I could say "everything", but that might not be very helpful. Nevertheless, there's quite a lot more in there than you might first think of. To begin with there's the skin, then some fatty tissue, then muscle and veins and arteries and nerves and membranes, then inside there are more fatty deposits, and all the squishy pipes and tubes, sometimes with matter inside (food, faeces), sometimes with air, and also slithery surfaces of the solid internal organs large and small. The point being that there are quite a lot of bits and pieces of various kinds and qualities that may impinge upon the consciousness of the practitioner.
So, amongst all this, what sorts of things am I especially interested in most patients?
- The general contours of the body, in a word its shape. I believe that, to an extent, the general form of your body can shape your health, as it influences the way in which your body copes with stresses of all kinds*, especially mechanical stresses.
- The alignment and orientation of the various parts of your body. For example, in the spine each vertebra should ideally conform to the normal curves when observed from the side, and be oriented reasonably symmetrically when seen from the back. Deviations from this norm are easily palpated, while they are often not easily appreciated on an x-ray.
- Tissue quality. When I say "tissue" I mean the fabric of your body: muscles, ligaments, connective tissue, and so on. I am testing their hardness, pliability and elasticity, and whether they feel smooth and homogeneous, or irregular and stringy, boggy, rough or nodular. I and people like me have a range of words for how tissues feel to the palpating hand.
- Tissue mobility: the degree to which joints and tissues allow movement and the quality of that movement, whether smooth or rough. And I am comparing from side to side and whether it is coherent up and down and from back to front. If a part does not move freely, we say it is "restricted". If it moves too much we say it is "hypermobile". We can also describe how it stops moving, whether the obstacle to further movement (we say the "barrier") is hard or soft.
- An undefinable quality. There is something that is a little more difficult to put into words. If I had to sum it up in one word I'd say "vitality". To me, a tissue that is pliant to just the right degree and elastic to just the right degree gives a sensation of vitality. This is what we work towards. So when you are more experienced you are looking for degrees of that sensation, rather than more objective things like mobility or tension. It is a composite quality that you couldn't measure with an instrument, not directly anyway.
- The abnormal. Although that might sound very vague, it is also very important. A pain may be caused by many things, minor and major. Distinguishing the normal from the abnormal, even at a vague and basic level, is of enormous utility in the detection of potentially serious disease. When you have palpated and manually treated thousands of patients, you develop a heightened sensitivity for the abnormal, the incongruent, the unusual and the unexpected. It is this ability which primarily focuses our attention, allowing us then to analyse, describe, and classify what we have come across. Often it will be taken into consideration in an osteopathic treatment plan, sometimes it (you!) will be referred for scans, tests, or specialist assessment and management.
(*) "Stresses of all kinds". In a general sense the word "stress" means "load" or "pressure". A stress that affects the organism can be of many kinds: physical, chemical, biological or psychological. Anything that places demands on the organism can be considered a stress.