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Visceral Manipulation (VM)

The Basics

Patients may complain of diffuse deep pain that may relate to referral patterns. Others may have musculoskeletal problems that have failed traditional PT, or reached a plateau with traditional PT techniques. Pelvic pain patients who have failed medication treatment, demonstrate clear colonoscopy, endoscopy. Chronic pain and chronic inflammatory syndrome patients may also benefit from visceral manipulation.

VM is a manual therapy consisting of gentle, specifically placed manual forces that encourage normal mobility, tone and inherent tissue motion of the viscera, their connective tissue and other areas of the body where physiologic motion has been impaired.

 

Development

Jean Pierre Barral, D.O. began his career as a physiotherapist in Grenoble under Dr. Arnaud, a lung specialist and master of cadaver dissection. He performed extensive cadaver dissections on former patients and began to recognize extensive tissue thickening around the viscera. He realized this was contributing to altered mechanical tension of surrounding tissues.

 

Stomach

Emotional/psychological attributes: The stomach represents the social, professional self—the image we give or want to give. More often in men than women.

Innervations:

Sympathetic: Cord level T6-10; through greater splanchnic nerve to celiac plexus

Parasympathetic: Vagus nerve

Sensory: Phrenic nerve L side C4-6 approx.

Referral pattern: Anterior below xiphoid, posterior midline from approx. from T6-T11 (pic)

Associated skeletal restrictionsLeft cervical vertebrae, L SCJ, anteriorly L 7th rib, L SIJ, GHJ periarthritis, C7/T1 and 1st rib (more severe cases)

 

Duodenum (4 parts) 

Emotional/psychological attributes: Similar to that of the stomach but more intense situation, as in long term social or professional frustration .

Innervations:

Sympathetic: Cord level T8-9 through greater splanchnic nerve to celiac plexus to superior mesenteric plexus (image)

Parasympathetic: Vagus nerve

Associated musculoskeletal restrictions: T12-L1, flexure has direct attachment to L1 (more often on R), R 6th costovertebral articulation, unresolved quadratus or psoas dysfunction, mechanical injury to D4 (whiplash) (lig of trietz)

 

Jejunum (sm. intestine)

Emotional/psychological attributes: The organ that joins the professional points of view with family life. The intestines are affected by long term somatization, frustration and stress. Tend to be overprotective of family, talks in fast manner, may exhibit hypochondriacal behavior. More often in women than men.  

Innervations:

Sympathetic: Cord level T5-11, particularly T9-10, greater and lesser splanchnic nerves through celiac ganglia and superior mesenteric ganglia

Parasympathetic: Vagus nerve

Referral pattern: Centrally above umbilicus

Associated musculoskeletal restrictions: T10-12, acute or chronic LBP (mes root), sciatica (L side due to venous circulation problems), lower abdominal distension, low energy 2hrs after eating, dreams of being chased

 

Colon (lrg. intestine)

Emotional/psychological attributes: The emotion is similar to small intestine, more often female, overprotective of family

Innervations:

Sympathetic, (cecum, appendix, ascending colon and R ⅔ of TV colon): Cord level T11-L1 through splanchnic nerves to celiac and superior mesenteric plexuses

Sympathetic, (left ⅓ of TV colon, descending colon and sigmoid colon): Cord levels L1-2 to inferior mesenteric plexus and superior and inferior hypogastric plexuses

Parasympathetic: Cord level S2-4 through pelvic splanchnic nerves to superior hypogastric plexus

Referral pattern: Midline of lower abdomen, below umbilicus

Associated musculoskeletal restrictions: Acute or chronic LBP, L sciatica (venous circulation), R sciatica (cecum), varicose veins on L, joint pain in lower limbs, GHJ periarthritis

 

Liver

Emotional/psychological attributes: The liver is the organ of identification of one’s deep self, the root of one’s personality. The liver reacts to intense anguish, cyclic rage, strong fears and or unbearable difficulties.

Innervations:

Sympathetic: Cord level T7-9; through greater splanchnic nerve to celiac plexus to hepatic plexus

Parasympathetic: Vagus nerve

Sensory: Afferent impulses carried through the phrenic nerve C4-5

Referral pattern: Left shoulder & left neck

Associated musculoskeletal restrictions: C4-5 on R, R scapula, R GHJ, R cervical/brachial plexus, T7-10, cranial base restrictions on R, frontonasal restrictions on R, L sciatica (venous hepatic origin), R sciatica (R hepatic fascia), R parietal/temporal and sphenoid bones, hormone imbalance

 

Gallbladder

Emotional/psychological attributes: The gallbladder is the organ of transient and superficial anger

Innervations:

Sympathetic: Cord level T7-9; through greater splanchnic nerve to celiac plexus to hepatic plexus on to cystic plexus

Parasympathetic: Vagus nerve

Sensory: Afferent impulses from phrenic nerve C4-5 cord level

Referral pattern: Right middle quadrant of abdomen

Associated musculoskeletal restrictions:  C4-6 on L (phrenic n.), C4 transverse process, T7-9 right costovertebral articulations, L frontotemporal region (HA symptoms), RUQ pain esp after heavy meal, N/V, pale stools, morning fatigue (stones can back up into pancreas, pt may demo pancreas sx’s)

 

Pancreas

Emotional/psychological attributes: Pancreas relates to grief of deep personal origin. The pancreas can also be linked to stress for which the individual has great difficulty integrating or compensating.

Innervations:

Sympathetic: Cord level T5-9, greater splanchnic nerves; celiac plexus

Parasympathetic: Vagus nerve

Referral pattern: Left of midline, below xiphoid process

Associated musculoskeletal restrictions: T9, Back pain T9-11 on L, L SIJ, L GHJ, pain at insertion of levator scap on L (can be attributed to an irritation of the phrenic nerve. This point is symmetrically opposite that of the gallbladder on the right scapula

 

Kidneys

Emotional/psychological attributes: L kidney is the organ that relates to our genetic roots, our roots of “being.” R kidney is associated with frustrated, intense anger. It relates to events too emotional for the liver. Low libido in women, impotence in men

Innervations:

Sympathetic: Cord level T10-12; through splanchnic nerves to renal plexus; formed by celiac ganglion and plexus, aorticorenal ganglion and aortic plexus

Parasympathetic: Vagus nerve

Referral pattern: Across the L1- L5 low back region, down lateral thighs and into groin

Associated musculoskeletal restrictions: Vertebral restrictions of T7, T11-12 and their associated ribs, vertebral restrictions at L1-4 (kidneys ride the rail of the psoas), dysfunction of lower limb (tibiofemoral jt, patellofemoral, navicular, 1st cuneiform, 5th metatarsal), SIJ, GHJ, L kidney can restrict the coccyx, L 1st rib and cervical spine (due to relationship with phrenic nerve).

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Tennis Elbow

Lateral Epicondylitis, more commonly known as Tennis Elbow, is the weakening of the extensor carpi radials brevis, causing microscopic tears in the tendon.  This in turn results in inflammation and pain. This is caused by the overuse of the elbow, especially when repeating the same motion, such as what happens when playing tennis, hence the name. However, Tennis Elbow does not just affect tennis players and extends beyond athletes too. People who have physical jobs such plumbers and painters, are also at risk. Those most effected between the ages of 30 to 50, and even more at risk if they are active.

 

Tennis elbow symptoms can come on gradually causing pain or burning on the outer part of the elbow, and weak grip strength. If exhibiting any of these symptoms it is best to seek medical attention, a doctor can use various methods to make a diagnosis including X-ray and MRI.  Treatments for Tennis Elbow can range from non-surgical options (including physical therapy) to surgery (which can come with more risks).

To learn more about Tennis Elbow visit: http://orthoinfo.aaos.org/topic.cfm?topic=a00068

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ITB Syndrome

Many people who exercise (especially runners) suffer from sore iliotibial bands (ITB).  ITB is a band that connects from the outside of the knee to the outside of the knee to the outside of the pelvis, running over the hip and knee joints.  When the leg swings the ITB can move from behind the femur to in front of it causing the rubbing of the ITB on the femoral epicondyle  This in turn can cause inflammation which combined with repeated flexion and extension is considered to be a cause of ITB Syndrome.

 

ITB Syndrome can make it difficult and painfully to not only run but to walk and carry on with daily activities.  Symptoms tend to be worse when walking or running downhill.  Many times symptoms don’t present themselves unless it is during running, so unfortunately many those suffering from ITB Syndrome, just stop running and don’t consult a doctor.  Those effected most by ITB Syndrome are inexperienced runners, including runner training for competitions such as marathons.

 

Ice and ant-immflatories can help ease the symptoms of ITB Syndrome, and it is best to consult a doctor if symptoms persist.

To learn more about ITB Syndrome go to: https://breakingmuscle.com/learn/how-to-recognize-fix-and-prevent-itb-syndrome

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Frozen Shoulder

Frozen shoulder can be a debilitating problem that effects both men and women, although mostly women, from ages 40 to 60.  Frozen shoulder, which is a common name for adhesive capsulitis, is when the tissues in your shoulder joint become thicker and tighter and not leaving the shoulder enough space to rotate properly.  Not only does this cause pain, it also limits the movement in the shoulder.  If the problem is severe enough it can limit your daily activities.

Frozen shoulder can have several causes.  Diabetes, a weakened immune system, and hormonal imbalances make you more prone to joint inflammation so those affected are susceptible.  Long periods of inactivity which could be from illness or injury can cause inflammation and adhesion, and in some cases scar tissue which limits the range of motion.

The best chances of speeding up recovery of frozen shoulder are: physical therapy, home care, medication, and surgery.  Of these options physical therapy is the most common, and its goal is to stretch the join and regain motion.

To learn more about the causes, symptoms, and treatments for frozen shoulder, visit: http://www.healthline.com/health/frozen-shoulder#Treatments6

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Sleep & Back Pain

Back pain and sleep problems are closely related and in fact the two can create a vicious cycle.  Back pain can make it difficult to sleep, and certain sleeping positions can aggravate back pain. In fact sleep deprivation can have a variety of effects,  according to Santhosh Thomas, DO  a spine specialist with the Cleveland Clinic and associate medical director of the Richard E. Jacobs Medical Center in Ohio says: “Sleep deprivation is known to affect mood and functional ability and negatively impacts perception of pain.”

And in turn, pain can cause lighter sleep and more frequent waking up in the night. A study published in the Asian Spine Journal in 2014, included 3,100 people and found that 32% who had low back pain suffered from poor sleep due to the pain, waking up at least twice a night.

There are ways to disrupt this cycle, and on of those ways is to change sleep position.  For example sleeping on your stomach can add strain to your back, however putting a pillow under your pelvis and lower abdomen to was the strain.  When sleeping on you back, place a pillow under you knees to maintain the natural curve in your spine.  When sleeping on your side, bring your legs slightly up towards your chest and sleep with a pillow between your legs.

To learn more about the relationship between sleep deprivation and back pain visit: http://www.everydayhealth.com/news/switch-sleep-positions-ease-back-pain/

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How to Recognize and Treat Limb Length Discrepancy

Limb Length Discrepancy (LLD) is a very common problem, yet not a widely discussed one. The average difference in length is only about 1.1 cm, and can usually be compensated for.  However, these discrepancies can cause problems and be symptomatic when out under stress, such as running. Larger discrepancies can cause a variety of problems throughout the body.

 

LLD can be broken into three categories:

Structural: Difference in length of the tibia or femur, which maybe be congenital, post-surgery, or post trauma etiology.

Functional: Due to an asymmetrical foot or limb function, which may have occurred from a variety of asymmetrical musculoskeletal findings.

Environmental:  Caused by the unevenness created by walking or running on crowned road surfaces, banked running tracks or along the beach. Excessive asymmetrical shoe wear may also create an environmental LLD.

 

To learn more about LLD and it’s treatments go to: http://www.podiatrytoday.com/keys-recognizing-and-treating-limb-length-discrepancy

 

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The probability of spontaneous regression of lumbar herniated disc: a systematic review.

Clin Rehabil. 2014 Jul 9. pii: 0269215514540919. [Epub ahead of print]

The probability of spontaneous regression of lumbar herniated disc: a systematic review.

Abstract

OBJECTIVE:

To determine the probability of spontaneous disc regression among each type of lumbar herniated disc, using a systematic review.

DATA SOURCES:

Medline, Cochrane Library, CINAHL, and Web of Science were searched using key words for relevant original articles published before March 2014. Articles were limited to those published in English and human studies.

REVIEW METHODS:

Articles had to: (1) include patients with lumbar disc herniation treated conservatively; (2) have at least two imaging evaluations of the lumbar spine; and (3) exclude patients with prior lumbar surgery, spinal infections, tumors, spondylolisthesis, or spinal stenosis. Two reviewers independently extracted study details and findings. Thirty-one studies met the inclusion criteria. Furthermore, if the classification of herniation matched the recommended classification of the combined Task Forces, the data were used for combined analysis of the probability of disc regression of each type. Nine studies were applicable for probability calculation.

RESULTS:

The rate of spontaneous regression was found to be 96% for disc sequestration, 70% for disc extrusion, 41% for disc protrusion, and 13% for disc bulging. The rate of complete resolution of disc herniation was 43% for sequestrated discs and 15% for extruded discs.

CONCLUSIONS:

Spontaneous regression of herniated disc tissue can occur, and can completely resolve after conservative treatment. Patients with disc extrusion and sequestration had a significantly higher possibility of having spontaneous regression than did those with bulging or protruding discs. Disc sequestration had a significantly higher rate of complete regression than did disc extrusion.

© The Author(s) 2014.

KEYWORDS:

Low back pain; disc herniation; probability; regression of hernation; systematic review

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Running: Pros and cons of running on a treadmill

treadmill       Whenever you get on a treadmill, you feel as if you are not running quite right as if  you are running slower, and that running motion isn’t the same as when you are out on the road.

So is running on a treadmill bad for you?

 

 

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Knee pain: surgery or physical therapy?

knee painAbout 80 percent of tears develop from wear and aging, and some researchers believe surgery in those cases should be significantly limited. Studies also found that patients undergoing surgery for knee pain did no better than those having physical therapy and taking medication.

A new study in The New England Journal of Medicine reports that a popular surgical procedure worked no better than fake operations in helping people with one type of common knee problem, suggesting that thousands of people may be undergoing unnecessary surgery.

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Chewing Gum and Migraine Headaches in Teens

gun and headache  Does Chewing Gum can cause Migraine Headaches in Teens?

    TAU (Tel Aviv University) study finds that 87 percent of teens who quit chewing experience significant relief .

   Teenagers are notorious for chewing a lot of gum. The lip smacking, bubble popping, discarded gum stuck to the sole give teachers and parents a headache.

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