Osteopathic Manipulation Techniques

Additional Core Osteopathic Concepts

The spectrum of osteopathic manipulation techniques (OMT) focuses on the principle that body structure and function are dependent on one another. When structure is altered via the musculoskeletal system, abnormalities occur in other body systems. This, in turn, can produce restriction of motion, tenderness, tissue changes, and asymmetry (somatic dysfunction).

Following are some of the manipulation procedures most commonly used by osteopathic physicians to diagnose and treat somatic dysfunctions.


The value of placing of hands on a patient is universally acknowledged by health professionals. This essential component of the doctor-patient relationship has a great deal to do with the patient's well-being, whether he or she suffers from a cold or a terminal disease. When the DO examines a patient by auscultation of the chest or palpation of the abdomen or spine, the treatment already has begun.


This procedure is commonly applied to the musculature surrounding the spine and consists of a rhythmic stretching, deep pressure, and traction. Its purpose is to move excess tissue fluids (edema) and to relax hypertonic muscles and myofascial (fibrous tissue) layers associated with somatic dysfunction.


This procedure is designed to treat primarily the myofascial structures. In the use of direct myofascial release treatment (MRT), a restrictive barrier is engaged for the myofascial tissues; the tissue is loaded with a constant force until release occurs. In treating with indirect MRT, the dysfunctional tissues are guided along a path of least resistance until free movement is achieved.


Cranial osteopathy is a specific approach within the osteopathic concept. It influences the structure and fluid surrounding the central nervous system, creating an impact on the total body and initiating the body's inherent capacity to heal itself. Fascial connections throughout the body are contiguous with the linings around the central nervous system, including the dura and other structures. Practitioners of cranial osteopathy utilize a manual approach to accomplish these goals within the practice of osteopathic medicine.


This manual procedure is designed to promote circulation of the lymphatic fluids and can be used to treat various difficulties. One technique is pressure applied with the physician's hands to the supine patient's upper anterior chest wall. When the force that is applied to the chest reaches its maximum on expiration, the physician's hands are removed suddenly. This increases negative pressure of the chest to assist the body's respiratory mechanism to move lymphatic fluids.


In this form of manipulation, the physician applies a high-velocity/low-amplitude thrust to restore specific joint motion. With such a technique, the joint regains its normal range of motion and rests neural reflexes. The procedure reduces and/or completely nullifies the physical signs of somatic dysfunction: tissue changes, asymmetry, restriction of motion, and tenderness.


In this manual technique, the patient is directed to use his or her muscles from a precise position and in a specific direction against a counterforce applied by the physician. The purpose is to restore motion, decrease muscle/tissue changes, and modify asymmetry of somatic dysfunction.


The counterstrain technique is a manual procedure in which the patient is moved passively away from the restricted motion barrier toward the position of greatest comfort. At this point, passive asymptomatic strain is induced.