5 Days to Sharper Osteopathic Technique

Small refinements. Better patient outcomes.

The shift that actually re-engages your mind and refocuses your hands.

Day 1: Contact Accuracy and Rhythm

Consider your contact and rhythm in your osteopathic technique

As an Osteopath your contact should be light, not threatening and intentional. Use a soft relaxed hand with as much surface area as possible and then focus your forces through a particular part of your hand to a specific structure. Remember that your contacts are active, they are:

• receiving information
• adapting to tissue response
• adjusting pressure and direction

Rhythm is an important principle in osteopathy for all body tissues. In regards to applied osteopathic technique we use precise contact and minimal input to remove restriction so the body’s own rhythmic motion can return. The technique aims to tune into the body’s existing rhythmic pattern so you can assess it and work with it rather than impose your own movement

Take for example the OA joint, a dysfunctional rhythm:

• is reduced or uneven
• stops abruptly / meets the barrier
• repeats the same limited pattern

How you use rhythm in technique

Feel the existing pattern, use small motions at varied speeds, encourage movement with minimal input where it is limited

Key point

Rhythm is how tissue express function, your technique aims to help improve that expression through precise contact and minimal, well-timed input.

Clinical Task: During your next clinic session focus on using the OA technique in the video and use the whole hand/s to contact and then generate your specificity through a particular part of your hand.

Also, experiment with tuning into the rhythm of the tissues and applying different speeds, rates and amplitudes.

Day 2: Direction of Force

The direction of your controlled force is important if you are going to be successful at applied osteopathic technique and use minimum input. Many osteopaths do not always consider this and end up using excessive force as a substitute.

For example, in the thoracic spine you are not just moving segments, you are following the facet planes, and the direction is what allows your technique to match that anatomy and actually influence the joint.

Direction must match joint mechanics to engage the restrictive barrier; if not, you miss it and the dysfunction remains.

Take for example the Supine Thoracic ‘DOG’ Technique

If you push straight down into the chest you miss the joint mechanics and need more force. This can be distressing for the patient and uncomfortable for you.  Angling your force inferior to superior and slightly into the chest follows the facet planes, takes you to the restrictive barrier quicker and requires less force.

Clinical Task: When using the supine thoracic technique in clinic today think: up and through the chest, not down into the bed!

Day 3: Positioning

In applied osteopathic technique, patient and osteopath positioning is crucial if the technique is to be effective for the patient and not hurt you in the process.

If the patient is uncomfortable then they will resist (and maybe not return), if the osteopath is uncomfortable then it is often a matter of time until they themselves get injured. 

Good positioning:

• Engages the barrier before you start
• Matches joint mechanics
• Reduces the force needed
• Increases specificity
• Allows the patient to be more relaxed

It will protect you, so you can:

• Use body weight instead of effort
• Keep in a neutral posture
• Avoid overexertion
• Improve control

Good positioning does most of the work. If the setup is right, the technique becomes easier, safer and more effective for both you and the patient.

Take for example: Rolling the patient during a lumbar roll technique. If you do not roll the patient enough then you will have to get into an awkward position as well as apply more force. 

Clinical Task: Think about you and your patients positioning, practice rolling the patient underneath you on the lumbar roll technique.

Day 4: When to Stop

Osteopathic technique and treatment is not done by the clock, it is applied according to tissues and body response.

This means that you have to tune into what you are seeing and feeling and what is or is not changing under your fingers. A wise experienced osteopath knows when to stop, when enough is enough, when the system is beginning to take over.

If you go by the clock or even switch off and stop being present, you will often over treat and therefore stimulate and irritate, or undertreat and not get any response at all.

An example of knowing when to stop may be when working with the soft tissues, remember we are not massage therapists, we are not engine wipers, we are feeling for often subtle changes in tone, resistance, fluidity or temperature. We get a respons,e we stop and move on.

 Osteopathic soft tissue technique requires no oil, no cream, no rubbing and no skin drag. It involves slow controlled precise movement, with each effort having a specific purpose. 

Clinical Task:  When working with the soft tissue today, do more with less. Slow things down and make each movement count: engage, hold, feel and release.  Listen to the tissues and move on when they respond.  No oil , cream, lotion or massage, don’t slip and slide.

Day 5: Control

Control is your ability to direct movement precisely

• how far
• how fast
• and where it goes

Without control you are just moving the patient.

Good control:

• engages the barrier accurately
• keeps movement specific
• reduces the need for force

In Osteopathic long lever techniques control is critical,  a long lever increases the force through the system, so it demands more control. You are working through larger body parts and arms or legs can be and get heavy.

If you lose control:

• movement spreads
• force increases
• precision drops
• you get fatigued

So you must:

• support the weight
• guide the movement
• stay specific to the target
• tune into the rhythm

Clinical Task: Work with the prone SIJ articulation technique in the video.  Focus on positioning, barrier, timing and rhythm.