Back pain is the number one complaint that brings people into my office for physiotherapy treatment, but rarely do people have just one issue. Many times people have a handful of symptoms, but either don’t think they are related, or don’t think it is necessary to mention it to their physiotherapist. Most people see stomach pain as an issue for their doctor and/or something they just have to live with, but in my experience doctors just prescribe symptom treating pills that don’t get at the crux of the problem. Stomach pain very much can be an acid balance problem, but it also can very commonly be a mechanical issue related to your mid back and the physical mobility of your stomach.
After learning the osteopathic approach of visceral manipulation, I started considering the physical toll people’s organs can have on their alignment and their pain. I started noticing and feeling the tension in people’s abdomens and ribcages in a different way because I had a better understanding of how the anatomy is attached to the inside of their ribcage and spine. More often than not, a client would come to see me complaining of mid to lower back pain, but I started asking “are you having any stomach problems,” because I started to pick up on a particular pattern of restriction in their mid-back and upper stomach. Enough clients started saying “how did you know?” that I started sensing that I was on to something.
Your stomach is a muscular bag that sits in the upper left quadrant of your abdomen and is squished up against your liver and under your diaphragm. To do its job properly it needs to be able to muscularly churn your food which requires mobility relative to its neighboring organs and surrounding structure. The mobility in the upper abdomen can and does get affected by the nerves that originate from your lower thoracic spine or mid back area. This lower part of your ribcage and mid to lower back area is one that takes the brunt of a lot of postural stress and compression. It is an area of your spine and ribcage that is built to rotate and an area of your abdomen that gets compressed by your diaphragm every time you take a breath. There is ample opportunity to mechanically irritate something and many times it becomes your stomach.
If you read my articles on Why Things Hurt and IMS dry needling, you will learn that when nerves get annoyed they send altered signals to the muscles that they innervate and the result is that the muscles create taut bands, don’t function well and tend to hurt. Nerve irritations in your mid back create upper abdominal tension and tend to make the stomach hypersensitive and relatively less mobile. The opposite can also be true, stomach ulcers and other problems can tend to irritate the mid back, so as the therapist I have to consider which is the chicken, and which is the egg. I find that people with long standing stomach issues have usually already seen their doctor and been prescribed some form of antacid or proton pump inhibitor with mixed success and would love to try an alternative treatment. Others, with a more recent onset of stomach troubles can be baffled why their stomach hurts even though they haven’t changed their diet or been sick. I have found good success fixing the latter group’s pain and moderate success in helping the chronic clients.
I have noticed that when a person’s lower ribcage area and thoracic spine is held in a mild to moderate torsion (i.e. a relatively twisted holding pattern), they typically also have relatively greater than normal tension when I palpate their upper abdomen and the mobility of their stomach. I have learned that if the upper part of the stomach rests too high up into a person’s diaphragm it can result in symptoms such as heart burn, reflux and/or pain and that if you manually draw the stomach down it can help alleviate some of those symptoms. I realized that I had the tools to help with both of these issues and started purposefully treating people’s gut symptoms.
I have found that if I use IMS dry needling to the muscles on either side of the lower thoracic spine, it significantly calms the tension in the upper abdomen, which makes it easier for me to access the person’s stomach with my hands. I can then use a technique from visceral manipulation to manually free up to mobility of the stomach and free it from the diaphragm and the liver. The result of treatment is typically a balancing of the twist in the lower ribcage, significant less abdominal pain and a stomach that is generally less irritable to various foods. It doesn’t work for everyone, but I have seen it help enough clients that I felt the need to write this post and I think it is a much healthier option than messing with your physiology with potentially damaging medications.
After I have treated the area, my next step is to help the person create some awareness of how their posture and movement affect that part of their back. Below are a few videos that I find helpful, but please look at the various playlists for more in depth explanations on improving your posture.
Please feel free to leave comments below and I will try my best to answer them.