This webpage contains a short, specialized article contemplating the core principle of osteopathic treatment. It is written in English to maintain the original terminology. For patients, there is no need to understand the material.

Osteopathic treatment has a facilitative nature and is applied in harmony with the patient’s body. This means that the patient is always the focal point of the treatment. This subtle interaction can easily be missed when the osteopath firmly holds on to specific explanatory theories. The citations below, derived from the legacy of osteopathic giants, illustrate what the facilitatory aspect of osteopathy is about: promoting the self-healing capacity of the patient.

The Fulcrum

Support and leverage

Offer the right fulcrum, at the right place, at the right time.” ^[1]

This seemingly simplistic citation by Anthony Chila captures what osteopaths must remember when they lay their hands on the patient. The fulcrum is osteopathic terminology for creating a manual lever by which obstructions in the connective tissues are removed so normal nervous and vascular functions can be restored. It can be seen as a leverage through which the patient is supported in regaining their health. The fulcrum can be seen as a doctor’s remedy for the patient. However, the ‘osteopathic remedy’ can only reach its full potential when applied precisely and in the required dosage: the right remedy (fulcrum), at the right place, at the right time.

Three basic components of a patient-centered osteopathic treatment approach: fulcrum plus visualization gives facilitation.

Visualization

Hands and mind united

The Hands and the mind should not be separated.” ^[2]

Osteopaths use mental images of the structural organization of the human body during treatment. Keeping anatomy in the mind’s eye is an essential principle of osteopathy. Dr. Miller wrote in the preface of Anatomy in a Nutshell: “We work at this discipline until the images are engraved in our minds. We work to a point where vivid images are brought to a conscious level as we interact with the
living body.”[3]

The principle of visualization in osteopathy also involves the palpable expression of the living human body. When we study anatomy in the dissection room and touch the corpses, everyone can sense that any form of expression is absent in those tissues. It is only form. Function does not exist anymore.

The living human body has numerous ways of expressing its liveliness: vibrations, circulatory dynamics, breathing patterns, heart rate, moisture, temperature changes, energy flows, etc. When the tissues lack expression, for example, a sense of sluggishness in lymphatic flow or severe spinal compression zones, this is a sign that the body’s self-healing capacity is impeded and can cause, or already have caused, “dis-ease.”

Herbert C. Miller emphasizes the importance of clear attention and deepening of the palpatory sense when he stated that “the hands and the mind should not be separated” during osteopathic treatment. “Direct mental and palpatory exposure creates a complete picture of the patient,” according to Dr. Miller.”[4]

It is the skill of the true osteopath to recognize, understand and visualize the dysfunctional patterns in the tissues, knowing how to use this information to facilitate the system in such a way it will activate the healing capacity of the patient.

Facilitation

Activating the healing capacity

The physician’s role is that of a facilitator. By appropriate facilitation, the physician is able to observe the capacity for change while the patient is enabled to expand the power of change. The standard for the successful outcome of this interchange is the motivation of the patient.” ^[5]

Numerous well-known DO’s described that the osteopath is not the healer but the facilitator for the patient in finding health. So what is meant by appropriate facilitation?
The goal of the osteopath is to activate the body’s innate healing force. Original methods of osteopathic treatment all endeavour after continuous and simultaneous facilitation and observation (visualization). As the correction comes from within the patient’s body, the osteopath follows the palpable change in the tissues and adapts the fulcrum to the body’s needs until the treatment process is completed.

One of the most insightful learnings about using the fulcrum in osteopathic treatment is in this quotation: “The Becker’s (Rollin E. Becker D.O. and his younger brother Alan R. Becker D.O.) learn to be with or slightly behind the change, never ahead of the change!”[6] This phrase is extremely helpful for improving one’s skills in osteopathy.

Osteopathy’s strength lies in its simplicity: fulcrum plus visualization gives facilitation.

In conclusion, please remember Doran A. Farnum, D.O., who practiced osteopathy for 78 years. Dr. Farnum concisely described how he sensed for the correction during his treatments when he said: “Tissue, when it is ready to respond, has to feel like melting butter.”[7]