The Sentient Cell: Implications for Osteopathic Medicine.

The Foundation of Osteopathic Research and Clinical Endorsement (FORCE) is an organization that includes various figures involved in clinical and non-profit research and does not depend on any private or government body. To better understand how the human body behaves, we need to observe cellular behavior. Considering the human body as layers, districts, and regions, or just as a machine, is severely limiting to understanding the systemic mechanisms that are implemented to maintain bodily health. For some years, FORCE has contributed several articles to the literature to support the view of a human body as a unit, a fascial continuum (solid and fluid fascia) capable of interacting consciously, and not as a passive mirror, with respect to external stresses. The article reviews the tensegrity theory applied to the cell, trying to bring to light that the mechanistic vision on which this theory is based does not meet biological reality. We review some concepts related to biology, the science that studies life, and quantum physics, the science that studies the invisible physical phenomena that underlie life. Understanding that the cells and tissues are aware of the therapeutic approaches they receive could better guide the decisions of the osteopathic clinician.

Symptoms Arising From the Diaphragm Muscle: Function and Dysfunction.

There can be many reasons that damage the function of the diaphragm, either transiently or permanently, involving one hemilate or both muscle portions. The diaphragm is associated only with breathing, but many other functions are related to it. The patient is not always aware of the presence of diaphragmatic dysfunction, and it is not always immediate to identify non-respiratory diaphragmatic symptoms. Pseudoanginal pain, night sweats, difficulty memorizing, or muscular and visceral problems of the pelvic floor are just some of the disorders linked to reduced diaphragmatic contractility. A decline in respiratory contractile force can be the basis for further pathological conditions that can increase the rate of mortality and morbidity. The article reviews the possible symptoms that may be presented by the patient, which are not necessarily related to lung function.

Pericardial Adhesion and Chronic Non-Specific Neck Pain following Thoracentesis: An Osteopathic Approach.

Cardiovascular diseases (CVDs) are the leading cause of death globally. Morbidity and disability related to non-fatal events are increasing exponentially. There are several symptoms that may arise after invasive therapeutic approaches such as coronary artery bypass graft (CABG), including chronic pain in anatomical areas connected to the mediastinum; these pains can be found not only initially after surgery but also years later. We present a case where non-specific neck pain (NNP), in a patient undergoing CABG five years earlier, was resolved with an osteopathic technique, working the pericardial area. To the knowledge of the authors, it is the first article illustrating an osteopathic approach with resolution of NNP, with a manual technique used on the pericardial area.

Rethinking the Origin of the Primary Respiratory Mechanism.

Spheno-occipital synchondrosis (SOS) is the joint regarded as the most important foundation for understanding cranial osteopathy and craniosacral therapy. SOS is the origin of the primary respiratory mechanism (PRM), a movement between the posterior surface of the body of the sphenoid bone and the anterior surface of the base of the occipital bone. From the PRM perspective, an alteration of the position between the two bone surfaces would create cranial and/or craniosacral dysfunction. These positional alterations of the SOS (in adults and children) would determine specific and schematical movements of the bones of the entire skull, whose movements are recognizable by palpation by trained operators. PRM expression is influenced by other elements, such as movement of the cranial bones, inherent movement of the central nervous system, cyclic movement of cerebrospinal fluid (CSF), mechanical tension of the cranial meninges, and passive movement of the sacral bone between the iliac bones. The article reviews the most up-to-date information on the evolution of cranial sutures/joints and meninges in adulthood, the fluctuations of the CSF, brain, and spinal mass movements. Research should reconsider the motivations that induce the operator to discriminate the palpable cranial rhythmic impulse, and probably, to rethink new cranial dysfunctional patterns.

Osteopathic Approach for Keloids and Hypertrophic Scars.

The skin is a complex organ, a system that influences and is influenced by the body system, with different skin layers always mechano-biologically active. In the presence of a lesion that damages the dermis, the skin undergoes sensory, morphological, and functional alterations. The subsequent adaptation is the formation of scar tissue, following distinct and overlapping biological phases. For reasons not yet fully elucidated, some healing processes lead to pathological scars, from which symptoms such as pain, itching, and functional limitations are derived. Currently, there is no gold standard treatment that fully meets the needs of different scars and can eliminate any symptoms that the patient suffers. One such treatment is manual medicine, which involves direct manual approaches to the site of injury. Reviewing the phases that allow the skin to be remodeled following an injury, this article reflects on the usefulness of resorting to these procedures, highlighting erroneous concepts on which the manual approach is based, compared to what the current literature highlights the cicatricial processes. Considering pathological scar adaptations, it would be better to follow a gentle manual approach.

Practice of Peritoneal Adhesions in Osteopathic Medicine: Part 2.

Peritoneal adhesions are an unwanted and frequent event following abdominal surgery, with a response rate that can reach 100%. The adhesions can be symptomatic, becoming a source of pain and discomfort for the patient, or asymptomatic, with possible chronic or acute visceral dysfunction. The article reviews what the diagnostic strategies are and discusses what could be the causes that lead to chronic pain in the presence of adhesions. The text reports the knowledge of the literature on the manual treatment of adhesions and illustrates possible symptoms that are not easily recognized by the clinician. To conclude, the article proposes osteopathic manual approaches derived from clinical experience and from what has been explained about the formation of peritoneal adhesions. Research must make further efforts to identify not only the causes triggering the formation of peritoneal neogenesis but also seek the most appropriate non-invasive treatments to help the patient.

Peritoneal Adhesions in Osteopathic Medicine: Theory, Part 1.

Peritoneal adhesions form as a result of trauma to the abdomen, injuries resulting from surgery, and infections. These tissutal neoformations are innervated and vascularized, and with lymphatic vessels, adherence becomes a new and independent structure, capable of negatively influencing visceral functions. Adherent neogenesis can be asymptomatic or can be a source of pain, limiting the patient's quality of life. Although adhesiolysis remains the elective approach to eliminate adhesions, this therapeutic route prepares the peritoneal anatomical area to recur. The article reviews information on adhesion formation and peritoneal anatomy, probable subjective predispositions, and pathways that carry nociception. The text aims to be a theoretical basis for making new treatment suggestions for non-invasive osteopathic medicine, through a second part will be discussed in another article.

Hyoid Bone Syndrome in a Patient Undergoing Left Ventricular Assist Device Implantation.

The clinical case describes the presence of hyoid bone syndrome (HBS) in a patient with a left ventricular assist device (LVAD) implantation, and the resolution of painful symptoms through an osteopathic manual technique (unwinding) applied to the tongue. To the knowledge of the authors, it is the first case report involving an LVAD patient with HBS treated with an osteopathic approach. The article briefly reviews the data relating to surgical therapy for patients with a clinical history of end-stage heart failure and symptoms related to HBS and posits some hypotheses on the presence of pain radiating from the hyoid bone to other areas of the body. The text reminds us to place greater clinical emphasis on the palpatory evaluation of the hyoid in the presence of non-specific painful symptoms.

The Osteopath's Imprint: Osteopathic Medicine Under the Nanoscopic Lens.

Scientific literature demonstrates how osteopathic manipulative treatments (OMT) are able to improve various somatic functional parameters, change somato-visceral and viscero-somatic reflexes toward a more physiological mechano-metabolic environment and, consequently, bring benefits to patients. These benefits can be long-lasting or short-lived. Multiple reasons can be found to explain the positive responses to OMT, ranging from neurological, vascular, lymphatic, and endocrine explanations. Not only the techniques, but the touch of the clinician prove to be important factors for a favorable adaptation by the patient. Another science capable of explaining the change in cellular status and from which reflections that pave the way for observing the human body in a different light can be extrapolated is quantum physics. The latter is rarely taken into consideration to obtain possible explanations of the physical events that occur between the clinician and the patient. The article tries to put the effects of OMT under the light of a new lens: the nanoscopic.

The Use of Instrument-Assisted Soft-Tissue Mobilization for Manual Medicine: Aiding Hand Health in Clinical Practice.

Instrument-assisted soft-tissue mobilization (IASTM) represents a treatment strategy for soft tissue (skin) and musculoskeletal tissue (myofascia). There are different morphologies of these tools that are used by clinicians and manual therapists for the management of scars, fibrotic formations, muscle-joint pain, and movement limitations. The literature demonstrates the effectiveness of IASTMs in different clinical areas. However, the literature does not consider the use of these tools for the protection of the clinician's hands. The main objective of this article is to draw attention to the fact that IASTM can protect clinicians from professional joint injuries of the hands and can likely become a preventive tool for the operator. Further research is needed to fully determine the positive adaptations in operators who use IASTMs compared to those who do not use them.

Fascial Nomenclature: Update 2022.

The connective tissue or fascia plays key roles in maintaining bodily function and health. The fascia is made up of solid and fluid portions, which interpenetrate and interact with each other, forming a polymorphic three-dimensional network. In the vast panorama of literature there is no univocal thought on the nomenclature and terminology that best represents the concept of fascia. The Foundation of Osteopathic Research and Clinical Endorsement (FORCE) organization brings together various scientific figures in a multidisciplinary perspective. FORCE tries to find a common nomenclature that can be shared, starting from the scientific notions currently available. Knowledge of the fascial continuum should always be at the service of the clinician and never become an exclusive for the presence of copyright, or commodified for the gain of a few. FORCE is a non-profit organization serving all professionals who deal with patient health. The article reviews the concepts of fascia, including some science subjects rarely considered, to gain an understanding of the broader fascial topic, and proposing new concepts, such as the holographic fascia.

The Importance of the Posterolateral Area of the Diaphragm Muscle for Palpation and for the Treatment of Manual Osteopathic Medicine.

The eupneic act in healthy subjects involves a coordinated combination of functional anatomy and neurological activation. Neurologically, a central pattern generator, the components of which are distributed between the brainstem and the spinal cord, are hypothesized to drive the process and are modeled mathematically. A functionally anatomical approach is easier to understand although just as complex. Osteopathic manipulative treatment (OMT) is part of osteopathic medicine, which has many manual techniques to approach the human body, trying to improve the patient's homeostatic response. The principle on which OMT is based is the stimulation of self-healing processes, researching the intrinsic physiological mechanisms of the person, taking into consideration not only the physical aspect, but also the emotional one and the context in which the patient lives. This article reviews how the diaphragm muscle moves, with a brief discussion on anatomy and the respiratory neural network. The goal is to highlight the critical issues of OMT on the correct positioning of the hands on the posterolateral area of the diaphragm around the diaphragm, trying to respect the existing scientific anatomical-physiological data, and laying a solid foundation for improving the data obtainable from future research. The correctness of the position of the operator's hands in this area allows a more effective palpatory perception and, consequently, a probably more incisive result on the respiratory function.

A Missing Voice: The Lingual Complex and Osteopathic Manual Medicine in the Context of Five Osteopathic Models.

The five osteopathic models recognized by the American Association of Colleges of Osteopathic Medicine guide clinicians in the evaluation and therapeutic choice which must be the most appropriate concerning the patient's needs. Skeletal muscles represent an important interpretation, such as screening and treatment, on which these models are based. A muscle district that is not considered by the usual osteopathic practice is the tongue. The lingual complex has numerous functions, both local and systemic; it can adapt negatively in the presence of pathology, just as it can influence the body system in a non-physiological manner if it is a source of dysfunctions. This paper, the first of its kind in the panorama of scientific literature, briefly reviews the anatomy and neurophysiology of the tongue, trying to highlight the logic and the need to insert this muscle in the context of the five osteopathic models. The clinician's goal is to restore the patient's homeostasis, and we believe that this task is more concrete if the patient is approached after understanding all the contractile districts, including the tongue.

Non-Instrumental Test for the Evaluation of Tongue Function.

The tongue undergoes various negative adaptations in the presence of local or systemic pathologies, adversely its behavior within the body context. Tongue assessments to correctly diagnose its functions are carried out using instrumentation, such as ultrasonography, magnetic resonance imaging, electromyography and different intraoral devices (swallowing, strength, posture, phonesis). Currently, there is no dynamic non-instrumental test in the scientific literature to highlight any lingual dysfunctions. The article describes a non-instrumental test for the assessment of lingual function in the body context, to obtain preliminary information on the quality of the neurological activities of the tongue, with respect to the balance and muscle strength that the patient expresses. The text briefly reviews the anatomy of the tongue and describes a clinical case to better understand how to use this test. Further studies will be needed for the validation of the test.

Palpation of the Respiratory System in Osteopathic Manual Medicine: From the Trachea to the Lungs.

There is a lack of published literature in osteopathic manual medicine on how to perform palpation of the lower respiratory tree such as the trachea, main bronchi, and lungs. Several authors have studied the osteopathic effect and respiratory response of palpation but have failed to demonstrate how to perform palpation of the visceral areas involved in breathing, either in the context of a clinical trial or as a case report. This paper reviews the innervation of these anatomical areas, the mechano-metabolic weight of the passage of fluids and air in the respiratory tract, the anatomical topography, and the movements involved in respiration. Drawing from current knowledge, this article illustrates, for the first time, how to place the hands for an effective osteopathic assessment of the tracheal, bronchial, and pulmonary structures. Understanding how to perform palpation of the lower areas is a fundamental tool in the clinic and potential therapy in osteopathic manual medicine.

Functional evaluation of the diaphragm with a noninvasive test.

Cardiac surgery with median sternotomy causes iatrogenic damage to the function of the diaphragm muscle that is both temporary and permanent. Myocardial infarction itself causes diaphragmatic genetic alterations, which lead the muscle to nonphysiological adaptation. The respiratory muscle area plays several roles in maintaining both physical and mental health, as well as in maximizing recovery after a cardiac event. The evaluation of the diaphragm is a fundamental step in the therapeutic process, including the use of instruments such as ultrasound, magnetic resonance imaging (MRI), and computed axial tomography (CT). This article reviews the neurophysiological relationships of the diaphragm muscle and the symptoms of diaphragmatic contractile dysfunction. The authors discuss a scientific basis for the use of a new noninstrumental diaphragmatic test in the hope of stimulating research.

Osteopathic Palpation of the Heart.

In the panorama of scientific literature, there is a paucity of literature on how to palpate the heart area in the osteopathic setting and relevant indications on which palpatory sensations the clinician should perceive during the evaluation. The article reviews the fascial anatomy of the heart area and the heart movements derived from magnetic resonance imaging (MRI) studies and describes the landmarks used by the cardiac surgeon to visualize the mediastinal area. The text sets out possible suggestions for a more adequate osteopathic palpatory evaluation and describes any tactile sensations arising from the patient's chest. To the knowledge of the authors, this is the first article that seeks to lay solid foundations for the improvement of osteopathic manual medicine in the cardiology field.

Osteopathic Principles: The Inspiration of Every Science Is Its Change.

The Educational Council on Osteopathic Principles (ECOP) annually renews and reviews the fundamental osteopathic principles that Dr. Still left behind for osteopathic medicine (OM). These tenets represent a guide and rationale for the osteopathic manual approach. The non-profit research organization, Foundation of Osteopathic Research and Clinical Endorsement (FORCE), which was founded in 2013 under the auspices of different international professionals, wishes to propose changes to these principles based on scientific knowledge, which did not exist in the nineteenth century, as well as all the information discovered subsequently. The proposal is not a constraint, but a further stimulus to improve the vision of OM. We believe, in fact, that a principle or a point of view never ceases to evolve: the inspiration of every science is its change.

The Cranial Bowl in the New Millennium and Sutherland's Legacy for Osteopathic Medicine: Part 1.

A theoretical model that does not evolve with new information deriving from scientific research, by changing the assumptions from which it was born, becomes a philosophy; the scientist becomes a scholarch. Cranial manual osteopathic medicine is very controversial, although it is commonly practiced, from the clinician to the nonmedical health worker. The article, divided into two parts, reviews the assumptions with which the cranial model was created, highlighting the scientific innovations and new anatomical-physiological reflections. In the first part we will review the synthesis and movement of cerebrospinal fluid (CSF), the movement of the central and peripheral nervous system; we will highlight the mechanical characteristics of the meninges. The aim of the article is to highlight the need to renew the existing cranial model.

The Cranial Bowl in the New Millennium and Sutherland's Legacy for Osteopathic Medicine: Part 2.

Cranial osteopathic medicine is practiced all over the world, respecting the dictates of the creator, Dr Sutherland. Despite the current manual approach faithfully follows the theoretical and practical bases that make up the cranial model of the last century, there are many scientific evidences that highlight the criticalities of the same model. In the first part we reviewed the role of the meninges and cerebrospinal fluid (CSF), as well as we discussed some rhythms present in the central nervous system; these latter elements are the pillars to support the theoretical idea of the movement of the skull evaluated and palpated by the osteopath. In this second part we will review the mechanical characteristics of other structures that make up the cranial system, highlighting new perspectives for clinical practice, thanks to the most recent data derived from scientific research.