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Visceral Manipulation Course Experience and Review

4/11/2017

1 Comment

 
This past weekend I went to a course I previously never would have though I would attend: Visceral Manipulation 1 by the Barral Institute. When I first got into PT, my mind was very biomechanical. If there wasn't a mechanical or evidence-supported explanation for how something worked, I didn't think it was worth learning. The more I've practiced and read research developments on pain science I have come to understand that not only does the mind and nervous system play an incredible role in treatment response, but that there is so much out there we don't understand at all.

About 2 years ago, my wife was suffering from some pelvic/abdominal pain following her c-section that several doctors and PT's were unable to treat or determine the source. It was at that time she sought a visceral therapist and was back to playing soccer nearly pain-free after 3 sessions. This past summer I had developed the sensation of a lump in my throat (which was later diagnosed as GERD) that at one point was so bad I couldn't breathe while laying supine. It was about 90% improved after just a couple sessions of visceral treatment. These experiences had peaked my interest in at least learning more about the style of treatment.
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On to the course. Throughout PT school, we are taught all about muscles, bones, ligaments, joints, nerves, etc., but the abdominal cavity is mostly ignored. Sure, we learn about organ function, pathology, and differential diagnosis, but how organs move is never even thought of. While there are certainly concepts that were explained that I am having a hard time wrapping my head around (motility, "listening" as an assessment, and mobilizing organs through ribs), the discussion on affecting mechanoreceptors and proprioceptors through the visceral manipulation is much more acceptable based on current research regarding manual therapy.

The biggest "sell" to me was the within class changes that occurred. Yes, we felt improved organ mobility whenever we were finished with a technique, but the bigger changes were seen elsewhere. One clinician with a significant Thomas Test deficit had almost normal motion following mobilization of her cecum. I had a drastic improvement in SLR mobility following mobilization of my sigmoid colon. We saw improved shoulder elevation mobility following liver mobilization. One clinician who had a history of rectocele and cystocele had recreation of labial and rectal pain following a stomach mobilization.

One of the aspects of research that is currently being developed by the instructor Brandi Kirk PT, PRPC, CVTP is regarding diastasis recti. She recently presented a case series poster at CSM 2017 on treating the disorder with manipulation of the mesenteric loop, root, and mesentery. In class, one of the clinicians presented with a diastasis recti of 4 finger-widths. After doing just one of the 3 treatments, the next day she had almost complete resolution of the disorder. The research has thus far shown retention a year later with no activity restrictions following discharge. Treatments like this could potentially help many to avoid surgeries. Thankfully the group at Barral Institute is working on developing higher level studies to show the potential benefits of visceral manipulation.
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Overall, I would say the class is an absolute must-take for every clinician. Visceral manipulation tends to be thought of more as a joke than an actual treatment style, unfortunately. In taking this course, not only am I better able to understand the proposed theory, but also how the successful treatments may be explained by current evidence. My only complaints about the class are that evidence hasn't caught up yet (and they are working on this as we speak!) and that not enough time was given to practice each technique 10 or 20 times (we only practiced each technique once or twice due to how many techniques there were and the complexity of them). Aside from that, the potential for this practice is incredible and changes can not only be seen within treatment but continue for weeks afterwards. While I'm not confident in applying these skills today, with practice, I look forward in implementing this treatment style into my practice and experimenting with further potential. Let me know if you have any specific questions about my experience. I highly recommend this class, as I plan on taking additional visceral manipulation classes in the future.

-Dr. Chris Fox, PT, DPT, OCS

If you are looking to improve upon your clinical skills, orthopaedic knowledge and clinical decision making, consider joining OPTIM's COMT program. With OPTIM, you can expect a residency-like learning experience without breaking the bank, all while learning from highly skilled physical therapists. Check out optimfellowship.com for more information!
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1 Comment
Liz
7/25/2020 05:59:01 pm

Hello Chris,

Thank you for providing such great information. It's been 3 years since you wrote the post. Did you continue taking VM classes? Also, was the experience you wrote about here, visceral manipulation 1 class? I was looking for info because I plan to take VM 1 iin Sept, followed by VM 2 in the near future. I don't know how long they recommend you wait in between classes - will find out Monday. I would then take other classes such as VM lymphatic . Have you taken that class? Have you incorporated VM into your PT practice? Thanks for your time!

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  • Home
  • About Us
  • TSPT Academy
  • Resources
    • Newsletter
    • Orthopedic Blog
    • Featured Articles
    • Research Articles
    • Residency Corner
  • Special Tests
    • Cervical Spine >
      • Alar Ligament Test
      • Bakody's Sign
      • Cervical Distraction Test
      • Cervical Rotation Lateral Flexion Test
      • Craniocervical Flexion Test (CCFT)
      • Deep Neck Flexor Endurance Test
      • Posterior-Anterior Segmental Mobility
      • Segmental Mobility
      • Sharp-Purser Test
      • Spurling's Maneuver
      • Transverse Ligament Test
      • ULNT - Median
      • ULNT - Radial
      • ULNT - Ulnar
      • Vertebral Artery Test
    • Thoracic Spine >
      • Adam's Forward Bend Test
      • Passive Neck Flexion Test
      • Thoracic Compression Test
      • Thoracic Distraction Test
      • Thoracic Foraminal Closure Test
    • Lumbar Spine/Sacroiliac Joint >
      • Active Sit-Up Test
      • Alternate Gillet Test
      • Crossed Straight Leg Raise Test
      • Extensor Endurance Test
      • FABER Test
      • Fortin's Sign
      • Gaenslen Test
      • Gillet Test
      • Gower's Sign
      • Lumbar Quadrant Test
      • POSH Test
      • Posteroanterior Mobility
      • Prone Knee Bend Test
      • Prone Instability Test
      • Resisted Abduction Test
      • Sacral Clearing Test
      • Seated Forward Flexion Test
      • SIJ Compression/Distraction Test
      • Slump Test
      • Sphinx Test
      • Spine Rotators & Multifidus Test
      • Squish Test
      • Standing Forward Flexion Test
      • Straight Leg Raise Test
      • Supine to Long Sit Test
    • Shoulder >
      • Active Compression Test
      • Anterior Apprehension
      • Biceps Load Test II
      • Drop Arm Sign
      • External Rotation Lag Sign
      • Hawkins-Kennedy Impingement Sign
      • Horizontal Adduction Test
      • Internal Rotation Lag Sign
      • Jobe Test
      • Ludington's Test
      • Neer Test
      • Painful Arc Sign
      • Pronated Load Test
      • Resisted Supination External Rotation Test
      • Speed's Test
      • Posterior Apprehension
      • Sulcus Sign
      • Thoracic Outlet Tests >
        • Adson's Test
        • Costoclavicular Brace
        • Hyperabduction Test
        • Roos (EAST)
      • Yergason's Test
    • Elbow >
      • Biceps Squeeze Test
      • Chair Sign
      • Cozen's Test
      • Elbow Extension Test
      • Medial Epicondylalgia Test
      • Mill's Test
      • Moving Valgus Stress Test
      • Push-up Sign
      • Ulnar Nerve Compression Test
      • Valgus Stress Test
      • Varus Stress Test
    • Wrist/Hand >
      • Allen's Test
      • Carpal Compression Test
      • Finkelstein Test
      • Phalen's Test
      • Reverse Phalen's Test
    • Hip >
      • Craig's Test
      • Dial Test
      • FABER Test
      • FAIR Test
      • Fitzgerald's Test
      • Hip Quadrant Test
      • Hop Test
      • Labral Anterior Impingement Test
      • Labral Posterior Impingement Test
      • Long-Axis Femoral Distraction Test
      • Noble Compression Test
      • Percussion Test
      • Sign of the Buttock
      • Trendelenburg Test
    • Knee >
      • Anterior Drawer Test
      • Dial Test (Tibial Rotation Test)
      • Joint Line Tenderness
      • Lachman Test
      • McMurray Test
      • Noble Compression Test
      • Pivot-Shift Test
      • Posterior Drawer Test
      • Posterior Sag Sign
      • Quad Active Test
      • Thessaly Test
      • Valgus Stress Test
      • Varus Stress Test
    • Foot/Ankle >
      • Anterior Drawer
      • Calf Squeeze Test
      • External Rotation Test
      • Fracture Screening Tests
      • Impingement Sign
      • Navicular Drop Test
      • Squeeze Test
      • Talar Tilt
      • Tarsal Tunnel Syndrome Test
      • Test for Interdigital Neuroma
      • Windlass Test