Puberty: An approach to diagnosis and management with an osteopathic component

Puberty is generally known as the emotional and physical maturation of a child to adulthood. This allows for sexual maturation and the means to reproduce. Children will undergo a pubertal growth spurt, as well as changes to the reproductive organs. While puberty is mostly associated with changes in reproduction and endocrine systems, it is multifaceted and affects the musculoskeletal, behavioral and vascular systems. Puberty occurs due to activation of the hypothalamic-pituitary-gonadal (HPG) axis and a progressive increase in the amount of gonadotropin-releasing hormone (GnRH) released. The average age of puberty is 13 years old in girls and 14 years old in boys. Associated pubertal diseases are usually split into two categories, based on whether the physical indicators appear earlier or later than expected. When these indicators occur at two standard deviations (SD) early, it is known as precocious puberty, and when they are 2–2.5 SDs late, it is known as delayed puberty. Because of the inseparability of physical and mental health, osteopathic medicine offers a practical approach for treatment of pubertal conditions using osteopathic manipulative treatment (OMT). Osteopathic medicine takes a holistic view of the person in which somatic, visceral and psychological dysfunction are united. Thus, physicians who incorporate OMT into their practice will be able to aid in promoting proper development during puberty as well as addressing accompanying somatic dysfunctions. In this paper, we will discuss the physiology of puberty, pubertal disorders, the epidemiology of puberty, current management protocols, osteopathic considerations in puberty and OMT’s role in treatment.