OMM: Practical Visceral Treatment

00:00 Visceral OMM. So for visceral OMM what we want to do is to apply osteopathic principles to treating the internal organs and so pretty much what you want to do is to first try to sense and palpate the organs that you want to address. Usually you could do a general screening. So first I'm just going to put my hand for the abdomen just, you know in the middle of the abdomen, trying to get a sense if there's any fascial pull, a region that is more inflamed or more restricted, you might be able to get a sense of that. You could also look more specifically at the specific organs if you wanted to get a sense of the spleen or the stomach or the liver. The key really is to understand the anatomy and the physiology of the organ itself and to use that knowledge to utilize layer palpation to get a sense of the organ and so if we were to try to sense the liver, I'm going to place one hand underneath the costal margin here and kind of go through the different layers looking at the anatomy, the skin, the adipose tissue, the muscles and then going deeper to the liver itself. If you have the picture of the anatomy as you're going through and varying your depth of pressure, that will help you sense the organ better. I could also place my hand underneath and having that anterior-posterior contact might help me with sensing the organ a little bit better. Once you are contacting the organ, you get a sense of particular motion, perhaps a restriction of motion whether or not there is a restriction and if there is a restriction then you could try to take it towards the freedom for an indirect treatment or you could take it towards the barrier for a direct treatment. You're going to hold it there until you feel a shift or change and then come back and then recheck the organ and you could also recheck for any fascial pulse and see if the technique helped to resolve the problem. Abdominal ganglion inhibition. So remember that abdominal ganglion supplies sympathetic innervation to the GI tract. We have our celiac ganglion, which is just underneath the xiphoid. We have the inferior mesenteric, which is just right above the umbilicus and your superior mesenteric is going to be in between them. And so we could provide some gentle inhibitory pressure to try to normalize the sympathetics going to the gut. So to perform the technique itself, what we are going to do is we are going to contact the celiac ganglion with my 3rd and 4th fingers, I like to put my pointer fingers over the superior mesenteric and my 3rd and 4th fingers on the other hand over the inferior mesenteric. So we want to keep our fingers relatively straight, the wrist relatively wrist, and we're going to use our finger pads to slowly sink in. So when the patient inhales, we're going to resist and on exhalation we're going to let our fingers kind of sink in deeper. If you feel any sort of pulsatile mass, you want to make sure that it's not a triple A aortic aneurysm, which will be a contraindication for this technique. So, I'm just slowly following with each exhalation, getting a sense of the tissue tension here.

03:07 Sometimes you may feel a little bit of a pulsation, that means that you're close to the aorta which is alright. Because the ganglion lie in front of the aorta, so sometimes you might feel a little bit of pulsation and then a softening of the tissue and when you feel that softening of the tissue you're going to slowly bring your fingers out and then reassess to see if there are any tissue texture changes and hopefully that will help with addressing the sympathetic innervation to the gut. Mesenteric lift. So we utilize the mesenteric lift to try to relieve any sort of strain that might be on the mesentery. There might be some restrictions that may contribute to ileus, constipation or other GI complaints. And so what we want to do is to try to lift the mesentery and remember the mesentery is attached to the posterior wall at a diagonal and because it's attached to the diagonal we want to bring everything towards its attachment so we're going to try to bring everything up towards the right upper quadrant. So in order to try to engage the mesentery, you want to relieve the tension in the abdomen. So we want to have the patient bend their knees up and just rest their feet on the table. This will decrease the amount of tension on the abdominal muscle so that we could try to scoop the mesentery a little bit more. I'm going to start with the left lower quadrant, I'm going to find the ASIS, get my fingers right above the ASIS and I will let my fingers kind of scoop underneath it and dive in a little bit deeper into the abdomen.

04:37 Once I feel like I have good contact there, I'm going to provide a lift towards the right upper quadrant. This will help to unwind some of the mesentery that might be restricted. If I wanted to promote more lymphatic and circulatory flow with my top hand, I could provide a little bit of an oscillation and this oscillation will just kind of help to loosen things up and get things moving a little bit more. Once I feel a little bit of a fascial release, less tension here, I could release that and address the right lower quadrant and so find the ASIS again. Let your fingers come underneath the mesentery and then you're going to lift up towards the right upper quadrant and again you could use your top hand to provide a little bit of a lymphatic pump and once you feel a little bit of release, you come back and then reassess to see if there is decreased drag in the mesentery and to see if the technique was successful. So the liver pump could be performed to try to promote increased blood circulation and to try to improve the function of the liver itself. So, we are going to to contact the lower ribs on the right side here and gently place our fingers over the region of the liver and then create a little bit of a gentle oscillatory pump and this is to try to encourage drainage, motion and movement of circulation or surrounding the liver and after you do this pump for 30 seconds to a minute, you could come back and double check. Make sure prior to performing the technique, you make sure that there are no contraindications. The patient does not have enlarged liver or any other concerns that may be a contraindication for this technique.

06:24 Splenic pump. We utilize a splenic pump to try to boost immunity and to help demarginalize those immune cells and get them into circulation. So for the splenic pump, we will get our hands underneath the lower rib cage and underneath the left costal margin and then provide a little bit of a gentle oscillatory force. This oscillation should be gentle, you should make sure that there are no contraindications before performing this technique, you want to make sure the patient doesn't have mono or any other potential causes for having an enlarged spleen and so after performing the oscillation 30 seconds to a minute you come back and then reassess to make sure that the area feels a little bit less tense. Colonic stimulation. So we could utilize colonic stimulation to help patients especially with constipation. Remember our GI tract is very mechanical, peristalsis really is based on when the GI tract receives a stretch or bolus of food that stimulates the lumen to contract and so what we're doing here is to provide a mechanical stimulation to try to improve colonic action. So first we're going to start in the right lower quadrant. I'm going to utilize 2 hands and gently apply a little bit of pressure down into the colon and then you could slowly follow the tract of the colon coming up until you reached the transverse colon and then from the transverse colon you come across and then all the way to the descending colon and so this gentle pressure going around the colon hopefully will help stimulate and improve GI tract mobility.