Nociception, pain, neuroplasticity and the practice of Osteopathic Manipulative Medicine

There is a growing body of evidence that chronic musculoskeletal injuries are associated with neurophysiological changes in distributed areas of the central nervous system. Traditionally a biomedical model based upon the belief that structural injury to anatomical structures was the sole driver of the condition has guided interventions. In osteopathy, the concept of somatic dysfunction has been the predominant model guiding clinical practice where areas of dysfunction are believed to result from mechanical restrictions that impact normal physiological function. However, despite these models, chronic musculoskeletal disorders such as chronic low back pain remain a challenge for osteopaths and other health care providers. The present article reviews the neurophysiological changes associated with chronic musculoskeletal disorders specifically in the sensorimotor and cognitive-affective-motivational areas of the brain. These neurophysiological changes appear to be part of the pathophysiological process, and are consistent with many of the clinical findings associated with chronic musculoskeletal disorders. Recommendations, inspired by evidence of neurophysiological effects of manual therapy, pain science, and principles driving neuroplastic changes deriving from human and animal studies, are made for osteopathic treatment of chronic musculoskeletal disorders to address these neurophysiological changes. Patient-osteopath interactions may help reconceptualise beliefs and cognitions, may alter behavioural responses, and engage forebrain structures tapping into self-regulatory and homeostatic processes. Neurophysiological effects of Osteopathic Manipulative Treatment may also help renormalize properties and organisation in cortical sensorimotor areas and impact the autonomic nervous system.