“It is the province of knowledge to speak and it is the privilege of wisdom to listen.”
-Oliver Wendell Holmes, Sr.
To be effective as a manual therapist, you need to know where to focus your attention and energy, especially when there are multiple complex problems happening at once.
This is where the technique of “Listening” comes in. Listening is the heart of hands-on work in osteopathic treatment. It is what guides a manual practitioner to the body part that needs to be treated. Importantly, it’s the area that the body wants treated, rather than what we think it needs.
How it Works
The practitioner lightly contacts the body with the hands, and with careful attention, can feel the hands being pulled or drawn in a particular direction. This pulling sensation is the body drawing the practitioner toward the problem, usually an area of tension. If the hands are placed somewhere else on the body, the hands will ultimately be drawn to the same spot.
The tensions in the tissues act kind of like a gravitational force; they take the hands to the same place no matter where on the body the hands are laid. It’s kind of like if you were lying on a big hammock or trampoline, and someone else got on too. You would feel your body shift toward them because they are putting a new tension in the system. In this analogy, the other person is the area of tension, and you are the practitioner’s hand.
Take this example: If the body’s biggest problem is a restriction in the low back on the right side, any time hands are laid on the legs, the hands will feel a pull upward in the body. And any time hands are on the shoulders, neck, or head, the pull will be downward. If the practitioner then sets the hands in the mid-section of the body, closer to that restricted spot, the hands now might be drawn more toward the front or back of the body (in this case, toward the back) and toward the right or left side (in this case, toward the right). It’s like following a trail of breadcrumbs.
Using Listening in Treatment
All the parts of the body will pull the hands toward that nexus of tension. In essence, “all roads lead to Rome”. We follow these roads (lines of tension) with our hands as we make contact with the tissues of the body, and by doing this, can triangulate an important structure to be treated. By “listening” to what the tissues are telling us, we are giving the body attention where it’s needed the most, even if it’s not where our symptoms are the greatest. In truth, most of the time listening does not take the practitioner to the symptomatic area, and the vast majority of the time those symptoms still improve by following this approach, even if it they are never directly treated. Because everything in the body is connected, everything is important to consider in treatment. The body doesn’t lie, and when we listen to it through the hands, we can get to the deeper root(s) of the problem.
Once the restricted area is adequately treated, “listening” to the body again should no longer draw the hands toward the same spot. What often happens then is that the practitioner’s hands are now drawn somewhere else in the body that needs to be treated- the next layer of the onion in the complex human puzzle.
If you’re thinking that this is a little too wu wu, or some kind of mystical intuition thing, I wouldn’t blame you. Using listening to guide a treatment plan is a major paradigm shift. But it is a real palpation skill that can be learned with training, and it is capable of discovering things like old traumas or even new, yet undetected problems- even things that don’t show up on imaging scans. Listening will sometimes take me to a problem in the body that a patient forgot to mention in his/her medical history. I love to use it alongside my battery of trusted orthopedic tests. Almost 100% of the time, when I repeat my strength and flexibility testing after a listening-based treatment, we see positive changes.
About the author:
Tim Newton, PT, DPT, OCS, CFMM and a board-certified Orthopedic Clinical Specialist who specializes in manual, osteopathic techniques to help pain and movement dysfunction. His expertise is in visceral manipulation, gentle spinal manipulation, and craniosacral therapy. He is the owner of Inspire Movement Physical Therapy in Columbia, MD.