The Liver is connected to...the shoulder???

Let me start with an amazing experience I had during the Visceral Manipulation course. I had some work done on the on the connective tissue of the small intestine.  After baby number 2 I had a two and a half centimeter separation of my abdominals with a lot of sinking and sponginess around my belly button. It has stopped me from getting back on my pole and progressing with my yoga. BUT after this treatment the tissue along my tummy felt a lot firmer, its now easier to connect to my middle fibres of transverse abdominis AND the gap is now down to a centimeter and a half. Mind BLOWN!!

But now to the liver. This is just one example of how complex and intricate the body is.

The liver lives here…

Can you see it moving up and down with the breath on this MRI?

http://yogaphysicaltherapy.com/wp-content/uploads/2016/01/breathing_mri.gif

You can see it sits on right side of the body at around the level of the 7th to 10th ribs. The main artery entering the liver is the hepatic artery and the portal vein takes the blood away. It has a few different nerves that help it function including the vagus nerve and the phrenic nerve. When the liver is stuck or restricted within it’s fascia (the tissue that surrounds the liver) it can cause restrictions in places you would never think. These include:

• Neck pain at levels of C4/5

• Right shoulder blade

• Right shoulder joint

  • How you ask? Well the phrenic nerve that goes to the liver comes from the neck and has some nerve branches that got to the shoulder and the shoulder blade. When nerves enter the spinal cord, they all go into the same part so when you affect one nerve lower down, it affects the nerve higher up! (It’s a lot more complex than this…but hopefully you get it!)

• 7th -10th thoracic vertebrae (mid back) and ribs

  • The liver sits behind/in front of these structures and is attached to them with some connective tissue

 The liver is also associated with the following emotional/psychological responses

• The core of your personality

• Intense anguish

• Rage

• Strong fears

• Unbearable difficulties

• Depression

• Decrease in creativity.

I know this seems a bit airy fairy…Liver problems = anger? But remember the brain is a complex complex organ and the neural connections within the body that produce emotion are closely liked to connections that control muscles and sensations.

So maybe that longstanding pain in your shoulder neck or bad could be some referred pain or restriction coming from your liver!

What is Visceral Manipulation?

If you have read any of my other blogs, you will have realised by now:

1. I am addicted to learning EVERYTHING I can to help my patients

2. I keep finding new explanations and reasons as to why things happen in the body – and how all the systems are connected.

I reckon Visceral Manipulation is bridging the gap between the musculoskeletal system, the connective tissue, the nervous system and the organs. Are you seriously telling me the liver can cause headaches? Yes I am!

Let me start with the background of whom developed visceral manipulation.  A chap named Jean-Pierre Barral was born in France in the mid forties. He started his career as a physiotherapist and went on to study Osteopathy.  When he was working in a Lung Disease Hospital in his hometown, he had the opportunity to perform cadaver dissections (you know…looking inside bodies). He notice around the viscera (internal organs) was some extensive tissue thickenings and he realised these thickenings were altering the mechanical tensions on the surrounding tissues. This led Jean-Pierre into the theoretical and practical development of the visceral manipulation techniques that are taught in these courses.

The viscera are the internal organs of the body typically in the chest, thorax and abdomen.  The quote below is taken directly from my study guide and it states that

“Visceral manipulation is a manual therapy consisting of gentle specifically placed manual forces that encourage normal mobility tone and inherent tissue motion of the viscera there connective tissue and other areas of the body were physiologic motion has been impaired.”

Our bodies need movement to be healthy (motion is lotion!) so for an organ to be healthy and functional optimally it has to be able to move with the structures and tissues surrounding it. If the tissues lose the normal motion, they do their job inefficiently and may become stuck.  In a nutshell, Visceral Manipulation is assessing and treating the motion of an organ.

Musculoskeletal physiotherapists bread and butter has always been the muscular skeletal system including the skeleton, muscles, ligaments and tendons to name a few.  As time has gone on we have discovered that the body is more interconnected than what we first thought. There is connective tissue that runs through the entire body, through the different layers of tissue and surrounds every organ.  If you take away the skin, the muscles and the vascular system but left the connective tissue in place you would have the perfect outline of a human being.  Connective tissue must be able to move between the layers of tissue within the body. When there are restrictions present it can cause restrictions in other places of the body.

So why on earth would I want to be concerned with the organs you ask?  Well let me tell you.  Through his extensive research and clinical practice Jean-Pierre has discovered organs are connected to other structures and even emotional response is due to the extensive neural (nerve) network throughout the body. In the next blog, I will use the liver as an example of an organ can connect to the rest of the body.

This was a fantastic course. My class mates above were a cracker bunch of humans. I learnt so much from them as well as the course itself. I don’t say it often but I was blessed and privileged to meet them all. If you are a manual therapist, massage therapist, physio, osteopath – you need to get on one of these courses. It will change how you practice!

If you want to learn more about this amazing therapy, please check out https://www.barral.co.nz/ or send me an email and I will gladly share my experience.

My first experience with Visceral Manipulation

Last week, I was on a course all about Visceral Manipulation. When I first signed up for it, I was a bit nervous and to be honest a bit skeptical about what I was going to be learning about especially as I knew it had something to do with the organs.

An incredible and very brilliant physiotherapist that I used to work for Krissy Gunn (who owns Contact Physiotherapy in Methven) introduced me Visceral Manipulation several years ago. I saw Krissy back in October 2020 to learn a bit more about it and she took me through a session. I could not believe what was happening.  Krissy knows I have two kids, but I had never told her that I'd had two cesarean sections or had any issues with my bladder. Through what is called the “General Listening” she was able to pick up that there was something going on in my pelvis and started to do some work releasing around my bladder.  I had been to the toilet for a pee just before my appointment with Krissy so my bladder was pretty empty. After about 15 minutes of treatment I could feel my bladder fill suddenly and rushed to the toilet to pee (a lot!) again. I explained to Krissy after my first cesarean section I’d had a lot of scar tissue that stuck my bladder to my abdominal wall and this was only discovered when I had my second Cesarean section with my daughter. During pregnancy I didn't really need to pee any more than usual, which is odd considering during my first pregnancy I did have to go way more than usual.  During my second cesarean, the obstetrician spent an extra 30 minutes taking the scar tissue away from my bladder and I had a catheter in for an extra  day post-op to try and stop the scarred tissue from reforming.  For 6 months after the second surgery I didn’t have great sensation and after some visceral manipulation my sensation and urge to go is completely fine.

Then Krissy brought out the big guns (no pun intended haha). She done some treatment to the base of my neck using Craniosacral Therapy. I was still breastfeeding and my daughter always preferred one breast more than the other.  Her neck range of movement seemed fine but Krissy had me place my fingertips ever so gently on base of my daughter’s neck similar to where Krissy had her hands on my neck. When she started treatment, my neck and head would release and follow the same movement of my daughters head and after a few minutes it was all done It felt AMAZING, I was instantly tired and slept peacefully for the first time in months. My daughter breastfeed perfectly on both sides. Th biggest improvement for me was that my anxiety was a hell of a lot better for honestly the first time in years. So naturally I went  home, looked up all about this Visceral Manipulation and booked into my first course.

Krissy has done all of these courses several times to really hone and perfect her skills. She was an incredible and experienced physiotherapist anyway and adding these skills on top of her physiotherapy  expertise means she has ever more techniques for approaching dysfunction in the body.  I'm going to write a separate blog on what Visceral Manipulation is and all about my course, but below are some case studies from Krissy’s practice show you how awesome visceral manipulation is. 

Please please check out Krissy’s Website and Facebook Page to learn more about her and the amazing services she offers.

Case Studies from Krissy’s patients

• A 52 year old man had a ten year history of tension and discomfort in his stomach and such severe acid reflux he had taken up to three ant-acids a day without relief. He had sought treatment from various GP’s and practitioners over the years with no benefit. After working his sphincters he felt immediate relief and a further two sessions on his stomach and duodenum resolved them completely. He is looking forward to regaining the five kg he had lost as he couldn’t eat!

• It was a similar story with a 46 year old farmer who was struggling to do sit ups due to acid reflux. A two year problem which was steadily getting worse and was only temporarily relieved by medication. Stress and anxiety increased the symptoms. Treatment resolved the physical symptoms and correspondingly reduced the anxiety but I would expect that high stress situations will necessitate further sessions as the increased input from the neural system kicks off the cycle again. He will incorporate relaxation exercises- if he gets time!

• A 50 year old mother of three had ongoing pelvic pain following a hysterectomy and follow up surgeries for pelvic floor repair and release of adhesions. We don’t work directly over surgical sites however connective tissue runs all through the body so working other organs helped considerably with her pain, bladder control and ability to exercise.

•  A 16 year old student had been unable to participate in athletics and cross country due to shoulder pain while he was running. It was severe and disabling however his shoulder examination was unremarkable. The diaphragm shares neural connections with the neck and shoulder and working in this area and providing strengthening exercises resolved his problem. Now he is regretting it with no excuse to avoid training on those cold foggy mornings!

Piston Science by Julie Wiebe

My addiction to learning started here. This was a life changing moment in my pelvic health career.

For years I’ve known there was more to the “core" than the Transverse abdominis (lower abs) contraction we have all been taught. I’ve read the research but I just couldn’t put it all together and make sense of it. Then came along Julie Wiebb’s Piston Science.

Finally it all made sense. I remember standing in my kitchen emptying the dishwasher watching the videos and having a genuine light bulb moment. My understanding of how the core and pelvic floor worked together was explained in a way I completely understood AND it was all evidence based! SCORE!!

But the awesomeness didn’t stop there. The biggest part of this was my realisation that everything, like everything comes down to breathing. All body functions need it, and as I write these blogs you will see it pops up everywhere. If you cant breathe well it affects everything (even pooping!) This course taught me how to take my pelvic rehab off the treatment table, and away from basic exercises (like leg lifts, bridges and clams etc) and into the gym using functional movements. Finally all my woman’s health training, musculoskeletal and sports physio learning to date blended together and made perfect sense.

What I took to practice?

This education gave me the “bean lift” analogy that I now use with all my patients and cue in my fitness classes – MamaFit, Pilates, Yoga and even Pole Fitness.

“Exhale and lift your beans” should be my catchphrase!

Julie’s courses bridged the massive gap between treatment and exercise. They gave me the theory and confidence to take treatment to the next level incorporating exercise and real life movements. I go back through this course regularly to refresh my skills and remember hidden gems of treatment.

You can check out Julie Wiebe’s information and courses on her website…definitely worth the read!