Visceral Manipulation Lab

Question 1

When performing visceral treatments, what is the order of treatment for Lymphatics, Mechanical, and Neurological?

Answer 1

1) Mechanical first
2) Neurological second
3) Lymphatics third

Question 2

What is the goal of treating the Mechanical part during visceral treatments?

Answer 2

• remove regional mechanical structural stress
  (e. g. lower ribs, TL spine, psoas, QL, pelvic floor mm.)
• reduce stress within visceral support and capsule
  (e. g. mesenteric attachments, visceral ligaments)

Question 3

What is the goal of treating the Neurological part during visceral treatments?

Answer 3

• treat areas related to sympathetic/parasympathetic innervation to normalize autonomic tone (normally the sympathetics are “on too high” and you need to crank it down)
• reduce reflex changes (Chapman Points)

Question 4

What is the goal of treating the Lymphatic part during visceral treatments?

Answer 4

• reduce lymphatic impediments (e.g. thoracoabdominal diaphragm b/c it’s the primary driver of lymphatic fluid)
• pump the lymphatics

Question 5

What vertebrae and ribs are associated with the thoracoabdominal diaphragm?

Answer 5

• directly associated w/ vertebrae T5-L3

- attached to ribs 5-12

Question 6

Describe Psoas Release.

Answer 6

• pt. supine at side of table w/dysfxnal leg hanging off
• put superior pressure on that ipsi ASIS
• apply gentle pressure on thigh to engage ext. barrier
• hold for MFR, or use MET for 3sec 3x

Question 7

Describe QL Recumbent Technique.

Answer 7

Patient: lies w/ affected side up

Doc: proximal forearms on iliac crest and inferior shoulder; fingers grasp QL and pull laterally, separating shoulder from hip

-can be rhythmic, static, or pt. can use MET to pull hip toward shoulder

Question 8

How do you test for thoracic visceral strain?

Answer 8

• one hand on mediastinum anterior and one hand posterior

- move hands both in parallel and in opposition to test for motion restrictions (L/R, sup/inf, SB, and torque)

Question 9

What are the treatment techniques for thoracic visceral strain?

Answer 9

-MFR (direct or indirect)

Question 10

Describe the splenic pump (on the Left) with recoil, and the liver pump (on the Right) with recoil.

Answer 10

Pt: supine w/doc at ipsi side of table as the organ

Doc: one hand on L or R costal margin, other hand on posterior; gently compress repetitively for 30-60secs w/ each compression about 3s each (20x/min)

With recoil: during early inhalation, quickly release

Question 11

What are the lymphatic fxns of the liver?

Answer 11

• forms half of the body’s lymph
• clears bacteria
• -hepato-biliary-pancreatic venous/lymphatic drainage
• intestinal venous drainage

Question 12

What is the positioning of the patient to perform colon release?

Answer 12

-pt. supine w/ knees bent

Question 13

What are the contact and force directions for colon release of the following: ascending, transverse, descending, sigmoid?

Answer 13

Ascending (R) and Descending (L): contact posterolateral flank w/ a medially-directed force

Transverse: contact abdomen just inferior to costal margin w/ an inferiorly-directed force

-force is gentle and constant until a softening occurs

Question 14

Describe kidney palpation and release.

Answer 14

Pt: supine w/ knees flexed

Doc: lift kidney from posterior with one hand; other hand begins medial to the ascending (or descending) colon and inferior to the transverse colon and slowly dives deep to engage the kidney GENTLY

-test anterior/posterior, medial/lateral, and superior/inferior motion; then use indirect fascial release

Question 15

What organs are innervated by the celiac ganglion (T5-T9)?

Answer 15

• distal esophagus, stomach, proximal duodenum

- liver, gallbladder, spleen, part of pancrease

Question 16

What organs are innervated by the superior mesenteric ganglion (T10-T11)?

Answer 16

• distal duodenum, jejunum, ileum, ascending colon, 2/3rds of the transverse colon
• part of the pancreas

Question 17

What organs are innervated by the inferior mesenteric ganglion (T12-L2)?

Answer 17

-distal 1/3rd of the transverse colon, descending colon, sigmoid colon, and rectum

Question 18

Where would you palpate the celiac ganglion?

Answer 18

1/4th of the way from the xiphoid to the umbilicus

Question 19

Where would you palpate the superior mesenteric ganglion?

Answer 19

halfway b/w the xiphoid and the umbilicus

Question 20

Where would you palpate the inferior mesenteric ganglion?

Answer 20

1/4th of the way from the umbilicus to the xiphoid

Question 21

Describe abdominal ganglia release.

Answer 21

—direct force posteriorly to engage the feather’s edge of the tissue restriction

–maintain gentle force and hold very still until softening occurs (30-90s)

Question 22

Describe sub-occipital release/inhibition.

Answer 22

–finger pads placed in the sub-occipital region

–apply a constant, inhibitory anterosuperior pressure for 30-60secs; (could also apply slow rhythmic pressure until tissue releases or for 2 mins)

Question 23

What do sacral rocking and sacral inhibition increase or decrease parasympathetic tone?

Answer 23

Sacral Rocking: increase parasympathetic tone

Sacral Inhibition: decrease parasympathetic tone

Question 24

Describe sacral rocking.

Answer 24

Pt: prone w/ doc standing on side of table

Doc: overlap hands on the sacrum in a superior/inferior direction

–induce rocking in sync w/ pt’s respiration for 30-60secs (extension w/ inhalation, and flexion w/ exhalation)

Question 25

Describe sacral inhibition.

Answer 25

Pt: prone w/ doc standing at side of table

Doc: overlap hands on sacrum in a superior/inferior direction

–resist respiratory motion of the sacrum for 30-60secs (do not let sacrum extend during inhalation; do not let sacrum flex during exhalation)

Question 26

How does fascial strain result in tissue congestion?

Answer 26

• lymphatic capillaries are pulled closed by fascial tension on anchoring filaments
• thus, treating the fascia opens the capillaries

Question 27

What parts of the body does the thoracic duct drain and what structure does it drain into?

Answer 27

• left head, neck, arm, thorax, abdomen,
• pelvis
• lower extremities

—> drains into the left subclavian v.

Question 28

What parts of the body does the right lymphatic duct drain and what structure does it drain into?

Answer 28

-right head, neck, arm, thorax

—> drains into the right subclavian v.

Question 29

Describe the procedure to release strain on the abdominal diaphragm.

Answer 29

Pt: supine w/ doc standing at side of table

Doc: grasp lateral rib cage at costal margin to feel motion in all three planes; place at point of balance where the global pull is gone

• -pt. takes 2-3 medium breaths
• -then move to the direct barrier
• -pt. then takes one large breath

Question 30

How many bpm’s do you do for pedal pump, and for how long?

Answer 30

• 120 bpm

- -1-2mins