This post was written by Justin Scherff, a physical therapist at Core Physical Therapy, with contributions from the whole team who shares how they’ve treated hundreds of patients through visceral manipulation.
What is visceral manipulation?
The guy that started all of this is Jean-Pierre Barral (JBP). Born and raised in France, he originally trained as a physical therapist, but then he chose to pursue further training as a Doctor of Osteopathy (D.O.). During his training, he worked with patients during their life and was also able to participate in the autopsies after their passing. In this unique opportunity, Jean-Pierre saw something that really intrigued him.
He saw that organs were surrounded in a thickened tissue and had attachments to other parts of the body. This tissue is a type of fascia that has a specific function for organ stability, vitality, and mobility. As his curiosity and investigation continued, he observed a direct connection to how this fascia surrounded the organs (a.k.a. viscera), and directly attached to other structures of the body, impacting how well they were able to move and function.
At that point in his career, he was treating patients primarily with what we would call manipulations of the spine/skeleton as a trained D.O. with hands-on techniques. One day, one of his patients showed up for an appointment with a notable improvement in his condition…but not from Jean-Pierre’s treatments.
His patient stated that in the French Alps was a “folk healer” that pushed on something in his abdomen, and made a notable improvement in his symptoms. Intrigued by this response, Jean-Pierre noted that this visceral treatment correlated to a significant improvement in his patient’s mobility, and the light bulb went off.
Jean-Pierre observed that the structural (skeleton) impairments he was trying to correct, would self-correct after proper visceral manipulation. Not only that, but it had a ripple effect throughout many other body systems. From that time until the present day, this discovery has led to a whole new way of treating the body for improving mobility, decreasing pain and soreness, improving health and wellness for people around the globe.
What is this visceral manipulation?
From the pioneer himself, JPB is quoted:
“The purpose of Visceral Manipulation (VM for short) is to recreate, harmonize and increased proprioceptive communication in the body to enhance its internal mechanism for better health.”
To break it down, the purpose is to improve the body’s internal communication for improving overall health. Visceral manipulation works to restore the normal motion that happens around the organs and tissues around it. As this stuff moves the way it was designed, its function improves, the surrounding tissues are able to move better, and generally people see improvement in their symptoms.
How do my organs tie into my body moving?
Let’s walk through an example. If you are reading this, raise your right arm over your head. Now check to see if anyone else around you is doing it, and wave hi! For most people, this should be a simple and easy motion. This could be something you do at a Taylor Swift Concert, cheering for your favorite sports team, putting on deodorant or reaching your top cupboard in the pantry.
Did you know that as you lift your right arm, there is also movement through your liver, gall bladder, and intestines?! I know I didn’t before getting into physical therapy.
Try this: using your left hand, grab your shirt and bunch it up on the side of your body into a knot with your left hand. Now, try to raise your right arm again…can you feel how it’s a lot harder to move? Harder to touch the top part of my head like I’m washing my hair in the shower, reaching behind me like I’m tucking in my shirt, or out to the side to grab something in the back seat of the car.
This example is exactly what happens inside your body. Notice how your right shoulder muscles have to work harder to move to the full range you had before knotting up your shirt? If you have to do this for a long period of time, can you see how those muscles have to work harder for each repetition, and that over-time this could cause tightness, inflammation, and pain? Also, could you see that by just working on the shoulder muscles, you likely will never fully resolve the problem because the knotted up shirt is the real problem? And can you then see how getting the knot to go away in the shirt is the answer for easy and pain-free mobility for the right arm? Rock on, right?
I had a patient who came in for right shoulder pain that was stopping her from doing anything overhead. We started working through the upper rib-cage, but then noticed that she had a lot of tightness around her diaphragm and upper abdomen. She had a massive scar from a gallbladder removal over twenty years ago. Working through this area of tightness, and in 2-3 visits she has full and pain-free shoulder mobility.
Notice, that this scar was from 20+ years ago… and is affecting her right now. We find this really common that injuries/incidents/surgeries/accidents from the past often show up in the future if they never really were properly addressed at that time.
How does someone develop visceral restrictions?
This is the million dollar question…why did this happen or what did I do to cause this? With as much as we know as physical therapists, there still aren’t many clear-cut, definitive answers. However, with what we do know, we can paint some pictures of possibility
Let’s take a deep dive into the human body. At the point of conception, each one of us living, breathing human beings started as one cell. Each one of us was so small that approximately 630 of us humans could fit onto the surface of a penny. From that point, one cell split into 2, 2 split into 4, 4 split into 16, and eventually grew into 28-36 trillion cells as a full grown adult! Since each of those cells split, they were and always do remain connected. Let’s put that in our back pocket for now.
Next, at the cellular level, each cell needs nutritions, water, communication, and waste removal for normal function. That requires movement of these substances into and out of the cell, and if this happens then optimal function occurs. Let’s Zoom out aways. All of our tissues are collections of these like-minded and like-structured cells, and yet still all connected. So your muscles are groups of cells that have the shape and function needed for a muscle to do its job, the liver and brain are the same, etc. Pretty amazing when you think about it.
So cells, tissues, organs have a need for a steady flow of stuff into and out of cells, for both the health and the function so optimal vitality can occur. In order to have this steady flow into and out of cells, tissues and organs, the body has a very complex system of tubes to do this, connected to big pumps that cause this to happen automatically. As you can see, movement inside the body is a really big deal.
A picture to help hit this home: Think about a river that has a constant flow to it, not too fast or not too slow. The stream is generally clear, animals inside the water are able to live, animals outside of it can come and drink, and plant life is sustained around it. A really nice ecosystem, really. Now imagine if the river gets blocked somehow, and it starts to create a flood. Or imagine the source of water starts to dry up, the life inside and around the river starts to suffer. So imbalances of too much or too little cause issues. Now sometimes this happens for short periods and the body is able to re-balance itself…yet if this happens for a prolonged period of time that’s when longer-lasting changes occur.
Another great example:
Think of a steak that is cooked really well, and assume all of you readers like steak and like it medium-rare. It’s moist and juicy, cuts really easy, is really tender and almost melts in your mouth with little effort.
Now, think about that same piece of meat made into beef jerky. It’s fully cooked, dried out, and takes a lot of effort to cut and chew, and frankly a lot of steak sauce or ketchup to get down.
The juicy steak is what our internal organs should have when it comes to overall mobility and health, but because of many different things sometimes these areas “dry out” become difficult to move, and this causes a ripple effect into other areas of the body.
Inside and around all of the organs, muscles, bones, arteries, veins, nerves is an intricate network of tissue, called fascia. For a deeper dive into what it is, check out this blog (link). This tissue is the support system for the movement of stuff in/out of the cells, the tubes needed, and also provides structure to support the organs in the body so they can function optimally. This tissue around the organs can become dysfunctional and cause a disruption in the organ function, and visa versa as the organ dysfunction can cause a fascial disruption.
Let’s recap: We started so small that a small Iowa town could fit onto a penny, into the same number of cells as the United States national debt (depending on when you read this). Each has a structure and function, that collectively create an organ structure and function. These all have needs for stuff into and out of the cells for optimal function. Fascia supports everything to make it happen. So anything that gets in the way of optimal function through the tubes, the support structure, or declining health of the cells/organs can cause a visceral restriction. So now the next question is….
What are some of these culprits?
This list could go on forever, which isn’t the purpose of listing all of the causes. But yet, I do want to reveal some really common causes that are in our lives today to help build awareness.
- Bugs in our system: Viruses (has anyone been through a recent pandemic?), staph, strep, Parasites, fungus, mold, the list goes on.
- Physical Events: any sort of physical contact to your body, ranging from sports to motor vehicle accidents, physical abuse, injuries such as falls, sprains/strains, broken bones, and a really common one being surgeries of all shapes and sizes.
- Movement: This can be too much of the same movement, or a lack of movement. For instance, swinging a golf club one way but not the other. Sitting too long. Bending forward but never backwards or sideways. Working exclusively right or left handed. Posture.
- Diet: This one is as wide as the ocean, but generally eating foods that raise the level of inflammation in the body. This can be different for different people, but most of the highly inflammatory foods could include dairy, wheat, corn, soy, alcohol.
- Environmental toxins: This one could be air pollution, exposure to environmental allergies, clothing, water, lotions, really anything that you could put on or breathe into your body.
- Emotional Stress: Another really big category, but some examples include stuffing emotions and not expressing yourself, past experiences that could be traumatic, negative thoughts/feelings towards others or yourself.
As a disclaimer, we are not dieticians or mental health providers, but rather informing you for awareness sake.
Let’s pause and check your pulse right now…our goal is not to create fear mongering. Our goal is to shine the light on something that can have a massive impact in your overall health and well-being, so that if there are areas for improvement you are aware of so you can make a plan for change!
Alright, moving on.
So we’ve established what is visceral manipulation, how it relates to our body’s ability to function, how these restrictions can develop and what are some culprits of restriction development. Now let’s dive into the restrictions themselves. You might be wondering, do I feel visceral restrictions, or how would I know if I have them?
What are some symptoms of visceral restrictions, and how is it related?
Our organs are attached to our skeleton and are meant to slip and slide past each-other. Consider your 20-26 ft of intestines in your abdomen. All of these loops and tubes should move like well-oiled spaghetti noodles in your abdomen.
However, the aforementioned section of causes could result in sticky “noodles.”. Have you ever cooked spaghetti, drained the water, left it in the pot, to come back and find them all stuck together? Yes, that can happen inside of us! That could result in decreasing absorption of your food into your body, a decreased ability for you to get waste out of the body, and cause a big, jumbled mess. Now your intestines are attached directly to the front of the vertebra, or bones, of the lower lumbar spine. Tightness and dysfunction here could be related to some of the following ailments:
- Joint pain in lower limbs
- Sciatica
- Acute or chronic low back pain
Remember, this is not a prescriptive list, meaning that if you have back pain, sciatic pain, or joint pain, that you have a restriction in your viscera. However, if you have these diagnoses and not found relief using other modalities, this is an area that we are specialized in.
What is happening when I’m receiving visceral manipulation?
That is a great question, and I will try to make it as simple as possible. When the tissues around the organs develop tightness patterns, that information goes to your brain. Your brain wants to protect you and the life-giving things (organs) inside you, so if you try to move throughout your day that causes tightness into this organ system, chances are you will experience tightness or pain. This isn’t because something is “wrong” with your body, it’s your body is trying to protect you from causing damage to something that is important for your survival. Who would have thought pain was something that was helpful?
What we do then is by releasing the tension within this tissue surrounding the organs, this changing tightness pattern decreases the “threat of harm” to your organs, which then the body is able to move with greater ease.
As this happens, you are able to adapt better to your environment and have a greater expression of health. Remember, the body wants to be in a state of health and well-being, disease is not the natural state.
Why is this at core physical therapy
The Core Physical Therapy way of physical therapy is to not just chase pain but to get to the root cause of the problem. Because the body is one whole unit of multiple systems working together, a problem in one area can cause a problem in another area. This philosophy of visceral manipulation is birthed out of the same thought processes as our myofascial release and craniosacral therapies. Because of this, our therapists are able to provide relief to people who have otherwise not had success with more traditional types of healing.
We are the only clinic in Central Iowa that has this number of physical therapists who have an appreciation and understanding of how the body interrelates, as well as skilled in treatment of these restrictions to assist with people’s healing journey. We have heard the cry for a more holistically-minded care that considers all parts of the person, and we have opened our doors wide open to receive those people who agree with this philosophy and treatment approach.
What are some prior successes of visceral manipulation?
Learn from our different therapists about specific examples they have seen.
“I had a patient who was in for acute back pain. He was making progress, showing improvement in mobility and decreasing pain. I then used a visceral manipulation technique for the connective tissue surrounding his colon and it immediately reproduced his low back sx. Turns out this tightness was the reason for the pain in his low back.” – Justin
“I had a patient that had terrible back pain associated with her menstrual cycles. After gentle visceral manipulation on her uterus the back pain resolved that same visit. I was able to show her some gentle simple self-maneuvers and has reported reduced back pain during her cycles since”. – Kate
“I have a patient who came in with 10/10 pain, bulging discs at L3 and 5, and a history of 8 major abdominal surgeries after getting salmonella poisoning and losing 21 feet of intestines. Needless to say he has significant scarring and fascial adhesions throughout his entire trunk. He found no relief with pain medication, previous physical therapy, or injections. Using myofascial release and visceral mobilization techniques has significantly reduced his pain intensity and frequency as well as allowed him to return to work and do yardwork. He says these techniques have been life-changing.” – Laura
“I saw a patient a few years ago, who had been suffering from TMJ problems for several years. She had received care from multiple providers with no success. In talking with her she indicated that her problems had started shortly after the birth of her last child. That made me curious about what kind of delivery she had. Turns out it was a C-section. So, in our exam I looked at mobility in her R lower abdominal quadrant and found very irritable areas around that scar affecting her soft tissue mobility and the anatomy in that area. Once we got that area moving better, and without touching her TMJ, she was already reporting about 70% improvement in her jaw symptoms. A little more direct care to her head and neck got her to a very good place and she has not been back!” – Blake
“I had a patient come to therapy for low back pain, and during the evaluation I discovered she had tightness through the lower rib-cage and abdomen. As we worked through this area her back pain got better, AND she also reported being able to take a deep breath for the first time in a long time. She never mentioned the breathing difficulty before the evaluation and treatment. Later that day, she called me to report that her breathing exercises at home not only got better, but her numbers were ABOVE the predicted range for her age. She later told me she was seeking care for breathing issues from multiple specialists across the country, never to find relief until the visceral treatments.” – Mike
“I had a patient that originally came in with low back pain, but upon further conversations found out she had a history of IBS and C-section birth, which she thought were unrelated. We discussed how these areas of the body are connected, and focused a good portion of her treatment on the fascial restrictions around the abdominal and pelvic viscera. Within a couple months she had significant improvement in her low back pain.” – Robin
“A patient who was experiencing pain throughout her body, including her abdomen, reported improvements in her mobility and her ability to use her core muscles after a couple visits where we utilized a variety of treatment techniques, including visceral treatments. She had previous physical therapy at another clinic where they used a more intense technique that resulted in more pain, but the gentle techniques we used provided a greater benefit with less discomfort.” – Jordan
“I had a patient with consistent deep aching in the R lower ribcage for 6+ months, also with a diagnosis of lower thoracic herniated disc. I identified and treated visceral restriction in the liver. She returned to her next appt with no more ache in the ribcage. A month later she had her blood labs taken and her cholesterol levels were normal (unbeknownst to me they were previously high enough to warrant the doctor wanting to place the patient on meds). She made no changes to meds or diet to warrant the cholesterol improvement.” – Lindsay
“I’ve had many patients whose gastroesophageal reflux improved by 75-100% with visceral work.” – Lindsay
“I have a number of somewhat mysterious symptoms, and I’ve always felt so seen and heard and cared for by the PTs at Core. They’ve helped me reduce my headaches, improve digestion and gain more stability, mobility and confidence in myself. With Core, there are always new steps that we can take or things that we can try. It’s been such a blessing and a relief!” – Kirsten
“A previous patient came in with non-specific lower back pain symptoms on their right side. After finding significant restriction through the anterior pelvis, treating through the right lower quadrant, and specifically the cecal ligaments led to improvements in symptoms and an elimination of the noted pain symptoms.” – Connor
“I have worked with a client who has had extensive surgeries and spinal issues (he was born with spina bifida and has a history of a tethered cord and chiari malformation). We often do visceral work along to improve motility through his gut as he struggles with chronic constipation. He reports back that these techniques have been helpful to him in helping manage these issues.” – Mary Beth
“I’ve had a lot of success with people with constipation and heartburn/reflux. I have one 10 year old in mind who was having BMs every 2 weeks, and after about 1x/week for 4 weeks of treatment focusing on visceral and nervous system regulation strategies, she started having BMs every day.” – Noel