Imaging technology and somatic dysfunction theory.

osteopaths, and others who practice manipulative therapy), it is not possible to bypass soft tissue to reach bony processes. Because these structures may be several inches below skin level (in my practice, I have commonly observed 4 inches below skin level in muscular adult men during back surgery, and sometimes more in cases of obesity), the question of the reliability of palpatory information, motion testing, and interexaminer reliability logically arises. Practitioners who have a high regard for their sensory prowess may not question their palpatory abilities. Anecdotes abound in which certain practitioners have been able to localize a hair lying on a table through a thick telephone directory. Practitioners who have some doubt concerning their sensory abilities may be more comfortable if their impressions are confirmed by a colleague. Still others remain doubtful despite confirmation by 1 or more colleagues— they all could be wrong in a given case. With more recent advances in imaging technology, it is possible to clarify some of these issues. Regarding assessment of the linear and angular range of motion for each of the 3 components of a given case of somatic dysfunction, the distance of an examiner’s palpating finger or thumb from the center of intervertebral movement would be a crucial factor. The question of the validity of palpatory assessment was partly addressed by a 1962 study2 that measured the distance between the spinous process and the approximate center of the corresponding vertebra at every level of 13 adult spines. The study revealed the level of magnitude of the linear excursions (given the angular excursions) with which a manipulator would be dealing. Answers to the question of the validity of palpatory examination for somatic dysfunction would be relevant in determining whether somatic dysfunction does or can occur in the manner conventionally declared. Such answers would also have a bearing on the validity of the examinations used and on the validity of interexaminer reliability. Imaging Technology and Somatic Dysfunction Theory