Osteopathy as an Holistic Philosophy of the mind-body-environment: Integrating Active Inference, biophysics, cognitive sciences and beyond..

Osteopathy has frequently been misconstrued as merely a collection of manual techniques aimed at manipulating joints and soft tissues. It’s precarious advertised as a group of techniques or based on “biomechanics” (in fact what it’s meant most of time is musculoskeletal physiology, since I rarely met an osteopath that understands truly what biomechanics is). Osteopathy should be understood as a comprehensive philosophy of health—one that emphasizes the body’s intrinsic capacity for self-regulation and healing through a systems‐based approach. The osteopathic paradigm is shifting, for some time now, with the main argument being primary that the value of osteopathy lies not in its specific techniques but in its integrative framework, which now increasingly incorporates concepts from active inference and free energy principles.

Central to osteopathic philosophy is the concept of allostasis, which involves maintaining stability through adaptive change. Rather than simply addressing isolated symptoms, osteopaths consider the patient as an interconnected whole, capable of self-regulation when provided with appropriate sensory input. As Lunghi et al. (2020) note, osteopathic care supports the adaptive capacities of the individual, facilitating a return to homeostasis by addressing systemic imbalances. This holistic approach allows practitioners to hypothesize links between altered physiological states and health disruptions, thereby targeting the underlying dysfunction rather than merely ameliorating localized pain.

In this context, the role of manual techniques transcends simple physical manipulation; it is reinterpreted as a form of communication with the body’s regulatory systems. The application of touch in osteopathy serves as an informational input that can interrupt maladaptive feedback loops. This process is now being explored through the lens of active inference—a theoretical framework proposed by Friston and colleagues. Active inference posits that biological systems act to minimize free energy by continuously updating internal models to predict sensory inputs (Friston & Esteves, 2022).

Moreover, osteopathy’s emphasis on the mind–body connection is particularly relevant in light of active inference theory. Osteopaths engage in meaningful dialogue with patients, challenging maladaptive beliefs and expectations that can impede the healing process. The active inference framework further reinforces this view by suggesting that successful therapy results from minimizing prediction errors through both sensory (touch) and cognitive (communication) channels. In osteopathic care, this means that manual interventions can be seen as “active” signals that help the patient’s system reduce uncertainty and restore balance (Esteves et al., 2022).

In addition to these neurophysiological and psychological mechanisms, osteopathy recognizes the importance of circulatory and lymphatic systems in sustaining health. Early osteopathic thought acknowledged that fluid dynamics were essential for maintaining health, and recent research has supported this view. For example, Verzella et al. (2022) demonstrated that manual interventions could improve lymphatic flow and modulate inflammatory responses by influencing cellular behavior in connective tissues. Such findings illustrate that osteopathic practice operates across multiple physiological systems, underscoring its role as a truly integrative discipline.

In conclusion, osteopathy should be re-conceptualized not as a set of isolated manual techniques but as a holistic philosophy that integrates biophysical, neuroimmune, and psychological processes. Its embrace of active inference and free energy principles further enriches this framework by providing a theoretical basis for understanding how touch and communication can minimize uncertainty and promote health. This integrative perspective not only distinguishes osteopathy from other manual therapies but also offers a more nuanced approach to patient care—one that truly harnesses the body’s inherent self-healing potential.

References

Esteves, J.E., Cerritelli, F., Kim, J. and Friston, K.J., 2022. Osteopathic care as (En)active inference: a theoretical framework for developing an integrative hypothesis in osteopathy. Frontiers in Psychology, 13, p.812926. doi: 10.3389/fpsyg.2022.812926.

Friston, K. and Esteves, J.E., 2022a. An active inference account of touch and verbal communication in therapy. Frontiers in Psychology. doi: 10.3389/fpsyg.2022.828952.

Christian, Lunghi and Liem Torsten. ““Models and theoretical frameworks for osteopathic care – A critical view and call for updates and research”.” International Journal of Osteopathic Medicine37 (2020): 48-51.

Tamburella F, Piras F, Piras F, Spanò B, Tramontano M and Gili T (2019) Cerebral Perfusion Changes After Osteopathic Manipulative Treatment: A Randomized Manual Placebo-Controlled Trial. Front. Physiol. 10:403. doi: 10.3389/fphys.2019.00403

Verzella, M.; Affede, E.; Di Pietrantonio, L.; Cozzolino, V.; Cicchitti, L. Tissutal and Fluidic Aspects in Osteopathic Manual Therapy: A Narrative Review. Healthcare 2022, 10, 1014. https://doi.org/10.3390/healthcare10061014