Somatic dysfunction: An osteopathic conundrum

Abstract

Somatic dysfunction is considered a central concept for the theory and practice of osteopathy, but its relevance to the modern profession is questionable due to its unclear pathophysiology and poor reliability of detection. This article will explore the factors that may produce clinical signs attributed to somatic dysfunction and discuss the plausibility of the concept. A conceptual model is presented for the clinical diagnostic cues attributed to intervertebral somatic dysfunction, where signs of dysfunction arise from tissue and neurological factors related by a cycle of tissue injury and nociceptive-driven functional changes. Finally, the relevance of the concept of somatic dysfunction to the modern osteopathic profession is discussed and recommendations for the osteopathic profession are made.

Integrating osteopathic approaches based on biopsychosocial therapeutic mechanisms. Part 2: Clinical approach

“…The medical jargon used by clinicians can have a powerful influence on a person's interpretation of their symptoms. Historically, osteopathic manipulative treatment was developed within a biomechanical conceptual framework and has given rise to a disparate range of labels for alleged biomechanical dysfunctions [86,98]. The use of medical and osteopathic jargon can scare and disempower people because benign dysfunctions (typically minor movement impairments) may be interpreted as serious impairments with long-term consequences that require ongoing passive manual treatment for correction.…”

Inhibitory Tests as Assessment Tools for Somatic Dysfunctions: Mechanisms and Practical Applications

“…In the 21st century, Howell and Willard [13] extended the proposal of the nociceptive model, adding the description of the antidromic action potentials (dorsal root reflex) that occur in the afferent neuron, sustaining inflammatory reactions in peripheral tissue receptors. Fryer proposed the revision of the facilitated segment concept proposed by Korr, due to the scientific expansion in recent decades on the characterization of a phenomenon apparently related to SDs, the central sensitization [1,2]. For the author, some aspects related to central sensitization (hyperalgesia and allodynia) could explain one of the parameters found in the SD: the increase in tissue sensitivity/tenderness [1].…”

“…The somatic dysfunction (SD) plays a central role in osteopathy and in several other methods in manual therapies. It is a functional disorder considered an obstacle to the inherent selfregulatory capabilities of the human body, characterized by clinical parameters that involve increased tissue "tension/density", positional "asymmetries", "restricted" mobility, and "tenderness" (TART) [1]. Several models about the genesis and maintenance of the SDs have been postulated throughout history, conditioning it to neurological reflexes, nociceptive disorders, and recently the neuro-fasciagenic model proposed the role of the modifications in fascial tissue physiology related to the SDs [2][3][4].…”

“…It supports a neurological loop that generates efferent reflexes to the dysfunctional tissue itself, affecting its neural, biomechanical, fluid, and physiological characteristics. Some authors suggest the close relationship of the SD with the central sensitization phenomenon, in such a way that this state of alertness could keep the receptors of the different tissues that converge their afferent information to the same spinal cord segment involved, with modifications in its activity threshold [1,5].…”

The Intraosseous Dysfunction in the Osteopathic Perspective: Mechanisms Implicating the Bone Tissue

“…Palpatory sensitivity (allodynia or hyperalgesia) of a dysfunctional tissue is well established as one of the parameters that evidence a SD [5], and it is a fundamental condition that may reveal a local process or neurological reflex, possibly related to the phenomenon of central sensitization [42].…”