Osteopathic Family Physician, 2026/07, 18(03):60–62. doi: 10.33181/18309, type of study: case report

Free full text   (https://acofp.org/docs/default-source/ofp/vol-18-no-3-summer-2026/12_identifying-and-treating-concurrent-referred-and-musculoskeletal-back-pain-using-an-osteopathic-approach.pdf?sfvrsn=15605429_1)

Keywords:

OMT [3924]
osteopathic manipulative treatment [3945]
referred muscle pain [2]
viscerosomatic reflex [6]
chronic back pain [8]
case report [736]
musculoskeletal pain [46]
visceral [155]

Abstract:

OMT is often used to treat musculoskeletal pain complaints. OMT can also help reveal and treat referred pain from visceral dysfunctions. This case illustrates the evaluation and treatment of both local tissue dysfunction and visceral sources of a single patient’s pain. A 44-year-old female presented with 10 years of thoracic pain medial to the inferior angle of the right scapula and 2 to 3 years of right-sided lumbar back pain near L4. Physical therapy, chiropractic, and massage therapy briefly reduced both, but failed to provide resolution. Imaging was reported as unremarkable. Medical history included gallstones with subsequent cholecystectomy, and multiple renal calculi requiring stent placement. Examination revealed rib and thoracic dysfunctions that reproduced the patient’s symptoms. They were successfully treated with OMT but failed to significantly reduce her pain. Given the cholecystectomy, a referred pain pattern was then considered. Tissues at the former base of the gallbladder were restricted, which was treated with myofascial release, resulting in immediate resolution of her thoracic back pain. Two weeks later, a viscerosomatic cause for her lumbar back pain was sought, given the history of renal lithiasis, but there were no transabdominal visceral findings. The local lumbar dysfunction was successfully treated with OMT, showing it to be effective in complete and longstanding symptom resolution. This case illustrates the benefit of seeking a visceral cause despite the appearance of local mechanical/tissue dysfunction pain. Similarly, despite a high likelihood of a viscerosomatic cause, local somatic dysfunction may still be causative, despite the prior failure to resolve with similar musculoskeletal treatments.