Does Osteopathic Heart-Focused Palpation Modify Heart Rate Variability in Stressed Participants with Musculoskeletal Pain? A Randomised Controlled Pilot Study.

Heart rate variability (HRV) describes fluctuations in time intervals between heartbeats and reflects autonomic activity. HRV is reduced in stressed patients with musculoskeletal pain and improved after osteopathic manipulative treatment and mind-body interventions. Heart-focused palpation (HFP) combines manual and mind-body approaches to facilitate relaxation. This randomised controlled pilot study investigated the feasibility and sample size for a future randomised controlled trial and the effect of a single treatment with HFP or sham HFP (SHAM) on short-term HRV. A total of Thirty-three adults (47.7 ± 13.5 years old) with stress and musculoskeletal pain completed the trial with acceptable rates of recruitment (8.25 subjects per site/month), retention (100%), adherence (100%), and adverse events (0%). HFP (n = 18), but not SHAM (n = 15), significantly increased the root mean square of successive RR interval differences (p = 0.036), standard deviation of the NN intervals (p = 0.009), and ratio of the low-frequency to high-frequency power band (p = 0.026). HFP and SHAM significantly decreased the heart rate (p < 0.001, p = 0.009) but not the stress index and ratio of the Poincaré plot standard deviation along and perpendicular to the line of identity (p > 0.05). A power analysis calculated 72 participants. Taken together, the study was feasible and HFP improved HRV in stressed subjects with musculoskeletal pain, suggesting a parasympathetic effect.

Reconceptualizing Principles and Models in Osteopathic Care: A Clinical Application of the Integral Theory.

The cornerstone of osteopathic care lies in the osteopathic tenets-first of all, the idea of a self-regulating, dynamic unit made of body-mind-spirit. The clinical application of the osteopathic principles mainly relies on the structure-function models, but the practitioners' community is still trying to reach a consensus on the fundamental theoretical framework. Mostly, the debate swings between the biomechanical-structural pole and the biopsychosocial pole. However, there is a compelling need for a robust conceptual framework in osteopathic care. It is necessary to draw up a more consistent interprofessional framework, emphasizing the distinctive focus of the osteopathic intervention in health care. In the present hypothesis paper, the different osteopathic care models are integrated into the 4-quadrant model of the Integral Theory. In light of the Integral Theory, osteopathic care can be construed to improve the individual mind-body function and spiritual behavior integrated with the environment.

Patient Active Approaches in Osteopathic Practice: A Scoping Review.

BACKGROUND: In the field of manual therapies there is a growing interest in moving from passive hands-on approaches to patient active approaches. In the osteopathic field there are both active and passive methods described as integrated in the process of care. However, this prospective linkage has not been formally explored and is not well shared in the community of practice. The present review aims to appraise the relevant literature on the functioning and principles of Patient active osteopathic approaches (PAOAs) and explore a prospective model for selecting the different types of PAOA, highlighting their integration into patient management strategies. METHODS: A scoping review was conducted to analyze the relevant literature on the functioning and the different principles of PAOA and to obtain a comprehensive perspective on the phenomenon. RESULTS: The eligible articles provide insights into the mechanisms of functioning and principles of application of active approaches to be integrated with hands-on approaches. These results provide new insights into the relevance of PAOA to clinical practice. CONCLUSIONS: The proposal, emerging from the review, may promote discussions in the community of practice and provide a road map for research towards achieving an evidence-based structure for PAOA.

The Role of Sphenobasilar Synchondrosis in Disease and Health.

BACKGROUND: The sphenobasilar synchondrosis (SBS; also, sphenobasilar synostosis or sphenooccipital synchondrosis) plays a major role in the concept of osteopathic cranial manipulative medicine (OCMM) and craniosacral therapy. Previous research suggests that many individuals, from newborns to adults, present with single or multiple SBS strain patterns as a result of the birth process and other traumatic forces throughout life. To date, it is unclear whether specific SBS lesion patterns are present in altered health states and disease and how they compare with healthy controls. OBJECTIVE: To identify research that reports on specific SBS strain patterns compared with healthy controls. METHODS: A literature review of electronic databases and hand-search of publication bibliographies was performed. Observational studies of newborns, children, and adults were included if there was information on the occurrence of cranial strain patterns related to the SBS in individuals with impaired health states and a healthy control group. RESULTS: Of 1123 citations, 836 articles were screened after duplicate removal, and 42 articles were evaluated by full-text assessment. Three articles were included in this review, including 1 prospective and 2 retrospective studies. The age ranges of the populations studied were newborns aged 5 days or younger, children aged 4 to 14 years, and adults aged 45 to 90 years. In adults with Parkinson disease, no significant difference in SBS strain patterns between the Parkinson disease group and the age-matched healthy control group were seen. In contrast, different SBS strain patterns were observed between newborns with a range of health impairments, such as jaundice and respiratory and nervous symptoms, and children with learning disabilities compared with their healthy counterparts. However, no statistical analysis was conducted in these 2 studies; hence, results are difficult to interpret. Reporting in all 3 studies was limited; therefore, the methodologic quality of the 3 identified studies was deemed incapable of being judged. CONCLUSION: The study landscape of this review highlights the scarcity of, poor reporting on, and unclear methodologic quality of research on SBS strain patterns in disease and health. It is still unclear whether and to what extent specific SBS strain patterns occur in impaired health states compared with healthy controls. Future studies should seek to improve study methods and reporting and minimize the risk of bias.

Osteopathic Treatment Approach to Psychoemotional Trauma by Means of Bifocal Integration.

Traumatic psychoemotional experiences often manifest in hypersympathetic states of excitement or in immobilization and withdrawal behaviors. A person with this kind of traumatic background may present with an autonomic response consistently maintained in the defensive state, which over time becomes a stressor. In this article, the authors discuss an osteopathic approach to psychoemotional trauma by means of bifocal integration, with an emphasis on promoting a relaxed body and mind by actively involving the patient in the healing process. They briefly discuss the role of mind-body therapies in treatment, considering the popular polyvagal theory and other neuropsychophysiological frameworks. The authors also focus on clinical practice, introducing the reader to the different elements of the osteopathic treatment, including the acknowledgement and integration of top-down and bottom-up dynamics in diagnosis and therapy.

Osteopathic Manipulative Treatment for Pertussis in the 19th and 20th Centuries: A Structured Historical Literature Review.

BACKGROUND: Cases of pertussis, or whooping cough, have increased in recent years despite widespread vaccination and adequate antibiotic treatments. Osteopathic physicians may want to consider using osteopathic manipulative treatment (OMT) as an adjunctive treatment modality for pertussis; however, suitable OMT techniques are not specified in the research literature. OBJECTIVE: To search the historical osteopathic literature to identify OMT techniques that were used in the management of pertussis in the pre-antibiotic era. METHODS: A structured literature review of electronic databases and historical osteopathic journals and books was conducted. Included were information on OMT techniques used for patients with pertussis. RESULTS: The 24 identified sources included 8 articles and 16 book contributions from the years 1886 to 1958. Most sources were published within the first quarter of the 20th century. Commonly identified OMT techniques included mobilization techniques, lymphatic pump techniques, and other manipulative techniques predominantly in the cervical and thoracic regions. CONCLUSION: The wealth of OMT techniques for patients with pertussis that were identified suggests that pertussis was commonly treated by early osteopaths. Further research is necessary to identify or establish the evidence base for these techniques so that in case of favorable outcomes, their use by osteopathic physicians is justified as adjunctive modalities when encountering a patient with pertussis.

Intuitive Judgement in the Context of Osteopathic Clinical Reasoning.

Previous research into osteopathic clinical and diagnostic decision making suggests that reasoning is commonly based on highly analytical as well as intuitive processes. According to the dual-process theory, the intuitive and analytical processing that leads to decision making is equally important in diagnostic reasoning. This article aims to explore the underlying and influencing factors that may lead to the development and reliability of intuition in clinical decision making generally and in osteopathic clinical reasoning specifically. Practical suggestions are given on how to encourage the development of intuition within the context of osteopathic teaching and practice.

A.T. Still's Osteopathic Lesion Theory and Evidence-Based Models Supporting the Emerged Concept of Somatic Dysfunction.

Andrew Taylor Still, MD, DO, coined the original idea of lesion based on the obstruction of flow of body fluids, but primarily referring to bony structures and more precisely to the spine. Throughout the 20th century, this idea was shaped and developed into the concept of somatic dysfunction, a term that is familiar to both US-trained osteopathic physicians and foreign-trained osteopaths and has been an essential cornerstone of osteopathic practice and teaching. The present historical narrative review offers an overview of the evolution of Still's original lesion concept, major evidence-based models of somatic dysfunction that attempt to explain the clinical findings, and a critique of the concept.

Osteopathy and (hatha) yoga.

Differences and points of contact between osteopathy and yoga as regards their history and practical application are outlined. Both seek to promote healing. Yoga seeks the attainment of consciousness; osteopathy aims for providing support to health. One fundamental difference is the personal involvement of the individual in yoga. Teacher and student alike are challenged to re-examine the attitudes of mind they have adopted toward their lives. Osteopathy generally involves a relatively passive patient while the osteopath is active in providing treatment. Practical examples are used to highlight points of contact between yoga and osteopathy. The text includes a discussion of the importance of physicality and a description of ways of using it in healing processes. Furthermore, processes of attaining consciousness are outlined. Possible reductionist misconceptions in yoga and osteopathy are also pointed out. Fundamental attitudes and focus that complement each other are presented, taking the concept of stillness as a particular example.