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Touch-testing in Biodynamic Skeletal Therapy Treatment

This is an excerpt from Unwinding Bone by Scott Sternthal.

Touch-Testing

Before we treat compactions, we need to find them! In my practice, sometimes I find compactions while I’m working on something else. For example, I could be mobilizing the scapulae and detect an extra-rigid section of the bone around the acromion process. Or I could be releasing the cervical fascia and feel that the second cervical vertebra (C2) is compacted. I also find compactions by deliberately scanning the body for them, a procedure I call touch-testing.

Touch-testing is like a treasure hunt for bony compactions, and it involves what the name implies: touching a bone to test it. Every bone? Well, yes. This may seem cumbersome within the confines of a single treatment, but with a little practice, you’ll be able to scan the entire body in minutes.

Touch-testing involves more than a simple touch, but less than a full mobility test, and accomplishes two things at once. First, contacting a bone for only a second or two allows us to quickly appreciate its texture and quality. Does it feel like wood or concrete? Wood is normal; concrete is not.

Second, touch-testing allows us to appreciate the micromobility of a bone in relation to its neighbors. Is there at least some micromovement between that bone and the bone to which it is connected? Some movement is normal; no movement is not. Some may suggest that the only way to test the mobility of a bone is to mobilize it through its full range of motion around a joint, including rotations, glides, and translations. True—touch-testing does not test the full range of motion. However, since we’re concerned with finding compacted bone(s), testing the micromobility of a bone is all we need. If a compaction is present between two bones, there’ll be virtually no discernible mobility in any direction or of any amplitude.

Trusting First Impressions

Trusting first impressions is important since we have the tendency to second-guess ourselves, especially while learning. In 2018, I took a postgraduate class at the CEO called “The Evaluation and Treatment of the Osseous Head.” The teacher of the course was Eric Prat, one of the cofounders of the osteopathic mechanical link (OML), a fascinating approach to osteopathic manual therapy that he developed with his teacher Paul Chauffour in the 1970s.

The OML approach involves evaluating a strictly defined series of points before making decisions about where to begin treatment. The points of the series are preselected according to their significance, so the series never changes. The tests are done quickly, relying on first impressions of tissue elasticity to determine the health of a structure.

When I watched Prat work, I was astounded at how fluidly he contacted and assessed dozens of points, especially around the face and skull. It was as if he wasn’t even touching the points, but gliding over them, perceiving them. Using more classical methods of cranial evaluation—evaluating each cranial and facial bone for mobility—could take up to an hour to complete. Using the OML system, Prat achieved this in about a minute.

Impressed, I immediately began using his protocol for my cranial evaluations. The first time I did the OML cranial series, it took 15 minutes—just for the head! But the more I practiced, the more efficient I became. Even more surprising to me was that the quicker I moved from one point to the next, relying on my first impressions, the more accurate the tests became.

Test Quickly, Treat Slowly

With OML and BST, we test a bone quickly. This is important for two reasons. First, a quick touch forces us to trust our first impressions (which are usually correct). Second, since bone is a viscoelastic material, its deformation is rate dependent. Therefore, the more quickly we touch a bone, the less chance there is of it changing (even if this change is infinitesimal) before we make a decision. Remember that viscoelasticity is the combination of the gooiness of a liquid and the elasticity of a solid, and it plays out in all kinds of neat ways across a wide range of materials. A shear-thickening fluid, for example, exhibits an abrupt increase in viscosity with an increasing shear rate. Oobleck, that weird combination of cornstarch and water, behaves this way. If you rest a spoon on the surface of a bowl of Oobleck, the utensil slowly sinks to the bottom. But if you tap the surface of the Oobleck with the same spoon, the spoon bounces off. Other viscoelastic materials include Silly Putty, taffy, thick honey, and your kids’ homemade slime concoctions made with borax. In all these materials, when force is applied suddenly, they feel solid. When force is applied slowly or removed altogether, they ooze. The bone-as-Oobleck visualization seems to work here.

The Two Phases of Biodynamic Skeletal Therapy Touch-Testing

There are two phases of the touch-test: phase 1 and phase 2. Phase 1 is an initial touch-test to determine if a compaction exists, and phase 2 is a more specific “spread-and-twist” test to determine the orientation of the torsional pattern of the compaction.
During phase 1, touch-test each point for no more than a few seconds (figure 14.1). The touch may be combined with a spread or a squeeze or a wiggle or a push. For some of the smaller bones of the hands and feet, squashing the bone will “spread” it from the center outward. Use your fingers, the palm of your hand, or your thumb. The specifics are unimportant. What’s crucial here is getting the information you need from making quick contact.

For phase 2 (and only once you’ve identified the presence of a compaction in phase 1), identify the torsional pattern of the compacted tissue. Retest the bone(s) by applying tension and torsion, spreading and twisting the tissue (figure 14.2).

More Excerpts From Unwinding Bone

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