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Principles of Manual Medicine

Basic Concepts

The osteopathic profession subscribes to the following tenets:
  • The body is capable of self-regulation, self-healing, and health maintenance.
  • Illness is often caused by mechanical impediments to normal flow of body fluids and nerve activity.
  • The body is a unit, and the person represents a combination of body, mind and spirit.
  • The body is capable of self-regulation, self-healing, and health maintenance.
  • Structure and function are reciprocally interrelated.
  • The human body is a dynamic unit of function.
These points could be summarized by saying, "Dysfunctional structures result in impairment of normal function". For example,
  • Hypertonic muscles may result in increased tension within the pelvic musculature that may result in a loss of the normal range of motion, pain, and/or discomfort.
  • Muscle spasm, that is a consequence of guarding due to pain, may result in a loss of the normal range of motion, pain, and/or discomfort.
  • Abnormal reflex activity, originating in the lower intestinal tract, may result in increased tension within the pelvic musculature that may result in a loss of the normal range of motion, pain, and/or discomfort.
  • Abnormal reflex activity, originating in the pelvic musculature, may result in dysfunction in the descending colon and pelvic organs.
  • Restriction of the normal range of motion of the thoracic cage and the thoracoabdominal diaphragm during inspiration and expiration may result in diminished oxygen exchange, decreased motility within the bowels, and reduced lymphatic drainage.
  • Diminished return of lymphatic fluid to the venous system may result in edema and contribute to pulmonary congestion.
Somatic dysfunction may be defined as an impairment, or altered function, of related components of the somatic (body framework) system: skeletal, arthrodial, and myofascial structures, and related vascular, lymphatic, and neural elements (Foundations for Osteopathic Medicine, 2nd ed, pg. 1249).

Somatic Dysfunction may be diagnosed by the presence of some, but not necessarily all, of the following:

  • Tissue Texture Abnormalities -- Surrounding tissues may feel hypertonic, rigid, fibrosed, atrophied, or edematous.
  • Asymmetry of Bony Landmarks and/or Function -- Bones, muscles, or joints may lack symmetry when compared to related structures.
  • Restriction of Motion -- A joint with a somatic dysfunction will have abnormal characteristics of motion. During the diagnostic process you should be constantly asking yourself the following four questions:
    1. Is the total range of motion symmetric?
    2. Is the total range of motion reduced from normal?
    3. What is the quality of the motion?
    4. What is the characteristic feel at the end point of motion?
  • Tenderness to Touch -- Pain may result from palpation of tissues associated with somatic dysfunction.
Somatic dysfunction can be further classified as shown in the following table.

Diagnostic Element
Characteristics of Acute Condition
Characteristics of Chronic Condition
History Recent injury Long-standing condition
Tissue Texture Changes Hypertonic muscles, muscle spasms, boggy edema, moist skin Decreased muscle tone, dry skin, decreased or no edema, fibrotic and/or ropy tissues
Asymmetry Present Present with compensation in other parts of the body
Restriction Present, painful with movement, sluggish quality Present, decreased or no pain, normal quality within the range that remains
Tenderness Severe, sharp, minimal evidence of somato-visceral effects Dull, achy, burning, evidence of somato-visceral effects
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