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FASCIAL AND VISCERAL MANIPULATION
ROLE IN INTERNAL DYSFUNCTION AND VISCEROSOMATIC PAIN
KANNABIRAN BHOJAN
CONSULTANT ORTHOPEDIC MANIPULATIVE SPORTS PHYSIOTHERAPIST
PROFESSOR –RVS COLLEGE OF PHYSIOTHERAPY
COIMBATORE
MAKE FEATURES FIT
"The manipulative physiotherapist will tell the
patient that the problem is like a jigsaw puzzle, and
it is her job to make 'all the pieces fit'. She needs his
help to do this, and it is her ability to communicate
that makes the difference between her being
successful in helping him with his problem or not"
(Maitland, Hengeveld, Banks, & English, 2005, p.
57).

25-Aug-18
referral patterns for visceral pain
NON-DISRUPTIVE
SYNDROMES
• No associated
mechanism of injury,
no definite trigger or
clear explanation for
the pain.
• Poorly localised pain.
• Non-mechanical
behaviour.

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DYSFUNCTION SYNDROME
Accurate diagnosis best
done by skilled
palpation
Motion segment
dysfunction
Adherent soft tissues and
adhesions
INTERNAL DYSFUNCTION

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REFERRED PAIN IN INTERNAL
DYSFUNCTION
SOMATOVISCERAL INTERACTION

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VISCEROSOMATIC INTERACTION

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VISCEROSOMATIC PAIN- A
PHYSIOTHERAPIST PERSPECTIVE

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Catenary in human body
CATENARIES AND DISTAL TENSORS

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APPLIED TO HUMAN BODY
PIVOT POINTS

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VISCEROSOMATIC PAIN
THOUGHT PROCESS
PHYSIOTHERAPIST AND EXTENDED SCOPE
IN PHYSIOTHERAPY PRACTISE
NEED FOR CHADUE TO
INCREASING RESPONSIBILITY

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VISCERAL CONNECTIONS
Pathology of Motion
Visceral Restrictions
Articular Restrictions (Adhesions and
Fixations)
Ligamentous Laxity (Ptoses)
Muscular Restrictions (Viscerospas
Problems of Rhythm
The fibrous net & visceral
connections
connective tissue net
extends into the dorsal
and ventral cavities as
well, to surround and
invest the organs.

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FASCIAL DYSFUNCTION AND
DISEASE
ADAPTATION TO OVERUSE ,DISUSE ,MISUSE & TRAUMA
DENSIFICATION AND LOSS OF FASCIAL SLIDING
FUNCTION
Fascial restrictions can apply excessive
pressure to tissues causing a variety of
symptoms ; pain, headaches or restriction of
motion.
This restrictions affect our flexibility and joint
stability, and sporting/ballistic movements of
the human body. How far we can hurl a stone,
how high we can jump, and how long we can
run depend not only on the contraction of our
muscle fibers, but also to a large degree on
how well the elastic recoil properties of our
fascial network are supporting these often

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The structure that binds
movement continuum
Fascia, of course, surrounds and embeds the viscera, and
the organs are simply a part of the movement continuum
within the body cavities.
The mesenteries, peritoneal ligaments and muscle walls of
the organs have various receptors that are sensitive to a
range of stimuli, both physical and chemical Grundy D. What
activates visceral afferents? Gut2004;53(Suppl 2):ii5-8.
Tension monitors
vitality of organs
fascial attachments of the organs can act as
tension monitors, detecting the amount and
possibly direction of forces acting upon the
organs. Grundy D. Speculations on the structure/function
relationship for vagal and splanchnic afferent endings supplying
the gastrointestinal tract. J Auton Nervous System 1988;22:175-80.

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3 DIMENSIONAL PRECEPTION
incorporate these concepts into their
general biomechanical assessment of
the body and these theories partly
underpin their approach to three-
dimensional movement disorders,
where asymptomatic visceral
restrictions are related to
musculoskeletal system restrictions,
strains and symptoms.
BALANCE WITH VESTIBULAR SYSTEM
AND THE FASCIAL CONNECTION
Factors that stimulate these receptors are not
completely understood but it is being
recognized that they might play a role in
whole-body balance mechanisms through
potential links with the vestibular system. von
Gierke HE, Parker DE. Differences in otolith and abdominal
viscera graviceptor dynamics: implications for motion sickness
and perceived body position. Aviat Space Environ Med
1994;65(8):747-51.

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VISCERO-PTOSIS
Consider visceral function is related to
efficient support, good circulation and
drainage, and efficient movement patterns.
In such circumstances visceral physiology
should be optimum. Poor posture affects the
integrity of the body cavity balance, leads to
muscular imbalance, relaxation in some areas
and tension in others. This affects visceral
support and often leads to viscero-ptosis.
The weight of the abdominal cavity is
normally supported through the pubis and is
spread over the ‘dome’ of the pelvic organs.
VISCERO-PTOSIS
The viscera literally support themselves and
are effectively arranged in layers, supported
by adjacent organs and by their mesenteric
attachments.
Any change in cavity dynamics or poor
posture will lead to altered visceral position,
and possibly viscero-ptosis. Viscero-ptosis can
be clinically relevant in a variety of situations.

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The abdominal sphincters
Sphincters are transitional areas from one organ to another that
regulate flow of the digestive content
They are highly innervated and have reflexogenic properties
,responding rapidly to information such as psychological stress. The
mind uses sphincters as outlet this way
Sphincters have rotational component, projecting into the coronal
plane ,moving clockwise and counter clockwise
A normal sphincter will have a balanced movement in both
directions ,with the clockwise movement being the most active.
Every time a sphincter is in spasm,the counterclockwise will be
stronger of the two motions

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MECHANICAL EFFECTS OF
POOR ORGAN SUPPORT
VISCIOUS CYCLE
PHYSIOTHERAPIST WILL INFER
HOLISTIC RESULTS
Fascial manipulation
Manipulation targets the centers of
coordination which are well defined
points on the deep fascia where
vectors of muscle forces converge
CC are involved in the coordination
of unidirectional ,segmental
movement

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Fascial mobilization
Mobilization acts on the centers of
fusion, which are broader areas or
points where the forces of several
myofascial units converge .these cfs are
involved in coordination of complex
movements ,which are involving more
than one plane
VISCEARL MANIPULATION
Articular visceral restrictions bring about a loss of
mobility and motility because of the inefficient
sliding of the organ on its surrounding structures.
When they result in a reduction of motility but
normal mobility,
we call these articular restrictions "adhesions:‘ If
both mobility and motility are affected, we call
them "fixations:' They can be partial or total and
are generally the sequelae of infectious
pathologies or surgical interventions.