How DOs can help their patients process trauma

Edward Stiles, DO, FAAO (Dist.), has dedicated his career to advancing osteopathic medicine. A graduate of A.T. Still University Kirksville College of Osteopathic Medicine (ATSU-KCOM), he was mentored by leading specialists and pioneered the first hospital-based osteopathic manipulative treatment (OMT) services and Medicare coding system. With decades of leadership at osteopathic colleges, including the University of Pikeville-Kentucky College of Osteopathic Medicine, he continues to champion the profession today.

The following is an edited narrative shared by Dr. Stiles. He discusses the physical symptoms that can manifest when patients have unresolved trauma and stressors, and he shares the unique role DOs can play in helping their patients overcome their trauma and stressors.

The connection between the body and the mind

As I came to fully understand osteopathic medicine by following the key tenets of body, mind and spirit, I learned that trauma not only affects the mind and spirit but also has long-term effects on the body via allostatic load. I put two and two together; this stress on the body will show in a sign or symptom with some type of body significance.

As I changed my interview style to try to link body significance to trauma, my patients became less guarded and started sharing more information. I had a male patient come into my clinic soon after that, complaining of neck pain. I casually asked him, “What do you feel is the real pain in your neck?” He started listing all his stressors, from his kids to his boss. He had been bottling up these problems for some time, but talking about them with someone was helpful, and his neck pain immediately made great improvements, and OMT later resolved the remaining symptomatology.

To further test my theory, I had another patient come in with a lot of gastrointestinal symptoms, and he said, “I’ve got peptic ulcer-like symptoms, but the testing couldn’t confirm it. But I’ve done all these diets, medications and workups, and nothing is helping it.”

I wondered to myself what the body significance of his case could be, and I went on to ask him, “What is your understanding of what a peptic ulcer is?” He vividly described it as “eating up your own stomach,” and so, I asked him, “What’s eating you?”

He was a schoolteacher, and he told me about 20 things that were eating at him about his job. I advised him to start working on those stressors, and while it took him a few months, his work on his life stressors helped to clear up all his gastrointestinal symptoms.

A surprising encounter

One of the wildest correlations that I experienced occurred in a female patient who came to my OMT clinic for her on-again, off-again lower back pain. She was a single mom who would see me for treatment of her intermittent pain. One particular time she called me and said, “I woke up this morning and my back is killing me. Is there any way you can see me?” I got her in at the end of the day and asked her about the history of her present illness and she denied lifting anything heavy. She told me, “I’ve been really behaving myself and not lifting anything remotely heavy.” I was not finding much somatic dysfunction to account for her symptomatology. I checked her neurologically and she was fine.

As I was screening her, the thought that kept coming to me was, “This is a broken back.” I kept pushing the idea away, telling myself, “This is not a broken back.” There was no trauma history and, neurologically, she was fine.

Finally, I said to her, “Hey, let me ask you a question. This may be off the wall, but you’ve known me for a long time and know that I do things differently.”

I went on to tell her that I keep feeling like I’m dealing with a broken back, so I asked her if there’s ever been a situation or relationship that could feel like it literally broke her back. She jumped up off the table, turned around, hit the floor facing me and said, “What did you say?”

When I repeated my question, she told me, “Ten years ago today, my husband left me with three kids and $100,000 in debt!” For almost that entire time I had been treating her back intermittently, it had never been on that particular day. She admitted to me that she needed to do some more mental and emotional work on processing her divorce. Twenty years later, she reached out to me and shared that she’s been doing great and hasn’t had any problems with her back since the last time I treated her.

New role, new perspective

In 1997, I moved to Kentucky and became chair of the osteopathic principles and practice (OPP) department at the University of Pikeville-Kentucky College of Osteopathic Medicine (UP-KYCOM). I was still practicing, but most of my time was spent teaching. I was not establishing the rapport with my patients that I had in my previous practice, so I didn’t do as much body significance language work.

One day, I saw a psychologist patient who brought with her a stack of MRIs that all showed that she needed back surgery. She told me that she was scared to death of surgery, and a friend had recommended me to her. I usually didn’t ask the body significance questions on the first visit, but I felt comfortable doing so this time. I did an osteopathic screen on her and didn’t find many dysfunctions that would account for her level of pain.

I said to her, “Usually, when I see a back like this, the patient has lifted or carried something too heavy, but you haven’t done that. Is there any possibility you’ve picked up a heavy load mentally or emotionally?”

She broke down and began crying. I asked her what was going on, and she shared with me that she’s had three major things happen in the last year. I asked, “Have you talked to anybody about them?” She said no; she had not even mentioned these life changes to her colleagues.

I was confused by her answer, seeing as she was a clinical psychologist, surrounded by other clinical psychologists, but didn’t reach out to any of them. I asked her why she had shared this with me and not others.

She explained: “While you were examining my back, you asked me a simple, nonthreatening question that connected the dots that I previously hadn’t connected. I was able to tell you about the issues without directly facing you. Plus, you were touching me, and when someone is touching you, you can’t keep your guard up.”

I thought to myself, “Wow, that’s why I’ve been doing OMT all these years!” I would expect that DOs who perform OMT are able to similarly help patients who are struggling with medical mysteries, because DOs who touch patients should expect to get better histories out of their patients, thanks to the physical touch and standing behind them.

The healing power of osteopathic medicine

For some of my patients, these stressors and adverse events had been developing over the years like emotional boils. Once I lanced them with my specific questions, all the junk was metaphorically drained. That was all they needed. My goal was to get the trauma out and help my patients process it so they could move forward.

In 2024, the Journal of the American Medical Association (JAMA) published an article titled “Emotional Awareness and Expression Therapy vs Cognitive Behavioral Therapy for Chronic Pain in Older Veterans.” Could this be another description of what I was doing 30-40 years earlier with osteopathic thinking?

I’ll leave you with this final thought: I jokingly compare processing your emotional baggage to composting. You take garbage and put it in a pile and cover it with some dirt and it becomes the richest soil there is. We all have some emotional “garbage,” can we “compost” it by talking through it? The takeaway is that patients are capable of overcoming past traumas. Oftentimes, when patients don’t talk through their stressors, they somatize them and ultimately present with physical complaints, leading to their bodies acting out the unresolved stressors.

My journey into understanding how the patient somatizes their traumas through an osteopathic lens was starting to take focus. What I went on to discover may have been new scientific findings but ultimately it brought me back to my osteopathic roots and A.T. Still, MD, DO.

To be continued …

Related reading:

How adopting OMT can improve both patient outcomes and physician satisfaction

More than just physical: Addressing mental health in sports injuries