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Why Visceral Manipulation?

Julia Kegelman physical therapist in Wilmington, DE performs functional manual therapy on a woman with a yellow shirt

The body is smart. So smart. 

Think of the body as a skeleton whose job it is to protect your life sustaining organs. Your skeleton has muscles attached to it so that those life sustaining organs can move throughout the world. Your organs also connect to your skeleton via fascia. Think of fascia like a seatbelt for your organ. It keeps everyone in their place during the ride.  

Identifying the primary restriction is the magic of visceral manipulation.  Everything in the body is enveloped and connected to each other by a network of fascia.  Knowing where to start unraveling the tangled web is driven by what the therapist feels, not the location of the patient’s pain.  

If you have ever cooked chicken, think of when you peel back the skin.  There is a thin film between the skin and the meat.  This is fascia.  Fascia doesn’t only separate the skin from the muscle.  Each muscle fiber is wrapped in fascia.  Then the body takes bundles of fibers and wraps them up. Finally there is another layer of fascia around the entire muscle separating it from its neighbors.  When the contractile part of a muscle terminates, fascia gathers together to become the tendon that anchors muscle to bone.  This method of fascial layering occurs in the organs as well.  So these life sustaining tissues are surrounded and encased in fascia and anchored to the skeleton like I mentioned above.  Nerves and blood vessels travel through fascia contributing to the most complex internal garment you will ever wear.  Just like a snag in a sweater that can distort the whole weave, restrictions within your tissues can affect tension throughout the entire body.  A small restriction may go unnoticed for months or even years.  But left unaddressed, your body will begin to compensate by tucking in here or stretching over there.  Eventually you run out of ways to compensate and are limited by pain.  

Moreover, if there is a restriction in one of your organs or the fascia that anchors your organ to the skeleton, your body uses pain to stop you from putting strain on these life sustaining tissues. Take shoulder pain for example.  You cannot reach your arm to the top shelf of the kitchen cabinet without spreading your ribs vertically.  On the inside of the rib cage lies the lungs connected to the ribs via the pleura. Instead of ripping your lung or pleura, shoulder pain will stop you from reaching too far.  So if the lung has limited mobility, so will your shoulder.

The French osteopath and physical therapist who created Visceral Manipulation, Jean Pierre Barral, discovered and honed the ability to identify the primary restriction in his patients using touch.  ‘Listening’ as this technique is called, can be likened to holding two magnets close enough to feel their attraction.  If something comes between the magnets, you will no longer feel the attraction.  Remove that interference and once again the attraction returns.  With my hand on top of your head, I will feel a faint pull into an area of your body.  Lying down on the table, I’m able to localize the area of greatest restriction even further by interrupting the pull with a light touch and removing my touch to feel the pull return.  It is this ability to be as specific as possible when deciding where we treat the body that is even more powerful than how we treat the body.  It has been said that the most mediocre technique in the right location is a far superior treatment than the most advanced technique in the wrong location.

I know that identifying where to begin bodywork in the VM paradigm is unconventional. There are a few things about the visceral manipulation treatment technique that make it unique as well. Treatment is performed using relatively light touch. The touch is not intended to break apart fascial restrictions, but rather to stimulate sensors embedded within the fascia. These proprioceptors, also called mechanoreceptors, are activated by pressure and stretch.  When surrounded by restrictions, these sensors are not getting activated as usual. With the right amount of touch, the dormant proprioceptors send a message to the brain informing it that this area needs attention. The brain processes this input and produces the release. Too much force from the therapist will cause the tissues to defensively resist any change. Too little force from the therapist and the brain does not get enough input to notice the need for a change. So in order to be effective, the force from the therapist must be just right.   

While it is thought that upwards of 80% of orthopedic injuries have their origins in visceral restrictions, many people are able to manage pain without this ‘outside the box’ technique.

So when do you know VM is right for you?

  • Slower healing time: circulation to the area may be impaired by deep fascial restrictions.  
  • Return of symptoms:  compensations, rather than the source, have been the focus of treatment thus far. 
  • Symptoms are associated with cycles of the body:
    • Daily:  Circadian rhythms of the organs or your eating/eliminating schedule have an impact on your symptoms.
    • Monthly: The luteal phases of the menstrual cycle produce greater fluid around the viscera exaggerating the impact of any restrictions.  Cramping/back pain during menstruation is also associated with visceral restrictions.
  • You want to resolve the source of the problem quickly