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Chapter Objectives

At the conclusion of this chapter, the reader will be able to:

  • Recognize the historic and ongoing contributions of osteopathic medicine with respect to various other manual therapy systems.

  • Understand the philosophy underlying the osteopathic approach to the treatment of musculoskeletal conditions.

  • Recognize the importance of incorporating manual treatment in the context of complete care and of incorporating complete care in the context of manual treatment.

  • Design and apply manual approaches using the interrelationship between structure and function, somatovisceral interactions, and the mental-emotional linkage to the physical body.

  • Recognize and classify biomechanical and other somatic clues to differential diagnoses found in the neuromusculoskeletal system.

  • Understand that somatic clues to diagnosis found in the neuromusculoskeletal system are potentially indicative of visceral or systemic problems.

  • Understand the osteopathic examination concepts and methods leading to the identification of somatic dysfunction.

  • Understand and competently apply the concepts and methods used to integrate positional diagnostic clues with active and/or passive motion testing.

  • Identify six documented somatic dysfunction diagnoses that are commonly found in patients with chronic low back pain that are amenable to manual intervention.

  • Understand the concepts of direct and indirect method manipulations in general and the concept of myofascial release specifically, and then demonstrate the ability to competently perform these techniques.

  • Understand the principles of muscle energy and demonstrate a basic level of competence in performing reciprocal inhibition, postisometric relaxation, and rhythmic resistive duction variations with this activating force.

  • Understand the principles of counterstrain and demonstrate a basic level of competence in performing this technique.


Major Osteopathic Contributors to the Evolution of Manual Systems

The Birth of Osteopathic Medicine

Osteopathic medicine is the fastest growing health-care profession in the United States today.1 Osteopathy was introduced by an allopathic physician, Andrew Taylor Still, MD, who in 1874 came to the conclusion that allopathy and homeopathy were ineffective as practiced by the medical doctors of that period. Still studied the structure and function of the neuromusculoskeletal system to become a lightning bonesetter and putatively integrated the science of spinal irritation2,3 to link his therapeutic manual treatments to more systemic care that went beyond the management of neuromusculoskeletal conditions.

Between his introduction of osteopathy in 1874 and the opening of the American School of Osteopathy in Kirksville, Missouri, in 1892, Still developed the philosophical underpinnings and manual skills that were to be his lasting contribution to a worldwide health-care movement. Still also came to the conclusion that the neuromusculoskeletal, or somatic, system, comprising 60% of the body mass, was the machinery of life. He concluded that inefficiency of this system may lead to the onset of disease.


  • Define the term somatic system.

  • Why is the somatic system referred to as the "machinery of life"?

  • How does inefficiency ...

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