Objective To compare competency standards and regulatory expectations for osteopathic practice across jurisdictions where the profession is formally regulated or recognised as a healthcare profession. Methods A documentary analysis was undertaken across regulated and formally recognised jurisdictions. National competency frameworks, regulatory standards and professional guidance documents were identified through regulatory and professional body websites and direct contact with relevant organisations. Nineteen national competency, regulatory or professional framework documents from 17 jurisdictions were included. The World Health Organization Benchmarks for Training in Osteopathy and EN16686 Osteopathic Healthcare Provision were included as international comparison points. Data were extracted using a structured template informed by international health profession competency frameworks. Template analysis identified shared competency domains and areas of regulatory, educational and practice variation. Results Core competencies expected of practising osteopaths showed strong international convergence. Common domains included patient-centred assessment, clinical reasoning and decision-making, safe and effective treatment, ethical and professional conduct, communication, evidence-informed practice, referral and collaboration. Variation was greatest in education pathways, qualification levels, continuing professional development requirements, scope-of-practice restrictions, health-system integration, and the operationalisation of digital health, quality improvement and outcome measurement. Conclusion Competency and regulatory standards for osteopathic practice show strong international alignment despite variation in regulatory structures, education, scope of practice and health-system integration. These findings support updating international benchmark guidance, including the World Health Organization Benchmarks for Training in Osteopathy, to reflect contemporary healthcare expectations while allowing national adaptation. Updated guidance may support comparability, public protection and regulatory alignment without imposing uniformity.
Background The effective management of people living with chronic pain within the osteopathic framework presents a multifaceted challenge for clinicians, including addressing psychosocial factors, incorporating evidence, and transitioning from a biomedical towards a biopsychosocial treatment approach. This study seeks to explore contemporary attitudes and beliefs regarding chronic pain management among osteopathic practitioners in Germany. Methods This qualitative study employed semi-structured interviews to explore the attitudes and beliefs of early-career German osteopaths regarding the management of people living with chronic pain. Eight practitioners (1–3 years' experience) were purposively recruited via osteopathic schools, associations, and graduate networks. Data collection continued until no new categories emerged from the iterative analysis, consistent with inductive thematic saturation (n=8). Data were analysed by one researcher using qualitative content analysis as per Mayring (2015), combining deductive and inductive category formation. Participants were not asked to validate the analysis. Results Seven themes were identified, reflecting participants' beliefs and attitudes toward chronic pain, the biopsychosocial model, chronic pain therapy, patient evaluation, strategies for improvement, challenges of clinical management, and responses to treatment failure. Conclusion Early-career German osteopaths demonstrated conceptual awareness of psychosocial factors and the biopsychosocial model, yet the translation of this knowledge into consistent clinical practice varied markedly among participants. Further research is needed to explore whether these findings reflect broader patterns within the German osteopathic community and to identify factors that facilitate or hinder biopsychosocial integration in clinical practice.
This letter provides a critical methodological appraisal of the exploratory pragmatic randomized trial by Curi et al. (2026) regarding osteopathic care and physical therapy for Long COVID fatigue. While the study's focus on non-musculoskeletal rehabilitation is highly relevant, this correspondence identifies four points that potentially compromise the validity of its outcome claims. First, a significant baseline mismatch in fatigue severity and body mass index between groups was not adjusted for in the statistical models, introducing a substantial risk of bias and regression to the mean. Second, fatal mathematical inconsistencies exist in the reporting of participant attrition and sample sizes between the study flowchart and final analysis tables, violating transparent reporting standards. Third, a mathematical logic error in the protocol description obscures the true dosage of therapy received by the control group. Finally, the authors present a conceptual contradiction by justifying the pragmatic trial design on the premise of routine care, while simultaneously attributing severe recruitment failures to the intervention's innovative nature. These critiques are presented to foster rigorous scientific dialectics and strengthen the methodological integrity of Long COVID rehabilitation research.
Autonomic nervous system dysfunction is frequently cited in the medical literature as an underlying factor in conditions such as irritable bowel syndrome, Crohn's disease, ulcerative colitis, functional abdominal pain, chronic pelvic pain of gastrointestinal origin, and median arcuate ligament syndrome. A Medline search revealed no other case reports documenting the use of osteopathic manipulative treatment to treat and resolve symptoms of median arcuate ligament syndrome. The patient in this report presented with severe abdominal pain, nausea, marked weight loss, and food aversion. Walking was painful, requiring the use of a cane and specially cushioned shoes, and he experienced severe pelvic pain due to difficulty emptying his bowels. His prior evaluations included magnetic resonance imaging, angiography, regular and specialized ultrasounds, esophagogastroduodenoscopy, anorectal manometry, and a celiac nerve block. Previous interventions included medications, physical therapy, and an inpatient hospital stay for functional abdominal pain. A surgeon specializing in median arcuate ligament syndrome confirmed the diagnosis. After several months of treatment with osteopathic manipulation, the patient's symptoms are resolved. The treatment protocol and its rationale are discussed.
Objective: To investigate the adding effects of thoracic manipulation (TM) versus myofascial release using instrument-assisted soft tissue mobilization (IASTM) to scapular stabilization exercises (SSEs), on pain, range of motion (ROM), proprioception, pain pressure threshold (PPT), and disability in patients with shoulder impingement syndrome (SIS). Methods: This single-blinded, parallel-group randomized controlled trial was conducted between November 2021 and May 2023 in outpatient physical therapy clinics. Sixty adults (25-40 years) with clinically diagnosed SIS were randomly allocated (1:1:1) using a computer-generated sequence with concealed allocation to SSEs alone, TM plus SSEs, or IASTM plus SSEs. Interventions were applied three times weekly for four weeks, with a four-week follow-up. The primary outcome measure was shoulder proprioception assessed by joint position error (JPE), while the secondary outcomes included pain intensity, PPT, shoulder ROM, and upper-limb disability. Data were analyzed using two-way mixed-model multivariate analysis of variance with Bonferroni-adjusted post hoc tests. Results: After four weeks, the IASTM group showed significantly greater improvements than the other groups (p < 0.001) in JPE (mean difference 2.14 degrees, 95% CI 1.13-3.14), pain intensity (17.5 mm, 95% CI 10.82-24.18), PPT (0.84 kg/cm(2), 95% CI 0.42-1.26), ROM (abduction:18.6 degrees, 95% CI 10.21-26.99), and upper-limb disability (9.45 points, 95% CI 4.98-13.92). Conclusion: Instrument-assisted soft tissue mobilization combined with scapular stabilization exercises was associated with greater improvements in pain, range of motion, proprioception, and disability compared with thoracic manipulation or exercise alone. Therefore, it may be considered an effective adjunct therapy for patients with shoulder impingement syndrome.
Therapeutic touch occupies a central place in osteopathic practice, yet its epistemological foundations remain insufficiently clarified. It is typically framed either as a technical intervention explicable through biomechanical or neurophysiological mechanisms, or as a vector of non-specific relational and contextual effects. While these perspectives provide valuable insights, neither fully accounts for the complexity of touch in osteopathic care. This article proposes a pluralistic epistemological framework that integrates scientific, experiential and operational dimensions of osteopathic touch. Evidence-based approaches to manual therapy have contributed to the scientific understanding of osteopathic interventions by identifying measurable mechanisms and therapeutic effects. However, there is a tendency to objectify, detaching it from the lived, perceptual and relational dynamics through which it actually unfolds in practice. Drawing on embodied and phenomenological approaches to care, this article argues that osteopathic touch emerges at the intersection of neurophysiological processes, lived experience, perceptual attunement, and situated clinical action. Rather than proposing a unified theory of touch, the framework clarifies how multiple epistemological perspectives may coexist within osteopathic practice without being reduced to a single explanatory model. This framework has concrete implications for osteopathic clinical reasoning, education, and reflexive practice: it provides practitioners and educators with a clearer conceptual foundation for navigating the biological, experiential, relational, and ecological dimensions of therapeutic touch. Implications for practice -Moving beyond the usual reductions of osteopathic touch: neither a simple technique, nor a simple « contextual effect », nor an ineffable experience.-This framework integrates different types of knowledge: scientific, pragmatic, and operational knowledge without reducing them to a single explanatory model. This may help reduce ontological, epistemological and pedagogical ambiguities, supporting clearer clinical reasoning, teaching and research practices.-It supports a stable professional identity grounded not in doctrinal adherence, but in the practitioner's capacity to adapt their actions to a situated bodily experience and a reflexive therapeutic relationship.-Osteopathic touch is not limited to correcting local dysfunctions or biomechanical problems. It also involves a relational and perceptual process through which patients can discover new ways of experiencing their bodies and regulating themselves.-The focus should shift towards the cultivating attentional and adaptive clinical skills, rather than merely reproducing manual techniques. Touch should be taught as a perceptual and interactive clinical skill, emphasising how practitioners perceive bodily responses, adapt their touch accordingly, and respond to patient feedback in real time.
Artificial intelligence (AI) tools, particularly large language models and generative AI platforms, are rapidly reshaping the preclinical medical education environment. Medical students increasingly use these tools for content review, board preparation, and clinical reasoning exercises, while faculty are beginning to explore AI-assisted case generation, adaptive feedback, and automated assessment. This letter to the editor examines the emerging evidence on AI in medical education through the lens of osteopathic medical training, where clinical reasoning depends not only on algorithmic knowledge but on the integration of structural examination, palpatory findings, and patient-centered care. The available evidence suggests that AI-generated educational content can achieve quality comparable to expert-authored materials and that AI-assisted pedagogies may produce equivalent or superior learning outcomes in controlled settings. However, significant risks accompany these opportunities, including cognitive offloading that may undermine the development of independent clinical reasoning, algorithmic bias in clinical content, and the potential erosion of collaborative learning. For osteopathic medical education specifically, the concern is that unguided AI use may consume cognitive bandwidth and study time that would otherwise develop irreplaceable competencies in structure-function integration and palpatory diagnosis. This letter argues that osteopathic medical institutions should pursue intentional, faculty-led AI integration through explicit use policies, targeted faculty development, assessment strategies that emphasize reasoning processes, AI literacy as an emerging clinical competency, and research examining how AI use interacts with the development of osteopathic-specific clinical skills.
Background While Osteopathic Manipulative Treatment (OMT) is proposed to modulate immune function, the scientific evidence remains fragmented. Objective To systematically synthesize literature on OMT's impact on immunological biomarkers and physiological mechanisms. Methods A search across PubMed, Cochrane, and ScienceDirect (to November 2024) identified original research quantifying OMT's effects on immune or lymphatic markers. Risk of bias was assessed for all included studies. Results Thirteen studies were included. Overall certainty of evidence was low, with high bias risk in most human trials. Animal models (low bias) demonstrated that lymphatic pumping transiently increased lymph flow, leukocyte mobilization, and cytokines (IL-6, IL-8). In humans, effects on cytokines, immunoglobulins, and lymphocytes (CD4/CD8) were highly inconsistent, transient, and technique-dependent. Conclusion Evidence regarding OMT’s impact on the immune system is strictly mechanistic and exploratory. Given the high risk of bias and intervention heterogeneity, there is currently no evidence to support clinical recommendations for using OMT to treat immune-mediated or inflammatory conditions. Rigorous longitudinal studies are required.
Musculoskeletal disorders (MSDs) are the primary cause of disability in many parts of the world, and physiotherapy is commonly included within evidence-informed management strategies for those conditions. However, in India, concerns have emerged regarding the use of professional titles such as "chiropractor" and “osteopath” in the absence of clear statutory regulation, standardized educational pathways, competency-based training frameworks, and formal licensing mechanisms. Some practitioners perform high-velocity manipulative procedures following short-term or non-standardized training pathways, which may increase concerns regarding the recognition of contraindications, clinical decision-making, and safe practice. This commentary addresses regulatory and patient safety considerations related to unregulated manipulative therapy practices in the Indian physiotherapy context. The main recommendations include the development of legislative frameworks, the establishment of regulatory councils, the implementation of accredited educational pathways, the protection of professional titles, and competency-based licensing systems. Regulatory control needs to be reinforced to guarantee patient safety, accountability by professionals, and aid the sound inclusion of manual therapy in the emerging Indian allied healthcare system.
This professional commentary analyzes the professionalization and identity construction of osteopathy in France against a backdrop of partial legal recognition and fragmented regulation. Drawing on a cross-disciplinary theoretical framework (Freidson; Abbott; Dubar; Wittorski; Larose), this commentary provides a multidimensional interpretation of the tensions between individual autonomy and collective structuring. In comparison with the British, American, Australian, New Zealand, Swiss, Belgian, and Italian trajectories, French osteopathy emerges as a hybrid model. It is characterized by training that remains largely outside the university-based health education system, a plurality of clinical and manual approaches, and limited institutional integration. This commentary proposes a five-dimensional analytical framework and highlights how clearer professional structuring may support clinical practice, patient safety, and professional recognition, including a clearer scope of practice and stronger therapeutic and pedagogical relationships.
Introduction The use of veterinary paraprofessionals, including osteopaths, to maintain the musculoskeletal wellbeing of animals has increased. Although the field of osteopathy is expanding rapidly, very little is known about the animal osteopathic profession and scope of practice within the United Kingdom (UK). Methods A questionnaire was developed to capture data relating to General Osteopathic Council registered animal osteopaths’ qualifications, practice types, animal species and conditions treated, treatment techniques utilised, adjunctive therapies used and advice given. This questionnaire underwent pilot testing prior to distribution through mailing lists and professional social media groups. Results Thirty-four osteopaths completed the survey between November 2024 and January 2025, with an estimated response rate of 17%. In this study, most UK osteopaths held a post-registration qualification in Animal Osteopathy. Animal osteopaths reported working with a number of different veterinary paraprofessionals and treated a range of different animal species, with cases pertaining to common musculoskeletal conditions. Treatment techniques included mobilisation, soft tissue techniques, High-Velocity Thrusts and fascial release with some differences between animal species. The use of adjunctive therapies was low in all animal species (9.1%-29%). Conclusion This survey described the training, qualifications and practice of UK animal osteopaths for the first time. Osteopaths report treating a broad range of animal species and musculoskeletal conditions using a variety of treatment techniques. Treatment appeared to be centred around the use of manual techniques, with the use of adjunctive therapies being low. Due to the necessarily small sample size these findings should be interpreted with caution.
Background: Understanding pain through a biopsychosocial framework is essential for effective, patient-centered care. Among osteopaths, misconceptions about pain mechanisms may hinder appropriate clinical reasoning, patient communication, and treatment options. Aim: This study assessed the knowledge and attitudes of osteopaths practicing in Switzerland regarding pain, and explored factors associated with contemporary pain-related beliefs. Methods: A cross-sectional online survey was distributed to practicing Swiss osteopaths. Pain knowledge and attitudes were assessed using the Knowledge and Attitudes of Pain (KNAP) questionnaire, which comprises two domains: Pain physiology and influencing factors and Treatment and management. Sociodemographic and educational variables were collected, and associations with KNAP scores were examined using bivariate and multivariable regression analyses. Results: A total of 262 osteopaths participated. The mean total KNAP score was 109.5 +/- 16.0, indicating generally good knowledge and moderately positive attitudes toward pain. Scores were highest in the Pain physiology and influencing factors domain (mean = 89.0 +/- 11.3). Completion of pain-related continuing education and academic-level training were independently associated with higher knowledge and more adaptive attitudes (p < .01). Conclusions: Swiss osteopaths demonstrate a sound understanding of pain science, yet variability persists. Pain-related education appears to be the key determinant of both knowledge and attitudes, supporting the notion that cognitive understanding fosters attitudinal and behavioural change. Integrating structured, evidence-based pain education throughout osteopathic training may strengthen biopsychosocial practice and improve patient communication.
Chest pain remains one of the most common reasons for presentation to emergency and primary care departments. While life-threatening cardiopulmonary causes must be excluded as a priority, a substantial proportion of patients are ultimately classified as having non-cardiac or non-pulmonary chest pain, with musculoskeletal chest wall disorders representing a large subgroup of patients.This commentary examines the clinical positioning of musculoskeletal chest wall pain in contemporary healthcare systems. Epidemiological data indicate that patients discharged with non-cardiopulmonary chest pain often experience persistent symptoms, functional limitations, and psychological distress. However, coordinated follow-up pathways are often lacking. Simultaneously, thoracic spine and chest wall dysfunction influence breathing mechanics, load transfer, and pain perception, a bidirectional interaction with respiratory disease that is rarely integrated into post-rule-out care.We argue that a clearer integration of structured musculoskeletal assessment within post-rule-out care, alongside closer collaboration with respiratory and multidisciplinary services, may improve clinical coherence and patient outcomes in the future. However, the current evidence base remains limited, particularly regarding pragmatic trials, prognostic indicators, and the implementation of diagnostic and interventional models for the management of primary chest wall pain. To advance research in this field and support evidence-informed practice, it is necessary to ensure conceptual clarity, interdisciplinary dialogue, and methodologically robust research.
Musculoskeletal pain is a leading cause of disability, with psychosocial factors influencing its onset and persistence. Biopsychosocial approaches are recommended for pain management, but their integration into osteopathic practice is limited. This study explores the perceptions of osteopaths trained in a psychologically informed osteopathic practice for pain management at the Italian Academy of Osteopathic Medicine. Using surveys and focus groups, it assesses the usefulness and clinical applicability of the training. Results show that while the course increased understanding of pain's multidimensional nature, barriers included insufficient tools for assessing psychosocial factors, limited mentorship, and continued reliance on biomedical approaches. Participants reported adopting a more person-centered approach, improving therapeutic alliances but the results show that more active learning and mentoring is needed to link theory and practice, as well as changes in professional identity and clinical culture.
Background: This study explored whether osteopathic care (OC) combined with physical therapy (PT) could be more effective than PT alone in reducing fatigue and functional limitations in adults with long COVID. Methods: Two-arm, assessor-blinded, pragmatic randomized controlled trial. The PT group received standard care including motor and respiratory exercises for cardiorespiratory and skeletal muscle functions. The OC + PT group received PT plus OC. The PT group attending up to 2 sessions per week and the OC + PT group receiving up to 7 OC sessions. Primary outcomes were fatigue and functional limitations, measured at 2 months using the Fatigue Severity Scale (FSS) and the Post-COVID Functional State (PCFS) scale. Secondary outcomes included fatigue and functional limitations at 3 months and perceived change post-treatment using the Perceived Change Scale (PCS-patient). Results: Of the planned 104 participants, 73 were screened for eligibility and 28 (26.9%) were randomized into OC + PT (n = 14) or PT alone (n = 14). The OC + PT group showed lower FSS scores at 2 months (MD [95%CI]) (-10.41 [-14.47;-6.35]) and 3 months (-12.25 [-16.52;-7.98]). The PCFS score was lower for the OC + PT group at 2 months (-0.70 [-1.11;-0.29]) but not at 3 months (-0.26 [-0.69; 0.16]). Perceived improvement was similar between groups at both 2 months (5.28 [-0.84; 11.40]) and 3 months (3.10 [-3.10; 9.30]). Conclusions: This exploratory trial suggests potential benefits of combining OC with PT over PT alone in reducing fatigue and improving functional status in long COVID patients over 2 months. Larger, fully-powered studies are needed to confirm these preliminary results. Implications for practice: center dot OC may have potential benefits for individuals experiencing fatigue due to long COVID and could be worthy of further investigation. center dot The addition of OC to routine physical therapy care might offer added value to patients with fatigue, but further studies are needed to confirm this. center dot Challenges in recruitment raised questions about the acceptability of proposing innovative rehabilitation interventions for non-musculoskeletal conditions in public health research settings
