Visceral Manipulation (VM)

VM is an Osteopathic manipulative technique developed by Jean-Pierre Barral, D.O. (France) who Dr. Kavieff is proud to have trained with for about 40 years.  In fact, Dr. Kavieff began Dr. Barral’s course series on The Brain at the end of 2023.  The story about VM begins with the concept that all organs have both mobility and motility.  Mobility is the ability of an organ to move within the confines of its suspensory ligaments which hold it in place against gravitational forces and to resist excessive movement with overall body movement.  Organs have enough mass to result in whiplash-like injuries to the suspensory ligaments in traumatic events like falls or car accidents.  In the case of the heart, the cardiovertebral ligaments attach the heart to the T3-T5 vertebra and are often sprained in car accidents or bad falls like in ski racing.  In most cases the mobility based VM techniques are very gentle direct techniques where  the physician puts the tissue under slight tension and follows the tissue as it unwinds and allows the mobility restriction of the organ to resolve.  At times indirect techniques can also be used.  The motility of an organ refers to the subtle motion that follows the embryologic developmental migration of the organ and then its gentle return towards an earlier phase of development.  This fluctuation is sensed by the physician and resistance to the affected movement pattern is offered and ultimately released to allow the motility to reset to a normal symmetric pattern.  

One aspect of Traditional Osteopathy that is unique is that it allows one to find the forest in the trees utilizing systems analysis rather than the linear logic algorithmic approach used by most physicians.  Let’s use a case of sciatica to illustrate this concept and the use of VM to solve the problem.  If a patient has a pain down their leg along a particular portion of the leg associated with a nerve in the lower back, and especially if an MRI shows an abnormality, it will be assumed that the problem is coming from this area.  However, if a patient falls hard like a hockey goalie on their buttocks or back, then sometimes the kidney on one side will be jarred, the suspensory ligaments sprained, and tension in the facial compartment that the kidney shares with the hamstring muscle and sciatic nerve is increased and this tightening pulls ultimately on the sciatic nerve, causing the leg pain that is called sciatica.  This situation can even result in unnecessary surgery and is one of the reasons that some say up to 90% of back surgery is unneeded.  Proper utilization of VM to restore the kidney’s mobility removes the pull on the sciatica nerve from the fascial tightening and resolves the pain.  Thank you Jeane-Pierre!