viscerosomatic levels
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Viscerosomatic Levels: A Practical Guide to getting questions right

To the right are the basic Viscerosomatic Levels outlined how I teach them in my course.

These are honestly, some pretty low hanging fruit for COMAT and COMLEX.

This was one of the keys to my success on the COMLEX and in medical school in general.

Scoring high on exams is about hard work, but honestly sometimes there is low hanging fruit that can really bump your score up if you get them right.

Lets Get into more details about viscerosomatic levels

viscerosomatic levels


As mentioned, these can be super simple and straightforward questions, and honestly can lead to huge score bumps on your tests.

Typically, these involve memorizing, and if you can do that then you will be geared up to get 5-10 easy questions right on test day.

The viscerosomatic levels are areas that you will see tissue changes based on organ dysfunction.

An easy way to think about these is to break down the name.

  • Viscero: Think organs
  • Somatic: Think muscle

The first part of the word is where the dysfunction is, and the second part is where the change happens.

So, if instead I said somatovisceral, then it would be a dysfunction in muscle causing a change in an organ.

Key Learning points

  • Know what level is associated with what organ
  • You need to know chronic tissue texture changes
  • Pay attention to acute tissue texture changes
  • Know sympathetic vs. parasympathetic levels
  • What level is associated with what Organ

Chronic Tissue Texture changes associated with Viscerosomatic levels

This can be a super easy way for you to get some points on test day.

Knowing how the chronic tissue texture changes present in questions is some of the lowest hanging fruit out there on test day.

These vary quite a bit from the acute changes.

Chronic tissue texture changes are typically described as ropy and hard. There are other descirptions that I go over in more detail in CPM OMM, but at the end of the day if you remember ropy and hard, then you will get the majority of the points.

So, when you see the descriptors of hard or ropy when the question/person is talking about tissue texture changes, then think chronic changes.

Acute Tissue Texture changes associated with Viscerosomatic levels

Similar to the chronic changes talked about above. Acute tissue texture change questions can really lead to some easy points for you on test day.

These have a lot of descriptors, but ultimately if you can remember boggy and warm you will be able to recognize this in test questions and get a good percentage of questions right based off of just that.

Sympathetic vs. parasympathetic changes

Simply put, you need to know that sympathetic changes come from the thoracolumbar spine, while parasympathetic changes comes from the craniosacral spine.

If you put this together with the acute vs chronic changes mentioned above then you will pretty easily be able to get questions right on test day.

There are more details here, but I am all about keeping it simple in these OMM articles. If you want more details, then check out this review course, if not then these few points should serve you well.

How Viscerosomatic levels present in questions

So, this can be questions on any test that you as an osteopathic med student may see.

Best way to demonstrate this is by showing you an example question.

Here it is:

A 65 year old male comes to you with a history of diarrhea. He has had this before, and he descirbes it as a bloody diarrhea. He also develops fever and joint aches during these flares of diarrhea. When you take his history you find out that he has a diagnosed history of chronic recurrent ulcerative colitis.

When you do your osteopathic structural screening, what would you expect to find, and where would you find it?

  1. Cold, ropy changes at T12-L2
  2. Hot, boggy changes at T10-T11
  3. Cold, ropy changes at T5-T9
  4. Hot, boggy changes at T5-T9

The answer is A.

Why is that the answer? 

First off, the patient has a history of ulcerative colitis. That starts at the rectum and moves through the colon. So, you can bet its going to involve the last 1/3 of the GI tract, as mentioned above. So, that narrows it to T12-L2.

Then, it mentions in the stem this isn’t the first time, and it evens says chronic, and chronic tissue changes are typically cold and ropy, among others, but just know the cold and ropy part to start off.

If you know how to go through one of these questions like this, then that proves you know the content pretty well.

Many students won’t systematically go through it like this. If you can then you will do very well.

Summary of learning points

  • Know parasympathetic vs sympathetic
  • Know the distribution levels
  • Acute and chronic changes of tissue textures


Alright, so knowing the viscersomatic levels is important for getting more questions right. Is it really a clinical tool?

That is for you to decide, the main purpose of this article is to help you be more informed and ultimately help you succeed on your path to becoming an Osteopathic Physician.

I hope this has helped.

FAQ’s related to Viscerosomatic levels

What are viscerosomatic reflexes?

A Viscerosomatic reflex is when pain from an organ sends the signal to the dorsal horn of the spinal cord, which is also where a lot of motor nerves to the musckuloskeletal system are found. This signal from the organ eventually crosses to the somatic nerves and creates changes in the muscle, fascia, and other MSK components.

Are viscerosomatic reflexes real?

The science behind them is certainly real. Using them to diagnose specific organ dysfunction, is helpful but not an end all be all. They can help in diagnostics, but shouldn’t be relied on as the only tool.

What does viscerosomatic mean?

To know what a term means, it is easiest to break it down.

Viscero means organ, and somatic means essentially the muscluloskeletal system.

This means a pathology in an organ system produces a response in the somatic system.

Another way to put it is that pain in an organ causes a tissue texture change in the muscle and skin.

How do you treat chapmans points?

You typically find a chapmans point by feel. It feels like a small bead under the skin. You treat chapmans points by applying pressure with your finger and gently performing a circular motion with the pressure applied.

Chapmans points are being discussed because they are essentially a viscerosomatic reflex.

What causes a chapman point?

A viscerosomatic reflex, like we have been discussing is what ultimately creates a chapman point.

These can be helpful in getting points right on test day, and are covered in CPM OMM, along with all other major OMM topics.

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