Articulatory technique is a type of Osteopathic Manipulative Treatment (OMT) performed by osteopathic practitioners and U.S. trained osteopathic physicians. The physician uses low velocity and moderate to high amplitude forces to carry a dysfunctional joint through its full range of motion, with the therapeutic goal of increasing range of motion. Usually this requires multiple repetitions of engaging the motion restriction, easing off slightly and re-engaging the motion restriction in an articulatory fashion.
Pathophysiology of joint dysfunction
The central nervous system has the ability to excite or inhibit most of the tissues throughout the body. Increased activity within alpha motor neurons can cause increased muscle contraction. The longer the tissues remain in this hyperactive state, the greater the chance of somatic dysfunction occurring. The current hypotheses state that the more nerves remain in a facilitated state, the more prone they are to lead to soft tissue stiffness, contracture and pain.
Mechanism of action for articulatory techniques
In a general sense, articulatory techniques use repetitive springing motions or repetitive concentric movements of a joint through a restrictive barrier. The intent is to improve the overall range of motion by repetitiously changing the position of the restrictive barrier.
Specifically, articulatory techniques introduce physiologic movement into a joint space. Movement disrupts stiffness and contractures while decreasing the degree of facilitation in the joint. In addition, serotonin and noradrenaline levels have been shown to increase in response to OMT which results in the patient experiencing less pain.
Indications and contraindications
Articulatory techniques are useful in stretching restricted muscles, ligaments and capsules. Since the motions involved are slow and deliberate, physicians can easily monitor the patient's response to the treatment.
Absolute contraindications include patient refusal, open wounds, fractures, tendon avulsions, severe osteoporosis and metastatic disease. Patients taking anticoagulants, joint hypermobility and osteopenia should be given special consideration before articulatory techniques are employed.
Articulatory techniques are just one example of osteopathic manipulative treatment. These techniques may be useful in the elderly, hospitalized patients and in preparation for other treatment modalities such as HVLA.
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- "Glossary of Osteopathic Terminology" (PDF). American Association of Colleges of Osteopathic Medicine. April 2009. p. 28. Retrieved 25 August 2012.
- Ward, Robert C. (2002). Foundations for osteopathic medicine (2nd ed.). Philadelphia: Lippincott Williams & Wilkins. ISBN 0-7817-3497-5.
- Patriquin, DA (September 1992). "The evolution of osteopathic manipulative technique: the Spencer technique.". The Journal of the American Osteopathic Association 92 (9): 1134–6, 1139–46. PMID 1429074.
- Skyba, D.A; Radhakrishnan, R; Rohlwing, J.J; Wright, A; Sluka, K.A (November 2003). "Joint manipulation reduces hyperalgesia by activation of monoamine receptors but not opioid or GABA receptors in the spinal cord". Pain 106 (1-2): 159–168. doi:10.1016/S0304-3959(03)00320-8. PMC 2732015. PMID 14581123. Retrieved 7 December 2012.