Maggie Abrams, DPT, founder of Nourish Meditation, thought she knew right where her stubborn back pain was coming from. It had been a part of her daily life ever since she was a teenager when she performed in a demanding show at her performing arts school. Her doctor diagnosed her with a stress reaction in her lumbar spine, and prescribed her the typical treatment, including a stint in a back brace, a regular physical therapy routine, and even some Pilates to strengthen her core. And while it did seriously reduce her daily aches, she’d still experience flare-ups now and again.
Then Dr. Abrams went to physical therapy school, and she learned about an interesting tool she could add to her practice: visceral manipulation. She’d come to find this wouldn’t just be a helpful therapy for her patients; it would also eliminate her back pain for good.
What is visceral manipulation?
Let’s break it down. “Viscera” are your soft internal organs, such as your kidneys, lungs, stomach, and liver. So, visceral manipulation is a type of gentle hands-on therapy that assesses and addresses organ mobility.
Wait, our organs are supposed to move? Yes! As strange as it may sound, our organs need to be able to move smoothly within our bodies for a pain-free life. One small but important example is our kidneys. When we breathe in, our kidneys should glide downward and then back up when we exhale, Dr. Abrams says.
This therapy, developed by French osteopath and physical therapist Jean-Pierre Barral, highlights the importance of treating the body as a connected system. “If an organ can't move properly, you can imagine that it might change how movement and loading affects the rest of your body and it might shift too much stress into one area, contributing to injury,” she says.
How is visceral manipulation done?
Manipulating your organs might sound intimidating, but don’t fret—a therapist won’t be smooshing your stomach like a stress ball. “What we’re ultimately working on is the fascia around the organs,” says Heather Jeffcoat, DPT, president of the Academy of Pelvic Health Physical Therapy. Fascia is the connective tissue that runs throughout the body—and holds every organ in place.
Although there are slightly different modalities, visceral manipulation typically goes something like this: The therapist will place their hand on a fascial landmark, like over your ascending colon, and gently move the tissue in each direction—up, down, left and right—looking for the direction with the most restriction. Once they’ve found it, they’ll gently pin down the tissue with their hand, coaxing that fascia to release. Sometimes, the therapist will ask clients to rotate their hips or flex their arms in a certain position to add additional tension to the fascia.
“It’s not like a belly rub. It’s a very targeted movement of the tissue looking for the most restricted direction,” Dr. Jeffcoat says.
Can you do visceral manipulation on your own?
Because this practice requires extensive training, it’s best if your first foray into visceral manipulation is with the help of a trained specialist. Through purposeful presses and strokes, they’ll feel around your abdominal cavity and identify tight fascial lines—something a newbie probably wouldn’t be able to do on their own.
Once your therapist has homed in on areas that need attention, they may give you some exercises you can do on your own at home. “The lines of tension can go in so many different directions so it’s not a cookie-cutter protocol,” Dr. Jeffcoat says.
Who might benefit from visceral manipulation?
The research around visceral manipulation is still developing, but therapists are finding it effective for a number of disorders, including endometriosis, irritable bowel syndrome, and bladder pain. One common cause of organ restriction is the growth of scar tissue. If you’ve had surgery, visceral manipulation could help release tightness caused by postoperative scar tissue.
Dr. Abrams says some of the most promising results are being seen among patients with non-specific back and neck pain. (You know, when doctors can’t pinpoint an exact reason for that nagging ache, but it’s there nonetheless.) If the origin isn’t from a specific injury or infection, it could be the result of restricted organ mobility. Oftentimes, back and neck pain is multifactorial, meaning it’s caused by a number of things.
That was the case for Dr. Abrams. Although she was dealing with a stress reaction in her spine, treating that didn’t make her back pain disappear. It wasn’t until she was in a visceral manipulation course that she found lasting relief. While training, partners practice on one another to get the hang of the technique. Dr. Abrams’ partner was practicing on her when she felt that the fascia around Dr. Abrams’ left kidney, sigmoid colon, and small intestine were incredibly tight. After some gentle manipulation to release them, Dr. Abrams noticed something pretty amazing: Her back pain flare-ups stopped—and her IBS improved dramatically, too.
“I've seen it be a game changer for so many patients who have struggled chronically for a long time, myself included in that category,” Dr. Abrams says. “The folks that aren't finding answers, they might be in visceral manipulation.”
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