An Overview of Osteopathic Manipulation Techniques 
The spectrum of osteopathic manipulation techniques focused on the principle that the body structure and function are dependent on one another. When structure is altered via the musculoskeletal system abnormalities occur in other body systems. This, in turn, can produce restrictions of motion, tenderness, tissue changes and asymmetry. Following are some of the manipulation procedures most commonly used by osteopathic physicians to diagnose and treat somatic dysfunctions:
Hands-on Contact – The value of the placing of hands on a patient is universally acknowledged by health professionals. This essential component of the doctor-patient relationship has a great deal to do with the patient’s well being, whether he or she suffers from a cold or a terminal disease. When the DO examines a patient by auscultation of the chest or palpation of the abdomen or spine, the treatment has already begun.
Soft-Tissue Technique – This technique is commonly applied to the musculature surrounding the spine and consists of a rhythmic stretching, deep pressure and traction. Its purpose is to move tissue fluids (edema) and to relax hypertonic muscles and myofascial (fibrous tissue) layers associated with somatic dysfunction.
Myofascial Release – This procedure is designed to treat primarily the myofascial structures. In the use of direct myofascial release treatment (MRT) a restrictive barrier is engaged for the myofascial tissues; the tissue is loaded with a constant force until release occurs. In treating with indirect MRT the dysfunctional tissues are guided along a path of least resistance until free movement is achieved.
Cranial Osteopathy – Inside the skull or cranium there is a covering over the brain, the dura, that continues down inside the spine to the tailbone or sacrum, protecting and supporting the central nervous system. This central nervous system controls the functioning of every organ, muscle and nerve in the body. Cranial Osteopathy is a systematic approach to patient diagnosis and treatment utilizing the body’s inherent third wave pulse, emanating from the central nervous system and the fluctuation of the cerebrospinal fluid. This is called the Cranial Rhythmic Impulse (CRI). This gentle, manual technique utilizes the CRI to treat the whole person, emphasizing the head and spinal regions.
Lymphatic Technique – This manual procedure is designed to promote circulation of the lymphatic fluids and can be used to relieve upper and lower respiratory infections. One technique is pressure applied with the physician’s hands to the prone patient’s upper anterior chest wall. When force applied to the chest reaches its maximum on expiration, the physician’s hands are removed suddenly. This increases negative pressure of the chest to assist the body’s respiratory mechanism to move lymphatic fluids.
Thrust Technique – In this form of manipulation, the physician applies a high velocity/low-amplitude thrust to restore specific joint motion. With such a technique, the joint regains its normal range of motion and re-sets neural reflexes. The procedure reduces and/or completely nullifies the physical signs of somatic dysfunction; tissue changes, asymmetry, restriction of motion and tenderness.
Muscle Energy Technique - In this manual technique the patient is directed to use his or her muscles from a precise position and in a specific direction against a counterforce applied by the physician. The purpose is to restore motion, decrease muscle/tissue changes and modify asymmetry of somatic dysfunction.
Counterstrain – The counterstrain technique is a manual procedure in which the patient is moved passively away from the restricted motion barrier, towards the position of greatest comfort. At this point, passive, asymptomatic strain is induced. This technique is used for relief of somatic dysfunctions that are too acute or too delicate to treat with other procedures.
A note About Cranio-sacral Therapy 
“Cranio-sacral Therapy “ is a trademarked term coined by John Upledger, D.O. and is a therapeutic system taught at his Institute. The insights and principles of Cranio-sacral therapy are Dr. Upledger’s re-working and restatement of traditional osteopathic principles and not a new invention or discovery. Unfortunately, this has caused much confusion amongst patients who mistakenly think that they are totally different approaches. Also unfortunate is the fact that education at the Upledger Institute is not a medical curriculum, an integral part of osteopathy. A board certified osteopathic physician utilizing cranial osteopathic techniques has a depth of understanding and a breadth of practical experience unmatched by institute graduates who are taught using a weekend seminar approach. Further, osteopathic physicians have access to many teachers within the osteopathic profession and thus have a broader experiential base for their work. For example, there are several more subtle and powerful rhythmic motions beyond the CRI, which are not taught at the Upledger Institute. The teaching of these subtle energetic healing techniques of Osteopathy is only available to osteopathic physicians via a teacher-student relationship fostered within the profession.
One such teacher is James Jealous, D.O. who has made his insights into the subtleties of Osteopathy available to the osteopathic profession via his courses in Biodynamics. Dr. Masiello has been a student of Dr. Jealous since the 1990s and utilizes his insights in his practice on a daily basis. He also had the great good fortune to have studied briefly with Robert Fulford, D.O. He was the doctor that Dr. Andrew Weil discovered in his worldwide quest to learn about healing. Dr. Fulford developed and championed the use of a percussion hammer in his osteopathic work. Dr. Masiello has used a percussion hammer since studying with Dr. Fulford in 1987.
 From a pamphlet issued by The American Academy of Osteopathy.
 The views expressed about Craniosacral Therapy are solely those of Dr. Masiello and are not official policy statements of the American Osteopathic Association or the American Academy of Osteopathy.