The challenge has been set. James Randi, Osteopathy-64 is waiting for your reply...

A french version of this article is available here

James Randi is a magician who for the last 30 years has been fighting pseudo-sciences, and the belief in paranormal phenomena.
As it is impossible to prove the inexistence of a paranormal phenomenon, James Randi had the clever idea to offer $1,000,000 (initially $10,000) to anyone who can prove to have paranormal ability.
The "James Randi Educational Fundation" (JREF) was created and for the last 30+ years, many mediums, telepaths, telekinepaths, healers(...) tried to take up the challenge but failed to prove their "extra-ordinary non-existing" gift.
No one ever won this Challenge.

What an interesting challenge for Osteopathy-64 !

James Randi, Thank you very much !

First of all we need to thank James Randi for being the instigator of such a project. Billions of people around the world believe in paranormal phenomena and millions of people use these beliefs to make money and exploit these believers. These irrational beliefs lead to distorted reasonings, provide false solutions, give false hopes, are responsible for the death of individuals, and are a colossal waste of money, time and intellectual resources for the entire humanity. (proof could be the time spent writing this article and you reading it!)

As we said in the introduction it is very difficult to prove the non existence of a phenomenon whereas it is very easy to claim the existence of a phenomenon without being contradicted. For example: "There is a rugby ball that floats in our solar system elsewhere than on Earth." It may seem incongruous, but as it is impossible to search the entire solar system it is impossible to prove this statement false.   Yet this is the type of reasoning that is at the origin of religions, cults, and many other irrational beliefs. The saying "the absence of evidence is not evidence of absence" is often used by those who defend the existence of paranormal phenomena.

Offering such a price (the sum of $ 1,000,000) seems to be an effective way to motivate anyone who has a paranormal ability to make themselves known to the JREF in order to prove their extraordinary ability. As no one has won this award for the past 30 years, it would seem that nobody, possessing paranormal abilities, has:

    * Pecuniary motivation
    * Never heard of the $ 1 million challenge,
    * A paranormal ability 

OR

    * That the JREF's jury does not recognize this phenomenon as a paranormal phenomenon
    * That the JREF is heavily biased and does not acknowledge that the subject has passed the test convincingly 

Of course, considering that the JREF is heavily biased remains the main argument of the "believers" in paranormal phenomena. The second argument is arguing that the claim  is paranormal phenomenon when it is not.

Périnormal or paranormal?

Wikipedia:

Paranormal is a general term (coined ca. 1915–1920^[1][2]) that designates experiences that lie outside "the range of normal experience or scientific explanation"^[3] or that indicates phenomena understood to be outside of science's current ability to explain or measure.^[1][4] Paranormal phenomena are distinct from certain hypothetical entities, such as dark matter and dark energy, only insofar as paranormal phenomena are inconsistent with the world as already understood through empirical observation coupled with scientific methodology.^[5]

Although this definition is quite clear, one could distinguish between a paranormal phenomenon and a "peri-normal" phenomenon (a term coined (?) by Dr. R. Dawkins). A paranormal phenomenon could be something that is a fantasy, an absolute impossibility, or a transgression that is only  possible in our imagination. As for the "peri-normal" it would be a phenomenon that is not yet proven at the present time but that will be in the future, but... if we retain the definition of "paranormal", it is something that is not currently explained by science. So if you have an ability that has not been demonstrated yet by science, your "gift" can be considered as paranormal.

In the following video we will see Dr. Richard Dawkins with James Randi talking about the $ 1000000 challenge and the possibility that this challenge could be won by a phenomenon "peri-normal" (see 4min50s):
   

Osteopathy-64's challenge

Over the last few years Osteopathy-64 supported a "new" theory to explain cranial osteopathy, visceral and fascial motility : "The ideomotor effect in osteopathy". See articles on the cranial movement and explanation by the ideomotor effect, The ideomotor effect: a keystone in osteopathy (in french here), Do osteopaths have a psychometric capability (french article here)? 

If this theory is correct then it may well be that the patient's emotional state has an ideomotor effect and that this effect increases the inherent muscle tone of some muscles of the body. If it is true that the osteopath can feel this increase in muscle tone with the use of fascial and cranial techniques then it is possible that he can feel the ideomotor effect of certain emotions and therefore he can recognise  the emotional state of a patient by palpation. 

Therefore Osteopathy-64's challenge is: 

It is possible to differentiate, blindfolded, through the sense of touch at least two different emotional states (such as anger and serenity) in an individual. The techniques used will be fascial and cranial techniques. 

The test groupe: age between 20 and 35 years, without histories of major physical or psychological trauma. 

Why can this challenge be considered as a paranormal phenomenon? 

The author does not claim to be the the only one being able to do this, many osteopaths and anyone with some palpatory skills can achieve it.

   1. The techniques used for this challenge (fascial and cranial techniques)  are considered ineffective in the eyes of science and the use of these techniques is even considered as quackery. In France the National Academy of Medicine has pushed for their withdrawal from osteopathic curriculum. On the JREF website we can also read about it : see here


"There is no scientific support for major elements of the underlying model, there is little scientific evidence to support the therapy, and research methods that could conclusively evaluate the therapy's effectiveness have not been applied."

   2. It has never been scientifically proven that we can feel the emotional state of someone else through the use of palpation. One might think that differentiating two emotional states is an easy task, but to prove it significantly (more than 16 times out of 20 for example) is not necessarily that easy. If you are stressed, if the subject is under stress (divorce, recent loss, lost his job ...), if two of your subjects are psychopathic or sociopathic and unable to feel an emotion, if they had a violent past trauma not remembered (as a baby/child), are all factors that may induce error in your judgment and greatly reduce your chances to differentiate these two emotional states. This is why, even if it could be possible to feel and differentiate more  emotional states, just being able to successfully 2 is already a good challenge. 

This ability, if it exists, should be classified as a "peri-normal" phenomenon and we can only agree with ​​Dr. Richard Dawkins because this ability follows a logical sequence of events that could be explained scientifically but which are not yet proven. But as this definition does not exist in the dictionary then we must classify this phenomenon as "paranormal". 

What would be an idea of ​​protocol in order to prove this "claim"?

   1. The "guinea pigs" must be relatively young (20-35years), because if they are young they will have a better muscle quality, thus it is clearer to distinguish the "at rest" muscle tone vs a hypertonic state. With older patients/guinea pigs/volunteers, chronic stress or chronic physical labor can make their muscles fibrotic and reduce the Δ (variation) of contractility , making the fascial (techniques on the fasciae) "reading" harder.
   2. These subjects should not have had any kind of major physical, emotional, pathological trauma,  or suffering from a severe or important chronic stress. These factors can increase the inherent muscle tone that can blur the clarity of the fascial "reading".
   3. Psychopaths and sociopaths should be avoided as they may have difficulties in feeling emotions!
   4. A number of 20 subjects would be ideal, and the "claim" should be validated if one (the therapist) can correctly guess at least 16 out of 20 emotional states.
   5. The therapist is looking for a change in the inherent muscle tone with cranial and fascial techniques. Therefore the therapist must first test the volunteers when they're relaxed.
   6. The the volunteers flip a coin (or pick up a paper, ball...) which will decide the emotion they will simulate (anger or serenity / calm)
   7. After a "beep" sound the guinea pigs should imagine different situations where they feel this emotion (conflict with someone / on the beach in the sun) for one minute in the most intense way possible, without showing it physically of course. A hypnotherapist may be asked to help to lead this state.
   8. In 30 sec, the therapist blind folded (while the volunteers continue to imagine their emotional state) must guess the imagined emotional state using  cranial or fascial techniques.

 What can we use this pseudo-gift for?

 It is definitely not as useful as telepathy or telekinesis! 

The implications of this "peri-normal" phenomenon are actually quite important:

Firstly it would show that the human body is very subtle and has "peri-normal" capabilities that until today were still unsuspected. 
This could be a new and more rational explanation for cranial osteopathy. This explanation opens up a new horizon of research. Indeed so far research in cranial osteopathy was not successful because we were looking in the wrong place! 
What about visceral and fascial motility? Are they also a palpatory illusion due to the ideomotor effect?
If the therapist can feel two diametrically opposed emotional states, could he feel even more emotional states ? 3, 4 5? 
Is it possible to date these emotions? 
If the therapist succeeds to release a muscle tension caused by a strong emotion, can it affect the psychology of the patient? Does this therapy becomes somato-psychological? 
Can there be an ideomotor communication? Can the therapist describe the patient's personality through fascial/cranial techniques without falling into cold reading techniques?
Does the muscle tone of certain muscle groups affects the psychology of an individual? 

These issues will need answers if the theory of ideomotor effect in osteopathy is to be verified. 

What about Osteopathy-64's application to the JREF? 

The application was sent on the 14th of December 2011.  

That envelope contained a letter describing the "claim" in English describing the "claim" signed by a delegate of the Mayor of Urrugne, France.  A  letter explaining the "claim", a letter of recommendation from a Dr/researcher and a CV. 

On January 30, 2012 the JREF has sent the following email:

"Dear Pierre de Lasteyrie du Saillant,

Thank you for applying for The James Randi Educational Foundation’s Million Dollar Challenge. Your application has been received and is under review. It will take approximately two to three weeks for the JREF to process your application at which time we will inform you as to whether your application meets all requirements and if we can proceed.
Sincerely,
James Randi Educational Foundation"

Despite sending two emails to know if the file was accepted or rejected, there has been no further news.

Some critics say the James Randi Educational Foundation  (JREF) refuses challenges that would be too risky for their $ 1000000. Is it in the interest of the JREF to lose $ 1 million? 
But let's not be conspiratorial in nature, the JREF is very busy handling many issues and organizing seminars for the development of critical thinking and fighting paranormal claims and movements, which is in the best interest of humanity. 

But we shouldn't let this "claim" fall into oblivion. This is why osteopathy-64 launches this article and a humorous little video to remind James Randi and the JREF they have a response to give to osteopathy-64's "claim". 

 If you support the cause of osteopathy-64 click "I like facebook" and / or video, 

Thank you for your support,

Cranio-sacral motion and the ideomotor effect

In a number of coutries, Osteopathy is becoming or close to be a healthcare profession. This should be considered an honor. But this rise to more responsability asks for a deeper introspection about what is based on belief from what is based on facts. This is especially true for the cranio-sacral concepts of Osteopathy.

Until recently, osteopaths were claiming that they could feel with their amazing palpation the movement of the Cerebro-spinal fluid that was pulsing in the cranium. Later on a few researches have shown that was impossible. Quick, hurry a new theory ! Electro-magnetic pulse? Venous pulse? Contractibility of the dura mater ? Quantum healing? The only research showing some effect of cranial therapy on a body's rythm was done in 2002 on 23 participants. It shows an effect a smoothening of the Traube-Hering-Mayer pulsations with a cranial approach. This is a bit weak to validate the existency of cranial motion. More than 5 researches were done to see if 2 osteopaths were feeling the same rythm on the same patient. None of them were conclusive! Whilst all the evidences seem to show that cranial motion is non-existent, nonetheless a lot of osteopaths still practice and believe in cranio-sacral therapy and its concept.

Osteopaths do feel a movement, Are you saying that thousands of osteopaths are having palpatory hallucinations ?

Yes and no...

Have you heard of the "Ideomotor Effect" or "Ideomotor movement"

Ideomotor Movement

Ideomotor movement are movements that we'll induce without realizing it, just by imagining consciously or incousciously the same movements. This effect is the explanation for radiaesthesia, the pendulum, and the ouija board. It might also well be the explanation of cranial osteopathy.

extract from wikipedia:


"Scientific tests by the English scientist Michael Faraday, the French chemist Michel Eugène Chevreul, and the American psychologists William James and Ray Hyman have demonstrated that many phenomena attributed to spiritual or paranormal forces, or to mysterious "energies," are actually due to ideomotor action. Furthermore, these tests demonstrate that "honest, intelligent people can unconsciously engage in muscular activity that is consistent with their expectations".[2] They also show that suggestions that can guide behavior can be given by subtle clues (Hyman 1977).

Some alternative medicine practitioners claim they can use the ideomotor effect to communicate with a patient's unconsciousness using a system of physical signals (such as finger movements) for the unconscious mind to indicate "yes", "no" or "I'm not ready to know that consciously"."

The pendulum example:

Before you use a pendulum, you have to calibrate it. You have to be in "resonance" with it. To do so, you have to ask yourself a few "yes" questions and notice in which direction the pendulum is turning (let's say clockwise). Try now with a "no answer" question and the pendulum should rotate in the other direction (anti-clockwise). The pendulum is now calibrated and you can ask any yes-no questions and check in which direction it is rotating.
This s due to the ideomotor effect. your subconscious mind is creating slight movement that are giving momentum to the pendulum and making it turn in one way or the other.

This effect feels real enough for thousands of people to believe in the extraordinary power of the pendulum, to check the gender of a futur baby, find your keys, find some water etc etc...

This is the same effect than the ouija borad used during a seance.

Would it be possible that the osteopath is also a victim of his proprioceptive sensations?

Can we accept the fact that radiesthesists could fool themselves but we as osteopaths, couldn't be fooled by our sensations when our job is essensialy based on proprioception ? Are we so full of ourselves that we can imagine not be tricked by our own feelings ?

Dear cranio-sacral practitioner, next time you are on a non-lesionnal sphenoid ask yourself this question: "can I feel a right side bending or is it possible to feel a right side bending?" and you will notice that strangely enough the sphenoid will follow a right side bending after a few seconds!

It is surely really unpleasant to think that for the last 80 years we believed in the existence of an non-existing phenomenon! a phenomenon that we induce ourselves !

Our teachers we right when they were telling us to put some intention in our techniques because with intention this movement and the ideo-motor effect are magnified!

Why do so many practitioner still believe in the cranial motion and in the IVM?

Imagine the cerebral effort that we need to put ourselves through to acknowledge the fact that our belief system (cranial motion) we had for years was wrong. It is as hard for a god believer to believe tha there is no god, or an American to believe that Socialism is not evil. This change of belief is possible but is intellectualy very costly.

Just Imagine how hard it is for the therapist to admit to his patients that what he was telling them for years was wrong... The patients should be pleased about the progress of their osteopath, but definitely others might have the feeling of having been fooled around for years.

Why does an osteopath want to believe in an inherent cranio-sacral motion ?

1. Osteopathy defies science: “This movement exists, we know it and we can feel it but science is unable to prove it. Science has limits and cannot prove everything.” This statement helps showing the superiority of Osteopathy against the "evil" scientific based medecine.

2. “This movement is so fine that only the skillful osteopath is able to feel it." This allows the osteopath to "show off" about his extraordinary palpation skills. Let's be serious, is the movement we feel really around a few micrometers ?

3. It allows to see the body with a vital energy (the osteopathic Qi)

Is all cranial osteopathy to be discarded ?

This doesn't mean that cranial osteopathy isn't effective, it just say that there is probably no inherent mobility of the cranial bones, and that the therapist himself is responsible for the movement that he is feeling. The cranial therapist is the source of the IVM (involuntary mechanism). This theory would just so easily explain why 2 osteopaths will feel 2 different rythms on the same patient.

In fact the movement felt by the practioner would be an interaction between the motion that he is inducing with the ideomotor movements and the reaction of the patients' cervical restrictions and fascial tensions.

This rythmic movement is really relaxing and a great number of patient is drifting away within minutes. This cranio-sacral approach rocks rythmically the cranium and the neck of the patient which is truly relaxing and can get rid of persisstent musculo-skelettal tension.

Let's try to explain what the practitioner feels during the treatment with an ideomotor movement perspective:

1. The therapist induces a rythmic Flexion/Extension on the cranium, but the neck of the patient is tense. This initiated movement is in conflict with the neck tensions. The practiotioner believes that there is no or a poor cranial movement.
2. After a few direct or indirect techniques some of the neck tensions disappear and slowly when the practitioner induces these F°/E° movement the head of the patient offers less resistance. The Cranial mobility seems greater.
3. After a few more minutes the head and neck of the patient is much more relaxed. The body of the patient understand what the osteopath wants to induce as a movement and start following it. The osteopath analysed a much better cranial movement freed of cranial tensions!

Conclusion:

Too few researches seem to prove that there is a cranial motion taking place.

We can say "absence of proof is not proof of abscence" But is there not a moment were we could be wrong? Do we have to wait another century of unsuccessful researches or the last 70 years are enough ?

Isn't it logical to say that this inherent movement doesn't seem to exist until proof of its existency ? And if one day it is proven to exist, we will still congratulate osteopathy to have discovered it !

Wouldn't it be more reasonable to say that if the practitioner feels a movement and that no researches proves the existence of such movement therefore there is a great chance that this movement is induced by the osteopath himself ? Ideomotor effect is a known fact for the explanation of similar deceptive feelings. Thousands of people have been deceived by the ideomotor effect wouldn't it be unreasonable to think that no osteopath could be as well deceived by this effect ?
This could also explain why certain osteopaths believe they can test allergies or intolerance by palpating the cranium of their patients. Themselves or the patient restrain the movement when testing this or that type of allergen.

Something interesting is that osteopaths who don't believe in cranial osteopathy and IVM are under intense criticism because they undermine the profession, but wouldn't it be the opposite that should be true?


Remember that saying that Cranial motion is created by the practitioner doesn't mean that cranial osteopathy is ineffective. he fact that the osteopath himself is the power of the motion doesn't change much about cranial osteopathy.

If we go along with this ideomotor theory then it can explains a lot of researches. Osteopathy will show to be mature enough to be able to introspect and criticise itself. We also remove from the hands of a lot of detractors the stick they are hiting us with. What a great step towards a healthcare profession.

A bit of fun for Christmas!

The reggae osteopath

The risk of cervical manipulation and the birthday paradox

I have removed this post because of faulty reasoning on my part

Placebo within osteopathy

We will try to exert self-criticism and bring the light on the subject of placebo effect within osteopathic treatments.

This article might be disturbing because it seems to reveal an important number of psychological manipulations. But if you look closer, you will see that this phenomenon exists everywhere: at school, in religions, in your local supermarket, at your doctor and of course at your osteopath! We use these techniques without realizing it, but being aware of it, allows you osteopath to increase the effect of the treatment.

The Placebo within osteopathy

It should be remembered that the patient in addition to be in pain, is in a bad mood, he is stressed, anxious to be vulnerable, does not understand what happens to him and might worry whether he will be able to work or even if he will ever recover.

This mindset parasites his ability to be positive and to improve. It is this aspect of the pain that the placebo effect will find its field of action.

The placebo effect is a psychosomatic effect. Therefore all the tricks that will increase the positivity or decrease the negativity towards the osteopath, osteopathy, and the point of view of the patient towards his own pain will have a positive effect on the patient.

We will attempt to define the main axes of the placebo effect during an osteopathic consultation.

1. The feeling towards osteopathy

• to be recommended to see a specific osteopath: the mindset of a patient to whom it is recommended to see a specific an osteopath is totally different than one who is looking for the first osteopath in the yellow pages. The first one will allow himself to wait several days for an appointment while the second will rush at the following number if the therapist is not available in the afternoon. Having followed the suggestion of his friend, the future patient is already conditioned to see a skilled osteopath and know that he will receive a good quality treatment.

• to make an appointment: this is one of the most important steps that the patient will do. He decides to be in charge of himself by coming to see an osteopath. Take such a decision shows that the patient has a "spark of desire" to get better. Because he wants to be there, the patient will generally be pro-active during treatment. The most difficult patients to treat are often patients whose appointment were booked by a third party without their full consent. They do not let themselves go and are not accommodating. They don't want to be here. They wait for only one thing, the end of treatment to tell their friend that the osteopathic treatment didn't change anything.

• the duration of treatment: the fact that treatment lasts at least 30 minutes allows the patient to be listened to, to be understood in their suffering. Just this fact allows the patients to unwind, to let go and to have time to empty their "bag".

• the cost of the consultation: The cost of the product also affects its efficiency! Some people claim that generics are not as effective, it could be because they are cheaper and thus their placebo effect is less. We interpret this as: "Generics are cheaper because they are of poorer quality" instead of "original medicines were excessively expensive". Similarly, the fact that a patient must pay for osteopathic treatment also contributes to a part of the placebo effect. Firstly because it's quite expensive (40-60 £) and secondly in France we do not usually pay for our health. It is obvious that the patient does not want to spend 40£ for nothing, so he will be into a state of mind "I want to get better." Moreover he will respect the treatment and will avoid the next few days to do anything "silly" that could "spoil" the treatment.

• to get undressed: to see the patient in his underwear is important clinically but also it has another advantage. The fact that the patient undresses makes him more suggestible. If a patient tries to establish a relationship such as "parent-child" with the osteopath, then it is very important for successful treatment for this patient not to keep his trousers for example. The fact that he is in his underwear rebalance that relationship to "adult-adult". However, if a patient is shy and force your hand into a relation "child-parent", then after the observation/examination provide a cover, or allow them to keep their trousers, they will feel more at ease and this will certainly improve the response to the osteopathic treatment.

• the principles of osteopathy: principles of osteopathy are simple and "speak" to the patient. They make sense. The patient can identify their problem as a matter of body mecanic. They self-suggest that osteopathy is the therapy that can help them.
  

2. The osteopath

• the practice: is the practice inviting? nice, clear, clean? or is it dark, obscure and looks like a summoning place for dark magic ?
  

• age: age is one factor that may work against the osteopath if he is young and be part of the factors "nocebo". If the osteopath is young and even competent, there's a good chance that the patient, even if he is getting better, will consider that an older ("more experienced") osteopath would have done better.Therefore e wil not be completely satisfied with the treatment.
  

• gender: the gender of the osteopath has an important influence on the treatment. Some women prefer to be treated by women, others by men and vice versa. The fact that the patient consults a male or female practitioner is rarely innocent. When a patient expect to be treated by a female or male practitioner and found out that it is the opposite, it can be problematic. Sometimes the unexpected happens, and this turns out to be benificial: this is called

• Cognitive Dissonance: Cognitive dissonance is a psychological concept developed by Leon Festinger in 1957 in his book "The failure of a prophecy." "Cognitive dissonance is an uncomfortable feeling caused by holding conflicting ideas simultaneously. The theory of cognitive dissonance proposes that people have a motivational drive to reduce dissonance. They do this by changing their attitudes, beliefs, and actions.^[2] Dissonance is also reduced by justifying, blaming, and denying. It is one of the most influential and extensively studied theories in social psychology".(wikipedia). The personal experience the following could be an example: one day I replaced an osteopath at the last minute and he had not had time to warn all patients. One of them was a woman who was violently raped three years previously and obviously this dreadful event was not digested. "She Might Be a little bit upset" he warned me ... When she saw me, she was obviously on the edge of canceling the appointment (perhaps the difficulty of trusting another man, a stranger, and to tell again her traumatic story) but she still accepted the treatment. We mostly worked with cranial and fascial approaches. The following week I heared that she has not felt that well for the last 3 years. Fascial treatment's effect or effect of cognitive dissonance?

• The white coat: The white coat is the dress code of the medical profession. It is a very effective barrier between the patient and the therapist. It constantly reminds the patient that he is dealing with a health practitioner. It is a very effective tool for young osteopath who need the help of a barrier. But such a barrier may also be a hindrance in the therapist-patient relationship.

• Do you have the "gift"?: Tring to show to your patients that you possess the "gift" can be a dangerous game and might be off the limits of ethics but it is a very powerful tool. The patient can be amazed and this effect makes him even more suggestible."The Gift" brings together different "extra-ordinary" abilities (magnetism, clairvoyance, radiesthesia ...). Whether it exists or not is not here the debate. But it is easy to pretend to have such a gift. It is said that some osteopaths can from a cranial hold are able to identify an old ankle injury for example. This can be done without this "gift". Here's how an unscrupulous osteopath could proceed: the patient lies on his back, then the osteopath performs a quick testing of the ankle (it takes 10sec and goes unnoticed). The osteopath locates a restriction, and then places his hands on the skull. After 3 minutes he can claim: "Ooh dear, you have a blockage in your right ankle, an old sprain maybe?". The effect is guaranteed ...

• "Cold reading":(read full facts book of cold reading Ian Rowland) is the ability to understand and "read" a person but also to make him believe we can read him/her. Using such techniques can help the therapist to subdue the patient. The patient is impressed by the "abilities" of the osteopath and this will make him more suggestible. Such techniques should be used carefully ... here are some examples:

1. when the patient describes his pain, he will often simultaneously touch the place that hurts. Without looking directly at the patient, the osteopath can see with his peripheral vision where the patient shows his pain. This information can be restored later to impress the patient, "it is the right knee that hurts you? I saw it at your gate"
2. Trying to make "hits" by asking negative questions: eg "you didn't have any headaches recently, did you?" the Osteopath is almost certain to make a "hit". If the patient answers yes then it is a "hit" and if he says no, he was not wrong!
3. the use of "Barnum statements": These statements are sentences that are true for 90% of patients but will perceive as being personal. For example: "You do have a lot of stress at the moment between work and the family, don't you?"
   

• Comparison with previous therapists: At the end of treatment it is legitimate to wonder whether if previous treatments that the patient had with other practitioners were similar to the treatment you just provided. This maneuver has two objectives: the first one is to get an idea of the approach of your colleagues and the second is to impregnate the patient with the quality of treatment that he just received.

3. Complex psychological pain patient

• the vocabulary used has an influence: in the book "predictably irrational" the author talks about an experiment conducted to evaluate the influence of words on our mood. The experiment was conducted on two groups of people, who were asked to read and memorize a lists of words. In the first group, the words were related to slow, rest, calm... In the second group, the words were synonymous of speed, stress, excitement. At the end of their memory exercise, an experimenter was discreetly timing how long it took them to travel along the corridor to the elevator. You guessed it, people in the first group took longer than the second group to reach the elevator. let' go back to a session of osteopathy: our patient is stressed, tense, on edge, it is clear that a semantic related to nervousness is to be avoided, choose a language rather quiet, sedating and a calming vocabulary.

2. subjective pain: (...). The techniques of trigger points are as effective tools to help the patient perspective the degree of pain he feels normal. These techniques mimic the pain experienced

• Subjectivity and suggestibility of an improvement: this part of the treatment takes place at the end of treatment or early treatment.

1. At the end of treatment: "Helping" the patient to feel changes in his/her body at the end of treatment is very important because it obliges the patient to recognize some efficacy of the treatment he has just received, this opens a door in accepting that some changes just happen and that it can get better in the future. Some patients, less suggestible, take care not to express their feelings.
2. At the start of second treatment: This moment is critical because the patient is not really sure what's better or not. Reevaluate the various movements or habits that were painful can give an idea of the improvement. Then ask him a percentage of improvement in order to show him the side of the "half full glass". The patient who tells you that there was no change (which is different from any temporary improvement) doesn't want to acknowledge the truth, or pays too little attention to his own body.
   

• Body language: be aware of body language and know how to read it. It shows whether the patient is receptive or not and helps to see if an action we do is perceived positively by the patient or not. Once upont the time an expert on body language began a conference in the U.S. by criticizing American mores. After a few minutes he stopped and asked his audience to stay in their body postures and to observe each other. The vast majority had their arms crossed! Crossing your arms or legs are often signs of reserve, or disagreeing. If your patient is lying on the table and hold such a posture, it is likely that it can influence negatively on their responsiveness to the osteopathic treatment. Ask them to "uncross" their legs or arms. It is important for the practitioner to "break" any body language which is in conflict with the treatment.
  

• The suggestion: the treatment can be assimilated to an induction of hypnosis. The patient is in an unusual position (lying naked in the hands of a therapist) and has run through a series of commands (get undressed, lie down, raise your leg, lie on the side ...). This makes him each time more and more suggestible at each one of your demands/commands. An experience told in "Petit traité de manipulation à l'usage des honnêtes gens" was the following: a group of students was asked to address passers for a little bit money. The result was not encouraging. Subsequently the experiment was repeated by asking them to first, ask the time and then ask for some money. They then increased massively their earnings! Acquiescence to the first suggestion makes the patient more conciliatory to the second suggestion ... During treatment it is not uncommon to repeat about 50 times, "you release, relax, let go ...." These suggestions are effective and temporarily break the state of tension and stress of the patient.

• Anchors: Suggestions are often used with anchors. It's actually a Pavlovian reflex. It combines a suggestion with a visual stimulation, touch, smell ... For example you can lightly tap the shoulder of the patient when you ask him to perform movements: like this it combines the "tapping" to respond to a command . Then involve the "tapping" to the command "relax, let go ...." Subsequently You will just have to tap the body part that you want the patient to relax. This is very effective and helps to avoid repeating the same suggestions over and over. Another powerful anchor is the power of smell. Use a cream with a pleasant smell during your treatment. The patient will associate this odor with the feeling of relaxation and being looked after. The products with camphor are a good example.

• correlations between feeling better and the osteopathic treatment: it is interesting to see how we are victims of our desire to find links between causes and effects between events that surround us. If a patient gets better after a treatment, even if it takes a week, provided that the osteopath said: "it will take several days to get better", then the patient will necessarily associate the fact that he is feeling better with the osteopathic treatment. Hasty conclusion ...

• Giving exercices and recommandations: Giving exercises or recommending to place ice pack on the pain can extend the influence of treatment. The patient is following the suggestions of his osteopath (which are effective or not), he is conditioned to be in charge of himself and to have a positive attitude. These are also firewall in case the patient does not improve: the osteopath may ask: "If you did put some ice as I recommended it, your side effects would have been much less important. " The side effects or unresolved problems are not because of the osteopath but because of the patient.

• Nutrition Recommendations: it works on the same principle as the previous examples.

• Warning: Forgetting to warn patients of side effects they might experience is a major mistake. Because knowing that they could have side effects reassure them. If side effects are felt, then the osteopath was right. He really knows his job...
  

Conclusion

If therapy only works in the field of suggestion such as hypnosis or NLP, which is the field of the placebo effect, can call them placebo therapies? of course not, because their field of expertise is suggestion.

If we consider osteopathy as a therapeutic approach strictly manual and mechanical that only treats musculoskeletal dysfonction then in this case, the placebo has a huge role in therapeutic efficacy.

But if the definition of osteopathy is considered as a holistic therapy that comprises a comprehensive care of the patient, in this case osteopathy has no placebo effect since it has expanded its fields of action with that of field of suggestion!

The more a therapist is aware of psychological variables which can influence positively the patient the less the placebo effect is important in treatment.