Understanding development as a whole clinically and making it therapeutically usable
Published in Osteopathische Medizin: 27th year, issue 1/2026, pp. 35-37, Elsevier GmbH, https://www.elsevier.com/locate/ostmed
Regina Forstner interviews Torsten Liem
The examination of development, form and function has accompanied osteopathy since its beginnings. In clinical practice, it is repeatedly shown that complaints cannot be understood in isolation, but are an expression of complex relationships between the body, experience and context. Against this background, the question of how developmental biology perspectives – particularly from embryology – can help to better understand such dynamics and make them therapeutically fruitful is becoming increasingly important.
Regina Forstner talks to Torsten Liem about his long-standing approach to embryology, its influence on diagnostic thinking and therapeutic action, and the opportunities and limitations of embryological models in osteopathy. The reason for the interview is a master’s thesis by Regina Forstner on the subject of embryology.
What sparked your interest in embryology and which aspects are particularly important to you?
My interest in embryology was sparked back in 1990 when my teacher and later friend Patrick van den Heede first introduced me to the embryological approach. This early encounter gave rise to my desire to gain a deeper understanding of the morphological and functional relationships of the human body and to place the practical challenges of clinical work in a broader developmental biology context. I was interested in the mechanisms that are effective in the morphological development of humans – in ontogenesis – and how these dynamics become relevant in clinical practice. This resulted in the book “Morphodynamics in Osteopathy” published by Haugverlag in 2006.
I was particularly fascinated by how metamers organize themselves in the body and interact with each other. It was equally important for me to relate ontogenesis to phylogenesis, i.e. evolution: to understand how adaptations are reflected embryologically in the course of evolution.
In practice, I have come to realize that every person goes through their own individual stages of development – and that development continues even after birth. For me, it is less about embryology in the narrower sense, but rather about development as a whole: understanding it clinically and making it therapeutically useful.
One example is reflex development. For osteopaths, it is essential to understand how reflexes develop and detach in order to enable more complex motor, emotional and cognitive development. In this way, developmental windows can be identified in which disorders can manifest themselves – and these can be given targeted therapeutic support.
What specific advantages or challenges do you see for osteopaths and osteopaths when they deal with embryology?
Studying embryology helps me to better understand the functional relationships between organs, tissues and systems. The concept of morphodynamics is central to this: tissues are not static, but are in a constant interplay between structure, function and context.
Embryological dynamics show that even early developmental processes can shape later functional patterns. This knowledge makes it possible to perceive tissue patterns in a more differentiated way and to consider functional interactions – for example between organs of the same origin – in a more targeted therapeutic manner.
I see a challenge in the tendency to over-interpret: we often feel what we assume to be the conceptual framework instead of what can actually be experienced palpatorily, without being aware of this process. The scientific evidence on the palpatory perceptibility of embryological phenomena is also extremely limited to date. I have also observed that older models, such as Blechschmidt’s, are often used in osteopathy without reference to more recent findings. Modern embryology, however, reveals much more complex, molecular and mechanobiological relationships that are often neglected.
Has your involvement with embryology changed your approach to the diagnostic process? If so, in what way?
Yes, studying embryology has changed my diagnostics. It makes it clear that structure and function are always interrelated – between morphogens, environmental stimuli and the individual development of tissues and organs.
In my diagnostics, I therefore try to look not only at the local structure, but also at the developmental logic that continues to have an effect in dysfunctional patterns. Above all, this includes understanding the metameric organization: organs, muscles, vessels, fascia and nerves are embryologically interconnected, which explains why complaints are often felt in distant regions.
I do not view structures in isolation, but as part of relationship and resonance spaces. The knowledge of common embryological origins – for example of the respiratory and digestive tracts – enables me to link symptoms functionally. The layer principle shows that regulation often occurs in a certain order: first horizontally (coordination within layers), then vertically (differentiation in depth).
The chronotopic-holarchic order describes the fact that early structures usually lie deeper and remain functionally fundamental. Newer systems build on this, but can also modulate or inhibit earlier ones – a principle that can be seen in the neuro-ontogenetic hierarchy: regulation usually runs from the bottom up and from the back to the front – from the vegetative basis to emotional integration and conscious control.
I do not use these models as dogmas, but as a heuristic orientation to recognize patterns of self-organization. Embryology, phylogenesis and other developmental dynamics are part of a person’s history. I therefore understand complaints not as an additive sum of soma and psyche, but as an expression of soma-physiological dynamics of experience in which tissue, physiology, experience and context are interconnected.
In my early osteopathic period around 1990, this understanding was further deepened by studying embryology. I was fascinated by Erich Blechschmidt’s descriptions of the so-called metabolic fields, as they showed certain similarities to palpatory perceptions and dynamics that I used – such as pressure, tension, shear, elasticity and fluid movements.
At the time, I thought that by palpating such phenomena or using them therapeutically, I could create resonances with embryological dynamics. Looking back, I see this as the beginning of my attempt to combine embryological concepts with practical experience – an early approach to what I later came to understand as somaphysiological experiential dynamics.
Has this also changed your therapeutic approach? If so, how does this manifest itself in your work?
Yes, the examination of ontogeny has influenced my therapeutic work. I no longer see the body as a collection of structures, but as an expression of ongoing developmental processes. In therapeutic terms, this means working in a less symptom-oriented way and focusing more on the underlying patterns behind dysfunctions. When I palpate, I am not only guided by local findings, but also by axes of order, distributions of tension and movement dynamics – phenomena that have emerged from embryonic development and remain present in the tissue to this day.
I have deliberately moved away from the idea of trying to palpate “embryonic movements”. Instead, I use embryological and ontogenetic findings as orientation knowledge in order to understand dynamics and transitions.
For me, healing does not mean restoring a previous state, but enabling the integration of different levels. Therapy is an emergent process: it creates conditions under which self-regulation can develop.
I am guided by the same principles as in diagnostics:
- The metameric organization provides a functional map.
- Common embryological origins allow coupled systems – such as respiration and digestion – to be treated together along the diaphragmatic axis.
- The layer principle structures the course of treatment: first horizontal expansion, then vertical integration.
- The chronotopic-holarchic order describes that earlier levels form the basis for later ones, and that newer ones can relativize and inhibit earlier ones.
I start where the system reacts in an accessible way and combine bottom-up with top-down dynamics – in other words, vegetative regulation from below with conscious attention from above. The result is not a linear scheme, but a dynamic interaction in which new functional order develops emergently.
With the concept of resonance spaces, I do not work selectively, but systemically – on relationships and transitions between regions. For me, osteopathy means accompanying development processes, not only physically, but also in the emotional and cognitive dimensions of the patient.
What recommendations would you give to future osteopaths who want to study embryology?
I recommend approaching embryology with an open mind and critical alertness. It offers valuable insights into the laws of morphodynamics and enables a deeper understanding of development and form.
However, it is important to consider the historical perspective: Blechschmidt’s descriptions were formative for their time, but do not reflect the current state of research. Since the 1980s, embryology has developed considerably thanks to genetics, epigenetics and mechanobiology. Terms such as “form force” can now be understood in a more differentiated way as an expression of molecular gradients and mechanical interactions.
It is crucial to relate such historical observations – as Blechschmidt did in the context of medical evolution – to current scientific findings and examine their relevance today. This often reveals that some assumptions need to be confirmed, others relativized or discarded. It is precisely this critical dialog that is central to promoting the further development of osteopathy as a responsible healing method. This is also how I deal with my own views and my practical work with these approaches.
Today, embryology is increasingly thought of as systemic and emergent: development arises from the interplay of genetic, molecular, mechanical and contextual factors. My advice is therefore to understand embryology as a framework for orientation – not as an object for palpation. When trying to palpate embryonic growth patterns, there is an easy danger of getting lost in projections or ideas and falling into the traps of reductionism, mystification or transfiguration instead of open perception.
For me, embryology is one piece of the puzzle among many that deepens our understanding of patients. Those who study it seriously not only broaden their diagnostic and therapeutic horizons, but also train their perception, attitude and understanding of context.
Is there another aspect that you consider particularly important that we have not yet addressed?
Yes, for me it is essential not to view embryology in isolation, but as part of a larger developmental history. It shows how body, mind and environment interact from the very beginning. Symptoms often arise where there is friction – between phylogenetic heritage, personal life history and the current context.
Our task as osteopaths is to support patients in better regulating these dynamics – through resonance, touch and awareness. This also includes cultivating our own perception and posture and incorporating the patient’s perception into the treatment.
I often hear that a kind of intuitive osteopathic treatment method is derived from Blechschmidt’s work. In my view, intuition in a therapeutic context should develop from repeated and conscious clinical reasoning. Intuition that is based on unreflected premises or beliefs, on the other hand, can have a dysfunctional effect. Intuitive perceptions can be helpful, but should always be critically reflected upon and reviewed, as they can easily lead to misjudgements – especially without a link to conscious analysis and clinical experience.
Embryology broadens our view – but only if we understand it critically and in a differentiated way in the light of current knowledge. It reminds us that structure, function, experience and context are inextricably linked – and that health remains a dynamic process of relationship and regulation.
Dear Mr. Liem, thank you very much for the interview.
