Principles of Diagnosis

The peculiarity of osteopathic diagnosis is the integral approach and the concentration on the musculo-skeletal system. When taking the history, attention is paid not only to how the disease has developed, but also to all previous injuries and traumas, to the workplace and patient's lifestyle, including sporting activities both past and present.

Examination includes the whole locomotor system, regardless of the area of the patient's complaint. General posture and flexibility is assessed and each motion segment in the lesioned area is examined in detail.

On the basis of the history and examination, a conclusion is made as to the structural and functional state of the locomotor system in general and the local lesions in detail. The next stage is to make a hypothesis on the most likely cause of the revealed abnormalities. A formulation of an osteopathic diagnosis is different with different practitioners, but it always includes the level and type of the functional lesion. In addition to it, or as a main diagnosis, some Osteopaths make a nosologic diagnosis (like spondylosis or osteoarthritis, for example). Others employ the name of a syndrome such as General Hypermobility, Overuse Syndrome, or Thoracic Outlet Syndrome. Some do not use a specific diagnosis. There are practitioners who try to establish changes in the subconscious that could be a cause of the problem, using psychoanalysis or other psychiatric methods (for instance, "painful spasm of medial adductors as a result of sexual abuse in the childhood").

Segmental Diagnosis

Osteopaths are divided into several groups according to the basis of how they make segmental diagnosis:

1. Positionalists make a conclusion about the position of a segment or a joint in relation to other structures. This approach dominated in early osteopathy and was developed further in USA in Fryette's school of thought. Examples of positional diagnosis are: "right occiput posterior", "posterior fibula", "elevated VII left rib". Modern positionalists determine the position of the segment/joint in a 3D plane, for instance, "C3FSBlRl". It means that the third cervical vertebrae is locked in the position of flexion, side-bending left and rotation left. From this positional segmental diagnosis one can determine which joint is dysfunctional. In the last example the C3-4 joint on the left is locked in a position of an "open joint".
2. Osteopaths who assess abnormalities of movement in the motion segment in a minimum of 3 planes. Quality is assessed as well as the range of movement typical for a certain segment - flexion-extension, side-bending, abduction-adduction, and also additional movements - anterior-posterior and side shifts, and compression-distraction. For a joint dysfunction this approach is very similar to positionalists. One just needs to "translate" a positional diagnosis to movements restrictions which is exactly the opposite. For example, the last lesion's movements restrictions would be "C3ESBrRr" (extension, side-bending right and rotation right). In addition to this, the movement impairment approach has the advantage of enabling evaluation of all segmental structures, including soft tissues.
3. Osteopaths who make a diagnosis of which joint is dysfunctional without identifying it's position or any impaired movement of this segment. They concentrate on finding a clinically significant lesion on the basis of changed mobility and soft tissue changes. A diagnosis is made usually indicating the level and the side of the lesion, for instance, "T4 on the right". Although simplistic at first sight this approach has several advantages. For instance, by artificially dividing complex bodily functions into components (positions or movements) the integral understanding of the body is likely to be lost, resulting in a one-sided approach or mistakes. If one, however, correctly determines which segment is the key lesion in the body then appropriate treatment or manipulation has a good chance of changing a movement pattern or structural change resulting in clinical improvement. That is why it may be more important to know WHAT to manipulate rather than in which DIRECTION.

Diagnosis Methods

The main instruments in osteopathic diagnosis are the practitioner's fingertips.

1. Palpation

   Palpation is widely used as a separate diagnostic method in osteopathy. On palpation a practitioner feels the tissue's temperature, tension, homogeneity. Body landmarks are also precisely determined by palpation (iliac crests, ribs, vertebral prominences etc.).

   A special type of palpation is layer palpation which examines tension, mobility, and displacement of layers of tissue from superficial tissues to deep ones: skin - fascia - muscles - bones.

   Apart from that, palpation is an important part of diagnostic tests of mobility and special tests.

2. Movements and mobility testing

   General mobility and movements in different areas and individual motion segments are tested. During examination attention is paid not only to the range of movements but also to the QUALITY of the movement which is a peculiar feature of osteopathic diagnosis. The range of movement may be full but it's quality may be changed - jerky versus smooth, tight with crepitus, or too loose without any resistance - all this is very significant. In addition, it is necessary to compare movements in symmetrical and neighboring joints/segments in order to find any difference and to get an impression of individual norm for that particular patient.

   With growing experience an Osteopath collects a database of his/her palpatory feelings that allows him/her to differentiate between a variety of processes in the area examined, for instance, inflammatory or degenerative, functional or pathological, acute or chronic. Some practitioners can even get an impression of the state of intervertebral disc by palpating movements in the segment!

3. Special tests

   There are several tests designed to facilitate diagnosis of segmental lesions. Many of them are subject to disagreement and discussions about their reliability, specificity or interpretation but they are widely used in practice. Examples of these are: the forward flexion test for lumbo-pelvic mechanics, head rotation from a fully bent position for C1-2 segment and many others.

   At the same time Osteopaths widely use common medical tests like straight leg raising, neurological and orthopaedic tests.

4. Instrumental investigations

   Osteopaths do not practice routine investigations as opposed, for instance, to the majority of chiropractors who do screening X-rays. Yet many Osteopaths have established connections for the referral of patients for laboratory or instrumental investigations if the clinical picture is unclear. Sometimes it is necessary to refer a patient back to his/her doctor. As a rule (except in the USA) Osteopaths cannot refer a patient to see a specialist.