Abstract
Osteopathy is a person-centred healthcare discipline that emphasizes the body’s structure-function interrelationship—and its self-regulatory mechanisms—to inform a whole-person approach to health and wellbeing. This paper aims to provide a theoretical framework for developing an integrative hypothesis in osteopathy, which is based on the enactivist and active inference accounts. We propose that osteopathic care can be reconceptualised under (En)active inference as a unifying framework. Active inference suggests that action-perception cycles operate to minimize uncertainty and optimize an individual’s internal model of the lived world and, crucially, the consequences of their behaviour. We argue that (En)active inference offers an integrative framework for osteopathy, which can evince the mechanisms underlying dyadic and triadic (e.g., in paediatric care) exchanges and osteopathic care outcomes. We propose that this theoretical framework can underpin osteopathic care across the lifespan, from preterm infants to the elderly and those with persistent pain and other physical symptoms. In situations of chronicity, as an ecological niche, the patient-practitioner dyad provides the osteopath and the patient with a set of affordances, i.e., possibilities for action provided by the environment, that through shared intentionally, can promote adaptations and restoration of productive agency. Through a dyadic therapeutic relationship, as they engage with their ecological niche’s affordances—a structured set of affordances shared by agents—osteopath and patient actively construct a shared sense-making narrative and realise a shared generative model of their relation to the niche. In general, touch plays a critical role in developing a robust therapeutic alliance, mental state alignment, and biobehavioural synchrony between patient and practitioner. However, its role is particularly crucial in the fields of neonatology and paediatrics, where it becomes central in regulating allostasis and restoring homeostasis. We argue that from an active inference standpoint, the dyadic shared ecological niche underwrites a robust therapeutic alliance, which is crucial to the effectiveness of osteopathic care. Considerations and implications of this model—to clinical practice and research, both within- and outside osteopathy—are critically discussed.
Highlights
Osteopathy is a person-centred healthcare discipline that emphasizes the body’s structure-function interrelationship and its self-regulatory mechanisms to inform a whole-person clinical approach to health and wellbeing, traditionally involving primarily manual treatment (European Standards EN 16686, 2015)
Littlejohn (1905), in his early conceptual framework for osteopathy, focused on the functional adaptation of the body in relation to the external environment. He viewed osteopathy as person-centred care, which is based on four key pillars: adaptation, function, environment and immunity (Gevitz, 1982). Many of these early osteopathic care concepts were lost to a predominantly cause-effect disease-based model, we argue that these ideas can be reconciled under the Free Energy Principle (FEP) and the enactivist and active inference frameworks
This paper aims to provide a theoretical framework for developing an integrative hypothesis in osteopathy, which is based on the enactivist and active inference accounts
Summary
Osteopathy is a person-centred healthcare discipline that emphasizes the body’s structure-function interrelationship and its self-regulatory mechanisms to inform a whole-person clinical approach to health and wellbeing, traditionally involving primarily manual treatment (European Standards EN 16686, 2015). He viewed osteopathy as person-centred care, which is based on four key pillars: adaptation, function, environment and immunity (Gevitz, 1982) Many of these early osteopathic care concepts were lost to a predominantly cause-effect disease-based model, we argue that these ideas can be reconciled under the Free Energy Principle (FEP) and the enactivist and active inference frameworks. Active inference foregrounds the crucial predisposition of living organisms to adapt by creating, updating, and maintaining inferences about their environment (Bouizegarene et al, 2020) This is fundamental in the context of osteopathy, and despite the still prevailing views that structural abnormality causes functional disorder (Tyreman, 2013), it is clearly aligned with osteopathic concepts of adaptation (Littlejohn, 1905; Vogel, 2021). We argue that from an (En)active inference standpoint, the shared ecological niche underwrites a robust therapeutic alliance, which is crucial to the effectiveness of osteopathic care and other forms of manual therapy
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