Background: Palpation is considered as much an art as a science. Its teaching therefore presents many challenges. Four main issues have been described in the manual therapies scientific literature and should be addressed to improve palpation teaching: hand positioning, amount and direction of force and interpretation of tissue response. Additionally and specifically to osteopathy, interpreting palpatory findings using the concept of somatic dysfunction is a potential source of confusion for students and educators, as terminology is not consistent and different concepts coexist. Purpose: To analyze the variations in terminology connected with the different theories surrounding palpation for diagnosis and treatment used in current professional, educational and scientific osteopathic literature. Methods: Educational and professional guidelines, governmental and non-governmental organizations' official documents and scientific publications were searched. Results: Different and even contradictory models currently coexist in palpation teaching for (1) diagnosis: somatic dysfunction has different physiological models and models for stages of severity, and for (2) treatment: the barrier concepts, and the classification of techniques according to their theoretical physiological effects or the nature of the force required. Discussion: Some theories and terminologies conflict with current scientific evidence, particularly for non-palpable deep structures and rhythms described only in osteopathic literature. Terminology for associated palpatory findings should therefore be carefully chosen. The current use of non-standardized terminology within the profession is a potential source of confusion for students, perhaps in part because the somatic dysfunction model does not fit with some recent osteopathic technique branches. As osteopathy is a complex intervention, teaching should focus on palpatory findings and health outcomes rather than hypothetical physiopathological mechanisms. Conclusion: Efforts should be made by osteopathic educators to simplify the description of palpation and use simple, evidence-based terminology. This could then help students to interpret palpatory findings within the model described in order to use them correctly and confidently in a clinical setting.
Rafael Zegarra-Parodi is currently involved in osteopathic practice, teaching and research in France. He gained his Diploma in Osteopathy at the BCNO (now BCOM) in 1997. He holds academic degrees in Education (University of Tours, 2008), in Clinical Research Methodology (University of Bordeaux 2, 2009) in Statistics (University of Bordeaux 2, 2010) and in Epidemiology (University of Bordeaux 2, 2011). He is in private practice in Paris with his wife Pauline. He has lectured in osteopathic structural techniques and in osteopathic diagnosis since 1999 and has been head of the Research department at CEESO since 2004. His main research interests are the neurophysiology of manipulations, their influences on pain perception and the reliability of osteopathic tests. He has published many papers and presented his research in various medical, scientific and osteopathic congresses both nationally and internationally. He is currently involved as a scientific advisor in two osteopathic randomized clinical studies in Paris hospitals.