Somatic dysfunction – Conceptually fascinating, but does it help us address health needs?

IJOM Vol 22, Dec 2016, Pages 1-2

You only need to read the title of Robert Moran’s editorial, to know that the answer to his question is probably going to be some sort of “No”.  This editorial accompanies Gary Fryer’s piece: “Somatic dysfunction:  An osteopathic conundrum”, published in this same IJOM last year.  I also commented on it in a blog entitled Is it time to jettison somatic dysfunction? Fryer has taken on an interesting issue, and  I was sorry to miss him speak at the BSO’s Manus Sinistra recently.

He has proposed that the term somatic dysfunction isn’t that helpful in communicating between osteopaths, and is even less helpful in communicating with non-osteopaths.  It has various problems:  it fails to address psychosocial factors; diagnostic validity and reliability are poor; the actual effects on health status are not established; and the term could scare patients and make them feel worse.  From what I recall, Fryer did think it had at least one  redeeming feature, in that it might be helpful in clinical reasoning i.e. when you’re looking at what’s wrong with a patient it might help you mentally make sense of what’s going on with them, but I think that was about it.

When I was at college, somatic dysfunction was high up on the list of ‘important distinguishing features of osteopathy’, and the diagnosis of somatic function was almost regarded as the USP of osteopathy.  Indeed one examiner I knew, way back when I was lucky enough to work in the sunny Waikato Valley, told me that when she was examining one cohort every single student without exception had diagnosed every single patient as having “somatic dysfunction”.  I only recently realised that chiropractic subluxation was basically the same thing.

Robert Moran feels that the colleges, (or OEIs for acronym-lovers), might (should?) address the issue.  In New Zealand they are trying to formulate a  curriculum which will produce graduates who are able to meet the future health needs of the population.  Sensible idea. He says a recent NZ government health strategy emphasized “health maintenance, health literacy and illness prevention” and the need for practitioners able to function “beyond traditional organisational boundaries.”  They forecast a growth in diseases such as heart and respiratory conditions, diabetes,  mental health problems and musculoskeletal conditions.  Moran therefore thinks that time in education might be better spent in improving knowledge and clinical skills relating to diet, physical activity, sleep and stress reduction, as these are “modifying determinants”, rather than exploring the nuances of somatic dysfunction.  These are things that our patients, not to say ourselves, generally need help with, and needs which I do not feel we were well-taught to meet back in the day when I was a student.

The approach he suggests is not really very radical, indeed it is only to embrace osteopathy’s whole-person philosophy in any case.  Moran perceptively points out the not-often-commented-on but

obvious mismatch between our apparent interest and enthusiasm for “whole-person” approaches in marketing materials, and the disconnect with our often narrow therapeutic approaches dominated by passive manual therapy

We can easily make a case (and some do) that the philosophical foundations of osteopathy were a forerunner to the current biopsychosocial awakening in physiotherapy, and the recognition of the need for person-centred healthcare in medicine.  He makes the well expressed point that

The transition from osteopathic tenets to biopsychosocial model is a simple exercise in mapping and no intellectual ‘heavy-lifting’ at all.

He concludes by suggesting that we need to be building bridges towards other professions (his italics), and “somatic dysfunction” might be “little more than a distraction” to developing a stronger and more sustainable basis for osteopathy in health care.  To put it  more strongly, it might even get in the way.

If you want more click here for Monica Noy’s exceptionally clever thoughts on the concept of the lesion and somatic dysfunction