Description Of Osteopathic Treatment

What Is Osteopathic Treatment?

Osteopathic treatment is a form of manual medicine first applied by Dr. Still and further developed by the osteopathic profession. It is used by DOs and properly trained MDs to treat structural restrictions (somatic dysfunction) and improve the level of health in their patients.
Osteopathic treatment has gone by various names: Osteopathic Adjustment, Osteopathic Manipulative Therapy, Osteopathic Manual Treatment, Osteopathic Manipulative Treatment, Osteopathic Manual Medicine, etc.
The level a treatment takes place on depends on a number of factors, among them, the level of skill, perception and experience of the physician. Some treatments are aimed primary at joints, others at membranes or fluids; still others at even deeper levels.
What makes a certain form of manual medicine osteopathic is not just the technique, but also the way in which it is applied, that is, according to osteopathic philosophy.

How Does It Work?

Osteopathic treatment works by engaging the innate forces of the body to do the work and preferably, to do it in a fashion in which the body is already trying to treat. By applying seemingly innocuous forces in a very precise manner, the bodies self-treatment can be enhanced to release strains and patterns imprinted on the body from trauma and stresses of life.

Self Treatment Patterns

There have always been a number of methods used to classify osteopathic treatment. The easiest way to understand these approaches is to look at the way in which the body treats itself.

For sake of simplicity, we use a classic model dealing with motion of one bone with respect to another, though it is truly much more complicated than this.

Fig. 1 “Normal” position of bones

Fig.2 Altered position from trauma

Indirect (Exaggeration of the problem)

Fig. 3 Indirect forces applied to altered anatomy.

In an indirect approach the pathologic position of the disturbed areas is exaggerated until a change occurs.


Fig. 4 Indirect forces applied to altered anatomy.

In a direct approach the pathologic position of the disturbed areas is reduced or taken directly towards their “normal” position until a change occurs.


Fig. 5 Disengaging forces applied to altered anatomy.

In disengagement the disturbed areas are separated and the tension adjusted until a change occurs.

Opposite Physiological Motion

Fig. 6 Forces applied appear opposite to a physiologic approach.

In this approach one part is positioned as if an indirect approach and the other as if a direct approach.


Fig. 7 “Normal” squamous bone.

Fig. 8 “Warped” squamous bone.
Fig. 9 Treatment forces applied by the body remolding the bone from inside the head.

Molding is useful for treating “warped” bones such as the thin bones of the head deformed from physical trauma. The forces essentially remold the shape of the bone.


There are a number of other approaches, which affect the body on deeper levels that are very uncommonn or too complex to discuss here.

Involved Forces

The above treatment methods can be applied with different types of forces

  • High velocity

  • Low velocity

  • Muscle energy

  • Balanced tension

  • Observation/Augmentation

These can be forces that are applied externally or they can be patient generated forces (the body always treats itself).

Tissue Levels

In addition, an individual treatment approach can be applied to different tissues or different levels of function of the body.
  • Bones

  • Connective tissue

  • Muscles

  • Ligaments

  • Membranes

  • Organs

  • Fluid

  • Potency

  • Embryologic matrix

  • Energetic

Treatment Techniques

Commonly used treatment techniques are as follows:


  • Direct

  • Indirect

High velocity low amplitude treatment uses forces quickly applied to a discrete area. This is familiar to many people as thrusting or “popping”technique. This is most commonly performed as a direct technique.

Muscle Energy

Muscle energy uses the force of patients voluntarily directed muscle contractions to treat. It is usually direct, but can be an indirect approach.


Counterstrain uses tender points (discrete tender areas that are caused by structural problems) to locate a problem and the body is positioned in such a fashion to relieve then tenderness at this point and held until the body fixes it. It is a form of indirect technique.

Fascial and Myofascial Release

Fascial release is a very old osteopathic technique, which can use direct or indirect forces to treat fascial restrictions.

Balanced Tension

This technique balances the tension of or across a given level to set up a condition where the body is less affected by the pathology and can treat itself.
Can be applied to all connective tissues. most commonly it a applied to ligaments, membranes, and articulations.


This balances the tension on the level of the fluid, which can develop physiologic restrictions. Remember the fluid contains electrolytes and proteins, which alter the characteristics of a fluid.


This balances the tension on the level of the potency, a level deeper than the cerebrospinal fluid.

Lateral Fluctuation

This sets up a wave in the fluid that fluctuates back and forth from one side of the body to another until it reduces in magnitude and sets up a change in the body.


A CV4 is a technique that brings the fluid towards the midline of the body to institute a change. An EV4 brings about a change by allowing the fluid to go away from the midline and towards the periphery. They are useful under different circumstances.


It would not seem that observing something would have any effect on it, but when a trained practitioner observes the body in the correct manner and at the proper level, he/she can augment the self-healing forces allowing the body to fix itself.


The use of percussion was pioneered by Robert Fulford, DO, and developed over many years of practice. This involves using a Foredom percussor over precise areas of the body at just the right speed (and correct length of time) to help the body treat itself.


Biodynamics is an approach named by James Jealous, DO, using the later writings of the founder of Cranial Osteopathy, W. G. Sutherland, DO.

Embryologic Matrix

Embryologic matrix technique is another new approach based on the ideas of W.G. Sutherland, DO and principles of embryology. It utilizes the matrix of embryologic development of the body (which the body uses to treat itself) to augment self-corrective forces.


There are numerous other approaches that were not mentioned, but most fall in the categories already mentioned.

All this being said, it is a misnomer to think that there are discrete structural “lesions” or problems in the body. Any problem anywhere in the body affects the whole and is a whole body problem. That is, the body is structurally one unit and becomes dysfunctional as a whole unit, not individual parts. As such, treatment is approached with this idea in mind and the treatment technique must be appropriately applied.