According to New Zealand based research by Kovanur and Roy (2015), most practising osteopaths in Aotearoa come across patients with a history of mood disorders.

As the New Zealand mental health 2020/2021 survey has shown, psychological distress in adults, and also in children, has increased from 7.5% the previous year possibly due to the pandemic and lockdowns. According to the same research, 100% of manual therapists perceived the need to manage and support clients with mood disorders during the osteopathic treatment. Being a current topic, I decided to show the evidence from our osteopathic point of view in how to manage patients affected by mood disorders. “Mood disorders are defined as serious mental illnesses that include depression, negative thoughts, anxiety, mood swings and bipolar behaviour”.​
​Osteopathic point of view and manual treatment
The balance between health and disease will always depend on the dynamic interaction between the intrinsic components of physical, mental and emotional states. Thus, a dysfunction of one of these three components can have repercussions on the others.
The core principle of osteopathy is that “structure and function are interrelated at all levels”.

In this context, it has been studied that emotional stress can alter the functionality of the cardiovascular, respiratory and musculoskeletal structural systems, increasing blood pressure, pulse, respiratory rate and sustaining the onset of musculoskeletal disorders.

Diaphragm muscle
Mood disorders commonly affect the functionality of the respiratory system and, consequently, the structure of the respiratory diaphragm muscle. During a stressful time, it has been shown that people tend to breathe quickly and shallowly, constantly increasing the tension in the diaphragm muscle Osteopathic manual treatment
At City Osteopaths, we offer fascial visceral treatment to assist the diaphragm muscle and the very gentle cranial osteopathic approach via the cranial rhythmic impulse. We also further support your recovery with the addition of specific guidance in breathing exercises, to help normalise the psychosomatic and somatic states.

Musculoskeletal system
​As mentioned above, diaphragm muscle dysfunction can happen as a consequence of mood disorders; but what is the connection with the musculoskeletal system and pain? To clarify this concept it is important to mention some anatomical information.
The diaphragm muscle is the most important respiratory muscle and it separates the thoracic cavity from the abdominal cavity. There are three attachments of the diaphragm: the xiphoid process of the sternum, costal cartilages of ribs 7-12, lumbar vertebrae ligaments, arcuate ligaments, right crus that arises from L1-L3 vertebrae and left crus that arises from L1-L2 vertebrae. The muscle fibres of the diaphragm combine to form a central tendon. Its innervation is via the phrenic nerve from the cervical roots of C3-C5.  If the diaphragm goes into fatigue, it follows that its attachments have a structural mechanical overload causing rib cage, dorsal spine and low back pain. Moreover, it’s also a common cause of neck pain in patients with high levels of stress, due to the neurological connection of the phrenic nerve that receives excessive aberrant signals from the dysfunctional diaphragm muscle back into the neck nerve spinal roots.

Osteopathic manual treatment
At City Osteopaths, we put into practice anatomical principles to treat the body structure and vertebral column in order to improve the function of the diaphragm muscle and, consequently, helping patients affected by mood disorders to increase their quality of life. Our goal is the patient’s wellbeing and we assist this with manual therapy.
Bibliography:
● https://www.health.govt.nz/publication/annual-update-key-results-2020-21-new-zealandhealth-survey
● Kovanur Sampath, K. and Roy, D. E. (2015) ‘Management of mood disorders by osteopaths in New Zealand: A survey of current clinical practice’, International Journal of Osteopathic Medicine, 18(3), pp. 161-170.
● Paulus, S. (2013) ‘The core principles of osteopathic philosophy, International Journal of Osteopathic Medicine, 16(1), pp.11-16.
​ ● Sagrillo, L. M. and Frigo, L. F. (2016) ‘The respiratory diaphragm in osteopathic vision: a literature review’, MTP & Rehab Journal, 14: 414, pp. 1-6