Editing Osteopathy (section)

== Practice ==
[[File:Manuellterapi5.jpg|right|450px|thumb|Osteopathic manipulative treatment (OMT) involves [[palpation]] and [[joint manipulation|manipulation]] of [[bone]]s, [[muscle]]s, [[joint]]s, and [[fascia]]e.]]
According to the [[American Osteopathic Association]] (AOA), osteopathic manipulative treatment (OMT) is considered to be only one component of osteopathic medicine and may be used alone or in combination with [[pharmacotherapy]], [[Rehabilitation medicine|rehabilitation]], [[surgery]], [[patient education]], [[Diet (nutrition)|diet]], and [[exercise]]. OMT techniques are not necessarily unique to osteopathic medicine; other disciplines, such as [[physical therapy]] or [[chiropractic]], use similar techniques.<ref name="aacom1">{{cite web |url=http://www.aacom.org/about/osteomed/Pages/default.aspx |title=What Is Osteopathic Medicine? |publisher=Aacom.org |access-date=24 May 2012}}</ref> Indeed, many DOs do not practice OMT at all, and, over time, DOs in general practice use OMT less and less and instead apply the common medical treatments.<ref name="pmid16585378">{{cite journal |vauthors=Gevitz N |title=Center or periphery? The future of osteopathic principles and practices |journal=[[Journal of Osteopathic Medicine|J Am Osteopath Assoc]] |volume=106 |issue=3 |pages=122–123 |date=March 2006 |pmid=16585378 |url=https://www.aacom.org/docs/default-source/hpf-2018/2017-09_seminar/center-or-periphery.pdf?sfvrsn=73e42097_0 |format=Free full text}}</ref>

One integral tenet of osteopathy is that problems in the body's anatomy can affect its proper functioning. Another tenet is the body's innate ability to heal itself. Many of osteopathic medicine's manipulative techniques are aimed at reducing or eliminating the impediments to proper structure and function so the self-healing mechanism can assume its role in restoring a person to health.<ref>{{cite web |title=What is Osteopathic Medicine |publisher=American Association of Colleges of Osteopathic Medicine (AACOM) |access-date=17 December 2014 |url=http://www.aacom.org/become-a-doctor/about-om#aboutom}}</ref> Osteopathic medicine defines a concept of health care that embraces the concept of the unity of the living organism's structure (anatomy) and function ([[Human physiology|physiology]]). The AOA states that the four major principles of osteopathic medicine are the following:<ref>{{cite web |title=Statement of Healthcare Policies and Principles |url=http://www.osteopathic.org/inside-aoa/advocacy/Documents/aoa-healthpolicy-principles.pdf |publisher=[[American Osteopathic Association]] |access-date=1 July 2012 |archive-url=https://web.archive.org/web/20120611122631/http://www.osteopathic.org/inside-aoa/advocacy/Documents/aoa-healthpolicy-principles.pdf |archive-date=11 June 2012 |url-status=dead}}</ref>

# The body is an integrated unit of mind, body, and spirit.
# The body possesses [[Homeostasis|self-regulatory mechanisms]], having the inherent capacity to defend, repair, and remodel itself.
# Structure and function are reciprocally interrelated.
# Rational therapy is based on consideration of the first three principles.

These principles are not held by Doctors of Osteopathic Medicine to be [[Scientific law|empirical law]]s; they serve, rather, as the underpinnings of the osteopathic approach to health and disease.{{citation needed|date=February 2014}}

=== Muscle energy ===
{{Main|Muscle energy technique}}
Muscle energy techniques address somatic dysfunction through stretching and muscle contraction. For example, if a person is unable to fully [[Abduction (kinesiology)|abduct]] their arm, the treating physician raises the patient's arm near the end of the patient's range of motion, also called the edge of the restrictive barrier. The patient then tries to lower their arm, while the physician provides resistance. This resistance against the patient's motion allows for [[muscle contraction|isotonic contraction]] of the patient's muscle. Once the patient relaxes, their range of motion increases slightly. The repetition of alternating cycles of contraction and subsequent relaxation help the treated muscle improve its range of motion.<ref name=DiGiovanna_83>{{Harvnb|DiGiovanna|Schiowitz|Dowling|2005|pp=83–5}}</ref> Muscle energy techniques are contraindicated in patients with fractures, [[Crush injury|crush injuries]], [[joint dislocation]]s, [[joint instability]], severe [[muscle spasms]] or strains, severe [[osteoporosis]], severe [[whiplash injury]], [[vertebrobasilar insufficiency]], severe illness, and recent surgery.

=== Counterstrain ===
{{Main|Counterstrain}}
Counterstrain is a system of diagnosis and treatment that considers the physical dysfunction to be a continuing, inappropriate strain [[reflex]], which is inhibited during treatment by applying a position of mild strain in the direction exactly opposite to that of the reflex.<ref name=DiGiovanna_86>{{Harvnb|DiGiovanna|Schiowitz|Dowling|2005|pp=86–8}}</ref> After a counterstrain point tender to palpation has been diagnosed,<ref name="Wong2014"/> the identified tender point is treated by the osteopathic physician who, while monitoring the tender point, positions the patient such that the point is no longer tender to palpation.<ref name="counterstrain">{{cite journal |author=Wong CK |title=Strain counterstrain: Current concepts and clinical evidence |date=February 2012 |journal=Manual Therapy |volume=17 |issue=1 |pages=2–8 |pmid=22030379 |doi=10.1016/j.math.2011.10.001}}</ref> This position is held for ninety seconds and the patient is subsequently returned to their normal posture.<ref name="Wong2014">{{cite journal |vauthors=Wong CK, Abraham T, Karimi P, Ow-Wing C |title=Strain counterstrain technique to decrease tender point palpation pain compared to control conditions: A systematic review with meta-analysis |date=April 2014 |journal=Journal of Bodywork and Movement Therapies |volume=18 |issue=2 |pages=165–73 |pmid=24725782 |doi=10.1016/j.jbmt.2013.09.010 |type=Systematic review and meta-analysis}}</ref> Most often this position of ease is usually achieved by shortening the muscle of interest.<ref name="counterstrain"/> Improvement or resolution of the tenderness at the identified counterstrain point is the desired outcome.<ref name="Wong2014"/> The use of counterstrain technique is contraindicated in patients with severe osteoporosis, pathology of the [[Vertebral artery|vertebral arteries]], and in patients who are very ill or cannot voluntarily relax during the procedure.

=== High-velocity, low-amplitude manipulation ===
High velocity, low amplitude (HVLA) manipulation is a technique which employs a rapid, targeted, therapeutic force of brief duration that travels a short distance within the anatomic range of motion of a joint and engages the restrictive barrier in one or more places of motion to elicit release of restriction.<ref name="aacom" /> The use of HVLA is contraindicated in patients with [[Down syndrome]] due to instability of the [[atlantoaxial joint]] which may stem from [[ligamentous laxity]], and in pathologic bone conditions such as [[bone fracture|fracture]], history of a [[pathologic fracture]], [[osteomyelitis]], osteoporosis, and severe cases of [[rheumatoid arthritis]].<ref name="Emergency">{{cite journal |first1=Raymond J. |last1=Roberge |first2=Marc R. |last2=Roberge |title=Overcoming Barriers to the Use of Osteopathic Manipulation Techniques in the Emergency Department |journal=[[Western Journal of Emergency Medicine]] |pmid=19718381 |pmc=2729220 |url=http://escholarship.org/uc/item/31547932 |volume=10 |issue=3 |year=2009 |pages=184–9}}</ref>{{sfn|Savarese|Copabianco|Cox|2009|p=146}} HVLA is also contraindicated in patients with [[vascular disease]] such as [[aneurysm]]s, or disease of the [[carotid artery|carotid arteries]] or vertebral arteries.<ref name="Emergency"/> People taking [[ciprofloxacin]] or [[anticoagulant]]s, or who have local [[Metastasis|metastases]] should not receive HVLA.<ref name="Emergency"/>

=== Myofascial release ===
{{Main|Myofascial release}}
''Myofascial release'' is a form of alternative treatment. The practitioners claim to treat skeletal muscle immobility and pain by relaxing contracted muscles. Palpatory feedback by the practitioner is said to be an integral part to achieving a release of myofascial tissues,<ref name="aacom">{{cite web |title=Glossary of Osteopathic Terminology, November 2011 Edition |url=http://www.aacom.org/resources/bookstore/Pages/glossary.aspx |publisher=[[American Association of Colleges of Osteopathic Medicine|AACOM]] |pages=30–31 |access-date=1 July 2012 |archive-url=https://web.archive.org/web/20120721233437/http://www.aacom.org/resources/bookstore/Pages/glossary.aspx |archive-date=21 July 2012 |url-status=dead}}</ref> accomplished by relaxing contracted muscles, increasing circulation and lymphatic drainage, and stimulating the [[stretch reflex]] of muscles and overlying [[fascia]].<ref name=DiGiovanna_80>{{Harvnb|DiGiovanna|Schiowitz|Dowling|2005|p=80}}</ref>

Practitioners who perform myofascial release consider the fascia and its corresponding muscle to be the main targets of their procedure, but assert that other tissue may be affected as well, including other connective tissue.<ref name=DiGiovanna_80 /> Fascia is the [[soft tissue]] component of the [[connective tissue]] that provides support and protection for most structures within the human body, including [[muscle]]. This soft tissue can become restricted due to [[psychogenic disease]], overuse, trauma, infectious agents, or inactivity, often resulting in pain, muscle tension, and corresponding [[ischemia|diminished blood flow]].{{sfn|DiGiovanna|Schiowitz|Dowling|2005|pp=80–1}}

Some osteopaths search for small lumps of tissue, called "Chapman release points" as part of their diagnostic procedure.<ref>{{cite book |last1=Chila |first1=Anthony G. |title=Foundations of Osteopathic Medicine |date=2010 |publisher=Lippincott Williams & Wilkins |isbn=9780781766715 |page=568 |url=https://books.google.com/books?id=_ZR6elRmQKEC&pg=PA568 |language=en |via=[[Google Books]]}}</ref>

=== Lymphatic pump treatment ===
{{main|Lymphatic pump}}
Lymphatic pump treatment (LPT) is a manual technique intended to encourage [[lymph]] flow in a person's [[lymphatic system]].<ref>{{Cite journal |last1=Pierce-Talsma |first1=Stacey |last2=Cuny |first2=Lee Ann |last3=Franzini |first3=Danielle |date=1 July 2018 |title=Osteopathic Lymphatic Pump Techniques |journal=The Journal of the American Osteopathic Association |language=en |volume=118 |issue=7 |pages=e43–e44 |doi=10.7556/jaoa.2018.112 |pmid=29946678 |issn=0098-6151 |doi-access=free}}</ref> The first modern lymphatic pump technique was developed in 1920, although osteopathic physicians used various forms of lymphatic techniques as early as the late 19th century.<ref name=Origins_Lymphatics>{{cite journal |first1=Bruno J. |last1=Chikly |title=Manual Techniques Addressing the Lymphatic System: Origins and Development |journal=The Journal of the American Osteopathic Association |pmid=16314678 |url=http://www.jaoa.org/cgi/pmidlookup?view=long&pmid=16314678 |year=2005 |volume=105 |issue=10 |pages=457–64}}</ref>

Relative contraindications for the use of lymphatic pump treatments include fractures, [[abscess]]es or localized infections, and severe bacterial infections with [[Fever|body temperature elevated]] higher than {{Convert|102|F|C}}.{{sfn|Savarese|Copabianco|Cox|2009|p=126}}