"The Rise of Psychosomatic Osteopathy: Integrating Modern Research and Healing Approaches"

In conventional medicine, psychosomatic medicine has existed as a separate speciality since the 1930s. Why wasn't psychosomatic osteopathy developed earlier?

‍Firstly, psychosomatic osteopathy (PSO) has little in common with so-called "psychosomatic medicine" - starting with its range of indications, the understanding of underlying mechanisms of action and risk factors, through to osteopathic diagnostic and therapeutic interventions. PSO was not developed earlier because its underlying research findings were not available to early osteopaths. Models, approaches, diagnostics and techniques of PSO are based in particular on research findings on aetiological factors, risk factors of health and allostasis as well as on findings on mechanisms of action and interactions with all body systems and organs - most of which have only become known in the last 20 to 30 years.

‍Shouldn't osteopathy fundamentally take psychosomatics into account?

‍As already mentioned, PSO is not psychosomatic medicine and the indications are not limited to so-called psychosomatic illnesses. It's not just about a bit of "psyche" in osteopathy. Rather, PSO takes into account the dynamic interactions between soma, physiology, the patient's experience and their contextual influences. In clinical terms, we therefore speak of "soma-physiology-experience-context dynamics or patterns". PSO is based on extended principles of osteopathy, for example the principle of energy. What all chronic patients have in common is that their energy balance and ATP production are impaired, which should be taken into account in the course of treatment.

The five osteopathic models, which were developed by my teachers Philip Greenman and Fred Mitchel Jr in 1987 and further developed by Hruby in 1991 and myself in recent years, also form the basis of PSO.

The main questions of practical relevance are Which factors actively fuel the allostasis process in the respective patient or prevent the inhibition of pathophysiological processes?

Which body systems are in allostasis and to what extent?

Which changes are still functional, epigenetic, anatomical or already pathological?

And as a therapeutic conclusion: Where are the access points in the respective patient that allow healing processes?

In addition, all afferents - exteroception, proprioception, interoception - play a much greater role than they usually do in osteopathy.

I first published approaches to reorganising the treatment sequence in 2006 in the book "Morphodynamics in Osteopathy", e.g. that evolutionary and ontogenetic early structures are more fundamental and new evolutionary structures are more significant. This has high clinical relevance: If several dysfunctions are present, evolutionarily older structures should be treated first, as the newer ones build on older ones. At the same time, the activation of newer evolutionary networks can relativise older ones and be used as co-regulation.

Top-down and bottom-up diagnostics allow the interaction of "big players" in the pathophysiological effect as well as resources in the healing process to be identified and options for action to be derived from this. In this way, mapping processes, e.g. of joints, bones and organs and resource-rich co-regulation can be improved. The proactivity of the patient is a central component of the new approaches - many times more than in osteopathy to date.

Effective diagnostic and treatment approaches and techniques have been developed, such as 15-step multimodal bifocal integration, which involves many exteroceptors, 6-step emotional regulation reset or integral OMT pain relief approaches. These are also being investigated in studies with regard to their effectiveness. PSO makes it possible to understand and effectively treat chronic complex clinical pictures. All the osteopathic repertoire acquired to date is still essential - only the references to the application have been expanded and refined.

‍As you write, psychosomatic osteopathic treatment requires further specialist knowledge and perceptual tools, takes place in five phases and the therapist also acts as a co-regulator. Is this all achievable in terms of learning and practical implementation?

‍New understanding leads to new options for action and approaches to treatment. This can of course be taught and learnt. One example: In particular, if pathophysiological patterns persist over many years, it is not enough to eliminate the original causes or triggers. Instead, mechanisms of action must be identified, differentiated and actively inhibited. At the beginning of the development of osteopathy, these mechanisms of action were hardly known. Yes, five phases can be distinguished, which also interact with each other: 1. therapeutic relationship 2. diagnostics with particular importance of proprio-interoception and exteroception, resources, co-regulation and feedback loops in the treatment setting 3. stabilisation phase 4. integration-confrontation incl. new techniques, co-regulation and resource-rich flow state 5. implementation in everyday life, as just because something has worked or been solved in practice or reference experiences have been made does not necessarily mean that it will also work in everyday life.

‍In your opinion, should a future osteopathic treatment always be a psychosomatic osteopathic treatment?

‍PSO could be the osteopathy of the future. The limited view of the term "somatic dysfunction", which underlies osteopathic action and reflection to date, and the frequently chosen analogy of "precision mechanic and machine" by AT Stills and the description of action "find it, fix it, leave it alone" must be relativised. I also consider the dichotomy of health and illness to be outdated, or at least it should be relativised. The consideration of "mechanisms of action" for health as well as for allostatic processes plays a major role in the osteopathic approach.

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