Treament Techniques Practiced at Manchester Osteopathic

Treatment Techniques
High Velocity-Low Amplitude (HVLA)
Muscle Energy
Counterstrain (aka Strain-Counterstrain)
Balanced Ligamentous or Membranous Tension
Cranial Technique

Injection Techniques
Joint Injections
Tendon and Ligament Injections
Trigger Point Injections
Dry Needling
Facet Blocks
Prolotherapy

Osteopathic Treatment Techniques Defined
The goal of Osteopathic Manipulative Treatment (OMT) is to restore motion and balance to affected areas of the musculoskeletal system.  With balance, fluid and healing elements can return to the area and the toxic byproducts of injury can be drained away.  To do this we use a variety of techniques some of which are outlined below:

High Velocity-Low Amplitude (HVLA):  In this technique the physician uses his or her hands to find joints that are not moving as well as or symmetrically with other joints.  He or she then engages the barrier to motion in the joint and uses a quick but short thrust to overcome that barrier.  Often a popping noise will ensue as motion is restored to the joint.
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Muscle Energy:  This technique is similar to HVLA in that the physician engages a barrier to motion in a joint but instead of using a thrust he or she asks the patient to contract specific muscles attached to the joint to overcome the barrier and restore motion. 
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Counterstrain (aka Strain-Counterstrain):  In this technique the physician identifies specific tender points in the musculoskeletal system, moves the patient into a pain-free position, and holds that position for 90 to 120 seconds.  After slowly releasing the patient from the position normal motion is typically restored. 
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Balanced Ligamentous or Membranous Tension:  The physician uses his or her hands to evaluate motion in the soft tissue.  If decreased or asymmetrical motion is detected the physician will follow the tissue in the direction opposite the restriction until the area feels balanced.  That position is maintained until a softening or release is felt.  The tissue is then slowly returned to its normal position. 
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Cranial Technique:  This technique is similar in approach to Balanced Membranous or Ligamentous Tension.  With his or her hands on the patient’s head the physician feels for asymmetrical or restricted areas of motion.  The physician follows that motion to its endpoint then waiting for it to release which restores normal motion.
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Injection Techniques
Joint Injections:  The joint is injected with an anesthetic similar to Novocaine and sometimes a steroid solution to decrease pain and inflammation of a joint.  This procedure is commonly performed for arthritic conditions. 
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Tendon and Ligament Injections:  Tendons and ligaments are the connective tissue that connects bones and muscles.  A tendon is the tissue that connects muscle to bone and a ligament connects bones to other bones.  These soft tissue structures may become inflamed and painful.  Injecting an anesthetic agent (and/or other agents) decreases pain and inflammation.  Your physician determines the specific agents used in each injection, with consideration given to your particular problem.
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Trigger Point Injections:  Trigger points are tender, painful areas of muscle or the junction between muscle and fascia (connective tissue).  Trigger points are generally associated with a taut band or thickening of the muscle tissue.  Typically when a trigger point is pressed upon, the area will be very tender or may cause pain to be felt elsewhere.  Trigger point injections are injections of an anesthetic similar to Novocaine and/or steroid solution to help the muscle relax and to decrease inflammation.
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Dry Needling:  A technique used for trigger points (see definition above) that involves inserting a very fine acupuncture needle (without injecting any solution) into the trigger point.  The insertion of the needle into the taut band of muscle produces a relaxation of the band, which then will allow the muscle to lengthen and relax, relieving pain.
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Facet Blocks:  The facet joints are small joints of the spine between the vertebrae (back bones) that allow your back to twist.  The injection of an anesthetic similar to Novocaine is performed to alleviate pain and may be helpful in determining if this joint is indeed the source of pain.
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Prolotherapy:  Prolotherapy is an injection treatment of tendons and ligaments. Tendons are the connective soft tissue between muscles and bones, and ligaments are the tissues that connect bones to one another at joints.  Tendons and ligaments may become weak or injured and may not heal back to their original strength or endurance.  Once they are injured, healing is often slow and may not be complete because of a limited blood supply.  Prolotherapy is designed to stimulate healing of chronic ligament and tendon weakness.  The painful, weakened areas are injected with a proliferant (such as dextrose or sugar water), to directly stimulate the growth of healthy, strong tissues.  This process occurs when the proliferant causes a local inflammatory response in the weakened area that results in increased flow of blood and other nutrients to stimulate the tissue to repair itself.  The healing process can be expected to take about four to six weeks after the initial treatment.  As the tendons and ligaments grow stronger and more capable of doing their tasks, the pain is alleviated.  The total number of injections can vary depending on severity, the condition being treated, and patient response. Please click here for guidleines concerning Prolotherapy treatment. Please see the Links section for more information on Prolotherapy.
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