Why Sport-Specific Application Matters with CMM
The Collective Mechanics Model (CMM), developed by Robert Johnston at the Canadian Academy of Osteopathy, provides osteopathic manual practitioners (OMPs) with a deep, assessment-driven foundation. It requires the OMP to view the body as a single interconnected system, in which a problem in one region can shift load to another region without an obvious connection.
Osteopathy uses four distinct criteria, known as ARTS, to identify the osteopathic lesion, or somatic dysfunction. Somatic dysfunction refers to impaired or altered function in related parts of the body’s framework: the bones, joints and myofascial tissues, along with their vascular, lymphatic and neural elements. Identifying these signs in a region or segment indicates a dysfunction that warrants treatment.
Asymmetry – How one side or region of the body differs from another
Restriction of motion – Where movement is noticeably limited
Tissue texture change – What the tissue feels like under the OMP’s hands
Sensory feedback – What the patient reports feeling (pain, weakness, numbness, etc.)
ARTS is structured, repeatable, and teachable. It keeps assessment ahead of treatment, exactly where it should be. One point many of my teachers made repeatedly was that an appointment needs to be objective and driven by findings, not by time spent treating. An OMP who is thorough in their assessment doesn’t need to do much to produce significant change in the body. By keeping an 80/20 approach, with roughly 80% of the appointment spent assessing and 20% treating, sessions stay short but highly effective.
What remains is practice and patients. But there is a noticeable gap in how tailored that process is to the athlete patient in front of you. None of what follows is a criticism of the CMM or the ARTS foundation. It is a question about what we do as OMPs with the findings once we have them, when the patient needs to perform in a specific way: a golfer, a baseball pitcher, or an Olympic weightlifter. These athletes will show significant asymmetries in muscle development and mobility, left to right or between the upper and lower body.
The Present Gap: A Static Read of a Dynamic Athlete
In a general patient, ARTS findings point to a dysfunction worth treating. In an athlete, the same findings may be an adaptation to their sport. What is less developed is how an OMP interprets their findings in light of a specific sport’s demands.
CMM assessment is largely performed on the treatment table. The patient is still, supported, and either sitting or lying down. That works well for someone whose body reflects a desk job or long hours spent standing. But an athlete lives a very different life.
Early in my career, I focused on sports populations. Writing this reminded me of the week and a half I spent with the Canadian national swim team at a training camp in Florida. The training routine was deliberate and structured. The average day began with a 2½-hour pool session in the morning, followed by a return to the hotel after lunch for treatments to flush the muscles, calm the nervous system, and address any lingering issues. By late afternoon, they were back in the pool for another 1½ to 2 hours, followed by dinner and more treatments. On other days, they might swap a pool session for 90 minutes in the weight room, but each day featured intense sessions in the water.
That training volume adds up quickly. Thousands of shoulder rotations and kicks build a very distinct physique, and repeating those movements day after day takes a toll on muscles, ligaments, and joints. The same is true for a baseball pitcher or an Olympic weightlifter. As a weightlifting coach and former track & field athlete, I understand how demanding training can be and how the body develops differently across sports. I also recognize that certain areas wear down, get injured, or are neglected.
A snapshot on the table can show the OMP what is asymmetrical. On its own, it cannot tell us why or whether that asymmetry is serving the athlete. That interpretation step is where the gap lies. Yes, agonist and antagonist muscles need balance, and the pelvis needs to stabilize under load. But that balance also needs to benefit the athlete. A recreational golfer rotates in the same direction hundreds of times a week; a professional, thousands. A pitcher, a tennis player, a javelin thrower and a hockey player all do something similar in their own sport.
Olympic weightlifting shows that the pattern isn’t always left versus right. The sport is largely bilateral and occurs in the sagittal plane. Lifters develop a strong posterior chain from the pulls in the two lifts, the snatch and the clean & jerk. They also have very flexible ankles, hips, shoulders and thoracic spine, yet when viewed straight on, they might not look all that athletic. On the table, that mobility could easily be read as excess range or instability. A well-developed posterior chain can be misread too. I can’t recall how many times an athlete has told me they were told they have an anterior pelvic tilt that needs correcting, when, in reality, they just have large glutes.
Asymmetry as Adaptation Is Not Equal to Dysfunction
The same ARTS finding can mean two very different things. It may be an adaptation the athlete has earned, one that supports their performance. Or it may be a dysfunction that is building toward pain, injury, or reduced performance. The table alone can’t distinguish between the two. Knowledge of the sport is what helps tell them apart.
If an OMP interprets every asymmetry as a problem to correct, our treatments will aim to restore symmetry. For most patients, that is a reasonable aim. For athletes, it can cause instability and poor performance outcomes.
Removing an adaptation the athlete relies on can leave them feeling unfamiliar with their own body. Timing, feel, and power in a well-grooved movement may drop off. A stable, loaded system can become less stable just when it needs to perform.
The goal with an athlete is not to unwind them. It is to support the body they have built for their sport and to address what is actually getting in the way. That shift matters most when an athlete is in-season and close to competition, when there is little time to adapt.
Assessing the Sport, Not Just the Athlete
The fix is not a new model. It is an extra layer of interpretation on top of CMM:
Understand the sport’s demands. What are the primary motions of the sport, and how often are they repeated? Are there rest periods, such as shifts in hockey, or is the effort prolonged, as in biathlon? How often do they train and compete, and are they in the off-season, preseason, in-season, or competitive season? How many competitive phases occur throughout the year? How long have they been in the sport, and what is their injury history? This is where the needs assessment comes into play, and it can extend to recovery, nutrition, and mental skills.
Map the expected pattern. Given those demands, what asymmetries would be expected in a healthy athlete in this sport or position?
Compare the findings to the expected pattern. Which findings fit the sport? Which fall outside it or are more extreme than expected?
Link findings to symptoms and performance. Is the finding associated with pain, a recent change, or something the athlete or coach has noticed in performance?
Treat with intent. Support adaptations that serve the athlete, and target findings that do not. Understand training volume, frequency and rest. Periodization and the yearly training plan (YTP) matter here.
Re-check in motion. Where possible, confirm with a sport-relevant movement, not just on the table. My professors always emphasized assess–treat–reassess. If you don’t reassess, you have no idea what you did, and you get lost in the process.
A baseline assessment taken preseason, when the athlete is healthy, makes steps 2 and 3 more reliable. It shows what the athlete’s normal is, not what it’s “supposed to be” according to a textbook.
All of these points converge on a common place: sports science. A background in sport, coaching, and strength & conditioning is significant, a “holder of the keys,” as it were, to understanding sport itself and why an athlete is a different animal from the typical patient.
That’s where the argument for “specialties” comes in. Osteopathy adapts to the person presenting, letting the findings guide the approach, and CMM builds on that observation. So why specialize if the model is so universal? One could argue there is no need to study the sport or its specific movements. But without in-depth knowledge of the unique demands of the sport that is the patient’s career or passion, you miss the mark. Overcorrecting a lesion pattern could set an athlete back at the worst possible time, leading to injury, poor performance, or a missed chance to qualify for a major championship.
Where Do We Go From Here?
CMM provides a strong foundation for manual practice. What it needs next, for OMPs treating athletes or working with sports teams, is a sport-specific way to interpret what they find. That means taking what OMPs already know and applying it alongside sport physiology, strength and conditioning, and coaching practice. That way, they can learn the ins and outs of sport demands and how athletes develop over weeks, months, and years of training and competition.
Our job with athletes is not to make them fully symmetrical. It is to keep them healthy, confident, and performing in the bodies their sport has built. That is why I have chosen this path and am pursuing my Master of Sports Science in Sports Coaching. I want in-depth knowledge of sport in all its aspects so that, in practice, I can meet each athlete’s individual needs, which often differ significantly from those of the general public.