Osteopathy, Naturopathy and Visceral Manipulation

Nowadays, Osteopathy is becoming more known and its field of expertise is continuously growing. At the same time, a vast number of patients have included a naturopath as part of their healthcare team. We believe these two specialities can be complementary. In this article, we propose to establish a link between Osteopathy and Naturopathy with the successful use of Visceral Osteopathy. In other words, how Visceral Osteopathy can improve diaphragm and organ mobility enough to improve organ function. And thus, their ability to absorb supplements prescribed in Naturopathic treatments to finally improve treatment results.

 

NB: We do not forget that an osteopath also uses Musculoskeletal, Neural, Circulatory and/or Craniosacral Manipulation within a session as required by the patient’s condition and complaints.

 

visc

 

Before elaborating more on visceral manipulation we need to enlighten the Diaphragm anatomy and physiology. The diaphragm is a thin muscle between the thoracic and abdominal cavity composed by two cupolas attached to the last ribs and the xiphoid process of the sternum and attach to the lumbar spine (L1 – L3) with two crus. It has three orifices to let pass the inferior vena cava (with right phrenic nerve), the aorta (with the thoracic canal) and the oesophagus (with the vagus nerves). Most of the time, its shape resembles two parachutes [1] [2]. It is the primary muscle for breathing.

During inhalation, it contracts to move downward and during exhalation it relaxes and returns to its previous state. The mobility of the diaphragm is obviously crucial for breathing, but it is also imperative for the circulatory system, especially for the venous and lymph circulation [3] which are passive systems and for the mobility of the organs.

 

 

Visceral Osteopathy

 

Since the vast work of G. Finet and C. Williame, two Belgian osteopaths, we know that the organs have their own mobility according to the respiratory rhythm imposed by the diaphragms [4]. Each organ has its own movement oriented by its connexions with other structures organised as a system of attachment. It is constituted by fascias (also called connective tissues) which can be ligaments (ex: gastro-phrenic ligament) or peritoneal folds (ex: mesocolon or mesenteries) depending on their compositions. The peritoneal folds are more important for the organ they are attached to because they contain blood vessels and autonomic nerves essential for the organ supply and function.

 

Capture

 

Brilliantly described by JC.Guimberteau, the entire body is constituted by a continuous interconnected fascia from the superficial layers to the deepest [5] [6] [7]. That is why, we believe that deep restriction can affect superficial layers and thus be found more easily.  This property allows us to work with a gentle superficial palpation avoiding a deep and painful one.

Another characteristic to know about the fascias (mainly in visceral ligaments) is that they have a viscoelastic property [8] and some contractile fibers [9]. It is important for us to have active responses during a treatment when we use the induction or breathing cycles.

The fascia viscoelasticity can be altered after a trauma (injury, surgery, digestive issues…). If for any reason, the fascia is not able to recover its normal texture during the healing process (inflammation, regeneration, remodeling) it would become fibrous and tight and create local adherences [10]. These adherences would modify its histological, physiological and biomechanical characteristics [11] [12].

 

Our experience leads us to strongly believe that the viscoelastic quality of the fascia surrounding the organ, especially the peritoneal folds due to their rich vascularization and innervation, is necessary to maintain a proper function of the organ! In other words, viscoelastic fascias are healthy and tight fascias with adherences can be the source of dysfunctions.

To support our theory and have a better understanding on why we think that the restriction can lead to altered organ functions, we look at the effects of a local abnormal tension (tight fascia) upon the neurovascular system:

  • The venous and lymphatic systems are passive systems meaning that they do not have enough muscle strength in their walls to support fluid movements. Their circulation depends on the external forces (muscle contractions, diaphragm motions…)[3]. In these conditions, they can easily be compressed by fascial tension and thus their flow rate would be decreased.
  • The arteries are not depending on external force to carry the blood because of their strong muscles located in their walls (3 layers)[13]. Within their walls, they have receptors sensitive to variation of pressure called baroreceptors [14]. In case of external stress on the artery, these receptors are activated and the reaction will be an increased strength and speed of contraction which creates local hypertension [15] [16].
  • The nerves have certain internal pressure which allows a good conductivity for the electrical current crucial for the right conveyance of the nervous message [17]. If the nerve is entrapped or compressed within a fascial tension within its pathway, its internal pressure could be modified and alter its ability to carry a message as seen for peripheral nerves[18].

 

It has been proven that, if the intra-abdominal pressure increases to a certain point (during certain pathologies), the organ functions can be altered [19] [20] [21] whereas most of the time they slow down [22]. We think the same mechanism can apply to local restrictions and the neurovascular structures supplying the organ being altered. The function of the organ would be impaired as well.

 

Overall, fascial restrictions will change and decrease the mobility of the organ leading to restricted diaphragmatic motions. We assess the mobility of both cupolas of the diaphragm (quantity and quality of the movement) to have a global idea of the tension pattern. We then become more precise and we assess the mobility of organs to determine where to start the treatment. The touch is very gentle and extremely precise to ensure targeting the right structures.

 

The visceral osteopathic treatment tends to address the restriction (tightness) in the fascias surrounding and in between the organs with hand-on mobilization. The treatment includes gentle mobilisation using induction, as developed by JP.Barral, directly on the area of the target organ to improve the viscoelastic property of the surrounding tissues [8]. The expected outcome is to normalize the system of attachment to engage the organs in their normal range of motion [23]. The long term goal is to improve the diaphragm motions, restore a better circulation for the venous and lymphatic systems and ultimately improve the function of the organ itself.

 

 

Natur’Osteopathic Approach ?

 

With Visceral Manipulations and with any other kind of osteopathic techniques, the ultimate goal is to remove restriction of mobility anywhere in the body that can decrease the blood flow (especially the venous one) or put abnormal pressure upon the different elements of the nervous system. We believe, and our experience comforts us, that if we can restore physiological mobility and thus a better vascularisation of the organs we can improve their functions.

If we are able to improve their function, the ability to absorb will improve as well.  For example, the B12 vitamin absorption by the stomach, calcium magnesium absorption by the duodenum or the important role of the small intestine in the absorption process etc.

This affirmation needs more investigation and we tempered even more our effects with patients dealing with long term disease. However, our first-hand experience in working in conjunction with Naturopathic doctors and at times with complicated cases leads us to this conclusion.

 

To sum up, we believe this approach (Naturopathy and Osteopathy) could be beneficial for patient following supplement therapy with poor results.

 

 

 

 

 

 

 

References

[1]
Whitelaw, W. A., L. E. Hajdo, and J. A. Wallace. « Relationships among pressure, tension, and shape of the diaphragm. » Journal of Applied Physiology 55.6 (1983): 1899-1905..
[2] Agostoni, Emilio, and Hermann Rahn. « Abdominal and thoracic pressures at different lung volumes. » Journal of Applied Physiology 15.6 (1960): 1087-1092..
[3] Abu-Hijleh, MARWAN F., OMAR A. Habbal, and SATEI T. Moqattash. « The role of the diaphragm in lymphatic absorption from the peritoneal cavity. » Journal of anatomy 186.Pt 3 (1995): 453..
[4] Finet, Georges, and Christian Williame. Treating Visceral Dysfunction: An Osteopathic Approach to Understanding and Treating the Abdominal Organs. Stillness Press, 2000..
[5] Guimberteau J.C., Sentucq-Rigall J., Panconi B., Boileau R., Mouton P. et Bakhach J. « Introduction à la connaissance du glissement des structures sous-cutanées humaines ». Annales de chirurgie plastique esthétique 50, 19-34 (2005).
[6] Guimberteau, J. C. « La mécanique du glissement des structures sous cutanées chez l’homme. Mise en évidence d’une unité fonctionnelle: la microvacuole. » e-mémoires de l’Académie Nationale de Chirurgie 4.4 (2005): 35-42..
[7] Guimberteau, J. C., et al. « The microvacuolar system: how connective tissue sliding works. » Journal of Hand Surgery (European Volume) 35.8 (2010): 614-622..
[8] Dunn MG, Silver FH, Viscoelastic behaviour of human connective tissues: relative contribution of viscous and elastic components. Connective Tissue Research 12:59-70, 1983.
[9] Schleip, Robert, Werner Klingler, and F. Lehmann-Horn. « Active fascial contractility: fascia may be able to contract in a smooth muscle-like manner and thereby influence musculoskeletal dynamics. » Medical hypotheses 65.2 (2005): 273-277..
[10] Gabarel B. et Roques M. « Les Fasciae en médecine ostéopathique. Tome 1, anatomo-physiologie et technologie ». Maloine, Paris (1985) ISBN 2-224-01999-0..
[11] Stecco, L., 2004. Fascial Manipulation. Piccin Ed, Padova..
[12] Hammer, W.I., 2007. Functional Soft-tissue Examination and Treatment by Manual Methods, third ed. Jones & Barlett Pub,Sudbury.
[13] Gasser, T. C., Ogden, R. W., & Holzapfel, G. A. (2006). Hyperelastic modelling of arterial layers with distributed collagen fibre orientations. Journal of the royal society interface, 3(6), 15-35..
[14] Kirchheim, H. R. (1976). Systemic arterial baroreceptor reflexes. Physiological Reviews, 56(1), 100-177..
[15] Xie, J., Zhou, J., & Fung, Y. C. (1995). Bending of blood vessel wall: stress-strain laws of the intima-media and adventitial layers. TRANSACTIONS-AMERICAN SOCIETY OF MECHANICAL ENGINEERS JOURNAL OF BIOMECHANICAL ENGINEERING, 117, 136-136..
[16] Dobrin, P. B. (1978). Mechanical properties of arterises. Physiological reviews, 58(2), 397-460..
[17] Brown, C. M., Molony, V., King, A. S., & Cook, R. D. (1972). Fibre size and conduction velocity in the vagus of the domestic fowl (Gallus domesticus). Cells Tissues Organs, 83(3), 451-460..
[18] O’brien, J. P., Mackinnon, S. E., MacLean, A. R., Hudson, A. R., Dellon, A. L., & Hunter, D. A. (1987). A model of chronic nerve compression in the rat. Annals of plastic surgery, 19(5), 430-435..
[19] Inal, Mehmet Turan, et al. « Effects of intra-abdominal pressure on liver function assessed with the LiMON in critically ill patients. » Canadian Journal of Surgery 54.3 (2011): 161..
[20] Diebel, Lawrence N., Scott A. Dulchavsky, and Robert F. Wilson. « Effect of increased intra-abdominal pressure on mesenteric arterial and intestinal mucosal blood flow. » Journal of Trauma and Acute Care Surgery 33.1 (1992): 45-49..
[21] Richardson, J. David, and J. Kent Trinkle. « Hemodynamic and respiratory alterations with increased intra-abdominal pressure. » Journal of surgical research 20.5 (1976): 401-404..
[22] Harman, P. KENT, et al. « Elevated intra-abdominal pressure and renal function. » Annals of surgery 196.5 (1982): 594..
[23] J. P. Barral. Visceral Manipulation II. « Eastland Press. » (1989): p36-37..

 

 

error: Content is protected !!