Visceral Manipulation

EVI

s O

,LOPATIlY ANlJ OTIlEI( SYS'I'E, S

ot manual m 'diein • have

a

ED

v'lriely of

mo dels

n1l'cll.lIl1CS of proper and impropcl' motion .

10

specific organs. and the manipulative

lh.. . 'lop cl

techniques

u

e ' nd f melion among t e int rnal urgan is at Ie' st as strung a. lhat among (,

conslitlll'nts of thl: ll1usculoskelttal

tl

and that, likt the musculoskeletal y ·tern, ma ni pul . tion of the viscera c n be ,stem;

i>l.'ndlcially used in the treatment m:,an clr"lul1clion To B'

I

fa!.

0,

.11

d Plerr

I'internal

thiS nd, l ean

Pierre

IeI' ier. D.O. have

The significance

of thi work for

cli i ner of manual medicine annot

p

be overestimated. E. Upledgel.

In hI' Foreword. lohn

.0., F.A.A.O. writes:

u111(:'

potential f)r the applic. tion of this concept in the diagnosis lIld treatment of internal organ dysfun c ion is. in my opini n, limitles!>."

developed an innuv atl ve II am work of con ·Lpl. lnd t ':c

Transverse colon

omentum

I_LuST

Phrenicocolic ligaments

luN .-

Local Anatomy of the Right Upper Quadrant The more the fingers move to the left, the more difficult it is to penetrate deeply. With overweight subjects, it is very difficult to

I LlUSl RA

ION

3

Topographical Anatomy of the Liver

carry out this approach; fortunately, such pa­ tients rarely need subcostal treatment-the liver is usually in good functional condition.

Depending on the subject, the gall bladder is

The lower biliary confluence (the union

located on a line connecting the umbilicus

of the cystic and hepatic canals) is found in

to either the right nipple or the right mid­

the lesser omentum at the lower edge of Ll.

clavicular point. The body of the gall blad­

The common bile duct then crosses the fixed

der is located where this line crosses RlO on

part of the superior duodenum and goes

the right. The common bile duct is found

right and downward to end in the ampulla

slightly posteromedial to the line.

of Vater at the posteroinferior aspect of the

During palpation, from right to left, the

descending duodenum. At the level of L3, its

fingers will encounter the transverse colon,

anterior abdominal projection is 2cm above

right phrenicocolic ligament and, behind the

and to the right of the umbilicus. By begin­

colon, the anterior face of the right kidney,

ning at the gall bladder and then moving the

which is often a sensitive area. A little fur­

fingers slightly to the left. one can reach the

ther to the left, and slightly anterior to the

upper part of the common bile duct across

superior duodenum, you can palpate the

the superior duodenum. The sphincter is

body of the gall bladder at the point de­

covered anteriorly by the transverse colon

scribed above. Sensitivity here signifies an

and the mesocolon; it is through these two

66

PHYSIOLOGIC MOTION

organs that one can perform a biliary flush­

may be misled by this rib movement into

ing technique which combines emptying

thinking that the liver is moving upward

of the gall bladder and manipulation of the

and outward with inhalation.

common bile duct (pages

75-76).

Physiologic Motion MOBILITY The passive movement of the liver follows the movement of the diaphragm. Move­ ments in the frontal plane are relatively easy to palpate compared to those in the sagittal and transverse planes. We shall discuss the movements of the liver during inhalation; those during exhalation are just the reverse. In the frontal plane, the liver is so well attached to the stringy central part of the diaphragm that when the diaphragm de­ scends, the liver follows. The diaphragmatic

IllUST ATI

movement comes mostly from the back

Mobility and Motility of the Liver-Frontal Plane

5

because the posterior diaphragm is a fleshy muscle, whereas the anterior part is more

In the sagittal plane, the liver carries out a

a thin musculoaponeurotic sheet. The dia­

rotation at the end of inhalation: the antero­

phragmatic push is therefore a movement

inferior side moves slightly posteroinferi­

in an inferior and slightly anterior direction

orly to close the angle with the hepatic duct.

and the parts of the viscera adjacent to the

One way to conceptualize this movement is

diaphragm will move accordingly with inha­

to think of the liver as rolling forward. Re­

lation.

member that the diaphragm moves slightly

The center of the diaphragm goes down

anteriorly due to its concave shape. The pos­

less than the lateral parts because abdomi­

terior skeletal structures are less mobile than

nal resistance is concentrated at this point.

the anterior ones. The rotational axis is on

The lateral parts of the diaphragm will push

an oblique frontal plane that passes through

the lateral part of the liver much further

the two triangular ligaments

(Illustration 4-

down and medially. Therefore, the whole

6). This bi-triangular axis goes in a right to

liver moves downward and then rotates

left and superior to inferior direction.

counterclockwise along the path of the fal­

In the transverse plane, there is a slight

ciform ligament, around an anteroposterior

rotation which is very difficult to appreci­

axis which passes through the left triangular

ate. It seems that the lateral edge of the liver

(Illustration 4-5). During inhala­

moves anteriorly and from right to left while

tion, all the diameters of the thorax increase

the ribs move in the opposite direction. The

ligament

and the lower ribs move upward and away

axis of this counterclockwise (when viewed

from the median axis, in such a way that

from above) rotation is vertical and goes

the thorax moves away from the liver, which

through the inferior vena cava

in turn moves toward the median axis. You

4-7).

67

(Illustration

CHAPTER 4

I

THE LIVER AND BILIARY SYSTEM

Liver

Posterior

Anrerior

Amerior Posterior

Il UTk

III I

Mobility and Motility of the Liver-Sagittal Plane

Mobility and Motility of the Liver-Transverse Plane

no

The result of the movements made on all three planes by the liver is complex but easy to appreciate, as the amplitude is quite large

(Illustration 4-8).

MOTILITY In almost every detail, the movements of motility are identical to those of mobil­ ity, but with a characteristically reduced amplitude and slower rhythm. The follow­ ing motions take place during expir (and

(

the opposite motions during inspir). These motions are comparable to the inhalational movements of mobility; please refer again to Illustrations 4-5 through 4-8. In the frontal plane, the liver makes a

-llUsr-.ATlO Mobility and Motility ofthe Liver-Resultant Motion

counterclockwise motion around an antero­ posterior axis which passes through the left

In the sagittal plane, the liver rotates or

triangular ligament. Along with the motion

"rolls" forward around a bi-triangular axis

of the lung, this is one of the most impor­

in a fashion similar to that of mobility. This

tant examples of visceral motility that exists.

motion is minimal and difficult to appreci­

It is relatively easy to palpate and, because

ate .

of the liver's many connections, can be used

In the transverse plane, the lateral edge

as an indicator for the general condition of

of the liver moves in a counterclockwise ro­

the viscera.

tation (when viewed from above) from back

68

INDICATIONS FOR VISCERAL EVALUATION

to front and from right to left. Although the

(in contrast to the total restrictions of this

amplitude is smail, it is very important to

area that occur after whiplash injuries). Very

percieve and follow this movement in in­

often, problems with these areas (including

duction techniques, as the ability to re-es­

craniosacral restrictions) are related to liver

tablish it is an important criterion for suc­

or gall bladder dysfunction. Interestingly,

cess.

there are often sensations appreciated by the patient in these areas during manipulation

Indications for Visceral Evaluation

of the liver or gall bladder. Another important indication for ma­ nipulation of the liver is nervous depression. The relationship between depression and

Because of the importance and wide-rang­

the liver is well known in traditional Orien­

ing effects of its functions, the liver plays a

tal medicine. In this tradition, as understood

central role in visceral manipulation. Ma­

in modern France, the liver deficiency is de­

nipulation of the liver has a double role: to

rived from a lack of energy in the brain, par­

optimize its metabolic activities and increase

ticularly from the right frontal areas; this in

the flow of blood, lymph and bile through

turn depletes the brain's energy. The finding

it. It is rare that we do not have to restart

of biliary pigments in cerebral tissue would

function of the liver in women, due to its

tend to support this concept.

role in metabolism of hormones (including

We have found, especially in children,

the estrogens). The liver has an increase in

positive short- and long-term results from

workload after ovulation, and manipulation

liver manipulations in patients with chronic

performed during the first part of the cycle

or recurrent

will be much more effective than that done

While we have no hard proof at present, we

after ovulation. In men, disorders of the liver are rarer, with the exception of viral infections or tox­

believe that the efficacy of these techniques in treating these problems points to a ben­ eficial influence on the immune system.

icity from alcohol or other chemicals. The indications for manipulation of the liver in

In conclusion, the primary indications for hepatic manipulation include:

men are more commonly for disorders of the excretory paths (e.g., spasms of the bile duct, cholecystitis, cholelithiasis, high cho­ lesterol levels and gastric bile reflux). Gastric bile reflux is one of the pri­ mary indications for manipulation of the

sinusitis and/or bronchitis.

•

•

•

•

decrease in hepatic metabolism biliary stasis nervous depression decrease in immune responses

bile ducts. Gastritis and duodenal ulcers

Another possible indication for manipu­

are made worse by the alkalization of the

lation of the liver is musculoskeletal dys­

stomach walls by the bile salts, as the gas­

function of the thoracic inlet, particularly

tric mucosa prefers acids to salt bases and

periarthritis of the right shoulder. There is

the presence of the latter disturbs gastric

a simple way to determine if the liver is in­

secretions. Commonly observed, but diffi­

volved in this condition. Test the range of

cult to explain, are connections between the ' liver and the right eye and frontal area, and

motion of the jOint and then inhibit the liver (by gently pressing on the right tenth inter­

between the gall bladder and the left eye,

costal space at the midclavicular line) and

face and neck. These cases often involve a

repeat the motion of the shoulder with the

restriction of C4/S with very slight motion

greatest restriction. If the liver is involved,

CHAPTER 4

you will see an immediate improvement of

I THE LIVER AND BILIARY SYSTEM

Examination of the liver should include percussion. In case of any doubt, do not

30-40 degrees of motion. the

hesitate to use the resources of the modern

gall bladder include the classic right upper

laboratory, e.g., biochemical and imaging

quadrant and/or right scapular pain that is

technologies. Using alternative or natural medicine should not mean rejecting the techniques of conventional medicine.

Indications

for

manipulation

of

precipitated by greasy food. Gall bladder dysfunction may also cause pain on exhala­ tion, as well as problems with the left eye, left frontal area or left neck. Often these problems become worse after surgery as

MOBILITY TESTS

the common bile duct becomes irritated

All the mobility tests described here and in

and edematous, resulting in stasis. This duct

the following chapters require some rela­

(along with the pylorus) should always be

tively deep palpation of the abdomen. In

treated after surgery.

our daily life, it is very rare to have someone

Techniques to improve mobility are

place an anteroposteriorly directed pres­

used when there are important restrictions

sure on our abdomen. This, combined with

of the liver such as sequelae of a viral, para­

a feeling that the abdomen is a relatively

sitic or bacterial illness. In these cases the

private place, invokes a reticence and some

liver, affected in its entirety, fixes itself in

mental defenses against abdominal palpation

position. In the same way, the sequelae of

in most patients. It is therefore important to

pleuropulmonary invasive illnesses can re­

conduct this part of the examination (and

strict the mobility of the liver. In the case

treatment) with gentleness and care.

of diaphragmatic adhesions accompanied by characteristic crepitations, the liver too closely follows the movements of the dia­ phragm. Movements of the liver in a frontal plane remain within normal limits, whereas movements on the other planes are affected and motility becomes virtually nonexistent. Mobilization techniques can lead to the release of these adhesions. Once again, we must emphasize that evaluations must not stop at the level of grossly apparent move­ ment; a normal cholecystography is not suf­ ficient proof of a properly functioning liver.

In general, most clinical evaluations are performed with the patient supine. Unfor­ tunately, that position causes the rectus and oblique muscles to be elongated, forcing the practitioner to press harder in order to evaluate the underlying structures. This, in turn, causes the muscles to tighten, espe­ cially if the right upper quadrant is sensitive to the pressure. Therefore we examine pa­ tients for problems of liver mobility directly, via a subcostal route. 1he patient sits bent forward in order to release the tension of the abdominal muscles. This makes it easier to penetrate deeply with the fingers without causing discomfort.

Evaluation

In the seated position, gravity brings the liver downward. Place your fingers with

The evaluation will depend upon your ca­

their ulnar edges just under the patient's

pacities and background. For a list of appro­

lower ribs and parallel to them. Go to the

priate questions, please consult the proper

lateral edge of the rectus abdominis muscle

medical texts. It is necessary to gain a

in order to avoid the normally tender gall

knowledge of past infections or a history of

bladder. The ulnar edges are used because

problems from vaccinations, as these often

they cause much less discomfort than the

impair the function of the liver.

finger tips

(Illustration 4-9).

Gradually in­

70

EVALUATION

crease the pressure, at first in a posterior

the hepatorenal ligament. Appreciating the

direction. When your fingers can no longer

amplitude and speed of the liver's return

move straight posteriorly, change to a pos­

inferiorly, as you release the pressure, tests

terosuperior direction. The more forward

for restrictions in the superior structures.

bent the patient, the deeper your fingers can

When there is a restriction, the return will

go.

be slower than normal and of a shorter dis­ tance. This test can be made more specific by modifying the direction of the push and the pOSition of the patient. For example, sidebending the patient to the left and di­ recting the posterosuperior push toward the right shoulder will allow a finer appreciation of any restrictions in the right triangular ligament. The left triangular ligament can some­ times be evaluated fairly directly. Place your fingers just to the left of the xiphoid process. Sidebend and rotate the patient to the left as you come under and just posterior to the ribs. From this position, a pressure directed towards the left triangular ligament from your fingers should allow you to evaluate that structure. To fully appreciate the sagittal or trans­ verse motions of the liver, it is necessary to push in a primarily posterior direction. If

I LU TRATION

you push your fingers directly toward the

-9

hack, this will lift the posterior aspect of

Direct Subcostal Approach to the Liver

the liver and the organ will fall forward. A delay or decreased distance in the return

Direct Tests

of the liver in this situation is related to the

When you push the central part of the liver

function of the anterior part of the coronary

posterosuperiorly as described above,

ligament.

it

should move by 1- 2cm. Of all mobilizations, that of the liver is the most objective be­

Indirect Tests

cause no other solid organ directly interferes

The elasticity of the lower ribs may be uti­

with or gets in the way of its movement. De­

lized for indirect evaluation of liver mobil­

pending on the location and direction of the

ity. These tests may be done in a supine,

pressure, you can test several structures of

left lateral decubitus or seated position. The

the liver. Many combinations and variations

ribs are compressed as you check for abnor­

of the tests described here are possible.

mal resistance. A feeling of normal costal

Pushing the liver superiorly tests the

elasticity but a resistance underneath them

level of restrict.ion in the inferior struc­

indicates some problem of liver mobility.

tures. For example, excessive resistance to

Depending on the direction of costal com­

this movement could reflect a problem with

pression, the areas of liver restriction can

:71

CHAPTER 4

/

THE LIVER AND BILIARY SYSTEM

be localized. However, these techniques are

corresponding to the liver can be done in

nonspecific because there are other possible

association with these tests.

reasons for abnormal rib movement, pri­ marily musculoskeletal dysfunctions. Before testing the right side, you should test the left side for the purpose of comparison. With the patient in the supine position,

MOTI LlTY TESTS With the patient in the supine position, place your right hand flat over the hepatic

place the palm of your hand on the inferior

region, fingertips above the sternoxiphoid

anterolateral aspect of the right thorax and

line, pointing toward the left triangular liga­

compress the ribs, pushing them anteri­

ment, and palm on the lateral part of R9-11

orly, inferiorly and medially. This technique

over the right lateral aspect of the hver. Your

should be painless and progressive. The

hand should follow the convexity of the rib

shape of the thorax should be easily de­

cage; in order to concentrate better, it is a

formed (think of all the variation due to sex,

good idea to place your left hand on top of

body type and age). During the movement,

your right. You must be passive in order to

place your other hand under the costal edge.

be objective. If the motion is difficult to ap­

Normally, except in children, the liver does

preciate, or in order to free your mind, try

not spill over the costal edge.

visualizing the anatomy of the liver-this

With the patient in the left lateral de­

is a good way of becoming precise and of

cubitus position, push the right costal mass

enhancing your perception. For the begin­

anteriorly and inferiorly, using the same

ner, it is usually easier to palpate the motion

methods as in the supine position.

during the expir phase.

With the patient in the seated position,

In the frontal plane, during expir, your

stand to his left. Surround the lower right

hand should rotate from right to left in a

ribs with your joined hands and compress

counterclockwise motion around an antero­

the thorax, bringing it towards you, while at

posterior axis that passes just distal to the

the same time rotating it first to the left and

third knuckle of the right hand. In this mo­

then to the right. The articulation tests of

tion the palm of the hand moves toward the

the costovertebral and costochondral joints

umbilicus

(Illustration 4-10).

ILLUSTRATION 4-10

Motility Test of the Liver­ Frontal Plane

72

RESTRICTIONS

ILlU lRA

ON

-

1

Motility Test of the Liver­ Sagittal Plane

ILLUS P TIO

'-1

Motility Test ofthe Liver­ Transverse Plane In the sagittal plane, during expir, the

planes one at a time, you can test them all

superior part of your hand rotates anteri­

simultaneously for a more complete appre­

orly and inferiorly around a transverse axis

ciation of the motility of the liver.

through the middle of the hand. The infe­ rior part of your hand rotates in a similar manner and therefore seems to press harder against the body (Illustration 4-11). In the transverse plane, during expir,

Restrictions There are many types of restrictions involv­

your hand rotates to the left around a verti­

ing the liver; we will mention some com­

cal axis that passes through the knuckles of

mon ones. With hepatitis the liver will feel

the sensing hand. This seems to bring the

tight, while in cases of chronic obstructive

palm away from the body while the fingers

lung disease it will feel heavy. Occasionally a

press in harder (Illustration 4-12). After you

total fixation of the liver can create a fibrosis

become comfortable testing these different

of its supporting ligaments; this is common

73

CHAPTER

in cases of cirrhosis. During direct mobiliza­

4

I

THE LIVER AND BILIARY SYSTEM

colonic impression in order to first release

tion techniques you can feel these restric­

the tension of the hepatic flexure of the

tions let go little by little, occasionally with

colon via the right phrenicocolic ligament.

a crackling sound. It is a marvelous sensa­

Then move toward the falciform and stom­

tion and reinforces one's appreciation of the

ach areas where, to treat the area of the left

efficacy of this technique. Posterior restric­

triangular ligament, the fingers should be

tions are common, perhaps because of the

pushed superiorly and laterally. To work on

pleuropulmonary relationship. Every pleural

the entire liver at once, put one hand me­

problem directly affects the mechanics of

dially and the other laterally. As you move

the liver through restriction of its connec­

your fingers to work on different areas, ad­

tions with the diaphragm. For this reason,

just the position of the patient to focus your

it is imperative to check the motions of the

effects on those areas.

liver in the aftermath of pulmonary diseases, and vice versa .

Manipulations Manipulations to improve mobility should usually precede those to treat problems of motility. Frequently, a dysfunction in the liver will not involve the gall bladder, and vice versa. If both organs are involved, treat the gall bladder first.

DIRECT TECHNIQUES Seated Position As noted above, mobilization of the liver with the patient in a seated position enables you to release restrictions as far toward the back as possible. The direct technique is just a rhythmic, slow (approximately 10 per min­ ute) repetition of the diagnostic technique; it involves evaluating the quality of motion by lifting the liver posterosuperiorly in a gentle

Il us RATION 4-

Direct Manipulation ofthe Liver-Seated Position

and progressive manner by 1-2cm and then releasing it. The motion is inversely propor­

This is very similar to manipulations for the

tional to the amount of restriction in the

stomach (see chapter

coronary ligament; the more severe the re­

organs and structures attached to the liver

(Illustration

are affected by this technique. When the

As the technique is repeated, the liga­

tension of the anterior organs is released,

striction, the less the excursion

4-13).

5).

Of course, all the

ment will release (sometimes with a popping

the liver must be pushed up; you can then

sound). Five to six repetitions should suffice.

direct your fingers more toward the back to

It is better to begin with the external part of

try to reach the anterosuperior part of the

the liver (the most mobile) at the level of the

kidney, if desired.

74

MANIPULATIONS

llUST

1("

4 1

Direct Manipulation of the Liver­ Left Lateral Decubitus Position

Left Lateral Decubitus Position Place yourself behind the patient and put the palms of your hands on the anterolat­ eral extremities of R7-9, with the pads of the fingers subcostal. Push the ribs anteriorly, inferiorly and medially (toward the umbili­ cus) and then in the opposite direction, in a slow back-and-forth cycle of around 10 per minute with steadily increasing ampli­ tude

(Illustration 4-14). It is not necessary

to synchronize the movements with respira­ tion. You can adjust the technique so that it focuses on motion in one particular plane. For frontal plane motion, push the ribs to­ ward the umbilicus with more movement of the lateral aspects. For motion in the trans­ verse plane, roll the ribs toward the midline.

abdominal wall are more effective. Tech­ niques which work through the ribs are used primarily when the abdomen is too tense, or as an adjunct.

Emptying of the Gall Bladder Place the patient in a seated position and stand behind him with your fingers subcos­ tal, just lateral to the gall bladder, as here the abdomen is more easily depressed. Flatten your fingers well against the inferior side of the liver and be careful not to confuse the gall bladder with the first part of the duo­ denum or the transverse colon. The supe­ rior duodenum is not sensitive to palpation, whereas the gall bladder often is. For this reason, first look for tender points in this area. You can easily reach the bottom of

For sagittal plane motion, press your thumbs

the gall bladder, which has a relatively an­

together on the posterior axillary line and

terior position. To force it to contract (and

use your fingers to rotate the ribs forward.

expel the bile or sediments which could be

Recoil (pushing medially and anteriorly in

in it), push your fingers rhythmically with a

all planes and then releasing suddenly) can

moderate amount of force in short (2-4cm)

also be performed here.

strokes superiorly, posteriorly and medially

This technique moves the ribs, pleura,

along the long axis of the gall bladder. As

peritoneum and liver and is a good general

you continue, the gall bladder will become

mobilization which is tiring for neither you

less sensitive. This is the first sign of an ef­

nor the patient. It is especially useful in pa­

fective treatment. If the gall bladder is tender

tients who have had hepatitis. In general,

it is important to do this technique gently at

however, techniques performed through the

first (4-8 times) until the tenderness has dis­

75

CHAPTER 4

/

THE LIVER AND BILIARY SYSTEM

sipated and then increase your force. At this

The common bile duct (a smooth canal with

point, change the direction of your force to

only one sphincter at its opening into the

inferior, posterior and medial to release the

duodenum) has fibromuscular walls and

nes, 91

90-91

64

including in ulcer treatment, 114

Fat

Duodenum

64

connection to left eye, 69

adhesions, 174·

Duodenal papilla s 104-105

.

anatomy,

associated osseous restrictions, 81

Falciform ligament, 64, 6S

sliding surfaces, 177

and phYSiologic visceral motion, 3

Heart

topographical anatomy, 35

support, 176-177

visceral articulations, 32-33

suspension, 174

Heaviness sensation, in gastric ptosis, 92

manipulations,95-100

topographical anatomy, 177

Hemorrhoids, coccygeal involvement in, 194

mechanical syndromes, 90-91

treatment effects, 185-186

Hepatic flexure

mobility tests, 92-93

tuba-ovarian motion 178

motility tests, 93-95

uterine deviations, 178

direct manipulation, 129

physiologic motion, 88

uterine motion, 177-178

evaluation procedure, 124

topical anatomy, 87-88

visceral articulations, 175-177

mobility test, 126

209

,

anatomy, 120

INDEX

palpation. 125

thoracic cavity. 45-47

osseous restrictions.151

relationship to liver and kidney. 122.139

tubo-ovarian induction, 186

palpation. 143-144

seated position manipulation. 129

Infectious phenomena. scar, as sequelae of.15

topographical anatomy. 123

Inferior diaphragm. 29

vi,eeral articulations. 121

Infertility

Hepatic

fos,a. 57

Hepatic vein. 65

pararen.l body and

membrane.

physiologic motion.141

emotional upset and. 182

posterior lamina.138

resolution through visceral manipulation,

posterior relationships. 139

186

Hepatitis

renal

138-139

direct manipulations in. 75

InOammation. and abdominal hypotonia. 58

restrictions in. 73

Inhalation

po.sterior topographical reference marks. 140

posterior vs, anterior palpation approach.

Hepatobiliary problems. 39

horizontaJ rib rotation during, 36

Hepatocolic ligament. 121-122

pleural forces and tensions. 35

ptoses.

pulmonary expansion during, 36

referred pain locations.139

Hepatorenal ligament. 64

direct tests of. 71

Inspir

Hiatus hernia.58

case study. 25

Ll restrictions in. 100

perturbations through pulmonary pathol­ ogy.8 symptoms of. 92

High cholesterol levels. in men. 69

Hilar vessels.139

physiologic motion. 141

History taking

Hormonal production. effect of visceral

manipulation on. 24

Hypertension. 137

postpartum.152

and renal pathol ogy. 142

Hypothalamic-pituitary axis. 186

Hypotonia

abdominal. 58

and gastric ptosis.91

restrictions, 145-146

lungs. 39

as retroperitoneal organs. 55

Iliac artery. 143.147.152

Immunity

dfect of visceral manipulation on. 24

relationship to liver. 69

Impotence. and left kidney ptosis. 142

Incontinence

coccy geal involvement in. 192

in women. 157. 162

Indirect manipulation techniques. 18. 19

kidneys. 148

right kidney via liver. 148

Induction techniques. 18.19-21

bladder and perineum. 167-168

bladder anterio-posterior. 168

bladder in expir. 167

colon. 132-133

colon expir. 133

esophagus and stomach. 99-100

female reproductive system. 184-185

kidneys. 151

sliding surfaces. 140

test. 41

supinc position combined techniques.

Intestinal ptosis. 108. 109

149-150

Intracavitary pressure. 12-13

supine position manipulations. 146-147.

holding kidneys in place. 56

147

regulation in small intestine. 106

topographical anatomy. 140

small intestine. 106

visceral articulations. 139-140

Intraperitoneal organs. anatomy. 55

Intrarect.1 exam. 180

visceral restriction examples.14

Kyphosis

as cause of hiatal

Intrauterine devices (IUDs). as contraindica­

tion to treatment, 21.165.183.187

visceral motion via, 9-10

Intrinsic motion. and health.13

Irritable bowel ,yndrome, 124

kidney restrictions and.145

Irritative s}'ndromes, esophagus and stomach.

91

hernia.90

and gastric pt osis. 91

Intravenous pyelography (IVP). observation of

L L1

restriction. in gastralgia.ulcers and hiatus

hernia. 100

Labbe's triangle. 92

Laboratory examinations. female

reproductive

system. 180

Lanz's point. 122

Jejunoileum, 103. 106

anatomical relationships. 105

direct manipulation technique. 112

fixations after appendectomy. 127

Ileum. as intraperitoneal organ. 55

150

seated position manipulations. 147

induction technique. 114. 115

motility. 123-124

Ileocecal valve. 119

ISO.

lnterpleural ligament. 32.33

Intervertebral articulations, mobilization

cyclical motion of. 126

motility te't. 126

techniques.

seated position combined techniques. 149

J

motility on expir. 127

reverse Trendelenburg pOSition combined

Internal rotation, in craniosacral rhythm, 5

renal,142

Ileocecal junction. 98

renal fascia.138

Intercostal neuralgia. 50. 146

for bladder and perineum. 163

restrictions. 186

145-146

defined. 7

Interior duodenum. 104

thoracic cavity. 39

HormonaJ disorders. and female osseous

137-138.143

motility test. 110

Jejunum. as intraperitoneal organ. 55

Laparotomy patients. testing for small

intestine restrictions. III

Lasegue's sign. 125

Lateral pulmonary pressure. 37

Law of precision. 21-22

Least

force. 21-22

Left eye. conneclion to gall bladder. 69

Left frontal headaches. origin in stomach. 92

K

Left shoulder pain. origin in stomach. 92

Lemon

Kidneys. 135-138

juice.

increa,ed efficacy of kidney

manipulations with. 152

adhesions. 146

Les>er omentum. 65. 87

adjunctive considerations. 151-152

Levator ani muscle. 1S8. 191

anatomical relationships. 139

anatomy. 138-140

anterior lamina. 138

as uterine support. 177

Ligamentous laxity. 10-16

in abdominal wall. 58

anterior relationships. 139

Ligamentous ,ystem. 12

calculi as contraindication to treatment, 21

Listening. 17-18

clinical case example. 152-153

combined techniques. 149, 149-150

dietary and lifestyle recommendations. 152

in induction technique s. 20

repeating at end of treatment. 21

Liver. 61-63

direct manipulations. 146-147

anatomical relationships.

evaluation procedures. 142-144

anotomy. 63- 67

63-64

indications for visceral evaluation. 141-142

associated osseous restrictions. 81

indirect manipulation via liver, 148

central role in visceral manipulation. 69

indirect techniques. 148

combined manipulation in sllpine position.

induction on inspir, 151

induction techniques. 151

78

coronary l iga ment.64. 71

ligamentous connection to liver, 64



and decreased immune responses.69

loss of motility after duodenal ulcer. 114

direct manip,dation techniques.74-76

liver. 79-80

manipulations.146-151

direct mobility tests. 71

right kidney on inspir. 141

mobility.141

direct subcostal approach.71

small intestine. 113-114

mobility on inhalation.141

disorders in women vs, men, 69

slOmach in supine position,99

mobility tests.144.144

superior lung lobe with counter-traction.

motility. 141

falciform ligament. 64

motility tests.144. 144

faligue with decreased motion of. 63

47

evaluation procedures.70-73

210

INDEX

frontal plane induction in expir, 79 frontal plane mobility, 67 frontal plane mobility and motility, 67

stomach: 88-89

Manipula tions. 18

thoracic cavity, 35-38

bladder and perineum, 165-168

front al plane motility test, 72

Mobility tests, 17

coccyx. 194-195

frontal p l ane motility tests, 72

bladder and perineum. 163

colon, 127-133

gastric impression. 63

bladder ill seated position, 164

contraindications,21

4

coccyx, 193-194

direct techniques, 19

indications for visceral evaluation, 69-70

colon, 125-126

esophagus and stomach, 95-100

tests. 71-72 techni qu e s, 79-80

indirect mobility induction

Significance relative to position, 137 small intestine, 107

Male reproductive system, 173

frontal plane motility, 68

hepatorenol ligament.

as sign of life, vii

M

frontal plane induction technique, 79

female reproductive system, 182-185 indirect techniques, 19

as intraperitoneal organ, 55

kidneys,144. 144

induction techniques, 19-21

left lateral decubitus position direct

lesser curvature of stomach. 93

kidneys, 146-151

manipulations, 75, 7S

liver and biliary system, 70-72

liver and biliary systems, 74-81

left lobe. 63

pylorus, 93

manne r of treatment, 21-23

left triang ular lig ament combined

small intestine, 109-111

right kidney in supine position, 147

manipulations. 78

superior gastric fundus, 93

small intestine. 111-114

ligamental fibrosis in c i rrhos is , 73

thoracic cavity, 40-41

thoracic cavity, 45--49

ligaments, 64-65

uterus via abdomina l route, 180

uterus via abdominal route, 183, 184

loss of contact with kidney in renal ptosis, 14

uterus via bimanual palpation, 181

Manner of treatment, 21

law of precision and least fo rce, 21-22

manipulations, 74-81

length of treatment sessions,22-23

mobility, 67-68

number and freque ncy of treatment s 22

motility. 68-69

rhythm and amplitude, 22

.

McBurney's paint, 120, 122, 127

phySiologic motion, 67-69

Meat, redUCing consumption in evening, 115

post- vs. premenstrual effects of treatment

Mechanical syndromes, esophagus and stomach. 90-91

reduced motility in nervous depreSSion. 14 relations hip to depression, 69

Mediastinal restrictions, schematic represen­

mediastinum, 39 right kidney on inspir. 142 small intestine, 107-108

deviations of, 50

sagiltal plane motility. 68

74

supine position combined manipuIJtions, 78 -79

topographical anatomy, 65-67, 66 transverse plane induction in cxpir, 80

transverse pbne induction techniq ue, 80

67

transverse plane mobility and motility. 68

Long lever mobilization in indirect techniques, 18. 19 liver in supine pOSition, 78 thoracic cavity, 47 Lower back pro blems. and urogenital organ position in women, 179 Lower bil i ary confluence, 66 Lung ligame nt 32,37 .

Lung mobility,37 l.ungs difficulty of treating, 29 effect of cardIac motion on,S induction of superior lobe with countertraction, 47

Motility tests, 17 -18

motility. 39

sliding surfaces, 65, 6S

Liver cirrhosis,74

thoracic cavity, 38-39

mobility, 37-38

.

77-78

visceral articulations, 64-65

stomach,89-YO

effect of cardiac motion on. 5

sagittal plane motility test. 73, 7 3

triangular ligaments, 64. 71

lungs,38-39

combined manipulation, 48

sagittal plane mobility, 67

triJngu!ar ligament manipulation, 77

liver transverse plane, 68

Mediastinum

sagittal plane induction technique, 80

transverse pla ne motility test, 73, 73

liver frontal plane, 67 liver sagittal plane, 68

38

sagittal plane induction in expir, 80

"

effects of viscera l manipulation on. 24 female reproductive system, 179

liver and biliary system, 68-69

Mediastinal pleura. 31, 37

Mediastinal tension, schematic rep resentation,

restrictions. 73-74

transverse plane moti l it) 68-6 9

colon, 123, 123-124,124

inh erent in vis cera, vi

tation, 44

relationship to right eye, 69

transverse plane mnbility.

.

amp litude of, 22

kidneys, 141

Medial umbilical ligaments. 160

70

seated position direct manipulations, 74.

41 Motility 9-10

Mechanistic osteopathy, viii

reduced mobility after pulmonary illness,

scated position combined manip ulations

Mobilization tests, inter vertebral articulations,

bladder and perineum,162

motility te sts . 72-7

on, 23

esophagus and sto mach, 93-93 female reproduc tive system, 180-181

bladder and perineum. 164

restrictions, 43-44

bladder in supine position, 164

traction on, 38

cervobrachial neuralgia. 24

Meninges, 11 Menopause, hiatal hernia during, 90

colon, 126 esophagus and stomach, 93-95

Menstrual cycle

female reproductive system. 181-182

aVOiding recral examinations during . 194

kidney s. 144, 144

awareness during treatment of female

liver and biliary system, 72-73

reproductive system, 186-187

liver frontal plane. 72

and evaluation of female patients, 23

liver sagittal plane, 73

and numb er / fre que n cy of treatments. 22 recommendations in bladder treat ment, 169

liver tran ::;verse plane, 73 rig ht lung, 42 small intestine, 110-111

Mesenteric root

ternumJ 42

direct manipulation technique 112 .

stomach in frontal plane, 94

palpation, 109

thora cic cavity, 41-42

Mesenteric system, 13 Metabolism, increased by visceral manipula­ tion, 23

Mobility,

uterus, 182 Motion importance relative to position, 97

8-9

abdom i nal postsurgical, 59 colon. 123 effect> of viseel.l manipulation on, 24 female reproductive system, 179 importance to female reproductive sy stem, 178

pathology of. 13-18 Multiparity association with ptosis, 16 and gastric ptOSiS, 91 and ovarian malpositioning, 174 Muscular restrictions, 16-17. 58 Muscular spasms, effect of visceral manipula­

kidneys, 141 liver and biliary system, 67-68 liver frontal plane, 67

tion on, 24 Muscular tissues. suita bility of induction techniques for. 20

liver s;JgittJI plane, 68 liver tran::i\'ers pla ne 68 .

mobility, 35-37

lung, 37

motility, 38-39

mediastinum, 37-38

N

top ographical anatomy, 34-35

restori ng before induction techniques, 21

Neck pain, 39

visceral articulations, 32

right kidney on inhalation, 142

Number of treatments,22

211

INDEX

visceral articui::Ihons,

o

Perineal gymnastics, 169

Obesity, as cause of hiatal hernia, 90

Obturator nerve, and colon restrictions, 125

Oddi's sphincter, 81

Omenta, posterior cavity, 57

Omental system, 13

Oranges, dilation of gastroesophageal

sphincter by, 100

Organ clock, 10

Orgasm, uterovaginal mobility and coccygeal

involvement, 192

Oriental medicine

application of cycles to osteopathy, 10

relotionship of liver to depression in, 69

Osseous restrictions

bladder and perineum, 169

colon, 133

female reproductive system, 186

kidneys, 151

liver and biliary system, 69, 81

smaLl intestine, 115

Osteopathic concept, 22

united global body function in, 59

Osteopathic lesions, 192

Osteopathy

as art of provoking self-correction, viii

as fringe medicine in Europe, 137

mechanistic

vs.

energetic schools, viii

Ovary

anatomy, 174

link to cecum, 124

motility test, 182

movement and suspension, 175

topographical anatomy, 177

Overtreatment, 23

Ovulation, increased liver workload after, 69

Postoperative constipation, 108

Postpartum conditions

Perineal transverse muscles, 158

cystoceles, 179

Perineum,155-157

heavy bleeding, 169

adjunctive considerations, 169

renal ptosis, 142

anatomy, 158-159

urethrovesical displacement, 161-162

combined techniques, 166-167

Pregnancy, 173

contraindications to manipulation, 165

as contraindication to manipulation, 165,

183,187

direct manipulation techniques, 165-166

hiatal

evaluation procedures, 163-164

indications for y"isceraimanipulation,

tests, 18

162-163

induction techniques, 167-168

Primary respiratory motion, 5

manipulations, 165-168

Progesterone, role in hiatal hernia, 90

mobiLity tests, 163-164

Prostate gland, effects of perineallbladder treatment on, 168

motility, 162

motility test, 164

Protein consumption, redUCing for small

intestine health, 115

osseous restrictions, 169

phYSiologic motion, 161-162

Psoas muscle, 143

colon and, 125

recommendations, 169

restrictions, 164-165

contact with kidney, 141

role in bladder continence, 162

as reference for female reproductive

system, 181

sliding surfaces, 160

in sigmoid colon manipulation, 130

topographical anatomy, 160-161

treatment effects, 168

Psoasstretch, 11'4

urethrovesical displacement, 161-162

Psyche, effect of visceral manipulation on, 24

vesical musculature, 161

Ptosis, 15-16, 58

combined manipulations for urogenital,

visceral articulations. 160

183

Peristaltic motion,S

female reproductive system, 173, 177

Peristaltic rhythm, 8

Peritoneal cavity, 56-57

gastric, 58

Peritoneal fluid, 15, 55

pelvic organs, 184

Peritoneum, 11

progressive traction manipulation in, 19

renal, 138

anatomy, 56-57

right kidney, 40

as link between viscera and related

uterine prolapse, 178

structures, 14

viscer::d restrictions and, 14

vascularization and innervation, 57

Phrenic center

Pubovesocaillgaments, 160

stretching of, 165-166

combined manipulation in seated/supine

p

positions, 49

deviations, 50

Palpation

kidneys, 143-144

in physical examination, 17

Pancreas

difficulty of palpation, 59

as retroperitoneal organ, 55

Pap smear, 180

Pararenal body, anatomy, 138-139

Parasympathetic tone, daily variations in,

10-11

Parietal peritoneum, fixations in, 15

Parietal pleura, 31-32

fixations in, 1515

stretching of, 46

Pathology of motion, 13-14

rhythm problems, 1

visceral restrictions, 14-18

Pelvic circulation problems, 179

coccygeal involvement in, 195

Pelvic congestion, 168

Phrenicocolic ligament, 122, 123

Physical activities, adjunctive recommenda­

tions on, 24

Physical examination, 17-18

thoracic cavity, 39-40

PhYSiologic motion, 3

abdominopelvic cavity, 57-59

bladder and perineum, 161-162

coccyx, 191-192

colon, 123-124

esophagus, 88

Pulmonary pathology, effect on other viscera,

8-9

deep muscles in females, 158

superficial muscles in females, 158

Pelvic mesocolon, mobility test. 126

kidneys, 141

liver and biliary system, 67-69

small intestine, 107-108

anatomy, 56

positioning relative to perineal floor, 157

Piriformis muscle, 158

Pleura, II

visceral articulations, 30-31

Pleural adhesions, 24-25

Pleural dome, 31, 34

with bile circulation, 91

Pylorus, direct manipulation technique, 98

R Recoil technique, 19

connection to coccyx, 191

as pelviC organ, 56

Reference marks

kidneys, 140

lungs, 34

Renal calculi, 149

and bladder/perineum manipulation, 168

Renal fascia, 138

suspensory ligament. 30, 32

Renal membrane, anatomy, 138-139

mobility restrictions, 70

in liver evaluation, 70

Pleuropulmonary noises, 40

in

Polyuria, 142

Pericardium, 11

in gastric ptosis, 91

Pyloric sphincter dysfuncbon, interference

restrictions, 45

Pleuropulmonary illnesses, sequeloe and liver

Pericardial stringy pouch, 37

Pyloric antrum, 88

Recto-uterine pouch, 56

Percussion

Pericardial ligaments, 33

upper ribs, 36

Pyelonephritis, 163

Rectum

Pleuromediastinal wall, 35

examination, 17

Pump handle movements, 37

thoracic cavity, 35-39

Pelvic stasis, 179

in colon evaluation, 125

Pulmonary suction system, 35

Pulmonary tuberculosis, 29

stomach, 88-90

combined manipulation, 48

Pelvic organs

Pulmonary respiration cycles, 11

female reproductive system, 177-179

forces and tensions during inhalation, 35

Pelvic floor

physic,,1

Pulmonary expansion, during inhalation, 36

Phrenic nerve, 81

colon, 125

hernia during, 90

Primary dysfunction, revealed by motility

Positional restrictions, 14

and restoration of motility, 25

Posterior pulmonary reference marks, 34

Renal ptosis, 137,

145. See also Ptosis

liver involvement and, 145

postpartum, 142

and recurrent cystitis, 145

Reproductive function, coccygeal involvement

in, 192

Respiratory rhythm, 41

Retroperitoneal organs

212

INDEX

anatomy, 55-56

Sigmoid mesocolon. 122

balanced supra- and subhiata[ traction. 90

Sliding su rfa ces. 11

Retzius' space, 160

Rever.sc Tl'endeienburg position, 152

combined left k idney manipulation in, 150

combined techn iques for colon manipula

­

lion in, 132

female rep roduc tive system manipulatio n

in, 183

female reproductive sy,tem mobility

testing in, 180-181

manipul. tion in gastric pta 'is. 96

recomm 'lidations for female reproductive sy-tem, 187

recommendations for small intestine as

anatomy. 85-88

supine position manipulation. 130

kidneys, 138

pat ients,

anato m ic al relationships. 86

131

ascending and descending ('olons, 119

liS

resting po sition in gastric ptosis, 100

97

case study. 24

bladder and perineum. 160

changing orientation of, 86

colon, 122

combined manipulation,

98

combined moti lity tests, 95

combi ned techn iques . 98-99

esophagus and stomach. 87

female reproductive system. 177

kidneys. 140

direct manipulation techniques. 95-98

liver and biliary system. 65. 65

dire ct subcostal app roach in seated posi tio n . 93

small intestine. 106

evaluation. 91-95

Sloshing sound. in gastric ptosis, 92

89

frontal plane mobility. 88-89.

Small intestine. 101-103

frontal plane motility. 89

adjunctive considerations, 114-115

anatomical relationships. 103.104,105

indications for visceral evaluation, 90-91

anatomy.103-107

induction in supine position.

associated osseous restrictions, 115

99

induction techniques. 99-100

dietary recommendations for.115

as intraperitoneal organ. 55

stomach manipLdation in,

direct manipulation techniques, 111-113

irritative syndromes. 91

use in bladder treatment, 169

direct pressure technique. 112-113

manipulation in reverse Trendelenburg

Rhythms

position,

duodeno)ejunal flexure induction. 113-114

comparative biological, 8

97

duodenum anatomy.103-105

manipulations. 95-100

in manner of trea tment, 22

duodenum direct manipulation.111-112

mechanical syndromes, 90-91

thoracic avity.41

duodenum induction, 113

mobtlity.88-89

effects on vesicouterine cul-de-sac, 177

mobility tests, 92-93

Rib mov menrs, 36

11Orizontal rib rotation during inhalation. 36

Right eye. connection to liver, 69

Right lung

motility

tests. 42

restrictions in motLlity. 43

R ight renal pto is. 14

Right sCilpular pain.and gall bladder

manipulation, 70

Right upper quadrant, anatomy. 66

moti[ity.89-90

evaluation. 109-111

indications for visceral evaluation. 108-109

mottlity test in frontal plane. 94

induction techniques. 113-114

motility tc'sts. 93-95

intracavitary pressure and turgor in, 106

physiologic motion, 88-90

jejunoi[eum anatomy.105

pro [apse.58



ptosis leading to renal ptosis. 145

jejunoileum direct manipulation. 112

jejunoi[eum induction.114

sagittal plane mobility. 89. 89

manipulations. 111-114

sagittal plane motility. 89

mobility. 107

sliding surfaces. 87



mobility tests, 109-110

and T6 restrictions, 100

motility. 107-108

topographical anatomy. 87 -88.88

s

motility tests. 110-111

transverse plane mobility. 89

Sacrococcygeal joint

restrictions, 111

transverse plane mobility and motility,

physiologic motion. 107-108

visceral articulations. 86-87. 87

restrictions in bladder problems. 169

sliding surfaces. 106

visceral repercussIons. 191

sphincter of Oddi induction. 113

Straight-knee leg raising test. 125

topographical anatomy. 106-107

Structural problems. vii

Sac rococcyge

I ligaments, 191

Sacroiliac restrictions. in colon problems . 133

Sacrotuberous ligaments. 191

surface area with mic rovilli . 108

visceral articulations, 105-106

Somatic dysfunction. 192

Sacrum

Somatic nervous system, visceral motion

induction. 168

restrictions in bladder problems.169

influenced by.3-4

Scars. and articular fixations, 15

Sore throat. and gastric reflux. 90-91

SciJtica, and sigmOid colon restrictions, 125,

Sotto-Hall test. 40

127

Scoliosis.relationship to pulmonary pathology.

Stretching. thoracic cavity. 45

Subhiatal traction. 90

Suction eff,'ct. of double layer system. 12

Superior diaphragm, 29. 30

Superior duodenum, 104

Superior gastric fundus. mobility test. 93

Supradiaphragmatic pressure, 13

Suprahiatal traction.90

Sphincter muscles. 159

Surgery

perineum.158

and adhesions/fixations.15

Sphincter of Oddi, 98. 106, 108.109. 112.

29 Secondary dysfunction.revealed by motility

18

Serotonin. effects of acupuncture and osteopathic treatment on. 23

tests,

Serous fluids. comparison with synovial fluids.

11

aVOiding in urinary incontinence, 168

114.133

and colonic restrictions.127

direct induction technique. 113

consequences in abdominal wall. 58-59

induction technique.114

Sphincter spasms. effect of visceral manipula­

tion on. 24

female reproductive system. 179

Suspensory l igament . 30. 32. 32. 37

associated restrictions, 50

Spleen

pleura, 30

as sliding surfaces of visce ral joints. 11

surrounding heart. 33

Short lever mobilization

in direct techniques. 18.19

thoracic cavity. 47

anatomy. 121

direct manipulation, 130

effects of manipulation on small intestine. bladder. genital organs.133

as intraperitoneal

organ. 55

ubitus position manipulation.

131

motility on expir. 127

palpation. 125. 143

supine position comb i ned manipulation.

213

schematic representation, 44

as intraperitoneal organ. 55

Splenic flexure

stretching of, 46

Sutherland. William G,. 5

anatomy. 120. 121

direct manipulation. 129-130

Synovial fluid. comparisons with serous fluids.

11

evaluation procedure. 124

mobility test, 126

palpation.125

Sigm oid colon

[cft lateral d·

restrictions. 44-45

difficulty of palpating. 59

Serous membranes

seated position combined manipulation. 132

Stasis. scars and.15

Sternum. motility test,

in craniosacral therapy vs. manipu l ation.20

T T6 restrictions. in stomach dysfunction.100

TherapeutiC pneumothorax. 29

42

Still point

Thoracic cavity.4.27-29

visceral

in small intestine induction. 113

thoracic cavity manipulations. 46. 47

Stomach.83-85

90

transverse plane motility. 89-90

adjunctive considerations. 50-51

anatomy.29-35

co mbined techniques . 47. 48,

49

direct manipu lation techniques, 45

effects of treatment. 49-50

evaluation. 39-43

INDEX

history taking, 39

Upledger, John E., vi, ix

indications for visceral evaluation, 39

Ureterovesical reflux, 149, 163

induction techniques, 45-47

Urethrovesical displacement, 161-162

and intracavitary pressure, 12

manipulations, 45-49

pathophysiology of, 162

Urinary tract infections

Visceral axes in health and embryological development, 8. vi

modification by scars . 15

Viscera l eval ualion

mediastinum res trictions, 43-44

coccygeal involvement in, 195

mobility, 35-38

bladder and per ineum, 163-164

recurrent, 142, 145, 163

esophagu s ond stomach, 91-95

mobility tests, 40 -4 1

motility, 38-39

motility tests, 41-42

Urogenital disorders

coccyx involvement, 191

origin in falls, 192-193

physical examination, 39-40

Uterine anteversion, 177, 178

physiologic motion, 35-39

Uterine deviations, 163, 178

restrictions, 42-45

anteversion, 177-178

visceral articular restrictions, 43-43

Ute rine fibromas, 179

visceral ligamentous restrictions, 43

Uterine motion, 177-178

Thoracic cavity anatomy, 29-30

anatomical relationships, 30

topographical, 33-35

visceral articulations, 30-33

Uterine prol apse, 178

Uterine ptosis, differentiating from vesical

ptosis, 163-164

Uterine retroversion, 178, 181. 187

1horacic inlet, 30, 40

Uterine suspension, 175

Thrombosis, as contraindication to treatment,

U te ros acral manipulation, lateral decubitus

21

Toldt's fascia, 123, 145

Tonsillitis, in children with hiatus hernia, 92

Topographical anatomy

position, 185

Uterus anatomical relationships, 175

broad ligaments, 175, 176

bladder and perineum, 160-161

connection to coccygeal restriction, 195

bronchi. 33-34

effects of bladder/perineal treatment on,

colon, 122-123

168

e sophagus and stomach, 87-88

extrinsic deviJtions, 178

female reproductive system , 177

influence of surrounding organs on

heart. 35

mobility, 179

kidneys, 140

links to pelvic portion of colon, 130

liver and biliar)' system, 65-67

manipulation via abdominal route, 183, 184

lungs, 34-35

mobility test via abdominal route, 180

small intestine, 106-107

motility test, 182

stomach,88

as p elviC organ, 56

thoracic cavity, 33-35

relationship to coccygeal restrictions, 194

Toxins, collection in intestinal tract, 108

retroJlexion of. 169, 178

Tracheal bifurcation, 33

retroversion of. 178

Trac tion

round ligaments, 174

in direct mani pulation, 19

support vs. suspens ion, 176

mediastinum, 38

right vs. left lung, 33

Transit problems abdominal wall role in, 58

and colonic evaluation, 124

Transverse colon

anatomy, 120

as intraperitoneal organ, 55

lack of mobility tests for, 126

visceral articulations, 122

Traube's semilunar space, 92

Treatment effecls, 23-24.

bladder and perineum, 168

coccyx, 195

colon, 133

liver and biliary system, 81

thoracic cavity, 49-50

Treatment session length, 22-23

'['reitz's muscle, 104, 105, 114

Trusses, 152

Tuba-ovarian adhe:"ions, 183

Tubo-ovarian induction, 186

Tubo-ovarian manipulations, 186

Tubo -ovarian motion, 178

Turgor, 12-13

holding kidneys in place, 56

importance to pelviC organ function, 56

role in stomach support and cohesion, 86

v

Vertebral column, fleXib ility and defor mabiJity

of. vii

Vertebral restrictions, 50

Vesical musculature, bladder and perineum,

161

Vesical ostia, 161

Vesical ptosis, 161

causes of, 164-165

distinguishing from uterine ptosis, 163

Vesicouterine ligaments, 176

Vesicouterine manipuJation. seated position, 184

Viscera] articular restrictions, thoracic cavity,

42-43

Visceral articula tion s, 3, 11

attachments and, 11-13

bladder and perineum, 160

colon, 121-122

esophagus and stomach, 86-87

female reproductive s)'stem. 175-177

heart, 32-33

kidneys, 139-140

ligamentous laxity, 15-16

liver and b il iar )' system, 64-65

lungs, 32

muscular restrictions, 16-17

u

pericardium, 31

pleura, 30-31

Ultrasound female reproductive s),stem, 180

observations of visceral motility via, 9

Unicellular axon reflexes, 23

ptosis, 15-16

sliding surface., and, II

small intestine, 105-106

thoracic cavity, 30-33

iodications for coccyx, 192-193

indications for colon, 124

indications for esophagus and stomach,

90-91

indications for kidney, 141-142

indication., for l iver and biliary system,

69-70

indications for small intestine, 108-109

kidneys, 142-144

thoracic indications, 39

Visceral induction. See Induction techniques

Visceral ligamentous restrictioos, thoracic

cavity, 43

Visceral manipulation

efficacy of, 197

increased metabolism due to, 23

ind.icati ons for bladder and perineum, 162-163

indications for female reproductive system,

179

Visceral mobility, 3

and viscerospasm, 16

Visceral mot i l it)', vi, 3, 6-8

cycles of. 11

frequency of. 18

importance relative to positional corree·

tion, 25

and intrinsic mo tio n, 13

pendulum- like nature of. 19-20

pro of of, 9-10

relationship to craniosacral rhythm, 7

reproducibilit)' criteria, 10

and viscer()Spa5;l11, 16

Visceral motion embryogen ic theory of. 6-7

four categories of, 3

pass ive, 4

Visceral pleura, 30-31

Visceral pOS itions, alteration through pathol­

ogy, 8

Visceral ptosis. See Ptosis Visceral restrictions, vii, 10,24

adhesions and fixations, 14-15

articular restrIctions, 14-15

bladder and per ineu m, 164-165

cocc)'x, 192

colon, 127

female reproductiv e system, 1 82

functional vs. posi t ional, 14

live r and bil i ary sy s tems, 73-74

localiZing and classif)'ing in trea t ment, 18

lumbosacral in female reproductive syste m, 186

pleural dome, 45

right l ung motility, 43

small i n testine, II

thoraciC cavity, 42-45'

Visceral rhythm, 8

Vis ceral spasm, gastriC, 91

Visceral subluxation, 14

Visceral volume, 12

Viscerospasrns, 16- 17, III

Voluntary movement, 3-4

Vomiting, follOWing gall b l adder manipulation.

81

w Weight loss, me l ting of pararenal body during, 139

White wine. visceral re.. tr iction s due to. 14

Wine, dilation of gastroesophageal sphincter

by, 100

214