MANUAL AND MASSAGE THERAPY

VISCERA - HAVE YOU GOT THE STOMACH

FOR A NEW CHALLENGE? By Stuart Robertson, MSc, BSc physiotherapy, BEd Hons

Cast your mind back to your therapist’s education. What were you taught about? Muscles, joints, ligaments, and nerves? How much time did you spend on the vis- cera? Does the musculoskeletal system exist in a vacuum? Bend forwards and back- wards, now side to side. Do your insides move or do they remain rigid? If your internal organs didn’t move then you wouldn’t move! How many of your clients have digestive problems, respiratory problems, gynaecological/menstrual prob- lems, cardiac or vascular problems? This article looks briefly at why the viscera deserve attention from therapists.

THE VISCERA Why should we be interested? The musculoskeletal system does not exist in a vacuum. It functions alongside and is inextricably integrated with all the other systems that make up the human organ- ism. Williams et al (1) recognised this relationship in embryological develop- ment, ‘it must never be overlooked that the analysis of a whole organism into divi- sions of individual systems.... is largely a product of the sequential nature of human perception. Not only do the several sys- tems into which we divide the organism (embryo) develop simultaneously, they also interact and modify each other.’

Various models of movement dysfunction have identified the concept of ‘give and restriction,’ if there is restriction in one part of a kinetic chain then there must be give at another point or points, ie. at the point of least resistance. This concept holds true not just for the myofascial sys- tem but the viscerofascial system, and other systems too. The ideas of cause and effect, action and reaction have been

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around for centuries, unfortunately many medical models of intervention have failed to address the interactions and integra- tion of the various systems. The medical models have focused solely on one or two systems to the exclusion of all the others and as a consequence have dealt with merely the effect or reaction.

HOW CAN THE VISCERA INFLUENCE SOMATIC STRUCTURES? The internal organs do not just flap around in the breeze. The purpose of this article is to illustrate the connectivity and continuity of the myofascial and viscero- fascial systems both from a mechanical and neuroanatomical point of view. It is not intended to be all encompassing, nor does intend to supply all the answers, in truth it will provide more questions than answers. The ultimate aim is to challenge the reader to review their clinical ratio- nale in the assessment and treatment of musculoskeletal dysfunction and to incor- porate reasoning based on the several sys- tems of the body as opposed to just the neuromusculoskeletal system.

Just as normal healthy joint articular sur- faces are able to glide freely on one another so too are the interfaces between the viscera, and the viscera and the mus- culoskeletal system. The fascial envelopes that encase either the muscular or viscer- al systems form these gliding articular interfaces. A restriction, like in any kinet- ic chain, will ultimately lead to a change elsewhere. Abnormal points of tension, either compressive or tensile within the system force the body to move in different ways, following the path of least resis- tance, eventually leading to poor move- ment patterns, muscle imbalances, joint irritation and eventually pain.

SOME INTERNAL ORGANS So if internal organs don’t just flap around in the breeze, where do they attach to?

The kidney The kidney is a retroperitoneal organ (ie. it lies behind the peritoneum forming the posterior abdominal wall). Each kidney is surrounded by renal fascia, the posterior layer of which attaches to the fascia enveloping psoas (muscle in the groin) at

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