Visceral Manipulation

1 - Overview & definitions

Viscera is a 'fancy' word for all of the wiggly bits under our skin!  Obviously, this definition is not found in the medical dictionaries, but serves to define what viscera is for the lay person.  Lungs, kidneys, heart, liver, bladder etc,.. all are viscera.  Included in Visceral Manipulation (VM) are the major and minor blood vessels, nerve trunks, lymphatic vessels and a heap more.

VM (Visceral Manipulation) is a group of techniques aimed at restoring mobility and motility to the viscera, eliminating a major trigger for muscular compensation and protection of those tissues.

2 - Mobility Vs Motility

Mobility is how an organ moves in relation to its neighbours and 'dances' through movement and function of the body.  Motility is a less well known quality where many organs also have a rhythmic cycle of shape changes within that organ - think of an organ having a stretch to work out a kink (nowhere near the correct explanation but close enough to give you an idea why motility exists).

3 - A logical approach to a functional problem

Let's use a major organ we all know exists and is pretty big - the liver.  Without a liver, your lifespan is measured in hours.  It makes sense then that if one of the major ligaments which govern the position of the liver becomes dysfunctional (say due to a bad lift and twist) and holds the liver in a 'bad' position, the body needs to minimise any further potential damage to that tissue.  The only way it has to defend the liver is to tighten up the muscles of the overlying rib cage and reducing the amount of effort being exerted on it by the diaphragm during breathing.

Now the liver is a HUGE organ, quite solid and very oddly shaped.  Every time you breath, that organ has to do a complex 'dance' with the other organs sharing the same space.  A bit like a dance floor full of waltzing couples.  If that same liver is restricted in mobility, it is a bit like one of our waltzing couples being drunk and caroming around the floor a bit less predictably.  Chaos ensues!  This is the head of a symptom cascade which might eventually lead to symptoms as diverse as shoulder problems, headaches, digestive upsets, sexual dysfunction, hip pain or general malaise, just to name a few.

Naturally, if the physical environment of the liver is upset, the function of the organ is likewise compromised.  This may bring about a huge range of other problems or make existing problems far more significant.

Read more about Symptom Cascades here

4 - How is Visceral Manipulation performed?

There are two main types of VM, Short lever (direct and indirect) and long lever.

Short lever techniques apply a mechanical pressure directly to the organ in question, facilitating the recovery of mobility by direct pressure into the axis of restriction or indirect pressure away from the axis of restriction.  In either case, the movement of an organ should be increased if not fully restored.  Short lever techniques are often the first taught to a therapist as they relate most directly to the structural anatomy learned by the student previously.

Long lever techniques use a different approach (whilst arguably achieving what short lever techniques do) requiring a far deeper knowledge of functional anatomy and often using large body movements to facilitate the reintegration of that organ's movement into the entire visceral 'dance floor'.

5 - Short and Long lever techniques compared

Disregarding for a moment the intricacies of the involved anatomy, let's imagine a liver is being held in a position where it has a reduced ability to glide to the left (a right shear). 

A direct short lever technique will require the therapist to work with the client's breath cycle to gently mobilise the liver into its more natural movement cycle.  The therapist's hands will be placed over the client's liver and pressures applied through the rib cage, under the rib cage etc. and the client asked to accommodate the adjustment by moving or breathing in specific ways.

A long lever approach might ask the next question of why this liver is not moving properly, but for this example, let's assume the problem lies within a structure called the Right Triangular Ligament (spasm).  A long lever approach would be to ask the client to perform a partial stomach crunch with breathing phases controlled and some other movements along the way.  The therapist in this case will still be applying a monitoring or corrective (depending on technique) pressure on or around the liver but is asking the body's innate mechanisms of health to recognise the restriction.  Once that recognition is achieved, then hopefully the body also finds itself in perfect position to release that same restriction, normalising the liver's movement.

6 - Advantages and disadvantages of short and long lever techniques

Advantages of short lever techniques are that they are relatively easy to teach, effective in most cases and have a good level of client comfort.  The potential to not achieve release in all of the co-factors of a misalignment and leave a small but significant restriction are considered the main disadvantages of short lever techniques.

Long lever techniques offer less likelihood of leaving those residual restrictions and changes are often integrated into the client's body faster than with short lever techniques due to the far more complete participation of the client.

The major disadvantage of long lever is the level of knowledge to design and perform the releases.  No two people will require the exact same release using long lever and techniques are dynamic and require a greater level of moment to moment adaptation.  Long lever techniques are far harder to teach effectively and require a strong level of functional anatomy.

The other main advantage of long lever techniques is that the body has a total 'right to refuse' that correction.  In a clinical setting, I had a client with a 'stuck' left kidney.  After resisting four different sessions attempting to achieve movement, she was referred for a nuclear scan which revealed a benign adrenal adenoma which was not yet triggering clinically defining symptoms beyond her body's restriction of mobility of the left kidney (eventually causing significant hip pain).

7 - Visceral Manipulation in Ashmore Health Centre

We tend to use mostly long lever techniques here at AHC.  We find that these techniques offer an excellent level of client compliance, comfort and efficacy.  On a case-by-case basis, short lever techniques may be used (especially in cases of hernias, specific bowel restrictions etc.) but we essentially tend towards the more whole-istic long lever techniques.