By: Chris Bates M.Ost
Feel and touch are not the only ways to really “feel”. I remember being told by one of my favorite teachers in my Osteopathy degree (for humans), “When you know the anatomy and how to work safely, then you can work with ‘no mind’, fluidly and without over thinking”.
His name was Greg Barker and he, unfortunately, passed away, but before he passed, he was instrumental in the development of many Osteopaths and was a highly regarded clinician and educator. Yes, I’m afraid this is one of those personal anecdote style articles, but bear with me I promise it’s worth it.
Do you feel it?
When I came to the world of Osteopathy, I had trained as a sports massage therapist and equine bodyworker. I thought I had pretty good hands-on skills and could feel what was going on under my hands. Little did I know that Osteopathy training would completely change the way I was perceiving the patient in front of me.
We spend many hours studying the principles of Osteopathy and looking at how our paradigm of assessment and treatment is very different to other approaches, but practice is vastly different to remembering data.
When we train, it is a little like we have been palpating (assessing through touch) with thick gloves on. Once the practice begins and you can learn by doing, the real information begins to become clear.
There would often be times in my degree during practical classes when other students would turn to each other and say “Do you feel it?”. The majority of the time, it would be answered with a weary head shake and “still no…”.
It’s very frustrating when a tutor is describing something that is apparently there and you are completely unable to pick it up. But looking back, I now know that I wasn’t “unable”, I was just not feeling enough, deeply enough.
Going through the layers
One thing that we were taught and that is imperative for any aspiring Osteopath, was feeling at depth. Palpation is not just the sensation of the surface tissue that your skin makes contact with, there are more tissues that are perceivable by adjusting your perception of them.
Having a thorough understanding of anatomy is so important here because you can visualize the areas and tissues beneath your fingers which helps to know the pressure you need and the type of sensation to expect.
Of course, it's also important not to let a visualization blur what is really happening. There is no “perfect” patient and so tissues will be different from person to person, animal to animal. We don’t want to let a visualization put a fake picture of what is happening in our minds and give us a false reading so to speak.
I was blown away at how little pressure was required to feel deeper; I had until then, been plowing my way through delicate tissues and ignoring the information that was so very useful. The problem is that when we start a new discipline, we are clumsy and unrefined, with practice it becomes second nature.
Imagine a gymnast at the top of their sport, they didn’t start with that level of balance, coordination and strength (unless their name is Simone Biles), they began by overshooting the energy, toppling over and missing marks.
We make contact with the skin and fur of the animal, we feel the temperature, moisture, quality of the coat, the glide of the skin over the subcutaneous tissues and we can feel if the animal reacts with retraction or shudders for example.
The touch for this is very subtle and if we press too hard, we completely lose a plethora of information. You get a better sensation of the animal’s skin temperature with very light touch for example.
But we don’t stop here. The tiniest amount of pressure we can gently sink into the connective tissues and fascia underneath. These tissues have slightly more resistance to glide and you can sense the direction in which the fascia “draws” as it is semi contractile.
We take time here to sense if there is a direction the fascia feels more restricted and can note this in our assessment as it may give us information of the deeper factors causing the animal’s presentation.
Keep going…
At this level we can even pick-up vascular motion and fluid dynamics, we get the pulse, swelling and oedema. But there is more to do, just beyond this level is the muscle, tendon and ligament tissues.
I often said to my students that the pressure needed to sense these was often only the pressure you could comfortably put up with on our closed eyelid, not much at all. Now we can really see how it is so easy to push blindly through the layers without perceiving them. At this deeper point we can feel tissue tension, spasm and fasciculation, interstitial fluid retention and of course observe for signs of pain.
But wait, it’s not over yet…
Widen your field of perception and you can even palpate bone! Yes, you can really feel the bones without having to be in a surgical suite. Bone is a vital and living tissue. Dense with blood, marrow and microvascular structures, not the light weight dead stuff we look at in classrooms.
It has a density that you can feel, you can sink into the tissues with your fingers and open your perception and you will palpate density, resistance, and of course, at a joint you will feel range of motion.
The Subtle Nature of Osteopathy…
In the realm of cranial Osteopathy that was first pioneered by William Garner Sutherland DO, there is so much more within and in-between the layers described above when palpating. The description above is really just to help open your mind to the possibility of feeling at a deeper level of understanding.
Cranial Osteopathy also palpates the intrinsic motion of the cerebrospinal fluid, the reciprocal tension membranes, the cranial bones and the sacrum. These motions are extremely subtle and difficult to feel but once you get that eureka moment, it opens up a whole new plane of diagnostic information.
In cranial lectures, I was always told to try and “tune in” to my patient, I found this very hard at first as I didn’t really understand what the tutor meant. It sounds rather out there to “tune in” like I should be wearing a tin foil hat or reciting a mantra, but the idea of tuning in is really just allowing your perception to meet the patient where they are.
Above I describe how we don’t want our visualization of the anatomy to override what we are actually feeling. This idea is vital in deeper palpation and certainly cranial Osteopathy. We mustn’t block the body motion with too much intrusive pressure, nor should we guess at what is happening, simply allow for the time to properly form a picture of the motion and sensations you feel.
Osteopaths have the luxury of often taking more time with their patients, although there is a prevailing industry standard of people giving patients 30 to 45 minutes for a session, I personally always set aside an hour because I do not dictate what the body has to “say” or how long it will take to adjust.
Going beyond
Feeling can also be less literal. Osteopathy is after all about the holistic view of the patient. What else can you feel?
- Pain
- Anxiety
- Joy
- Awkwardness
- Relief
- Concern
The list would go on and on. The point I’m making is that we can gather a lot from how a situation makes us “feel” at an emotional level. It would be unprofessional to let emotion take over or to pretend to be an expert of psychology and behavior but we have all felt what it is like to “sense” an animal’s emotional state.
We use our empathy as a palpation tool very often. Your “gut feeling” as some may call it, is incredibly useful to guide your investigations and treatment. We don’t note our gut feelings down in our forms and write ups as this would not be a metric that could be admissible for veterinary follow-ups or referrals, but it is certainly an aspect of your personal approach that can make you stand out as a practitioner.
Some might describe this deeper sense of perception as being in the zone or in a flow state. These states of awareness are profound and create an ability to do what you do without really even thinking about it. Remember earlier what my teacher said to me? “….. Work with no mind, fluidly and without overthinking”. He really was one of the greats, R.I.P. Greg.
Flow is letting yourself feel, don’t obstruct your assessment with preconceived ideas. I have always found it quite interesting that letting yourself feel is a similar principle to letting the patient’s body do the healing.
The Osteopath really just removes the barriers to health and the body does the rest. Remove your barriers to feeling and you reach this flow state of truly sensing what is there, the senses do the rest. The Daoist philosophy would call it “wu-wei”, roughly translating as “action without action” or to go with the flow.
How Do We Get Better at Feeling?
There are ways to train our senses to improve our Osteopathy. We used to play a game at University where the teacher would place a number of small objects underneath a piece of paper or a cloth and we had to touch over the cloth/paper to see what they were.
Initially, they were easier things like a spoon, a phone charging cable, or a large coin. Eventually, we would have to identify much harder things like string, a human hair or what type of coin was under the paper.
This makes you engage with your fingertips and really helps. When we practice these types of exercises, the neuroplasticity of our brain and peripheral pathways gets more connected to this sense. It’s like walking the same track through a forest again and again, the path becomes easier and quicker to use. Of course, hands-on practice with the animals helps practice this too.
We can enhance our skills by just feeling lots of different things. Hold something in your hands and really connect with the feeling of it. What is the surface like? Is it warm or cold? Is it mobile? Is it pliable?
Feel the shape of it and make an image in your mind without looking at it directly. You can touch a tree or a leaf and determine its health, is the leaf dry and brittle? Is the tree solid and dense? It sounds silly to go around feeling things but it isn’t about how many things you feel, it’s about how you actually perceive them and what information you can gather.
As regards getting into that flow state of feel, I recommend finding a craft or hobby that involves physical touch of movement and practicing it until it becomes second nature. This ability to then dissolve into the sensation of doing without the mind getting in the way will help you allow yourself to delve deeper into your Osteopathy.
It is also very useful to have a craft or hobby that is separate from Osteopathy anyway as it acts as a relaxation time where you can recharge. Riding horses can be that hobby or maybe knitting or painting.
LCAO offers practical masterclasses to consolidate your learning and give you feedback on your palpatory and treatment skills. Our video submissions and case studies also give tutors the chance to assess your ability in sensing the animals in front of you. Our classical approach to Osteopathy emphasizes the need for good palpatory skills and hands-on practice.
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