The Visceral Connection to Musculoskeletal Pain

In this episode of the Unreal Results podcast, I unpack the relationship between the viscera, the nervous system, and the musculoskeletal system and why understanding this connection can completely change your clinical outcomes. I walk you through the physiology behind visceral referred pain, how the spine and organs influence each other, and how to start integrating this into your assessment and treatment approach without overcomplicating your process.

In This Episode, You’ll Hear:

• How visceral organs create referred pain through shared neural pathways
• The difference between visceral referral and viscerosomatic reflexes
• Why common pain presentations (low back, shoulder, pelvic) may not be musculoskeletal in origin
• How to use spinal levels and anatomy to guide more effective treatment

This episode is about expanding your lens so you’re not just treating symptoms, but understanding what’s driving them.

Resources & Links Mentioned In This Episode:
Get my Visceral Referrals Cheat Sheet HERE
Ep. 125: You're Already Treating The Viscera... You Just Don't Know It
Book I Mentioned - From Manual Evaluation to General Diagnosis: Assessing Patient Information before Hands-On Treatment by Alain Croibier*
Learn the LTAP® In-Person in one of my upcoming courses

*This link is an Amazon affiliate link, meaning I earn a commission from any qualifying purchases that you make

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Transcript

Anna Hartman: Hey there and welcome. I'm Anna Hartman and this is Unreal Results, a podcast where I help you get better outcomes and gain the confidence that you can help anyone, even the most complex cases. Join me as I teach about the influence of the visceral organs in the nervous system on movement, pain and injuries, all while shifting the paradigm of what whole body assessment and treatment really looks like.

I'm glad you're here. Let's dive in.

Hello. Hello. Welcome back to another episode of the Unreal Results Podcast. Um, where have I been since the last time I recorded? I went to Washington, Washington, DC for the only East coast, um, in person LTAP level one of this year. Um, and it was so great. My buddy Chris at Align, uh, in DC hosted us and he was so amazing.

He took great care of us. He cooked us food, like the whole group food for lunch. Um, he had snacks for us, like, um, homemade, um, cinnamon rolls and. Like pastries one morning for breakfast. Like literally spoiled the crap out of us. And um, yeah, it was just, it was a really great, um, class and, um, I had a great time in dc I do really like dc um, like the vibe.

It's good vibe. Um. Lots of like things to do and like, you know, everybody's like, every time I've been there, like the streets are just like busy with people and restaurants are hopping and, um, yeah, it's a fun vibe. Um, and then like similar, I think the age, like average age of people, like must be around my age or like a little bit younger.

Um, but like everybody is like. The vibe of everybody is like, just like, go-getter, like driven, that kind of thing. It was cool. I, I enjoyed it. But anyways, um, what was I gonna say? Oh, the, the propaganda, the propaganda of our president there is pretty, pretty funny to. A bit of an eye sore. Um, and it was also very, um, interesting to experience seeing, um, the National Guard roaming the streets, you know, protecting the city.

Um, and kind of made me sad just to like witness the state of the union that, you know. At least for me, like has mostly just been witnessed through video and like tv, I guess. Um, so, and um, it was interesting, you know, uh, one of the things that's interesting about the National Guard in the city is just like number one.

The vehicle which they roll in and then like all get out of it was like an unmarked van, kind of weird, shady feeling. And then two, they're walking down the street in their group, um, number one, like how freaking young they are, like just groups of young men. And it makes me a little sad because, you know.

They're doing their job and people are giving 'em a hard time because of what it represents, um, which I understand. Like I don't necessarily agree with it either. Um, but come to find out, um, you know, Chris had told me that recently, uh, one of them had been murdered. So like when they're at, um, you know, when they were at intersections.

Stop, like waiting across the street. They stand with their back towards each other, so they're in a circle so they can like have eyeballs on like full 360 degree, 60 degrees around them from like a safety standpoint. And I'm like, that's so freaking sad. And yeah, it's just amplified sadness too. Just this state of how things are.

And then also like. Again, like how young they are and how much like, yeah, tough anyways. Um, so that was interesting. But overall, I had a great weekend, a good group. Um, always loved teaching people the LTAP. Um, a lot of the times too, I loved teaching because it, like, every time I teach, it just like makes me like get more and more clear with

what principles and like what there is to teach. So I love it. Like I can't, who knows how many classes I've taught at this point, like upwards over 25 probably. But, um, yeah, each time it like gets better and better and like even to me the principles like it, it starts. I don't wanna say, say stars, 'cause it, it makes sense to me, but it like, even like, solidifies my ideas, my approach and, um, and not, like I say, my ideas, my approach.

This is not just my ideas, my ideas and my approach. This is a collective of what I've learned over the years through all the classes, you know. Through, yes, all the classes from the Barral Institute, but then like all my other education too, like I've learned from other osteopaths, I've learned through a lot of like allopathic type medicine too.

And, and it's just like cool to see it all come together and like pull the red threads out of it. And, um, yeah. So anyways, I'm also, um. I'm also preparing for this weekend in San Diego. I have a group coming in for the annual mentorship seminar weekend, which is a three day weekend that, um, clinicians can come to.

It's like invite only, invite only, meaning that you have to have previously attended an in-person, LA level one with me or have gone through the revitalized mentorship, um, course. So, um, yeah, like the invite is only to a, a, a select group of people. The topic every year changes. And, um, part of that is because it's like, I want it to be more about community building and, and then also too, like more about true mentorship in terms of, you know, like.

Come with, come with ideas of what you want to learn from me and then like let's just kind of like naturally riff now from a teaching and class standpoint. People don't always love that because they like to have notes and like things like that too. So I try to have some like general guidelines of like what we're covering.

And then the last couple years I've used the seminar weekend to actually beta test some new course ideas for me. Um, so that's what this. Three day weekend will be is I am beta testing the ltap level three, which is what it's called right now. I have a feeling that, um, as I continue to roll things out, I'm gonna get rid of the nomenclature of levels because it's confusing.

Um, I mean, level one's still gonna be level one, but then after that, instead of calling it level two and three, I'm just gonna have different topics, uh, prerequisites still gonna be level one for all of it because again, level one, as I've talked about probably on previous, um, episodes level, level one provides us like, um, the nomenclature, the foundational like

model framework, the foundational lens of view and assessment piece that like is like getting us to all speak the same language. Um, and then, then these courses will like further dive into like more specific and precise assessment and treatment of the body. So as I've been sort of like thinking about in my head what, what I wanted to cover, um, over these three days, asking the group what they're looking forward to, like the answers they're looking forward to, um, getting, or the clarity they're looking forward to getting over this three days.

Like, um, you know, I've been, I've been in it, I've been in my brain quite a bit. Um. Sorting out thoughts. And then when I do that, I've talked about this also on the podcast 'cause it's a little bit of the process of how I prepare for a podcast episode is I go back to some of my textbooks, some of my old course material and just like kind of organize like re, I don't wanna say reorganize my thoughts, but like to validate my thoughts.

And it's funny because one of the books I've been reading. A lot of lately is this book I've had for a while. Um, and it's one of those books that it's like, I haven't, I don't necessarily, I haven't read it like front cover to back cover, but I'll read it like chunks of sections at a time. And so as I've gone through it the last few days, I've realized like I've actually read most of this book, um, just not front to back as intended.

And, um. In this book, um, and actually a theme that has come up in the last teaching, the last couple in-person courses has been this, this, this need for, for me as a clinician, like, you know, even talking about like how the LA was born and it was in this need to corroborate, um my diagnosis or assessment of the body, this need to have multiple assessments pointing me in the direction of a certain thing as the primary dysfunction or the primary treatment target. And you know, part of it was born out of this, this necessity of not. At first, trusting my hands with what I feel in an I osteopathic diagnostic standpoint.

And so needing more, um, what felt like more objective or like concrete orthopedic tests that would lead me to these same areas of primary dysfunction or primary tension, primary, um, disturbance of the body, uh, you know. Where my general listening would take me. And, um, and so too, as I teach it and as I talk to other practitioners about my, my processes, it gets more and more clear that a lot of what I'm doing as I'm assessing my patients and, you know, blending, you know, assessment and treatment throughout a session is I am, um, arriving at a diagno, what's called what? I, I didn't even know there was something, it was called it, I thought it was just, I was like a skeptical person and like needed more evidence that I should like go where, you know, like I sh like am truly being directed into a certain area. And it's, it was interesting because as I'm reading this book, he talks about it as being a like diagnostic convergence and how important that is in evaluation and diagnosis is to have, um, have diagnostic convergence of like a lot of your assessment all pointing to one thing. And I was like, oh, like how cool is it that. That's like an actual thing. And, um, that it's, it is always nice when you're like, oh, it's not just me.

It's not just me. It's like an actual thing and like an actual goal. Is this like. Convergence of like all the information that you're gathering. I can't, I can't find the word for word, but all the information that you're gathering should point into this direction and, and oftentimes too, you know, nothing.

I, I really, truly believe, like nothing is truly like an original idea. Like I, I truly believe I. You know, you take all this knowledge in throughout your life and also like, there's just like a collective knowledge from our humanity over the millions of years of our species that I don't think necessarily goes away when you, um, when you die, and this is where things I guess start to get a little woowoo in terms of like my opinion on this, and again, this is not even an original idea. I heard it from someone else and I was like, oh, that resonates. I believe that. And it's just this understanding that like this collective knowledge that is out there, sort of like in the ether that we have developed over the millions of years of our species, you know, and like is always there, it never goes away.

And that at any time we sort can sort of like tap into that knowledge base. Um, and it's much like in your career, you know, that's kind of like a universal. Thought process of it, but like within your, your lifetime and within your career, you're constantly learning from people. You're learning from teachers, from professors, fellow students, your patients, your mentors, teachers in continued education classes like and you're learning from them what they've learned from everyone, right? And it's like, yes, that makes it their own unique thing, but at the end of the day, it's not an original thought necessarily. Um, the original ness is of it, is like how it's presented and how it's like integrated into their own practice.

And it's been, what's interesting is reading this book. I just kind of chuckle because reading this book, I'm like, oh, you know, it's cool to, it's cool to see it all come together in a book. And, um, obviously it's not my book. I didn't write the book, and if I were to write a book like it, there would be a lot of similarities, but then there would be different things too, because I, I've learned from different people than he has learned from.

But, um, Going through the book, I've realized that one, yes, I've pretty much read the whole thing, but then two, I I thought, oh, in the 23 or whatever, however many courses I've taken through the Barral Institute, as well as from other osteopaths. Like I do think that all of my learning and conversations I've had with Phillip Beach also contributed to a lot of this knowledge, not just, not just the Braw Institute, but the other osteopaths I've sort of learned from around the way, and then even too like.

Though the college, the university I went to for graduate school was not, didn't necessarily outright teach us osteopathic a approach. It, it was part of an osteopathic university. And so I think there is like naturally some teachings from that. And then, um, so it's just cool to see it sort of like, oh wow.

All these principles that they have been teaching throughout the bra courses that I've picked up that I, you know, then when I went to teach people what I do, I like laid 'em out.

In a presentation, and it's not like I Googled what are the osteopathic principles. It was just like, these are the principles I, I've learned through the techniques I've learned, um, through the words, through the, the ways the teachers have decided to teach because it's not necessarily laid out, organized in their textbooks.

You know, the, the, the textbooks that go with the class and in the handbooks that go with the class and, and in the handouts from the class and, and, um, so land the plane Anna.. So reading this book, there is a section that goes over osteopathy and I was just like. Chuckled because there's like multiple paragraphs, a whole chapter talking about principles of osteopathy and what they are, and I, and I was like, wow.

I was able to filter out all of those exact principles. Like it's literally like almost word for word of what I filtered out by just learning it through the years. And I think that's really cool. And I think that is like. It's like one of the core beliefs of my course and is like this embracing of my favorite quote by Harrington Emerson.

You know about we learn techniques and in order to understand principles, and once you understand principles you can create your own techniques. Like it really truly is that to come to life and I think be. As much as I had a complaint that it wasn't all laid out for us. I actually think that I learned it better because it wasn't all laid out for us, and that is like the core belief that I share in my classes of like, yes, I lay out the principles because I think it is helpful to sort of like see them, but my emphasis is don't trust me.

Right? Don't trust me. Don't trust these principles like blatantly. I want you to use the techniques, use the assessment tools. Like I want you to be curious about seeing them like in real life interplay. So, um. Again, like that, always, like whenever I say that out loud, I just chuckle because it reminds me of being in the fifth grade working on my science project.

This is what it's all about, like the scientific process. And um, I love that it comes full circle like that. So the other thing that I thought was funny reading this book was, you know, my big thing is as I'm trying to teach the world. To operate differently, to to consider the visceral in the nervous system and consider the like the, what I call the whole organism paradigm versus just often say just the biomechanical, which could also just be like just the musculoskeletal system or bias. And I wholeheartedly believe that, and that does come from these osteopathic principles. Um, but it also just comes from like, when I, when you see it in action, it ma it gets such better results and then also it makes so much more sense.

But, um, I. I often, you know, you find yourself trying to explain how things are different than traditional allopathic medicine and like traditional allopathic care, which is like the, the, the world we operate in quite a bit, um, versus,

um, osteopathy and. The funny thing is, is, you know, osteopathy has been around for a long time and it was like a older type of medicine. Um,

and I'm sorry, I'm looking at the, you know, how I am with de definitions. It's like Allopathy is highly regulated.

Allopathy acts against symptoms to suppress or eliminate them. It's disease oriented, symptom focused, ideal for acute life threatening emergency situations, categorized and diagnostic categories.

But, um. As I'm, as I often like described osteopathy to people at the end of the day too, like when you think of osteopathic medicine, osteopathic doctors, it actually fundamentally goes down to this. Idea that the biomechanics having perfect, having the perfect biomechanics actually results in good health.

And so it's, it made me chuckle when I read that because I was like, oh, I guess that is what it's always talked about. And it makes you realize like, oh, actually the osteopathic model, believing that the biomechanics like cures a lot. Um, is actually probably like the reason why we're all here in the first place looking at biomechanics in the musculoskeletal system as such a big focus.

Um, and yes, that's true, right? I always say like, it's not that I don't think the musculoskeletal system in the biomechanics don't matter at all. It's that we've gotten away from understanding why they got thrown off in the first place, right? The model is a problem in the sense that the model was not including things like the viscera and the nervous system and their influence on the biomechanics.

And that's, that's the problem with the model. And ultimately like, yeah, with the osteopath, if you're really, truly, like following osteopathic principles, like restoring biomechanics is key for like health and function and wellness of the body. Not just the musculoskeletal system, but the, the viscera and the, um, nervous system and, and just the fluids, like all the things.

So anyways, I just thought it was. Kind of funny, um, that, um. It made me chuckle in the fact of like, yeah, the, the bio, it's not that the biomechanics don't matter, and I, and I hope whenever I say that, it's like an outdated paradigm, an outdated model. People are understanding that it is an outdated model when all you care about is the biomechanics, and the only strategy used to fix the biomechanics is the musculoskeletal system.

Right? You're, you've lost. You've lost context and nuance when your only treatment tool, your only assessment tool is the same thing you're trying to fix. So, um, anyways, a long, this is a long intro to like, tell you where my head's been at and be like, yeah, this is why we didn't have an episode last week, because I'm in the messy middle of like organizing my thoughts and, and organizing, you know, and like reading.

Reading a book about, about it sort of in a way. Um, but I did wanna talk a little bit about the visceral referral cheat sheet. Um, I am like realizing like I have this visceral referral cheat sheet. I think it's great and it is like one of the free downloads that I have and, um, I've never. I talk about it in terms of, I tell you it exists and sometimes I like mention it as a resource for treatment, a resource for assessment, a resource for like, just like differential diagnosis and thought process.

But I've never really like talked about, um, in depth like about the viscera and the musculoskeletal system and like the visceral somatic relationships of like. Why, like, why it happens. And I may have mentioned it on like one or two episodes, I guess, um, maybe even recently. But it's one of those things that I'm like, I, I dunno, I feel like it kind of deserves its own, like maybe it deserves its own podcast episode. And so, you know, there's this idea of, I talk about, so the visceral referral cheat sheet, I have it pulled up in my other window here so I can make sure, you know, I say it's a must have resource for PTs and ATS to unlock better outcomes for your clients. I share about like why I created it.

Which is also why I created this is for the same reason of like why I am teaching in this way, is because I want you to be able to have a differential diagnosis that includes like, could this pain be a referral from an organ? And is this organ, is this referral, like emergency red flag? Like you're catching a disease that was missed by a doctor sort of thing.

Um, so. This is like a reference guide for that, and it provides you some general areas of visceral referred pain and the level of the spine that there then is the visceral somatic reflex. So let's talk about this. So, the visceral organs, they don't have the greatest innervation to them or map of them in our brain, like our body does.

Like our, our our a somatic mapping. This somatosensory map in our brain has mapped the, our. Body parts, our body and how there's a very good representation of like our hand, our tongue, our feet, our genitals, our arms, our legs, our trunk, our head, right? Like it's very well mapped in our body, sorry, mapped in our brain, our body, and also mapped not just in our big brain, but our little brain, which is our cerebellum.

Now the visceral organs, yes. Part of our body are not mapped quite as well because there's less peripheral nerves to them. There's less peripheral nerves to them. And so what happens is because there's less peripheral nerves to the organs than the rest of the musculoskeletal system, the messages that come from the organs sometimes converge with the peripheral nerves, innervating the body, the musculoskeletal system, and you get visceral referred pain.

Right, so that's called visceral convergence. Visceral convergence, and this is, I'm reading this definition from the interwebs. Visceral somatic convergence is the neurophysiological mechanism where, where visceral organ and somatic nerves, this nerves to the skin and the muscles converge on the same spinal cord neuron.

Okay. Visceral referral is the result, the pain perceived in somatic areas, not the organ itself. So convergence causes the referral because the brain confuses organ pain with skin pain due to shared pathways. Okay? Then you have what is called a visceral somatic reflex. A visceral somatic reflex is a related concept where visceral inflammation or visceral dysfunction, um, causes chronic, localized muscular tension or dysfunction in a corresponding segment of the spine. Right? So, and this has to do with the relationship between the sympathetic nerves and the organ areas. So oftentimes, and in the visceral referral cheat sheet, I share all of these.

I share with you the visceral referral pain areas, which are going to be more of what is commonly referred to as head zones, head zones, because the doctor who like discovered them or first started sharing about them was his last name was Head. So these are the pain areas, the referred pain areas. The somatic referred pain areas from the viscera.

These ones you already probably are familiar with this is like when you have a heart attack, you have left shoulder, like jaw pain, upper back pain, spleen also can go to the left shoulder. Um, what else would it be like gallbladder, the. You know, the shoulders, the mid back, pancreas like that, mid back wrapping around pain, um, appendix, the like, hip low back pain, kidneys, low back pain.

Like these things are a little bit more mapped and, um, classic referred pain spots. And these are from that visceral convergence. The visceral somatic reflex is this more. The sympathetic nerves going from that nerve root area to the organ or from the organ back to that nerve root area causing a reflexive effect at the spine, either within the facet joints, the muscles around the, um, joints of the spine or the intervertebral joint, like all the little nerves that innervate the different ligaments of the spine, that, et cetera.

Okay. So, um, the cool thing is, is you can use this knowledge as a way to like differential diagnosis, right? For some reason, when it comes to the athletic training room or the PT clinic, when somebody walks in with left shoulder pain. You, you don't first think, you don't think heart first thing because you know, maybe the age of the person or like it's not that severe or it's been going on for a while.

Right? Like sometimes the thing that makes us think it's a heart attack versus like. Rotator cuff tendonitis is the chronicity of it, or like the onset of it, right? But just like a heart attack can instantly create this pain. Just dysfunction in the pericardium or within other organs in the area can start to create that pain pattern as well.

And so it's funny that we don't think about it especially too, the other example I give people is like, you know, people who have uterus, especially like who menstruate? Um. Like, hello, you have visceral, somatic referred pain on a regular basis. We have, you know, what's called low back pain, but it's really pain on your sacrum or pelvic pain.

Um, it's so common, but yet when someone comes in with back pain, you don. And you ask them to point to it and it's down light low like that. Oftentimes our first thought is not, oh, it could be your visceral organs of your uterus, your rectum, your bladder, your ovaries, or like your um, prostate. We think, oh, it's your SI joint.

So it's interesting that our brain just doesn't like, it associates it with visceral sometimes in some settings, but yet clinically it's like we, it goes. Disappears. And so it's a little bit of like, I like that thought pro, like right there. That whole comment should be like, make you be like, why do I do that?

Like it's like a no duh moment of like, oh no, duh. Like ugh, why don't I think about that? And so it's a little bit of understanding those connections, but then two. Um, it's this appreciation that it can go back and forth, right? The, the visceral organ can affect the spine, but the spine can affect the visceral organ, vice versa.

So it gives you more treatment points too. Which, which, when it comes to, you know, what I teach in the. Locator test assessment protocol level one course is like being able to figure out like, is the shoulder pain? Is it, is it coming from your liver or your gallbladder? But then it's like, okay, if it is, how do I treat it?

Because like if you haven't learned visceral manipulation, now all of a sudden it's like I don't understand how to treat the liver or their gallbladder. And I have a whole episode that I'll have Joe link in the show notes is basically like, you've always been treating the viscera in the nervous system.

You just haven't seen it that way. But this visceral referral cheat sheet helped. Helps you to see it that way of like, no, if it's their liver, you can treat T7 to T9, right? Assess it first. Maybe. 'cause when you assess it first you're like, oh, look at that. There is a facet restriction on the left side of T8..

Let's treat that right. Or you can just treat it generally. And then also like understand where the liver is right side. Mostly it goes to the left, but like most of the right side of the lower part of your thoracic cage. Underneath the diaphragm, but within the thoracic cage, so you could treat that whole area.

Right, and then the further step you take it is like, like having to learn a little bit more about the anatomy of the liver and the peritoneum around it and how it attaches the hard frame because it is that parietal piece, the container that the organs live in, in their attachment to the heart frame.

That really has a huge effect on our posture in our biomechanics. And so then too, that opens up a whole nother area of yes. Not only could you have this visceral, somatic referred pain, this visceral somatic reflex to the spine, but now you introduce another concept of this parietal. Um, postural effect on the biomechanics and a disruption of this perfect balance or this dynamic alignment that allows for us to move our body in an efficient way for the fluid to flow efficiently, for the nerves to transmit efficiently.

Right? And this is why it's important to be able to have an assessment like the LTAP or general listening or any other sort of viscoelastic, visceral assessment of the containers, right? So you can appreciate is someone's foot pain coming from their liver? Because foot pain is not a normal, visceral somatic referral from the liver, but you can definitely have foot pain from a body that is organizing itself.

Dynamically around the area of the liver because the liver has lost its mobility or motility because the liver is having a visceral dysfunction from this lack of movement or inflammation or disease or whatever it may be. Right? And that's when you too start understanding. One of the osteopathic principles that I talk about a lot is just this idea that movement is health.

And I talk about movement in health as a macro level, which is what like everybody in the physical therapy and athletic training industries already appreciates, right? We know that people, when they're sedentary or immobilized, there's a lot of problems that come with it, right? We get that, but even on a more micro level, the organs inside of our.

Musculoskeletal system need to move in order to maintain their health too. And then on the cellular, cellular level, within that organ, the cells need to be able to freely, like go through their rhythm as well. And then the fluid movement needs to be able to get there too. So sometimes when the biomechanic organize itself around a dysfunctional.

Visceral organ, right? Because the mobility is lacking. That also then limits the blood flow and the nerve transmission to the area too, and causes another sort of like kink in the whole system, which is again, why this. Osteopathic principle of this drive for perfect biomechanics, what they're really meaning.

'cause they appreciate when you have perfect biomechanics, all the containers of the viscera, all the containers that the nerves and the vascular structures and the cerebral spinal fluid flow in that provide the vitality of the body to be well. Are able to, uh, you know, to quote loosely from at still the founder of osteopathic medicine, they are all free to do and act, free to do and act, to do their part in maintaining a vitality of life force, right?

So, um, this is. Hopefully getting you to sort of understand a little bit of what's going on. Right. Because too, um, in, well, in general too, it is just like, like I said at the beginning, the, the visceral organs are just not mapped as well, and so I think there is often a lot of convergence. When you can give it a more clear picture of what's going on, the body often is like, oh, instantly changes.

But a, a lot of it is coming from just like we see in biomechanics this, um, injury to the, um, parietal structures or the suspensory ligaments that from just life movement, life trauma, um, and a proprioceptive disinformation coming from those structures, which makes an already very blurry, not clear message from the organs because of the lack of peripheral nerves.

Now you've got a blurry, muddy, not clear message from the receptors around the containers that the organs are in, right? The mechanoreceptors, the pressure receptors. The chemo receptors, um, pressure mechano, chemoreceptors, I feel like I'm missing one volume receptors. But um, yeah, this is again why the work can be so powerful when we add back in the viscera and the nervous system to this biomechanical model, which.

Is then appreciates the whole organism, which is why I call it whole organism approach and, um, a whole organism paradigm because it starts to appreciate too, not only that, there's sometimes a deeper driver to why the biomechanics are off, but the reason why you then, like the target of what you're trying to, I hate using the word fix, but like where you're trying to direct your attention to, to help.

This is part of the whole organism piece, understanding that you are actually not doing the fixing. You're directing attention. That body's brain to that area to be like reminded, you have some work to do here. You're trying to restore the balance of that fluid flow, the life force energy and the sensory information to that area so that the body can.

Go back into the self-regulating, self-healing, um, capacity it has that is deeply embedded into it. Which again, like that's another osteopathic principle that we're operating under, right? That the body can heal itself. Ah, so hopefully you followed that and it makes sense and maybe it's a little bit more clear to you on like.

All the ways that the visceral organs can be represented in the musculoskeletal system and biomechanical model. Um, and then also appreciate that it's, again, it's not that the biomechanics don't matter, it's that we can't only rely on the musculoskeletal system to be the. Information that we need, and then also the treatment tool that we use to address things, which is ironic given that at the end of the day, the musculoskeletal system.

Is always going to be the treatment tool that we're using, but different than just exercise, different than, um, just exercising to exercise different in the sense of like, we're not gonna see a quad that's weak and assume it's weak. We're gonna see a quad that is weak and we're going to use our assessment determine is it really truly weak?

Is there a reason for this? Like, were they immobilized and it's truly atrophied so it truly is weak, like it doesn't have the muscles in cells in, um, parallel to create good, strong contraction? Or is it inhibited? The body is choosing to organize itself in that way, to protect an organ or to organize itself around an organ that doesn't have clear messages from it or good mobility to it.

Right. And this again goes back to this primary thing of this idea of this diagnostic convergence of why we have to spend so much time assessing is because we're trying to. Quote, you know, we're trying to get as much evidence as we need to, to, to figure it out, right? To have a working hypothesis of what the primary dysfunction is and how it relates to what's going on in their body.

So anyways, hope that's helpful. If you haven't downloaded it already, download the visceral referral cheat sheet, check it out, and um, see if it gives you some clarity or opens up some new ways of thinking about how to treat things or how to assess things or differential diagnosis to consider. Have a great day.

We'll see you next week.