VISCERAL TECHNIQUES
25.9.2012 Lecture no.1
On the first lecture with Valeria Fereira and Enda Butler we talked about fascial network and diaphragm. In groups of six we first of all discussed a case of a 40 yoa male patient that presented with poor health (sinusitis, R diaphragm decreased function, R T8-9 costal margins tenderness, R scapular elevation, hypoxic and fatigued back/neck tissue, funnel thora and musculoskeletal issues due to hemochromatosis. I have learned that this disorder is caused by high level of iron in the blood that tend to saturate in the liver. The symptoms are of a wide range: abdominal pain, fatigue, generalized darkening of the skin colour, joint pain, lack of energy, loss of body hair, loss of sexual desire, weight loss, weakness. The treatment is phlebotomy in order to remove excess iron from the body.
We have discussed the effect of this disorder on the diaphragm, posture, CVS, vagus nerve, breathing, phrenic nerve, sinovitis (which the patient suffered from) extensively. It was interesting to see how different approaches to this presentation each group of students had and how many of us think mostly structurally. Only one group involved into their understanding of the problem fascial relations in the body.
Valeria showed us two techniques for diaphragm release. These were taught on the end of our 3rd year already so she did not explain the purpose and the aim of the technique. However, I have missed that lecture last year and not understanding what I was aiming for to achieve, I found it difficult to rehearse technique. My colleague I practices with did not seem to be helpful at explaining the forces and directions I was meant to stretch the fascia in and as we ran of the time, my questions remained unanswered. I then spoke to several colleagues about their experience and they all confirmed that they felt similar - confused and left guessing what to do. Together we tried to work out the logic behind the techniques but the interpretations vary so much I am not sure that without Valeria's detailed explanation we will work it out for ourselves.
My aim is to speak to my tutors during next lecture about the theory behind these techniques and ask them to help me practicing them.
We have discussed the effect of this disorder on the diaphragm, posture, CVS, vagus nerve, breathing, phrenic nerve, sinovitis (which the patient suffered from) extensively. It was interesting to see how different approaches to this presentation each group of students had and how many of us think mostly structurally. Only one group involved into their understanding of the problem fascial relations in the body.
Valeria showed us two techniques for diaphragm release. These were taught on the end of our 3rd year already so she did not explain the purpose and the aim of the technique. However, I have missed that lecture last year and not understanding what I was aiming for to achieve, I found it difficult to rehearse technique. My colleague I practices with did not seem to be helpful at explaining the forces and directions I was meant to stretch the fascia in and as we ran of the time, my questions remained unanswered. I then spoke to several colleagues about their experience and they all confirmed that they felt similar - confused and left guessing what to do. Together we tried to work out the logic behind the techniques but the interpretations vary so much I am not sure that without Valeria's detailed explanation we will work it out for ourselves.
My aim is to speak to my tutors during next lecture about the theory behind these techniques and ask them to help me practicing them.
2.10.2012 Lecture no.2
Today I clarified with Enda the logic behind the fascial release of the diaphragm. He explaind that the aim is always to stretch the fibres of the fascia. He lead me through the techniques and I could feel what I am supposed to aim to feel and achieve. I think that being a patient and feeling what a technique does is very usefull learning tool for me. In a future I will try to get treatment/demonstration of technique done on me as often as possible as this way it can help my learning and also I can give better feedback to my colleagues.
We later discussed the case from the last week again and then concentrated on the fascial treatment of the clavicle, sublavius muscle, and SCM muscle. I have practised these techniques with my colleague Margaret and I realised that the palpation of the fascial pulls will take time and practice in order to improve my skills. I have comprehended the aim of all three techniques this time and I am happy to practise them with my colleagues at the clinic or during study groups.
We later discussed the case from the last week again and then concentrated on the fascial treatment of the clavicle, sublavius muscle, and SCM muscle. I have practised these techniques with my colleague Margaret and I realised that the palpation of the fascial pulls will take time and practice in order to improve my skills. I have comprehended the aim of all three techniques this time and I am happy to practise them with my colleagues at the clinic or during study groups.
9.10.2012 Lecture no.3
I had a very good experience today. Finally I have realised that what we are aiming to achieve in this lectures is to listen to the tissues and allow them to go where they want to go. It is similar concept as in Balanced ligamentous tension course (BLT) I did back in spring with Sue Turner. Today we looked at the subclavius muscle, sternum and ribs. We started with the assessment of the thorax comparing the left and right, lower and upper part springiness, looking at the shoulders, AC, SC joint, also at the pull of the skin and fascia in the different directions, and the feel of the bones where they sit and how springy they are. We practised on each other these technique and I felt that whatever it was I was asked to do, it made sense to me without the need of any precise anatomical or physiological explanation. it was all about feeling and feeling only. I reckon I was in a good state of mind as i could feel extremely strongly the tissues and the life in them. It was great experience and I can not wait to use any of the learnt techniques on my patients.
16.10.2012 Lecture no.4
Today I felt a little bit overwhelmed by the amount of the techniques we were shown and how little time we got to practice only two of them. However I managed three. First of all we practices to feel for bonchies. I worked with EJ and i could appreciate the different feeling around the apexes of the lungs that to me felt like a chocolate mousse where else closer I moved towards bronchus I felt the more resistance. We talked also about the natural movement of the lungs on expiration and inspiration. we were supposed to feel them on each other and give them a little nudge once we reminded them where it their innate position and movement supposed to be. I also managed to try to work on the pec minor muscle that seemed to be quite a brutal technique. it was similar to the subclavius release but much more firmer. the patient used his own arm to move it in order to stretch the muscle. I enjoyed the lecture a lot but realised that the anatomy of the viscera is something i need to look at before the next lecture.
23.10.2012 Lecture no.5 Palpating of the GIT sphincters
Based on the last week introduction to the surface anatomy of the sphincters of the gastrointestinal tract, we spent lecture learning how to palpate and release the sphincters. Based on JP Barral's experience, the healthy sphincter has tendency to rotate on the palpation clockwise and the sphincter in the shock or the one with problem tends to prefer rotation anticlockwise. We palpated on each other sphincters and it was good to feel some of them. Personally I find difficult to palpate cardiac sphincter (eosophageal entrance to the stomach) which is sitting laterally left from xyfoid process. More than anything these lectures are good for improving palpation, and the calm atmosphere and the help from the tutors ads to the all over experience. I really enjoy these lectures and also watching videos from Gill Hedley helps to visualise what we are working on. These lectures also help me to calm down and feel the signals, tissues and movements in the body I can not palpate while in the clinic as there I find time constrains too stressful and whole experience with the patient rushed and at most times ineffective.
6.11.2012 Lecture no.6 Stomach release
Today we watched a JP Barral video on palpation and treatment of the stomach. We were shown and practised these techniques: Finding the stomach's boundaries: Pressing with the hypothenar eminence on the area of cardiac sphincter with the cranial hand while palpating with the fingers of the caudal hand around the lateral border of the rectus abdomens. we were supposed to feel for a "leather bottle" type structure. then we were palpating in the midline down from the xyphoid process and slightly laterally for a medial curvature of the stomach. other technique explored lateral and medial "shifting" of the stomach with the intention to go slightly deeply on the borders to appreciate the 3D structure. It felt like a massage of the stomach exploring possible adhesions and tightness and allowing the stomach to find its correct place. The last technique was done is a sitting position. the practitioner had a right foot on the table with the patient's right arm hanging over the practitioner's bent knee. with both hands in a style of cigarette rolling we were supposed to roll the skin from the costal margin in the midline and slightly to the left, then inserting the pads of the fingers under the costal margin, ask the patient to bend over and thus get the access into the transitional area. the fingers were facing towards practitioner's xyphoid and exploring the fascial adhesions of the stomach while shifting the patients body to the left and right. I really enjoyed the lecture today as i also benefited from the treatment as i had some stomach discomfort that feels better now.
13.11.2012 Lecture no.7 the stomach and the liver
Today we finished the stomach release/manipulation side lying and then we started to look at the liver. It is interesting to see how liver moves in relation to the diaphragm and ribs in inspiration (antero medial movement) and expiration (postero lateral movement) and what are liver's connections with the surrounding tissues ( lateral and medial triangular ligament, coronary ligament, falciform ligament (used to be umbilical cord), connection with stomach via lesser omentum and connection with ascending colon via hepatocolonic ligament). we have learned how to assess the liver in sitting position by putting the fingers of both hands below costal margin about 3 cm from the xyphoid process and get the pt to slump. then to feel is the liver is in any way obstructed on the left or right side. Depending on the findings, then we were shown two approaches for the liver release. if any obstruction is felt on the right side, then in the side lying position on the left the forces via ribs are directed toward midline and down. if the obstruction of the liver is felt on the left side, then in the same position via contact with ribs, the forces are directed superiorly and towards the midline. the slow pumping movement repeated about 10 times is recommended by Barral.
Todays lecture seemed to be a little bit disjoined and i felt that the tutor should probably have a week of holiday as she seemed to be exhausted and talking sometimes a bit off the tangin. Otherwise I still feel that the visceral release is something I'm very interested in and i can feel benefits myself from receiving treatment during the lectures.
Todays lecture seemed to be a little bit disjoined and i felt that the tutor should probably have a week of holiday as she seemed to be exhausted and talking sometimes a bit off the tangin. Otherwise I still feel that the visceral release is something I'm very interested in and i can feel benefits myself from receiving treatment during the lectures.
Lecture no.8 - Back to the liver
We carried on today to work on the liver. Valeria showed to us more techniques of palpating the liver in the supine position. she placed her cranial hand under the ribs on the back of the patients body and the elbow of this arm was pressed firmly against her ASIS so she could control the movement of the arm with her whole body. the caudal hand was placed on the top of the ribs (top of the liver). she then examined the liver moving in three planes - it was more like following where the liver wanted to go. On the student she was showing the technique she identified problem with right kidney so she released that. We watched the video to appreciate the approximity of the liver and kidney. however we did not have time to practice these techniques so perhaps we will do it next week. we only got to practice on the beginning of the lecture techniques shown the week before. I managed to get a good hold of the liver side lying. My colleague with whom i practices got to practice on me sitting release of the liver. Valeria showed her on me how to do it. it was a great experience to feel how is it supposed to be done. she used her knee to support the right hand to press down on the right ribs. it was really powerful technique.
Lecture no.9 - Kidneys
Today we watched the video of the gill hadley's disection with the aim to understand the appreciate the fact that we can not manipulate kidneys themselves because they are covered in the thick fat protective layer which we can influence by the visceral treatment. the adrenal glands themselves grow on the surface of these fat coatings and intermingle into each other.
We practised supine manipulation of the kidneys. on the right side we palpated for the gutter between the ascending colon and the duodenum descending laterally on the right side of the naval. at the level of the naval we inserted the heel (hypothenar eminence) of the caudal hand and the cranial hand was inserted on the back of the patient, just around the level of L3 segment. with the heel of the caudal hand as an autumn leaf we entered the abdominal cavity and tried to appreciate that we felt the presence of the kidneys between our hands. we then were asked to try to move them medially and up (in the direction of the psoas muscle), down, laterally and medially to feel any restrictions. we did the same on the left side apart the insertion of the hypothenar eminence into the abdomen was about 2 cm above the naval, and laterally about 3 cm. this is where the duodeno-jejunum 'DJ junction' is located.
we were shown also the side lying approaches to the kidney release. we again used the 20p point (where the lat. border of QL and the 12th rib meet). the patient had bent knees and the superior upper extremity directly touching the couch. the patient was in a semiwound up position and the practitioner inserted their thumb into the superior 20p point. patient was asked to straighten the superior leg down the plinth while the practitioner was keeping the pressure on 20p point with cranial hand thumb and rolling the patient more on their back.
We practised supine manipulation of the kidneys. on the right side we palpated for the gutter between the ascending colon and the duodenum descending laterally on the right side of the naval. at the level of the naval we inserted the heel (hypothenar eminence) of the caudal hand and the cranial hand was inserted on the back of the patient, just around the level of L3 segment. with the heel of the caudal hand as an autumn leaf we entered the abdominal cavity and tried to appreciate that we felt the presence of the kidneys between our hands. we then were asked to try to move them medially and up (in the direction of the psoas muscle), down, laterally and medially to feel any restrictions. we did the same on the left side apart the insertion of the hypothenar eminence into the abdomen was about 2 cm above the naval, and laterally about 3 cm. this is where the duodeno-jejunum 'DJ junction' is located.
we were shown also the side lying approaches to the kidney release. we again used the 20p point (where the lat. border of QL and the 12th rib meet). the patient had bent knees and the superior upper extremity directly touching the couch. the patient was in a semiwound up position and the practitioner inserted their thumb into the superior 20p point. patient was asked to straighten the superior leg down the plinth while the practitioner was keeping the pressure on 20p point with cranial hand thumb and rolling the patient more on their back.
Lecture no.10 - Pelvis
Today we finished the term off by quick revision of the female pelvis and the organs. We talked about the position, relations and attachments of the uterus and bladder. Valeria demonstrated the techniques for treatment of bladder and uterus. However the reviosion took so long that the pelvis for me remained untouched area for now. it was too much info, video and no time to practice. Mission for the future. :-)