Although the link between visceral functioning and musculoskeletal system was documented, the implication of visceral applied techniques in osteopathic practice remain a point of discussion. Musculoskeletal, visceral, neurodynamic, cranial applied techniques and dietary corrections indicate the holistic approach of osteopathic care in an interdisciplinary consultation. The mechanism based assessment and therapy are indicated in the approach of patients.
In the osteopathic practice, musculoskeletal, visceral and cranial applied techniques are commonly used. Although the impact of visceral disturbances on musculoskeletal functioning is known, and vice versa, the practical application remains a subject of discussion. Osteopathic diagnosis and therapy of the abdominal and thoracic content were extensively described in osteopathic literature 1,2 but multiple aspects of this approach remain unclear or seem to have insufficient evidence based reference. Also, the fact that osteopaths should be added in multidisciplinary teams remains a point of discussion. Otherwise research results indicate the importance of osteopathic care, using a holistic approach, including visceral applied techniques. In multiple health problems, different ways of diagnosis and treatment using a mechanism based approach can be indicated. 3 This article tries to show the relevance of a holistic approach, based on literature and clinical research.
Pain of visceral origin can be referred to somatic locations 4,5 such as the skin (Headsche zones) and to the musculature (McKenzie zones). 6 Visceral pain is often felt in places of the body away from the location of the affected organ. Referred pain can be of use to diagnose visceral diseases. 6-8 Diseases of the gut, the bladder or genital organs can provoke pain in the abdomen, the pelvic area or the back with the patient not being able to locate the pain accurately. 8-11 Visceral pain tends to be diffuse because of the organisation of the visceral nociceptive pathways in the central nervous system, the absence of separate visceral sensory pathways and the low proportion of visceral afferent fibres, compared with the somatic system. 12 The convergence of visceral and somatic afferent fibres onto the same spinal sensory neurons leads to this misinterpretation by higher brain centres. 13 The pain can spread over broad somatic regions. Taken the history and palpation does not always give the right indication. It provides information to complete the diagnosis, and must be complemented by technical examinations. 14 Differential diagnosis based on musculoskeletal conditions, referred pain patterns and palpation is well documented. 8 Visceral pain is accompanied with somatic and autonomic reactions. 6,9,11,15-20 Referred muscle pain with hyperalgesia may be attributed to a process of central sensitization taking place in the central nervous system (CNS), triggered by the massive afferent visceral impact upon convergent viscero-somatic neurons. 9 Sweating, tachycardia, increased respiration and other autonomic processes can accompany visceral pain. 21