1. Introduction / Plain Theory

Stress is the body’s natural response to physical, emotional, or environmental challenges. It involves activation of the autonomic nervous system and the hypothalamic–pituitary–adrenal (HPA) axis, releasing hormones such as adrenaline and cortisol to prepare for “fight or flight.”

While this reaction is protective in the short term, chronic or prolonged stress can lead to imbalance — affecting sleep, digestion, immune function, and musculoskeletal health.
In today’s society, stress is one of the most common contributing factors behind pain, tension, and fatigue seen in clinical practice.

Long-term activation of stress pathways can cause:

• Persistent muscle tightness and restricted breathing.

• Changes in posture and movement patterns.

• Heightened pain sensitivity due to central sensitisation.

• Impaired recovery, immunity, and digestion.

Osteopathy recognises that stress manifests both physically and physiologically, influencing the entire body system.

2. Typical Symptoms and Functional Impact

• Neck and shoulder tension or headaches.

• Jaw clenching or bruxism.

• Digestive issues (bloating, reflux, constipation).

• Sleep disturbance and fatigue.

• Difficulty concentrating, anxiety, or irritability.

• Shallow or irregular breathing patterns.

Functional impact:
Chronic stress can reduce quality of life, affect work performance, and exacerbate existing pain or chronic health conditions. Over time, it may contribute to burnout or mood disorders if left unaddressed.

Red flags:
Sudden mood changes, chest pain, fainting, or panic attacks that interfere with daily life should be evaluated by a healthcare professional.

3. Contributing Factors / Underlying Causes

Stress arises from an interaction between external pressures and internal coping resources.
Common contributing factors include:

• Workload or life events: high responsibility, lack of rest, or emotional strain.

• Physical strain: injury, chronic pain, or poor posture.

• Sleep deprivation and poor recovery.

• Lifestyle factors: diet, caffeine, alcohol, inactivity.

• Emotional and social components: isolation, anxiety, or perfectionism.

Chronic stress affects the body through autonomic imbalance — dominance of the sympathetic (“fight or flight”) system — and reduced parasympathetic (vagal) activity.
This imbalance disrupts breathing, digestion, circulation, and immune function, often sustaining the stress–tension–pain cycle.

4. Osteopathic Approach

Osteopathic care can play a supportive role in helping the body recover from the physiological effects of stress. The focus is not psychological therapy, but restoring balance within the body’s structure and function to promote relaxation, circulation, and regulation.

An osteopathic assessment may include:

• Evaluation of breathing patterns, posture, and areas of muscular tension.

• Gentle manual techniques (cranial, myofascial, rib, and diaphragmatic work) to reduce mechanical restriction and stimulate parasympathetic activity.

• Supporting autonomic regulation through improved movement and fluid dynamics.

• Guidance on ergonomics, pacing, and self-awareness of tension patterns.

The aim is to help the nervous system shift from a chronic stress state toward recovery and adaptability, complementing psychological or lifestyle interventions where relevant.

5. Scientific Evidence & References

Emerging research supports the link between manual therapy and modulation of the autonomic nervous system, particularly in enhancing parasympathetic tone and reducing stress-related physiological markers.
While osteopathic treatment does not “cure” stress, it can support the body’s recovery mechanisms, contributing to improved relaxation, pain reduction, and well-being when used alongside healthy lifestyle and stress-management strategies.

References

1. McEwen BS. Protective and damaging effects of stress mediators. N Engl J Med. 1998;338(3):171–179. Link

2. Chrousos GP. Stress and disorders of the stress system. Nat Rev Endocrinol. 2009;5(7):374–381. Link

3. Thayer JF, Lane RD. Claude Bernard and the heart–brain connection: further elaboration of a model of neurovisceral integration. Neurosci Biobehav Rev. 2009;33(2):81–88. Link

4. Cerritelli F, Esteves JE, Sciomachen P, et al. Osteopathic manipulative treatment and heart rate variability in healthy adults: a randomized controlled trial. Complement Ther Med. 2020;52:102519. Link

5. Henley CE, Ivins D, Mills M, Wen FK, Benjamin BA. Osteopathic manipulative treatment and its relationship to autonomic nervous system activity as demonstrated by heart rate variability: a repeated measures study. J Am Osteopath Assoc. 2008;108(6):337–343. Link

6. Giles PD, Hensel KL, Pacchia CF, Smith ML. Osteopathic manipulative therapy and its immediate effects on heart rate variability and blood pressure. J Altern Complement Med. 2013;19(2):92–96. Link

7. Curi D, Cerritelli F, Lorenzini A, et al. The effect of osteopathic manipulative treatment on psychological distress and HRV: systematic review and meta-analysis. J Bodyw Mov Ther. 2022;31:1–11. Link

8. Pizzolorusso G, Barlafante G, Cerritelli F. The role of osteopathic treatment in stress-related disorders: narrative review. Int J Osteopath Med. 2023;50:1–8. Link