Osteopathic Manipulative Medicine: Assessment and Techniques (Part 2)

With a focus on function and range of motion, osteopathic techniques can be used to assess and treat a variety of painful areas.

Osteopathic Manipulative Medicine can help people manage several areas of pain. In general, osteopathic manipulative medicine (OMM),sometimes called osteopathic manipulative treatment (OMT), uses a comprehensive set of manual, or hands-on, maneuvers to help diagnose, prevent, and treat a range of conditions and injuries.

Patients seeking out OMM for pain in the upper extremity (shoulder, arm, wrist, hand) or lower extremity (hip, knee, ankle) are typically excellent candidates for treatment (see Part 1, Am I a Candidate for OMM). However, individuals with osteoporosis, who have experienced a bone fracture, or live with bone fragility due to metastatic cancer should be cautious about this treatment. It is possible that OMM can still be used on these individuals if the techniques are modified and applied more subtly. For head, neck and back pain, OMM can help to realign the vertebrae by normalizing spastic musculature, which may be placing pressure on spinal nerves causing pain.

OMM may also help aid in the recovery of underlying organs with treatments. To explain, in what is called a viscerosomatic reflex, a dysfunctional organ can transmit abnormal sensory input into the spine, leading to an exaggerated response and causing the affected spinal area to deviate away from its normal position. Correction of this structural problem is thought to calm this response and, therefore, help diseased organs heal.

In acute disease states of the gallbladder, as another example, a person may feel pain in the middle of the back at the level of the shoulder blade. OMM may help determine where this pain is coming from. Other organs can cause similar reflexes, including but not limited to the: lungs, stomach, small intestine, pancreas, spleen, kidney, bladder, heart, and thyroid.

Patients may be placed in seated, prone (laying on the belly), or supine (laying on the back) positions during an osteopathic manipulation session. (Image: iStock)

What Does an OMM Assessment Involve?

Your physician, most likely a Doctor of Osteopathic Medicine (DO), will test the range of motion in any painful or affected areas, including neuromuscular testing of the upper and lower limbs. They may also examine your body mechanics, assess muscles, and look for compensatory changes. The DO may examine your spine for tissue texture changes or pronounced asymmetries. Finally, to make a diagnosis, the physician will use their hands to feel the underlying bone structure and ask patients to move their bodies in different directions to determine where the area is capable of more or less movement.  Once a diagnosis is made, an appropriate treatment plan can be developed.

Leonard Powell, DO, CMD, assistant professor of Geriatrics and Osteopathic Medicine at Rowan School of Osteopathic Medicine in New Jersey, explains, “With any OMM treatment, a patient can be expected to be placed in positions to treat their somatic dysfunctions. The positions are not nor should not be uncomfortable. In some cases, they will feel like a gentle stretch. In others, the patient will have to resist a small amount of force the physician applies. There should not be any pain involved and, if the patient feels pain, they should notify the physician and cease treatment. Patients may be in the seated, prone (laying on the belly), or supine (laying on the back) positions.”

Dr. Powell points out that some homework will be required on the part of the patient. “After the office visit, the patient may be given home exercises to perform as well as pain medications (acetaminophen, NSAIDs, or steroids, for example) and be advised to have adequate water intake.”

A follow-up visit will likely scheduled after 2 weeks.


What Techniques Are Used with Osteopathic Manipulation?

Osteopathic manipulative medicine techniques are classified into two general categories: direct and indirect. Both approaches aim to improve the person’s overall ease of motion using either motion barriers or musculature. Techniques can include:

Myofascial (or soft tissue) release: The physician will use gentle pressure to release tension in connective tissues that encompasses bones, organs, and muscles. During these treatments, you may feel stretching or pressure in the muscles of affected areas. 

Muscle energy: The physician will move the patient into their motion barrier (where the affected area does not want to move) and the patient is asked to return to a neutral position. The physician then moves the patient further into this barrier and the process is repeated several times.

High-velocity low-amplitude (HVLA): The physician provides a quick thrust over a very short distance to help remove motion loss from an affected area. The physician will ask the patient to breathe and apply force as they exhale, so that the body is further relaxed, making the treatment potentially more effective.  This technique may not be appropriate for all patients, including those who are frail.

Lymphatic techniques: These focus on the lymphatic system, which serves to cleanse the body of bacteria or viruses. The physician will work to increase lymphatic flow through the direct application of pressure. 

Counter-strain: This indirect technique involves identifying small areas of tenderness known as a tenderpoints (about the size of a fingertip). The physician will locate a tenderpoint and place the patient in a position of comfort while palpating the tenderpoint and holding it for roughly 90 seconds.

Each manipulation only lasts a few minutes, however as multiple areas will likely be affected, several techniques may be performed in one office visit. Patients may be placed in seated, prone (laying on the belly), or supine (laying on the back) positions during the manipulations and given home exercises to do after a visit.


How Can OMM Help My Pain?

As noted, OMM can help to manage pain in a variety of areas. One of osteopathic medicine’s principles rests on the notion that the body’s structure and function—as well as the mind -- are interconnected.  So, if the shoulder is bothersome, explains Dr. Powell, the physician will examine connecting areas, such as the clavicles, ribs, thoracic spine, and elbow to determine if any contributing factors are present. For pain in a lower extremity, such as the knee, the physician may also examine the hips, pelvis, sacrum, lumbar spine, foot/ankle, and other relevant bones.

“Treatment will be targeted to the affected area and peripheral dysfunctions,” he says, that is, areas close to the affected area, “will also be assessed and treated if necessary.” Homework will be given to the patient as well, including exercises and proper hydration.

Overall, OMM provides an alternative and complementary treatment to other traditional means of pain management, such as medication. By focusing on movement and function, the whole person is treated.

Updated on: 05/04/20
Continue Reading:
Am I a Candidate for Osteopathic Manipulative Medicine?