the tissues can form enough resistance to
permit efficient thrust procedures. They will
reach a target tissue or structure without
reaching the end of range of the joint. This is
much less potentially traumatic and uncomfortable, and allows a chance to use this
category of technique in a wider range of
patients. It is accepted that not all practitioners
can achieve this ideal of ultra rapid acceleration
and very controlled braking force. Inevitably
some thrust techniques will be of a lower or
intermediate velocity, but the aim of minimal
amplitude remains consistent. A force short
of adequate joint separation is not going to be
traumatic; an excessive force or amplitude is
potentially dangerous.
Thrust techniques are usually performed parallel or at right angles to the plane of the joint and in a direction
designed to break joint fixation in the most efficient way. The barrier to motion in a well-positioned thrust technique
has a characteristic feel of potential or dynamic tension. It is necessary to balance all the available components of a
particular thrust technique to achieve the 'best' barrier, which is not necessarily the maximum barrier. Original
osteopathic thinking was traditionally designed to 'reverse' the path of a lesion.
Diagnosis was concerned with discovering the pathway of the lesion, and thus the correct path of 'correction'.
Although this is an attractive concept it has become accepted that many cases do not require this type of analysis. A
simple breaking of fixation in the direction of optimum barrier is sufficient to improve range and quality, and
positional correction is often unnecessary and excessively complex. Attempts to classify fixations by directions of
lesion can be extremely limiting, particularly for students whose palpatory awareness is not able to perceive the fine
differences. There are certainly some cases where specific directions play a part, but these are relatively rare, and
results are just as good if this element is largely ignored. This approach angers some traditionalists. It is interesting,
however, that their detailed
analysis and decision of lesion correction direction will be found to give the same path of optimum barrier sense
achieved with far less effort by the methods described here.
The palpatory cues of barrier sense are less likely to give the operator a wrong message than a conceptional model
of lesion correction analysis. This means that traditional descriptions of a rotation lesion or a sidebending lesion are
becoming less common in schools adopting this principle. There may be a description of a segment that is reluctant
to rotate or sidebend, but this information can be immediately introduced into the choice of vectors of force most
likely to break fixation. If an accurate palpatory assessment is not possible in a static or dynamic examination, the
patient can be placed in a thrust position, and the vectors and components adjusted to find the optimum barrier. The
resistance to particular movement pathways will then become more evident as much of the joint play will have been
absorbed, and the best path can be chosen. This places greater emphasis on good operator control and balance of
available components, and is not an excuse for poorly applied technique skill. If anything, it requires greater skill, as
the decision about the best pathway to produce the release will change slightly as the patient is moved into the
technique position.
Neither is this an excuse for merely 'popping' joints. The purpose of any technique is improvement or restoration of
normal function, not simply the completion of the technique. Re-assessment of function, range and quality is the
critical element.
Traditional 'manipulation' is performed at the end-of-range, and then by the application of overpressure beyond the
point of control of the patient. Well-controlled osteopathic thrust technique is not usually performed in this way. The
act of inducing multiple components produces a point of useful tension that is short of the end of anatomical range.
The thrust is performed in a chosen direction
