OsteopathyThe basics of practiceJoo Moita Somatic dysfunction Treatment principles Classification of osteopathic techniquesTreatment 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. Effleurage1. 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 contraction2. 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 contraction2.2. 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 reactivity6. 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 rate8. Effleurage Borrowed from the massage Drainage effect on the lymphatic channels Promotes circulatory responseThrust techniquesRapid 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-divisions1. Combined leverage and thrust2. Combined leverage and thrust using momentum3. Minimal leverage4. Non-leverage thrust5. Non-leverage thrust using momentum1. Combined leverage and thrust Thrust applied at or near to the point of lesion Static fulcrum created by pressure or fixationa) Thrust at the lesion point (i.e. typical cervical thrust; sidebendingwith 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 arm2. 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 overlocking3. 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 positioning3.1. 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 tissues4. 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 preferable5. 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