A CLINICAL STUDY ON THE EFFECTS OF VISCERAL MANIPULATION FOR LOW BACK SPINAL DYSFUNCTION

A CLINICAL STUDY ON THE EFFECTS OF VISCERAL MANIPULATION FOR LOW BACK SPINAL DYSFUNCTION

GAIL WETZLER, RPT, CVMI, BI-D, EDO

Introduction:  The more patients we treat with low back spinal dysfunctions, the more we realize that low back pain hides a multitude of dysfunctions.  This study examines the neuroreflexive and structural relationship between the internal organs, its attachments and the musculoskeletal low back when in a state of dysfunction.  Observations are based on the premise that all viscera have physiological movement.

Materials and Methods:  Patients charts were referenced with the diagnosis of low back spinal dysfunction.  Ninety charts were compiled dating from 1989 to 1991.  A random selection, every third chart categorized alphabetically, was retained for information gathering.  The survey tool used consisted of age, sex, history of abdominal disorders or surgeries, and the number of treatment sessions before and after the use of Visceral Manipulation (VM) techniques.

            The objective data also consisted of subjective and objective findings in detail within the Result section.

Results: 

I.                    The age range was 24 to 62 years with the most frequent ages seen for treatment at 42-44 years.

II.                 The random selection obtained 28 females and 2 male subjects.

III.               The history of abdominal disorders or surgeries proved the following:

·        Abdominal surgeries 53%

·        Female disorders 36%

·        Nervous stomach 33%

·        Trauma to abdomen 26%

·        Constipation 26%

·        Colitis 26%

·        Infections 10%

·        Difficult digest 6%

·        Post delivery 6%

·        No history 6%

IV.              Average number of treatment sessions prior to VM was 12.5

A.     22 patients had prior treatment

B.     8 patients had no prior treatment

V.                 Average number of treatment sessions after VM

A.     20 patients with previous treatment was 5.4

B.     8 patients with no previous treatment was 6.8

C.     2 patients were sent for further medical care after 6 sessions with no changes

VI.              Subjective Findings:

A.     Using a pain scale of 0 (no pain) to 10 (severe pain), the study compared pain relief from treatments of various procedures prior to VM and after the utilization of VM.

                                                Before                          After                            3 Months

                    No VM                  8.5                             4.8                                  6.25

                          VM                  6.25                           3.16                                 2.11

B.     Neurological signs of low back, buttock and/or lower extremities equaled     31% before visceral techniques and 12% after usage.

C.     Symptom changes of lumber extension from prone position press up indicated an 88% subjective improvement.

VII.            Objective Findings:

A.     Palpable soft tissue restrictions

Primary organ when (R) L/B symptoms – cecum

Primary organ when (R) LE symptoms – (R) kidney

When bilateral L/B symptoms small intestine/Foot

Primary organ when (L) L/B symptoms – Sigmoid/Duo

Primary organ when LE symptoms – Sigmoid

Most frequently found viscera to be in dysfunction in relations to lumbar spine:

Cecum 50%

Small Intestine 50%

Root of Massantary 36%

Ascending colon 30%

Uterus 30%

Kidney 30%

Sigmoid 26%

Duodenum 26%

Bladder 23%

Liver 20%

Descending colon 16%

(L) Kidney 6%

B.     Lumbar flexibility:

1.  Gain in passive ROM with primary vertebral restriction 60%

2.  Gain in passive ROM with primary soft tissue restriction 93%

3. Active ROM gain:

    a. Forward Flexion 55%

    b. Side Bend R/L 36%

    c. Pelvic ant/post excursion 50%

    d. Hams length 19%

    e. Hip joint int/ext rotation 40%

     C.  Lumbar strength using lumbar protective mechanism and lower abdominal        muscle test

          1.  Isolated lower abdominals:

·        Pre Fair

·        Post Fair+/Good

2.      Lumbar protective mechanism

Pre poor initiation and slow to respond over involved viscera

Post all appropriate candidates progressed to a lower trunk re-education program

Discussion:  Several factors influence the choice of treatment for patients with L/B spinal dysfunction.  This study has provided objective evidence that low back signs and symptoms can be associated with the visceral system.  The association may be neuroreflexive, structural or pathological in nature.  It is important to acknowledge differential diagnosis and refer to the medical physician when pathological disorders are suspected.  Two such cases were advised in this manner.  One was found to have endocrine imbalances and the other epithelial cell malformation of the hollow organs.

Considerations of a patient’s abdominal history is strongly advised as 94% had significant findings.

The study also indicates that pain can be reduced for a longer period of time and that spinal ROM and Strength can be influenced by Visceral Manipulation.

Conclusion:  Based on these clinical observations, low back spinal dysfunction may be more effectively and efficiently resolved with the addition of Visceral Manipulation into the treatment program.

References: 

Barral, J.P., Mercier, P., Visceral Manipulation Volume I, Eastland Press, Seattle,   WA, USA, 1988

Barral, J.P., Visceral Manipulation Volume II, Eastland Press, Seattle, WA, USA, 1989

Boissonnault, WN, Eass, C, Pathological Origins of Trunk and Neck Pain: Part I- Pelvic and Abdominal Visceral Disorders, Journal of Orthopedic and Sports P.T. 12:5, November 1990.

Author: 

Gail Wetzler, P.T., Certified Visceral Manipulation Instructor, Focus on Health, Santa Ana, CA., USA

Published by:   The Institute of Graduate Physical Therapy and The International Federation of Orthopaedic Manipulative Therapists

Title:  Abstracts from the 5th International Conference of  I.F.O.M.T.

June 1-5, 1992

Document provided for private discussion. May be removed from this site once read.

Not meant for public circulation. Commentary may be coursed via www.manualmed.blogspot.com

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June 20, 2010.

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What is Visceral Manipulation?

Trauma, lack of exercise, physical deconditioning, cumulative soft tissue injury, inflammation, surgery, or obesity can displace, restrict, tighten, or scar ligament and fascia that surround, support, or suspend organs. Fascial and ligamentous injury can result in focal strains that cause tissue or organ dysfunction and injury. Pain and inflammation cycles are facilitated. VM uses soft vectoral techniques aimed at re-engaging normal suspension or movement of internal tissues / organs.

The notion of tissue restrictions or compliance to movement extends to the viscera. Organs, fascia, mesentery, and visceral ligaments move along and in relation to each other in much the same way that we know normal fascia-muscle compartments do. This notion of mobility in relation to each other is differentiated from intrinsic organ motility. Organs are mobile in relation to each other and often possess an internal movement or motility. As all fascia moves with breathing, the lungs move as we breathe, the stomach and intestines move in relation to each other during peristalsis, the urinary bladder shifts location somewhat when we piss. Viscera also move around a bit with ambulation. Visceral mobility restrictions are thought to restrict normal fluid, solid, and impulse conduction through individual organs. Visceral Manipulation addresses these restrictions. Visceral Manipulation is a hands-on set of techniques that resolve organ tissue motility and mobility problems. An organ in its proper place, moving the way it should, is a happy and functional organ. That is the goal of Visceral Manipulation.

Musculoskeletal conditions linked to visceral involvement include:

1. Mid to low back pain: The colon’s attachment to the back of the abdominal compartment may be strained. This can lend ligamentous tightness or displacement which, in turn, can inhibit normal spinal movement. These spinal segmental dysfunctions result in their related pain constellations.

2. Neck stiffness and pain: The suspensory ligaments of the lung and the pericardium all attach to cervical vertebrae. Ligamentous involvement here can cause cervical joint compression and flexion cervical somatic dysfunction. A forward head posture may thus actually be more closely related to a lung problem than to a thoracic spine dysfunction.

3. Shoulder restrictions and pain: Most paramedical personnel are familiar with the fact that gallbladder inflammation can result in pain that radiates to the right shoulder. Nerves that supply the suspensory ligaments of the liver stem from the spinal segment that innervates the shoulder. Liver suspensory ligament involvement may thus result in shoulder somatic dysfunctions.

4. Peripheral joint pain: Visceral compartment restrictions can transmit tension via adjacent myofascial trains into the limbs. These tension lines can cause compressive and torsional joint irritation and dysfunction.


How can visceral manipulation help me?

Visceral Manipulation has been known to improve:

1. Fatigue: Abnormal fascial tension or scarring from at the visceral suspension system may result from inflammation, surgery, and blunt or countercoup trauma. Loss of organ mobility due to restrictions of surrounding and supporting tissues have been linked to general fatigue. By example, lessened fatigue has been reported by whiplash-injured VA patients. Faster recovery rates and lower incidences of depressive symptoms have likewise been reported.

2. GI motility disorders: Ileus, constipation, and irritable bowel syndrome: Abnormal fascial tension or scarring from at the small and large intestinal suspension system may result from inflammation, surgery, or blunt trauma. This causes restrictions that negatively alter bowel motility and function.

3. Hemorrhoids: The venous drainage from the rectum toward the liver is impeded when the hepatoduodenal ligament is abnormally tight. The resultant vascular congestion can cause or aggravate hemorrhoids.

4. Incontinence: Ligamentous tightness and muscle hypertonus may limit proper urinary bladder expansion and emptying.

5. Comparative Studies have found Visceral Manipulation Beneficial for:
Bloating and Constipation
Nausea
Acid Reflux / GERD
Swallowing Dysfunctions
Chronic Pelvic Pain
Endometriosis
Fibroids and Cysts
Dysmenorrhea
Bladder Incontinence
Prostate Dysfunction
Referred Testicular Pain
Effects of Menopause
Pain Related to Post-operative Scar Tissue
Post-infection Scar Tissue
Autonomic Mechanism Dysfunctions
Constipation and Gastritis
Persistent Vomiting
Vesicoureteral Reflux
Infant Colic
Anxiety and Depression
Post-Traumatic Stress Disorder


Are you a Therapist or Doctor?
Visceral Manipulation involves hands-on techniques that alter restrictions imposed on the visceral organs. The aim is release of previously impaired mobility and motility. This normalized organ freedom of movement may also release musculoskeletal structures that have been secondarily affected. Reflexive guarding and adhesions causing Somatic Dysfunctions may be broken up with Visceral techniques.


Are there Studies that prove this works?
Comparative Studies have found Visceral Manipulation also Beneficial for:
Somatic-Visceral Interactions
Chronic Spinal Dysfunction
Headaches and Migraine headaches
Carpal Tunnel Syndrome
Hip and Knee Pain
Sciatica
Whiplash
Seatbelt Injuries
Chest or Abdominal Sports Injuries

Perhaps the best reasons i've heard on
why one should see a Visceral Manipulation Specialist are
1. "when nothing Else has worked," and
2. "there has to be a safer alternative than surgery."

Practitioner Notes for Cranio-sacral and Visceral Manipulation

These notes are meant for the MMG Kids.
If you are not an MMGer and these notes still make great sense to you,
then these notes are meant for you, too!

Remember the maxims "Reflexes First, and then Superficial to Deep?"
Let's stretch that notion with this application:
Guarding or Protective Reflexes with polysynaptic multimotor multisystem involvement have to be turned off first. The Frontal Induction Technique from the RDT arsenal is great for turning off Generalized Protective Modes.
Note how "superficial" the Somato-Emotional Dissonance Mapping is. Turn that off. That's the best way to get an accurate NMF map tracking. Said another way, Please note that the main usefulness of the Emotional Dissonance Motility Field is that if that is positive - meaning there's dissonance, the standard nmfr mapping is not a good representation of the physical dysfunctions. The EDMF must first be neutralized in order to detect the true myofascial mapping.


Note that, on top of standard mobilities, the organs have reciprocal motilities.
Once you have palpated the mobility and inherent motility of the organs, an induction technique can improve the organs' movement. The best initial guage is organ movement in comparison to its contralateral twin.
The induction technique in its simplest form would involve chasing and enhancing organ movement at its endrange.

By contrast, an endrange challenge plus microsecond counter-push is best for treating allergy and emotional dissonance motilities.

The Structural Tensegrity Induction Technique may be used for most connective tissue. It is part of the RDT protocols for turning off neuromyofascial protective modes.

That's it for this installment of MMG Practitioner Notes.

We hope to see familiar faces and great new ones when next we meet.
Proposed dates: June 06, 2010 - Cebu or Pasig
May 31 - Pasig City or San Juan
Proposed topics: "Articulatory Techniques for Everything," and
"Integrated Techniques for Manipulation of the Thorax"

See ya then, see ya there.


Yours in the Evolution of the Field,

Strix