• The fascial system consists of four concentric layers, with the visceral layer, which is the most complex, beginning at the naso-pharynx and ending at the anal aperture¹.
• The abdominopelvic canister is “A functional and anatomical construct based on the components of the abdominal and pelvic cavities that work together synergistically”².
• The walls of the canister, although part of the musculoskeletal system, are intimately connected to the visceral structures found within via fascial and ligamentous connections³.
• In order to function optimally the viscera must be able to move, not only in relationship to one another, but with respect to their surrounding container⁴.
• Most importantly, the viscera are subject to the same laws of physics as the remainder of the locomotor system with solid structures such as the liver and spleen particularly affected by blunt force trauma^{5, 6}.

Information is presented on embryology of the viscera and connective tissue system as it applies to associated visceral and fascial anatomy. The science behind and evidence supporting visceral and fascial-based manual therapy for patients with a variety of diagnoses related to musculoskeletal and pelvic health physical therapy is incorporated into each lecture.

This manual therapy course emphasizes clinical reasoning with the goal of immediate implementation of an extensive number of treatment techniques into an existing musculoskeletal and pelvic health practice. The material presented has applications for diagnosis such as abdomino-pelvic pain, gastroparesis, GERD, constipation, abdominal adhesions, and urinary issues. Additionally, the solid organs of the GI system play a profound effect on the thorax contributing to spinal issues and breathing pattern dysfunction (Bordoni & Zanier ,2013). Course work is geared toward the pelvic health therapist who wishes to integrate advanced manual therapy skills into their treatment regime for their pelvic and orthopedic clientele.

This course includes extensive lab work, all attendees should come prepared to participate as both clinician and patient. Male course attendees may participate fully in the entire course. Pregnant attendees may participate in a limited capacity, as deep palpation to the abdomen is ill- advised for pregnant women. Seminar content is targeted to licensed health care professionals working within the field of pelvic health. Content is not intended for use outside the scope of the learner’s license or regulation.

Goals and Objectives:

Upon completion of this course, participants should be able to:

• Understand the neurophysiology of fascial based manual therapy
• Understand basic fascial structure and function to include all four fascial layers and how they interrelate within the systems of the body
• Understand the biological plausibility of how alteration of the normal mobility of visceral fascial structures can contribute to multiple diagnoses related to pelvic dysfunction
• Cite potential causes for development of restrictions in the visceral fascia of the abdominal, pelvis, and thoracic cavity.
• Describe the theory and application of mobilization of visceral fascial structures as they influence the somatosensory system within the scope of a physical therapy practice
• Differentiate between direct and indirect mobilization techniques and understand the proper application of each
• Express an understanding of the visceral structures within the peritoneal cavity and how their normal mobility is related to somatic and autonomic function
• Identify visceral structures within the GI system via abdominal and pelvic landmarks
• Apply the technique of three-dimensional fascial mobilization to visceral structures, utilizing external approaches.
• Recognize and treat fascial restrictions throughout the pelvis, and abdomen as they may relate to diagnoses of dysfunction within the gastrointestinal system
• Understand the contribution of chronic G-I distention to central sensitization and the visceral-somatic reflex
• Incorporate fascial mobilization techniques into a comprehensive treatment program for the patient with varied diagnoses to include orthopedic, urologic, gynecologic, gastrointestinal, and pelvic pain as they relate to the scope of physical therapy treatment

Prerequisites:

Minimum of pelvic floor level 1 training (to be approved if not completed through PHS) to include internal vaginal examinations and relative clinical experience or Pediatric therapists that have attended a live training course such as Pediatric Incontinence and Pelvic Floor Dysfunction

Pre-course Work:

1)  Horton (2015) Clinical Review: Visceral mobilization for pelvic dysfunction

2)  Review visceral anatomy terms (will be provided)

References

Willard, F. H. (2012) Visceral fascia. In: Schleip R, Findley TW, Chaitow L, Huijing P (Eds.) Fascia-The Tensional Network of The Human Body. (pp. 53-56). Elsevier, Edinburgh.

Lee, D., Lee, L., McLaughlin, L. (2008). Stability, continence and breathing: The role of fascia following pregnancy and delivery. Journal of Bodywork and Movement Therapies, 12(4), 333-348.

Bordoni, B. & Zanier, E. (2013). Anatomic connections of the diaphragm: influence of respiration on the body system. Journal of Multidisciplinary Healthcare, 6, 281–291.

Uberoi, R., D’Costa, H., Brown, C., & Dubbins, P. (1995). Visceral slide for intraperitoneal adhesions? A prospective study in 48 patients with surgical correlation. Journal of clinical ultrasound, 23(6), 363-366.

Cheynel, N., Serre, T., Arnoux, P-J, Ortega-Deballon P., Benoit L. ,Brunet, C. (2009). Comparison of the biomechanical behavior of the liver during frontal and lateral deceleration.

Cox, E. (1984). Blunt abdominal trauma. A 5-year analysis of 870 patients requiring celiotomy. Annals of Surgery. 199(4), 467-474The Journal of Trauma, 67(1), 40-44

Registration Form

Visceral GI November 2023