Osteopathic manipulations comprise a number of techniques
- high velocity, low amplitude (HVLA) thrusts;
- muscle energy techniques;
- myofascial release;
- cranio-sacral manipulation;
- lymphatic pump techniques.
Of these, by far the most common are HVLA thrusts, muscle energy techniques and myofascial release. Cranio-sacral manipulation is generally performed by a cranial osteopath.
An HVLA thrust, as its name implies, involves a quick thrust through a short distance. The manipulation itself is performed on the joints of the skeletal system. In theory, a high velocity thrust can be performed on any joint, but they are typically used on the spine.
This is the classic technique that most people associate with osteopathy. It often produces a clicking, or crunching, sound in the patient.
HVLA thrusts are designed to correct misalignment and never (or rarely) exceed the joint’s normal range of motion. When performed on the spine, an HVLA thrust should (in theory) decompress the vertebral joints.
Chiropractic manipulation also uses high velocity thrusts, but their amplitudes tend to be greater (the joint is often moved beyond its natural range of motion). By their nature, however, all thrusts are relatively violent. For this reason, there are a number of conditions (known as contra-indications) where they shouldn’t be used.
In essence, muscle energy techniques are a form of assisted stretching. For example, to stretch the hamstring, an osteopath might raise the leg of his (or her) patient and place the ankle on his shoulder. The patient is then asked to press into the osteopath’s shoulder, causing the hamstring to contract isometrically (that is, develop tension without changing length). Following on from this, the osteopath should then be able to raise the leg beyond its previous limit. The exercise (also known as PNF stretching) can be repeated as necessary. Muscle energy techniques are very low risk, and can be used where high velocity thrusts are contra-indicated.
The term myo-fascial refers to both muscle (myo) and fascia, thin sheaths of fibrous tissue that surround muscle fibres and organs. Whereas muscles can be contracted, fascia cannot. It can, however, be passively, elastically deformed (the term passive here, means without input from the patient). As a result, fascia can retain tension due to physical and emotional trauma.
Myofascial release (MFR) is similar to deep massage, but the technique is more precise. Traction is applied to the long axis of a particular muscle, the aim being to stretch both the muscle and the surrounding fascia. As a result, MFR is used to promote blood flow and relieve tension; again, the risk involved is very low.
Osteopathy tends to yield reasonably favourable outcomes for patients suffering from short term, acute pain, which may be the result of accident or injury. It is not however, suited to the treatment of long term, or chronic, back pain.
High velocity thrusts, for example, often result in musculoskeletal trauma which can aggravate long-term conditions. This will lead to prolonged and more severe symptoms. Other techniques, such as PNF stretching and myofascial release, only treat the symptoms of musculoskeletal pain, not the cause. For example, attempting to stretch the hamstring is largely futile if the spinal nerve controlling this muscle is compressed. But, decompressing the lumbar spine and then stretching the hamstrings will work (not only relieving the patient of back pain and Sciatica, but also increasing soft tissue elasticity).
Please note that, at the time of writing, the website of the General Osteopathic Council (GOC) states: ‘For some acute pain one or two treatments may be all that is necessary. Chronic conditions may need ongoing maintenance’.
In some instances, back pain sufferers will spend a lot of money, over a number of years, attempting to manage their pain via the use of osteopathy and/or chiropractic.