5 Years of Insight

November will always be a significant turn of the calendar for me. It was on the first of the month, back in 2020, when I showed up for the first day of my career. The learning curve of my first five years in practice was steep. I knew this career would challenge me in ways no classroom ever could. After graduation, you earn the title of Osteopathic Manual Practitioner—but the real education begins once you start working with patients. Expanding my knowledge and refining my treatment application became, and still remains, my top priority. A better practitioner produces better outcomes, which is the ultimate goal for patients. At the same time, I had to grow into the role of business owner and member of the local healthcare community. What I learned early on is that no amount of theory can fully prepare you for the genuine, often emotional, human interactions that take place in the treatment room.

The treatment room becomes a haven where patients share their concerns, frustrations, and questions about their wellbeing. I soon learned there was so much I did not know about the vastness of the issues that plague the general population. More often than not, further research was required to understand the content and ultimately answer the questions I was asked. I learned that clear, compassionate communication that remained within my scope of practice was necessary to augment treatment, and that admitting “I don’t know” was more helpful than providing inadequate answers. Over time, I realized how powerful proper patient education can be. The take-home messages, the advice on behavioural habits that help treatments “stick,” and the encouragement that empowers patients to take control of their health—these elements often elevate the treatment beyond the hands-on work itself.

I could never capture every conversation, every lesson, or every moment of growth from my first five years in practice. I’m sure there are things I’ve missed, but after much personal reflection, I did my best to narrow down what I believe are the five most crucial insights I’ve gained in my first 5 years of practice—insights that shape how I practice and how I guide patients today. 

• You Are Responsible for Your Health

• The Patient’s Body Dictates the Treatment

• The Importance of the Reflex Loop

• Fascia Is the Most Underappreciated System in the Body

• Build Your Core Strength

1) You Are Responsible for Your Health 

A great deal of progress can be made in a single treatment, and that progress can compound over successive sessions. However, the time a patient spends outside the practitioner’s office is far greater than the time spent in treatment, and this is where regression back to old patterns often occurs. One of the most common questions I’m asked is, “What should I do after treatment?” Although the specifics vary based on a patient’s mobility, stability, habits, posture, and activity, one universal truth remains: patients are ultimately responsible for their own health. Practitioners can guide and correct, but what patients do on their own determines long-term success.

For those who are less proactive with their health, providing complex routines is ineffective. They must first commit to the basic tenets of well-being: moving their bodies regularly, eating whole foods, drinking enough water, and sleeping well. Without these foundations, any additional recommendations will have limited impact. Patients also need to understand the patterns that contribute to their pain. Many people are locked into repetitive movements or sustained postures at work. Stationary individuals need to move more; those who sit for long periods need to stretch and strengthen their core; and those who overuse one side of the body must rest it and balance their strength. Treatment can offer relief and correction, but maintaining those improvements requires self-awareness and daily effort. Identifying the root of the problem is essential before meaningful solutions can be applied.

Ideally, treatment helps reveal limitations and gives patients a sense of what proper alignment and mobility feel like. If osteopathic care does not fully resolve their pain, patients must continue advocating for themselves by seeking further opinions or approaches. As a practitioner, it can feel awkward to place responsibility back on the patient; in a perfect world, I would guide every person back to ideal health on my own. But that isn’t always possible. What I can do is empower people to stay committed to their progress and remind them that they are ultimately in control. I’m honoured to be part of their journey—hopefully a significant part—but in the end, the outcome is up to them.

2) The Patient’s Body Dictates the Treatment 

When a patient seeks the help of a manual practitioner they expect to find answers to the issues holding them back. As practitioners we look back on our education, and experience to help us find the answer. The accumulated knowledge base is critical but it can also run interference to the solution. Practitioners are prone to put patients in boxes, figuratively. Treating all hip problems the same way may help some patients by chance, but no two hip issues are the same. Every patient has different genetics and health history; they have all accumulated different trauma and injury; they have different hobbies and levels of activity. The fact that everyone is different can sound cliche, but it cannot be overstated. That’s why all of your prior experience can fall short when you treat a patient like you treated a prior patient. You have to remind yourself to re-engage in the present moment, The answers are in the tissues. The tissues tell the story. 

Treatment needs to be an engagement that is felt and negotiated in real time. Practitioners have to put aside their ego and realize that treatment is not something that is done “to” or “on” someone, it is done with them. If the practitioner allows themself to feel the tissues and tension in their hands, it will guide them to the areas that require attention. The correct application of treatment can be a trial and error process. I typically try to address the most obvious restrictions first, in global or regional patterns, that have a higher likelihood of influencing smaller or more distal structures. It is entirely possible that this is the incorrect assumption, maybe the source of the dysfunction is that smaller or distal part. Bodies are fluid, and treatments need to be as well. If the previous treatment yields unsatisfactory results we need to step back and re-evaluate. 

Practitioners need to consult with patients on how their body responded to the prior treatment. We also need to determine in real time how the patient is responding to whatever you are trying to accomplish. Are they enjoying the treatment? Does it feel good, or relieving to them? Are the tissues relaxing or guarding? Are you able to make the changes you think you should make? If the answers are affirmative to the following line of questioning, you’re probably on the right track. If positive changes are made, that is usually an indication to stop treatment and allow the patient to recover and absorb the changes. Next treatment the patient’s body may present new patterns that need to be addressed next. This process continues until the restrictions have been flushed out and you have successfully reverse-engineered the pattern that created the pain and dysfunction. 

There needs to be a constant back-and-forth communication with the patient, both verbally and sensorially. Ultimately practitioners must always defer to the patient and their tissues. If you ask the right questions, their body will provide the answers. The patient dictates the treatment. 

3) The Importance of the Reflex Loop

Osteopathy is impossible to summarize in a sentence, let alone a paragraph. It would be like trying to explain how the human body works, it is far too broad with too many intricacies and variables. But it is a common question nonetheless, especially for patients experiencing it for the first time: What is Osteopathy? How does it work? What is this doing? I do find myself summarizing and trying to simplify “Reflex Loops” to patients quite often, because of the significance and frequency of trying to correct them in treatment. A Reflex Loop (RL) is a phenomenon that occurs automatically, or without consciousness, hence the word Reflex. In Osteopathy, it is important to note that when we reference a Reflex Loop (RL), it is a sequence that involves the spinal cord as the central processing centre. 

There are essentially three component parts of a RL. A Stimulus, or Input; a central Processing Centre, and a Response, or Output. There are multiple systems involved in these loops: Somatic, Visceral, and Psychological. These systems can serve as the source of the stimulus or the site where the output manifests. Every cell, tissue and organ in the human body prefers optimal physiological conditions like: pH, temperature, resting membrane potential, nutrient availability, oxygen level and waste removal. Stimuli can stem internally or from external/environmental factors, abnormalities can increase or decrease the activity of the cell, tissue or organ. The stimulus comes into the spine, where input gets relayed to produce an output. Abnormal stimuli create abnormal outputs. The Somatic system describes primarily the musculo-skeletal system: muscles, connective tissue, and joints. Visceral describes the organ field; common organs like the heart, lungs, liver, kidneys but also structures like glands. The Psychological system refers to thoughts and emotions. Reflex loops can remain within a singular system, or spill over into others; the latter scenario occurring when the RL remains unchecked and unresolved over longer periods of time. The body and mind are not separate, everything is connected and affects everything else. There are no boundaries on the relationships that may manifest, but here are some simplified examples of reflexes between the systems:

• Somato - Visceral : musculoskeletal dysfunction affecting the viscera

  • Ex) a tight hip flexor muscle constricting the kidney

• Somato - Psycho: musculoskeletal dysfunction affecting emotions

  • Ex) tight fascia creating emotional stress 

• Viscero - Somatic: organ dysfunction relaying out to the muscle

  • Ex) abnormal heart rhythm creating tension along the spine from T1-T4

• Viscero - Psycho: organ dysfunction altering emotion regulation

  • Distress in the gut creates anxiety and a poor mood.

• Psycho-Somatic: mental distress creating musculoskeletal tension

  • Negative stress leading to upper trapezius and neck muscle contraction 

• Psycho-Visceral: mental distress creating organ dysfunction

  • Negative stress creating a stomach ulcer. 

Since we cannot put our hands on the physiology, the function, within the body, we have to search for the structural input or output. Determining whether the structural expression is causative or a resultant can be tricky. This is where a proper health history consultation and assessment is paramount, we are trying to crack the chicken-or-the-egg conundrum of what came first. Treatment is explorative, it is a negotiation between the practitioner, who feels for structural issues and applies techniques to elicit positive changes, and the patients tissues that will respond favourably or unfavourably. A successful structural correction will normalize the inputs and outputs of the reflex loop, allowing for proper function of the systems involved. 

4) Fascia is the Most Underappreciated Tissue/ System Amongst the Population. 

“The fascia is the place to look for the cause of disease and the place to consult and begin the action of remedies in all diseases.” – Dr. A.T. Still

This quote from the late 1800s by the founder of Osteopathy, speaks to his understanding of fascia over a century ago. Somehow, that understanding was not shared by all, and did not continue through the decades to the present day. Fascia remains one of the least understood yet most vital tissues in the human body. Making up roughly half of the body’s mass, it forms a continuous 3D matrix that covers, connects, and supports every structure—muscles, bones, nerves, vessels, and organs alike. Its structure, composed of collagenous, elastic, mucous, reticular, osseous, and cartilaginous tissues with varying cellular compositions, determines its diverse functions.

The Four Ps of Fascia

Packaging: Encases muscles to direct force and motion; creates compartments that limit infection spread.

Protection (Stabilization): Forms ligaments, tendons, and capsules that stabilize joints and bones.

Posturing: Houses proprioceptors that sense movement and position; stores “memory” of injuries.

Passageways: Serves as conduits for nerves, blood vessels, and other body systems.

Beyond these, fascia facilitates fluid transport, supports internal structures, and transmits sensation—being far more sensitive than muscle tissue. Its form adapts to function: thick bands as tendons, flexible webs under skin, or plastic-wrap-like sheets around organs.

Dysfunction and Its Consequences

When fascia experiences prolonged stress, immobility, or injury, it thickens and stiffens by depositing excess collagen, reducing flexibility and fluid exchange. This leads to poor oxygenation, waste buildup, and pain. Post-injury adhesions and scar tissue further restrict motion, forcing compensatory strain elsewhere in the body. Chronic fascial tension can result in stiffness, restricted movement, or systemic discomfort. A slouched posture decreases energy and increases negative emotions such as loneliness, sadness, isolation, and sleepiness.

“ When you deal with the fasciae you are doing business with the branch offices of the brain.” - Dr. A.T. Still

Maintaining Fascial Health

Fascial wellness depends on movement, hydration, nutrition, and sleep.

Movement & Stretching: Maintain mobility, identify restrictions, and restore range of motion.

Hydration: Fascia holds most of the body’s water; dehydration causes stiffness and toxin buildup.

Nutrition: Limit toxins and sugar. Excess sugar forms AGEs (advanced glycation end-products) that cross-link collagen, making fascia brittle and impairing glide.

Sleep: Essential for tissue repair; lack of it increases pain sensitivity.

Fascia is not just connective tissue—it is a dynamic, responsive system central to structural integrity, communication, and overall health. Understanding and caring for it is key to preventing dysfunction and promoting holistic well-being.

“Fascia belts each muscle, vein, nerve and all organs of the body. It is almost a network of nerves, cells and tubes, running to and from it; it is crossed and filled with, no doubt, millions of nerve centers and fibers to carry the work of secreting and excreting fluid vital and destructive. By its action we live, and by its failure we shrink, or swell, and die.” - Dr. A.T. Still

5) Build your Core strength 

The core is not your six-pack, or lack thereof. The core refers to the body’s central stabilizing region — the integrated system of muscles, fascia, bones, and connective tissues that provide support, stability, and force transfer between the upper and lower body. It functions as the body’s central pillar, maintaining posture, protecting internal organs, and enabling efficient movement.

Think of your core like a soup can. The top is your respiratory diaphragm, the bottom is your pelvic diaphragm or pelvic floor. The walls enclose your abdominal cavity, composed of the layers of tissue from muscles, bones and fascia. From the time we’re babies, we are building our core strength. It begins in the early months during tummy time where we begin to activate our core as we build the strength necessary to lift our head off the ground. As we learn to roll we begin to coordinate our upper and lower body that allows us to twist and turn. Crawling plays an even bigger role as we activate our entire core, and integrate opposite-side limb movement, building the stability for upright posture. Without proper core development, balance becomes difficult and our gait pattern can be delayed. The spine and pelvis must be stable and limbs coordinated to continue to develop our ability to walk and perform future motor skills like running and jumping.

There are consistent findings of core weakness and imbalance in patients that I treat who complain of pain in their low back and pelvic regions. Whether you stand all day or sit all day, your core plays a major role in maintaining your posture and allowing you to function efficiently in your job or sport. Core weakness can be achieved in a variety of ways. Primarily through lack of purposeful strengthening, and practicing poor posture. Slouching and slumping as you curl your body over your desk, work station or steering wheel rounds out your low back creating tension along your spine and compression through your abdomen. One can also slump to the right or left creating tension and compression on either side of the spine, laterally. Women who go through pregnancy undergo expansion of the abdomen anteriorly, known as diastasis recti,  where the soft tissue line from sternum to pelvis tears and separates. Men can also experience diastasis recti via poor posture, improper lifting and weight gain. This weakness in the soup can forces the muscles of the lumbar spine to compensate and stiffen to maintain integrity in the lumbar spine, not to mention increase the probability of a hernia as internal organs protrude through these openings. 

Pelvic posture is vital. An anterior pelvic tilt hyper extends the lumbar spine, and tilts the sacrum anteriorly at the top, putting a strain through the pelvic floor muscles. A posterior pelvic tilt flattens the lumbar curvature, and tilts the sacrum posteriorly at the top, compressing the muscles of the pelvic floor. Training your core corrects a multitude of issues. It equalizes the tension on all the soft tissue structures, above, below and along the sides. It strengthens and stabilizes the connective tissues and joints of the lumbar spine and pelvis. A balance of strength and tension makes you more agile and athletic through your torso; improves the strength, athleticism and breathing mechanics. Improvements to your core will benefit neighboring joints and muscle groups: up the spine to the cranium, through the shoulders and down the lower limbs. If a patient wants or needs to improve their strength, posture, balance or performance, the core is the best place to start.