Palpation

What makes an osteopath’s great specificity is his ability to perceive the “movements” that permanently animate the body. And this motility is particularly decried by the detractors of this medicine. Admittedly, no scientific study has highlighted this activity today, but has one really looked for it? What about the legitimate subsidies allocated to Osteopaths in order to develop their expertise?
There are several tens of thousands of osteopaths throughout the world who perceive these phenomena and it is certainly not a view of the mind as we will try to see it .

We are not equals in the ability to feel, to feel the tissue move under our hands. Some people can perceive these mobilities after a few seconds while some osteopaths do not…
These perceptions, if they are not immediately felt, can be acquired through work and various experiments… So be patient…

The following exercises will allow you to test your palpatory capacities, but also to highlight certain characteristics of this motility.

The first exercises will perhaps allow the neophyte to perceive these phenomena of what is commonly known as Primary Respiratory Mechanism (PRM), then in a second stage you will find exercises more specific to Permanent Muscular Motility (PMM) where the pressure exerted by the tester’s hand will have to be greater and adapted to the motility of the underlying tissues.

The Primary Respiratory Mechanism (PRM)

For the neophyte, the easiest approach is the thigh.
Have a subject lie down on his back, and sitting beside him, put your hand wide open, fingers apart, on the widest part of his thigh.

You should feel your subject’s thigh after a while, spread your fingers apart and then let them tighten rhythmically. This is the motility that we talk so much about, which will pulse under your fingers 8 to 12 times a minute or maybe half as many. If you don’t feel anything.

Another exercise is to put your hand flat on the patient’s thigh and feel the tissue sliding up and down rhythmically.

Now let’s go one step further to highlight this phenomenon called Permanent Muscle Motility.

Permanent Muscle Motility (PMM)

Here are some brief tests that will allow you to highlight certain physiological or lesional characteristics concerning PMM.

• The muscle pump
• Multiple rhythmicity
• Asynchronisms (desynchronizations)
• Loss of amplitude
• Thoraco-diaphragmatic respiration and MMP

The muscle pump (PMM)

In the first place, PMM concerns the muscle. We are therefore going to highlight this muscle rhythmicity. Compared to the first exercise, you will need to apply a little more pressure and depth to be able to perceive the muscular rhythmicity.
The muscle which is the least difficult to apprehend will be the medial gastrocnemius or medial gastrocnemius, which is the internal muscle of the calf (for neophytes).
With your two hands embrace the muscle and feel it inflate and deflate. 80% of teachers at an osteopathic school have been able to feel the muscle inflate and deflate on the first attempt.

Multiple rhythmicities

PMM is environmentally sensitive.
Test the rhythmicity of a limb at rest, count the rhythms.
Test with heat or cold patches and recount.
It won’t be so obvious
Run your subject and then recount. You’ll need to find some strongly accelerated rhythms…

And if you have not yet acquired this ability, you may feel, wrongly, a decrease in rhythm.
Etc, etc, etc

Loss of rhythm

When a musculo-articular chain is injured, whether of articular or muscular origin, it is possible that the rhythmicity of the whole chain is halved.
Palpate several muscles, you will find some with loss of rhythm. Test the left adductor magnus often in lesion and release l1 on l2 on the same side and test again.

Amplitude losses

It’s a much harder exercise. Here it is a question of perceiving a restriction in the mobility of the muscle. It may be obvious when the restriction is massive but we will often have to compare two sides to become aware of it. So compare…

Loss of synchronicity

Test two symmetrical muscles. In theory their gliding should not alternate. Test and you will find out.  When one muscle will slide up, the other will slide down…
Same for the joints. To your temporals… Thoraco-diaphragmatic respiration and PMM.

Stand next to a subject lying on his or her back. Put the femur above the knee with one hand and the tibia below the knee with the other. You should feel the knee being moved regularly in the direction of internal rotation / external rotation. Ask your patient to breathe in apnea, then you will feel the femur do an external rotation on the tibia. Ask your patient to do an apnea exhale, then you will feel the femur doing an internal rotation on the tibia. If you have a different result, then a lesion will be hidden somewhere…

The interest of this exercise is to show the relationship that exists between the motilities that animate us and the thoraco-diaphragmatic breathing…