Visceral Manipulation Therapy (VMT)

Visceral Manipulation Therapy (VMT) in physiotherapy is a gentle, hands-on technique that focuses on the internal organs (viscera) such as the liver, kidneys, intestines, and the other soft tissues of the body. The goal of VMT is to enhance the functioning of these organs and to restore mechanical, vascular, and neurologic function of the body.

Over time, due to surgery, trauma, infection, or lifestyle factors, organs can develop restrictions and adhesions. These can affect the movement and function of the organs and cause pain or dysfunction. VMT views the body as an interconnected system. Dysfunction in one organ can affect the overall health and function of the entire body.

 

Key Concepts of Visceral Manipulation Therapy

Mobility, Motility and Motricity:

• Mobility: The movement of the organs in relation to the structures around them.
• Motility: The inherent motion of the organs themselves described as slow-frequency, low-amplitude internal movement of the organs.
• Motricity: The passive adjustments in the location of the organs brought on by arbitrary locomotor activity.

 

Visceral Manipulation Therapy Techniques

• Gentle Manipulation: Physiotherapist uses gentle, precise manipulation to encourage normal mobility, tone, and inherent tissue motion of the viscera, their connective tissue, and other areas of the body.
• Palpation: Physiotherapist palpates the position, size, and motility of the internal organs to detect abnormal tensions and restrictions.

 

Benefits of Visceral Manipulation Therapy

• Pain Relief - help alleviate chronic pain conditions that are associated with internal organs.
• Improved Function - enhances the function of the organs, potentially improving digestion, circulation, and overall vitality.
• Post-Surgical Recovery - helps in breaking down adhesions and scar tissue, promoting better recovery after surgery.

 

Conditions Treated with Visceral Manipulation Therapy

• Digestive Issues (e.g., IBS, constipation)
• Chronic Pelvic Pain
• Post-Surgical Adhesions
• Low Back, Cervical, and Shoulder pain
• Musculoskeletal Pain
• Anxiety and Stress-related Disorder

 

Chronic Low Back Pain (CLBP) and Visceral Manipulation Therapy

Pain and lumbar spine mobility is improved when VMT is performed for CLBP. It is important to decrease the tension on the abdominal wall when performing the technique. 

Commonly used techniques are:

• Cardia manipulation
• Pylorus manipulation
• Oddi sphincter manipulation
• Duodenojejunal valve manipulation
• Ileocecal valve manipulation
• Sigmoid colon manipulation
• Liver global manipulation
• Global hemodynamic manipulation

 

Frozen Shoulder and Visceral Manipulation Therapy

VMT can be used alongside conventional treatments like physical therapy and medications for frozen shoulder. VMT facilitates local segmental responses that is excitation and facilitation. In this approach, an excitatory or inhibitory interneuron might act as a bridge between sensory stimulation and a motor or sympathetic nerve

The physiotherapist should avoid performing the technique in following conditions:

• History of recent trauma to the neck.
• Recently diagnosed tumors.
• Chronic liver disease (fatty liver)

Visceral Manipulations (VM) for Frozen Shoulder is based on three planes that is transverse, coronal and sagittal plane. 

Transverse Plane

The position of patient is in side lyig with affected side up and both knee in flexion. Therapist’s left hand is over the right epigastric region and right hand behind the left on the top of the right costal arch. The therapist will place her hand to load fascia & connect the liver behind the ribs and follow movement (medial/lateral rolling) of liver in a direction of ease

Coronal Plane

The patient is in supine lying. The therapist will place her right hand over the 5th/6th ribs (fingers pointing towards umbilicus) & left hand below her right hand over the right costal area.

Sagittal Plane

The patient is in side-lying position with the affected side up and both legs bent towards chest. The physiotherapist places left hand vertically on the posterior side of 5th/6th rib at the right costal arch and right hand vertically on the anterior side of the right costal arch, whereas both thumbs pointing towards the right shoulder. He follow movement (anterior/posterior rolling) of the liver in a direction of ease.

Contraindications of Visceral Manipulation Therapy

Visceral Manipulation Therapy (VMT) can be highly beneficial for many individuals, but it is not suitable for everyone. Certain conditions and situations may contraindicate the use of VMT. Here are some of the key contraindications:

Absolute Contraindications:

• Acute Infection – such as appendicitis or peritonitis
• Active Internal Bleeding - such as gastrointestinal bleeding or bleeding disorders
• Recent Abdominal Surgery
• Severe Osteoporosis
• Malignancy
• Aneurysms - Abdominal Aortic Aneurysms

Relative Contraindications:

• Pregnancy
• Crohn's Disease
• Ulcerative Colitis
• Uncontrolled Hypertension
• Recent Trauma
• Inguinal or Umbilical Hernias
• Unexplained severe pain in the Abdominal or Pelvic Region
• Bowel Obstruction
• Severe Anxiety or Psychological Conditions
• Fibromyalgia
• chronic fatigue syndrome,
• Increasing Age
• Medications - anticoagulant therapy or other medications that affect tissue healing and clotting should be treated with caution