by Dr. Corey Campbell, DC - Vice President - MPI
It’s graduation day and you are excited and maybe a little scared. You have done all that has been asked from the college AND MORE. You have taken weekend classes in DNS, ART, SFMA, FMS, MPI, GRASTON, MCKENZIE, K-TAPE, NKT, etc. You can throw so many letters behind your DC that you need an 8X12 sheet, not a business card. Now what? What do you do with all this, and how do you get people to know how much you know?
Answer: You start with your hands.
But you’re more than your hands…right!? You learned how to adjust and palpate, so why would you start there? We can all do that…you are that and more. You know more than the majority of the profession, so you don’t have to be good with your hands to get people better, and all you have to do is build a model around your intelligence…and those letters…all those letters and certifications.
All of this is true and false all at the same time. Students and new doctors are inundated with a large number of great classes they can attend and certifications that they can achieve. Some classes can teach you how to release muscles, how to be a functional master, how to help disc herniations reduce, how to eliminate trigger points with needles, how to manage a practice, and so on and so on. We (the instructors of the Motion Palpation Institute) have taken a large number of these classes and what we have found is that practice building, sustainability, and the buy-in would never have been there for these other things had we not been really good with our hands first. Students have so many options now that they may not truly understand, respect, or love the art of palpation and adjusting. There is more than enough evidence to support adjusting/manipulation as an effective treatment tool, but most new (and some not so new) DC’s don’t give it much credence or priority. The evidence-based movement will discredit the palpation as a valid diagnostic tool for the joint, but it’s an art, and there are many valid reasons it doesn’t hold up under research studies and trials.
It’s hard, and there is no protocol or algorithm or pictures or numbers and…it’s hard. There are only hours, months, and years of practice in front of you to be good at palpating. You can learn other things quickly, and they have numbers, pictures, and protocols. We get it, and we have done it, and it all has value, and it will help you expand your toolbox. This is important for a profession that prides itself on “thinking outside of the box.” The problem is most don’t have mastery of what is inside the box before they start heading out of it. Inside the box is the joint system, the muscle system, and the CNS. If mastery is attained there first, then you do not need to leave the box… you simply expand its boundaries to fit your ever-expanding skill and knowledge set. Mastery starts by understanding how the joint system works and then being able to assess it through palpation. Of all the examination procedures you incorporate, palpation will be the hardest to master but will give you massive amounts of valuable information, and it will help you connect to the patient in a way that gets them out of the left brain (thinking) and into the right brain (feeling or limbic). It will build confidence in you as a clinician because the better you get at palpating, the better your adjusting becomes because you’ll be on the restriction and you’ll know exactly what plane or axis needs to be affected. Your patient will know he/she is in the right place because they will be able to FEEL the same thing you FEEL and that moves them into the right brain, and that breeds CONFIDENCE and ENTHUSIASM… two things my friend and colleague, Dr. Brett Winchester, says every successful clinician must have.
Does this mean that we don’t use all of the other really good manual therapy techniques out there? No, we use many different techniques and tools in patient treatment, but we let our thorough exam guide us to the set of skills and techniques that will be best employed at that time with that patient. This thorough evaluation allows us to have fun because then we get to use and integrate the techniques and tools that best fit the patient versus the same thing on every patient. We let the exam tell us what to plug in! We let our findings guide our treatment. This frees us from symptoms, forces us to be informed and skillful at other things, and creates an environment of team with you and the patient. The ultimate confidence, however, comes from our ability to assess and treat a patient with our hands. Our palpation skills become a default, much like a great orthopedic surgeon will default to his testing over MRI findings. We will be able to do this is because we have deliberately practiced and continued to try and master that very thing that makes us unique, that very thing that makes us chiropractors…palpation and adjusting.
The father of manual medicine, Karel Lewit, MD once said that “the problem with palpation isn’t its reliability, it’s that people won’t take the time to get good at it.” All joints work along three axes of rotation with 6 degrees of motion (flexion, extension, right and left lateral bending, and right and left rotation) and muscles that attach to this structure can affect those motions. Our job as DC’s is to 1.) Serve our patients with love, respect, and expertise and 2.) Be ABSOLUTE MASTERS of the above system and be able to assess it and treat it based on those findings. The best way to assess the joint system is to be able to palpate the joints and the muscles associated with the kinetic chain. Can you do functional/movement assessment, neurological testing, orthopedic testing, end range loading, and a good history and get that information? No. You can get extremely valuable information from those tests and approaches, and we use all of those in our evaluation, but you can’t get a true view of how joints are or are not working without using your hands…and there is no other way that is superior to palpation…none. Yes, you can get information from functional screening where joint motion may be lacking (step down testing, movement screens, T4 and hip extension testing, etc.) but it will not tell you what axis is restricted or how to treat it…that information comes from your palpation…your hands.
The Motion Palpation Institute(MPI) feels we are at a unique crossroads in our profession. One in which we have so much useful information that we are swimming in information but drowning in application and integration. We also feel that we are on the verge of exploding as a profession that has all of the best in holistic health care options. Chiropractors may very well be the last line of defense for our patients. We are truly the last holistic and drugless direct access to healthcare professionals. We may very well be the last true HEALTH advocates. I personally can say what started out as an interest, became a job, then a career is now a true calling for me.
We feel proud that we are a hands-on profession but are worried that we don’t give our hands enough credence, practice, and respect as diagnostic (palpation) and therapeutic (adjusting, soft tissue work) healing tools. There is no easy way to gain mastery in palpation, but easy never forged greatness. There are no algorithms we can give you to plug in right away. MPI can show you a systematic way to palpate the kinetic chain, and those palpations may lead to more palpations and so on go your hands…putting pieces of the musculoskeletal system puzzle together. We truly feel it’s time we take back pride in our profession and its hands-on the foundation. MPI feels it’s time we once again seek excellence in the skill and the art of palpation, adjusting, and integration (knowledge). It’s time to do away with being a technician and doing the same thing over and over again with no diagnostic reasoning. It’s time to revel in the grind, push our potential, seek mastery in our hands, our minds and our hearts and push the boundaries of our box outward until all our patients and potential patients see what an amazing healing capacity the profession can provide. That time is now and now is your time.