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Palpation skills
126
Complementary Therapies in Medicine
graduates is a tribute to his organization and teaching methods. The book Specific Adjusting Technique contains three sections: Historical and theoretical basis, Etiology and diagnosis, and Techniques, together with six reference appendices. In the first section, the author discusses his concepts of the osteopathic lesion and its positional and functional aspects. In the second section, detailed guidance is given in the examination and assessment of the patient. The information on radiographic analysis is to be welcomed, since most SAT practitioners would consider that the importance of radiographic evidence as a guide to treatment is too often neglected by the osteopathic profession. If there were to be a criticism, it would be that this section could, with advantage, have been fuller. Concerning actual technique, I feel sure that Tom Dummer would be the last to advocate learning techniques from a book. However, this section does provide invaluable guidance and orientation for a trained osteopath wishing to explore SAT. The inclusion of the fairly extensive details of the management of five individual cases is particularly valuable. The choice of adjustment(s) to be given at each stage forms the keystone of successful treatment rationale and distinguishes the proficient artist from the empirical manipulator. Whilst SAT is principally concerned with the application of mechanical procedures, the orientation of 'the person behind the hands' is always important - without appropriate inspiration guiding his/her hands, the osteopath's treatment is likely to be mundanely mechanical. Tom Dummer fills the reader in with important philosophical considerations. The Appendices contain interesting material: Appendix 1 is on the Frymann Phenomenon which is relevant to the craniosacral concept. Appendix 2 discusses Dr Laborit's oscillation post-stress reaction. Appendix 3 gives further consideration to the application of technique in relation to functional, structural and positional lesions. Appendix 4 discusses the sacral toggle technique. Appendix 5 is devoted to the interaction between body chemistry and osteopathy as put forward by Dr Dudley Tee, with whom Parnell Bradbury had collaborated on a research basis for many years. In Appendix 6 Mr Dummer mentions some aspects concerning non-responsive patients. Taken together, the Appendices give a balanced view which prevents the reader looking upon SAT entirely as a mechanical procedure. Having myself given courses in the Bradbury method, my feeling is this book clearly fills a gap in the existing literature and will appeal both as a handy reference for ESO graduates and others desirous of acquiring more specific knowledge.
Keith Lamont, Practising Osteopath, Basingstoke, Hants, UK
Palpation skills by Leon Chaitow Edinburgh: Churchill Livingstone, 1996. xiii+283pp. £30 (paper) ISBN: 0 443 05320 0 There are few texts in the area of palpatory studies. Thus, to have such a well-illustrated tome is a pleasure. In its breadth Chaitow's book is probably the best on the subject. What I believe he has done is to have collected the views of the major schools of palpatory thought, and then skilfully cross-referenced and categorized them into chapter headings. The rich historical legacy that palpatory studies owe to the osteopathic profession seems to be indicated by the fact that many of the authorities quoted are osteopaths, and most of the references are to the osteopathic literature. The writer of this book is a well-known and respected osteopathic and naturopathic practitioner of many years' experience and is the author of several books. His book aims to help both the experienced practitioner/therapist and the student attain confidence and hopefully excellence in palpatory literacy, i.e. to learn how to palpate. His beautiful definition of palpatory excellence, he believes, arrives at that time when a skilled practitioner can intuitively switch from palpation to treatment and back again. Sadly, though, the interpretation of the information obtained from palpation is beyond the remit of his text. He provides a catalogue of some extremely useful, although occasionally logistically impractical (for example simultaneous palpation of living and cadaverous tissue), palpatory exercises. As an aid to the learning experience, either as a student text or for self study, it would be useful to have far more illustrations to consult. The early chapters examine the value of palpation and also give basic guidance in the form of structured exercises on how to develop this skill. One area where Chaitow extends the remit of the book and crosses the ill-defined boundary between palpation and treatment is in the chapter on palpation of muscle. Here, the author makes reference to Neuro-Muscular Technique, Jones' Tender Points, Travell and Simons Trigger Points, Chapmens Neuro Lymphatic Reflex Points, and Lewit's Periosteal Pain Points. Perhaps the area of the book that may be the most contentious for some osteopaths and some manual medicine practitioners is the palpation of subtle movements including that of cerebrospinal fluid circulation, energy layers, energy cysts, chakras, restricted energy flow, and energy palpation and zero balancing. It is possible that this chapter may lessen the scientific and theoretical credibility of the book in those who are completely closed to the idea that everything in the area of manual medicine can be easily explained through conventional scientific thought.
Reviews a n d c u r r e n t literature
T h e c h a p t e r on the spine a n d pelvis has over 40 exercises a n d tests o f a p a l p a t o r y a n d d i a g n o s t i c nature. I t w o u l d also be a very useful section for m a n y m e d i c a l s t u d e n t s to s t u d y in o r d e r to a p p r e c i a t e the d i a g n o s t i c c o m p l e x i t y involved in the analysis o f spinal dysfunction. T h e final three c h a p t e r s o n visceral p a l p a t i o n a n d b r e a t h i n g f u n c t i o n assessment, palpation without touch, and palpation and emot i o n a l states, rightly help to extend the scope o f palp a t o r y studies b e y o n d their t r a d i t i o n a l b o u n d a r i e s . H e r e again, the a u t h o r challenges the r e a d e r to o p e n u p to n o n - c o n v e n t i o n a l views o f p a l p a t o r y t h o u g h t . W h e r e the b o o k suffers is in the l a c k o f any indicat i o n o f the relative i n t r a - a n d i n t e r - r a t e r reliability, specificity a n d sensitivity o f the v a r i o u s p a l p a t o r y a n d d i a g n o s t i c tests; hence the r e a d e r m a y well end u p with a broader range of palpatory and diagnostic p r o c e d u r e s b u t m a y n o t necessarily k n o w which are the b e s t to use in w h i c h circumstances. Hopefully, the a u t h o r will r e m e d y this situation in the next edition, o r will p e n a c o m p a n i o n volume. W h e r e I w o u l d also disagree w i t h the a u t h o r ' s wishful t h i n k i n g is where he says t h a t 'the reliability a n d a c c u r a c y ' o f p a l p a t i o n h a s been 'well established'; in m y o p i n i o n , it has not. A s a b o o k for s t u d e n t s s t u d y i n g the p a l p a t o r y elem e n t o f a course, this v o l u m e with all its exercises w o u l d b e w o r t h the i n v e s t m e n t a n d m a y well serve as the m a i n b o o k to a c c o m p a n y a syllabus in p a l p a t o r y studies. Several o f its c h a p t e r s w o u l d also be o f value in a course in m a n u a l m e d i c i n e diagnosis.
Alan 0 Szmelskyj, Registered Osteopath; Research Fellow, British School of Osteopathy, London, UK
BOOKS RECENTLY RECEIVED Advances in chioropractic, voi 2. Editor-in-Chief: DJ Lawrence. St Louis: Mosby, 1996. 520pp. £35. ISBN: 0 8151 5308 2.
127
Bai, Xinghua. Acupuncture in clinical practice: a practical guide to the use of acupuncture and related therapies. Oxford: Butterworth-Heinemann, 1996. 286pp. £27.50. ISBN: 0 75062670 4. Barnett, Robert A. Tonics. New York: HarperPerennial, 1997. 256pp. £7.99 (paper). ISBN: 0 06 095111 7. [Naturopathy] British herbal pharmacopeia 1996. Completely revised by Scientific Committee. 4th edn. British Herbal Medicine Association, 1996. 212pp. £50. ISBN: 0 903032 10 x. Candegabe EF. Comparative materia medica. Beaconsfield: Beaconsfield Publ, 1997. 352pp. £24.50 (paper). ISBN: 0 906584 36 1. Cant, Sarah & Sharma, Ursula, eds. Complementary and alternative medicines: knowledge in practice. London: Free Association Books, 1996. 220pp. £15.95 (paper). ISBN: 1 85343 352 7 [FAB Ltd, 57 Warren Street, London Wl0 5PA] Horrigan, Carol, ed. Relaxation for concentration, stress management and pain control, using the Fleming Method. (From the work of Ursula Fleming, compiled by Anne Fleming). Oxford: Butterworth-Heinemann, 1997. xiv+155pp. £14.95 (paper). ISBN: 0 7506 2439 6. McKone, W Llewellyn. Osteopathic athletic health care: principles and practice. London: Chapman & Hall, 1997. 394pp. £24.99 (paper). ISBN: 0 4125 9090 5. McNamara, Sheila & Song Xuan Ke. Traditional Chinese medicine. London: Hamish Hamilton, 1997. 288pp. £12 (paper). ISBN: 0 241 00190 0. Micozzi, Marc S, ed. Fundamentals of complementary and alternative medicine. New York: Churchill Livingstone, 1996. 303pp. ISBN: 0 443 05355 3. [paperback edn of original published in 1994] Tobyn, Graeme. Culpeper's medicine: the traditional practice of Western holistic medicine. Shaftesbury: Element, 1997. 256pp. £16.99. ISBN: 1 85230 943 1. Yan, Wu & Fischer, Warren. Practical therapeutics of traditional Chinese medicine. Brooklyn, Mass: Paradigm, 1997. 600pp. £35. ISBN: 0 912111 39 9.
NEW JOURNALS FACT: Focus on alternative and complementary therapies. Vol 1 no 1-, December 1996-. Dept Complementary Medicine, Postgraduate Medical School, University of Exeter. Quarterly. UK/Europe £40 (institutions £70); ROW £50 (institutions £80) p.a. [Summaries, commentaries, book reviews, literature surveys, events calendar, contents pages] Proof!: what works in alternative medicine. Vol 1 no 1-, Autumn 1996-. London: Consumer Medical Reports, 4 Wallace Road, London N1 2 PG. Quarterly. £18.75pa. ISSN: 1364-6931.
Some of these titles will be reviewed in future issues.
Complementary Therapies in Medicine
graduates is a tribute to his organization and teaching methods. The book Specific Adjusting Technique contains three sections: Historical and theoretical basis, Etiology and diagnosis, and Techniques, together with six reference appendices. In the first section, the author discusses his concepts of the osteopathic lesion and its positional and functional aspects. In the second section, detailed guidance is given in the examination and assessment of the patient. The information on radiographic analysis is to be welcomed, since most SAT practitioners would consider that the importance of radiographic evidence as a guide to treatment is too often neglected by the osteopathic profession. If there were to be a criticism, it would be that this section could, with advantage, have been fuller. Concerning actual technique, I feel sure that Tom Dummer would be the last to advocate learning techniques from a book. However, this section does provide invaluable guidance and orientation for a trained osteopath wishing to explore SAT. The inclusion of the fairly extensive details of the management of five individual cases is particularly valuable. The choice of adjustment(s) to be given at each stage forms the keystone of successful treatment rationale and distinguishes the proficient artist from the empirical manipulator. Whilst SAT is principally concerned with the application of mechanical procedures, the orientation of 'the person behind the hands' is always important - without appropriate inspiration guiding his/her hands, the osteopath's treatment is likely to be mundanely mechanical. Tom Dummer fills the reader in with important philosophical considerations. The Appendices contain interesting material: Appendix 1 is on the Frymann Phenomenon which is relevant to the craniosacral concept. Appendix 2 discusses Dr Laborit's oscillation post-stress reaction. Appendix 3 gives further consideration to the application of technique in relation to functional, structural and positional lesions. Appendix 4 discusses the sacral toggle technique. Appendix 5 is devoted to the interaction between body chemistry and osteopathy as put forward by Dr Dudley Tee, with whom Parnell Bradbury had collaborated on a research basis for many years. In Appendix 6 Mr Dummer mentions some aspects concerning non-responsive patients. Taken together, the Appendices give a balanced view which prevents the reader looking upon SAT entirely as a mechanical procedure. Having myself given courses in the Bradbury method, my feeling is this book clearly fills a gap in the existing literature and will appeal both as a handy reference for ESO graduates and others desirous of acquiring more specific knowledge.
Keith Lamont, Practising Osteopath, Basingstoke, Hants, UK
Palpation skills by Leon Chaitow Edinburgh: Churchill Livingstone, 1996. xiii+283pp. £30 (paper) ISBN: 0 443 05320 0 There are few texts in the area of palpatory studies. Thus, to have such a well-illustrated tome is a pleasure. In its breadth Chaitow's book is probably the best on the subject. What I believe he has done is to have collected the views of the major schools of palpatory thought, and then skilfully cross-referenced and categorized them into chapter headings. The rich historical legacy that palpatory studies owe to the osteopathic profession seems to be indicated by the fact that many of the authorities quoted are osteopaths, and most of the references are to the osteopathic literature. The writer of this book is a well-known and respected osteopathic and naturopathic practitioner of many years' experience and is the author of several books. His book aims to help both the experienced practitioner/therapist and the student attain confidence and hopefully excellence in palpatory literacy, i.e. to learn how to palpate. His beautiful definition of palpatory excellence, he believes, arrives at that time when a skilled practitioner can intuitively switch from palpation to treatment and back again. Sadly, though, the interpretation of the information obtained from palpation is beyond the remit of his text. He provides a catalogue of some extremely useful, although occasionally logistically impractical (for example simultaneous palpation of living and cadaverous tissue), palpatory exercises. As an aid to the learning experience, either as a student text or for self study, it would be useful to have far more illustrations to consult. The early chapters examine the value of palpation and also give basic guidance in the form of structured exercises on how to develop this skill. One area where Chaitow extends the remit of the book and crosses the ill-defined boundary between palpation and treatment is in the chapter on palpation of muscle. Here, the author makes reference to Neuro-Muscular Technique, Jones' Tender Points, Travell and Simons Trigger Points, Chapmens Neuro Lymphatic Reflex Points, and Lewit's Periosteal Pain Points. Perhaps the area of the book that may be the most contentious for some osteopaths and some manual medicine practitioners is the palpation of subtle movements including that of cerebrospinal fluid circulation, energy layers, energy cysts, chakras, restricted energy flow, and energy palpation and zero balancing. It is possible that this chapter may lessen the scientific and theoretical credibility of the book in those who are completely closed to the idea that everything in the area of manual medicine can be easily explained through conventional scientific thought.
Reviews a n d c u r r e n t literature
T h e c h a p t e r on the spine a n d pelvis has over 40 exercises a n d tests o f a p a l p a t o r y a n d d i a g n o s t i c nature. I t w o u l d also be a very useful section for m a n y m e d i c a l s t u d e n t s to s t u d y in o r d e r to a p p r e c i a t e the d i a g n o s t i c c o m p l e x i t y involved in the analysis o f spinal dysfunction. T h e final three c h a p t e r s o n visceral p a l p a t i o n a n d b r e a t h i n g f u n c t i o n assessment, palpation without touch, and palpation and emot i o n a l states, rightly help to extend the scope o f palp a t o r y studies b e y o n d their t r a d i t i o n a l b o u n d a r i e s . H e r e again, the a u t h o r challenges the r e a d e r to o p e n u p to n o n - c o n v e n t i o n a l views o f p a l p a t o r y t h o u g h t . W h e r e the b o o k suffers is in the l a c k o f any indicat i o n o f the relative i n t r a - a n d i n t e r - r a t e r reliability, specificity a n d sensitivity o f the v a r i o u s p a l p a t o r y a n d d i a g n o s t i c tests; hence the r e a d e r m a y well end u p with a broader range of palpatory and diagnostic p r o c e d u r e s b u t m a y n o t necessarily k n o w which are the b e s t to use in w h i c h circumstances. Hopefully, the a u t h o r will r e m e d y this situation in the next edition, o r will p e n a c o m p a n i o n volume. W h e r e I w o u l d also disagree w i t h the a u t h o r ' s wishful t h i n k i n g is where he says t h a t 'the reliability a n d a c c u r a c y ' o f p a l p a t i o n h a s been 'well established'; in m y o p i n i o n , it has not. A s a b o o k for s t u d e n t s s t u d y i n g the p a l p a t o r y elem e n t o f a course, this v o l u m e with all its exercises w o u l d b e w o r t h the i n v e s t m e n t a n d m a y well serve as the m a i n b o o k to a c c o m p a n y a syllabus in p a l p a t o r y studies. Several o f its c h a p t e r s w o u l d also be o f value in a course in m a n u a l m e d i c i n e diagnosis.
Alan 0 Szmelskyj, Registered Osteopath; Research Fellow, British School of Osteopathy, London, UK
BOOKS RECENTLY RECEIVED Advances in chioropractic, voi 2. Editor-in-Chief: DJ Lawrence. St Louis: Mosby, 1996. 520pp. £35. ISBN: 0 8151 5308 2.
127
Bai, Xinghua. Acupuncture in clinical practice: a practical guide to the use of acupuncture and related therapies. Oxford: Butterworth-Heinemann, 1996. 286pp. £27.50. ISBN: 0 75062670 4. Barnett, Robert A. Tonics. New York: HarperPerennial, 1997. 256pp. £7.99 (paper). ISBN: 0 06 095111 7. [Naturopathy] British herbal pharmacopeia 1996. Completely revised by Scientific Committee. 4th edn. British Herbal Medicine Association, 1996. 212pp. £50. ISBN: 0 903032 10 x. Candegabe EF. Comparative materia medica. Beaconsfield: Beaconsfield Publ, 1997. 352pp. £24.50 (paper). ISBN: 0 906584 36 1. Cant, Sarah & Sharma, Ursula, eds. Complementary and alternative medicines: knowledge in practice. London: Free Association Books, 1996. 220pp. £15.95 (paper). ISBN: 1 85343 352 7 [FAB Ltd, 57 Warren Street, London Wl0 5PA] Horrigan, Carol, ed. Relaxation for concentration, stress management and pain control, using the Fleming Method. (From the work of Ursula Fleming, compiled by Anne Fleming). Oxford: Butterworth-Heinemann, 1997. xiv+155pp. £14.95 (paper). ISBN: 0 7506 2439 6. McKone, W Llewellyn. Osteopathic athletic health care: principles and practice. London: Chapman & Hall, 1997. 394pp. £24.99 (paper). ISBN: 0 4125 9090 5. McNamara, Sheila & Song Xuan Ke. Traditional Chinese medicine. London: Hamish Hamilton, 1997. 288pp. £12 (paper). ISBN: 0 241 00190 0. Micozzi, Marc S, ed. Fundamentals of complementary and alternative medicine. New York: Churchill Livingstone, 1996. 303pp. ISBN: 0 443 05355 3. [paperback edn of original published in 1994] Tobyn, Graeme. Culpeper's medicine: the traditional practice of Western holistic medicine. Shaftesbury: Element, 1997. 256pp. £16.99. ISBN: 1 85230 943 1. Yan, Wu & Fischer, Warren. Practical therapeutics of traditional Chinese medicine. Brooklyn, Mass: Paradigm, 1997. 600pp. £35. ISBN: 0 912111 39 9.
NEW JOURNALS FACT: Focus on alternative and complementary therapies. Vol 1 no 1-, December 1996-. Dept Complementary Medicine, Postgraduate Medical School, University of Exeter. Quarterly. UK/Europe £40 (institutions £70); ROW £50 (institutions £80) p.a. [Summaries, commentaries, book reviews, literature surveys, events calendar, contents pages] Proof!: what works in alternative medicine. Vol 1 no 1-, Autumn 1996-. London: Consumer Medical Reports, 4 Wallace Road, London N1 2 PG. Quarterly. £18.75pa. ISSN: 1364-6931.
Some of these titles will be reviewed in future issues.