In Reciprocal Tension [M5]

Location: Hawkwood College, STROUD
Duration: 3 days
Price: £895 (non-residential) £995 (residential*)
Entry criteria: Module 2
Next delivery: 15—17 February 2019
Leader:  Pamela Vaill Carter

How does the body maintain its shape strength and stability when moving? Have you been curious why a patient presented with a headache after a fall on the pelvis or back ache after a car accident? Did you know that between them, the tentorium and falx are connected to every bone in the neurocranium?

Inspired by Sutherland's observations, we start to look at the body from the perspective of the spaces he described and how they are contained and connected. By developing our sense of these spaces within and around the body through practicals, palpation and exercises, we can start to understand how the body might organise itself in response to the different forces, stresses and strains it encounters. We discover how we as osteopaths can engage with the intelligent connective tissue matrix in treatment.

Course Content

  • Introduction to the concept of Reciprocal Tension, the distinction between the Reciprocal Tension Membrane, and reciprocal tension as a principle at work within the membranes of the whole body. The concept of fulcrums & the idea of a self adjusting suspensory 'fulcrum' for forces within the RTM (known as Sutherland's fulcrum).
  • Reciprocal tension systems in the body as a whole, a presentation of anatomical dissections highlighting the fascial relationships in the whole body, the interrelationships of the 4 diaphragms. Practical: The role of reciprocal tension in diagnosis and treatment using the principal of balanced membranous tension and engaging the therapeutic forces of the body's physiology.
  • Anatomy and clinical importance of the meninges: continuity of pia arachnoid and dura from occiput to sacrum (the core link), and into the cranial and peripheral nerves. Practical exploring the quality, individual layers and continuity of the meninges from brain to bony cranium. Treatment of dura using BMT.
  • The venous sinuses, structure and importance of involuntary motion for function. Practical: Viola Fryman venous sinus drainage technique
  • Embryology of the dura. Practical: palpation and treatment of dural reflections of falx, tent and anterior dural girdle in relation to the notochord.
  • Physiology of fascia: Extracellular matrix (ECM) as an intelligent organ, its relationship to neuro-endocrine-immune systems and homeostasis. Insights from Still and Sutherland to modern scientific understanding. Practical: exploring the innate wisdom of the ECM, and the how the membranous tissues respond to the fluctuation of the tide as expressed in involuntary motion
  • Reciprocal tension in the endocrine system and what that means in terms of therapeutic intervention for hormone related imbalances.
  • Tensegrity within the connective tissue systems of the body
  • Reciprocal tension and the 5 phenomena. How do the concepts covered in the course enhance our application and understanding of familiar treatment approaches such as CV4, potency within the CSF and CNS, BMT of sutures?

Course Format

Our faculty share their latest research and development discoveries in short lectures and presentations which are followed by group practicals and tutorials with a 1:4 tutor to student ratio. In your tutor groups, you will be encouraged to explore different aspects of the material through worksheets, discussions palpation exercises and hands on practicals. You will be given individual guidance from your tutor and will be invited to discuss your learning with colleagues in a friendly and mutually supportive environment. Excellent course notes are provided.

Course Details

This course is run approximately once every 2 years in the UK.

* Residential accommodation at Hawkwood is in shared rooms, a limited number of singles are available at a supplement and allocated on a first-come-first-served basis.

Osteopathic Practice Standards & CPD

Learning Outcomes & Assessment Criteria
On completion of this course you should be able to:
To achieve the learning outcome you must demonstrate the ability to:
1 The student should be able to describe the anatomy of the dura mater and discuss its functional significance including reference to the lymphatic system. Articulate, analyse and interpret examination findings with reference to the dura mater in a practical setting and show that they can offer an informed explanation of the functional significance of their findings.
2 The student should be able to demonstrate and articulate palpatory and therapeutic skills helpful in improving their sensory awareness during their interactions with patients. Apply diagnostic/interpretive osteopathic skills in a practical setting. To reflect-in- action during a therapeutic encounter using self-correction when their practical approach needs to be modified according to the response of the patients’ tissues.
3 The student should be able to apply the concept of reciprocal tension to different systems across the body. The student should be able to express an understanding of the concept of Reciprocal Tension and make the case for its application to multiple systems in both a theoretical and practical setting.
4 Manage patients and monitor outcomes in a manner that is responsive to the complex and dynamic needs of the patient over time and ensures best care. Construct, implement and monitor osteopathic management plans for your patients and adapt them in response to clinical evidence and patient needs over time.
Student Learning
Type of LearningLearning ActivityNLH*
Scheduled Learning Hours Lectures 6
Practical classes 12
Scheduled online activities  
Guided Learning Directed reading & research 4
Reflective portfolio development  
Peer assisted learning  
Independent Learning Unguided reading from defined reading list  
Assessment preparation (optional case study) (12)
Tutor defined project / Dissertation activity  
Autonomous Learning Reading from non-specific sources  
Reflection on clinical experiences 2
Placement Clinical observations  

* Notional Learning Hours

CPD Requirements: Mapping to the OPS
OPS Theme OPS Mapping
  1 2 3 4
Communication & Patient Partnership
Knowledge, Skill & Performance
Safety & Quality in Practice
CPD Standards  
CPD activities are relevant to the full range of osteopathic practice See above mapping exercise      
Objective activities have contributed to practice Peer review/Observation      
Case-based discussion activity      
Seek to ensure that CPD activities benefit patients Communication/Consent activity      
Maintain CPD documentation Certificate of attendance/Overview document provided to student