Functional techniques are among the oldest but least understood techniques in the osteopathic armamentarium. There is no single functional technique, but rather they are represented by a diverse group of techniques related by their dependence on the functional, rather than the structural, component of the structure-function relationship. Because they are difficult to teach, they have often been forgotten or neglected. It is only recently that some of these procedures have been standardized and are again being more widely used. Much of the credit for this revival goes to three individuals—William Johnston’s functional methods (1), Stanley Schiowitz’s facilitated positional release (FPR) (2), and Richard VanBuskirk’s Still technique (3). Although one may argue that these methods are different, they all share fundamental characteristics.

The New England Academy of Applied Osteopathy (NEAAO) first introduced the term functional technique to the osteopathic profession in the 1950s (4). They defined a group of techniques characterized by establishing an “ease-response” relationship with the restricted segment, maintenance of the “ease-response” by the clinician as the segment was carried through its range of motion, then returning the segment to neutral, at which point the athlete’s body could maintain the “ease-response” on its own. Using these criteria for defining functional technique, it becomes readily apparent that the methods described by the NEAAO were rediscovered techniques rather than truly original ones.

This resurgence is best demonstrated by the recent work of Richard VanBuskirk, who rediscovered many of the techniques thought to have been practiced by Andrew Taylor Still, the founder of osteopathy (5). In recognition of this fact, VanBuskirk named it the Still technique. He also recognized the similarity of the Still technique to the functional methods taught by Johnston, FPR as taught by Schiowitz, and a group of unnamed techniques (6) taught by Edward Stiles, who learned them from George Laughlin, a direct descendant of Still. All of these techniques have in common the basic tenets described by the NEAAO in 1955.

Functional technique relies on the evaluation of a segmental tissue response to specific motion demands. Rather than assessing the position of a given segment with respect to somatic dysfunction, specific motions are introduced to test how the segment moves (i.e., its function). Particularly, an attempt is made to determine in which direction the segment has the greatest amount of motion—the “ease-response.” This is in contradistinction to direct techniques, such as the high-velocity, low-amplitude (HVLA) thrust, which depend on determination of the motion restriction or barrier.

Functional evaluation is not interested in an isolated plane or direction of motion, but rather in their summation. The motion of a vertebral segment (the examples presented later in the chapter assume that we are discussing vertebral motion unless otherwise stated) is described as rotation around the three ordinal
axes, x, y, and z: spinal flexion-extension is rotation around the x-axis, axial rotation is rotation around the y-axis, and sidebending is rotation around the z-axis.

Functional evaluation begins with identification of a vertebral segment that has a limited range of motion. The clinician can use any method of screening to identify somatic dysfunction. Once the dysfunctional segment has been identified, its motion characteristics must be identified. In the presence of somatic dysfunction, the greatest ease of motion is no longer the midline neutral position, but rather somewhere between the restrictive barrier and the anatomic-physiologic end point. It is the duty of the clinician to find the position of greatest ease, because it is from this position that treatment will begin.

Each direction of motion is tested to determine where the point of maximum ease is to be found. This is accomplished by placing one hand over the dysfunctional segment (the receiving hand), while the other hand (the motive hand) introduces gross motion down to the affected segment. The receiving hand evaluates the sense of ease or bind at the affected segment. Increasing ease is associated with decreased sense of tissue texture and tension. Each motion is tested sequentially in combination: first flexion-extension, then rotation and side bending. An attempt is made to find the point of maximum ease around all three axes of motion simultaneously. Fine-tuning this sense of maximum ease is accomplished by testing the very subtle translatory motions of movement along each axis. Bowles stated, “It is not position, nor is it motion, which is a change of position, which you feel. It is a physiological tissue response to demand for performance. The bind you feel may be a lesioned response or a normal response to the specific motion demand, but it is always a physiological response and its source lies in organized body processes.” (4) The key point to this evaluation is that although the motion demands involve gross motions, the response is specific and focused to a single segment: the evaluation of a specified segment undergoing motion.

Functional treatment is very easy on both the athlete and clinician; it takes only seconds to accomplish and is atraumatic. Although the previous description was confined to vertebral segments, the basic principles are applicable to any joint, most ligaments, and even many tendons. It is equally effective for both acute and chronic somatic dysfunction.