What Are the Most Useful Osteopathic Tests? – Sacral Musings – Osteopathy Community

What Are the Most Useful Osteopathic Tests?

Each of us will regularly use a number of tests when examining patients, each test having a part to play in providing a complete diagnosis. Tests also help to evaluate a patient’s response to treatment, as well as to serve as differential diagnosis during the initial consultation. 

Some tests tend to be more reliable than others, and many tests in the teaching manuals are rarely used because they are forgotten in time.

Please think of some of the tests you like to use in practice. 

• When and why do you use them?

• What is your rational in using one whilst excluding others?

• Do you conduct some tests all the time and with every patient?


I’ve listed three tests below that I regularly use with more or less every patient as they help me understand flexibility patterns, gait, specific areas of weakness and stress levels. I test them regularly and mark them as +/- and on an objective scale of 0-10 (high=excellent, low=poor)

I also ask the patient to provide their subjective input using the same criteria.


• Adam’s Test
This gives a simple visual test for pelvic symmetry and is used in functional or anatomical scoliosis assessment. In addition to the static test, which allows for the diagnosis of short leg conditions, the patient can be asked to conduct an active version of this test. Lateral flexion, flexion and rotation of the trunk on the pelvis may be a useful addition to diagnosing limited active range.

Adams test is a simple tool, which relies on visual parameters. Frequently it is helpful to assess the subject’s active ranges from a distance, as well as close up.

During the active assessment of flexion of the trunk on the pelvis, the assessor’s eyes are lined up horizontally with the Posterior Superior Iliac Spines, with their thumb positioned over the PSIS landmark.

A positive Adams is seen when the spinal column loses its vertical plane relative to the pelvis. The thoraco-lumbar spine produces a torsional deviation from the vertical. One side of the lumbar spine will produce a concavity, the other a convexity. The quadratus lumborum will be palpably shorter on the concave side.

In dynamic short leg conditions where the soft tissues are asymmetric due to factors such as fascial contraction, spasm or nerve irritation, the degree of asymmetry will change quickly over a few days when treatment commences. 

In anatomical or fixed cases where contraction of tissues has occurred over time and with associated calcification and stenosis of adjacent joints, reversal is not anticipated.

The CAO Difference | Classical Osteopathy in Ontario

I just returned from my first module in my second academic year at theCanadian Academy of Osteopathyand I want to share some thoughts. I want to share what I see as the standout qualities of the CAO.

The CAO is a school that is true to its stated purpose – to teach students the principles of Osteopathy so that they may work with any condition effectively and not rely on technique. This is extremely evident in the way that the classes flow between lectures and labs – there is a lecture on a certain subject that discusses the principles of a treatment (including relevant anatomy and physiology) and then it is straight to the tables where students are challenged to apply those principles to a treatment of their lab partner. During the lab all students are questioned and further taught about relevant anatomy and physiology. The principles of Osteopathy are always present and the information is woven together seamlessly. There is never a time when Osteopathy is not being taught. There is no segregation of topics, no time when we as students are dealing with Muscle Energy to the quadratus lumborum and nothing else – we as students are taught the principles of Muscle Energy, Strain – Counter-strain, Myofascial Release, Functional Technique, and every other “Osteopathic technique” and then challenged to create a “technique” using the principles from all different angles and positions. Through this process technique becomes irrelevant to a CAO student, the only thing left is treatment of Osteopathic lesions based on the principles.

Could Cranial motion be in fact an “ideomotor effect” ? – Sacral Musings – Osteopathy Community

In a number of coutries, Osteopathy is becoming or close to be a healthcare profession. This should be considered an honor. But this rise to more responsability asks for a deeper introspection about what is based on belief from what is based on facts. This is especially true for the cranio-sacral concepts of Osteopathy.

Until recently, osteopaths were claiming that they could feel with their amazing palpation the movement of the Cerebro-spinal fluid that was pulsing in the cranium. Later on a few researches have shown that was impossible. Quick, hurry a new theory ! Electro-magnetic pulse? Venous pulse? Contractibility of the dura mater ? Quantum healing? The only research showing some effect of cranial therapy on a body’s rythm was done in 2002 on 23 participants. It shows an effect a smoothening of the Traube-Hering-Mayer pulsations with a cranial approach. This is a bit weak to validate the existency of cranial motion. More than 5 researches were done to see if 2 osteopaths were feeling the same rythm on the same patient. None of them were conclusive! Whilst all the evidences seem to show that cranial motion is non-existent, nonetheless a lot of osteopaths still practice and believe in cranio-sacral therapy and its concept.

Osteopaths do feel a movement, Are you saying that thousands of osteopaths are having palpatory hallucinations ?

Yes and no…

Pain – Is It All In Your Head? | Classical Osteopathy in Ontario

I came across this interesting video onSacral Musings. The basic premise is that pain is not the reality of a situation – it is the efferent modulating response to protect the human organism from stimulus that may be harmful. Watch the video and then read on…

As a student at the Canadian Academy of Osteopathy this concept is often highlighted by Vice Principal Brandon Stevens when he says: pain is born at the dorsal horn but it isn’t pain until it reaches the brain. What we have is a situation where afferent stimulus is assigned meaning in the cerebrum based on past experiences with the stimulus and then the efferent response reflects the meaning that has been assigned to the stimulus (as is evidenced in Mr. Moseley’s explanation of being bitten by the snake). From this it can be inferred that the job of pain is simply protective as it is not indicative of the reality of the stimulus.

What might this mean for an Osteopathic Operator? Stimulus that has created pain for a patient in the past will create efferent responses that will likely be dominated by the sympathetic nervous system. If an Operator does not monitor ALL barriers (including mental – these are palpable in the body and are displayed through efferent responses) then treatment will not have the intended goals. Some pain/discomfort is entirely social – a good example would be the removal of clothing for treatment is not a comfortable thing for most Canadians so I leave my patients fully clothed to avoid the discomfort that may get in the way of an effective treatment. Patients present with different life stories and those will alter the way that an Operator is able to effectively touch them which is one of the reasons that reliance on technique is problematic – if my patient has had an issue with the way their neck has been handled in the past I can not just use standard cervical “techniques”, I will have to understand how else I might effectively use the principles of Osteopathic treatment to work with the mechanics of this individual patient’s cervical spine without scaring them to a point that I am unable to treat them. Every Operator will approach this from different angles and that is fine as long as the patient is provided with effective results.

The Ninth Thoracic Vertebra

The ninth dorsal segment is next on the list for my Marion Clark exploration. A lesion of the ninth dorsal is most often an anterior displacement or a torsion according to Clark. Considering the rotational and flexion bias of the dorsal vertebrae this should be fairly clear. From a pathology point of view the anterior displacement is more likely problematic due to the decrease of size in the intervertebral foramina.

For most people, a lesion of the ninth dorsal segment is most likely to affect thegreater splanchic nerve (due to some quirks of anatomy it may also affect the lesser splanchic nerve for some individuals). As a result of influence over the greater splanchic nerve effects will be seen in the: stomach, spleen, gall bladder, liver, kidney, small intestine, the ascending and transverse colon. It is also important to consider the connections to the celiac ganglia and adrenal medulla via the greater splanchic nerve. Also keep in mind that the greater splanchic nerve passes through the diaphragm on the way to the abdomen making it highly unlikely that any treatment aimed at the ninth dorsal segment or the greater splanchic nerve would be complete without addressing the diaphragm locally as well as neurologically (via thephrenic nerve). According to Clark the most affected viscus is the kidney when the ninth dorsal segment is in lesion.

As always, depending on the nature of the lesion in the ninth dorsal segment there will be excitation or inhibition to neurologically connected areas. If the intervertbral foramina is lessened bilaterally or unilaterally then the lesion will be inhibitory where the foramina is lessened.

Through my present investigation of Clark’s work I am currently very much in the mindset that basing much of my treatment on mechanical principles is the most effective way to provide physiological modulation. I am positive that my viewpoint will continue to evolve and I look forward to it. At the moment I am of the opinion that most results through Osteopathic treatment arise from the balancing of mechanical function – not only is there a display of localized alteration in physiological movement there is also alteration in structurally related physiology. This should be self evident through the principles of Osteopathy – my current point is that most treatment need not be localized to viscera or other specific structures. To provide an engineering reference (similar to what Dr. Still seemed fond of) there is no point fixing the steering wheel if you have a bent chassis – straighten the chassis and then see if the steering wheel needs to be fixed.

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