It is estimated by Statistics Canada that 8% of the population in Canada today suffer from some form of Post-Traumatic Stress Disorder (PTSD) and they believe this number could now be as high as 21% post-pandemic. In a recent poll, the Provincial Health Services Authority states that 25% of the Canadian population reported feeling mild to extreme stress daily, while Statistics Canada reports that 7.8% of the population meet the diagnostic criteria for a range of anxiety disorders. This amounts to a total of 18.19 million Canadians – 8.19 million PTSD, 9.75 million extreme stress daily, and 5+ million having some kind of anxiety disorder, respectively. Also, according to Statistics Canada, in 2022 the number of Canadians over the age of 15 who experienced a Major Depressive Episode (MDE) was 7.6% – that is an additional 3.1 million people suffering from mental health issues. These are only the cases officially recorded plus an estimate at the lower end of the probability scale. The total estimate of Canadians with some form of mental health issue such as PTSD, stress, depression and anxiety, if unrecorded cases were also considered, is expected to be much higher, and could even total as much as two-thirds of the population. This is an enormous number of people. Recent research shows that PTSD, depression, stress and anxiety, if left untreated, cause many negative physiological health conditions as well as mental health issues – these can include musculoskeletal pain, breathing problems, visceral issues, stress headaches and migraines, digestive difficulties, and many more symptoms and pathologies. There is an overwhelming amount of data from scientific research that proves a connection between mental health and physical health, while allopathic health care costs have spiralled upwards and for many Canadians this cost is now sadly out of reach financially. In Canada, likely as a response to these trends, there has been a growth in patients seeking Osteopathic Manual Therapy (OMT) for relief from physiological and mental health issues, as many patients claim that Osteopathy alleviates many of these very successfully. In this article I outline the current evidence for the impact of OMT on patients with physical and mental health symptoms of PTSD, stress, depression and anxiety, to establish whether there are positive, negative or neutral effects. I also consider current thinking, previous studies and future opportunities for research and the wider use of OMT for people with depression, stress, anxiety and PTSD.
There is a growing body of scientific research today proving the inextricable connection between the structure and functions of the body with the thoughts and processes of the brain. PTSD, stress, depression and anxiety have all been linked to physiological illnesses and as having a negative impact on the body’s structures and systems – and vice-versa – if left untreated. Professor Michael Häfner, Berlin University of the Arts, states that “the body and mind are inseparable…and that all psychological processes are influenced by the body’s morphology, mental representation, and sensorimotor states and experiences (Hafner 2013.)” Known in some fields as “embodied cognition” this has great bearing when Osteopaths treat patients with PTSD, stress, depression and anxiety disorders. The concept of embodied cognition – the body and mind being inseparable – has resonance with the Osteopathic principle of “structure affects function” especially when physical therapies, OMT and Craniosacral Therapy is applied. There is growing evidence that PTSD, chronic anxiety and stress increase the allostatic load on the body, causing significant physical illnesses. A prolonged, or chronic, sympathetic nervous system response to trauma, stress, depression and anxiety has been shown to lead to abnormal muscular and fascia tensions, joint imbalance and even joint misalignment. When tensions contort the musculoskeletal structure, this can in turn constrict blood flow to the viscera, pinch nerves and restrict other structures in the body. This will lead to further health problems if not corrected for a chronic period. PTSD, stress, depression and anxiety induce the hypothalamic-pituitary-adrenal (HPA) axis to down-regulate gene-changing hormones such as glucocorticord and cortisol, and can produce a chronic inflammatory response (Christena Abraham, BS, Shelly N.B. Sloan, 2021.) Similar types of illnesses and negative body responses are vast in number and can range from chronic musculoskeletal problems (such as neck pain, joint pains in the scapular girdle, lower back pain, muscle tension and imbalances, joint and muscle asymmetries), digestive problems (such as gastric reflux, colitis, gastritis and constipation), hypertension, hyperlipoidaemia, obesity, insomnia, adrenal fatigue, headaches, migraines, breathing difficulties, cardiovascular disease, dizziness and more. When prolonged these physical conditions can lead to allostatic overload and ‘somatic dysfunction/disorder’. If left untreated, PTSD, stress, depression and anxiety’s impact on the body can develop from primary pathologies onto further secondary pathologies – known as Primary and Secondary Somatic Disorder – and eventually onto very serious illnesses. (Collebrusco, Fabri, Furfaro, Tanini, Lombardini, Rizza, Zavarella 2018.) However, Osteopathy can potentially alleviate allostatic load and other symptoms by helping to activate the parasympathetic nervous system, our ‘rest and digest’ response, and aiding the body and mind to move into a homeostatic relaxation state.
Studies so far are limited in number but the few published are beginning to demonstrate that physical therapies like OMT not only alleviate many body conditions but can also affect the mind in a positive way. As stated above, PTSD, stress, depression and anxiety can cause measurable musculoskeletal tension and OMT can reduce those physical tensions. There are many OMT techniques that help reduce physical stress and symptoms such as Rib Raising, Sacral Rock, Suboccipital Inhibition, Fourth Ventricle treatment (CV4), Muscle Energy Technique, Joint Mobilization, Strain-Counter-Strain, Balanced Ligamentous Tension Technique, Facilitated Positional Release, Osteopathic Soft Tissue and Craniosacral Therapy (CST). These OMT methods can slow down the heart rate, decrease high blood pressure and hypertension, while increasing healthy vagal afferent activity as measured by Heart-Rate Variability (HRV.) In a ten-year peer-review study by Anna Zurowska et al. at the Wrocław Medical University, 2017, it was shown that Osteopathic Soft Tissue (OST) and Craniosacral Therapy (CST), particularly compression of the Fourth Ventricle (CV4), has a positive impact on behavioral manifestations associated with chronic activation of the HPA axis – such as anxiety and depression – while decreasing plasma, urinary, and salivary cortisol and urinary corticotropin releasing factor-like immunoreactivity (CRF-LI.) Osteopaths in the study used OMT and CST to treat Somatic Dysfunction, such as abnormal tissue modifications, organ motility restriction, impaired range of motion, and structural asymmetries. OMT was proven to produce anti-inflammatory and hyper-parasympathetic effects which are often associated with PTSD, stress, depression and anxiety conditions. CST is a gentle approach of working with the cranial bones and the sacrum which releases tension deep in the body. This relieves pain and dysfunctions, and eventually improves the whole body. OMT practitioners take advantage of several manual techniques and approaches, the most popular ranging from joint mobilization and articulation, fascial release, visceral manipulation, to CST. CV4 is a CST manipulation technique aimed at influencing the function of the nervous system, including the autonomic nervous system, and increasing electroencephalography alpha absolute power by activating the vagus nerve. In Zurowska’s study reduced sleep latency, and even decreased anxiety was demonstrated. Other benefits of CV4 cranial manipulation were shown to calm the heart rate, aid blood flow velocity and cerebral tissue oxygenation. Of the combined participants in Zurowska’s 2017 study, 90% were recorded as having positive effects from OMT and CST treatments.
In a pilot study by Christena Abraham and Charles Coker, et al, 2021, they examined the efficacy of OMT for improving symptoms of stress, anxiety, and depression (SAD) among first responders. Four standard OMT methods were used: Rib Raising, Sacral Rock, Suboccipital Inhibition, and, again, CV4 treatment. SAD indicators were examined pre- and post-study. The results suggested overall improvement in both mental states and SAD-associated biomarkers after OMT sessions. The control group who did not receive OMT had significantly fewer positive results in their SAD-associated biomarkers. Average work satisfaction was higher in those who received OMT and there was a minor decrease in trauma indicators. Participants increased their positive coping mechanisms and decreased their negative coping strategies, such as alcohol and pharmaceutical use. Biomarkers for stress, anxiety and depression showed a decrease. It is important to note that the study had a relatively small number of participants and that a larger sample size is needed for further research. Overall, however, OMT was perceived to have a positive impact on PTSD, stress, depression and anxiety in the participants.
Further research by Osteopaths Torsten Liem and Winfried Neuhuber, published in a 2020 edition of The Journal of Osteopathic Medicine, stated that “the vagus nerve has a significant impact on emotions and other behavioral states by virtue of its large afferent portion. Vagal afferents, which account for about 80% of vagus axons, are relayed through the nucleus of the solitary tract to the periaqueductal gray (PAG), hypothalamus, amygdala, as well as the insular, cingulate, and prefrontal cortices, where they are integrated into emotional and cognitive processes… [and] that subdiaphragmatic vagal afferents influence innate anxiety, learned fear, and other behaviors.” Liem and Neuhuber show in their research that Mind-Body-Therapies such as OMT and CST use stimulation of vagal, somatic, visceral, and chemosensory receptors, to induce muscle and autonomic nervous system relaxation. OMT and CST techniques send messages via the cerebral cortex to relax body and mind, to ‘rest and digest.’ Patients showed an increased HRV score and a reduction of expressed cytokines. Effectively their research has demonstrated that people experiencing trauma, with their autonomic response in a chronic defensive state, will be in a state of downregulation. OMT techniques relax the body and mind, and activate the parasympathetic nervous system, as well as attenuating the HPA axis thereby helping to upregulate their autonomic response. Liem and Neuhuber show that by using Osteopathic palpation and OMT to facilitate relaxation, to create rhythmic flow and vitality in the body, trauma can be re-associated by the patient with calm breathing and a relaxed heart rate, as well as relaxed muscles. This effect can be strengthened by CST of the vagal cardiopulmonary and trigeminal afferent nerves. By using this combination of OMT and CST in just 30 minutes, patients’ stress scale decreased from 9.5 to 0.5. Their muscular tension decreased, and breathing slowed down. After two more treatments of this kind, the perceived burden of patients with past trauma had decreased to 0. This demonstrates how OMT and CST’s effect on the somatic system and autonomic nervous system can have a significant positive impact in reducing the physical problems caused by stress and PTSD.
A further piece of research by Hope‑Bell, Draper‑Rodi and Edwards on Chiropractic and Manual Therapies, published in 2024, studied the effects of one-hour manual therapy treatments on 33 participants. They showed positive variations in effects on HRV, interoceptive accuracy, and an improvement of various mental health issues such as depression and anxiety. Even though the participant size was small this study provides evidence to support the need for more thorough scientific investigation into Osteopathic treatments for patients presenting with PTSD, stress, depression and anxiety. Hope-Bell et al. indicate in their study that not only more research studies with much larger sample sizes are necessary but that they be completed by a combination of experts from both the medical profession and Osteopaths.
In a Frontiers in Psychology article in 2012, Lucas, Bohlen, Shaw et al. provide evidence for the need of more studies on the efficacy of Osteopathy in treating mental health issues. The article says “Osteopaths frequently treat patients with… chronic pain and comorbid depression… linked to physical and mental states associated with depression… Osteopathic care plays a crucial role in allostatic [load] regulation and therefore health and wellbeing, particularly through active interoceptive inference… (arguably alleviating symptoms). In this way, Osteopathic treatment might reduce… physical and mental states associated with chronic pain and comorbid depression.”
However, many studies previously undertaken have been bibliometric in nature and actual research is still few and far between. Despite the growth of Osteopathy and the positive results of these few studies, its true efficacy is still being debated. There is a strong need for, and absence of, a combined analysis of all previous research into Osteopathy and future commitment by leaders in the field to undertake larger empirical, scientific medical research into the efficacy of Osteopathy. Between 1980 to 2014 the quantity of empirical studies into Osteopathy did increase but were largely contained within Osteopathic journals. To be fully accepted with mainstream allopathic medicine, Osteopathy needs to be studied within the medical framework.
Conclusion
When in combination with psychiatric therapies such as Cognitive Behavioural Therapy, psychoanalysis, somatic experiencing, and other therapies, OMT can have a significant positive impact on alleviating both physical and mental conditions of people with trauma, depression, anxiety and stress. Research so far shows that patients with PTSD who received OMT and other mind-body therapies report positive effects on their symptoms, including therapeutic effects on stress responses, reductions in anxiety, depression, anger, an increase in pain tolerance, improved self-esteem, and an enhanced ability to relax and to cope with stressful situations. Mind-body therapies such as Osteopathic treatment of the muscles, ligaments, organs and nervous system work by stimulation of somatic, visceral, and chemosensory receptors, influencing central neural processing and mental processes via ascending pathways from the periphery to the cerebral cortex. This effectively reduces the symptoms of PTSD.
With approximately 21+ million people in Canada experiencing some form of PTSD, stress, depression and anxiety and with studies so far suggesting OMT has a positive impact on both physical and mental symptoms of these conditions, there is a great need for further scientific research. There is also the need for OMT, CST and other manual therapies to be integrated into mainstream health service and social fabric as both a preventative health measure and as a highly effective rehabilitation method enabling patients to heal quicker and in a more complete way. Osteopathy offers a non-invasive, gentle, alternative, affordable physical therapy that provides relief from stress, anxiety and chronic pain, and can help prevent injuries and pathologies which directly alleviates the burden on health services. The United Kingdom and United States currently lead the way in the integration of Osteopathy with allopathic medicine and there is huge potential for Canada and the rest of the world to follow this path.
Written by Max Edwards, Osteopathic Manual Practitioner (OMP) & Bodywork Specialist
Ithaca Wellness www.ithacawellness.ca
Coquitlam, British Columbia
Ithaca Wellness provides osteopathy in Coquitlam, Port Moody, Anmore, Belcarra, Westwood Plateau, Burke Mountain and in the Greater Vancouver area, British Columbia.
Max Edwards brings Manual Osteopathy for stress reduction, relaxation, pain relief and more to the comfort of your own home.
Max’s Locations
Monday – 10am to 8pm @ Mobile in-house/at-work service Tri-Cities and Greater Vancouver – Book here: https://ithaca.noterro.com
Tuesday – 2pm to 8pm @ Dovira Care Integrative Health Clinic, 3020 Lincoln Ave, 109, Coquitlam, BC, V3B 6B4 – Book here: https://dovira.janeapp.com
Saturday – 10am to 8pm @ Dovira Care Integrative Health Clinic, 3020 Lincoln Ave, 109, Coquitlam, BC, V3B 6B4 – Book here: https://dovira.janeapp.com
Sunday – 11am to 5pm @ Mobile in-house/at-work service Tri-Cities and Greater Vancouver – Book here: https://ithaca.noterro.com
If you have any questions about bookings or Manual Osteopathy & Therapeutic Bodywork please email Max at ithacawellnesscanada@gmail.com or call 778-929-6143
Bibliography / References
- Collebrusco, L., Fabri, S., Furfaro, A., Tanini, I., Lombardini, R., Rizza, A. and Zavarella, P. (2018) Osteopathy and Emergency: A Model of Osteopathic Treatment Aimed at Managing the Post-Traumatic Stress—Part 1. Health, 10, 998-1005. https://doi.org/10.4236/health.2018.107074 . Received: June 27, 2018. Accepted: July 23, 2018. Published: July 26, 2018. Copyright © 2018 by authors and Scientific Research Publishing Inc. This work is licensed under the Creative Commons Attribution International License (CC BY 4.0). http://creativecommons.org/licenses/by/4.0/
- Häfner M. (2013). When body and mind are talking: interoception moderates embodied cognition. Exp. Psychol. 60 255–259. 10.1027/1618-3169/a000194.
- Osteopathic Manipulative Treatment as an Intervention to Reduce Stress, Anxiety, and Depression in First Responders: A Pilot Study by Christena Abraham, BS, Shelly N.B. Sloan, Missouri Medicine | September/October 2021.
- Review Article: Compression of the Fourth Ventricle Using a Craniosacral Osteopathic Technique: A Systematic Review of the Clinical Evidence: Anna Zurowska, Roksana Malak, Anna Kolcz-Trzwsicka, Wlodzimierz Samborski, and Malgorzata Paprocka-Borowicz, Department of Physiotherapy, Faculty of Health Sciences, Wrocław Medical University, Poland and Department of Rheumatology and Rehabilitation, Faculty of Health Sciences, Poznan University of Medical Sciences, Poland, 2017
- Liem, Torsten and Neuhuber, Winfried. “Osteopathic Treatment Approach to Psychoemotional Trauma by Means of Bifocal Integration” Journal of Osteopathic Medicine, vol. 120, no. 3, 2020, pp. 180-189. https://doi.org/10.7556/jaoa.2020.021
- Osteopathy and Mental Health: An Embodied, Predictive, and Interoceptive Framework; Frontiers in Psychology Published: 27 October 2021; Lucas Bohlen 1*, Robert Shaw 2, 3, Francesco Cerritelli 3, 4 and Jorge E. Esteves 4, 5, 6 1 Osteopathic Research Institute, Osteopathie Schule Deutschland, Hamburg, Germany, 2 Scandinavian College of Osteopathy, Gothenburg, Sweden, 3 Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), University of Technology Sydney, Ultimo, NSW, Australia, 4 Clinical-based Human Research Department, Foundation COME Collaboration, Pescara, Italy, 5 Research Department, University College of Osteopathy, London, United Kingdom,6 International College of Osteopathic Medicine, Malta, Italy.
- Berthoud HR, Neuhuber WL. Functional and chemical anatomy of the afferent vagal system. Auton Neurosci. 2000;85(1-3):1-17. [CrossRef] [PubMed]
- Campbell SM. Winkelmann R. Walkowski S. Osteopathic Manipulative Treatment: Novel Application to Dermatological Disease https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3486778/
- Collard K. Preliminary prediction models for autonomic nervous system response to a cranial Osteopathic technique
- Kim SH, Schneider SM, Kravitz L, Mermier C, Burge MR. Mind-body practices for posttraumatic stress disorder. J Investig Med. 2013;61(5):827-834. doi: 10.2310/JIM.0b013e3182906862 [CrossRef] [PubMed]
- Dr Peter Levine, Walking the Tiger: Healing Trauma, 1997
- Dr Bessel van der Kolk, The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma, 2014
- Torsten Liem MSc(Ost), MSc(PaedOst), DO, DPO, GOsC(GB): Psychosomatic Osteopathy; Cranial Osteopathy 2004
- Applying an Osteopathic intervention to improve mild to moderate mental health symptoms: a mixed‑methods feasibility randomised trial: Josh Hope‑Bell1,2*, Jerry Draper‑Rodi3,4 and Darren J. Edwards1: Chiropractic & Manual Therapies (2024) 32:32 https://doi.org/10.1186/s12998-024-00556-x
We would like to respectfully acknowledge that Ithaca Wellness operates on the traditional, ancestral, and unceded shared territories of the kʷikʷəƛ̓əm (Kwikwetlem), sq̓əc̓iy̓aɁɬ təməxʷ (Katzie), səlilwətaɬ (Tsleil-Waututh), xʷməθkʷəy̓əm (Musqueam), Sḵwx̱wú7mesh (Squamish), and Stó:lō (Sto:lo) First Nations. We give thanks to these nations who continue to live on and care for these lands and waters, and for their wisdom towards wildlife.