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:
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”
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’