Posts by: Patrick van Dun

“It’s all about the story”. Osteopaths’ experiences of exploring menopausal symptoms: A qualitative interview study

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The prevalence of natural menopause means that middle aged women seeking osteopathic treatment are likely to have symptoms, but it is unknown how osteopaths explore and give advice about it. The aim of this study was to explore osteopaths’ experiences of screening for symptoms of menopause and providing advice to climacteric patients … ABSTRACT

Enabling health potential: exploring nonlinear and complex results of osteopathic manual medicine through complex systems theory

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Osteopathic medicine is a holistic, patient-specific approach. Explaining the impact of osteopathic manipulative medicine (OMM) has been problematic because many of its effects are nonlinear. Complex systems theory (CST) is explored as a mechanism of understanding the interplay of the body’s anatomy and physiology, an illness process, and the effects of OMM. Tensegrity is discussed as an example of an emergent property of the body’s systems that affects not only biomechanics but also pathophysiology. Previous explanations of osteopathic philosophy are reviewed. The Host + Disease=Illness paradigm is a way to think through the impact of host and disease factors on an illness state, and how targeted interventions may affect the illness. The Osteopathic 5 Models are another way to view the body’s complexity. The area of greatest restriction (AGR) screen can be understood to direct OMM in a way that respects complexity and enables asymmetric and nonlocal results to realize health potential. The impact of this framework is in coherently explaining the impact of osteopathic philosophy and OMM and exploring new approaches to research … MORE

Revisiting chronic low back pain: evidence that it is not non-specific

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There is a common symptom pattern with most chronic low back pain (CLBP), suggesting that there is a common underlying etiology, belying the term “nonspecific.” Many studies of CLBP and its treatment have been conducted with the assumption of nonspecificity, and as a result, treatment has not been focused, thus there has not been a significant change in CLBP prevalence over the past several decades. It is the thesis of this study to show that there is an underlying, specific cause of CLBP and that the presumption that CLBP is nonspecific is misdirected. The lumbosacropelvic (LSP) region, including the sacroiliac joint (SIJ), is part of a neuromusculoskeletal (NMSK) feedback system, and it is proposed here that CLBP is the result of a change in the feedback (afferent) aspect in that system. The objectives of this study are to show that CLBP presents as a pattern of symptoms that actually represents the final common pathway for a dysfunctional LSP joint system. Rather than being “nonspecific,” the majority of CLBP has an underlying cause that is quite specific and predictable … MORE

Historical Osteopathic Principles and Practices in Contemporary Care: An Anthropological Perspective to Foster Evidence-Informed and Culturally Sensitive Patient-Centered Care: A Commentary

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Historical osteopathic principles and practices (OPP)—considering the patient as a dynamic interaction of the body, mind, and spirit and incorporating the body’s self-healing ability into care—are inherited from traditional/complementary and alternative (CAM) principles. Both concepts are familiar to contemporary osteopathic practitioners, but their incorporation into healthcare for evidence-informed, patient-centered care (PCC) remains unclear. Further, a polarity exists in the osteopathic profession between a ‘traditional-minded’ group following historical OPP despite evidence against those models and an ‘evidence-minded’ group following the current available evidence for common patient complaints. By shifting professional practices towards evidence-based practices for manual therapy in line with the Western dominant biomedical paradigm, the latter group is challenging the osteopathic professional identity. To alleviate this polarity, we would like to refocus on patient values and expectations, highlighting cultural diversity from an anthropological perspective. Increasing an awareness of diverse sociocultural health assumptions may foster culturally sensitive PCC, especially when including non-Western sociocultural belief systems of health into that person-centered care. Therefore, the current medical anthropological perspective on the legacy of traditional/CAM principles in historical OPP is offered to advance the osteopathic profession by promoting ethical, culturally sensitive, and evidence-informed PCC in a Western secular environment. Such inclusive approaches are likely to meet patients’ values and expectations, whether informed by Western or non-Western sociocultural beliefs, and improve their satisfaction and clinical outcomes … MORE

Gravity and the Gut: A Hypothesis of Irritable Bowel Syndrome

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The pathogenesis of irritable bowel syndrome (IBS)—a disorder of gut-brain interaction that affects up to 10% of the world’s population—remains uncertain. It is puzzling that a disorder so prevalent and archetypal among humans can be explained by disparate theories, respond to treatments with vastly different mechanisms of action, and present with a dazzling array of comorbidities. It is reasonable to question whether there is a unifying factor that binds these divergent theories and observations, and if so, what that factor might be. This article offers a testable hypothesis that seeks to accommodate the manifold theories, clinical symptoms, somatic comorbidities, neuropsychological features, and treatment outcomes of IBS by describing the syndrome in relation to a principal force of human evolution: gravity. In short, the hypothesis proposed here is that IBS may result from ineffective anatomical, physiological, and neuropsychological gravity management systems designed to optimize gastrointestinal form and function, protect somatic and visceral integrity, and maximize survival in a gravity-bound world. To explain this unconventional hypothesis of IBS pathogenesis, referred to herein as the gravity hypothesis, this article reviews the influence of gravity on human evolution; discusses how Homo sapiens imperfectly evolved to manage this universal force of attraction; and explores the mechanical, microbial, and neuropsychological consequences of gravity intolerance with a focus on explaining IBS. This article concludes by considering the diagnostic and therapeutic implications of this new hypothesis and proposes experiments to support or reject this line of inquiry. It is hoped that the ideas in this thought experiment may also help encourage new or different ways of thinking about this common disorder … MORE

Early Osteopathic Thought on Serious Mental Illness and How Osteopathic Medicine Fits Into Psychiatry Today

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Osteopathic medical students spend considerable time learning the history, philosophy, and theories of osteopathic manipulative medicine (OMM) and skills of osteopathic manipulative treatment (OMT), all of which are tested on licensing exams. Data from the National Resident Matching Program show that 17.4% of fourth-year osteopathic medical students matched into psychiatry postgraduate year-1 positions in 2021, compared with 6.5% in 2019. However, very few osteopathic psychiatrists utilize OMT.

Since its inception, osteopathic medicine has theorized about and proposed treatments for serious mental illness, such as mood disorders and schizophrenia. However, there has been minimal mention in osteopathic textbooks of the treatment of these conditions with OMT (1), limited studies investigating use of OMT for serious mental illness, and no official OMT clinical guidelines for psychiatric conditions. Furthermore, application of OMT requires physical touch—a controversial and ethically charged topic within psychiatry. The goal of this article is to contextualize early osteopathic thought about the treatment of serious mental illness, propose reasons for the decline in OMT utilization in psychiatry, and briefly discuss current literature on using OMT in psychiatry … MORE

Avoiding nocebo and other undesirable effects in chiropractic, osteopathy and physiotherapy: An invitation to reflect

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While the placebo effect is increasingly recognised as a contributor to treatment effects in clinical practice, the nocebo and other undesirable effects are less well explored and likely underestimated. In the chiropractic, osteopathy and physiotherapy professions, some aspects of historical models of care may arguably increase the risk of nocebo effects. In this masterclass article, clinicians, researchers, and educators are invited to reflect on such possibilities, in an attempt to stimulate research and raise awareness for the mitigation of such undesirable effects … ABSTRACT

Inter-rater reliability between osteopaths of differing clinical experience on sagittal plane running gait analysis: A pilot study

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Clinical running analysis is commonly employed in the screening of running related injuries. Currently, there remains little research exploring the use of clinical running analysis within the osteopathic profession. Hence, the aim of this pilot study is to investigate the inter-rater reliability of sagittal plane visual gait observation amongst osteopathic practitioners … ABSTRACT

Opportunities to Incorporate Osteopathic Manipulative Treatment Within Cancer Rehabilitation and the Current State of the Evidence

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Cancer rehabilitation involves addressing the impact of cancer and its treatments upon the function of an individual. The goal of this paper is to determine how osteopathic manipulative treatment (OMT) can be utilized in treating common conditions seen in cancer rehabilitation, such as post-mastectomy pain syndrome and radiation fibrosis, to improve pain and function … ABSTRACT

Pain and functional recovery from chronic low back pain over 12 months: implications for osteopathic medicine

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Although low back pain is a common medical condition that often progresses to become a chronic problem, little is known about the likelihood of recovery from chronic low back pain (CLBP). This study aimed to measure the risk of recovery from CLBP based on low back pain intensity and back-related functioning measures reported by participants within a pain research registry over 12 months of observation and to consider the implications for osteopathic medicine … MORE

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