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Osteopathic practitioners have a responsibility to diagnose and refer patients as appropriate when the patient’s condition requires therapeutic intervention that falls outside the practitioner’s competence. It is also necessary to recognize when specific approaches and techniques may be contraindicated in specific conditions.
Osteopathic practitioners consider that a contraindication to OMT in one area of the body does not preclude osteopathic treatment in a different area. Likewise, a contraindication for any specific technique does not negate the appropriateness of a different type of technique in the same patient. Absolute and relative contraindications for OMT are often based upon the technique employed in each particular clinical situation.
The contraindications identified by the community of osteopathic practitioners are regrouped in function of the osteopathic techniques considered: these can be direct, indirect, combined, fluid and/or reflex-based (1). Direct techniques, such as muscle energy, thrust and articulatory manoeuvres, pose different risks from indirect, fluid and reflex-based techniques. There is only little published evidence on which techniques should be avoided in specific conditions. Osteopathic practitioners use their understanding of the pathophysiology of the patient’s condition and the mechanism of action of the technique to establish absolute and relative contraindications that are biologically plausible. On that basis the lists below have been established.
Direct techniques, may use thrust, impulse, muscle contraction, fascial loading or passive range of motion, to achieve tissue response. They can be applied specifically to a joint or nonspecifically to a larger area of the body. Often an area that should not be treated using a direct technique may safely and effectively be treated using an alternative technique, e.g. indirect, fluid or reflex-based. There are absolute and relative contraindications to direct techniques.
Systemic conditions that constitute absolute contraindications to direct techniques
Systemic conditions that constitute relative contraindications to direct techniques
Absolute contraindications to direct techniques specifically applied at a local site
Absolute contraindications to direct techniques that specifically involve thrust or impulse applied at a local site
Relative contraindications to direct techniques that specifically involve thrust or impulse applied at a local site
Indirect, fluid, balancing or reflex-based techniques may be applied specifically to a joint or non-specifically to a larger area of the body. These techniques do not engage the restrictive barrier. They may include fascial and soft-tissue loading or unloading, hydraulic pressures, phases of respiration and cranial or postural adjustments, as part of the application of the technique. Relative contraindications to indirect techniques usually concern the clinical-temporal profile of the problem.
Absolute contraindications to indirect, fluid, balancing or reflex-based techniques applied at a local site
Relative contraindications to any indirect, fluid, balancing or reflex-based technique applied at the local site