Visceral Manipulation Lab Flashcards
When performing visceral treatments, what is the order of treatment for Lymphatics, Mechanical, and Neurological?
1) Mechanical first
2) Neurological second
3) Lymphatics third
What is the goal of treating the Mechanical part during visceral treatments?
- 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)
What is the goal of treating the Neurological part during visceral treatments?
- 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)
What is the goal of treating the Lymphatic part during visceral treatments?
- reduce lymphatic impediments (e.g. thoracoabdominal diaphragm b/c it’s the primary driver of lymphatic fluid)
- pump the lymphatics
What vertebrae and ribs are associated with the thoracoabdominal diaphragm?
- directly associated w/ vertebrae T5-L3
- attached to ribs 5-12
Describe Psoas Release.
- 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
Describe QL Recumbent Technique.
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
How do you test for thoracic visceral strain?
- 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)
What are the treatment techniques for thoracic visceral strain?
-MFR (direct or indirect)
Describe the splenic pump (on the Left) with recoil, and the liver pump (on the Right) with recoil.
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
What are the lymphatic fxns of the liver?
- forms half of the body’s lymph
- clears bacteria
- -hepato-biliary-pancreatic venous/lymphatic drainage
- intestinal venous drainage
What is the positioning of the patient to perform colon release?
-pt. supine w/ knees bent
What are the contact and force directions for colon release of the following: ascending, transverse, descending, sigmoid?
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
Describe kidney palpation and release.
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
What organs are innervated by the celiac ganglion (T5-T9)?
- distal esophagus, stomach, proximal duodenum
- liver, gallbladder, spleen, part of pancrease
What organs are innervated by the superior mesenteric ganglion (T10-T11)?
- distal duodenum, jejunum, ileum, ascending colon, 2/3rds of the transverse colon
- part of the pancreas
What organs are innervated by the inferior mesenteric ganglion (T12-L2)?
-distal 1/3rd of the transverse colon, descending colon, sigmoid colon, and rectum
Where would you palpate the celiac ganglion?
1/4th of the way from the xiphoid to the umbilicus
Where would you palpate the superior mesenteric ganglion?
halfway b/w the xiphoid and the umbilicus
Where would you palpate the inferior mesenteric ganglion?
1/4th of the way from the umbilicus to the xiphoid
Describe abdominal ganglia release.
—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)
Describe sub-occipital release/inhibition.
–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)
What do sacral rocking and sacral inhibition increase or decrease parasympathetic tone?
Sacral Rocking: increase parasympathetic tone
Sacral Inhibition: decrease parasympathetic tone
Describe sacral rocking.
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)
Describe sacral inhibition.
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)
How does fascial strain result in tissue congestion?
- lymphatic capillaries are pulled closed by fascial tension on anchoring filaments
- thus, treating the fascia opens the capillaries
What parts of the body does the thoracic duct drain and what structure does it drain into?
- left head, neck, arm, thorax, abdomen,
- pelvis
- lower extremities
—> drains into the left subclavian v.
What parts of the body does the right lymphatic duct drain and what structure does it drain into?
-right head, neck, arm, thorax
—> drains into the right subclavian v.
Describe the procedure to release strain on the abdominal diaphragm.
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
How many bpm’s do you do for pedal pump, and for how long?
- 120 bpm
- -1-2mins