Osteopathic Manipulative Treatment and Technique
Core concepts
Know the major categories: soft tissue, myofascial release, articulatory, muscle energy, counterstrain, facilitated positional release, high-velocity low-amplitude (HVLA), lymphatic, craniosacral, and visceral techniques. For each, understand the mechanism, the barrier concept (direct versus indirect), the patient's active versus passive role, indications, and contraindications.
Direct versus indirect
Direct techniques engage the restrictive barrier and are typical of muscle energy, HVLA, and articulatory methods. Indirect techniques move away from the barrier and are typical of counterstrain and facilitated positional release. Questions often describe a setup and ask which category is being used - identify the barrier direction first.
Traps
- Applying HVLA where contraindicated: instability, fracture, severe osteoporosis, anticoagulation, or active inflammatory arthropathy.
- Confusing muscle energy (patient actively contracts) with myofascial release (operator-directed, patient passive).
- Assuming more force means more effect; minimal adequate force is the standard.
- Skipping informed consent and post-treatment reassessment.
Rule of thumb
Match the technique to the tissue: muscle and fascia to soft tissue and muscle energy, joint restriction to HVLA or articulatory, tender points to counterstrain, fluid congestion to lymphatic methods.
Worked example
A patient with a restricted lumbar segment and good bone quality is positioned at the barrier and asked to gently contract against resistance, then relax into a new barrier. That is muscle energy - direct, patient-active, and safe for this presentation.