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Structural Techniques
Description
Structural techniques mobilize joints and reduce tension in muscles, ligaments and fascia. They take the pressure off of blood vessels and nerves, better enabling the immune system to do its job.
 Observation of posture and gait provides information on where there may be a structural dysfunction. Orthopedic testing identifies any mechanical problems in the body such as restrictions or dysfunctions in any of the joints and tissues that may be causing pain. Everything is connected and when one part of the body isn’t working properly, the rest of the body has to work harder and compensations develop. Each person is unique. Osteopaths also assess the health that is still present in the person and focus on strengthening that vitality by creating a more balanced state.
“Nature itself is the best physician”
(Hippocrates)
Structural techniques include: massage, functional, strain/counterstrain, muscle energy, myofascial release and osteoarticular.
Note: It is important that you speak with your medical doctor for the complete diagnosis of any medical condition.
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Massage Technique
Massage techniques are used to relax the patient and the soft tissues. These techniques are used to reduce muscle spasm and increase range of motion, and promote a drainage effect on lymphatic channels in cases of congestion or injury. Massage also has an inhibitory effect on pain, stimulating mechanoreceptors in the skin and joints to block pain signals before they reach the brain.
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Functional Technique
This is a very comfortable technique for the patient. Functional techniques may be used on any of the body’s structures: bone, muscle, cranium, viscera etc. It is based on the concept that afferent feedback to the spinal cord is disturbed in a dysfunctional structure or segment and by using functional technique, these signals will be reduced and a more harmonious movement pattern can be restored.
Functional technique involves evaluating a restricted segment of the body for mobility, assessing the direction it is restricted in, and finding the pathway of ease where resistance does not occur. A point of balance will be found and then a still point. Eventually, there will be a softening in the tissue and a sense of release of the restriction, and it will slowly start to move back into a neutral position.
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Strain/Counterstrain
Lawrence H. Jones, DO, developed the technique of strain/counterstrain. This technique is similar to functional technique in that it involves placing a dysfunctional or painful joint in a position of greatest comfort or ease. The difference is that Jones has charted common tender points associated with joint dysfunctions. These tender points are relieved not by pressure alone, but by correct positioning of the body, and holding it there for 90 seconds to decrease the firing of proprioceptors in the joint. The structures can then be returned to their neutral position very slowly to avoid re-facilitation of the reflex arc.
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 Muscle Energy Technique (MET)
Muscle energy technique was first described by Fred Mitchell Sr., DO in 1958, and was developed extensively by his son Fred Mitchell Jr., DO. This is a direct technique guiding the mechanical dysfunction along the path of correction using active patient resistance. A muscle or joint barrier is localized by the therapist, the patient is asked to actively contract the muscle, then relax, and the therapist relocates the new barrier and repeats the treatment until a release or greater range of motion is achieved.
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Myofascial Release (MFR)
The term, “myofascial”, means muscle and fascia combined. Fascia is a continuous sheet of connective tissue from our head to our toes. It wraps around and infuses muscles, bones, viscera (organs), nerves and blood vessels all the way down to the cellular level. It offers support and spaces for all fluids of the body and the nerves to travel through.
 Fascia is composed of an elasto-collagenous complex. The elastic component is stretchable and the collagen fibres are extremely tough with little extensibility. There is also a matrix or ground substance, which under normal circumstances has a gel like consistency. Trauma, inflammatory conditions and poor posture can cause fascia to become solidified or shortened. It can become bound down or restricted and cause malfunction in any of the structures it surrounds. Fascia, just like bone, will organize along the lines of tension imposed upon it but due to its continuity, this can produce stresses and symptoms in seemingly unrelated areas of the body.
Myofascial release treats the fascial system by normalizing tensions within the fascial planes, thereby improving all tissue mobility and vascularization. It’s a very slow and gentle technique that involves exaggerating the tension that is already present in the tissue and following it as it twists and turns from barrier to barrier until there is a softening, a release or a transverse spreading.
The critical element of myofascial release success is the use of sufficient time holding the stretch to allow permanent changes in the tissue to occur. These changes in the fascia occur because the elastic component has been sufficiently stretched, the collagen fibres re-aligned and the viscosity of the ground substance given the chance to change from a more solid state to a gel state. There is also a positive, relaxing effect on the muscle spindles and the tone of the nervous system.
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Decompaction Technique
This technique is indicated when a joint (or suture) has been traumatically forced together or compressed.  Soft tissues like muscles and fascia maintain the compression so this technique is actually a myofascial technique. The osteopath gently approximates the joint surfaces even more and follows the tensions in the tissue to find the optimal direction of compaction. A point of balance is found, a still point follows and when the tissue is felt to move slightly, the osteopath separates the joint surfaces using a gentle traction.
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Joint Play Technique
Gentle joint play mobilizations can be combined with decompaction technique to gain more mobility. All joints have a physiological range of motion but stiff joints can become blocked in some movements and this can cause compensations and pain. Joint play gently tractions the joint and guides it in all the directions it was designed to move in. Decompaction techniques and joint play mobilizations can help restore good range of motion and decrease or eliminate pain.
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Osteoarticular Adjustments (OA)
Osteoarticular means the place where two bones meet, a joint. This also means where the vertebrae meet all along the spine. Osteoarticular adjustment is a technique used to restore mobility (not just position) and tissue quality within a restricted vertebral or peripheral joint. Joints are designed to move and osteoarticular techniques aim to re-establish mobility through joint play movements and/or energetic adjustments. This technique also improves vascular and venous drainage of the tissues and de-facilitates the nervous system.
 Osteopathic osteoarticular adjustments are distinct from spinal manipulation or chiropractic adjustments. They are gentle, energetic impulses generated by the osteopath that encourage the strained articulation to return to its natural state.
Treatment includes evaluation of the articulation and osteopathic differential diagnosis of the position and mobility. The technique does not need to be performed at the anatomical end of a range of movement of the joint but by combining many parameters, a barrier is formed, which is at a cumulative end of range. This should be comfortable for the patient. This barrier to motion will have the feel of a potential or dynamic tension. At this point, the patient is asked to breathe out and the osteopath applies an energetic impulse into the restriction along the path of correction. Sometimes just a gentle shift of the bone is felt, and sometimes a popping noise can be heard. The noise is caused by pressure being released in the joint as it begins to moves again.
“Bones do not always pop when they go back to their proper places nor does it mean they are properly adjusted when they do pop”
(A.T. Still, DO, 1910)
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