• Cranial Osteopathy, Cranial-sacral Therapy, Doctor of Osteopathy (D.O.), Greenman Muscle-energy, Jones Counterstrain, Mobilization, Myofascial Release, Osteopathic Medicine, Osteopathy, Strain-counterstrain
Osteopathy originated as a 19th century alternative medical approach focusing on physical manipulation. Today, osteopathic physicians study and practice the same types of medical and surgical techniques as conventional medical doctors. Some of osteopathy's original techniques still persist, however; these, taken together, are called osteopathic manipulation (OM). OM is less well-known to the public than chiropractic spinal manipulation
History of Osteopathic Manipulation
Osteopathic medicine was founded in 1874 by Andrew Taylor Still, a US physician. Physicians educated in this method were called doctors of osteopathy, or DOs. Subsequently, however, schools of osteopathic medicine became integrated with conventional medical schools, and today the license of DO is legally equivalent to that of M.D.
Forms of Osteopathic Manipulation
Osteopathic and chiropractic techniques overlap, but they are not identical. As a general rule, chiropractors focus most of their attention on the spine, while osteopathic practitioners devote more of the their efforts to the manipulation of soft tissues and joints outside the spine. Another general difference is that chiropractic spinal manipulation tends to make use of rapid short movements (spinal manipulation, which is a high-velocity, low-amplitude technique), while OM typically concentrates on gentle, larger movements (mobilization, which is a low-velocity, high-amplitude technique). But neither of these distinctions is absolute, and many chiropractic and osteopathic methods do not fit neatly into these categories.
There are several specific osteopathic techniques in wide use, many of which are named after their founders. Some of the more popular are Greenman muscle-energy, Jones counterstrain (also known as strain-counterstrain), myofascial release, and cranial-sacral therapy (formally known as osteopathy in the cranial field).
Greenman Muscle-energy Technique
Greenman muscle-energy technique involves bending a joint just up to the point where muscular resistance to movement begins (“the barrier”), and then holding it there while the patient gently resists. The pressure is maintained for a few seconds and then released. After a brief pause to allow the affected muscles to relax, the practitioner then moves the joint a little farther into the barrier, which will usually have shifted slightly toward improved mobility during the interval.
Strain-counterstrain Technique (Jones Counterstrain)
Strain-counterstrain technique (Jones counterstrain) involves finding tender points and then manipulating the joint connected to them in order to find a position where the tenderness decreases toward zero. Once this precise angle is found, it is held for 90 seconds and then released. Like muscle-energy work, strain-counterstrain progressively increases range of motion and, it is hoped, decreases muscle spasm and pain.
Myofascial release focuses on the fascial tissues that surround muscles. The practitioner first positions the painful area either at the edge of the barrier to movement or, alternatively, at the opposite extreme (the area of greatest comfort). Next, while the patient breathes slowly and easily, the practitioner palpates the fascial tissues, looking for a subtle sensation that indicates the tissues are ready to “unwind.” After receiving this indication, the practitioner then helps the tissue to follow a pattern of spontaneous movement. This process is repeated over several sessions until a full release is achieved. Myofascial release is said to be especially useful in pain conditions that have persisted for months or years.
Cranial-sacral therapy, more properly called cranial osteopathy (or just cranial for short), is a very specialized technique based on the scientifically unconfirmed belief that the tissues surrounding the brain and spinal cord undergo a rhythmic pulsation. This “cranial rhythm” is supposed to cause subtle movements of the bones of the skull. A practitioner of cranial-sacral therapy gently manipulates these bones in time with the rhythm (as determined by the practitioner’s awareness), in order to repair “cranial lesions.” This therapy is said to be helpful for numerous conditions ranging from headaches and sinus allergies to multiple sclerosis and asthma. However, many researchers have serious doubts that the cranial rhythm even exists.
What Is Osteopathic Manipulation Used For?
Osteopathic manipulation is primarily used to treat musculoskeletal pain
Some advocates of OM believe that it has numerous additional benefits, including the enhancement of
What Is the Scientific Evidence for Osteopathic Manipulation?
There is little evidence as yet that osteopathic manipulation is helpful for the treatment of any medical condition. There are several possible reasons for this, but one is fundamental: Even with the best of intentions, it is difficult to properly ascertain the effectiveness of a hands-on therapy like OM.
Only one form of study can truly prove that a treatment is effective—the double-blind, placebo-controlled trial
Because of these problems, all studies of OM fall short of optimum design. Many have compared OM against no treatment. However, studies of that type cannot provide reliable evidence about the efficacy of a treatment: If a benefit is seen, there is no way to determine whether it was a result of OM specifically or just attention generally. (Attention alone will almost always produce some reported benefit.)
More meaningful trials used fake osteopathy for the control group. Such studies are
Still other studies have simply involved giving people OM and seeing if they improve. These trials are particularly meaningless; it has long since been proven that both participants and examining physicians will think, at least, that they observe improvement in people given a treatment, whether or not the treatment does anything on its own; such studies are not reported here.
Given these caveats, the following is a summary of what science knows about the effects of OM.
Possible Effects of OM
Most studies of OM have involved its potential use for various pain conditions.
In a study of 183 people with
In a 14-week, single-blind study of 29 elderly people with
In a small randomized, placebo-controlled trial researchers used oscillating-energy manual therapy, an osteopathic technique based on the principle of craniosacral therapy, to treat 23 subjects with chronic
In another study, 24 women with
Although OM has shown some promise for the treatment of
A much smaller study reportedly found that muscle-energy technique enhances recovery from back pain, but this study does not appear to have used a meaningful placebo treatment.
Some studies have evaluated the potential benefits of OM for speeding healing in people recovering from
In a much less meaningful study, OM was compared to no treatment in people recovering from knee or hip surgery.
Finding a Qualified Practitioner of Osteopathic Manipulation
Although there are many licensed doctors of osteopathy (DOs), most practice conventional medicine and do not specialize in OM. Some do, and many of those have been certified by the American Osteopathic Board of Neuromusculoskeletal Medicine.
In addition, many physical therapists and massage therapists use some osteopathic techniques, with variable amounts of training.
Safety of Osteopathic Manipulation
Most forms of OM, because of their gentle nature, are believed to be quite safe. However, mild short-term pain may occur immediately following treatment.
In addition, some osteopathic practitioners use the high-velocity thrusts common to chiropractic and might, therefore, incur some slight safety risks. (See the
1. Knebl JA, Shores JH, Gamber RG, et al. Improving functional ability in the elderly via the Spencer technique, an osteopathic manipulative treatment: a randomized, controlled trial. J Am Osteopath Assoc . 2002;102:387-396.
2. Gamber RG, Shores JH, Russo DP, et al. Osteopathic manipulative treatment in conjunction with medication relieves pain associated with fibromyalgia syndrome: results of a randomized clinical pilot project. J Am Osteopath Assoc . 2002;102:321-325.
8. Jarski RW, Loniewski EG, Williams J, et al. The effectiveness of osteopathic manipulative treatment as complementary therapy following surgery: a prospective, match-controlled outcome study. Altern Ther Health Med . 2000;6:77-81.
10. Knebl JA, Shores JH, Gamber RG, et al. Improving functional ability in the elderly via the Spencer technique, an osteopathic manipulative treatment: a randomized, controlled trial. J Am Osteopath Assoc . 2002;102:387-396.
12. Korthals-de Bos IB, Hoving JL, van Tulder MW, et al. Cost effectiveness of physiotherapy, manual therapy, and general practitioner care for neck pain: economic evaluation alongside a randomised controlled trial [electronic version]. BMJ . 2003;326:911.
13. Ventegodt S, Merrick J, Andersen NJ, et al. A Combination of Gestalt Therapy, Rosen Body Work, and Cranio Sacral Therapy did not help in Chronic Whiplash-Associated Disorders (WAD) - Results of a Randomized Clinical Trial. ScientificWorldJournal . 2005;4:1055-1068.
Last reviewed April 2009 by EBSCO CAM Review Board
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