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

Osteo-articular Adjustments

Cranial-sacral Application

Visceral Normalization

Fascial Release

Each treatment requires the Osteopathic Manual Practitioner to have direct and intentional physical contact with the intended tissue(s). During treatment, the Osteopathic Manual Practitioner uses sensory palpation, while applying a very specific and deliberate (albeit small) motion.

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 (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. 

This seemingly contrary action of taking the tissue towards termed (indirect treatment) 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.

With an indirect technique it is the decision of the body's physiology that determines if, and at what pace, the correction takes 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 without restriction. 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

Osteopathy works under the premise that the cranium as well as all the living 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 “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.

Cranial-sacral treatment is a sub-discipline of Osteopathy, developed by William Garner Sutherland, DO.  Sutherland was a student of the profession's founder, A.T. Still. 

The cranial touch focuses on the restoration of the inherent motility of PRM. This application is not restricted to the cranium alone, rather it may also be applied to any other tissue or system, as this motility is expressed throughout the body. 

Treatment is aimed at restoring the optimal rhythms of the patient's PRM.  Depending upon the health and state of the tissues under evaluation, motility is detected in varying degrees of normality, by the palpating Osteopathic Manual Practitioner. It is the Osteopath's knowledge of when, where, and how to apply cranial techniques that makes Osteopathic treatment so effective.

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.

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. As many of the body’s organs are not within the physical reach of the Osteopathic Manual Practitioner's hand, the practitioner also relies upon 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.

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

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.