Manual medicine can be maddening…

I often say that the human body is complex and the answers are never straightforward or easy. Right when you think you have a handle on treating, something new comes along to make you question everything.

The writings of my friend and colleague Craig Harness, DO(Q), PhD(c), remind me that my thoughts on this subject may not be quite accurate. Craig states in a blog post he wrote for somafinder.com that our shared mentor, Guy Voyer says that “osteopathy (manual medicine) is easy once you know the anatomy.”

I was reminded of this lesson in a challenging way recently.

While treating a woman for persistent pain at the ischial tuberosity with limited and transient results, I was at a crossroad. I thought I had tried everything in my arsenal. I worked distal from the lesion. I worked all of the chains. I tried strengthening all of the areas that might be contributing to the problem. We tried myofascial stretching and ELDOA.  I treated all of the relevant tissue in the area. Or at least I thought so…

While going through an anatomy book from the turn of the last century by Carl Toldt researching other issues, I came across this picture:

I realized that I forgot to take into account ALL of the structures that were in the area. Toldt beautifully depicts the many bursae in the buttock area. Specifically, the bursa of the biceps femoris muscle (yellow arrow above) was depicted. Volia! I suddenly had another avenue to explore.

I had not been instructed in a technique exactly for this bursa. I had, however been instructed in treatment techniques for many other bursae in the body. So, as Voyer told Craig, if I knew the anatomy and I understood the principles, this problem should be easy to solve. With both of these data points, I set out to treat this bursa as best I could.

The author treating the bursa of the biceps femoris

The author treating the bursa of the biceps femoris

After treating the bursa with the “new” technique for a few minutes, I asked the patient to test the movements that always elicited the pain. She complied, and for the first time in our efforts to help her. she had no pain.

Zero, nada, zilch!

I share this story not to bring attention to myself or the techniques. I wanted to share this story to remind us all about the power of life long anatomical study. The best manual therapists I know spend time with anatomy every day. They also have multiple sources of anatomical references.

Carl Toldt’s books are free in the public domain and are better than most books written today.

One of my favorite references is the five volume series of French anatomy books from Alain Bouchet and Jacques Cuilleret. There is no need to speak French. The drawings are clean and there are many views of the same structure to get a clear understanding of its relation to other structures.

And, there is always the Complimentary and Alternative Medicine Human Dissection Experience presented by the aforementioned Craig Harness. The CAM-HDE is an open curriculum dissection of soft-embalmed cadavers at Queens University in Kingston, Ontario. I did this course and it changed the way that I treat and see the human body forever.

Remember, like Voyer says, treating is easy if you know the anatomy. Now just go get it.


When something is right…


Brian Murer, DC/SMTh, is the co-founder of the Evolutions Institute of SOMA Instruction.  EISI is a school based on the work of Guy Voyer, MD/DO and is committed to training the next generation of manual therapist and exercise professionals. To learn more about EISI and their course offerings, go to www.evolutionsinstitute.com


Craig Harness, MSc, PhD(c), RMT, DO(Q),  is a Lecturer of Anatomy and Pedagogical Director of the CAM - HD Experience at Queen’s University with an extensive background in the fields of both Anatomy and Osteopathy.  He completed his Bachelor of Science, Human Sciences degree (Athabasca University) and his Masters of Anatomy & Cell Biology (Queen’s University) with a focus of professional anatomy education for members of the Complementary and Alternative Medicine streams.  He completed his Diplôme d’Ostéopathie from Académie Sutherland d’Ostéopathie du Québec where he has also held the position of professor.  For more information about the CAM-HDE go to: dbms.queensu.ca/home/camhde