1. Introduction / Plain Theory

Visceral pain refers to discomfort or pain arising from the internal organs (viscera) of the thoracic, abdominal, or pelvic cavities.
Unlike somatic (muscle or joint) pain, which is often sharp and localized, visceral pain tends to be diffuse, deep, and poorly defined — sometimes perceived far from the actual source (a phenomenon known as referred pain).

Visceral pain is transmitted through the autonomic nervous system, often accompanied by changes in blood pressure, sweating, or nausea.
It can result from inflammation, distension, ischemia, or mechanical irritation of organ walls.

Common examples include:

• Upper abdominal discomfort from reflux, gallbladder, or stomach irritation.

• Lower abdominal or pelvic pain related to bowel, bladder, or reproductive organs.

• Chest or shoulder pain referred from the diaphragm or heart.

The osteopathic view recognises that visceral and musculoskeletal systems are closely linked, sharing neurological and fascial connections.
This means dysfunction in one system can manifest as pain or restriction in the other.

2. Typical Symptoms and Functional Impact

• Deep, dull, or cramping pain in the chest, abdomen, or pelvis.

• Referred pain to the back, shoulders, or neck (e.g., gallbladder to right shoulder).

• Bloating, digestive discomfort, or altered bowel function.

• Increased tension in surrounding muscles or connective tissue.

• Sensitivity to posture, breathing, or emotional stress.

Functional impact:
Visceral pain can affect appetite, sleep, and daily comfort, often creating a cycle of pain, tension, and altered autonomic tone.
Chronic visceral pain may lead to fatigue, anxiety, or reduced physical activity.

Red flags:
Severe, sudden, or unexplained visceral pain; fever; vomiting; gastrointestinal bleeding; or changes in bowel/bladder control require immediate medical evaluation. Osteopaths always work in collaboration with medical professionals to rule out serious pathology.

3. Contributing Factors / Underlying Causes

Visceral pain has multifactorial origins, involving both local and systemic influences:

• Organ inflammation or irritation: gastritis, irritable bowel syndrome (IBS), dysmenorrhea, gallbladder dysfunction, etc.

• Fascial tension: restriction in the connective tissue linking organs to the spine and diaphragm.

• Autonomic imbalance: increased sympathetic tone leading to altered blood flow or motility.

• Somato-visceral and viscero-somatic reflexes: interaction between internal organs and related spinal segments.

• Postural or diaphragmatic restriction: limiting motion and fluid exchange in thoracic or abdominal regions.

• Emotional stress: affecting vagal tone and visceral sensitivity.

Chronic visceral pain may persist even after the original insult resolves, due to central sensitisation or ongoing autonomic dysfunction.

4. Osteopathic Approach

Osteopathic care for visceral pain focuses on supporting function and mobility of both the affected viscera and surrounding musculoskeletal structures — never replacing medical diagnosis or treatment.

An osteopathic assessment may include:

• Review of medical history to exclude red flags or systemic disease.

• Evaluation of posture, breathing, diaphragm motion, and spinal mobility.

• Gentle visceral and myofascial techniques to improve organ mobility, fluid dynamics, and neural regulation.

• Addressing compensatory patterns in the spine, pelvis, and rib cage.

• Supporting autonomic balance through cranial or functional techniques.

• Collaboration with GPs, gastroenterologists, or gynecologists where appropriate.

The goal is to reduce mechanical strain, enhance circulation and drainage, and help the body restore natural rhythm and regulation — complementing medical and nutritional management.

5. Scientific Evidence & References

Emerging research supports the use of visceral manual therapy as a complementary approach for certain functional disorders, including IBS, dysmenorrhea, and chronic pelvic pain.
Evidence suggests it may help improve pain, mobility, and quality of life, likely through modulation of autonomic function and fascial tension.

However, treatment should always be individualised, medically informed, and applied within safe clinical boundaries.

References

1. Cervero F, Laird JM. Understanding the signaling and transmission of visceral pain. Pain. 1999;82(Suppl 1):S1–S9. Link

2. Dorn SD, Palsson OS, Thiwan SI, et al. Increased colonic pain sensitivity in irritable bowel syndrome is associated with autonomic dysregulation. Gastroenterology. 2007;133(5):1199–1206. Link

3. Bordoni B, Zanier E. Anatomic connections of the diaphragm: influence of respiration on the body system. J Multidiscip Healthc. 2013;6:281–291. Link

4. Barral JP, Mercier P. Visceral Manipulation. Seattle: Eastland Press; 2006.

5. Tozzi P. A unifying neuro-fasciagenic model of somatic dysfunction — underlying mechanisms and treatment – Part II. J Bodyw Mov Ther. 2015;19(2):254–265. Link

6. Portero P, Vidal C, Bouchoucha M, et al. Visceral osteopathy in the management of irritable bowel syndrome: a systematic review and meta-analysis. J Bodyw Mov Ther. 2019;23(2):339–346. Link

7. Cerritelli F, Esteves JE, Martelli M, et al. The effects of visceral osteopathic treatment on autonomic nervous system and pain perception: a systematic review. J Altern Complement Med. 2020;26(4):281–293. Link

8. Xie Y, Chen Z, Yang Z, et al. Comparative efficacy of manual therapy interventions for functional visceral pain: network meta-analysis. Front Med. 2024;15:1507291. Link