When we talk about musculoskeletal disorders (MSDs), most people think of well-known conditions such as low back pain, neck pain, osteoarthritis, rheumatoid arthritis, and gout. In global epidemiology, these make up the “big five” MSD categories in the Global Burden of Disease (GBD) framework.

Everything else – from fibromyalgia and myofascial pain syndrome to tendinopathies, bursitis, systemic lupus erythematosus, and spondyloarthropathies – is grouped into a residual category known as “other musculoskeletal disorders” (other MSDs). Importantly, these are not captured as long-term sequelae of injuries and often include non-traumatic, systemic, and stress-related conditions.

Looking Back: Limited Data Before 2000
For most of the 20th century, there are no comprehensive global datasets that separate “other MSDs” from the rest. Diagnostic coding systems were less standardised, and many of these conditions were either under diagnosed, misclassified, or overshadowed by injury-related and degenerative MSDs. Their recorded numbers were low – not necessarily because they were rare, but because they didn’t stand out in the data or were subsumed under broader, ill-defined categories.

It is therefore reasonable to assume that their proportion in earlier decades was both under-recognised and under-reported. Chronic, non-traumatic MSDs were simply not a statistical priority in an era where infectious disease and acute injury dominated health concerns.

What the Data Shows Since 1990
From 1990 to 2019, “other MSDs” increased in disability burden (DALYs) by 129%, compared with just 47% for low back pain. In prevalence terms, they now account for around 26–27% of all MSD cases worldwide (453 million out of ~1.71 billion in 2019/2021).

This faster growth suggests that other MSDs are taking up a larger slice of the total MSD burden – and projections indicate the trend will continue. The Lancet Rheumatology 2023 study forecasts that by 2050, “other MSDs” will more than double to 1.06 billion cases, roughly one-third of all MSDs.

Why This Matters
Many “other MSDs” are non-traumatic and systemic, often linked to chronic stress and autonomic dysregulation (Hallman and Lyskov, 2012a,b). Their rise reflects changes in lifestyle, work patterns, and psychosocial demands – a shift that traditional biomechanical treatment models were never designed to address.

For manual therapists, this is both a warning and an opportunity:

• The caseload is changing.
• Recognition and early intervention in non-traumatic MSDs will be critical.
• Integrating regulation-first strategies could be the key to meeting the needs of the 21st-century patient.

Abstract

Dysautonomia is currently described as an umbrella term for a variety of medical conditions involving dysfunction of the autonomic nervous system (ANS). The ANS is known to regulate numerous involuntary physiological processes such as heart rate, blood pressure, digestion, pupil dilation, kidney function, and thermoregulation. However, these functions do not occur through isolated ANS activity; they depend on dynamic interactions with other autonomic regulatory systems, notably the central autonomic network, the neuroendocrine system, and the immune–inflammatory system. Given this inherent interconnectedness, it is scientifically insufficient and clinically limiting to reduce dysautonomia exclusively to ANS dysfunction. This is especially the case to explain the full spectrum of stress-related physiological disorders where such reductionism fosters diagnostic fragmentation and therapeutic inefficiency. Drawing from clinical experience and current scientific literature, this paper argues for reframing dysautonomia as a systemic regulatory failure within the Extended Autonomic Regulatory System – to better reflect the complex pathophysiology of dysautonomic conditions seen in practice.

Background

Dysautonomia is currently described as an abnormality in the function of the autonomic nervous system (ANS) (Reichgott, 1990), encompassing a wide range of clinical manifestations including musculoskeletal disorders, respiratory difficulties, heart palpitations, chest discomfort, digestive dysfunction, lightheadedness, and nausea, among others. However, viewing these processes exclusively through the lens of ANS dysfunction neglects their integration within broader regulatory frameworks, notably the central autonomic network (CAN), the neuroendocrine system (NE-S), and the immune–inflammatory system (IIS). Because the ANS does not function independently of these systems, limiting the conceptualisation of dysautonomia solely to the ANS undermines both diagnostic accuracy and therapeutic effectiveness.

Clinically complex, multisystemic presentations frequently lead to mismatches in diagnosis and treatment. For instance, a patient presenting with the previously mentioned ANS-related symptoms – alongside additional issues such as brain fog, cognitive decline, insomnia, hormonal imbalances, and muscle or joint aches – often fails to meet traditional ANS-centric diagnostic criteria for dysautonomia. Yet, when assessed through the broader autonomic regulatory framework that incorporates the CAN, NE-S, and IIS, such presentations clearly fit within the scope of dysautonomia. Treatment strategies designed within this expanded autonomic perspective consistently yield improved and accelerated patient outcomes. Conversely, focusing solely on ANS-related symptoms and separately addressing additional manifestations – such as cognitive decline through psychopharmacology and psychotherapy – typically results in limited efficacy, symptom exacerbation, and the emergence of additional symptoms over time.

Consequently, redefining dysautonomia as a systemic regulatory disorder encompassing multiple interdependent physiological systems will enhance diagnostic accuracy, facilitate targeted treatments, and improve overall patient outcomes. Adopting this systemic approach promises faster patient recovery and significant cost reductions for healthcare systems.

Current Research Paradigm and Limitations

Contemporary dysautonomia research remains predominantly neurocentric, with a strong emphasis on ANS biomarkers such as heart rate variability, baroreflex sensitivity, and vagal tone, and interventions targeting these markers. Although these biomarkers and interventions have clinical significance, their isolated application neglects the broader systemic interactions integral to ANS function. Consequently, this limited perspective inadequately addresses the complex multisystem dysregulation commonly observed in clinical practice.

Complex clinical presentations characterised by multiple unexplained symptoms, such as persistent fatigue, cognitive impairment, diffuse musculoskeletal pain, and other hallmark features frequently observed (but not exclusively) in long COVID, highlight significant gaps in current diagnostic and therapeutic approaches. Patients presenting multisystemic patterns are often misdiagnosed or unjustly categorised as psychosomatic. While these symptoms can, if observed within the EARS, clearly have a biological basis.

In my practice, I frequently encounter patients who are referred to psychologists when medical examinations and diagnostic tests yield inconclusive results. One other common recommendation is to try vagal stimulation, as the reductionist approach suggests that certain symptoms may be associated with the imbalance between sympathetic and parasympathetic activity. Restoring the balance through stimulating vagal activity is then the rationale. However, in my experience – listening closely to patients – vagal stimulation has often led to a worsening of symptoms in nearly all who have tried it. I believe this is because isolated vagal stimulation does not necessarily result in sympathetic downregulation. As a result, both sympathetic and parasympathetic activity can become simultaneously upregulated.

This observation has reinforced my belief that narrowing dysautonomia to solely the autonomic nervous system is an inappropriate approach. Such a narrow definition often leads to treatment mismatches, resulting in paradoxical autonomic responses and exacerbating systemic dysregulation rather than alleviating symptoms.

Furthermore, the fact is that the ANS does not function in isolation; it operates under the regulatory influence of the CAN, the NE-S, and the IIS. Therapeutic approaches that disregard these broader regulatory interactions frequently result in suboptimal or counterproductive outcomes.

In summary, the principal limitations of the current dysautonomia research paradigm include:

• Underestimation of the regulatory complexity inherent in chronic, multisystem conditions.
  
• Fragmented therapeutic interventions that lack systemic coherence and effectiveness.
• Reinforcement of diagnostic silos, complicating accurate diagnosis and effective management of multisystem symptomatology.
• Treatment mismatches.

The Extended Autonomic Regulatory System

Recent efforts to broaden the understanding of autonomic regulation have emerged, notably Goldstein's "Extended Autonomic System" (2021, 2024). Building upon and refining these foundations, I introduce the concept of the Extended Autonomic Regulatory System to highlight the necessity of systemic regulatory coherence rather than isolated nerve signalling.

EARS comprises:

• Central Autonomic Network: Brain regions integrating interoception, visceromotor control, and affective regulation.
  
• Autonomic Nervous System: Sympathetic, parasympathetic, and enteric branches.
• Neuroendocrine System: Primarily the hypothalamic–pituitary–adrenal (HPA) axis.
• Immune–Inflammatory System: Including both innate and adaptive immune responses and inflammatory signalling pathways.

These components function as an interconnected regulatory matrix, dynamically modulating each other to maintain physiological homeostasis in response to internal and external stressors.

Dysautonomia as Multi-System Dysregulation

Patients frequently present with sudden-onset musculoskeletal pain or depression like symptoms or general malaise without clear triggers. These symptoms often coexist with insomnia or fragmented sleep, heart palpitations or fluttering sensations disconnection from self, gastrointestinal disturbances, fatigue or low energy, hormonal imbalances, unexplained (low-grade) fevers, bloating, wondering symptoms, flare-ups or relapses. Seemingly these symptoms seem unrelated and often put down to stress seen some of the symptoms. Diagnosis done stress is then in itself narrowed to the ANS. The ANS does’t explain all the symptoms but a let’s see attitude is often seen or treated separately with prescribed rest, medication and psychotherapy. 

While seen from the broader EARS model all can be related and diagnosed and treated accordingly not as separate symptoms but as symptoms with one origin that probably is stress-related.

Clinical Implications and the Reaset Approach

Recognising systemic dysregulation necessitates interventions capable of restoring coherent regulatory interactions across the EARS. The Reaset Approach exemplifies such a systems-level therapeutic model, employing body-centred, sensory-based techniques to facilitate systemic regulation.

This approach does not require precise localisation of dysfunction but aims to recalibrate overall system coherence. Clinically, patients with functional dysautonomia frequently respond positively within one or two sessions, provided no structural lesion has developed.

Functional Dysautonomia vs. Autonomic Lesion

A critical distinction must be acknowledged:

• Functional dysautonomia: Dynamic, reversible regulatory imbalance responsive to interventions like the Reaset Approach.
  
• Autonomic lesion: Structural or degenerative pathologies resulting from prolonged dysregulation or underlying diseases (e.g., neurodegenerative, autoimmune).
  

Distinguishing between these two entities is essential to ensure appropriate clinical management, as misclassification risks ineffective treatment strategies.

Future Directions for Research

The EARS model opens several avenues for future interdisciplinary investigation:
Detailed mapping of interactions among EARS components in various dysautonomic conditions.

Identification of robust biomarkers indicative of systemic dysregulation.
Systematic assessment of therapeutic interventions (manual therapy, lifestyle modification, pharmacological agents) on systemic regulatory coherence.

Such research promises not only more effective interventions but also deeper insights into the fundamental mechanisms underlying systemic adaptive processes.

Conclusion

To address the growing burden of dysautonomic conditions effectively, we must transition from a neurocentric model towards a comprehensive, systems-level understanding. The EARS framework articulated here offers a robust conceptual foundation for future research, diagnosis, and treatment, aligning clinical practice with physiological complexity. This evolution is imperative, scientifically justified, and ethically necessary in an era of increasingly prevalent stress-related disorders.

Abstract

The widely used phrase ‘fight, flight, or freeze’ has long shaped our understanding of the stress response. However, this tripartite model oversimplifies the dynamic and multi-layered nature of human defensive behaviours. Drawing from evolutionary biology, trauma theory, and autonomic neuroscience, this conceptual paper proposes a refined vocabulary: ‘fright’ (initial orienting alertness) and ‘flop’ (collapsed immobility) are added to the sequence, while ‘freeze’ is reframed to refer specifically to the hypertonic rigidity of tonic immobility. These adaptations, closely aligned with the defence cascade outlined by Kozlowska et al. (2015), aim to improve clinical clarity for manual therapists who encounter patients with stress-related autonomic dysregulation.

Introduction

The stress response is a fundamental adaptive process that enables organisms to respond to both threats and demands. In evolutionary terms, these demands were often immediate and life-threatening, requiring rapid mobilisation of physiological and behavioural resources. Today, many modern stressors – while not directly life-threatening – still trigger the same ancient systems, creating a mismatch between biology and environment.

Traditionally summarised as “fight, flight, or freeze,” the stress response has become part of common language. Yet this simplification conceals important distinctions between different states of defensive activation and immobilisation. As Kozlowska et al. (2015) demonstrated, the human defence response is better understood as a branching, context-dependent cascade that includes multiple forms of immobility, each with distinct neurophysiological features. 

This paper proposes a refinement of this model by:

• Introducing fright as the initial orienting response to a potential threat or demand;
• Reserving freeze for tonic immobility (a hypertonic state);
• Using flop to describe collapsed immobility (a hypotonic, parasympathetic-dominant state).
• Noting fawn as a behaviourally learned appeasement response with distinct features.

From Cannon to Kozlowska: An Evolving Model

Walter Cannon (1915) laid the foundation for modern stress theory by describing the fight-or-flight response. Later, the idea of a “freeze” response was added to account for immobility under threat – popularised through trauma research (van der Kolk, 2014) and survival literature (Levine, 1997). Yet over time, “freeze” became a catch-all term, blurring the distinction between immobilised states driven by muscle tension and those marked by flaccidity and shutdown.

Kozlowska et al. (2015) clarified this confusion by identifying six distinct stages of the defence cascade:

1. Arousal – heightened alertness and orientation,
2. Fight or Flight – active sympathetic mobilisation,
3. Freezing – motor inhibition with high muscle tone,
4. Tonic Immobility – involuntary rigid stillness, often with dissociation,
5. Collapsed Immobility – hypotonic, flaccid state linked to dorsal vagal dominance.
6. Quiescent Immobility – a state of restorative stillness after threat passes.

In this paper, we reframe “arousal” as fright, “tonic immobility” as freeze, and “collapsed immobility” as flop to better reflect both clinical experience and pedagogical clarity. Fawn is also mentioned as an additional behaviourally conditioned state.

The Updated Sequence: Fright, Fight or Flight, Freeze or Flop (Fawn and Quiescent)

Fright - The initial orienting phase – marked by high alertness, vigilance, and activation of the amygdala and periaqueductal grey – is what we propose to call fright (Fanselow, 1994). This precedes active responses and prepares the organism to assess risk or respond.

Fight or Flight - When escape or resistance is possible, sympathetic activation drives either mobilisation (flight) or confrontation (fight) (Cannon, 1915). This state is metabolically expensive and linked to increased heart rate, blood pressure, and muscle perfusion.

Freeze – Freeze, as redefined here, refers to tonic immobility – a state of motor inhibition with sustained high muscle tone. Though the body appears still, it is physiologically braced, often with co-activation of sympathetic and parasympathetic systems (Roelofs, 2017). Clinically, this may appear as rigid posture, holding patterns, or internal “stuckness.”

Flop – When neither escape nor defence is viable, the system may enter flop – a parasympathetic-dominant, hypotonic state akin to collapsed immobility. This is mediated by the dorsal vagal complex and often presents as limp, passive, unresponsive behaviour. While a patient muscles feel relaxed, it reflects a profound state of autonomic withdrawal and disconnection (Marx et al., 2008; Kozlowska et al., 2015).

Fawn - A behavioural defence strategy characterised by appeasement, people-pleasing, or compliance in response to perceived threat or relational instability (Walker, 2013). It reflects a learned psychological adaptation that may mask underlying autonomic dysregulation, though this remains under-researched. 
Quiescent Immobility – The sixth stage, quiescent immobility, reflects a post-threat restorative state, promoting healing and integration. This state is mentioned here for completeness but is not the focus of this paper.

Clinical Relevance: Freeze ≠ Flop

From a clinical standpoint, freeze and flop may appear similar but represent very different states. A patient in a freeze state may still function outwardly, but internally experience immobilisation and rigidity. Their muscles feel tense, their breath may be held, and they report being “stuck.”

In contrast, patients in a flop state may walk and talk, yet present with hypotonic muscles, poor responsiveness, and symptoms of resignation, hopelessness, fatigue, or depression. This can be easily misinterpreted as relaxation, when in fact it reflects parasympathetic dominance and loss of adaptive capacity.

Recognising this difference is critical. Manual therapists must move beyond the false assumption that softness equals relaxation and that all is well. Tense muscles may reflect a defensive brace (freeze), while soft ones may signal autonomic withdrawal (flop). Misreading these states can lead to inappropriate treatment strategies.

Implications for Manual Therapists and Body-Centred Practitioners

For osteopaths, physiotherapists, and other body-centred therapists, this refined terminology helps bridge psychophysiological theory with hands-on practice. The Reaset Approach (Meyers, 2014, 2019), for example, prioritises autonomic regulation – recognising that structural and functional interventions have limited effect when the nervous system is dysregulated.

Understanding the differences between fright, freeze, and flop allows practitioners to:

• Better assess the patient’s underlying autonomic state,
  
• Avoid mistaking parasympathetic collapse for relaxation,
• Tailor interventions to support recovery from dysregulation,
• And restore a sense of safety before structural correction.

Conclusion

The classical model of “fight, flight, or freeze” no longer suffices to capture the complexity of human stress responses. By refining the vocabulary to include fright and flop, and by clarifying the definitions of freeze and collapse, we move towards a more accurate, clinically useful framework. These distinctions are not just academic – they are essential for effective diagnosis, communication, and care.

As our understanding of autonomic regulation deepens, so too must the language we use to describe it. A clear, precise vocabulary helps clinicians align interventions with the patient’s true physiological state – improving outcomes and restoring balance where it begins: in the body.

References

• Cannon, W. B. (1915). Bodily changes in pain, hunger, fear and rage. New York: Appleton.
  
• Fanselow, M. S. (1994). Neural organization of the defensive behavior system responsible for fear. Psychonomic Bulletin & Review, 1(4), 429–438. https://doi.org/10.3758/BF03210947
  
• Gallup, G. G. (1977). Tonic immobility: The role of fear and predation. The Psychological Record, 27(1), 41–61.
• Kozlowska, K., Walker, P., McLean, L., & Carrive, P. (2015). Fear and the Defense Cascade: Clinical Implications and Management. Harvard Review of Psychiatry, 23(4), 263–287. https://doi.org/10.1097/HRP.0000000000000065
  
• Marx, B. P., Forsyth, J. P., Gallup, G. G., Fusé, T., & Lexington, J. M. (2008). Tonic immobility as an evolved predator defence: Implications for sexual assault survivors. Clinical Psychology: Science and Practice, 15(1), 74–90.
  
• Meyers, T. (2014). The effect of the Reaset Approach on the autonomic nervous system, state-trait anxiety and musculoskeletal pain in patients with work-related stress: A pilot study [BSc thesis]. Dresden: Dresden International University in cooperation with Osteopathie Schule Deutschland. Available from: https://drive.google.com/file/d/19P_mKjKx4YG0p6VijTnl6wHXaUGknvVm/view
  
• Meyers, T. (2019). The effect of the “Reaset Approach” on the autonomic nervous system, neck-shoulder pain, state-trait anxiety and perceived stress in office workers: A randomised controlled trial [MSc thesis]. Dresden: Dresden International University in cooperation with Osteopathie Schule Deutschland. Available from: https://drive.google.com/file/d/14ElvJBLRwAbZvQm20ydg9X5oEWRJD_0E/view
  
• Porges, S. W. (2011). The polyvagal theory: Neurophysiological foundations of emotions, attachment, communication, and self-regulation. W. W. Norton & Company.
• Roelofs, K. (2017). Freeze for action: Neurobiological mechanisms in animal and human freezing. Philosophical Transactions of the Royal Society B, 372(1718), 20160206. https://doi.org/10.1098/rstb.2016.0206
  
• van der Kolk, B. (2014). The body keeps the score: Brain, mind, and body in the healing of trauma. Penguin Books.
• Walker, P. (2013). Complex PTSD: From surviving to thriving: A guide and map for recovering from childhood trauma. Azure Coyote. 

This article was written by Tom Meyers with the assistance of ChatGPT, blending personal insights and advanced AI support to create a compelling and impactful message.

Introduction

Since its inception, osteopathy has positioned itself as a treatment guided by reason rather than rule – focusing not on suppressing symptoms but on identifying and addressing the underlying cause of disease. Developed by Dr Andrew Taylor Still in the late 19th century, the profession emerged as a drug-free, hands-on approach to health, grounded in the belief that the body possesses inherent structural and physiological capacities for self-regulation and healing.

While grounded in osteopathy’s founding principles, the concepts explored in this article extend beyond osteopathy to inform manual therapy more broadly. Practitioners across disciplines – including physiotherapists, chiropractors, and integrative bodyworkers – are increasingly confronted with patients whose symptoms are not the result of physical trauma, but of chronic psychosocial stress. The patterns of a.o. musculoskeletal pain, fatigue, brain fog, and emotional distress they observe reflect persistent stress-related dysfunctions in regulatory systems, which in turn give rise to both physical and mental health conditions. Accordingly, this article contributes not only to the evolution of osteopathic reasoning, but also to a broader re-evaluation of clinical priorities across manual therapy in response to the health challenges of the 21st century.

At the heart of Dr A.T. Still’s philosophy was a deep appreciation for the interconnectedness of bodily systems, and his writings reveal a clinical method that began with identifying mechanical disruptions as the root cause of dysfunction. Structural interventions, in this context, were never an end in themselves. Rather, they served to liberate physiological processes – by restoring blood flow, relieving neural obstructions, and re-establishing what Dr A.T. Still described as the flow of “vital force.” As Lewis (2012) summarises, “The aim of treatment was not simply to normalise deranged structure but… to free nerve and blood supply… the vital force.” This emphasis on structure as a gateway to regulation reflected the health challenges of his time, where trauma, infection, and mechanical lesions were dominant.

Today, however, the landscape has changed. While structural dysfunction remains clinically relevant, many modern physical and mental health conditions arise primarily from chronic psychosocial stress. This stress disrupts the Central Autonomic Network (CAN), the Autonomic Nervous System (ANS), the Neuroendocrine System (NE-S), and the Immune–Inflammatory System (IIS), impairing the body’s adaptive capacities and contributing to functional somatic syndromes, mood disorders, and autoimmune conditions – even in the absence of structural pathology.

In light of this shift, the therapeutic sequence originally proposed by Dr A.T. Still warrants reconsideration. Emerging clinical and scientific evidence suggests that regulation – due to the changing aetiology of health problems – must now take precedence.
This article therefore proposes an evolution in osteopathic and broader manual therapy reasoning – one that explicitly recognises regulation as a foundational pillar alongside structure and function. By positioning regulation not merely as a by-product of structural correction but as a primary therapeutic focus, osteopathy and other manual therapy approaches can better meet the complex, stress-related challenges of modern healthcare. This reframing preserves the profession’s philosophical roots while advancing its scientific precision, clinical logic, and relevance in contemporary practice.

A Historical View: Self-Regulation in Dr A.T. Still’s Philosophy

While Dr A.T. Still never used modern terms like “autonomic nervous system” or “homeostasis,” his writings clearly reveal a deep appreciation for what we would now recognise as systemic regulation. Central to his philosophy was the idea that health depended on the unimpeded flow of vital forces throughout the body – primarily through the arterial system, but also via the nerves and cerebrospinal pathways. He famously stated, “The rule of the artery is supreme,” (Dr A.T. Still, 1902, p. 36) reflecting his conviction that vascular integrity was essential for physiological balance.

Dr A.T. Still also emphasised that if a part of the body was “shut off from the nerve current,” it would become diseased – highlighting his belief in the necessity of free neural transmission for health. In The Philosophy of Osteopathy (1899,p. 19), he wrote: “The cerebrospinal system is the source of all the vital forces… the centre from which vitality is dispensed to all parts of the body.”

Although framed in the language of vitalism, these observations reveal a systems-based perspective in which the nervous, vascular, and cerebrospinal systems worked together to coordinate health. Dr A.T. Still saw the nervous system not merely as a communication highway, but as a governing principle capable of influencing and regulating the entire organism. He further noted: “No artery, vein, or nerve is built wrongly. Nature makes no mistakes in their location, length, or purpose. When a part of the body is shut off from the nerve current, that part is sick.” (Still, 1899, p. 163)

To Dr A.T. Still, disease was the result of obstruction – not only physical, but functional. He believed that when the circulatory or neurological pathways were disrupted, the body lost its capacity to regulate and heal itself. Manual intervention, therefore, was not just about correcting structural misalignments, but about restoring what he considered the vital flow of ‘life force’ – which we might now interpret as regulatory signalling across integrated physiological systems.

It is therefore evident that regulation – though not explicitly termed as such – was foundational in Still’s vision. However, as osteopathy became more formalised, particularly in the mid to late 20th century, its focus increasingly shifted toward biomechanics and the structural model as therapeutic priorities in their own right. In Europe especially, this transition was reinforced by the alignment of osteopathic education with physiotherapy programmes, which often prioritised orthopaedic reasoning and manual techniques grounded in anatomical and kinesiological frameworks. While this alignment brought scientific legitimacy and broader professional recognition, it also contributed to sidelining the subtle, systems-oriented view of regulation that underpinned Dr A.T. Still’s original philosophy.

The Structure–Function Tenet: A Posthumous Codification

One of the key principles on which osteopathy is based today – “structure and function are reciprocally interrelated” – was not introduced by Dr A.T. Still himself. It emerged in the early 20th century as part of efforts to codify osteopathic principles and distinguish the profession from allopathy and chiropractic. While aligned with Dr A.T. Still’s holistic perspective, the tenet came to emphasise the dynamic interplay between anatomical structures (such as bones, muscles, and organs) and the specific physiological functions of those parts.
It helped osteopathy gain legitimacy in scientific and academic circles, aligning it more closely with anatomy, kinesiology, and pathology. However, this codification may have inadvertently reduced the richness of Dr A.T. Still’s original philosophy – especially his emphasis on regulation.

Today, many osteopaths continue to work within a structure–function principle grounded in 19th- and 20th-century kinesiological and biomechanical frameworks – often without accounting for the evolving aetiology of contemporary health conditions, many of which no longer stem from physical trauma but from an evolutionary mismatch between biology and culture, resulting in chronic disruptions of autonomic regulation.

The Modern Mismatch: Chronic Stress, Dysautonomia, and Loss of Adaptability

We live in a world vastly different from that of Dr A.T. Still and the context in which The Osteopathic Concept was published in 1953. Today’s predominant health challenges – including musculoskeletal pain – are no longer primarily rooted in physical trauma or anatomical lesions. Instead, they increasingly stem from chronic psychosocial stress and its impact on the body’s ability to regulate itself. This results in persistent maladaptive patterns across the EARS.

In Why Zebras Don’t Get Ulcers, neuroscientist and stress researcher Robert Sapolsky outlines how chronic stress affects the body’s regulatory systems:

• Dysregulation of the CAN
  
• Overactivation of the HPA axis and cortisol dysrhythmia (NE-S)
• Sympathetic dominance or vagal withdrawal (ANS)
• Disrupted circadian rhythms, immune activation, and emotional dysregulation (IIS)

and how this translates into:

• Musculoskeletal pain without trauma, headaches, digestive problems…;
  
• Non-restorative sleep, brain fog, emotional lability, anxiety and depression;
• Digestive disturbances, palpitations, fatigue, or medically unexplained symptoms and multimodal disorders without clinical explanation.

Symptoms once attributed to mechanical dysfunctions are now understood, in many cases, as expressions of chronic stress-related dysautonomia. In prolonged cases, this can culminate in what I define as an autonomic lesion – a persistent dysfunction in the body’s regulatory hierarchy (CAN, ANS, NE-S, and IIS), where neural circuits have undergone structural and functional changes that do not self-correct without targeted therapeutic intervention aimed at re-establishing regulatory coherence.

If the origin of disease has shifted from predominantly physical causes to disturbances in regulatory function, and if – as Dr A.T. Still asserted – treatment must be guided by reason rather than rule, then the osteopath’s search for causality can no longer begin solely with structural analysis. Focusing exclusively on the structure–function relationship risks overlooking the true onset in many modern cases. In today’s evolving clinical landscape, diagnostic reasoning and therapeutic intervention must also consider the level of regulation – depending on the patient’s history, presenting symptoms, and the context revealed during anamnesis. 

In light of this shift, it becomes necessary to critically reconsider the scope of the structure–function principle.

Expanding the Structure–Function Paradigm: A Case for Making Regulation Explicit

However, rather than discarding the structure–function principle, this article proposes an evolution of it – one that explicitly integrates regulation as a foundational dimension within the structure–function interrelationship.

By positioning regulation at the base of an inverted clinical pyramid, we affirm its foundational role in supporting structural and functional integrity – particularly in the context of 21st-century health challenges driven by chronic stress and systemic dysregulation. This reframing gives rise to a revised clinical hierarchy:

• Regulation – Restore autonomic balance, coherence, and adaptability
• Structure – Address restrictions, lesions, and anatomical dynamics
• Function – Enable structures to perform their physiological roles effectively

In other words, when symptoms arise from autonomic dysfunction or what can be termed an autonomic lesion – the root cause – regulation must be addressed first, prior to treating the structural and functional consequences. In fact, restoring regulatory balance may prove beneficial as the initial step in any therapeutic process, regardless of the perceived onset of the patient’s condition.

Expanding the traditional structure–function principle to explicitly include regulation responds to the pressing demands of our fast-changing and stress-laden world. The primary impact of modern challenges is often not structural in nature but regulatory – disrupting the body’s ability to adapt and maintain balance. This evolution has relevance beyond osteopathy and extends to the broader field of manual therapy. It invites physiotherapists, chiropractors, craniosacral therapists, and practitioners of fascia-focused modalities to re-evaluate their treatment priorities and integrate regulatory assessment as a core component of care.

Summary: Why Regulation Must Be Made Explicit

Because it honours Dr A.T. Still’s original vision
Dr A.T. Still taught that osteopathic practice was not to be governed by rules, but by two complementary principles: cause and effect, and nature’s inexorable drive to express health. In other words, treatment must be guided by reason. Given the shifting origin of disease from physical trauma to regulatory dysfunction, it is reasonable to conclude that restoring the body’s inherent healing capacity must now begin with regulation – the very source of imbalance in most modern health problems. Integrating regulation as a clinical pillar also aligns with Still’s enduring tenet that “the rule of the artery is supreme.” Today, it is not structural obstruction but autonomic dysregulation that most often compromises blood flow. To remain faithful to Still’s vision of enabling the body to heal itself, we must recognise that in the 21st century, liberation begins not with structure, but with the restoration of regulatory coherence. Regulation is now the logical starting point for clinical reasoning and therapeutic intervention.

Because it aligns with the lived experience of patients
In contemporary clinical practice, patients increasingly present without a clear or identifiable onset of symptoms. Complaints often arise abruptly – sometimes overnight or following routine physical activity – and are frequently accompanied by multiple, seemingly unrelated symptoms. It is now common for musculoskeletal discomfort to occur alongside fatigue, cognitive fog, emotional lability, tension, or a sense of disconnection. Such multimodal symptom patterns seldom reflect isolated biomechanical dysfunctions. Rather, they suggest disturbances in the body’s regulatory systems, frequently linked to sustained psychosocial stress. This stress – driven by a growing mismatch between human biology and modern cultural environments – disrupts autonomic, neuroendocrine, and immune balance. By explicitly integrating regulation into clinical reasoning, manual therapists can more effectively identify the root causes of dysfunction and align their diagnostic and therapeutic strategies with the complex realities of 21st-century health – ultimately enhancing both treatment precision and patient outcomes.

Because health depends on regulation
Before physiological function can improve – and before structural corrections can hold – the body must be capable of adapting and manage change. This adaptive capacity is governed by the integrity of its regulatory systems. When these systems are dysregulated, even the most skilful manual interventions risk being temporary or ineffective. True therapeutic progress requires first restoring coherence within the EARS, allowing the body to re-establish internal balance and respond constructively to further treatment. In this light, regulation is not secondary – it is the precondition for healing.

Conclusion

Making regulation explicit within osteopathic thinking is not a departure from tradition – it is a refinement and maturation of it. Although Dr A.T. Still may not have used the term regulation, his writings consistently emphasised the vital role of neurological, circulatory, and systemic coordination in sustaining health. He also never claimed that all disease was caused by bony displacements. On the contrary, he acknowledged that his science would be incomplete “were it only concerned in irregularities in the framework,” recognising that other influences – including emotional shock, bereavement, loss of property or friends, and extremes of weather – could initiate or sustain abnormal functioning (Lewis, 2012).

In today’s evolving clinical landscape, shaped by chronic stress, dysautonomia, and an accelerating mismatch between biology and culture (i.e. environment), it is imperative that these broader contributors to dysfunction are brought to the forefront of clinical reasoning.
By adopting a triadic model of Regulation – Structure – Function, we take osteopathic philosophy back to its origin and align it with contemporary science, practice and the lived experience of patients. Adding regulation reflects the clinical reality that without autonomic coherence and systemic adaptability, structural interventions often fail to yield sustainable functional change.

This represents not a semantic adjustment, but a necessary paradigm shift in clinical reasoning and practice. In an era where pathology is increasingly rooted in dysregulation rather than anatomical lesion, the capacity for dynamic regulation emerges as the cornerstone of resilience, adaptability, and recovery.

To honour osteopathy’s original commitment to treating the whole person and activating the body’s self-healing capacity, we must now add regulation as pilar for care – not as an afterthought, but include it explicitly to the structure-function principle as the active interface between environment, adaptation, and health. In doing so, we ensure that osteopathy – and manual therapy more broadly – continues to evolve in both relevance and rigour: grounded in history, but responsive to the physiological and psychosocial realities of the 21st century.

ABSTRACT
This commentary explores the concept of autonomic asymmetry – particularly the role of rightward hemispheric dominance in maintaining heightened sympathetic tone – and how it may contribute to lateralised tension patterns in the body. Drawing on long-term clinical observations by the author, developed over many years of osteopathic practice and during the creation of The Reaset Approach – a method prioritising body-centred autonomic regulation before addressing structural and functional somatic dysfunctions – recurring right-sided somatic dysfunctions were observed in patients presenting with suspected stress-related dysautonomia or autonomic lesions. These patterns align with theoretical models such as the Bihemispheric Autonomic Model, which links traumatic stress to hemispheric imbalance and prolonged autonomic dysregulation. If autonomic asymmetry indeed contributes to lateralised tension patterns in the body, this perspective could offer a valuable diagnostic lens – particularly for identifying stress-related musculoskeletal disorders rooted in dysautonomia or autonomic lesions. Recognising such patterns may help prevent treatment mismatch by distinguishing stress-related musculoskeletal disorders – those less likely to respond to conventional biomechanical interventions – from biomechanical disorders that do, thereby enabling a more effective therapeutic strategy to be initiated from the outset.

In our fast-changing world, an unspoken fear lingers in many minds: Are we ready for what’s coming? The rapid pace of technological advancement, societal upheaval, and environmental challenges has left many feeling overwhelmed, uncertain, and disconnected. This anxiety often remains unspoken, yet it shapes our behaviour, relationships, and health. But what if we could face the future not with fear, but with purpose? What if we could adapt, flourish, and thrive in this evolving world by addressing the biopsychosocial and evolutionary roots of the crises we face? This is the vision behind Homo Evolopsis—the self-evolving human—a term I coined to explore how humanity must intentionally evolve to navigate the complexities of our rapidly changing world with clarity, resilience, and purpose, and to define my role in fostering this transformation.

The Hidden Fear: Losing Control in a World of Change

Beneath the surface of modern life lies a growing unease. As technology accelerates, the climate shifts, and social tensions escalate, many people feel they’re being swept along by forces they can’t control.

1. Technology: Will AI and automation replace our value as humans?

Solution: Building resilience helps us adapt to technological shifts, ensuring we see change not as a threat but as an opportunity to innovate and thrive.

2. Stress: How do we cope with the endless demands of modern life?

Solution: Cultivating a sense of purpose gives us clarity and direction, enabling us to navigate stress with intention rather than being overwhelmed by it.

3. Climate Crisis: Are we powerless to stop the environmental degradation threatening our future?

Solution: By reconnecting with ourselves and others, we can foster sustainable behaviours that align with the well-being of humanity and the planet.

4. Social Upheaval: How do we navigate increasing polarisation, inequality, and instability?

Solution: Taking purposeful action allows us to move beyond fear and into collaborative solutions for the collective challenges we face.

These concerns, though daunting, are not insurmountable. When we strengthen our resilience, live with purpose, reconnect with ourselves, and act with intention, we can meet these challenges head-on, building a future where humanity flourishes and thrives.

A Solution Rooted in Intentional Evolution

We don’t have to be passive participants in this fast-changing world. Instead, we can take an active role in shaping our future—both individually and collectively. This is the essence of Homo Evolopsis: the deliberate process of evolving with intention and purpose. It is about embracing personal growth, adaptability, and progress not just for survival but for thriving in an ever-changing world.
Intentional evolution involves strengthening key pillars that guide us through uncertainty:

• Resilience: Building the capacity to adapt to change without losing balance.
• Purpose: Living with clarity about who we are and where we’re going.
• Connection: Reuniting the body and mind to navigate challenges with ease.
• Action: Recognising that our internal states—our stress, fear, and disconnection—are deeply linked to external crises like climate change and societal unrest.

At the heart of these pillars lie Futurizing Yourself and The Reaset Approach. Futurizing Yourself provides the mental anchor that strengthens resilience and guides purposeful action. By fostering a stronger connection with your future self, it helps align today’s decisions with long-term aspirations, empowering individuals to navigate change with clarity and intention.

The Reaset Approach, on the other hand, is an innovative manual therapy method designed for manual therapists to incorporate into their treatments. It helps individuals re-establish balance within their autonomic nervous system, fostering a state of ease and connection that supports resilience and well-being.

Together, these approaches offer the biopsychosocial and spiritual support needed to flourish and thrive in a fast-changing world, contributing to the evolution of Homo Evolopsis—the self-evolving human.

The Four Essential Needs in a Changing World

1. Resilience

The Challenge: As the pace of change accelerates, people often feel unprepared to adapt without becoming overwhelmed. Stress and uncertainty erode mental, emotional, and physical balance, leaving individuals vulnerable to burnout.

The Solution: Futurizing Yourself helps people build the capacity to adapt to change while staying grounded. This involves forward-thinking practices that align vision, values, and actions with the demands of a rapidly changing environment. By consciously shaping your approach to the future, you cultivate resilience and a calm adaptability.

2. Purpose

The Challenge: Many people feel lost in the noise of modern life, disconnected from their values and uncertain about their direction. Without clarity about who we are and where we’re going, we struggle to make meaningful decisions.

The Solution: Futurizing Yourself provides tools for living with clarity and intention. By exploring your potential and defining your goals in alignment with your values, you can navigate the future with confidence and a strong sense of purpose. This empowers you to flourish and thrive, even in times of uncertainty.

3. Connection

The Challenge: Disconnection from our bodies, minds, and emotions is increasingly common in a world of overstimulation, digital distractions, and relentless demands. This fragmentation makes it harder to navigate challenges or feel at ease.

The Solution: A treatment including The Reaset Approach re-establishes the vital connection between the body and mind. By focusing on reasetting the eANS, this method fosters balance and harmony, helping individuals to feel grounded and whole. A connected body-mind system is better equipped to handle life’s complexities with ease.

4. Action

The Challenge: Stress, fear, and disconnection prevent us from addressing larger external crises, such as climate change and societal unrest. When overwhelmed by internal struggles, we lose the clarity and capacity to act meaningfully.

The Solution: A treatment with The Reaset Approach empowers individuals to recalibrate their autonomic nervous system, alleviating pain and restoring balance. This renewed state of ease fosters clear thinking and a sense of agency, enabling effective engagement with external challenges. At the same time, Futurizing Yourself aligns today’s actions with long-term aspirations, helping individuals approach external crises with vision and purpose. When we take action with calm, connection, and clarity, we contribute to collective solutions like climate resilience, social harmony, and sustainable living.

Together, Futurizing Yourself and The Reaset Approach form a comprehensive framework for intentional evolution. This vision, embodied by Homo Evolopsis, empowers humanity to take control of its future.

Resilience and Purpose: Emphasising Self-Continuity

Resilience today is about more than bouncing back—it’s about bouncing forward. To do this, we must connect with our future selves. When we feel a strong sense of self-continuity, we’re more likely to invest in decisions that benefit us long-term.

For example, imagine your future self thriving in a world shaped by rapid change. How do you feel? What habits, relationships, or goals brought you there? This connection fosters emotional endurance and motivates actions today that align with your vision for tomorrow.
Similarly, a sense of purpose strengthens resilience by anchoring us to our values. When we align our present decisions with our future aspirations, we gain clarity and confidence. By futurizing yourself—actively envisioning your future self—you create a mental bridge that empowers you to make intentional choices in the present.

Connection and Action: The Wellbeing of Y’our Health

As we stand on the brink of unprecedented change, the question is not just how we will survive, but how we will flourish and thrive. To address the external crises we face—climate change, social instability, and the uncertainty of the future—we must first recognise their deep connection to our internal states.

A stressed and disconnected humanity remains trapped in survival mode, unable to think clearly about the future or its role in shaping it. In this state, the parts of the brain responsible for reasoning, planning, and envisioning the collective good are offline. However, a humanity grounded in ease, balance, and purpose can rise to the challenge. When balance is restored within, our capacity to think critically and act intentionally is reawakened.

Before we can futurize ourselves, we must first cultivate internal balance. This foundation allows us to approach the future with clarity, resilience, and the readiness to take meaningful action.

Navigate the challenges of the 21st century

We have a choice to make:

• To let the tides of technology, environmental crises, and social changes dictate our path.
• Or to take control, shaping our evolution with purpose, values, and humanity at the forefront.

We once shaped our environment to suit our needs; now, our environment compels us to reshape ourselves. By fostering conversations about our future—not from a perspective of fear, but from a place of intention and aspiration—we can focus on what we truly want, who we want to be, and who we wish to become. By minding our body before it reminds us and intentionally carrying it into the future, we can help humanity navigate this transition with greater ease. Not by becoming technology, but by learning to use it wisely. Not by succumbing to fear, but by acting with clarity, purpose, and connection.

A Call to Action: Questions to Shape Y’our Future

As we move forward, the question isn’t just how to survive the changes ahead—it’s how to thrive with intention, clarity, and connection. To begin shaping your future and humanity’s shared path, I invite you to reflect deeply and ask yourself:

• What do I want for myself—and for humanity?
• Who do I want to be in this evolving world?
• Am I living in alignment with my aspirations?
• How do I feel—right now?
• What action can I take today to connect with my future self?

These questions are your compass to intentional evolution. And as you reflect on them, ask yourself one final, pivotal question:

“What is one small step you can take today to create a future you’re proud to live in?”

Resilience, purpose, connection, and action are not abstract ideals—they are the practical keys to thriving in a fast-changing world. By asking the right questions and fostering clarity about who we are and who we want to become, we can shape a future that reflects our highest values. This is the essence of Homo Evolopsis—intentional evolution for individuals and humanity.

The Power of Intentional Evolution

Resilience, purpose, connection, and action are not abstract ideals; they are practical, actionable steps we can take to navigate a world that demands adaptability. The future isn’t something that happens to us; it’s something we create. By transforming ourselves, we lay the foundation for transforming our communities, societies, and planet.

Intentional evolution isn’t just about individual well-being—it’s about building a future where humanity thrives together. This is the essence of Homo Evolopsis: intentional evolution for individuals and humanity.

Let us face the future not with fear, but with purpose. Let us shape the future not through reaction, but through thoughtful action. And let us build a future not just for ourselves, but for all who come after us.

This article was written by Tom Meyers with the assistance of ChatGPT, blending personal insights and advanced AI support to create a compelling and impactful message.

I recently read that COVID-19 has left broader, lingering effects on the population. Research shows that many people who’ve had COVID-19 are now more prone to illness and recurrent health issues. However, these cases don’t qualify as long COVID, where symptoms persist over a prolonged period after infection.

In a flash, it dawned on me: from a certain perspective, COVID-19 has slowed us down—delaying recovery, tampering with our immune systems, affecting cognitive function, and reducing our capacity to adapt and manage change. And this is happening at a time when we need adaptability the most.

While our evolutionary pace has slowed, technology continues to accelerate the rate of environmental change. In my mind’s eye, I could see how the conflict between biology and culture is worsening, rather than closing.

I’m not a scientist but a practitioner. I hear from my patients how they feel less resilient and more prone to illness without a clear reason. They regularly develop musculoskeletal problems and other health issues, including mental health struggles, without fully understanding why.

Could it be that our biological resistance has slowed, while our stress response becomes more active in defence?

By Tom Meyers (Belgium, Osteopath D.O., Body-centred Stress Coach, Founder of The Reaset Approach and Author of Futurize Yourself and The Futures Effect.

Abstract

The concept of the myodural bridge has traditionally been limited to the connection between the sub-occipital muscles, the posterior atlantooccipital membrane, and the cervical dura mater. However, new observations suggest that these anatomical connections may extend throughout the entire cervical spine, involving multiple cervical muscles beyond those commonly discussed. This expanded understanding could have significant implications for health, particularly in managing stress-related disorders, chronic neck pain, and cervicogenic headaches. Further research into the presence of multiple myodural bridges at different cervical levels is recommended to confirm their existence and clinical relevance. Their role, particularly in stress-related conditions, may prove to be valuable in the treatment of a wide range of disorders that are currently classified as medically unexplained.

Introduction

For years, the myodural bridge has been described as a specialised anatomical connection with the dura mater located between the occiput and atlas (C0-C1) and occiput and axis (C0-C2). This relationship has primarily garnered interest in the context of cervicogenic headaches and upper cervical biomechanics. Recent research has also highlighted the crucial role of the posterior atlanto-occipital membrane (PAOM), which serves as a critical anchor for these bridges and merges with the craniocervical dura to stabilise the cervical region.

However, during a visit to the Body Worlds exhibition in Amsterdam, osteopath D.O. MSc Tom Meyers observed, while examining plastinated bodies, that these dural connections were not confined to the upper cervical region but appeared to extend throughout the cervical spine, involving other structures that had not previously been associated with myodural bridges. If so, these myodural bridges may have broader clinical relevance than previously thought, particularly, Meyers believes, in the management of stress-related disorders, chronic neck pain, and other neuromusculoskeletal conditions. This discovery calls for further research and may lead to new insights into medically unexplained symptoms, as well as new therapeutic applications.

New Anatomical Insights: Extending Beyond the Sub-Occipital Region

Beyond the Expected: Multiple Myodural Bridges Throughout the Cervical Spine
While the classical view of myodural bridges focuses on their connection to sub-occipital muscles such as the rectus capitis posterior minor and major, as well as the obliquus capitis superior and inferior, it is possible that other neck muscles, such as the semispinalis capitis and multifidus (extending from C2 to C7), also connect directly or indirectly to the dura mater.
Furthermore, the posterior atlanto-occipital membrane (PAOM) plays a critical role in this network. Research shows that the PAOM merges with the craniocervical dura, extending to the C3 level, forming a membrane-dura complex that stabilises the cervical dura mater beyond the classical C1-C2 region.

It is also possible that the dural bridges observed in the lower neck are not related to muscular structures but to fascial structures or, for example, the ligamentum nuchae, a prominent structure in the cervical spine.

The potential direct or indirect influence on dural tension through fascial or ligamentous connections should be further researched or, at the very least, considered in discussions of myodural dynamics, particularly in the lower cervical levels, where traditional myodural bridges might not be as prominent.

Why Further Research is Needed for Stress-Related Disorders

Stress is a major contributor to musculoskeletal dysfunction, particularly in the cervical region. Prolonged stress causes muscle tension, which, in turn, can affect the function of myodural bridges, potentially leading to symptoms such as headaches, neck pain, and even dizziness. By examining these bridges in the context of stress-related disorders, we could better understand how chronic tension impacts the dura mater and nervous system. Therapeutic approaches such as osteopathic manipulative techniques, The Reaset Approach, and craniosacral therapy could be refined to target these myodural connections, offering patients relief from stress-induced symptoms.

Clinical Implications of the Newly Identified Myodural Bridges

Cervicogenic Headaches and Migraines
With the recognition that myodural bridges are not limited to the C0-C1 region, it becomes clear that cervicogenic headaches and migraines might have a more complex origin involving dural tension across multiple cervical levels. This expanded understanding allows for more precise and effective treatments that address tension and dysfunction along the entire cervical spine.

Chronic Neck Pain and Postural Syndromes
Chronic neck pain is often associated with muscular imbalances and poor posture, both of which may exacerbate tension in myodural bridges. Recognising their widespread presence throughout the cervical spine suggests that treatments focusing on the entire cervical musculature, rather than just the sub-occipital region, may be more effective in relieving persistent pain.

Stress-Related Musculoskeletal Disorders
Stress often manifests as tension in the neck and shoulders. With multiple myodural bridges potentially involved in transmitting that tension to the dura mater, understanding how to treat these structures could significantly improve outcomes for patients suffering from stress-related conditions. Manual therapies that release tension in these muscles and bridges may reduce the frequency and severity of stress-induced headaches and neck pain.

Potential Role in Long COVID Symptoms
Although speculative, it is possible that chronic inflammation and muscle tension seen in Long COVID could affect myodural bridges, particularly given their role in regulating cerebrospinal fluid flow and dural tension. Future research might uncover connections between these structures and the neurological symptoms of Long COVID, such as brain fog, headaches, dizziness/vertigo, altered sensory perception, tinnitus, cervical dizziness, tension-type headache, cervical radiculopathy, restricted range of motion, and occipital neuralgia.

Conclusion

The discovery that dural bridges extend beyond the known C1-C3 levels and potentially involve all cervical levels challenges the traditional anatomical view. Recognising the possibility of these myodural, or at least ligamentous, bridges existing in the lower segments of the cervical spine opens up new avenues for understanding their role in both health and disease. From cervicogenic headaches to stress-related disorders, these structures may play a crucial role in influencing dural tension and cervical biomechanics.
Further research is necessary to explore their full clinical relevance, particularly in managing medically unexplained symptoms and conditions associated with chronic stress.
And perhaps, as this observation by Meyers is further validated, these structures might even be referred to in the future as “Meyers Bridges”—it would be a fitting tribute. However, the broader message would be that keen observation is something everyone can engage in, and meaningful contributions to science are not restricted to scientists alone.

References

Alix, M. E., & Bates, D. K. (1999). A proposed etiology of cervicogenic headache: the neurophysiologic basis and anatomic relationship between the dura mater and the rectus posterior capitis minor muscle. Journal of manipulative and physiological therapeutics, 22(8), 534–539. https://doi.org/10.1016/S0161-4754(99)70006-0

Enix, D. E., Scali, F., & Pontell, M. E. (2014). The cervical myodural bridge, a review of literature and clinical implications. The Journal of the Canadian Chiropractic Association, 58(2), 184–192.
Humphreys, B. K., Kenin, S., Hubbard, B. B., & Cramer, G. D. (2003). Investigation of connective tissue attachments to the cervical spinal dura mater. Clinical anatomy (New York, N.Y.), 16(2), 152–159. https://doi.org/10.1002/ca.10109

Humphreys, B. K. (2008). Cervical Dural Attachments: An Anatomic Study. The Journal of Manual & Manipulative Therapy, 16(3), E1-E8.

Mitchell, B. S., Humphreys, B. K., & O'Sullivan, E. (1998). Attachments of the ligamentum nuchae to cervical posterior spinal dura and the lateral part of the occipital bone. Journal of manipulative and physiological therapeutics, 21(3), 145–148.

Scali, F., Pontell, M. E., Enix, D. E., & Marshall, E. (2011). Histological Analysis of the Rectus Capitis Posterior Minor’s Myodural Bridge. Clinical Anatomy, 24(7), 933-937.

Scali, F., Enix, D. E., Pontell, M. E. (2013). The Myodural Bridge: A Review of Literature and Clinical Implications. The Journal of the American Osteopathic Association, 113(8), 623-633.
Scali, F., Ohno, A., Enix, D., & Hassan, S. (2022). The Posterior Atlantooccipital Membrane: The Anchor for the Myodural Bridge and Meningovertebral Structures. Cureus, 14(5), e25484. https://doi.org/10.7759/cureus.25484

Song, X., Yu, S. B., Yuan, X. Y., Alam Shah, M. A., Li, C., Chi, Y. Y., Zheng, N., & Sui, H. J. (2024). Evidence for chronic headaches induced by pathological changes of myodural bridge complex. Scientific reports, 14(1), 5285. https://doi.org/10.1038/s41598-024-55069-7

References:
- https://drdenef.com/covid-long
- https://link.springer.com/article/10.1007/s12035-021-02696-0
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10166245
- https://www.sciencedirect.com/science/article/pii/S1201971221007517

In the 21st century, healthcare professionals are witnessing a growing trend of musculoskeletal disorders (MSDs) that no longer respond effectively to traditional treatment methods. This phenomenon, which I term "treatment mismatch," arises from the rapid and profound changes in our environment and lifestyle. Understanding this concept is crucial for developing more effective therapeutic strategies that address the modern aetiology of these disorders.

The Evolutionary Mismatch

To comprehend the treatment mismatch, we must first explore the concept of evolutionary mismatch. For 99% of our evolutionary history, humans lived as hunter-gatherers in small, nomadic groups. This lifestyle, deeply intertwined with nature, shaped our physiology and behaviour. Our bodies evolved to respond to acute, short-term stressors with the fight-or-flight response, a mechanism designed to handle immediate physical threats.
However, the last 10,000 years have seen a dramatic shift. We transitioned from a nomadic lifestyle to agrarian societies, then to industrialised cities, and now to an information age characterised by rapid technological advancement. These changes have occurred so quickly that our physiological adaptations have not had time to keep pace. As a result, our stress response, once advantageous for survival, has become maladaptive in the face of chronic, psychosocial stressors such as work overload, social pressures, and the constant connectivity of modern life.

The Rise of Psychosocial Stressors

In today's world, many MSDs are not caused by physical trauma but by psychosocial stress. Chronic stress, job insecurity, fear of change, and even frustrations like an internet outage trigger the same physical stress response our ancestors used to deal with immediate threats. This includes neurohormonal changes that tense muscles, alter vascularisation, and redistribute nutrients—all of which are inappropriate for addressing the subtler, chronic challenges of the modern environment.

Traditional Treatments and Their Limitations

Traditional treatment methods for MSDs, developed in the 19th and 20th centuries, were primarily designed to address biomechanical issues resulting from physical trauma. These methods include manual therapies, physical exercises, and ergonomic adjustments that focus on correcting mechanical dysfunctions and alleviating pain through physical means.

While these treatments can be effective for conditions with a clear biomechanical origin, they often fall short in addressing MSDs driven by chronic stress and psychosocial factors. This is the crux of the treatment mismatch: therapies that worked well for the health problems of the past are less effective for the stress-related disorders prevalent today.

Addressing the Treatment Mismatch

To bridge this gap, manual therapists and healthcare professionals must adopt a more integral approach that integrates the understanding of psychosocial stressors and their impact on physical health. Here are several strategies to consider:

1. Integral Assessment: Evaluate patients not only for biomechanical issues but also for psychosocial stressors. Understanding the broader context of a patient's life can provide insights into the underlying causes of their MSDs.
2. Stress Management Techniques: Incorporate autonomic nervous system balancing methods, like The Reaset Approach, into treatment plans. Techniques that modulate the stress response and reduce its impact on the musculoskeletal system should be applied first, before treating overcompensations and the biomechanical dysfunction(s) themselves.
3. Patient Education: Educate patients about the role of stress in their condition and teach them self-management strategies. Empowering patients with knowledge and tools to manage stress can enhance the effectiveness of their treatment.
4. Adaptive Therapeutic Practices: Stay informed about the latest research and developments in the field of psychosocial health. Incorporate evidence-based practices that address the evolving nature of MSDs into your therapeutic repertoire.

Conclusion

The concept of treatment mismatch highlights the need for a paradigm shift in how we approach musculoskeletal disorders. By recognising the role of psychosocial stressors and adopting holistic, interdisciplinary strategies, we can develop more effective treatments that are attuned to the realities of modern life. Addressing this mismatch is essential for improving patient outcomes and promoting long-term health and wellbeing in the 21st century.