This is an account of the techniques I have learned in the visceral classes. First thing we discussed, apparently there is no such thing as visceral osteopathy. We are merely osteopaths working on the viscera. Valeria emphasised this, I think mainly because Jean Pierre Barral is a mastermind in visceral, and well if he says so, it must be true.

We discussed the importance of the diaphragm, its quite amazing the effect on the body a dysfunctional diaphragm is. Discussion included, importance of breathing, ligamentus attachments to other organs, oesophageal hiatus, the massage effect of the viscera via greater ommentum, stress depositing in diaphragm, drainage and plenty more.
We had learned listening tests for the diaphragm. Sitting and supine. My preference towards supine as the patient is not flexed  at the abdomen or trunk, making it easier to palpate and listen to the diaphragm. You can asses tone and symmetry better also.

After assessing, we had learned how to release the diaphragm. This was a difficult task. Most of the students were fit and healthy and it was hard to pick up any dysfunctions or asymmetry. None the less, we had seen a sitting technique and a side lying technique working to release the crura.

Personally I had discussed with Enda about the somatic aspect of the diaphragm, concluded that I would prefer to work on both to influence somato-visceral and viscero-somatic changes.

Subclavius and associated fascia
Anatomy revision done, subclavius arises by a short, thick tendon from the first rib and its cartilage at their junction, in front of the costoclavicular ligament.
We had learned a subclavius release. This was done side lying coming from behind. Using tip of the thumb and first finger, which was my preference, on to the subclavius on the medial aspect. Using the patients arm, we could open the area and collapse the body more over our fingertips to get a better contact point, hold until you start to feel the release.

We also learned clavipectorial fascial release. Various benefits of this technique discussed as it occupies the interval between the pec major and subclavius and protects the axillary vessels and nerves. This again was a side lying technique, but this time needs to be more gentle and delicate. However, I felt comfortable with the technique, quite simple and effective.

We were given basic principles on dealing with fascia and was told to explore the fascia of the anterior chest. I found that instead of finding asymmetries, or one side being under more tension than the other, it felt like pockets of fascia were more under tension, even on the same side! Which makes sense, considering you have fascial chains that come from various structures. 
What I found really effective in terms of releasing the fascia, is that I had used a broad palmar applicator. Shifting and rotating my palm I could feel where the fascia was happy and not happy to go, and thus I treated what I found.  On re-examination I felt a positive result, I was really surprised, in how much difference it had made.

Sternal Release   
This technique is to release of the costochondral joints in the thorax. Also, hypothetically, Valeria and I discussed that on recoil, the anterior thorax fascia was having a burst stretch (sounds worser than it is :)

To do this, I was on the right of my colleague, with my right hand, I placed the base of my palm transverse to the manubrium and my left hand transverse to the xiphoid, then together I added slight pressure and rotated my hands toward facing each other. 
As my colleague took in 2 deep breaths, on expiration I had added slight more pressure so each inspiration after has some resistance, on the 3rd breath as my colleague was about to breath in, I had released the pressure. 

I liked having this technique done on me and think its effective.

(The right triangular ligament is missing -_-*, bit its on the top left of the liver opposite to the left triangular ligament)

We revisited liver anatomy, mainly the ligaments that support the liver and their associated attachments to other organs. We looked at the motility of the liver n relation to breathing aswell, which included discussions about the greater ommentum and lungs in relation to breathing. We watched a video of a cadavar. The lungs were being inflated and deflated and it showed the massive link to the liver. Inflating the lungs were moving the liver, via diaphragm and greater ommentum from what I could see.

Examination was done in supine and side lying. My preference was assessing in side lying. We would place our hands on the liver, as valeria described, as a suction cup on on to the right flank of the lover thorax. Ligaments included, left and right triangular ligaments, falciform ligament, coronary ligament and round ligament.

Mobilisation was easy to understand, but difficult to do. It was to slowly take the liver away from the angle of the ligament to assess its tension. Treatment consisted of bringing the ligament on tension then either applying a slight thrust along the ligamentus angle, or rhythmically articulate. Re assess.

A sitting technique was also done, colleagues seated, placing fingertips over the inferior border of the ribs, patient slumps forward over the fingertips allowng to come on to the liver and have zero skin drag. Were test the motion of traction and extension. Manipulate the angles and go towards restriction gently. 

GI Tract
We examined the junctional points, 
Cardiac sphincter -  most medial intercostal margin of 6th/7th rib, or 7th/8th. Pyloric sphincter - 3 fingers up (for me, may change depending on finger sizes), from the umbilicus. Generally slight away from midline. Ilio-cecal valve – halfway between the right ASIS and umbilicus, from her palpate locally along this line and should hopefully find a small bump, as with all other junction/sphincters. Duodenal junction is on the line midclavicular line, left, to the umbilicus, 2-3cm on the line up from the umbilicus. Sphincter of Oddi is simiar to the duodenal junction but the right right sided.

We were told a theory in which fascia prefer to be able to move clockwise, so when finding these sphincters, we place a finger pad/tip on the sphincter and we test which way if likes to move. Treatment is same technique as examination but going to end range of clockwise rotation and adding tiny rhythmic clockwise impulses. Helps reduce the tension and the motility of the junctions to be increased.

Probably the most deceiving out of all techniques. When practicing on different people stomach sizes vary ridiculously.
Identification of the landmarks of the lesser curvature of the stomach. 
Treatment is similar to one of the diaphragm releases. Patient sitting, placing fingertips over the inferior border of the left ribs, patient slumps forward over the fingertips allowing to come on to the liver and have zero skin drag. Here what we do now is lean on our back leg and traction the stomach, to where it is less comfortable going to.

This technique was not shown but I had asked Valeria to show me it during class. I have always wanted to be able to work on the kidneys. People who are always stressed are sympathetically aroused and producing adrenalin constantly to manage through the day and keep them going. 
There were two ways. Firstly is to is to have patient supine, one broad contact on the back to the side depending which kidney your working on. Remember right kidney lower then the left. On hand on the top between ASIS and lower most rib, then slight compression and traction inferiorly. Second way is to find the lower pole of the kidney through palpation and fix down on it, then fix on to the diaphragm and get the patient to breath in, which tractions the kidney as the diaphragm raises the viscera.

To this day I have only used visceral once, although I have done a hell of a lot of diaphragm work, I had known these techniques and others before attending this class.
I would like to thank Valeria who is very passionate about Visceral work and Enda who is extremely clever.



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    May 2013