Hands pressed together representing palpation


Palpation skills are paramount to effective osteopathic practice, but teaching students how to palpate and learning palpation is a real pedagogical challenge.

The Centre Ostéopathique du Québec have been using a ‘7-step’ palpation method, described with the acronym P.A.L.P.A.T.E.,  in an attempt to provide a stronger framework for their learners to develop their palpation skills:

A table showing the details of the 7-step palpation method

In a paper by Andrée Aubin et al, the details and challenges of the 7-step method are discussed, and it is interesting for both newcomers to palpation and those who have more experience in the field. In relation to the effectiveness of the 7-step method the authors state:

“…students seemed more confident and, as predicted, demanded less external validation in technique classes. They understood more clearly the stakes of palpation and the importance of repeating each technical movement. They stayed focused for longer periods in practice sessions and have shown more interest in the palpation process itself rather than in its final result alone.

Some of the higher-level students, who were not systematically exposed to this palpation method and who had major difficulties developing palpation skills, showed interest for this new learning tool in individual follow-ups and have, for the majority, greatly improved their technical performance afterward”

Of course, Rollin E. Becker’s work  ‘Diagnostic Touch: Its Principles and Application’  is required reading for those interested in working in OCF, particularly when thinking of the concept of the ‘fulcrum’ which is not addressed in the 7-step method despite the author stating that it was primarily used for teaching Cranial Osteopathy.  Becker was always very much concerned with developing a ‘listening approach’, and stated

“It was by deliberately taking the patient’s opinion and setting it aside, taking my diagnosis and setting it aside, and going to the structure-function of the anatomical-physiological mechanisms of the patient’s body that I was able to acquire this knowledge”

Ultimately, palpation is a life-long self-development journey, and every osteopath is responsible for improving this skill throughout their working life. Better palpatory understanding helps us to get closer to the ‘truth’ of the presenting problem in the way that the person’s body knows it – again Becker puts it most clearly:

“A diagnostic touch is as essential in the accuracy of determining the diagnosis of a patient’s problem as is the routine physical examination and the tests made by the laboratory and scientific instruments”


Our upcoming 5-day course provides more guidance and practical help with developing your palpation skill


1. Aubin, A., Gagnon, K. & Morin, C. The seven-step palpation method: A proposal to improve palpation skills. Int. J. Osteopath. Med. 17, 66–72 (2014).

2. Becker, R.E., Diagnostic Touch: Its Principles and Application, Parts 1-4 Life In Motion – The Osteopathic Vision of Rollin E. Becker, Edited by Rachel Brooks

‘Hands’ image by ‘Obraprima’

Tree Pangolin showing scales

Pangolins and the Art and Science of Cranial Osteopathy

Researcher Graham Scarr D.O. has proposed a biological mechanism to explain Cranial Osteopaths’ awareness of helical movement in the fasciae of patients’ limbs, when palpating the cranial mechanism (phew!).

animated sinusoidal helixes

‘Helix’ by de:Benutzer:Averse [CC-BY-SA-2.0], via Wikimedia Commons

See here for the full article:

His published research on ‘Myofascial Helixes’ explains that the intersection angles of collagen fibres are critical to the physiology of connective tissues, and that the structure of a Pangolin’s skin illustrates this point. However, disturbances in the arrangement of these helixes at both a macro and microscopic level could play a part in chronic musculoskeletal limb disease, such as tennis elbow, due to disturbances in cellular nutrition associated with reduced tissue movement.

For those of you also treating dogs, horses and other animals, Scarr also proposes that ‘this pattern may be an intrinsic part of mammalian limb development’.

If you’d like to begin to understand some of the science behind our experience of palpation, this is a great place to start.


(Pangolin Image By Valerius Tygart (Own work) [CC-BY-SA-3.0 or GFDL], via Wikimedia Commons)