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Visceral Manipulation

Anterior view of the position of the liver (re...
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What is Visceral Manipulation??

Visceral Manipulation is based on anatomically specific placement of gentle manual forces to encourage normal mobility, tone, and inherent tissue motion of the viscera and their connective tissues and other areas of the body where physiologic motion has been impaired.  These gentle forces can potentially improve the functioning of individual organs, organ systems, and the structural integrity of the entire body.

How was Visceral Manipulation developed?

Methods such as Visceral Manipulation have been a part of medical cultures of Europe and Asia since prerecorded times.  Manual manipulation of the internal organs has long been a component of some types of Oriental Medicine.  Jean-Pierre Barral, DO, first became interested in the biomechanics of the body when he worked as a Physical Therapist in France.  There he met Dr. Arnaud, a recognized specialist in lung diseases and master of cadaver dissection.  Through cadaver dissection, Jean-Pierre was able to follow patterns of stress in the tissues and their potential to promote lines of tension within the body.  This was fundamental to his development of Visceral Manipulation.  Jean-Pierre graduated from the European School of Osteopathy in 1974 and began teaching spinal biomechanics in England in 1975.  Jean-Pierre first began teaching Visceral Manipulation in the United States in 1985 through the Upledger Institute.

Do organs move?

The body functions at its optimal best when motion is free and excursion is full.  When motion is labored, overexcited, depressed, or conflicting with neighboring structures, their mobility dysfunction will arise.  Tissues lose their normal motion when they become inflamed.  The natural healing process involves local disruption of normal tissue fibers and their replacement with relatively inelastic granular tissue.  It can be conceptualized as a local drying out of the affected tissues.  Many factors cause tissue inflammation including: infection, direct trauma, repetitious movement, diet, environmental toxins, emotional stress, and surgery.

Organs move in two ways: the first, mobility is caused by the push and pull of the surrounding tissues and motility which is the organ’s own intrinsic active movement.  By treating the organ and restoring the natural physiologic motion, the function of the organ itself will improve.

What is the fascia?

The word fascia is derived from Latin and means band.  It is a layer of fibrous tissue that permeates the body.  It interpenetrates and surrounds the muscles, bones, organs, nerves and blood vessels.  It is an uninterrupted, three dimensional web of tissue that extends from head to toe, from front to back, from interior to exterior.  The fascia can create tight knots or connective tissue adhesions which may act as trigger points and cause pain following surgery, physical trauma, infection, sedentary lifestyle, pollution, bad diet, poor posture, and pregnancy and delivery.  This fascial restriction may cause local pain, may cause restricted movement to an organ that it envelopes, or a line of tension across the abdominal or pelvic cavity or even into the extremities.

What is the peritoneum?

The abdominal cavity and all of the structures within it are covered by a thin serous membrane called the peritoneum.  This membrane secretes serous fluid which acts as a lubricant for the organs within the abdominal cavity allowing it to move against one another or on each other freely.  The peritoneum is one continuous membrane that runs throughout the body.  The peritoneum has different names depending on the part of the body it is in.  The visceral ligaments attach organs to the body wall or to another organ.  The greater omentum is a double fold of peritoneum that attaches the stomach to the transverse colon while the lesser omentum attaches the stomach to the liver.  The messentary is a double fold of peritoneum that attaches the intestines to the posterior abdominal cavity.

Knowing where the peritoneal ligaments are and where they attach helps Physical Therapists understand the motions of the organs and where our manipulations should be directed.  When we treat the mobility of an organ, we stretch and release tension within the visceral ligaments.  Visceral ligaments have a rich nerve supply.  By releasing a restriction within the visceral ligaments, we harmonize this tissue, and via the nervous system, have an effect on the proprioceptive communication in the body.

What happens when the fascia is restricted?

Mobility of the hollow organs of the stomach, small intestine, and colon can be affected by direct pressures, pulls, and twists.  These abdominal forces can create irritation and spasm resulting in problems with digestion, absorption, elimination as well as impaired vascular and lymphatic function.  When the body is no longer bound in a pattern from a restriction of the viscera, it can move with greater ease, increase its ability to adapt to its environment, and have greater health.

How do Physical Therapist use Visceral Manipulation?

Physical Therapists are familiar with the feel of fascia and ligamentous restrictions that are interconnected with the mechanical restrictions from within the abdominal or pelvic cavities.   Therapists are trained to feel the movement of the organ and its ligamentous attachment and how it relates to the structures adjacent to it or structures that may be in the extremities.  Once a restriction is located, the therapist will use the organ to tension the ligament or tension the ligament itself.  Once the correct tension is achieved, the release will follow.   Some treatments will consist of following the organ through its normal movement and encouraging it to move a bit further in each plane.   This is a much more gentle treatment, but is often helpful to “wake up” the organ and encourage it to return to its normal movement pattern.

Sometimes we can feel a “line of tension” that may extend across the body or into the extremities.   Internal cavity restrictions that are connected to ligamentous or fascial restrictions in the leg or foot will not improve significantly unless both are addressed.

Case Study:

My greatest joy was to help a 34 year old mother of two boys, 5 and 7, who had complaints of sharp stabbing pains under her left ribs and had been living on pain killers for 4 years.   Her husband was an Iraqi soldier so she’d had the “million dollar army work-up” that revealed nothing.  She was afraid to do much of anything that would increase the pain and as a result had gained 100 pounds.  She had been educated as a therapist to work with children but was only working 10 hours/week due to the pain.  Using Visceral Manipulation, I worked the fascial restrictions surrounding her small intestines, esophagus, stomach and diaphragm.  Upon evaluation, she could barely get onto my treatment table without crying.  After 9 treatments she was significantly improved.  She was unable to finish with PT as she moved out of the state, but upon discharge was working 25-30 hours/week and was off her narcotics.

Closing thoughts:

Visceral Manipulation has taught me to look at the body as a whole entity.  For 18 years, I treated spine patients with joint and soft tissue mobilization, looking at them only from behind.  For the past 5 years, since I started my Visceral Manipulation training, I have wondered what is going on in front and how that relates to their low back pain.  I question patients about falls, car accidents, surgeries or any trauma.  It is always interesting to me how my patients fail to mention certain injuries to me; my favorite, “my horse kicked me in the stomach” and how these injuries may affect their progress with Physical Therapy.  In November I look forward to taking a Visceral Manipulation cadaver dissection where I will be able to see the organs and their ligaments and lines of tension up close and personal!

Mary Boyd, MS, PT is the owner of Mountain View Physical Therapy and member of the Sandpoint Wellness Council.  She can be reached at 290-5575 for questions or on the web at www.MtnViewPT.com .

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