Osteopathic Manipulative Medicine: A Brief Review of the Hands-On Treatment Approaches and Their Therapeutic Uses

Abstract

Osteopathic manipulative medicine (OMM) is an emerging practice in the healthcare field with increasing popularity and evidence-based therapy. Osteopathic manipulative treatments (OMT) include hands-on manipulations of different body structures to increase systemic homeostasis and total patient well-being. Indeed, this new realm of the whole patient-based approach is being taught in osteopathic schools around the country, and the osteopathic principles of a mind-body-spirit-based treatment are being instilled in many new Doctor of Osteopathy (D.O.) students. However, despite their proven therapeutic value, there are still many individuals, both in and outside the medical profession, who are unaware (or misinformed) of the therapeutic uses and potential benefits of OMT. Here, we provide a brief introduction to this osteopathic therapeutic approach, focusing on the hands-on techniques that are regularly implemented in the clinical setting. It is becoming increasingly evident that different OMTs can be implemented to enhance patient recovery, both alone and in conjunction with the targeted therapies used in allopathic regimens. Therefore, it may be beneficial to inform the general medical community and educate the public and those associated with the healthcare field about the benefits of using OMT as a treatment modality. OMT is lower-cost, noninvasive, and highly effective in promoting full-body healing by targeting the nervous, lymphatic, immune, and vascular systems. There is a growing body of literature related to osteopathic research and the possible molecular pathways involved in the healing process, and this burgeoning field of medicine is expected to increase in value in the healthcare field. This brief review article explains the frequently utilized OMT modalities and their recognized therapeutic benefits, which underscore the need to understand the possible molecular mechanisms and circulating biomarkers linked to the systemic benefits of osteopathic medicine.

Keywords: HVLA (High-velocity low amplitude); balanced ligamentous tension; cranial osteopathy; diaphragm; lymphatic pump; muscle energy; myofascial release; osteopathy.

Figure 1

The principles of palpatory diagnosis and manipulative technique. The figure shows the procedure for the abduction of the legs. The osteopathic physician compares abduction of both left and right legs to determine which muscle to treat. Whichever leg has greater restriction compared to the other would be the leg selected for treatment.

Figure 2

Post-isometric relaxation and reciprocal inhibition. Neuromuscular actions are mediated by Golgi tendon organs and inhibitory interneurons of the spinal cord [10]. (A) Contraction of agonist (adductor), and the reflexive post-isometric relaxation of the same muscle. (B) Contraction of antagonist (abductor), and the reciprocal inhibition/relaxation of the agonist (adductor).

Figure 3

Muscle energy technique on the lumbar spine. The physician is in contact with the shoulders to control the position of the trunk and spine in 3 dimensions. The physician uses a free hand to monitor the lumbar spine for localization of the barrier at the appropriate segmental level. The monitoring hand will remain on the vertebral processes of the somatic dysfunction to detect the tissue’s responses to vectors.

Figure 4

Hand placement and force vectors for diaphragm doming technique.

Figure 5

Sympathetic chain ganglionic pathway. The bilaterally symmetric sympathetic chain ganglia are located just ventral and lateral to the spinal cord and run parallel with the thoracic spine. The sympathetic chain ganglionic pathway extends from the upper neck down to the coccyx, forming the cervical, thoracic, lumbar, or sacral ganglions. The postganglionic fiber extends to the thoracic cavity, abdominal cavity, or pelvic cavity, and dysfunctions in many organs can be addressed by different variations of the rib raising techniques. Adapted from Karemaker et al. (2017) [45]. The eighth and the ninth thoracic vertebrae are designated as T8 and T9, respectively. The eighth and ninth thoracic spinal nerves run beneath these vertebrae. The green arrows designate afferent neurons and the brown arrows designate the efferent neurons.

Figure 6

Rib raising technique variations. (A) The osteopathic physician has the patient in a supine position. The hands are positioned at the position of the rib angles to gain proximity to the thoracic chain ganglia. With the fingers placed at the rib angles, pressure can be applied through the shoulders and the elbows into the wrists. This position is held until the soft tissues release. Once soft tissue release is appreciated, the hands are then repositioned to subsequent ribs. (B) Lateral recumbent positioning. (C) Seated positioning.

Figure 7

Lymphatic pumping techniques. Both the thoracic (A) and pedal (B) pump techniques can be used to enhance the body’s lymphatic flow. The white arrows in each panel indicate the physician’s force inducing fluid movement, while the black arrows indicate dynamic fluid movement back towards the physician to create a continuous, rhythmic oscillating motion.