What is Visceral Manipulation? An Integrated Part of Physiotherapy

Visceral manipulation is the practice of an experienced therapist using his or her hands to move and release fascial restrictions in your abdomen to encourage the normal movement and function of your internal organs.

Brent Stevenson


photo: euskalanato

Visceral manipulation is the practice of an experienced therapist using his or her hands to move and release fascial restrictions in your abdomen and pelvis to encourage the normal movement and function of your internal organs.  Most people are familiar with the idea of joint and muscle restrictions causing tightness, pain and limited movement in their bodies, but don't consider the role of their organs.  It is common place for people to go to their physio, chiro, or massage therapist to treat pain and alignment issues; unfortunately, many times these practitioners may just be treating the outer shell of the problem if they aren't considering the mobility of your organs in your alignment and movement patterns.

I have been a physiotherapist for ten years and have continued to add layers of knowledge and skills to my tool belt.  Two of those skills have been real eye openers and game changers for me.  The first big one was the profound effectiveness of skilled dry needling called IMS acupuncture.  I trained with Dr Chan Gunn in 2008 and the skills I learned completely changed my practice for the better.  I recently took a course on Visceral Manipulation through the Barral Institute and feel like I can now properly treat the body as a whole.  I had previously learned how every joint in the body works, where all the muscles attach and which nerves innervate them, but had failed to properly learn how the inside of the body effects the outside.  Visceral Manipulation is helping me properly understand just how connected everything really is.

Your trunk and pelvis form a boney, muscular, fascial outer shell to protect and encase all of your internal organs.  Your organs are not just loosely floating around in there though; they are mostly supported by tissue called fascia and pleura.  The whole thing is a sealed system under pressure that squishes everything tightly together; each organ is wrapped in its own pleura and bathed in a little bit of fluid so it can slide and move around or over its neighbouring organs.  Things that affect the pressures in the system or the ability of the organs to slide and move around in their close quarters will affect the ability of the body to move and function properly.

Pregnancy, abdominal surgery, infection, jarring injuries and emotional behaviours can all affect the mobility of your organs or viscera.  Pregnancy involves a lot of stretching and reorganizing of most everything in a woman's abdomen; this happens gradually over nine months and the body amazingly figures out how to create space for a whole other person in there.  The issues can arise more during and after labour when everything is asked to change in a relatively short period of time.  There is a huge pressure change and all of a sudden organs can start dropping back down; whether they find their proper, functional place to be depends on how the labour went, how much damage there was to the supportive muscles and if any surgery was done.
C-Sections are a much more invasive surgery than most people realize, but any abdominal surgery will create 'stickiness' in the viscera.  As I mentioned, your organs are bathed in a small amount of fluid to allow them to slide around as you move; any time you expose the abdomen to air and surgical lights it is bound to create some dryness or stickiness that restricts normal mobility of the organs.  A therapist trained in visceral manipulation by means of light touch can assess and treat any restrictions to help restore mobility.
Because the fascial wrappings of your organs are essentially one big continuous piece of connective tissue, restrictions in one area can manifest as symptoms in other areas.  A good analogy is to wear a relatively tight T-shirt and twist a piece in one corner up into a knot.  You will likely see and feel the pull from your lower left abdomen all the way up in your right shoulder; this same concept effectively happens inside you.  Your body will start to 'hug' or protect the area of restriction which leads to alignment issues and compensatory movement patterns.  Alignment issues and poor movement patterns tend to lead to pain and tension in the boney and muscular systems; treating these usually helps provide relief, but if the problem just keeps coming back, it is quite likely that the root of the problem may be a visceral restriction.

I am relatively new to using visceral manipulation as a treatment modality but have already found it to be the missing piece of the puzzle with many of my clients with stubborn, persistent pain issues.  It is a totally painless, light touch form of manual therapy that requires therapists to really know their anatomy.  Used in conjunction with other forms of manual therapy, dry needling and movement training it makes most conditions treatable by conservative means.

Jarring forces involved in sports, car accidents and falls can affect your organs just as much as your muscles and bones.  The shear forces can create tearing and scar tissue.  The impact forces can create bruising.  Your body does its best to protect vital organs during extreme forces but in doing so can create an aftermath of restrictions that can result in pain.  Therapists should consider that the driving issue behind their client's pain could be coming from something inside that may be harder to get at than just treating the muscles.

The emotional piece was one of the most interesting parts of learning about visceral work.  To paraphrase the late Osteopath Dr. John Upledger, our organs echo our emotions.  You may have a 'gut feeling' or 'butterflies in your stomach.'  In stressful or intense situations your brain passes the stress onto your organs and creates an organ-behaviour relationship.  Each person tends to have his or her own weak link in a particular organ and this relates back to their underlying personality traits.  A few examples taken from Upledger's poster: Understanding your Organs:

The intestines:
-insecurity, melodramatic, overly chatty, hypochondria

The Stomach:
-Importance of appearance and self image, social status very important, sees power in extroversion, poor self esteem, frustration, spontaneous anger

The Bladder:
-Controlling, guilt, avoid tension, hard time making decisions

The Liver:
-Dependency on the past, pessimism, bad moods, fits of anger, depression

The Kidneys:
-Fear, feeling of being abandoned, insecurity, deep seated anger, a need to lead, generosity

These are only a few examples but the concept makes a lot of sense to me as a physiotherapist.  I see people all the time that seem to have a back or a shoulder that always 'goes out' on them at very inopportune times….before a big meeting, or trip, or Christmas time.  They have no idea what they did and don't understand why it comes back 2-3 times a year.  They have done all the core classes they could find, but strength just wasn't the issue.  Their chronic issue is where their body holds stress and how it protectively reacts around it.  Stress is a powerful thing and your organs are the crossover between physical and mental wellbeing.

The fascinating part of the osteopathic approach to treating pain is that it can provide explanations based purely on anatomy for very common, but poorly understood ailments.  Frozen shoulder can relate to a nerve irritation stemming from the visceral pleura.  Chronically cold feet can be your small intestines.  Persistent left sciatica or SI pain can be your sigmoid colon.  Right medial knee pain and instability can be an irritation of your obturator nerve near your large intestine.  Right shoulder pain can be a restriction in your liver.  Heartburn and gastric reflux can mean your stomach is sitting too high.  The list goes on and it is a bit more complicated than that, but the amazing part is that it is all treatable by a good manual therapist that knows his anatomy inside and out (literally).

Visceral Manipulation is unlikely to be the answer for everything, but it can be the missing piece of the puzzle for a lot of people.  If you want to find a practitioner that uses visceral manipulation you are best to start looking in this order for someone in your area: an Osteopath, a Registered Massage Therapist, a Physiotherapist, a Naturopath. 

Click here to search the International Association of Healthcare Practitioners website

Useful links from this article:

The Barral Institute Dr Jean-Pierre Barral
The Upledger Institute Dr John Upledger
Discover Physio- Diane Lee & LJ Lee
Institute for the Study & Treatment of Pain- Dr Chan Gunn

Please feel free to ask questions or leave comments about your experience with visceral work below.

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