When Alberto Giardini, DO '19, was studying biological anthropology as an undergraduate, he discovered the field of osteopathic manipulative medicine (OMM) at a PCOM open house. Now, as first-year course director of Osteopathic Principles and Practice in PCOM's Department of Osteopathic Manipulative Medicine, that experience comes full circle as he treats patients, teaches students, and presents at those same events.
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.
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.
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.
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.
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.
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.
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.
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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