NOC Reykjavik, Iceland 2025

“The Long-Term Patient – Clinical Considerations in Managing Chronic Conditions.”

Hosted by the Nordic Osteopathic Alliance

The Nordic Osteopathic Congress (NOC) was held Saturday 13 September, and Sunday 14. September 2025 at the Center Hotel Plaza, in Reykjavik, Iceland. Keynote lectures were accompanied by panel talks. Please see below for presentation of topics and lecturers.

Lecturers

Pål Andre Amundsen

“Integrating key theories, predictive processing, and the perspectives of the complex pain patient into clinical management”

In this presentation I will introduce the differences between primary and secondary persistent pain and their practical implications for osteopaths, and delve deeper into the management of primary pain: how can key theories underlying pain and illness be practically transferred into the management of the long-term patient? As part of my PhD, I was involved in a placebo surgery trial for spinal stenosis: can we learn something of these trials and use concepts of (placebo) predictive processing in practice? Additionally, I will use insight from my PhD work on Work & Health: what can we learn from the people unemployed due to persistent pain?

The aim of this session is to provide the practicing clinicians with valuable take-home messages to enhance patient outcomes.

Pål Andre Amundsen has submitted his doctoral dissertation on the topic of chronic pain and return to work. During his PhD he also worked with researchers in Australia on a placebo surgery trial for spinal stenosis. He is a trained Osteopath and worked in clinical practice before starting as a lecturer at Kristiania University College in 2013. Pål Andre holds a master’s degree in clinical management of pain from the University of Edinburgh, where he was named the best student two years in a row. Until November 2021, he was an assistant professor and study program leader for the Bachelor’s in Osteopathy and for continuing education in Osteopathy. His research interests lie within the realm of persistent pain and research methodology, particularly the complexities involved in understanding the causes and mechanisms of persistent pain.

Steven Vogel

“When Working with People with Persistent Pain”

Effective communication and reassurance are critical when working with individuals experiencing persistent pain. This talk will explore the core principles and techniques osteopaths can employ to enhance their interactions with patients suffering from persistent pain conditions.

Patients frequently experience not only physical discomfort but also emotional and psychological distress. It is therefore important that osteopaths include the effective use of communication skills to address the multifaceted nature of persistent pain.

This presentation will cover several key areas:

The importance of empathy and active listening: Understanding the patient’s experience and validating their feelings can significantly improve the therapeutic relationship.
Building trust and rapport: Techniques for creating a safe and supportive environment where patients feel comfortable sharing their concerns.
Effective verbal and non-verbal communication: Strategies for conveying information clearly and confidently, ensuring that patients understand their condition and treatment options.
Reassurance and education: Methods for providing types of reassurance and information without minimising the patient’s pain and supporting patient engagement with their own self-management.
Addressing psychological factors: Recognizing and managing the psychological dimensions of persistent pain, including anxiety, depression, and fear-avoidance behaviours.

The talk will draw on research evidence and also include practical examples. It is anticipated that attendees will gain insights into how to foster a therapeutic alliance with their patients and shared decision making, ultimately leading to improved outcomes and enhanced patient satisfaction.

Steven Vogel is Professor of Musculoskeletal Health and Care at the Health Sciences University. He practiced osteopathy in the UK National Health Service in primary care for over 20 years alongside working in research, educational and clinical management before working full time in academia. He has held executive positions in higher education and been involved in governance and leading charitable organisations related to osteopathy and musculoskeletal research. Steven has sat on two Guideline Development Groups for The National Institute for Health and Care Excellence and for the National Clinical Pathway for Back Pain in the UK and has recently been an expert reviewer of the WHO back pain guideline. He has published research with interprofessional colleagues on a range of MSK and manual therapy pain and treatment related issues. Current interests include evidence informed practice, communication and consent, adverse events and interprofessional conceptions of manual therapy. He is Editor-in-Chief of the International Journal of Osteopathic Medicine, President of the Society for Back Pain Research, a member of the Board for the Osteopathic Foundation and the United Kingdom Spine Societies Board.

Dr Niklas Sinderholm Sposato

Musculoskeletal Perspectives in Respiratory Care: Insights from Cystic Fibrosis”

This presentation examines the dynamic interplay between musculoskeletal health and respiratory care. Focusing on cystic fibrosis, it explores evidence-based, practical approaches to enhance patient outcomes. Grounded in both research and clinical experience, this session provides clinicians with tools to effectively incorporate respiratory care into their practice.

Dr Niklas Sinderholm Sposato has been a clinician since 2001, combining over two decades of clinical experience with extensive teaching and research activities in Sweden and internationally. His research focuses on musculoskeletal health, respiratory medicine, multimodal care strategies, and person-centred healthcare.

Currently, Dr Sinderholm Sposato conducts research at the Sahlgrenska Academy, University of Gothenburg, and is a visiting research fellow at the University of Technology Sydney (UTS), Australia. He is particularly interested in bridging knowledge traditions and advancing integrative approaches in healthcare, reflecting his commitment to balancing evidence-based practices with individualised care. Dr Niklas Sinderholm Sposato, Med.dr (PhD), MSc (Osteopathy)

Dr Mia D. Eriksson, DO, PhD

“Melancholia or Not”

The lecture is based on Mia’s doctoral dissertation “Melancholia or Not; The Mysterious Differences in Depression – A Study of Pathophysiological Differences Between Depressive Subtypes – Findings From TheHelsinki Birth Cohort Study“. The lecture focuses on differences between depressive subtypes, but also touches on how interrelated physical and mental health is. Mia will also discuss the meaning of these findings through the lens of osteopathy and why medical research like this should be of interest to osteopaths.

Dr Mia D. Eriksson, DO, PhD, is a Finnish osteopathic physician who works as a general surgery resident at the Helsinki University Hospital in Finland. Mia moved to the USA in 2012 and received her bachelor’s degree in neuroscience from Texas Christian University in Fort Worth, Texas in 2016. During this time, she was involved in research both in Finland and the Texas, with topics involving Alzheimer’s disease, depression, and early-life stress. Mia studied osteopathic medicine at Texas College of Osteopathic Medicine, from which she graduated in 2020. During the pandemic Mia completed her PhD on the topic of depression and successfully defended her thesis at the University of Helsinki.

Jósep Ó.Blöndal, MD, MDT

“Interdisciplinary diagnosis, treatment and secondary prevention of chronic spinal pain – What works and what doesn’t –and why?”

Drawing on 38 years of experience as a humble student, practitioner, teacher and lecturer in the field of Orthopaedic Medicine, and as a member of an interdisciplinary spinal pain team for 27 years, the lecturer shares his thoughts on the demographics, aetiology, pathogenesis, diagnosis, treatment and secondary prevention of spinal pain, and presents the results of a third-party evaluation of a short, interdisciplinary, inpatient team-based programme at a rural hospital in Iceland, 2 and 7 years after discharge, respectively.

Jósep Ó.Blöndal, MD,MDT, born  in Siglufjörður, Iceland. Graduated from the University of Copenhagen 1976.  Postgraduate training in general surgery in Skellefteå and Örebro, Sweden, 1976- 1984. Chief Physician and General Surgeon in Patreksfjörður Iceland, 1984 – 1990. Chief Physician/Surgeon at St.Franciscus´ Hospital in Stykkishólmur, 1990 -2017.  Invited to London by Patricia Cyriax in April, 1986. Diploma in  Orthopaedic Medicine at the Cyriax Organization in 1989. Became a pioneer in the discipline in his country. Established in 1992 an inpatient, interdisciplinary  spinal pain clinic. Has  lectured on the subject of spinal pain in Iceland and abroad and taught hundreds of students of medicine and physiotherapy. Jósep is an active amateur musician. Graduated 2006 from the Music School in Stykkishólmur as a classical pianist. 

Roger Engel

“The long-term patient – clinical considerations in managing chronic respiratory comorbidities.”

Chronic diseases like diabetes, heart and respiratory disease, stroke and cancer continue to be a major cause of worldwide morbidity and mortality. Chronic Obstructive Pulmonary Disease (COPD) is a preventable and treatable respiratory disease with significant extrapulmonary effects that contribute to the severity in individuals. These extrapulmonary effects include chest tightness and dyspnoea. The disease is also characterised by decreasing exercise capacity, a prognostic indicator for long-term survival in people with COPD. Exercise limiting dyspnoea (ELD) is a key driver of decreasing exercise capacity. Our research has shown that a combination of Osteopathic manual therapy (OMT) and exercise, administered in a particular way, is effective in delaying the onset of ELD thereby facilitating an increase in exercise performance. Over time, this can lead to an increase in exercise capacity and an improvement in long-term prognosis.

Pre-reading (recommended)

Engel R, Vemulpad S. The effect of combining spinal manipulation with exercise on the respiratory function of normal individuals: a randomized control trial. Journal of Manipulative Physiological Therapeutics. 2007;30: 509-13. https://doi.org/10.1016/j.jmpt.2007.07.006

Engel RM, Vemulpad S, Beath K. Short term effects of combining manual therapy and exercise in people with moderate chronic obstructive pulmonary disease: a preliminary clinical trial. Journal of Manipulative Physiological Therapeutics. 2013; 36:490-496. https://doi.org/10.1016/j.jmpt.2013.05.028

Engel RM, Gonski P, Beath K, Vemulpad S. Medium term effects of including manual therapy in a pulmonary rehabilitation program for chronic obstructive pulmonary disease (COPD): a randomized controlled pilot trial. Journal of Manual and Manipulative Therapy. 2016; 24: 80 89. https://doi.org/10.1179/2042618614y.0000000074

Cruz-Montecinos C, Godoy-Olave D, Contreras-Briceno FA, Gutiérrez P, Torres-Castro R, Miret-Venegas L, Engel RM. The immediate effect of soft tissue manual therapy intervention on lung function in severe chronic obstructive pulmonary disease: a case series. International Journal of Chronic Obstructive Pulmonary Disease. 2017; 12:691-696. https://doi.org/10.2147/copd.s127742

Engel RM, de Luca K, Graham PL, Farshchi MK, Vemulpad S, Byles J. Predictors of chronic obstructive pulmonary disease in women who never smoked: A cohort study. ERJ Open. 2022; 8:00532-2021. https://doi.org/10.1183/23120541.00532-2021

Engel RM, Gonski P, Vemulpad S, Graham P. The long-term effect of exercise with and without manual therapy for mild chronic obstructive pulmonary disease: a randomized controlled trial. Journal of Cardiopulmonary Rehabilitation and Prevention. 2024;44: 257-265. https://doi.org/10.1097/hcr.0000000000000871

Roger Engel is an Osteopath and Chiropractor with over 40 years’ experience in clinical practice in Australia, the US and Indonesia. He currently holds appointments as Adjunct Associate Professor in the Faculty of Health at Southern Cross University and Honorary Senior Research Fellow in the Faculty of Medicine, Health and Human Sciences at Macquarie University. Roger is a clinician scientist who has been involved in clinical research for more than 25 years. His research interests cover several fields including the non-pharmacological management of chronic respiratory disease, paediatric and maternal care, and more recently post-concussion syndrome. He has authored over 75 papers in peer-reviewed journals and supervises PhD and Masters Research students.

Christian Fossum, DO

“Osteopathic Management of Pain – Mechanisms and the Medical Ritual”

Patients are seeking osteopathic care for a variety of clinical conditions, the most common one being for musculoskeletal pain. Studies are showing a high degree of patient satisfaction with osteopathic care, and outcome studies and clinical guidelines are providing evidence for the use of manipulative therapies as a part of a interdisciplinary management strategy in patients with musculoskeletal pain. In this presentation we will look at the clinical encounter as a meeting place facilitating changes important to the patient. Both in relationship to nociception, the experience of symptoms and potential behaviour related to having pain. The presentation will highlight the role of the osteopath in providing whole-person healthcare, including an overview of both specific mechanisms related to osteopathic manipulative care and contextual factors embedded in the notion of an osteopathic approach to patient management.

Christian Fossum, DO, is an associate professor at the School of Health Sciences, Kristiania, in Oslo, Norway. He is a past Vice-Principal of the European School of Osteopathy (Maidstone, UK); Assistant Professor, Department of Osteopathic Manipulative Medicine at the Kirksville College of Osteopathic Medicine (Kirksville, USA); Associate Director, A.T. Still Research Institute (Kirksville, USA). In addition he lectures at conferences and post-graduate courses world-wide and has authored numerous articles and book chapters. He has received several awards for his contributions to education and practice in the osteopathic profession.

In and around Reykjavik

Relax at the Blue Lagoon

Named one of the 25 wonders of the world by National Geographic in 2012, the Blue Lagoon is renowned for its unique geothermal seawater, rich in silica, algae, and minerals. These elements nourish the skin and create its iconic milky-blue colour. Located amidst lava fields, this is a place of rejuvenation and tranquillity, offering luxurious spa treatments and unforgettable scenery.

Farther afield

Vatnajökull Glacier and National Park

As Europe’s largest glacier, Vatnajökull is a natural wonder that defines Iceland’s landscape. Explore the glacier, hike its surrounding volcanic terrain, or venture into its mesmerizing ice caves. The park also houses Hvannadalshnjúkur, Iceland’s tallest peak, making it a haven for outdoor enthusiasts.

Jökulsárlón Glacier Lagoon and Diamond Beach

Jökulsárlón is a stunning glacier lagoon where icebergs, calved from the nearby glacier, float serenely toward the sea. Adjacent Diamond Beach contrasts with shimmering ice fragments on black sand. Both sites are perfect for photographers and nature lovers.