(or until you feel one of the processes slightly out of line with the others). Then take both thumbs and dig in on either side to feel the transverse processes (but move up a 1/3rd of a level on average because remember the tips of the spinous processes sit lower than the tips of the transverse processes). If one transverse process is notably deeper than the other (and it's a small notable difference but even an OMT skeptic like me can tell the difference), then the vertebra is rotated. You can't really feel sidebending, but take a skeleton and slightly rotate one vertebra and you'll see it naturally take on a small amount of sidebending also because the ways the facets lock together force the concominant conformational change. A segment can't rotate or sidebend in isolation; it has to do both. And yes, a second blinded practitioner can diagnose the same dysfunction.
Obviously I am not a DO, but if I were and I heard this stuff in medical school I would immediately ask for the supporting research. Certainly some of the curious DOs on this board must have done so. Is there research to support this? For example...
You said a second blinded practioner can diagnose the same dysfunction. I guess I should be more clear. I am not asking if a second practitioner who walks in after you to the same back pain patient will "diagnose" vertebral dysfunction. Rather, I am wondering if 25 patients (some with back pain, some without, some with "vertebral dysnfunction", some with radiographically diagnosed subluxation) were examined independently and blindly by two - or better yet, twenty-five - "expert practitioners", how accurate and reproducible would the diagnoses be...and would they be of the same degree at the same location. Of course, I just made up these numbers, but I think you get my point. Where is the research??????
And then, after someone gave me research similar to above, I would want to know what the CT spine showed for these same patients...AND the MRI (to check for ligament injury). This or similar work must have been done, right?!?
I suspect there are many DOs on this board...can someone point me in the direction of this type of research? I know, I know, I can go look it up myself, but certainly DOs must have access to it and have already looked it up or been provided with it during medical school. If no one can, I guess I will try after my shift today or tomorrow.
Lastly, if, in fact, DOs can reliably and accurately diagnose ligament injury of the spine using hands, I am now a bit frightened of DO residents. I am not an attending, but when I am, the last thing I want a resident to be doing is taking one of my patients with a subluxation or ligament injury of the spine and forcefully manipulating the spine!
This may be OK in osteopathic residencies and maybe for some DOs attendings working in allopathic residencies, but I bet the great majority of MD attendings would be furious if a resident started "manipulating" such a spinal injury.
Possibly going off the deep end but still open to being "educated",
HH
**but getting very close to Veers' opinion: "this is utter nonsense"