Mobilising models in osteopathic care: Towards a situated epistemology of clinical practice

Contemporary osteopathic care mobilises heterogeneous forms of knowledge that remain poorly integrated within existing epistemological frameworks. Current perspectives often rely on singular explanatory models, failing to fully capture the situated mobilisation and transformation of knowledge during clinical encounters. This theoretical paper proposes a mixed epistemological framework to elucidate how scientific, pragmatic, and operational knowledge coordinate in osteopathic practice. Using therapeutic touch as an illustrative epistemic practice—rather than merely a defining feature of care—we demonstrate how perceptual, relational, embodied, and scientific knowledge integrate in action. Drawing on pluralist epistemology, pragmatism, and complex health intervention research, we argue that clinical practice is not the direct application of theoretical models. Instead, scientific concepts are contextually transformed through pragmatic and operational modelling to address concrete clinical realities. Rather than imposing an additional explanatory model, this framework clarifies the conditions under which diverse knowledge types are clinically utilised. We introduce the concept of epistemic flexibility : a clinician's capacity to recognise, coordinate, and adapt varied epistemological resources to meet evolving patient needs. This perspective provides a robust theoretical foundation for advancing context-sensitive clinical care, reflective education, and mixed-methodologies research in osteopathy.