Manual Medicine

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Osteopathic Manipulative Medicine

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Manual Medicine

Osteopathic Manipulative Medicine (OMM) is a form of manual (“hands on”) medicine used for the diagnosis and treatment of many painful conditions. OMM is a unique and complementary medical treatment used by D.O.s (Doctors of Osteopathic Medicine). OMM treatments are beneficial to increase range of motion (ROM), modulate pain, decrease inflammation, alter muscle tone, and increase circulation to ultimately improve function and movement. Osteopathic Medicine is based on the following principles:​

  1. The body is a unit.
  2. The body is capable of self-regulation, self-healing, and health maintenance.
  3. Structure and function are reciprocally interrelated.
  4. Effective treatment is based upon an understanding and application of the above.

How is OMM Utilized at NESS?

Many of our body systems are integrated including the musculoskeletal, circulatory, lymphatic and nervous systems. A problem in one system can manifest in dysfunction in other body systems (e.g. feeling pain in the left arm during a heart attack or foot pain from a pinched nerve in the low back). During an OMM session, the physician palpates body structures similar to a general physical examination in order to diagnose “somatic dysfunctions” which can be perceived as changes in tissue temperature or texture, restrictions in range of motion, lack of symmetry or malalignment. Often, the “muscle spasms” we perceive are due to overstimulation of signals to our central nervous system (brain, spinal cord) causing the muscles to become irritable with a lower threshold to contract (called “facilitation”). Our muscles and connective tissue also undergo “involuntary guarding” as a protective mechanism to create stability for an underlying unstable joint or region. This can cause tremendous pain that is local or that radiates, called “trigger points”. Once a diagnosis is made, a variety of gentle hands-on techniques can be used to manipulate or mobilize soft tissues such as muscle, connective tissue (fascia), bones, joints and spinal segments. These techniques can aid the body’s natural abilities to stimulate blood flow and lymphatic drainage, encourage normal physiological motion, relieve muscle tension, normalize our nervous system and decrease inflammation and pain. OMM serves as an efficacious treatment that can provide relief to patients who have failed conventional therapies or are seeking a less invasive, non-pharmacological approach to their care.

Myofascial Release

Muscles play a significant role in affording strength to our limbs and help to stabilize our joints through their tendinous attachments. Muscle hypertonicity, or increased tone, can cause pain and limit flexibility. Muscles exposed to repetitive trauma can undergo a process called “aberrant repair” which can lead to deposition of scar tissue further restricting motion. Persistent tone within the muscles and connective tissues can restrict joint movement leading to further underlying degeneration. Ultimately, this can affect our ability to perform specific movements or activities and affect our quality of life. Soft tissue mobilization and myofascial release techniques aim to reduce fibrous adhesions (scar tissue) and relax muscle tension. The treatment consists of rhythmic stretching and deep pressure. These techniques typically involve placing a traction force on the tight area with an attempt to restore normal texture to tissue and reduce associated pain.


Counterstrain, also known as strain-counterstrain is a gentle manual treatment which is excellent for relieving musculoskeletal pain in the acute stages. The technique focuses on correcting abnormal neuromuscular reflexes (signal pathways from nerve to muscles) that can lead to increased pain perception. A typical counterstrain aims to carefully reposition the affected area in a specific way until the pain dissipates between 70-100%. The position is then maintained for 1-2 minutes. During this time, the input-output signalling the nervous system “resets” which allows the tissue to normalize tension, “quiet down” and relax. The response is typically felt immediately following the procedure.

Muscle Energy

Muscle energy treatments help mobilize restricted joints and lengthen shortened muscles. This treatment involves a voluntary contraction of the patient’s muscles against a controlled counterforce. Respiration helps to minimize guarding and promote relaxation. Following a 3-5 second contraction against resistance, the joint will be gently moved to a new restriction where the technique will be repeated until range of motion is optimized. Muscle energy treatments are generally painless and very well tolerated.

High Velocity, Low Amplitude (HVLA)

HVLA is the procedure best known for the “thrusting” maneuver which people refer to as “cracking” or “popping”. By bringing the joint up to the restriction point, a quick thrust helps to release adhesions and gap the joint which often causes the sought-after sound. HVLA is utilized to restore the motion of joints once the superficial stabilizers have been released, enabling them to function effectively. HVLA is effective to restore mobility and function to a previously restricted joint and prevent secondary muscle spasm. HVLA restores healthy joint motion and does not move a joint beyond its anatomical limit. However, it should be performed with caution in certain patient populations.

Regenerative Osteopathic Manipulative Medicine (ROMM)

ROMM is a proprietary use of OMM to effect molecular changes within the body in regions that have been recently treated with regenerative medicine injection procedures such as prolotherapy, platelet rich plasma (PRP), bone marrow aspirate concentrate (BMAC) or adipose-derived stem cell treatments.

Why Choose Osteopathic Manipulative Medicine at NESS

As an osteopathic physician with extensive training in sports and spine medicine, board certification in physical medicine & rehabilitation and regenerative medicine and advanced certification in musculoskeletal ultrasound, Dr. Nevo has advanced and unique tools at his disposal to provide effective regenerative medicine procedures and guide post-injection rehabilitation, vital to long term success and prevention of reinjury. ...