Complexity-informed osteopathic care for chronic low back pain in a 60-year-old woman: a case report

Background Chronic low back pain is a pervasive condition that challenges healthcare systems and can compromise healthy ageing. This case report describes a person-centred osteopathic approach in a 60-year-old woman. Case presentation A 60-year-old woman presented with a 10-year history of chronic low back pain (working diagnosis) radiating to the coccyx, accompanied by shoulder pain and recurrent cervicogenic headaches. Her clinical picture was complicated by diabetes, depression, and a history of trauma, illustrating a complex case of multimorbidity. Prior physical therapy had been only partly undertaken and prescribed glucocorticoid injections were declined, with limited relief and progressive functional decline. A structured conventional examination preceded a personalized osteopathic assessment informed by reasoning based on the Cynefin Framework—a complexity-science approach to making sense of her presentation—with the complete framework mapping assembled retrospectively for this report. The multimodal osteopathic care plan, delivered by a single practitioner, comprised osteopathic manipulative treatment (including myofascial release and balanced ligamentous tension), patient active-participatory graded movement (such as functional neuromyofascial activity), prescribed home activity, shared decision-making, and reassurance addressing kinesiophobia. Progress was monitored with the RAND-36 Health Survey (scored at baseline and the third session, with unchanged scores confirmed at the two subsequent encounters, through ∼10.6 months) and the Visual Analogue Scale (VAS, current pain, recorded at every encounter). The VAS decreased from 7 to 2, and substantial numerical improvements were recorded across multiple RAND-36 domains, temporally associated with the course of osteopathic care. Discussion In this single, uncontrolled case, clinical improvement occurred but cannot be attributed to the intervention alone, as regression to the mean, natural symptom fluctuation, expectancy effects, and the therapeutic alliance cannot be excluded. The case suggests a potential role for a holistic, biopsychosocial approach grounded in complexity-informed, person-centred reasoning and shared decision-making, and may inform wider discussions of non-pharmacological care within universal health coverage and healthy-ageing strategies, including tertiary-prevention objectives that minimize morbidity and maximize functional and psychosocial recovery in long-term conditions. These broader implications are, however, hypothesis-generating and not established by a single case. Controlled prospective research is required to evaluate efficacy and clarify the underlying mechanisms.