As an Osteopathic student (and future Operator) it is imperative that I am able to perform an Osteopathic Structural Diagnosis. What is an Osteopathic Structural Diagnosis? I will do my best to explain with my current knowledge.
An Osteopathic Structural Diagnosis is a physical examination that requires knowledge of anatomy to test the structures of the body and a knowledge of physiology to understand how any structural abnormalities may affect bodily functions. It differs from standard medical diagnosis in that an Osteopathic Structural Diagnosis is not looking for conditions, it is looking for structural abnormalities.
Knowledge of anatomical structures is critical as it will allow an Operator to utilize a rational testing methodology. The intent of the Osteopathic Structural Diagnosis is to see if a structure will do what it is supposed to do. As an example, when testing the lumbar spine flexion and extension in the sagittal plane are the primary movement characteristics due to the superior facets being directed medially and the inferior facets being directed laterally (think of a boat in a lock – it doesn’t have much room to wiggle sideways). There is side-bending and rotation available in the lumbar spine so it must be tested and there are both static and dynamic tests to do this. The important thing to keep in mind are coupled movements as described in Fryette Mechanics.
To delve a bit deeper, when a structural abnormality is tested and diagnosed, the Operator now needs to start making connections. If there is a structural abnormality in the lower limb the Operator needs to recognize where they are on the lower limb and know what nerve root in the lumbar spine is responsible for the function of the area. The Operator then needs to go about determining whether the primary cause of the lesion (structural abnormality) is in the lower limb, in the lumbar spine, or somewhere in between. To do that the Operator needs to use their knowledge of anatomy and physiology to start differentiating between issues to determine if there is an issue in the soft or hard tissues and where along the path of the nerve, artery, vein, and lymphatic supply to the area there is a causative lesion.
The Operator also needs to be considering tissue texture as physiological responses will manifest differentially in the skin.
Although I am only describing some of the things that an Operator is considering during an Osteopathic Structural Diagnosis it should be obvious that there are a lot of levels to the process. As Dr. Still often stated, an Operator must have a clear picture of anatomy in their mind at all times. With a clear understanding of anatomy (structure) the Operator can find structural abnormalities that alter related functions so that they may rationally remove the structural issues. When doing an Osteopathic Structural Diagnosis always be sure that dynamic testing is more important than static testing, every plane and axis is checked, and all somatic dysfunctions are noted.
As I am able to perform more Osteopathic Structural Diagnoses I will continue to revisit this topic with new insight. For now, I have laid it out there for everyone to get an initial understanding of the who, what, when, where, why, and how of an Osteopathic Structural Diagnosis.