What to Expect in an Osteopathic Exam

What Can I expect in an Osteopathic Exam?

We will ask all patients for their medical history.  There will be a focus on past trauma, including past surgical trauma, as well as on active medical conditions and symptoms.

There will be a visual scan to assess for postural symmetry and balance as well as for possible lines of tension.

There will be an examination for structural asymmetry and for asymmetric motion, both in terms of range of motion as well as quality of movement.

The hands on exam includes general myofascial ‘listening’:  a technique in which the examiner places his or her hands on the patient, feels for lines of tension and uses touch receptors in both hands to triangulate or localize what is likely the strongest restriction in the patient’s body at that particular moment.  It also includes local myofascial ‘listening,’ in which the provider places his or her hands on the anterior midline of the body from the neck to the pubic bone and feels for a pull or draw within the tissues to more precisely localize any restrictions.  These examination techniques provide important information regarding tension impacting the three-dimensional structure of the human body.  If indicated, there are also local myofascial listening techniques for the legs and arms.  

The techniques are useful regardless of whether restrictions are present in the connective tissue supporting organs or the connective tissue attaching to the spine, limbs or head.

The examination will not be limited to the area of the primary patient complaint or discomfort.  The area of discomfort will be examined but structures distant from a site of pain can be responsible for tension that in turn causes an individual’s pain.  Pain should be looked upon as more of a billboard, advertising that something is wrong, rather than a road map telling the patient or the provider where the problem is.  This is sometimes confusing for patients, so a few examples are in order. 

• A chronic restriction in an ankle after an ankle sprain might alter gait and be responsible for lines of tension going up the leg, which in turn can cause inflammation, wear and breakdown, or pain up the extremities to include knee pain, shin splints, hip pain, low back or pelvic pain.  
• A fall on the buttocks may cause mechanical problems with the pelvis and low back with associated pain, but the shockwave traveling up the spine and body can impact the base of the skull and its attachments to the upper neck.  Twisting forces, forces on the outstretched arm used to try to break the fall, may all play an active role in a patient’s symptom complex.  Forces involved in trauma can also cause alteration in the position of solid organs such as the liver or a kidney.  The tension from a shift in the position of a kidney may then lead to flank pain, bladder irritability, or irritable bowel symptoms.  A shifted liver may pull on the pelvis contributing to back pain or to the diaphragm and chest wall which can lead to a side stitch when exercising or shoulder and or upper back pain.
• A patient may present with complaints of low back pain without recognized trauma. Surgical intervention for a hysterectomy, an ovarian cyst or an appendectomy can cause contracted scar tissue that then pulls on internal connective tissue that in turn has attachments to the spine.  Until the effects of the scar tissue are addressed, the back pain cannot be treated with long term success.

The osteopathic examination and treatment process is all about detecting and treating altered tension that may be leading to or contributing to the patient’s symptom complex.  Restoring appropriate structural relationships improves fluid and mechanical flow within the body and reduces tension on nerves, which can normalize reflexes and diminish pain.