Osteopaths examine and treat patients with pain.

We look for the complaint causing structure and we can determine the pain generator (damage, near-damage, inflammation, infection, ischemia).

We do this by using a thorough case history, observation, palpation, provocation tests and mobility and differentiation tests.

From there we can, for example:

• Distribute the compression (gravity) evenly over the joints by mobilizing non-physiological axes (stretching).

• Stretch retractive capsules, fascia and muscles to restore joint mobility around the correct (most economical) axes and thus prevent overstretching of soft tissues or abnormal compressions in joints.

• Mobilize tissues in trigger point areas that generate and amplify pain.

• Improve local arterial circulation by treating the sympathetic segments.

• Improve venous and lymphatic drainage of body regions.

• Optimize the O2/CO2 balance in the blood by strengthening the heart function and by increasing the exchange surface of the lungs in case of generalized ischemia.

• Treat the mechanical stressors in joints and other musculoskeletal, visceral and neurological structures by manipulation, mobilization, drainage, muscular techniques and fascial stretching techniques.

• Eliminate the stretching and expansion of visceral fascia and organs through drainage and mobilization techniques.

• Improve posture (posturology) to prevent overloading of different body structures.

• Advise that overweight and nutrition can play a role in certain disorders.

• Advise on the excessive use of joints, ligaments and muscles. The same goes for activating patients to get them out of a sedentary lifestyle.

• Balance the neurovegetative system with specific techniques that work on the sympathetic and parasympathetic systems.

• Refer patients when we suspect real damage, infection or other diseases.

• Collaborate with other health professionals such as doctors who have more attention and knowledge about diagnosing and treating diseases and can provide the right medication. We are convinced that osteopaths play an important role in the overall treatment of the patient. This role can be more or less important, depending on the patient's problem.

Let us also not forget to have a specific influence on the pain mechanisms.

Acute complaints can best be treated locally and quickly, so that chronic processes such as sensitization cannot take place.

Chronic patients, patients with peripheral or central sensitization, patients with damaged neurons in the periphery, in the segments and/or in the brain will not be helped with only a local approach.

In many of these chronic cases, just palpation (touch), paying attention to the patient and working on the awareness of what sensitization is can change the pain experience.

Removing the attention from the pain area is important for patients to work on their pain and symptoms themselves.

Raising expectations can be delicate but it can still be important because it stimulates the positive placebo effect.

Keep in mind that good or bad mood are also elements that influence the perception of pain. Striving for pleasure, not punishment.

All this means that osteopaths should take into account the context of the pain.

This individual context consists of several factors that may be present to a greater or lesser extent:

• Health comorbidities such as obesity or mental health problems.

• Physical factors such as physical capacity, muscle tone and strength.

• Social factors such as support from family or friends, work stress, relationship stress.

• Psychological factors such as detachment or avoidance behaviour, beliefs.

• Lifestyle factors such as lack of sleep or exercise.

All of the above does not mean that osteopaths should participate in the popular fashion trend of coaching. It does mean, however, that we should pay attention, in addition to our physical approach, to the context of pain.

‘Change of context = change of pain'

I think the above is called a holistic approach.

Luc Peeters, MSc.Ost.