Visceral Osteopathy

Visceral Osteopathy can be used for a variety of conditions, particularly digestive issues.  It is similar to abdominal massage, however visceral osteopathy uses more specific techniques and is used in the normal scope of osteopathic treatment which always looks at the whole body to help address where pain and dysfunction may be originating from. 

About Visceral Osteopathy

There is the belief that all health starts in the gut! That's where visceral osteopathy may be able to help. 

In the past 20 years, much research of the ‘gut-brain’ axis, an established bidirectional communication between both, has been conducted. This has been particularly so in relation to physiological and psychological health with dysregulation of the pathway being implicated in conditions like IBS, functional dyspepsia, chronic pain, and mood disorders, like anxiety and depression (1 - 5). Particularly so, anxiety has been shown to have a high prevalence in individuals with IBS (6).

Some research suggests that in both human and animal models, acute and chronic physical and psychological stress, may lead to permeation of the gut lining, allowing the entry of pathogens. This is due to the increase in corticotrophin-releasing hormone (CRH), which stimulates release of the stress hormone cortisol, resulting in an intestinal inflammatory response (7, 8). It is speculated that GI diseases, chronic disease, autoimmune conditions, and altered mood states may potentially be associated with this alteration (7 - 9). So, in other words  chronic stress states may potentially have a negative effect on gut function and possibly vice versa.

Visceral osteopathy treatment (VOT) is a branch of osteopathy that utilises techniques that help address issues within the thoracic, abdominal, and pelvic cavities that may be the result of restrictions within the facia, ligaments and other associated structures that may be impeding circulation, lymphatic flow, and proprioceptive communication within the body. Like our musculoskeletal system, our internal organs also have their own motion and physiological motility that is needed for optimal function.  The musculoskeletal and visceral systems are interrelated through their fascial attachments and therefore dysfunction in one system may influence the other.  Therefore, it is vital that visceral osteopathy is not seen as separate from general osteopathic treatment but an important element of it.

Some small studies have shown that VOT may help to benefit individuals experiencing digestive issues and discomfort like constipation and IBS (10, 11,). Some small studies have also shown that it may aid with menstrual discomforts like menstrual pain and discomfort (12, 13). Further, other small studies have suggested VOT may help with lower back pain (14). Treating the back may also be important in helping improve digestive function. This is due to organs being attached to the spine via fascial connections and ligaments. These fascial connections suspend the organs within the abdominal cavity and should ideally move freely. As osteopathy does with joints and other soft tissue structures of the body, the aim of VOT is to improve movement and function in the same way with the aim of aiding digestive physiological processes and fluid dynamics through improving circulation in the area.

Additionally, treating areas of the spine, including the neck, is also important due to relationship with the autonomic nervous system, as nerves involved in gut function stem from the spine. Therefore, VOT is not a modality on its own but is used as part of normal osteopathic care which embraces looking at the whole body in a holistic manner. This is integral for optimal recovery. For example, your osteopath may treat your neck due to some dysfunction in the joints or muscles in the area that may be impeding optimal function of the vagus nerve, the nerve which innervates the gut and is vital for aiding digestive processes. 

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References

  1. Mayer EA, Tillisch K and Gupta A. Gut/brain axis and the microbiota. J Clin Invest. 2015 2; 125(3): 926-38.
  2. Koloski NA, Jones M, and Talley NJ. Evidence that independent gut-to-brain and brain-to-gut pathways operate in the irritable bowel syndrome and functional dyspepsia: a 1-year population-based prospective study. Aliment Pharmacol Ther. 2016 Sep; 44(6): 592-600.
  3. Mussell M, Kroenke K, Spitzer RL et al. Gastrointestinal Symptoms in Primary Care: Prevalence and Association with depression and Anxiety. J Psychosom Res. 2008; 64: 605-12
  4. Kurina L, Goldacre M, Yeates D, et al. Depression and anxiety in people with inflammatory bowel disease. J Epidemiol Community Health. 2001 Oct; 55(10): 716–720.
  5. Walter SA, Jones MP, Talley NJ, et al. Abdominal pain is associated with anxiety and depression scores in a sample of the general adult population with no signs of organic gastrointestinal disease. Neurogastroenterol Motil. 2013; 25(9): 741-e576.
  6. Mykletun A, Jacka F, Williams L, et al. Prevalence of Mood and Anxiety Disorder in Self-Reported Irritable Bowel Syndrome (IBS). An Epidemiological Population Based Study of Women. BMC Gastroenterology 2010; 10:88, 1-9.
  7. Vanuytsel T, van Wanrooy S, Vanheel H, et al. Psychological stress and corticotropin-releasing hormone increase intestinal permeability in humans by a mast cell-dependent mechanism. Gut. 2014; 63(8): 1293-9.
  8.  Rodiño-Janeiro BK, Alonso-Cotoner C, et al. Role of Corticotropin-releasing Factor in Gastrointestinal Permeability. J Neurogastroenterol Motil. 2015; 21(1): 33-50.
  9. Leclercq S, Matamoros S, Cani PD, et al. Intestinal permeability, gut-bacterial dysbiosis, and behavioral markers of alcohol-dependence severity. Proc Natl Acad Sci U S A. 2014; 111(42): E4485-93.
  10. Attali TV, Bouchoucha M, and Benamouzig R. Treatment of refractory irritable bowel syndrome with visceral osteopathy: short-term and long-term results of a randomized trial. J Dig Dis. 2013; 14(12):654-61.
  11. Brugmana R, Fitzgerald K and Fryer G. The effect of Osteopathic Treatment on Chronic Constipation – A Pilot Study. IJOM. 2010; 13(1): 17-23.
  12. Schweria F, Wirthwein P, Rutz M, et al. Osteopathic treatment of women with primary dysmenorrhoea: A randomised controlled trial. IJOM. 2013; 13(3)127.
  13. Sillem M, Juhasz-Böss I, Klausmeier I et al. Osteopathy for Endometriosis and Chronic Pelvic Pain – a Pilot Study. Geburtshilfe Frauenheilkd. 2016; 76(9):960-963.
  14. Tamer S, Öz M, and Ülger Ö. The effect of visceral osteopathic manual therapy applications on pain, quality of life and function in patients with chronic nonspecific low back pain. J Back Musculoskelet Rehabil. 2017; 30(3):419-425.

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