Background: Chiropractic, osteopathy, and physiotherapy (COP) professionals regulated outside the United States traditionally incorporate hands-on procedures aligned with their historical principles to guide patient care. However, some authors in COP research advocate a pan-professional, evidence-informed, patient-centered approach to musculoskeletal care, emphasizing hands-off management of patients through education and exercise therapy. The extent to which non-Western sociocultural beliefs about body representations in health and disease, including Indigenous beliefs, could influence the patient–practitioner dyad and affect the interpretation of pillars of evidence-informed practice, such as patient-centered care and patient expectations, remains unknown. Methods: our perspective paper combines the best available evidence with expert insights and unique viewpoints to address gaps in the scientific literature and inform an interdisciplinary readership. Results: A COP pan-professional approach tends to marginalize approaches, such as prevention-oriented clinical scenarios traditionally advocated by osteopathic practitioners for patients with non-Western sociocultural health assumptions. The Cynefin framework was introduced as a decision-making tool to aid clinicians in managing complex clinical scenarios and promoting evidence-informed, patient-centered, and culturally sensitive care. Conclusion: Epistemological flexibility is historically rooted in osteopathic care, due to his Indigenous roots. It is imperative to reintroduce conceptual and operative clinical frameworks that better address contemporary health needs, promote inclusion and equality in healthcare, and enhance the quality of manual therapy services beyond COP’s Western-centered perspective.

Introduction: Within family medicine it is generally accepted that the more we know about patients' lives, the better the care we provide. Few studies have sought to quantify this historical assumption. We wondered if knowing their chronic pain, patients' life stories would improve the physician–patient relationship in a family medicine residency training program clinic. Methods: We selected patients in chronic pain with depression and/or anxiety who were considered difficult. After a lead in period to establish stability of ratings, we obtained a life story interview for 125 such patients after administering the doctor–patient relationship questionnaire to them and their physicians. Patients completed the McGill Pain Inventory (MPQ), the Zung Anxiety Inventory, and the Center for Epidemiological Studies Depression Scale. Physicians completed the Jefferson Physicians Empathy Scale. Questionnaires were repeated every 4 months. Results: The quality of the physician–patient relationship increased significantly over the course of the year for patients (increase of 0.60, standard deviation [SD] = 0.13, 95% confidence interval [CI] = 0.57 to 0.63, p < 0.001) and for doctors (increase of 0.77, SD = 0.20, 95% CI = 0.72 to 0.81, p < 0.001). The perceived level of pain on the MPQ decreased significantly on the sensory component (71.2 ± 7.6 to 11.7 + 9.4, 95% CI = 0.589 to 9.411, p = 0.0270 and the affective component (4.2 + 3.4 to 2.1 + 4.3, 95% CI = 0.131 to 4.069, p = 0.037). Anxiety and depression ratings did not change. Physicians' empathy ratings increased significantly over the course of the year from a mean of 117.2 (SD = 10.2) to 125.1 (SD = 16.1) for a difference of 7.90, which was significant at p = 0.0273 with a 95% CI of −14.85 to −0.915. Discussion: Knowing the patient's life story improves the physician–patient relationship for both patients and physicians. When the physician–patient relationship improves, the perceived level of pain decreases. Physicians' empathy ratings increase. While the interview requires 90–120 min, it is billable, and can be done by medical students, medical assistants, social workers, or behavioral health. Conclusions: Obtaining life stories of chronic pain patients is a cost-effective way to reduce pain while simultaneously improving the physician–patient relationship and increasing physician empathy.

Background/Objectives: Indigenous perspectives, which emphasize non-materialistic dimensions of healing, such as the interconnectedness of the body, mind, and spirit, align with one foundational principle of osteopathic care. Integrating these perspectives into person-centered care may enhance therapeutic effectiveness by accommodating diverse understandings of health and well-being. This perspective paper explores how various epistemological frameworks, including Indigenous non-materialistic approaches, can inform manual therapy techniques and therapeutic alliances to advance person-centered care. Methods: We synthesized the best available evidence with expert insights and interdisciplinary viewpoints to address the gaps in the scientific literature. Our approach integrates conceptual analysis and emerging research to provide a comprehensive discussion for a broad professional audience. Results: We focused on detailing the existing sociocultural and experiential frameworks available to describe patients’ bodily perceptions rather than abstract intellectual constructs. Our findings were divided into two sections. The first examines the incorporation of diverse body representations that extend beyond purely biomechanical interpretations, emphasizing the role of non-materialistic components in therapeutic processes. The second explores recent neuroscientific research on self and consciousness, demonstrating how these insights intersect with Indigenous perspectives to enrich the theoretical and practical applications of osteopathic principles in different clinical contexts. Conclusions: Epistemological flexibility has the potential to refine clinical frameworks and ensure that they reflect the full scope of osteopathic practices beyond musculoskeletal care. By integrating diverse sociocultural perspectives without reinforcing stereotypes or rigid cultural constructs, this approach clarifies the diversity of body representations in osteopathic practices, addresses gaps in academic discourse, and promotes the integration of multiple worldviews as a foundation for truly person-centered care.

We explore the historical connection of Andrew Taylor Still, hereafter referred to as Still, with Indigenous peoples of the Central Plains, USA, notably the Shawnee, Pawnee, Kickapoo, Cherokee, and Pottawatomie. These nations had well-developed forms of hands-on healing and practicing lightning bone setting. We trace evidence through Still for his connectedness with these people and respect for their traditions. We use an autoethnographic approach to explore the traditional hands-on therapies of these nations and discovered that they are quite similar to osteopathy. The authors compared practices, finding that American osteopathy was strikingly similar to what is practiced by traditional Cherokee hands-on healers. We propose that Still did not invent osteopathy de novo but built it on Indigenous practices already existing among the tribes of Missouri. We believe this is important because the osteopathic community does not acknowledge any contribution of Indigenous people to their field, which should change.

Lewis Mehl-Madrona, MD, PhD1,2,3,4,5; Barbara Mainguy, MA, MSW3,4 Perm J...