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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
Philippe Druelle
Philippe Druelle DO
Each sub-discipline requires the Osteopathic Manual Practitioner to have direct physical contact with the tissue to be treated. Light, intentional contact with the tissues is made. During treatment, the Osteopathic Manual Practitioner combines sensory palpation with application of a very specific and deliberate motion, albeit small, to the intended tissue.
In the case of osteo-articular adjustments, the motion imparted is quite soft. In the case of visceral normalizations, cranial-sacral application or fascial release, a sense of mild pressure might be obvious to the patient, but the patient 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 tissue into a more natural or correct position (termed direct treatment). In other cases, the Osteopathic Manual Practitioner chooses a technique that actually moves the tissue more toward the problem or strain pattern than toward the correction (termed indirect treatment).
The seemingly contrary actions of indirect treatment—moving the tissue toward the problem rather than away from it—allow the tissue to relax. Relaxation occurs because the Osteopathic Manual Practitioner, rather than the tissue, 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 be aimed at either 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 could determine if he or she 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 return as circulating fluids are allowed to pass in, through, and out of the area. As the flow of these fluids returns, so does the life- and health-sustaining elements that are contained in the fluids.
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 intended tissue or the rest of the patient's body.
Cranial-sacral application
Cranial-sacral treatment is a sub-discipline of Osteopathy that was developed by William Garner Sutherland, DO, who was a student of the profession's founder, A.T. Still. The Osteopathic Manual Practitioner 's knowledge of when, where, and how to apply cranial techniques is what makes this form of osteopathic treatment so effective.
Osteopathy works under the premise that the cranium, as well as all the other 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. The motion is imparted to all living tissues as a “micro-mobility” termed motility, which is expressed at a frequency that is detectable by the human hand through precise and experienced palpation. This motility is the focus of much scientific research.
The cranial touch focuses on restoration of the inherent motility of PRM. This application is not restricted to the cranium. 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 condition of the tissues under evaluation, the motility can be 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
In recognition of the fact that a dysfunctional relationship between the organs and the musculoskeletal system has been proven to be a source of physical pain and discomfort, visceral normalization seeks to alleviate this dysfunction.
Treatment is usually directed toward ensuring that each organ has adequate mobility or space in which to perform its functions. This treatment helps to ensure that each organ is not impeding any major vessels or nerves in the area, and that the organ 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 or her knowledge of normal and abnormal anatomy and physiology. Furthermore, because many of the organs are not within the physical reach of the Osteopathic Manual Practitioner's hand, the practitioner must rely on his or her refined sense of palpation. Using this sense there is no tissue that is out of the reach of a skilled and experienced Osteopathic Manual Practitioner's sensory abilities.
Fascial release
Fascial release is a generalized term used 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. The Osteopathic Manual Practitioner's palpatory skill in both sensing the state of the tissue and in simultaneously moving the tissue allows him or 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.