ʻOsteopathy: Incorporating the Visceral Dimensionʼ

3rd 4th March 2012 Auckland

Overview

The practice of New Zealand Osteopathy is heavily influenced by the British model which is primarily, some would say overwhelmingly, musculoskeletal. Some French osteopathic schools have a very different emphasis in which 25% of the syllabus is devoted to the visceral dimension. Belgian osteopaths employ visceral diagnosis approximately 4 times as often as UK osteopaths and visceral treatment 5 times as often (2008). Are the Brits and the Kiwis missing something?

ʻMusculoskeletalʼ presentations can be of visceral origin and ʻvisceralʼ presentations of musculoskeletal origin. The incorporation of a quick, adaptable and effective visceral element into the screening routine is vital if the viscera are to be routinely assessed in the generality of osteopathic practice. The first day of the course will introduce participants to such a routine.

This weekend will look at how to differentiate these causes by screening and also testing visceral restrictions against musculoskeletal signs and symptoms to assess causation. The screening routines include mobility testing of key visceral tissue and the use of general, regional and local ʻlisteningʼ to determine tissue lesion primacy. Assessment of causation with symptomatic tissue is mostly by relieving rather than provocation testing. In this way, for example, the role of intrathoracic, abdominal or pelvic organ restriction in upper extremity, neck and lower extremity signs and symptoms can be evaluated. A ʻcranial assessment can be incorporated into the routine. Aspects of the case history which indicate a likely visceral component will be discussed.

The second day of the course will be devoted to consideration of approaches to some of (time constraining) the following: The hypertonic abdomen 
ʻIrritable Bowel Syndromeʼ,
 chronic pelvic pain, 
inferior abdominal pain (iliac fossae, suprapubic) ʻstichesʼ, hypochondral pain
, dysmenorrhea
pleuro-pericardial mobility restrictions or other conditions nominated by the participants
. The techniques demonstrated will be both direct and indirect.

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Detail Day 1

09.00 -09.15
Introduction and confirmation of participantʼs experience and expectations of course. Need for evidential testing for visceral treatment

09.15-09.45

Review of mesenteries and how to palpate and mobility test them – demonstration and practice

09.45-12.00 (15 min break at 10.15)
Demonstrations and practice of viscero-somatic connections between thoracic, abdominal and pelvic viscera and neck, upper extremity and lower extremity mobility. Some discussion of the neural, mechanical and vascular connections.
- coecum
- mesenteric roots (transverse, small intestine, sigmoid)
- liver
- stomach
- uterus/bladder
- mediastinum

12.00-13.00
Lunch

13.00- 14.00
ʻListening (global, regional and local) both visceral and somatic

14-00 -15-00
Mobility testing the intrathoracic viscera

15.00 – 17.00
An integrated screening routine: demonstration and practice

17.00
Finish for day

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Detail Day 2

09.00 – 09.15
Review and comment on previous day

09.15 – 10.15
Releasing the hypertonic (but not acute) abdomen – approaches. What to do if the screening identifies a hypertonic abdomen so individual structures cannot be palpated.

10.15 – 10.45
Irritable Bowel Syndrome some possible causes and treatment approaches techniques including cranial/ meningeal, visceral and somatic

10.45 – 11.00
Break

11.00 – 12.00

Chronic Pelvic Pain. A visceral and congestive condition? Treatment approaches, global and local.

12.00 – 13.00
Lunch

13.00 -14.00
Inferior abdominal pain: visceral and somatic structures and somatogenic reflexes. Approaches and techniques, visceral and somatic

14.00 – 14.10
Short break

14.10 – 15.15

Hypochondral pain: visceral manipulation solutions for left and right including ʻstichesʼ.

15.15.- 15.30

Questions and discussion

15.30
Finish