Palpatory Musculoskeletal Findings as Early Indicators of Visceral Disease Somatic Vertebral Dysfunction and Spinal Manipulative Therapy – A Review of the Literature History of Somatic Dysfunction and Spinal Manipulation Historian Elizabeth Lomax 1 , presented her 250 Review Summary of the Literature in The 1975 Conference presentation, Research Status of Spinal Manipulative therapy, and stated: "the physician could clinch the diagnosis by finding tenderness in the appropriate vertebra". The use of Palpatory Musculoskeletal Spinal Exams as a tool for diagnosing disease were discussed by Avicenna, the father of Modern Medicine, in The Canon of Medicine 2 , and the strongest, M.D. proponent of Spinal Manipulation was John McMennel 3 , 4 who wrote an article in JMPT "Understanding Manipulative Medicine in General Practice” published in JMPT in 1989. This article states "Then suddenly we find ourselves in practice where 80% of our patients complain to us of some sort of musculo-skeletal pain, 80% may sound high, yet remember that visceral and systemic diseases very frequently manifest themselves initially as musculoskeletal pain.” Again John McMennel concludes his article as follows: "Joint dysfunction is not only a diagnosis but an early sign of visceral and systemic diseases". Manipulative therapy has known a parallel development throughout many parts of the world. Three professions, Osteopathy, Chiropractic and Physiotherapy, have incorporated their own variations of Spinal Manipulative Therapy in their practice. Physiotherapist Erland Pettman 5 states: The earliest historical reference to the practice of manipulative therapy in Europe dates back to 400 BCE. Over the centuries, manipulative interventions have fallen in and out of favor with the medical profession. Manipulative therapy also was initially the mainstay of the two leading alternative health care systems, osteopathy and chiropractic, both founded in the latter part of the 19th century in response to shortcomings in allopathic medicine. With medical and osteopathic physicians initially instrumental in introducing manipulative therapy to the profession of physical therapy, physical therapists have since then provided strong contributions to the field, thereby solidifying the profession's claim to have manipulative therapy within in its legally regulated scope of practice. While Chiropractic Literature lacks the presentation of evidence based studies of the caliber Burns 6 , Cervero 7 , Bonica 8 , Beal 9 , Korr 10 have presented, Osteopathy, Medicine and Physiotherapists themselves have contributed greatly to the scientific validation of the role Spinal Manipulation plays in both early detection, diagnosis and Clinical Management of Visceral Diseases. 1 Lomaz, Elizabeth in Goldstein, Murray, "Manipulative therapy: a historical perspective from ancient times to the modern era," which appeared in The Research Status of Spinal Manipulative Therapy, published by the United States Government Printing Office (1975), pp. 11-17. 2 Ibn Sina, Abu Ali al-Hussain Ibn Abdallah, (Avicenna) – Qanun Al Tib (Canon of Medicine) 3 Mennell JM. The Science and Art of Joint Manipulation. Volume 2 The Spinal Column. New York, NY: Blakiston, 1952. 4 Mennell JM. Understanding Manipulative Medicine in General Practice J Manipulative Physiol Ther. 1989 Jun;12(3):231-5. 5 Erland Pettman, A History of Manipulative Therapy The Journal of Manual & Manipulative Therapy Vol. 15 No. 3 (2007), 165–174 6 Burns, Louisa, Viscero-Somatic and Somato Visceral Reflexes - JAOA • Vol 100 • No 4 • April 2000 • 249-257 7 Cervero, Fernando Sensory Innervation of the Viscera: Peripheral Basis of Visceral Pain Physiol Rev 1994; 74: 9 5 – 1 3 8 Bonica JJ: The Management of Pain. Lea & Feibger Philadelphia. 1990; Vol. 1: p 229 9 Beal, Myron, Viscerosomatic Reflexes, A Review. JAOA • Vol 85 • No 12 • December 1985 • 786-801 10 IM Korr The spinal cord as organizer of disease processes: some preliminary perspectives J Am Osteopath Assoc, Sep 1976; 76: 35.