Let’s talk about how we do an
osteopathic exam to a patient.
Let’s check out our patients.
Let’s see what’s going on with an exam.
That’s our stock and trade. That’s what we do
and every exam starts with
a chief complaint
and a history of present illness.
They start from the patient coming in
and saying, “Here’s why I’m here,”
and in their own words,
they get to start the visit
and they get to guide
where it’s going to focus.
The problem is,
a chief complaint is subjective,
it’s what the patient thinks,
it’s what the patient learned
from the internet,
and it’s what they were told by their
friends, they should focus on.
And it isn’t always what needs
to be focused on.
It’s where we need to start. It
needs to be addressed.
It needs to be taken seriously.
It needs to be repeated so the
patient knows you’re listening.
But we also realize that
subjective is different,
and every time we get a positive,
we ask more questions.
If there’s a pain; what’s the location,
what’s the quality of the pain,
what’s the chronology—when did it start,
when is it worse, when is it better;
what are the associated
manifestations to it.
So those are questions you
ask for every positive
and then you develop a
review of each system.
So were there headaches involved,
are there pain symptoms,
or are there things that make
it better or worse.
You review each positive
and you get more of a picture and
you round out the complaint.
Then, once you’ve got some good clear
understandings of what’s going on,
you do an exam, and the exam is objective.
That’s data we can take to the bank.
It’s data that we see, that
we are determining,
that’s coming from outside the patient
to either validate with
what the patient said
or give us another aspect of what’s going on
that may be related to
what the patient said.
The osteopathic exam is a
It always includes a review of systems
and it starts from the time the
patient enters the room.
Every osteopathic examination should
be done in at least 2 positions—
sitting and standing, standing and walking,
and moving from side to side.
You’re not going to get a view of function
unless the person is functioning.
So it’s not just the structure of the body,
it’s not just anatomy
but how that anatomy is effected by motion.
People complain saying, “But, but,
but it’s so much easier
to look at it in one dimension,
and when we do x-rays, x-rays are anatomic.
We actually take the weight off of
somebody to take the x-ray.
Well chiropractors don’t. Podiatrists don’t.
They want to see the anatomy in action
and we can actually request
that we look at flexion and extension
views of the cervical spines.
Let’s see the motion of it.
Let’s examine it in activity and not
just the anatomy of it.
So the ONMM exam is a dynamic exam.
It’s an exam that starts from the beginning
of the interaction with the patient.
Watch the patient stand up.
Watch the patient move.
And one of the things that I like to note,
and take a note in my mind,
is this person functioning comfortably?
Do they look comfortable or uncomfortable?
And it’s not just the look on their face,
it’s the fluidity of motion.
And I’m going to introduce
Fryette’s laws here.
Fryette’s laws talk about motion.
For a body to be efficient,
if you sidebend right you rotate left.
You displace the force and the weight
amongst as much of the vertebra as possible
and that means that a person is healthy.
If somebody can’t use their muscles well
and they need to use their larger muscles,
they’re going to override
some of the suppler movements
and they’ll sidebend right, rotate right to
use the larger muscles to push up.
That’s someone who’s going
to look uncomfortable,
who’s going to look weak,
and you know they’ve got problems
that are going beyond pain they
may be presenting with
and it may be weak muscles,
it may be hypertrophied muscles,
it may be nutritional, and it may
be hormonal or endocrine.
Those are all things you need to look at.
So the musculoskeletal functioning,
whether they’re in neutral mechanics
or non-neutral mechanics,
tells you a lot.
And we have a 10-step exam as
a way of examining people
that can give you all the
information you need
to see if the person will benefit from
the treatments we have to offer them
because you don’t treat somebody
without a diagnosis
and you don’t diagnosis somebody
without examining them
and getting their history
and doing a physical.