resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
5 Simple Steps to Create an Effective Marketing Calendar
In the educational experience of most healthcare practitioners, business and marketing are overlooked topics.
Applying the Thin Skull Principle
The "thin skull" principle, also known as the "you take your victim as you find them" principle, is a legal principle that can be summed up by the following statement.
How Much Do You Know About the Benefits of Birds Nest?
Edible bird's nest is the nest made by the Swiftlet bird of Southeast Asia that is usually prepared as a soup and prized in Chinese culture as a healthful delicacy.
Turning a Blind Eye to History – and Reality
The American Medical Association is taking the Supreme Court's Feb. 25, 2015 decision exactly as it always does – by turning a blind eye to history, legal precedent and reality.
The Acupuncturist's Problem
I want share with you some observations and insights into what seems to be the most common problem my colleagues in the acupuncture profession struggles with. If you also struggle with this problem, I hope you get a valuable "aha" moment from reading this.
Marijuana, Apathy and Chinese Medicine, Part 1
This article was written in response to the unheeded acceptance of marijuana as a harmless substance that potentially does good when used for the medical relief of pain.
Low Back Pain in Professional Golf: A Common Muscular Relationship
Every sport creates its own unique demands on the body. Some sports require such a myriad of body positions that assessing pathology is often difficult and unpredictable.
The Tide is Rising in the Acupuncture Profession
Former President Ronald Regan said, "When the tide rises all boats float." The tide is rising for the acupuncture profession. Many forces outside the profession are helping the tides to rise.
Animal Acupuncture: A Case Study in the Treatment of Traumatic Injury in the Equine
The rise of animal acupuncture in the U.S. began in the early 1970's as a result of the work by members of the National Acupuncture Association in Westwood, Calif.
The Challenges of Integrating Eastern and Western Medicine
My Masters thesis was titled, "The Challenges of Integrating Eastern and Western Medicine," which highlighted several reasons why it is hard for these two worlds to mix.
Integrating Art with Clinical Practice for Patients with PTSD: The Artemis Project
Are you restricted by those one-on-one clinic dynamics? Why not join colleagues and clients in experimental group settings? Three of us volunteered to do just that in Austin on behalf of women veteranss from all branches of the service.
Term Limits: What's in a Word?
It was the French historian and philosopher Voltaire who once declared the Holy Roman Empire was neither holy nor Roman nor an empire.
A View From the ER
The University of Western States has inked an innovative agreement with local nonprofit health system Legacy Health whereby UWS sports-medicine fellows can experience observational clinical rotations in emergency-room settings within the Legacy system.
Functional Hip Impingement (Part 1)
Every time I sit down to write an article, I realize how much more there is to know about musculoskeletal pain. I also learn something new every time. (I want to give special thanks to Lucy Whyte Ferguson for assisting with this article.)
Optimism = Compassion = Trust
A randomized clinical trial recently published online in JAMA Oncology examined how patients viewed their doctor based upon how the practitioner presented bad news to the patient.
Medicine is Clumsy, Don't You Be
All medical systems have clumsiness in them. If the technique isn't, the practitioner is. Everyone in every form of medicine is striving to improve. That is why we call it practice.
Sleep, Less Sleep or No Sleep?
I had a dream I wasn't getting enough sleep. It was a very realistic dream, even though I was probably slightly awake and not really deep dreaming. Most likely I had been dozing, caught in that twilight of sleep and wakefulness.
A House Divided?
The American Chiropractic Association's House of Delegates voted on 30 resolutions at its annual business meeting in Washington D.C., but two in particular took immediate center stage due to their controversial nature.
5 Tips for Using Pinterest to Market Your Practice
Pinterest is a very popular, but often under-utilized, social media platform where people can bookmark, or "pin," fun and interesting things from all across the internet.
Talking to Patients About Lumbar Facet Denervation (Medial Branch Neurotomy)
Lumbar facet denervation, more appropriately termed medial branch neurotomy (MBN), is a procedure that may be considered when patients suffer from recalcitrant non-radicular axial back and/or leg pain.
June, 2008, Vol. 08, Issue 06
The Essence of Palpation: How Do You Feel?
By Leon Chaitow, ND, DO
Palpation lies at the heart of much that we do in manual medicine and bodywork in general, and massage in particular. But how accurate and reliable is it?
What we do therapeutically commonly is determined by prior palpation and the meaning we give to what has been palpated.In other words, we assess and decide what treatment is needed and then apply techniques in order to achieve those ends. If, however, our palpation skills are limited or our interpretation of what it is we are feeling is inaccurate, then the treatment we choose to apply based on such misinformation is likely to fail.
Famous osteopathic physician Viola Fryman said: "Palpation cannot be learned by reading or listening; it can only be learned by palpation."1 Palpation represents a two-way communication between the examiner and the patient. Decisions as to what to do therapeutically often will be based on a variety of palpation and assessment methods, together with the symptoms and the patient's responses to these manual (and sometimes observational) evaluation procedures.
In other instances - I am thinking of methods such as neuromuscular technique or many massage techniques - palpation and treatment are synchronous with decisions over how we should respond by varying the degree, duration and directions of forces. These decisions are determined by what is being assessed/felt by the contact hand(s), and how this is interpreted in real time, moment by moment. What is being done therapeutically in such a setting is directly related to what is being palpated and assessed at that moment, rather than having been planned ahead.
For experienced practitioners and therapists, much of the instant decision-making that results in modifications of application of forces (compression/stretch, etc.) happens without due deliberation. The hands do the thinking - intuitively, so to speak. - in much the same way a tightrope walker makes instant, non-cognitive decisions based on the processing of multiple pieces of information.
In other circumstances, active deliberation and thought are required as to what to do next. How accurate such decision-making is will be based on a combination of experience and learned information, as well as being present in the moment and truly in touch with tissues that offer information requiring interpretation.
So, at the heart of palpation is what I termed palpatory literacy many years ago. Do we know how to read the signs and signals the body and its tissues offer us? Nowadays, with the clamour for "evidence-based" methods, a great deal of effort goes into evaluating how reliable and valid (accurate) palpation and assessment-methods are. These can be looked at in several ways. The most common are studies that try to see how reliable an examiner's findings (and therefore the methods used) are. This is measurement of intra-examiner reliability. The other major focus is on how repeatable findings are when different examiners are involved. This is measuring inter-examiner reliability.
The difference between these is that one (intra-) looks at how competent you are in making judgements about what you palpate, and whether the same findings are repeatable when you apply them to other people or other tissues that display similar characteristics. Do your current findings commonly agree with your previous findings? In this case, there is good intra-examiner reliability.
Inter-examiner evaluation looks at how much agreement there is when others palpate the same tissues. Do they come to the same conclusions you did? In that case, there is good inter-examiner reliability.
It's worth reminding ourselves that such reliability does not necessarily mean accuracy has been achieved. The interpretation of methods of palpation that can reliably be duplicated and which agree with the palpation findings of someone else, does not in and of itself mean the conclusions deriving from the palpation exercise are accurate. You may both be wrong, depending on the basis for your interpretation of similar palpation findings. For example, you could reliably aim and hit a dartboard every time you threw a dart, and this would reflect your throwing reliability. However, only if you consistently or frequently hit the bull's-eye would the dart-throwing be categorised as accurate.
So, how can we ensure better intra- and inter-examiner reliability and accuracy? I've explored ways to do this in my book Palpation and Assessment Skills, which attempts to lead the reader through multiple graduated exercises that should result in enhanced skills. Assessment and palpation methods need to be standardized, well-taught and regularly assessed for both reliability and validity (accuracy). The acronym STAR is used in osteopathic medicine to describe characteristics that commonly are present and assessable when dysfunction exists:
Some of these elements are measurable and some not. In other words, some are subjective (tissue texture, for example) and some are objective (range of motion, for example). One thing is certain: The more you practice palpation methods, the more sensitive and reliable your methods should become. What your palpation and assessment means depends on the degree of knowledge you have acquired and your particular belief system. For example, when palpating the radial pulse, your belief system might cause you to interpret findings as relating to heart rate, whereas someone else who appears to be performing precisely the same palpation might be evaluating qi levels in different meridian systems. I will return to the vast topic of palpation in a future issue.
Click here for more information about Leon Chaitow, ND, DO.
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