types of osteopathic procedures

Osteopaths are not defined by technique. Technique (osteopathic procedures), are an expression of principles and philosophy. Osteopathic procedures are generally defined as direct or indirect. This distinction refers to the direction and orientation of practitioner force in relation to perceived tissue restriction or motion preference. When practitioner force is applied into a restrictive barrier, the technique is direct. Examples of direct approaches are:

Muscle energy technique (MET): utilising precise and voluntary contract-relax of muscles around a joint to improve local function.

Articulation: passive amplification of joint movement through direct manipulation of that joints accessory movement. By influencing accessory movement, articulation improves voluntary gross motion.

Myofascial release: stretching muscular and associated connective tissue (fascia) structures in a manner that harmonises functional/regional relationships.

Joint manipulation: specific application of a high velocity-low amplitude force to a functional unit of motion. This could be a spinal joint, but these approaches can be applied to any joint, with a few notable exceptions like cranial sutures.

Indirect approaches are tremendously varied and informed by differing explanatory models and agencies of therapeutic change.

Indirect approaches include:

Balance ligamentous tension/balanced membranous tension: involves subtle positioning of structures around specific anatomical fulcrum(s) to produces a sense of maximum ease and balance. Release of a restriction is through connective tissue elements – ligamentous and interosseous membranes.

Positional release: passive positioning and shortening of muscular and ligamentous structures to facilitate relaxation neuromuscular reflexes and therefore resting tension. 

Osteopathy in the cranial field: remains theoretically contested and divisive amongst many osteopaths and other health professional. Although referred to as cranial, these approaches are applied anywhere on the body. Cranial osteopathy involves the diagnosis and treatment of cranial structures and involuntary motion in the central nervous system. The Sutherland cranial model is a natural extension of the original osteopathic concept to cranial structures and central nervous system. Historically strong emphasis on articular strain patterns between cranial bones. Phylogenetic homologies inspired Sutherland to explore the cranium, membranes and fluid as a dynamic system with primary respiratory motion distinct and separate from pulmonary respiration. A more recently articulated cranial approach is the Biodynamics of osteopathy. Here there is less articular emphasis and a focus on motion present, dynamic stillness and fluid potency. Biodynamics is a systematic approach to many of the seemingly less tangible and subtle ‘afferents’ of a practitioner-patient interaction. Biodynamics is informed by distinct embryological model of motion.

As osteopaths mature they tend to shift imperceptibly between different approaches, responding intuitively to patients varied and idiosyncratic therapeutic responses.