A common question from patients when being treated osteopathically is: “so what does that do?” This article is going to address various techniques that are often used by osteopaths and what they do, on a physiological level.

Soft tissue techniques

Soft tissue techniques are scientific massages. They usually involve deeper manoeuvres which work on the neurological system. There are not usually any relaxing, gliding techniques such as those used in Swedish and remedial massages. Nor is there use of aromatherapy oils – aqeuous cream is usually the chosen lubricant as it is absorbed into the skin quickly. With osteopathic soft tissue techniques, levers are often used – this means the osteopath will move parts of the body such as the arms and legs while putting pressure on certain muscles. What these techniques do is create blood flow to the muscles and also send a neurological response to the brain which then sends an inhibitory neurological response back to the muscle which causes the muscle to relax. Lymphatic fluids are also drained from areas where it may be stagnant.

Muscle energy techniques (METs)

This is a soft tissue technique which is a little bit like a stretch. However, before stretching a muscle, the practitioner takes the muscle to it’s “barrier” which is the point where resistance is felt from the practitioner’s perspective. This may well be before the patient experiences any kind of stretch. At this point, the osteopath asks the patient to gently resist a particular movement and push against the osteopath – using 10 percent of their maximal force. Of course, 10 percent is hard to measure so “a minimal amount of force” is sometimes the terminology used. The osteopath then counts to 15, asks the patient to breathe in and as they breathe out they ask the patient to relax, at that point they stretch the muscle further. The stretch can be held for 5-7 seconds but this varies in different methods. This process can be carried out 3 times.

What does it do?

This technique is used to reduce, increase blood flow and lymphatic drainage, increase range of motion and reduce muscular tension.

How does it work?

The particular MET explained above is called a “direct (post isometric relaxation)” variation of an MET. It activates the golgi tendon organs (GTOs) in the opposing muscle to which is being contracted which activates a neurological message to the spine which then activates an inhibitory “relaxation” interneuron which sends a message to the muscle which is being contracted – thus producing relaxation which allows the joint to be taken further into a stretch when the patient is asked to relax.


Some osteopaths go on to train in acupuncture or dry needling. Acupuncture is an ancient Chinese medicine which works by stimulating specific parts of the skin. The needle is pressed into nerve-rich areas of the body with the aim of influencing different parts of the body, such as muscles and organs. Each acupuncture makes a tiny entry into the body and although it’s a miniscule one which is often not felt, it is enough to create a response in the body. The research into acupuncture says this response increases blood flow, promotes wound healing, pain modulation and an increase in immunity.

Joint mobilisations

Joint mobilisations are used when an osteopath believes a joint to not be moving as fully as it could. For example, a healthy knee joint usually moves into 135 degrees of flexion, anything less than this would be deemed to be restricted. Also, the quality of the movement is also assessed when osteopaths move your joints for you, which means checking how the joint moves – whether it clicks for example. Osteopaths will also assess how the joints feel at the end of the movement. A mobilisation technique can increase motions, help with stiffness, stretch joint structures such as capsules, synovium and ligaments as well as increase blood flow and lymph. This contributes to pain reduction.

High Velocity Low Amplitude Thrusts (HVLATs or HVTs)

Aka the “cracking”, HVTs are often used by osteopaths for the same reason as joint mobilisations. An osteopath will usually prepare the joint with soft tissue techniques (see above) first, before performing a very quick movement often accompanied by an audible click which is nitrogen escaping the joint space. The click itself does not cause the therapeutic effects – it is the movement which leads to reduced muscular and tissue tension and the neurological benefits of the technique.


Above are just some of the main techniques which are often used by osteopaths. There are many more. If you ever have any questions during a treatment, your osteopath should answer them to the best of their ability. Please do not hesitate to contact your local osteopath for any clarification on if any of these techniques could benefit you. Osteopaths will tailor the treatment with the most appropriate techniques for your body and health. If anything ever feels uncomfortable, inform your osteopath and they will have another technique that can use to help you.

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