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Visceral Osteopathy - a technical concept hiding a great discovery

An Interview with the Physiotherapist and Practicing Psychotherapist Nijesh Ulrich Hesse

1. Visceral manipulation, visceral osteopathy – it all sounds very technical. Hardly anybody, excepting a relatively narrow circle of professional osteopaths and craniosacral therapists knows and uses this method of treatment. Barral speaks of the visceral manipulation as the „missing link“ – a link between what?

As physiotherapists we have dealt for many years primarily with the locomotor (musculoskeletal) system (bones, muscles and joints) and the nervous system. Up to now the inner organs have not had the same significance in manual therapy. Today we are aware of the fact that inner organs often represent the link between musculoskeletal and nervous systems. All three systems – nervous and musculoskeletal ones, and the inner organs – influence one another. We can, e.g., find that, as a result of visceral manipulation, the blood perfusion of the brainstem raises for a short time by up to 40 %! On the basis of an appropriate finding from an osteopathic examination we often treat the symptoms of the musculoskeletal system, e.g. limited range of movement in the shoulder joint, by means of visceral manipulation. For me, this is what makes the work so exciting.


2. The link should be understood as particular anatomical connective tissues (ligaments) between organs and the musculoskeletal apparatus. What is their role with certain disease symptoms?

The connective tissues between inner organs, their ligaments and fascia (bags / sacks / skins) and the locomotor apparatus are quite concrete. I am reminded of one patient who came into my consulting room several years after a deep abdomen operation. She suffered from painful limitation of the movement scope in her left shoulder joint. The physiotherapist‘s approach was to treat the shoulder locally. The difficulties appeared again. The result of osteopathic visual and palpation examination showed serious fixations and limitation of movement of several organs in the abdomen. Scars, ligaments and organs were attended to viscerally approximately 25 times. As a result the symptoms in the shoulder disappeared completely. The reason why: in the long-term perspective, through the so-called „lesion-chaining“ the local tensions in the fascia were passed on. You can imagine this like a tough rubber band.


3. What was then the great discovery of Jean-Pierre Barral?

I think the techniques of visceral examination and treatment have existed for a very long time. Andrew Taylor Still, the founder of osteopathy, had probably used visceral approach. Nevertheless, Barral was the first man who, thanks to his osteopathic and physiotherapeutic activities in a clinique for airways diseases, had the oportunity of clinically evaluating visceral manipulation and e.g. prove the effect of that experienced airways diseases on the spinal column. Moreover, Barral distinguishes between „mobility“ and „motility“ of inner organs. „Mobility“ is induced by diaphragm breathing, i.e. every inner organ moves along a clearly defined physiological axis. „Motility“ is an inherent energetic movement, whose direction and dynamics comes from embryological development. And: Jean-Pierre Barral has collected data for decades and thus developed the psychosomatics of inner organs. His book has only appeared recently. It is worth reading – also as it was written for the lay reader.(1)


4.In what cases should we consider using the visceral treatment?

From the osteopathic angle the treatment „flows“ mostly between parietal techniques (related to the locomotor apparatus), visceral and craniosacral ones. However, there are clear indications and symptoms, which make me proceed primarily in the visceral direction: gastrointestinal complaints, flatulence, unclear bellyache, scars in abdominal area after operations, colics, chronical inflammatory processes, ptoses, bladder inflammation, menstruation complaints, airways diseases; in the case of unclear backache it is preferable to carry out a thorough visceral examination. Also general weakness, tiredness, lethargy and depression as well as certain kinds of headaches can have their grounds in the visceral area. Among other causes, liver can play a very important part here.


5. The inner organs are covered with a „skin“, e.g. pleura and peritoneum, just as the nervous system, all bones and muscles and the whole human body. This is a totally „autonomous“ and very surprising communication through ligaments and fascia which goes on within our body, independent of our wakeful consciousness. We „take notice“ of it to a certain extent when something fails to function properly through physical pain,uneasiness, illness, bad feelings.Can you give us a concrete example of a visceral problem?

Let us go back to liver: most „civilized“ people have a liver which is too weak. The same often applies to pancreas. Sooner or later we can feel latent tiredness or heaviness (especially in the legs), we tire out quickly – we have, so to speak, no „energy“ and experience no joy of living any more. In the worst case we sink into a deep depression. Here we are asked for advice: it is necessary to talk about eating habits, physical activity and exercise, stress factors. Liver, weakened by unsuitable nutrition and suppressed emotions, is no longer able to detoxify properly. The toxins land eventually in the large intestine, through the walls of which they are resorbed again into the body and so this circulation of toxins is ever growing stronger. It burdens the liver and naturally the colon more and more. Many chronic diseases, such as arthritis and arthrosis can well be treated by means of a holistic approach and if the patient cooperates the prognosis is favourable. Many school MDs have already become aware of this.


„Typical“ are unclear pains in lower back or in iliosacral joints that sometimes cannot be explained from the platform of orthopaedy. A deep visceral examination leads us sometimes simply to the scars after an apendicitis operation or, possibly, to the organs of the urogenital tract.



6. Is visceral treatment very uncomfortable for the patient?

I always try to work in a painless way, i.e. under the pain threshold. We work with the body and offer it possibilities of correcting what is necessary. The healing is done by the patient, namely his or her self-healing power. It seems to me the word „Visceral Manipulation“ can also be misinterpreted. The most important osteopathic principle in this kontext is: the least possible strength bound with the greatest possible precision. The treatment can be, like with the stretching exercises, very intensive and yet pleasant. In case there is a vegetative reaction such as feeling sick, vomiting, sweating or heart palpitation, I stop the work.


  7.Children should profit from such a treatment as well.                 How?

Children react significantly stronger and more quickly to visceral techniques. This is why we should also use minimum strength. Often it is sufficient to work just with the „motility“ of the particular organ. Experience shows that in cases of difficult childbirth (e.g. forceps, bell) the osteopathic techniques are excellent. Mostly we choose to do craniosacral diagnosis and therapy, through which the visceral symptoms can be also treated. Important: first examine the parents and if necessary treat them! Here is also useful to speak about food, eating habits and lifestyle.


8. What is so fascinating about visceral manipulation for you personally?

During a serious illness I underwent among other things an osteopathic therapy. Simultaneously, I consulted regularly an ayurvedic doctor and gradually rebuilt my diet. My osteopath used predominantly visceral work. I was impressed by the precision of her diagnosis and treatment. Contrary to the school-medicine verdict („incurable“) I had healed completely within three years and was fully recovered and capable of working, also under stress. Especially fascinating for me is, that the causes of symptoms presented by the patient can very often be found in the visceral area.


© Interview 2009: (




Nijesh Ulrich Hesse is a physiotherapist and Heilpraktiker for psychotherapy. Next to his own practice he gives courses and seminars in Germany and Slovakia.





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Interview with Nijesh U. Hesse | Visceral Osteopathy