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About Osteopathy Osteopathic Assessment and Treatment

Osteopathic Assessment and Treatment

A strong feature of the Canadian School of Osteopathy Manual Practice is its emphasis on Clinical Methodology.

Through extensive training and experience, the Osteopathic Manual Practitioner understands that the site of the patient's complaints may not correspond to the site of the cause (or causes) of these complaints. In addition, many people have had multiple overlapping injuries and conditions. In response to these common conditions, the Osteopathic Manual Practitioner assesses and treats the whole patient recognizing that each individual may have physical, emotional and mental conditions.

The Clinical Methodology, as presented at the Canadian School of Osteopathy Manual Practice, provides a prioritized plan by which the Osteopathic Manual Practitioner first assesses and then treats the patient, in a methodical sequence. This sequence of determining and treating the most severe problems first, is a highly effective way of liberating an area of the body that when released, provides a cascading effect of other releases throughout the body.

By using a precise methodology, the Osteopathic Manual Practitioner is able to achieve the maximum change in the patient with the minimum amount of treatment. More importantly, choosing the appropriate area to begin the treatment minimizes the side effects of treatment soreness. Treatment soreness describes a situation of feeling worse after treatment than better, and is often caused by treating the symptoms before the cause of the symptoms is addressed.

As the ancient saying goes, “First do no harm” (Primum non nocere).

Osteopathic treatment combines the four main types of osteopathic sub-disciplines:

     Osteo-articular adjustments
     Cranial-sacral application
     Visceral normalization
     Fascial release
Philippe Druelle DO
Each sub-discipline requires that the Osteopathic Manual Practitioner to have direct physical contact 
with the intended tissue. In treatment, the Osteopathic Manual Practitioner combines sensory palpation, while applying a very specific and deliberate motion (albeit small) to the intended tissue.

In the case of Osteo-articular adjustments, the motion imparted is quite gentle. In the case of visceral normalizations, cranial-sacral application or fascial release, a sense of mild pressure or intent may be obvious to the patient but he may not always be aware of the movement that the Osteopathic Manual Practitioner transmits to the selected tissues.

In some cases, the Osteopathic Manual Practitioner may move the tissues into a more natural or correct position (termed direct treatment), but just as frequently the Osteopathic Manual Practitioner chooses a technique that actually takes the tissues more towards the problem or strain pattern than the correction (termed indirect treatment).

This seemingly contrary action or indirect treatment, of taking the tissue towards the problem rather than away, actually allows the tissues to relax. This occurs because the Osteopathic Manual Practitioner, not the tissues, is now doing the holding. One may use the analogy of a patient holding a bowling ball at arm's length. A direct treatment would either be aimed at removing the bowling ball or lowering the patient's arm. An indirect treatment would have the Osteopathic Manual Practitioner supporting the patient's arm and thus the bowling ball. The arm would then begin to relax and at that point the patient (or the patient's tissues) could determine if they wanted to drop the ball, lower the ball, or hold the ball closer to the body.

In an indirect technique, it is the decision of the body's physiology that determines if and at what pace the correction is to take place. Once the position and mobility are re-established, the quality and vitality of the tissue gradually returns as circulating fluids are allowed to pass in, through, and out of the area. With the return of the flow of these fluids, comes the life and health sustaining elements that are contained within that fluid.

Osteo-articular adjustments

As described by Philippe Druelle, DO, “an osteo-articular adjustment is a precise methodical and exacting manual osteopathic technique, which requires specificity.” The Osteopathic Manual Practitioner's goal is to restore the natural physiological relationship between the elements comprising the articular functional unit without using force.

Rather than attempting to physically move the bones, the Osteopathic Manual Practitioner delivers a precisely timed and placed “impulse,” in order to reduce the strain upon the intended articular functional unit. This impulse allows the unit to return to its natural position without stressing either the tissues, the body, or the patient.

Cranial-sacral application

Cranial-sacral treatment is actually a sub-discipline of Osteopathy, developed by William Garner Sutherland, DO, who was a student of the profession's founder, A.T. Still. It is the Osteopath's knowledge of when, where, and how to apply cranial techniques that makes osteopathic treatment so effective.

Osteopathy works under the premise that the cranium as well as all the tissues and systems of the body are in a constant motion. This motion is the Primary Respiratory Mechanism (PRM), an idea that originated with Osteopathy. This function imparts to all living tissue a motion. This “micro-mobility” termed motility, is expressed at a frequency that is detectable by the human hand through precise and experienced palpation. Lately this motility has become the focus of much scientific research.

The cranial touch focuses on this restoration of the inherent motility of PRM. This application is not restricted to the cranium alone. It may also be applied to any other tissue or system of body, because this motility is expressed everywhere in the body. Depending upon the health and state of the tissues under evaluation, this motility is detected in varying degrees of normality by the palpating Osteopathic Manual Practitioner. Treatment is aimed at restoring the optimal rhythms of the patient's PRM.

Visceral normalization

Recognizing that a dysfunctional relationship between the organs and the musculoskeletal system has been proven to be a source of physical pain or discomfort, visceral normalization seeks to alleviate this dysfunction.

Treatment is usually directed towards ensuring that each organ has adequate mobility or space in which to perform its functions. This treatment works to ensure that each organ is not impeding any major vessels or nerves in the area, and that it has its own sense of motility.

Even more so than with other techniques, the Osteopathic Manual Practitioner who performs visceral normalizations must be able to fully apply his knowledge of normal and abnormal anatomy and physiology. In addition, since many of the organs are not within the physical reach of the Osteopathic Manual Practitioner's hand, the Osteopathic Manual Practitioner relies on his refined sense of palpation. Using this sense there is no tissue that is out of the reach of a skilled and experience Osteopathic Manual Practitioner's sensory abilities.

Fascial release

Fascial release is a generalized term to describe treatment that is aimed at restoring soft tissue mobility and motility, particularly that of membranous-like tissues. These membranes or connecting tissues comprise the fabric that holds the human body together as a functioning system.

Once again, the Osteopathic Manual Practitioner's palpatory skill in both sensing the state of the tissue, and by moving the tissue at the same time, allows him/her to achieve release without the application of force.

There are many types of fascial release that have been developed by Osteopathic Manual Practitioners. These include:

•  General Osteopathic Treatment (GOT) that is primarily rhythmical.
•  Strain Counterstrain as first described by Lawrence H. Jones, DO.
•  Muscle Energy as first described by Fred Mitchell Sr., DO.
•  Reciprocal Membranous Tension.