Visceral Osteopathy as an approach to relieving back pain

Back pain is a very common problem, affecting millions of people worldwide. Although it is often associated with changes in the spine, muscles or joints, its origin is not always exclusively musculoskeletal.

In some cases, back pain can have a visceral origin, meaning it results from changes in the functioning of internal organs such as the stomach, kidneys, liver, or intestines. Due to the neurological connections between these organs and the spine, pain can be perceived at a distance from the primary site of dysfunction, manifesting, for example, in the lumbar, dorsal, or cervical region.

Back pain is one of the most common complaints, affecting a large proportion of the global population. Often associated with problems in the spine, muscles, or joints, the origin of the pain is not always limited to these structures. In many cases, back pain can have a visceral origin, meaning it is related to dysfunctions in internal organs such as the stomach, liver, kidneys, or intestines. Due to the neurological and fascial interactions between these organs and the spine, pain can radiate to areas distant from its origin, such as the lumbar, dorsal, or cervical regions. Visceral Osteopathy offers an effective therapeutic approach to deal with this type of pain, treating not only the symptoms but also the underlying causes.

Visceral Osteopathy: A Therapeutic Approach

Visceral Osteopathy is a manual therapeutic approach that aims to restore the functional balance of internal organs and optimise the body's dynamics. Using specific manual techniques, this approach addresses the interactions between internal organs and the spine, contributing to the reduction of back pain of visceral origin and promoting the patient's overall well-being.

Back pain of visceral origin: mechanism and causes

Back pain of visceral origin does not stem from structural changes in the spine, but rather from functional processes in internal organs and how sensory information from these organs is processed by the central nervous system. Internal organs (or viscera) are intimately connected to the autonomic nervous system, which regulates involuntary functions such as digestion, circulation, and respiration. Communication between internal organs and the musculoskeletal system occurs via sensory afferent pathways, meaning nerve fibres that transmit information from the organs to the central nervous system (Cervero & Laird, 1999).

This information converges in the spinal cord, more specifically in the dorsal horn, where signals from different tissues are processed together. Visceral afferents (from internal organs) combine with somatic afferents (from the skin, muscles, and vertebral tissues). This viscero-somatic convergence can make it difficult to identify the origin of pain, as the nervous system may interpret the pain signal as originating from the spine, even if it originates in an internal organ (Wilfrid Jänig, 2009).

Furthermore, certain visceral processes, such as inflammation, distension of hollow organs, changes in intestinal motility, and digestive dysfunctions, can increase the excitability of sensory pathways, making the perception of referred pain more likely. This phenomenon occurs due to central sensitisation, a process that lowers the pain activation threshold, causing stimuli of lower intensity to be perceived as more painful (Woolf, 2011).

Therefore, a functional change in an internal organ can manifest as lower back, dorsal, or cervical pain, even without visible structural changes in the spine. Visceral pain should be understood as a real neurophysiological phenomenon and not as a psychological manifestation. The experience of pain arises from how the central nervous system integrates and modulates sensory information originating from different tissues, based on its anatomical and functional organisation (Gebhart, 2000).

Referred pain mechanism

The referred pain experienced occurs when the pain felt in one part of the body originates from an internal organ. This phenomenon is caused by the convergence of nerve pathways that transmit sensory signals from both internal organs and musculoskeletal structures, which are located in the same segments of the spinal cord. Consequently, the nervous system can interpret the pain in an area distant from the actual source of the problem.

The convergence of sensory afferents from viscera and musculoskeletal structures in the spinal cord, meaning the fusion of signals from internal organs and muscles in the dorsal horn, makes it difficult to discriminate the origin of pain. Both types of nociceptive signals are processed in the same region of the cord, which can lead to a misinterpretation of the origin of the painful stimulus. This phenomenon is common in various visceral conditions, posing a diagnostic challenge, as the pain may not be located in the area of the original problem, but in distant regions (Cervero & Laird, 1999). For example, a dysfunction in the liver or gallbladder may be felt as pain in the right shoulder, due to the neural interconnection between these areas.

Visceral Osteopathy recognises musculoskeletal pain of visceral origin as a crucial phenomenon for understanding symptoms that manifest outside the primary site of dysfunction. The main mechanism involved is the convergence of sensory afferents from the viscera and musculoskeletal tissues in the spinal cord, making it difficult to discriminate between the visceral and musculoskeletal origin of the nociceptive stimulus (Wilfrid Jänig, 2009).

The relationship between viscera, fascia and spine

Internal organs do not function independently of the musculoskeletal system. Each organ is integrated into a continuous fascial system, which envelops and connects internal organs to muscles, the spine, and the pelvis. This fascial system allows organs to adapt to the demands of movement, posture, and variations in intra-abdominal pressure.

When the fascial system loses its ability to adapt, due to factors such as inflammation, scarring, chronic stress, or functional overload, restrictions in visceral and fascial mobility can arise. These restrictions can generate tensions that affect distant areas, such as the spine, diaphragm, and pelvis, resulting in musculoskeletal pain patterns. The alterations can lead to:

• Increased reflex muscle tone in specific spinal segments;
• Reduced joint mobility, especially in the lumbar and thoracic regions.;
• Changes in breathing pattern, with reduced diaphragmatic excursion.

Over time, these adaptations can result in lumbar stiffness, persistent back strain or cervical discomfort, even in the absence of visible structural changes in the spine. In this case, back pain is not just a local problem, but a functional interaction between the internal organs, the fascia and the musculoskeletal system.

Clinical examples of back pain of visceral origin

Visceral dynamics can be relevant in various clinical scenarios. For example:

• Persistent lower back pain with no structural changes: Patients with chronic lower back pain, but without visible changes in imaging examinations, may have visceral dysfunctions, such as restrictions in colon mobility or alterations in respiratory mechanics. These dysfunctions can generate fascial tension patterns, affecting the lumbar region and resulting in persistent pain. Visceral Osteopathy can be useful for restoring visceral mobility and relieving tension, contributing to the reduction of chronic pain.
• Neck and shoulder girdle discomfort Another example involves recurring neck discomfort and a feeling of tension in the shoulder blade area. When changes occur in thoracic mobility and the functional interaction between the thoracic organs, diaphragm and cervical spine, this can affect muscle tone and postural control, exacerbating symptoms. Visceral dysfunctions can influence muscle dynamics, increasing stiffness and hindering movement.

These examples illustrate how visceral dysfunctions and fascial adaptations can contribute to back pain, often without an identifiable structural cause. The interaction between the visceral and musculoskeletal systems is clear and proven, making a detailed assessment by an osteopath specialising in Visceral Osteopathy essential to identify these interactions and guide the approach effectively.

When to consider a visceral component in back pain

Certain clinical patterns may indicate the possibility of a visceral contribution to back pain, without this constituting a definitive diagnosis in itself. Among the signs that can suggest a visceral component are:

• Little influenced by movement or stretching;
• Deep, diffuse or poorly localised pain;
• Association with digestive, urinary, respiratory or pelvic symptoms;
• Symptoms vary with meals, stress, menstrual cycle or sleep quality;
• Frequent recurrence of pain despite adequate musculoskeletal intervention.

When these clinical patterns are present, it is fundamental to carry out a complete evaluation that considers the interaction with the visceral system to provide a more comprehensive and detailed understanding of the clinical picture.

How Visceral Osteopathy can help

Visceral Osteopathy is based on the idea that the human body is an interdependent system, in which the function of the internal organs is interconnected with the musculoskeletal system, the fascia and the autonomic nervous system. This approach recognises that alterations in the mobility, motility or tension of internal organs can have repercussions on other body structures, such as muscles and joints, even when the symptoms manifest in areas far from the primary organ affected.

During an Osteopathic Visceral assessment, the osteopath seeks to identify areas of tension or restriction in the mobility of internal organs, such as the colon, liver, or other abdominal and thoracic organs. The assessment considers not only the organs but also their biomechanical relationships with the fascial system, the musculoskeletal system, neurovegetative regulation, and the patient's respiratory patterns. This integrative approach allows for the identification of visceral dysfunctions that may be causing or contributing to musculoskeletal complaints.

The visceral dysfunctions identified during the assessment can be treated through gentle and specific manual techniques, with the aim of restoring visceral mobility, relieving fascial tensions, and promoting the body's functional adaptation. Among the main techniques used are:

• Myofascial ReleaseThis technique involves applying controlled pressure to the fasciae that surround both internal organs and musculoskeletal structures. The aim is to facilitate sliding between the fascial planes, improving the distribution of tensions and promoting the relief of tension points. Myofascial release helps to restore flexibility and mobility to the tissues, helping to reduce pain and discomfort.
• Visceral MobilisationVisceral mobilisation aims to improve the mobility of internal organs and their support structures. This type of approach helps restore the physiological dynamics of the organs, promoting circulation and ensuring that the visceral systems function harmoniously and without restrictions.
• Autonomic Nervous System RegulationThe regulation of the autonomic nervous system through manual approaches seeks to optimise the body's balance and improve its response to stress and pain. These techniques modulate pain perception and adjust muscle tone patterns, influencing viscerosomatic reflexes and the neurovegetative response, thereby promoting an improvement in general well-being.

What does the scientific evidence suggest

Visceral Osteopathy has, in many cases, proven to be an effective therapeutic approach for back pain of visceral origin. By restoring the mobility of internal organs and relieving tension in fascial tissues, this technique has, in some patients, contributed to a reduction in pain and an improvement in quality of life. However, the response to treatment can vary depending on the individual characteristics of each patient.

Studies suggest that Visceral Osteopathy may be beneficial in reducing pain and improving physical function in some cases, although results can vary between individuals. A study published in the journal Explore In 2022, evidence was found that visceral manipulation had a positive impact on mobility and pain relief (Pope et al., 2022). Another study, published in Journal of Bodywork and Movement Therapies In 2012, it was indicated that sigmoid colon manipulation was effective in reducing lower back pain, especially in patients with intestinal disorders (Migliorini et al., 2012).

The available scientific evidence suggests that Visceral Osteopathy, when used in conjunction with other manual therapy approaches, may be useful in treating underlying visceral dysfunctions, contributing to improved internal organ functionality and long-term pain relief (O’Conner & Pridmore, 2011).

Understanding visceral back pain from an integrative perspective

Visceral dysfunctions can be responsible for back pain and pain in other parts of the body due to the complex interaction between the visceral and musculoskeletal systems. When these dysfunctions are not identified, conventional treatment for back pain may be ineffective. Visceral Osteopathy, by integrating the treatment of visceral dysfunctions with specific manual techniques, can provide significant symptom relief and promote patient well-being, offering an integrative approach to treating back pain.

Therefore, Visceral Osteopathy offers an effective approach to treating back pain, taking into account the complex interaction between the visceral and musculoskeletal systems. By treating the underlying visceral dysfunctions, Visceral Osteopathy can promote global improvement in well-being and functional recovery.

At Integrativa, Visceral Osteopathy consultations are part of a global clinical approach, where we assess the body in an integrative way, considering the interactions between the musculoskeletal (Structural Osteopathy), visceral (Visceral Osteopathy), and cranial (Cranial Osteopathy) systems.

Book an assessment with an Osteopath specialising in Visceral Osteopathy and discover, in a careful and personalised way, how this integrative approach can help with your specific case.