Written by Lee Jarvis. Proofreading and Editing by Sasha Wilde-Benning.
There seems to be a capacity within the application of Osteopathic Manual Therapy (OMT) to calm the patient in a way that is noticeable to the patient and palpable to the practitioner. This calming effect is not exclusive to OMT, other manual fields are also capable of it, but we do seem to do a good job at it traditionally. The capacity to help the patient fall into this state of relaxation, for any prolonged period of time, is rarely talked about but can have benefits to the entirety of the body that are worth achieving as a treatment outcome entirely on their own.
Pain, and the patients who have it, seem so often to be a primary focus of treatment, this is due to several reasons, good reasons. The first and foremost reason pain is often our focus, is that the patients who seek out treatment very often do so specifically for the purpose of reducing their pain. It is understandable that the practitioner would want to help the patient by alleviating that pain in whatever way we are capable of. In this way, the decreasing or increasing of pain experienced by the patient becomes the rating scale or “metric” for determining the success of the treatment process.
Another excellent reason we place importance on pain is all of the new and frankly fantastic research about pain that has and continues to be produced in the last 40 years (or so). Much of the most relevant research has occurred in the last decade on the concept of Nociplastic pain, however the concept of Central Sensitization was first mentioned in 1983 (Steven E. Harte et al.). Based on this, pain research is not a “brand new” subject, though it still quite young compared to many other research fields regarding the human body, and therefore some element of excitement is understandable. Being that the study of pain is on the cutting edge of science, of course we want to use that metric to show improvement of the patient and therefore efficacy in our treatments. That being said, pain and the reduction of it, is not the only way to show that a patient is improving. The absence of pain is a goal worth aspiring to, but it is not the same thing as the achievement of health.
One such state or metric that can signify an increased capacity to achieve health is a state of calmness, or reduced stress, or speaking physiologically: a Parasympathetic dominant state. Before I go into justifying this previous statement, it helps to understand that what we so often interpret as “healing” in the body is probably not entirely correct. The body does not get injured, “repair” itself back to “normal”, and then stop this process entirely. There is no “normal” as the body is constantly being “renovated”, essentially pulled apart and rebuilt at all times to greater and lesser degrees. It is more accurate to say that the body is in a constant state of death and replacement wherein the “healing” is the cellular replacement process. There is an expected/average day to day amount of cellular death and replacement that can be considered the “normal” and should a higher amount of cells die due to sudden injury, the replacement process can be increased to compensate (within reason of course). This process of cell replacement occurs best in a parasympathetic state, and the parasympathetic state occurs best when relaxing and resting is possible.
To some extent, the parasympathetic nervous system (PNS) is entering public or common knowledge, though it seems to be often misinterpreted on social media (but it is still a good effort, this is just how these things go). Again, we recover and repair best when we are capable of being in a calm/restful/parasympathetic state. This concept it seems, has been coined by the internet as “stimulating the Vagus nerve”. The first issue with this statement is that while the vagus nerve does genuinely represent a large portion of the parasympathetic nervous system’s afferent and efferent arms, it does not comprise all of it. Several of the cranial nerves and the S2-4 region are also part of the parasympathetic nervous system. Additionally, the parasympathetic nervous system is self-stimulating under the right conditions, unless a specific nerve or the brainstem has been damaged (but this type of damage is not relevant to the current article). The best way to get the vagus nerve (or any part of the PNS) to act fully is to remove excess Sympathetic Nervous System (SNS) stimulation. The sympathetic nervous system, what is often called the “fight or flight” part of the nervous system, will not allow the full activation of the parasympathetic nervous system. Therefore, if someone is not able to get out of a state of “fight or flight”, or stress — sympathetic dominance, they are less capable of fully healing/repairing/replacing cells.
To keep this very general, the reason a parasympathetic state is capable of facilitating healing is because the PNS is highly involved in digestion and hormonal release. The PNS is involved quite directly in releasing the necessary enzymes for the breakdown of food. This effective breakdown ensures that we can absorb the nutrients within our food, providing the body with the basic building blocks for constructing new cells. Incidentally, the increased blood flow and the direction of that blood flow to the gut to absorb nutrients is also a PNS function. A calm or resting state, particularly when we sleep, is when we optimally release hormones that help to build our cells. Hormones like Growth Hormone, Thyroid Hormone, and Insulin-like Growth Factor to name a few, all help growth and development, particularly in puberty, but all throughout life as well.
So, when the patient comes in for osteopathic treatment with pain, we should definitely try to make the reduction of pain one of our goals. However, if the patient only notes that they are feeling generally calmer, perhaps even sleeping better, but the pain remains the same, then you have still done them a service. Hopefully the eventual outcome will be that the patient’s pain is reduced (preferably gone entirely) as a result of continued manual treatment, but preceding that time there can still be other consequences of treatment that are effective and beneficial.
References
Harte, Steven E.; Harris, Richard E.; Clauw, Daniel J. (2018). “The neurobiology of central sensitization.” Journal of Applied Biobehavioral Research 23(2): n/a-n/a.
Waxenbaum JA, Reddy V, Varacallo MA. Anatomy, Autonomic Nervous System. [Updated 2023 Jul 24]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK539845/