Are we harnessing the full potential of osteopathy in the healthcare system? A Critical Narrative Review

Abstract

This article is a critical narrative review, conceptual in nature, that does not aim to present direct empirical evidence on the clinical effectiveness of osteopathy. It rather intends to synthesise and integrate emerging theoretical and empirical contributions toward an updated understanding of the potential of osteopathic care within contemporary healthcare systems. Health is increasingly recognised as a dynamic, relational, and multiscale process that transcends the reductive biomedical view focused solely on the absence of disease. Within this context, osteopathy has been progressively redefined as an ecological and person-centred clinical practice aimed at fostering adaptive regulation, resilience, and self-organisation of living systems. Drawing on advances in cognitive science — particularly enactivism, predictive processing, and active inference — as well as a systemic understanding of chronic low-grade inflammation and emerging evidence on neuroendocrine-immune modulation through touch, it is argued that osteopathy may be understood not merely as a collection of manual techniques but as an embodied and relational process of co-regulation. Through therapeutic touch, the therapeutic alliance, and the shared construction of meaning, osteopathic care may modulate interoceptive, autonomic, immune, and affective processes, potentially facilitating allostatic recalibration and the updating of maladaptive predictive models associated with persistent pain, inflammation, and mental health disorders. It is proposed, as a theoretical hypothesis, that when integrated within multidisciplinary care networks, osteopathy may contribute to more preventive, integrative, and person-centred healthcare systems.