Osteopathic approaches are generally defined as direct or indirect. This distinction refers to the direction of practitioner input relative to perceived restriction or motion preference.
Examples of direct approaches are:
- Muscle energy technique (MET): utilising precise and voluntary contract-relax responseof muscles around a joint to improve local function.
- Articulation: passive amplification of joint movement through direct manipulation of a joints accessory movement. By influencing accessory movement, articulation improves voluntary gross motion. Articulation includes oscillation.
- Myofascial release: stretching muscular and associated connective tissue (fascia) – promotes integrated functional and regional relationships.
- Joint manipulation: specific application of a high velocity-low amplitude impulse 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 various explanatory models and agencies of therapeutic change.
Indirect approaches include:
- Balance ligamentous tension/balanced membranous tension: involves positioning of structures around specific anatomical fulcrum(s) to produces a sense of maximum ease and balance. Release of a restriction is through dense connective tissues like ligaments and interosseous membranes.
- Positional release: passive positioning and shortening of muscular and ligamentous structures to facilitate relaxation of neuromuscular reflexes and resting tone.
- Osteopathy in the cranial field: Although referred to as cranial, these approaches are applied anywhere on the body. Cranial osteopathy involves the diagnosis and treatment of systemic involuntary motion. The Sutherland model is an extension of the osteopathic concept to cranial structures, central nervous system and associated fluids. Sutherland regarded the cranium, membranes and fluid as a dynamic system with primary respiratory motion distinct and separate from pulmonary respiration. Historically this model has emphasised treatment of articular strain patterns between and within cranial bones. A more recently codified approach is the Biodynamics of osteopathy. In his development of the Biodynamic syllabus, Jim Jealous is intellectually indebted to Sutherland but integrates the more recent insights of some of Sutherland’s eminent students who have shared their insights informally and orally. In Biodynamics of Osteopathy there is less articular emphasis and a focus on motion present, dynamic stillness and fluid potency. Biodynamics is informed by a distinct embryological and developmental model of form, function and motion.
Osteopaths tend to shift imperceptibly between different approaches, responding to patients idiosyncratic therapeutic responses and needs.