Osteopathy
The basics of practice
Joo Moita
The basics of practice
Somatic dysfunction
Treatment principles
Classification of osteopathic techniques
Treatment principles
Osteopathic technique Osteopathic treatment
There is no such thing as osteopathic technique since the repertoire can be endless
Nevertheless, techniques are classified and analyzed, by covering the basic
principles of technical approach for teaching purposes
Manipulative methods regardless of the discipline of the practitioner,
should be totally guided by the raw material that we work with: the human
body!
The technique relies on the method based on the Osteopathic diagnosis
Osteopathic diagnosis - the method of differentiation between a
mechanically well adapted human structure which is capable of
functioning normally in its environment , and a structure unable to
adapt itself to its environmental demands because of internal disease
or disorder, poorly body mechanics and/or misuse of the structure. It
will determine if the osteopathic treatment is considered appropriate.
Classification of osteopathic techniques (BSO system)
Organized into three main categories based on the application of
forces:
Rhythmic techniques
Thrust techniques
Low velocity stress techniques
Functional technique
Rhythmic Techniques
Can be classified as repetitive procedures where the control of the
rhythm plays the essential part
Forces are applied and released in graduated fashion
They fall into eight groups:
1. Kneading; 2. Stretching; 3. Articulation; 4. Rhythmic traction; 5. Springing; 6.
Inhibition; 7. Vibration; 8. Effleurage
1. Kneading
Slow rhythmical movement combined with pressure
Applied to: skin, fascia, muscle
Control variables: speed and pressure depth
Normal speed rhythm: 10 - 15 cycles per minute ( stimulatory effect,
up to 36 cycles/min)
1.1. Speed and pressure
Slow stroking with maintained touch: slowly adapting tactile receptors
and parasympathetic stimulation (general inhibition through skin
desensitization)
Firm deep pressure: activates tactile receptors and muscle proprioceptors
Enhance muscle response
Brief, light pressure: rapidly adapting tactile receptors and sympathetic
stimulation
Excitatory response on muscle contraction
2. Stretching
Slow rhythmic technique
Applied to: muscle attachments; fascia; ligaments; membrane
Control variable: amplitude, speed and time (intensity)
Short amplitude stretching (i.e. intra-articular of a spinal segment)
Longer amplitude stretching (i.e. extrinsic structures of the joint)
2.1. Prolonged stretch
Receptor: muscle spindle endings and golgi tendon organ
Stimulus: maintained stretch in a lengthened range
Response: dampens muscle contraction
2.2. Quick stretch
Receptor: muscle spindle endings, detecting length and velocity
changes.
Stimulus: quick stretch or tapping over muscle belly or tendon
Response: activates agonist to contract
Reciprocal innervation effect will inhibit the antagonist; activates synergists.
Response is temporary; can add resistance to augment response; not
appropriate to use in muscles where increased muscle tone limits function.
3. Articulation
Old osteopathic terminology for: repetitive passive joint motion
Control variable: range of motion (ROM)
End movement emphasis: enhances tissues reactivity as they are moved at
different rates
Best applied to joints with large ROM (i.e. shoulder; hip joint)
4. Rhythmic traction
Objective: to separate and release joint surfaces producing gentle stretch
of inter and peri-articular structures
Stimulates joint receptors
Control variable: speed
Handling: should be performed slowly and monitoring the tissues response
Often performed after thrust techniques and articulatory techniques
Takes advantage of synovial fluid change after the separation of the joint surfaces
(refractory period of relative hypermobility)
5. Springing
Repetitive pressure of graduated nature sometimes combined with
very short leverages
Control variable: speed and pressure
Handling: slow rhythmical pressure and release
Sometimes used as a diagnostic technique for assessing tenderness,
resistance and reactivity
6. Inhibition
Consists in applying pressure for a fairly long period, being slowly and
deeply brought into play and then slowly and gradually released.
Control variable: pressure depth
Handling: applied over small areas where the inhibitory effect is considered
necessary; can be combined with positional techniques
Is designed to produce relaxation, improvement in local circulation and
reduction in facilitation of afferent impulse response
7. Vibration
Rapid oscillatory pressure or movement
Applied superficially at a fairy fast rate
8. Effleurage
Borrowed from the massage
Drainage effect on the lymphatic channels
Promotes circulatory response
Thrust techniques
Rapid application of force
They are usually applied parallel or at right angles to the plane of the
articulation and in the direction against the barrier of joint fixation
Joint must be positioned in the most favourable position
Thrust techniques do not necessarily have to be carried out at the limit at
of a range of motion
Thrust techniques comprise five broad sub-divisions:
Thrust techniques sub-divisions
1. Combined leverage and thrust
2. Combined leverage and thrust using momentum
3. Minimal leverage
4. Non-leverage thrust
5. Non-leverage thrust using momentum
1. Combined leverage and thrust
Thrust applied at or near to the point of lesion
Static fulcrum created by pressure or fixation
a) Thrust at the lesion point (i.e. typical cervical thrust; sidebending
with reverse rotation)
b) Thrust at the extremity of the lever arm (i.e. supine mid-dorsal)
c) Combination thrust: lesion point and extremity of the lever arm
2. Combined leverage and thrust using momentum
Sub-division of the previous combined leverage and thrust
A build-up of momentum in the primary leverage direction is used
Particularly useful for heavily built patients and very rigid areas
It is a more dynamic technique but has the danger of losing control of
the amplitude and be potentially traumatic through overlocking
3. Minimal leverage
It uses the general principles of a combination of leverages and then a
thrust, but whereas in the standard method the leverage is
deliberately employed to supplement the thrust, in the minimal
leverage it is kept to an absolute minimum
Combined leverages are used only as a way of placing the segment in
an available position and in a maximum relaxation attitude
Contact point accessible for thrust
Neutral tension positioning
3.1. Minimal leverage
The accent is on the thrust
Very high velocity
Applied when torsion or other tension in the tissues is not possible
i.e. acute disc prolapse
Is the most delicate thrust technique and the and the most difficult to
master
Highly accurate tension sense needed
It has the benefits of far less trauma and after-treatment reaction
Separation of joint surfaces can be achieved with very small degrees of capsular
stretch and stress on the surrounding tissues
4. Non-leverage thrust
Directed to bony landmarks such as spinous process without the use
of a leverage
Preliminary pressure in a particular direction substitutes for a
leverage and minimises the eventual amplitude of the thrust
It uses compression for extending the length of the lever arm
It is performed with very high speed or very high force
Speed is preferable
5. Non-leverage thrust using momentum
The same as the previous technique whereas the momentum effect is
produced by applying and releasing the contact point pressure several
times until a state of relaxation is sensed
