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Features Practice Technique
An Osteopathic Perspective

Osteopathy is a holistic system of health care that emphasizes the use of hands-on diagnosis and manual treatment techniques. Osteopathy was founded more than 110 years ago in the United Sates by Andrew Taylor Still, M.D. (inset) as a parallel but distinct approach to the practice of medicine.


September 25, 2009
By Todd Bezilla

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Osteopathy is a holistic system of health care that emphasizes the use of hands-on diagnosis and manual treatment techniques. Osteopathy was founded more than 110 years ago in the United Sates by Andrew Taylor Still, M.D. (inset) as a parallel but distinct approach to the practice of medicine.

Osteo2.jpgAs Osteopathy has spread throughout the world, specifically outside the U.S., it has taken on mostly a non-medical approach towards training and application. This means that most practitioners of Osteopathy trained outside the United Sates are not physicians. In the non-medical Osteopathic world, the emphasis on evaluation of a patient is on the neuromusculoskeletal system. Osteopathic manipulation is directed at Somatic Dysfunctions, which are said to be present whenever there is asymmetry, restriction or alteration of normal motion, tissue texture changes, or patient complaints of pain or other sensorial changes. Ultimately, the Osteopathic principles are used to determine the best course of action for the person and define a technique as being Osteopathic or not. 

These principles are as follows:

  • A person is a complete dynamic unit of function, including body, mind, and spirit
  • A person has inherent self-repair, self-defense, and self-regulating mechanisms
  • A person’s structure & function are inter-related
  • Rational treatment addresses these principles before initiating an intervention

Description of Primary Modalities Used

Osteopathic manipulation, exercise, nutrition, and Holistic self-care are the primary tools utilized in the holistic health care approach in Osteopathy.

Osteopathic manipulation consists of various diagnostic and technique styles which include but are not necessarily limited to the following: Bioenergetic, Counterstrain, Cranial-sacral, Facilitated Positional Release, Functional, Ligamentous Articular Strain, Lymphatic (Activation, Drainage, Pumps), Muscle Energy, Myofascial & Active Release, Osteoarticular, Reflexes (Chapman’s, Ganglia, and other), Silent Dialogue, Trigger points, and Visceral approaches. This extreme diversity of manual technique allows for a wide range of intervention and diversity for both the practitioner and the patient.

Exercises consist of specific and general practitioner-directed and patient-performed movements with and without resistance to maximize the patient’s normal healing processes and minimize disability. These may be taught or prescribed in the office/clinic and performed under formal therapy/clinic/gym settings or informal home settings depending on the patient’s abilities and needs.

Nutrition consists of making any dietary or supplement recommendations that may assist the patient in achieving a better state of health so that their recovery and healing may be maximized.

Osteo1.jpgHolistic self-care consists of the proper use of ice and heat, ergonomic recommendations, stress-management techniques, proper hygiene, and other approaches as the need arises.

Short-Term Goals for this client; including method of treatment utilized to reach those goals
Short-term goals for this patient would consist of pain and inflammation reduction, restricted movement normalization, identifying and treating any significant somatic dysfunctions, along with addressing breathing, ergonomic, and postural re-education as indicated.

Pain and inflammation reduction would be initiated by the frequent and regular use of ice to those areas strained and with pain. Additionally, pharmaceutical pain control and anti-inflammatory medications could be used. If the patient is averse to such medicines and prefers a “natural” approach, then Homeopathic Arnica Montana could be used, as well as supplements such as Bromelain or other proteolytic enzyme-based formulas.

Motion normalization as well as pain and inflammation reduction would be primarily achieved by the use of
various manual techniques. The techniques I use would be dictated by the nature of the somatic dysfunctions that were present, as different findings tend to respond better to different approaches. In this case, due to the symptoms expressed, I would consider the use of the following approaches:

Indirect, positional release techniques such as Counter-strain, Facilitated Positional Release, and Ligamentous Articular Strain; techniques that make use of reciprocal neural inhibitory mechanisms such as Muscle Energy; and techniques that address the fascia and fluid of the body such as Lymphatic Drainage, Myofascial Release and Cranio-sacral approaches.

Also in this particular case, I would take extra care to thoroughly evaluate this patient’s sacral and pelvic regions, sternum, rib cage, and shoulder girdle, along with her thoracic and cervical regions and cranium.

Tremendous whole-body forces are experienced in a motor vehicle accident and various force-trauma vectors are often retained and present in the patient’s body tissues, in part by activation of muscle spindles, which, in theory, cause involuntary sustained muscular contraction.

An area of particular interest to me would her sublingual, submandibular, root-of-the-tongue, and hyoid regions, as these are commonly overlooked, and are often loaded with somatic dysfunction after such a mechanism of injury.

Osteo3.jpgI would evaluate and help the patient correct any breathing or postural pattern disturbances that may be present as a result of her traumatic experience.

Often, deep diaphragmatic breathing is nearly impossible following a motor vehicle accident due to involuntary gasp/startle reflex mechanisms that can cause diaphragm-atic hypertonicity and dysfunction. Additionally, postural patterns are usually acutely changed as well, in part by the mechanical trauma experienced, but also in part due to the psychological impact of the event.

Theoretically, the sympathetic nervous system becomes overactive and various involuntary guarding and defense postures often manifest.

I would also review her ergonomics and teach her therapeutic movements to discharge the abnormal patterns, re-establish normal patterns, and maintain the normal functions of her body.

Brief Treatment Plan

Initially, since this is an acute event, I would recommend she come in perhaps two to three times the first week.  I would evaluate her entire body, not just the areas of primary complaint, as her whole person was involved in the accident, not just her head and neck.

Often times, there are important and key lower body, pelvis, sacral, rib cage, and soft tissue injuries and strain patterns that go overlooked because everyone focuses on the areas with the most obvious pain and disability. Therefore, I would treat whatever areas with somatic dysfunction I found, in order of severity (most severe to least). I would also perform various maneuvers such as lymphatic drainage and oscillatory pumps at the end of the treatment to help facilitate the patient’s overall healing process.

Each treatment session would probably run between 15-30 minutes of actual hands-on evaluation and treatment time, noting that a certain amount of discussion and education would also occur during this time. Additional time at the end of the visit would be given to discuss the home-treatment plan and teach any exercises that are prescribed.  So the total visit would probably last between 45-60 minutes including completion of all paperwork.

After the first week, the frequency of visits would be lessened as the patient improves. Ideally, the sequence would be something as follows: 2-3 visits, week one;
1-2 visits, week two; 1 visit, week three; 1 visit, week four; 1 visit, week five; 1 visit, week six; skip week seven, return for evaluation week eight, and discharge after this visit if the patient is fully recovered.

Long-Term Goals for this client; including method of treatment utilized to reach those goals
Long-term goals for this patient would be to have a preventative maintenance program. This would consist of routine periodic Osteopathic evaluations and treatments, perhaps once every few months depending on what somatic dysfunctions are present, how she feels, and what is going on in her life; regular daily physical activity and routine (2-3 times/week) cardiovascular and resistance training exercises; a healthful diet; and basic Holistic self-care including ergonomics, stress management, and hygiene so that she will be able to function in her daily life and be more resistant to illness and disease.

More information or comments about referral and/or a multi-disciplinary approach with other health care professionals in the treatment of musculoskeletal injury
First and foremost, Osteopathy is about helping and treating people, not injuries. This is an important issue, as all too often people/patients are compartmentalized into regions or labeled by a diagnosis and the big picture is lost. It is easy to miss major contributing factors and problems by simply looking at where it hurts, or at what diagnosis has been given. The whole person needs to be evaluated, mind-body-spirit, as this is the essence of Osteopathy and Holistic health care.

Regarding the treatment outlined previously, if I felt the patient required additional education or intervention that I am not qualified or able to give, then by all means I would make a referral to those that are qualified and able. In Osteopathy and Holistic health care, it is all about helping the person/patient, by any and all means possible.


About Todd Bezilla. Todd Bezilla received his B.S. in Chemistry and Biology from West Chester University, West Chester, PA, his M.Ed., in Exercise Physiology from Temple University, Philadelphia, PA and his D.O. from the Philadelphia College of Osteopathic Medicine, Philadelphia, PA. He is board certified in Neuromusculoskeletal Medicine & Osteopathic Manipulative Medicine as well as Holistic Medicine. He is competency certified by The Cranial Academy, and is a Certified Strength & Conditioning Specialist by the National Strength & Conditioning Association. He is in private practice in Wilmington, Delaware and is the Director of Education & Curriculum Development of The Canadian Academy of Osteopathy & Holistic Health Sciences, Inc.

• For more on Osteopathy and Holistic Health Science education and training opportunities, contact The Canadian Academy of Osteopathy & Holistic Health Sciences, Inc. at 154 Grosvenor Ave. S., Hamilton, Ont., Canada L8M-3L5  Phone: (905)-312-9898  WEB: www.cao-hhs.org


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