In the conversation below, Giardini and Andrew Levin, DO, assistant professor of osteopathic manipulative medicine, highlight how skeletal
development and anatomical variation shape lifelong health, movement, and more personalized
whole person care.
What is skeletal development, and why is it important to whole-person health?
Levin: Skeletal development refers to the complex biological processes that shape our bones
from infancy through adulthood, laying the foundation for posture, movement and overall
health. It is influenced by factors such as diet, physical activity and hormonal balance—especially
during critical periods of growth before the growth plates close.
In osteopathic medicine, where structure and function are deeply interconnected, understanding skeletal development is essential to treating
the whole person by identifying how structural variations may contribute to dysfunction
or discomfort elsewhere in the body.
What are some of the important factors and biological processes that influence skeletal
development?
Giardini: Genetics lay the foundation for how our skeleton is shaped, but factors like movement
patterns, injuries or surgeries can alter that structure over time—sometimes accelerating
wear, asymmetry or degeneration.
Diet, physical activity and sports play a critical role in early skeletal development,
especially before growth plates close.
Nutrition also plays a key role in bone health, particularly vitamin D and hormonal
balance as we age. While these internal factors matter, external influences—especially
in childhood—are just as critical.
Levin: Diet, physical activity and sports play a critical role in early skeletal development,
especially before growth plates close. Increasing technology use at younger ages has
also contributed to poor posture, which can lead to spinal deformities.
How might OMM practitioners apply knowledge of skeletal variation to patient care?
Andrew Levin, DO
Levin: An understanding of skeletal variation is essential, as it can affect everything
from head to toe. Osteopathic physicians treat the whole person, not just the site of pain—especially when skeletal differences
influence that pain. Subtle variations, like leg length discrepancies or spinal asymmetries,
can cause compensatory patterns that lead to discomfort elsewhere. Recognizing these
nuances allows for more precise treatment that targets root causes, not just symptoms.
Giardini: OMM is entirely based in anatomy, and a tenet of osteopathic philosophy is that form begets function. If a bone is shaped a certain way then it will move
a certain way, whether that is normal or not.
We're trained to treat patients using movements specific to their body; there's no
“one size fits all” technique. I see many patients with anatomic variations and must
treat each one differently. You can't throw a football like a baseball—their shapes
dictate how you move around them.
Are there specific skeletal traits or growth patterns that physicians should be particularly
aware of?
Giardini: One that I see frequently in my clinic is a variation in the spinal bones, specifically
the bones of the lower back, or the lumbar spine. This variation can cause incomplete
bone formation between the last back bone (lumbar) and the tailbones (sacrum and coccyx),
resulting in a bone that appears unsure whether to resemble one or the other—sometimes
looking like both, or sometimes it turns into an extra back bone entirely! This changes
how we treat this patient based on the shape of their own skeleton.
How can collaboration between musculoskeletal scientists and osteopathic physicians
benefit patient care?
Levin: OMM centers on the relationship between structure and function. Understanding a patient's
anatomy helps physicians anticipate movements that support health or cause injury,
and through manipulation, they can correct dysfunctional patterns, improving both
structure and overall well-being.
Osteopathic physicians treat the whole person, not just the site of pain—especially
when skeletal differences influence that pain.
Giardini: Collaboration between musculoskeletal scientists and osteopathic physicians can deepen
our understanding of how structure affects function—especially in conditions like
headaches and concussions.
As patients often report unexpected responses during treatment, research can help
uncover the mechanisms behind these effects. Together, they can develop evidence-based
approaches that enhance whole-person care and bridge gaps between anatomy and clinical
outcomes.
What future research directions are exciting in the field of skeletal development?
Giardini: As people live longer, conditions like osteoporosis are becoming increasingly common,
highlighting the need for improved treatments that support bone health throughout
the aging process. I'm also hopeful for more research exploring how osteopathic treatments
can enhance immune function.
As skeletal development research grows, continued collaboration between scientists
and osteopathic physicians will be essential to advancing whole-person care and training
the next generation of clinicians.
About Philadelphia College of Osteopathic Medicine
Established in 1899, Philadelphia College of Osteopathic Medicine (PCOM) has trained
thousands of highly competent, caring physicians, health practitioners and behavioral
scientists who practice a “whole person” approach to care—treating people, not just
symptoms. PCOM, a private, not-for-profit accredited institution of higher education,
operates three campuses (PCOM, PCOM Georgia and PCOM South Georgia) and offers doctoral degrees in clinical psychology, educational psychology, osteopathic
medicine, pharmacy, physical therapy, and school psychology. The college also offers
graduate degrees in applied behavior analysis, applied positive psychology, biomedical
sciences, forensic medicine, medical laboratory science, mental health counseling,
physician assistant studies, and school psychology. PCOM students learn the importance
of health promotion, research, education and service to the community. Through its
community-based Healthcare Centers, PCOM provides care to medically underserved populations.
For more information, visit pcom.edu or call 215-871-6100.
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