-relation we can determine from those findings what areas are most causative of the patient’s current problem. We call this a structural diagnosis. Based on the position, tissue qualities, and reactivity of the areas we can formulate a treatment that addresses the problem at that moment that will lead to a resolution.
This is a basic rundown of the standard Osteopathic method that follows a rational and straightforward process and works well much of the time. A skilled practitioner watching another skilled practitioner should however also be able to do the inverse; view the treatment and work out the structural diagnosis and findings. Understandably, this comes from quite a bit of experience, not something that is learned immediately but is an opportunity to learn. Though requiring work, any skilled professional should want to take that opportunity given the chance as it provides them the capacity to see very different perspectives on how to work effectively in the Osteopathic field.
In the same spirit that brought me to write this article, I will say just enough to indicate how something is done without ever fully explaining it. I will briefly describe the things that have helped me interpret manual applications as performed by other practitioners. Hopefully, any frustration created will inspire learning, not angry emails.
1. Most of the time the practitioner is either doing more of what the body is already doing or the opposite of what the body is doing. The former being indirect positioning and the latter being direct positioning. Balanced methods are also a possibility, but usually, people seem to like to indicate when they’re doing that. By determining whether the practitioner is working direct to the barrier to indirect to the barrier you have a general idea of what the original findings were as long as you understand the positioning or setup and how the hands are moving.
2. The way the body of the patient is set up or positioned often is already addressing the problem. The setup is almost already “treating” as it were and, if the setup is done well, by simply exaggerating it slightly we often get the desired effect. Much of the time the movement created after the setup only further emphasizes the position of that setup.
3. Hand position is vitally important to understanding all methods but the way those hands generate or apply contact is of equal importance. The way the tissue is made contact with or “dropped into” while establishing hand holds or the way the body is moved into creating a secure hold is often where the direct or indirect position is initiated.
4. The practitioner’s body movement is almost as important as hand position. Once a hold is established the practitioner’s hands often stay still while their body moves. So, while the practitioner’s hands could be placed in a position that appears direct or indirect, they could be moving in the opposite direction.
5. Intensity tells you about intent. Indirect work is rarely done vigorously. Moving fluid requires on and off pressure for a significant duration of time. Point work tends to be done on acutely painful parts.
Using these simple understandings you can begin to comprehend and reverse engineer the meaning behind some of the methods you see. Hopefully, you will also enjoy the process of this reverse engineering method and find that it allows you to better comprehend your own work.
With all of that being said, one of the easiest ways to gain experience in understanding how other practitioners work is to receive treatment from those other practitioners directly. There’s nothing like experiencing the depth and specific positioning of a practitioner’s leverage to help understand the intent behind the method. This is of course all dependent on how open their schedule is and how willing they are to answer questions.
In closing, in future publications of the Osteopathyst please forgive us if we should forget the complete structural explanation. Hopefully, you will strive to fill in the parts and pieces that bring meaning to the work.