Many of our patients want a holistic approach to thoroughly address all components of their symptoms, and they want results as quickly as possible. Patients also demand that we, as clinicians, explain our objective findings. They benefit when we describe how the treatment plan will address each aspect. Patients feel empowered, understood, and encouraged when they learn something new about their bodies and how they can help themselves.

Criteria for Customer Outcomes and Satisfaction

As physical therapists, we find that patient satisfaction depends on:

• thoroughness as we search for underlying causes of pain or movement restrictions through our evaluation;
• how effectively we communicate our findings and approach;
• how quickly we achieve a desirable functional outcome;
• maintenance of gains and prevention of reoccurrence of symptoms.

Failure to reach desirable outcomes within a reasonable timeframe motivates practitioners to learn more—to seek continuing education and teachers who expand our knowledge and improve our skills to more effectively evaluate and treat our patients.

The Need for Including Visceral Manipulation

Patient satisfaction and good outcomes demand that we as clinicians maintain a curiosity and openness to a thorough holistic approach to musculoskeletal and neuromuscular system dysfunction. Low back pain and spinal dysfunction may result from many underlying causes. A holistic approach to evaluation and treatment of spinal dysfunction or any musculoskeletal dysfunction demands evaluation/assessment of structural relationships between the internal organs and their fascial or ligamentous attachments to the musculoskeletal system.

All viscera have physiological motion that relates to normal pain-free movement. Therefore knowledge of these relationships and the anatomy involved is essential in order to see patients within a holistic framework. Restrictions within the cylinder of the body commonly affect ease of movement of the musculoskeletal system; yet knowledge and evaluation of visceral-fascial relationships is often excluded from a physical therapist’s assessment. Our evaluations must include methods for assessing and treating the influence of these visceral structures that lie in front of the spine.

Relationships of Organs to the Spine

Visceral Manipulation, or organ-specific fascial mobilization, addresses dysfunction within the cylinder of the torso and pelvis. Each organ has a relationship through its fascial attachment to the spine. For example:

• The mesenteric root of the small intestine can limit the mobility of the spine as it crosses the third and fourth lumbar vertebrae.
• A mechanical restriction at the first lumbar vertebra may be influenced through a constant irritation of an old appendectomy scar stimulating the autonomic nervous system.
• The cecum/appendix and L1 share this viscerosomatic interchange.
• Decreased flexibility of the fascial connection between the bladder and the head of the femur can limit the mobility of both structures.
• Dysfunction of the right and left sacroiliac joint can result from decreased mobility of the cecum and sigmoid, respectively, within the iliea.

Description of Visceral Manipulation

Visceral Manipulation is a manual therapy consisting of light, gentle, specifically placed manual forces that encourage normal mobility, tone, and inherent tissue motion of the viscera and their connective tissues. An important concept in Visceral Manipulation is that organs need to move in order to have good physiologic function. This physiologic motion creates homeostasis for proper organ function and for each organ’s surrounding tissue relationships. The ability for organs to move as we are moving our bodies, as we breathe, as the heart pumps, and as fluids move through our bodies is essential for functional mobility.
 
With Visceral Manipulation, the practitioner contacts the organ and structures related to that organ and treats either directly or in the direction of ease.

Clinical Research

Jean-Pierre Barral, R.P.T., D.O., developer of this manual therapy, has more than 100,000 patient files that provide clinical evidence of the effectiveness of Visceral Manipulation. He has found through his clinical treatments and research that up to 90 percent of musculoskeletal problems have a visceral structural component.

Gail Wetzler, R.P.T., of Newport Beach, Calif., performed a clinical study of 90 low back pain patients. She examined the viscerosomatic and structural relationship between the internal organs, their attachments, and the musculoskeletal low back when in a state of dysfunction. The findings of the study indicated that low back spinal dysfunction was more effectively and efficiently resolved with the addition of Visceral Manipulation into the treatment program.

The most common dominant visceral fascial relationship that resolved the low back pain was the mesenteric root of the small intestine (The International Federation of Orthopaedic Manipulative Physical Therapists[IFOMPT] Publications, 1994).

Conclusion

Practicing the art of physical therapy with these tools is exciting, challenging, and rewarding. As we demand more autonomy and independence as clinicians, we must demand more of ourselves. We invite you to look inside the cylinder of the body for possible organ-specific fascial restrictions that may contribute to musculoskeletal pain and dysfunction.

For more information regarding Visceral Manipulation, how it can benefit your patients, and training seminars, please go to Barralinstitute.com.

Last revised: January 16, 2014
by Barbara LeVan, P.T. and Jean Anne Zollars, M.A., P.T.