The Swiss Cheese Approach: Why Osteopathy Works Best When We Combine Techniques
No treatment is perfect. Every technique we use, from spinal manipulation to dry needling to exercise, has strengths, and every one has gaps. The trick isn't finding one perfect treatment. It's layering several good ones so the gaps in one are covered by the strengths of another.
There's a useful way to picture this, and it comes from an unexpected place: a slice of Swiss cheese.
What is the Swiss cheese model?
The Swiss cheese model was developed by psychologist James Reason to explain how accidents happen, and how to prevent them, in fields like aviation and hospital safety. It became widely known during the COVID-19 pandemic.
Think of each protective measure as a slice of Swiss cheese. Each slice is useful, but each one has holes: weaknesses or situations where it doesn't work. If you rely on one slice, plenty gets through. But when you stack several slices, the holes rarely line up. Something that slips through one layer gets caught by the next.
The model was designed for safety, but the idea applies well to treating pain and injury.
Why one treatment is rarely enough
Musculoskeletal pain is rarely caused by one thing. A stiff neck with headaches might involve:
Joints in the upper neck that aren't moving well
Muscles around the neck and shoulders that are tight, overactive and sensitive
Movement and loading habits, like long hours at a desk or paddling for hours
Strength and endurance deficits that let the problem keep coming back
A sensitised nervous system that has been in pain for a while
Every treatment works on some of these factors better than others. Manipulation might free up a stiff joint but do little for weak deep neck muscles. Exercise builds long-term capacity but can be hard to start when everything is locked up and sore. If we only use one tool, the holes in that tool are where your recovery stalls.
The slices: what each technique brings, and where its holes are
Not every patient needs every technique. We choose the slices based on your assessment. Here's how each one fits in.
Spinal manipulation
What it's good for: A quick, targeted thrust to a stiff spinal joint. It can produce a fast reduction in pain and an immediate improvement in movement, which opens a window to get moving again.
Its holes: The effect is often short-term on its own. It doesn't build strength or change the habits that made the joint stiff in the first place, and it isn't suitable for everyone.
Osteopathic manipulative therapy (OMT)
What it's good for: The wider set of hands-on osteopathic techniques. This includes joint articulation, muscle energy technique, counterstrain, myofascial release and cranial approaches. These are gentler, more adaptable ways to improve how joints, muscles and connective tissue move together. They work well when a region is too sore or irritable for manipulation, and they let us treat the body as a connected system rather than one sore spot.
Its holes: Like any hands-on treatment, the effect needs to be backed up with movement and loading or it tends to fade.
Dry needling
What it's good for: Getting a direct response from stubborn, overactive muscle and trigger points that won't let go with hands-on work alone. It's especially useful for neck and shoulder tension, headaches and deep hip and glute muscles. (Read more in Dry Needling at Medela: What It Is, Why We Use It, and How It Fits Into Your Treatment.)
Its holes: It targets muscle very well, but it doesn't address joint stiffness or rebuild strength, and some people don't like needles.
Cupping
What it's good for: Applying suction to lift and decompress the soft tissues. This can ease muscle tightness and make an area feel freer, especially across broad areas like the upper back, lats and lower back. Many patients find it a comfortable alternative or add-on to deeper manual work.
It's also a clinic favourite after a hard block of training. When patients come in very sore from heavy sessions, Hyrox, CrossFit or a big week in the surf, many of them tell us cupping is one of the most relieving parts of their treatment. That's our experience in the clinic rather than a research finding, but it's a big reason we keep it as an option.
Its holes: The evidence for cupping is still developing, and its effects are mostly short-term and on the soft tissue. It works best as a support layer, not the main treatment.
Soft tissue massage
What it's good for: Reducing muscle tension and tenderness, improving circulation and helping the nervous system settle. Massage also helps patients relax into the session, which makes the other techniques more effective and more comfortable.
Its holes: On its own it rarely changes how a joint moves or how strong a muscle is. Relief can be temporary if the underlying load isn't addressed.
Exercise therapy
What it's good for: This is the slice that lasts. Targeted exercise builds strength, endurance and control, so your body can handle the loads of daily life, work and sport. Of all these techniques, exercise has the strongest research support for long-term outcomes in most musculoskeletal conditions.
Its holes: It's hard to exercise well when you're in a lot of pain or can barely move a joint. Results take weeks, not minutes, so motivation can drop before you feel the benefit.
Why stacking the slices works so well
Look at the holes and strengths side by side and they complement each other:
Manipulation and OMT restore movement quickly. That makes it easier to start exercise without pain getting in the way.
Dry needling, cupping and massage settle tight, sensitive muscles. That makes hands-on joint work more comfortable and more effective.
Exercise locks in the short-term gains from hands-on treatment, so the improvement holds between sessions and the problem is less likely to come back.
Each technique covers for the others' gaps. Short-term relief from hands-on work makes long-term change through exercise possible, and the exercise makes that relief last. When a problem slips through one layer, the next one catches it.
Why having it all in one place matters
You could build a similar stack by seeing a chiropractor for manipulation, a massage therapist for soft tissue work, someone else for dry needling and an exercise physiologist for rehab. But spreading your care across clinics has its own holes:
Nobody sees the full picture. Each practitioner treats their part, often without knowing what the others are doing.
Mixed messages. Different explanations and advice can leave you unsure what's actually wrong or what to prioritise.
Timing is lost. Many of these techniques work best together in the same session. Needling a muscle and then treating the joint it's guarding is far more effective than doing them a week apart.
More appointments, more cost and more travel. That makes it harder to stick with the plan.
At Medela, our osteopaths can use all of these techniques in a single consult. The same person assesses you, chooses the right combination for your problem, applies it, and checks your response as the session goes. If something isn't helping, we change it on the spot rather than waiting for your next appointment somewhere else.
Dry needling and cupping are included in the standard consult at no extra cost. Your osteopath uses whatever combination suits you best. If you'd like extra soft tissue work, our in-house remedial massage therapist can book you in for dedicated remedial massage sessions, which work well between osteo appointments.
Every stack is different
Swiss cheese care doesn't mean doing everything to everyone. A surfer with a stiff shoulder, a desk worker with daily headaches and a CrossFit athlete with a cranky lower back will each get a different combination, and that combination will change as you improve. Early sessions might lean more on hands-on work to settle pain. Later sessions shift toward exercise and building resilience so you stay well.
What stays the same is the thinking behind it. Assess carefully, choose the right layers, and stack them so the holes don't line up.
Ready to get started?
If you've tried one approach and hit a wall, it may be that you only had one slice of the cheese. Book an osteopathy consult and we'll work out the right combination for you.
Medela Osteopathy & Co, Suite 9, 69 Wharf Street, Tweed Heads. A short walk from Coolangatta.
