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General visceral techniques

Notes

Notes

Viscera

General visceral techniques

Introduction to visceral dysfunction

Visceral dysfunction is defined as “impaired or altered mobility or motility of the visceral system and related fascial, neurological, vascular, skeletal, and lymphatic elements” (Seffinger).

Mobility refers to the movement of an organ in response to forces generated outside of the organ, e.g., diaphragmatic and cardiac motions which affect the ascent and descent of the viscera, along with blood flow.

Motility refers to the inherent movements of an organ, e.g., peristalsis.

The steps to properly diagnose visceral dysfunction are as follows:
  1. Inspection
  2. Auscultation
  3. Percussion
  4. Palpation
  5. Osteopathic screening exam
Once dysfunction in a particular organ or region has been identified, treatment may be initiated.

Treatment of visceral dysfunction

1. Treat the appropriate ganglia corresponding to the dysfunctional organ via myofascial release
  • Celiac ganglion
    • Innervates the foregut (distal esophagus, stomach, proximal duodenum, liver, gallbladder, spleen, portions of the pancreas)
  • Superior mesenteric ganglion
    • Innervates the midgut (distal duodenum, portions of the pancreas, ileum, jejunum, ascending colon, proximal ⅔ of the transverse colon)
  • Inferior mesenteric ganglion
    • Innervates the hindgut (distal ⅓ of the transverse colon, descending colon, sigmoid colon, rectum)
2. Treat any viscerosomatic reflex by addressing vertebral dysfunction at the corresponding level
3. Treat the corresponding Chapman point of the dysfunctional organ
4. Treat the dysfunctional organ itself via indirect or direct myofascial release
GENERAL VISCERAL TECHNIQUES
TECHNIQUE
TREATMENT
INDICATIONS
Diaphragm release
  • Stand behind the patient 
  • Gently grasp with your fingers beneath the inferior costal margins and position the diaphragm indirectly (position of ease), use respiratory cooperation (phase that relaxes the diaphragm) and hold the tissues until they relax
  • Lymphatic congestion distal to the diaphragm 
  • Impaired breathing
Mesenteric lift: sigmoid colon
  • Stand at the right side of the patient
  • Gently apply heel of the right hand near the sigmoid colon (near left ASIS and just superior to inguinal ligament) and gently lift the sigmoid colon cephalad and toward the hepatic flexure of the colon until the tissues relax
  • Bloating
  • Constipation
  • Non-infectious diarrhea
  • Pelvic or abdominal pain
Mesenteric lift: descending colon
  • Stand behind the patient in the left lateral recumbent position
  • Place your fingers in the left lower quadrant of the abdomen, gently scoop the descending colon and lean slightly backward until the tissues relax
  • Bloating
  • Constipation
  • Non-infectious diarrhea
  • Pelvic or abdominal pain
Mesenteric lift: ascending colon
  • Stand behind the patient in the right lateral recumbent position
  • Place your fingers in the right lower quadrant of the abdomen, gently scoop the ascending colon and lean slightly backward until the tissues relax
  • Bloating
  • Constipation
  • Non-infectious diarrhea
  • Pelvic or abdominal pain
Mesenteric lift: cecum

  • Stand at the right side of the patient
  • Gently apply heel of the right hand near the cecum (near right ASIS and just superior to inguinal ligament) and gently lift the cecum toward the hepatic flexure of the colon until the tissues relax
  • Bloating
  • Constipation
  • Non-infectious diarrhea
  • Pelvic or abdominal pain
Mesenteric lift: small intestine
  • Stand at the right side of the patient
  • Gently apply heel of the right hand at the right lower quadrant and gently lift the small intestine toward the umbilicus and hepatic flexure of the colon until the tissues relax
  • Bloating
  • Constipation
  • Non-infectious diarrhea
  • Pelvic or abdominal pain