Visceral Manipulation

Visceral Manipulation (VM) is excellent for many conditions. Click here for more.

Visceral Manipulation (VM) is a series of gentle manual techniques designed to increase the range of motion of organs. In some ways it is similar to CranioSacral Therapy, another osteopathic myofascial release technique. Each organ has a range of motion, just like your shoulder or neck. Most of us don't really think about it but our organs are all pressed together vying for space. Organs like the lungs and stomach change size continuously. When they are full, they compress their neighboring organs. As they empty, the neighbors push back and compress them. Your kidneys travel about 1.5 miles per day, moving an inch at a time with each breath. As your diaphragm contracts, it pulls downward on the upper abdomen, causing the kidneys to slide downward. As your diaphragm relaxes and you exhale, your kidneys glide back upward (hopefully).

Joints Articulate
Most of us think about "range of motion" as having to do with our joints. Joints do have a Range Of Motion (ROM) and it is very important to maintain a good ROM to keep the joint happy. Arthritis, a common joint malady, is defined by inflammation and reduced ROM. In Spanish the word for joint is "articulacion" and we use the term "articular surface" to describe the area where two bones meet. We have cartilage here, called articular cartilage, at the ends of the bones that allows the bones to smoothly glide. The cartilage is bathed in synovial fluid which lubricates and oils the joint. The articular surface of many joints is relatively small when compared to the size of the bones, especially joints like the shoulder and hip.

If there is too much tension that compresses the joint, there will be increased friction. This friction increases heat, grinds the cartilage and wears it out. Also, if the joint isn't lubricated it suffers from increased friction. When joints become dry, they erode and the cartilage gets lumpy instead of being flat and smooth. Over time, these arthritic changes deform the joints and they lose function.

Organs Get Arthritis Too
A similar process happens with the organs. Arthritis is strictly a joint disease, so organs don't literally get arthritis. They do, however, undergo similar degenerative changes which makes the analogy useful. When the fluids get dry or the pressure between two surfaces increases, there is increased friction. Imagine that kidney if it were unable to glide downward as the diaphragm descends for inhalation. It would get squashed from above. This would certainly reduce its ability to filter the blood and remove waste. The body may sense that the kidney is being squashed so it would then reduce the movement of the diaphragm in efforts to minimize the trauma on the kidney. While this does help to alleviate the kidney, it also hurts because the diaphragm is now limited and so breathing is shallow. This can deprive cells of oxygen. So now not only is the blood acidic from poor kidney function, it is also oxygen deprived. Even slight reductions in organ function can impact the overall health and cause diseases, especially if these restrictions go untreated.

The viscous cycle continues because the low-oxygen, acidic milieu around the cells creates inflammation, which creates even more pollution. These toxins and free radicals further dry up the lubricating fluid ("serous fluid") between the organs. It is important to note that virtually the entire surface of most organs is articular. That is, instead of having a small area where the movement happens (like the shoulder joint), the entire surface must glide. So if an area is inflamed, gets dry or chafes for whatever reason, the organ movement becomes restricted. With all of the dynamics of breathing, digestion (peristalsis) and physical movement (and especially inactivity), you can see how the cards start to stack up against you. All of these factors tend to lead to diminished ROM of your organs. Over time this process builds and the reduced organ function allows disease processes to accelerate and dominate the physiology.

Liquid Osteopathy
This term describes the use of osteopathy to treat the gooey organs. Just like a chiropractor who adjusts the spine to facilitate better alignment, with liquid osteopathy we maximize the ROM of the organs and other "liquid" tissues. However, we do this very gently without force.

We find and treat restrictions in an organ's movement with our hands. By palpating very gently we can feel variances in muscle tone that lead us to restricted sites. We train our hands to recognize subtle organ movements (and restrictions) that we call "listening". Listening to the tissues reveals information about the state and quality of the tissues as well as its ROM. Once we identify the pathology of a given tissue, we begin treatment.

Visceral Manipulation employs two main tactics to release restrictions or adhesions. One is a direct technique that stretches or breaks up an adhesion. If a tissue is contracting, it is getting shorter. Stretching it can lengthen it and counteract the constriction.

The other approach is more frequently utilized. This indirect technique involves moving toward ease. If a tissue is pulling, it is creating tension. If you stretch the tissue, you are pulling on it even more and increasing the tension on those fibers. If you moved in the opposite direction, and created slack, we say you are moving toward ease. Imagine a long rubber band stretched about half way to the maximum. If you put your hand gently on it you might feel (or listen to) the tension under your hand. You might notice the direction of the rubber band and estimate its tension. To apply the indirect technique you could trace the rubber band (line of tension) to one of the ends (where it is being held). If you gave that point a nudge in the direction of the other end, you would create less tension in the rubber band. The tension in the rubber band is pulling on the ends, trying to bring them closer. All we are doing is facilitating the ease in the rubber band. At some point the rubber band would be slack and not stretched at all. We say it is moving toward ease because it moving in the direction of reduced tension.

Moving toward Ease
One great thing about moving toward ease is that it seems to train the neurological system to let go. So many tension patterns in the body are maintained by the neurological messages sent to the tissues. It's as if the nervous system were programmed to repeatedly send the same messages, even if they are unnecessary. You may have experienced shoulder or jaw tension that seemed to have a mind of its own. It's not like you purposefully try to tighten your jaw when you are diving but yet you find yourself tight for no apparent reason. Your nerves are telling your jaw to tighten up, and your jaw has no other choice but to obey the nerve signals. If we could send other signals to the jaw, then we disrupt this tension pattern. Moving toward ease allows the nervous system to pause and reconsider its tendency to constantly send signals to tighten the jaw. At this moment, the body is learning another way of being. This trains your body to release tension and to function in a healthier state.

We can blend our rubber band analogy and out jaw example and imagine that the jaw muscle is a rubber band. This is fairly accurate since muscle tissue is contractile and elastic like a rubber band. As you know rubber bands can only stretch so far. Eventually it will break. Also, if a rubber band is overstretched (but not to the breaking point) it can lose its elasticity. You may have seen rubber bands that don't shrink back to their original size when not being stretched. These rubber bands become flaccid and not springy. Usually this happens when the band is over stretched or stored in a stretched state. As the rubber dries, it is more likely to lose elasticity. In the same way the joints lose their lubrication when the synovial fluids get dry, all connective tissues (ligaments, tendons, muscles, and even bones) lose elasticity when dry. Rubber bands that are being constantly over stretched will wear out faster, break more easily, and loose their springy elasticity faster than regular rubber bands that aren't over stretched. The ligaments and fascia that support the organs are hopefully pliable and flexible enough stretch, allowing the organs to move. We also want them to be elastic enough to gently spring back to their original length when not being pulled.

VM Mottos

To read some of the principles of VM, click here.

More on VM
French osteopath named Jean-Pierre Barral is the 'father' of VM. His tireless research, advanced clinical expertise, and ability to teach have helped create a comprehensive curriculum that trains many VM around the world. Because the work is so subtle, many people consider it 'alternative'. I find it more accurate to classify VM as Holistic Western Medicine. It is anatomically based osteopathy and therefore Western yet it is different from many other modern therapies in that it recognizes the relationships that exist between body systems. It is also a tissue-based medicine, which is absent in most Western medical practices. Another feature of VM is that it is a manual skill. Over the past century, modern doctors have relied more and more on lab results (including blood tests, x-rays, MRIs, etc.) to diagnose patients. Manual and palpation skills are subjective and often considered unscientific and inferior. I am amazed with the technology of the various imaging methods and I use this information routinely in my practice. Without blood work and imagining, our medicine would be severely limited. However, I do not believe they provide all of the information necessary to treat effectively. Humans are very complex, in constant flux, and unique, so to better treat people we must be able to interact directly, not just with abstract information from images or blood work. I resonate with this type of work since it enables me to directly read and then treat restrictions in the body.