September 2024 Still Point

School Affiliation: UIW School of Osteopathic Medicine

Author: Jacob Seemann, OMS

Position: Chapter Vice President

Submission Title: On-Hands

On-Hands

“... It is believed that the dominant hand is unconsciously placed on top when the hands are clasped together...Without consciously thinking about it, clasp the hands together in front of the body, with one hand on top of the other … The top hand will most likely be the dominant hand. If one hand is stronger than the other, practice applying equal pressure over equivalent structures, in order to develop accurate interpretation of dominant and nondominant proprioceptive feedback from each hand.”

- Walter C. Ehrenfeuchter, Foundations of Osteopathic Medicine 4th edition

A patient in her sixth decade of life presents to the campus volunteer OMT clinic with Dupuytren’s contractures of the right hand. Following an animal bite of several months past, the patient had reconstructive orthopedic surgery and has since developed tender, severe rigor in the affected hand and forearm. A scene of panic arises as students flip through handbooks and manuals, looking for something that isn’t prolotherapy, enzymatic injections, or dry needling, as we are all out of needles.

What is it that makes us take something for granted?

The patient had previously made her living performing manual therapy. Some students, and certainly a majority of SAAO members, can keenly remember “a-ha” moments from their training and development of palpatory skill. As we progress further in our training, these small patterns become background information of a larger patient picture, but the fact remains that an osteopathic skill lives and dies by the hands of the practitioner and their ability to detect states of disease. Here sat a patient with a keen mutual understanding of that sense. Moreso, here sat a patient whose senses and ability in that domain had been significantly diminished. As Dr. Irvin Korr stated in his 1987 essay Osteopathic principles for basic scientists: “The person is the environment in which parts exist and operate... Inclusion of the human context should, however, be viewed not as denial of the (unquestionable) value of the reductionist paradigm, but as recognition of its in-completeness.” [author’s emphasis]

A student doctor, eager to apply their training in the Fascial Distortion Model, takes up the hand of the patient and began to isolate fascial adhesions. Slowly, deliberately, the student doctor cradles the dorsal aspect of the hand and prods their dominant thumb amongst and between delicate, tightly packed structures, working around and through them. The interaction relaxes and softens as the treatment begins to fall into a rhythm, punctuated by small breaks to stretch the most recently treated finger. An occasional pause and distraction toward muscle energy technique and, “Here. Hold my hand this way.”

Much has been written about the “osteopathic healing touch.” Aside from the physical techniques that we all receive training in, the simple act of reassurance and interpersonal connection that underpins and reinforces the treatment of “spirit” in the osteopathic model of a patient. It takes many varied forms, from the closeness of the physician and careful monitoring during OMM, to something so simple as a reassuring hand on the back while delivering uncomfortable news. What could be more intimate in this context than holding the very tools that had defined a person’s livelihood?

From the other side of the table, I watched the relationship between student and patient change. Hand in hand as the student explained what they were doing in a manner that was intimately familiar to the patient. The fears and tension that had grown in this person’s body from apprehension of painful physical therapy sessions melted away while the student fastidiously, reassuringly sought to restore completeness to their patient.