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E. Hebgen | S. WilmsVisceral Manipulation in Osteopathy

A Practical Handbook ISBN: 9783131472014

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Foreword to the English Edition

When asked to consider writing a foreword to VisceralManipulation in Osteopathy by Eric Hebgen, DO, I wasconflicted but intrigued. Leaving the next day to lecturein Australia, I had hoped to empty my plateful of writingprojects on the long flight, yet treatment of visceral dys-function was near dear to my heart (no pun intended). Inthe end, the title of Chapter 3 proved impossible to resist.I offered to examine the text and happily so.

The clear, uncluttered diagrams and dynamic picturesof osteopathic manipulative technique (OMT) immedi-ately impressed me. Coupled with the publisherʼs spa-cious layout, Visceral Manipulation in Osteopathy wasremarkably easy to read and “digest” (pun intended for acooking analogy!). The author is an effective chef whohas carefully balanced precise appetizers and chosen justthe right amount in each entrée to nourish—but not over-stuff—clinicians.● Appetizers: In his first four chapters, the author pares

down and deconstructs several key osteopathicapproaches; treatments reflecting both European andAmerican flavors. For complete recipes and theirrationale, the reader should really return to the origi-nal texts; but for an overview or a quick trip down“memory-lane,” the author handily summarizes ter-minology and many key concepts related to visceraltreatment.

● Entrées: Having introduced ingredients (concepts andtechniques) in the first four chapters, Eric Hebgen then

specifically serves up 18 additional organs in his won-derfully uncomplicated style. His simple clarity pro-vides immense clinical practicality.

I would like to close this foreword by observing that in1990 when we wrote our first text, Osteopathic Consider-ations in Systemic Dysfunction, we could not have imag-ined its impact. In later texts and editions, we continuedto build upon the acknowledged work of our respectedteachers and mentors (especially Korr, Denslow, Kim-berly, Frymann, and Zink), just as they built upon thework of Sutherland, Chapman, Burns and others. Asfuture texts synthesize improved, coordinated osteo-pathic approaches promoting health and visceral homeo-stasis, they will benefit from access to this text—I knowour subsequent editions will.

Because of its clear explanations, quality graphics andintent to convey some of the contributions of the authorʼscolleagues and teachers, I recommend you make this textpart of your library. While it benefits from a number ofpractical OMT “recipes,” in caring for patients I trust youwill find that Visceral Manipulation in Osteopathy will bemore than a mere cookbook.

Prof. Michael L. Kuchera, DO, FAAO(Author of Osteopathic Principles in Practice,

Osteopathic Considerations in Systemic Dysfunction,and Osteopathic Considerations in HEENT Disorders)

Thieme-VerlagFrau Kurz

Sommer-DruckFeuchtwangen

Hebgen:Visceral Manipulation

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30.8.2010Hebgen_Titelei

aus: Hebgen, Visceral Manipulation in Osteopathy (ISBN 9783131472014) © 2010 Georg Thieme Verlag KG

V

Foreword to the 3rd German Edition

During the 150 years in the history of osteopathy, numer-ous approaches have been developed.

Andrew Taylor Still, the founder of osteopathy, was farahead of his times and formulated a number of thoughtsthat continue to enjoy unchanged validity for contempo-rary medicine and for osteopathy. It was his desire towarn and preserve the medicine of his times againstoverly radical specialization and mechanization. He advo-cated a holistic and individualized perspective in medi-cine.

For this purpose, he emphasized placing the patient atthe center of the consultation. His ideal of medicine wasto first do everything in one’s power to activate the auto-regulatory powers of the patient. It was only when thelimits of autoregulation were reached that allopathyshould get involved. His first yardstick for the healthyfunctioning of the human body was movement, in thelargest sense of the word.

Eric U. Hebgen, the author of the present book, and histeacher Josi Potaznik have grasped the meaning of thisphilosophy. Especially in our modern world with its host

of stimulations and overstimulations, the osteopathicview of the patient is gaining new significance. It offersan extremely interesting approach, in the context of theviscera in particular. The decision to write this book wastherefore not far-fetched. To create a comprehensive sur-vey, Eric U. Hebgen has adopted and integrated muchinformation from previous publications by differentauthors. This book is also rooted in the visceral instruc-tions by Dr med Josi Potaznik, DO, who has collaboratedin the development of visceral instruction at the Institutefor Applied Osteopathy for a long time.

The present book serves not only as a general treat-ment of visceral manipulation, but also as a guidepostand textbook, describing the organs according to osteo-pathic criteria in their physiologic movement, definingmovement disorders, and presenting pathologic effects.

Werner Langer, DODirector, Institute for Applied Osteopathy

Bitburg, Germany




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VI

Preface

It is my pleasure and honor to offer you this book, whichwas first published in Germany in 2003 as Viszeralosteo-pathie—Grundlagen und Techniken, now in its Englishtranslation as Visceral Manipulation in Osteopathy. Thepublication of an osteopathic book in the “mothertongue” of osteopathy, as it were, appears particularly sig-nificant to me. I hope that you will find suggestions andinspiration for your daily work.

The osteopathic manipulation of the internal organs isas old as osteopathy itself. Andrew T. Still’s books showthat he already treated the internal organs. He describesmanipulations that primarily affect the organs throughthe circulatory system and aim at strengthening theirself-healing powers. William A. Kuchera, DO, and MichaelL. Kuchera, DO, compiled and refined these treatments inan outstanding book that was published in 1994. This tra-ditional American treatment approach is part of thisbook, as is the reflex therapy according to F. Chapman,DO, an American osteopath who at the start of the twen-tieth century discovered the reflex points named afterhim and linked them to certain organs, as a result ofwhich we know that treating the points improves thehealth of the organ.

European practitioners also began to manually treatthe abdominal organs in the late nineteenth century. TheSwedish gymnast Mårten Thure Emil Brandt (1819–1895), for example, developed a diagnostic and therapeu-tic method for treating the organs of the lesser pelvis.Thus, a repositioning technique for uterine prolapse isnamed after him, which is still used successfully today.Henri Stapfer, one of Brandt’s students, further refinedthese methods. The French physician Frantz Glénard(1848–1920) also described visceral palpations andmanipulations of different organs systematically duringthis time. In addition, he introduced a first visceral con-cept.

In the 1970s and 1980s, French osteopaths such asJacques Weischenk, DO, in turn took on the known treat-ment methods and developed them further. And, finally,we have Jean-Pierre Barral, DO, to thank for the fact

that the visceral manipulation of the internal organscould be established as a part of osteopathy in Europe. Hesystematized and structured existing information, carriedout his own studies, and published a visceral concept thathas become the most widespread model in Europeanosteopathy. In the present book, I have therefore devotedthe largest amount of space to Barral’s therapeuticapproach.

Furthermore, the two Belgian osteopaths GeorgesFinet, DO, and Christian Williame, DO, also carried outextensive studies in the 1980s to investigate the mobilityof the organs in relation to the movements of diaphrag-matic breathing. On the basis of their research, theydeveloped a fascial treatment of the internal organs thatsurely deserves more attention. In this book, I introduceone part of this treatment concept that I consider themost effective.

For many people, manual treatments of the internalorgans initially appear strange, and they may ask why weshould even push around on the abdomen at all. Thus, weshould take into consideration the fact that the internalorgans are affixed mechanically to each other as well asto parts of the locomotor system and are subject to thesame physical laws as the rest of the body. If we thereforerecognize them as part of the mechanics of the body andtake into account the anatomical connections, we can seehow a disturbance in the movement of an organ has anaffect on other parts of the body. Bear in mind: I am refer-ring here to an osteopathic dysfunction, as it occurs alsoin the locomotor system, and not to an illness of an organ,even though in such cases Andrew T. Still himself estab-lished the circulatory treatment method. Thus, I amfirmly convinced that the osteopathic manipulation ofthe internal organs presents an enrichment of therapeu-tic skills. Anybody who has personally discovered themwill never want to manage without them again.

Eric U. Hebgen, DO, MRO




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VII

Contents

I Foundations and Techniques . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

1 Visceral Manipulation accordingto Barral . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Theory of Visceral Manipulation . . . . . . . . . . . . . . . . . 3Physiology of Organ Movement . . . . . . . . . . . . . . . . 3

Motricity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3Mobility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3Motility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Visceral Joint . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3Double-Leaf System . . . . . . . . . . . . . . . . . . . . . . . 4Ligamentary System . . . . . . . . . . . . . . . . . . . . . . . 4Turgor and Intracavitary Pressure . . . . . . . . . . . . 4Mesenteries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4Omenta . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Pathology of Organ Movement . . . . . . . . . . . . . . . . . 4Disturbed Mobility . . . . . . . . . . . . . . . . . . . . . . . . 4Disturbed Motility . . . . . . . . . . . . . . . . . . . . . . . . 5

Diagnosis and General Treatment Principlesin Visceral Osteopathy . . . . . . . . . . . . . . . . . . . . . . . . . 5

Medical History . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5Inspection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5Palpation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

Superficial Palpation . . . . . . . . . . . . . . . . . . . . . . . 6Deep Palpation . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

Inspection and Palpation Results . . . . . . . . . . . . . . . 6Listening Tests according to Barral . . . . . . . . . . . . . . 9

Listening Test in Standing Position . . . . . . . . . . . . 9Listening Test in Seated Position . . . . . . . . . . . . . 9Listening Test in Supine Position . . . . . . . . . . . . . 9Local Listening Test . . . . . . . . . . . . . . . . . . . . . . . . 10

Sotto–Hall Test according to Barral . . . . . . . . . . . . . 11Rebound Test according to Barral . . . . . . . . . . . . . . . 11Completed Tests according to Barral . . . . . . . . . . . . 12Ventilation Test according to Barral . . . . . . . . . . . . . 12Hyperextension Test according to Barral . . . . . . . . . 12General Treatment Principles and Possibilitiesin Visceral Treatment . . . . . . . . . . . . . . . . . . . . . . . . 12Possibilities in Visceral Manipulation . . . . . . . . . . . . 13

Reflex Point Treatment according to Barral . . . . . 13

Inhibitions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13Rebound Technique . . . . . . . . . . . . . . . . . . . . . . . 13Treatment of Mobility . . . . . . . . . . . . . . . . . . . . . . 13Treatment of Motility according to Barral . . . . . . 13

2 Fascial Treatment of the Organs accordingto Finet and Williame . . . . . . . . . . . . . . . . . . . . 15

Foundations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15Principles of Diagnosis . . . . . . . . . . . . . . . . . . . . . . . . . 15Principles of Fascial Organ Treatment . . . . . . . . . . . . . 15Principles of the Technique for Expiratory Dysfunction 15Contraindications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16Hemodynamic Test . . . . . . . . . . . . . . . . . . . . . . . . . . . 16Fascial Induction Test . . . . . . . . . . . . . . . . . . . . . . . . . . 16

3 Circulatory Techniques accordingto Kuchera . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

Objective . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18Principle of the Techniques . . . . . . . . . . . . . . . . . . . . . 19

Arterial Stimulation . . . . . . . . . . . . . . . . . . . . . . . 19Venous Stimulation . . . . . . . . . . . . . . . . . . . . . . . . 19Lymphatic Stimulation . . . . . . . . . . . . . . . . . . . . . 19Vegetative Harmonization . . . . . . . . . . . . . . . . . . 19

Techniques . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20Vegetative Harmonization . . . . . . . . . . . . . . . . . . 20Lymphatic Stimulation . . . . . . . . . . . . . . . . . . . . . 24Venous Stimulation . . . . . . . . . . . . . . . . . . . . . . . . 26Diaphragm Technique . . . . . . . . . . . . . . . . . . . . . . 27

4 Reflex Point Treatment accordingto Chapman . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28

Definition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28Location and Shape . . . . . . . . . . . . . . . . . . . . . . . . . . . 28Principle of Treatment . . . . . . . . . . . . . . . . . . . . . . . . . 28Significance of the Reflex Points . . . . . . . . . . . . . . . . . 28




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II Osteopathy of the Individual Organs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31

5 The Liver . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33

Anatomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33General Facts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33Location . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33Topographic Relationships . . . . . . . . . . . . . . . . . . 33Attachments/Suspensions . . . . . . . . . . . . . . . . . . . 34Circulation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34Movement Physiology according to Barral . . . . . . 35

Physiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36Metabolic Functions of the Liver . . . . . . . . . . . . . 36

Pathologies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36Symptoms that Require Medical Clarification . . . 36Icterus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36Acute Hepatitis . . . . . . . . . . . . . . . . . . . . . . . . . . . 37Chronic Hepatitis . . . . . . . . . . . . . . . . . . . . . . . . . 37Fatty Liver . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38Liver Damage from Alcohol . . . . . . . . . . . . . . . . . . 38Cirrhosis of the Liver . . . . . . . . . . . . . . . . . . . . . . . 38Portal Hypertension . . . . . . . . . . . . . . . . . . . . . . . 38Primary Hepatocellular Carcinoma . . . . . . . . . . . . 39

Osteopathic Practice . . . . . . . . . . . . . . . . . . . . . . . . . . . 39Cardinal Symptoms . . . . . . . . . . . . . . . . . . . . . . . . 39Typical Dysfunctions . . . . . . . . . . . . . . . . . . . . . . . 39Associated Structural Dysfunctions . . . . . . . . . . . 39Atypical Symptoms . . . . . . . . . . . . . . . . . . . . . . . . 39Indications for Osteopathic Treatment . . . . . . . . . 39Contraindications for Osteopathic Treatment . . . 40Notes for Clinical Application . . . . . . . . . . . . . . . . 40

Osteopathic Tests and Treatment . . . . . . . . . . . . . . . . . 41Direct Mobilization of the Liver . . . . . . . . . . . . . . 41Indirect Mobilization of the Liver . . . . . . . . . . . . . 42Liver Pump according to Barral . . . . . . . . . . . . . . . 45Oscillations on the Liver . . . . . . . . . . . . . . . . . . . . 45Test and Treatment of Liver Motility accordingto Barral . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46Fascial Treatment according to Finetand Williame . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46Circulatory Techniques according to Kuchera . . . 47Reflex Point Treatment according to Chapman . . 47Recommendations for the Patient . . . . . . . . . . . . 48

6 The Gallbladder . . . . . . . . . . . . . . . . . . . . . . . . . . 49

Anatomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49General Facts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49Location . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49Topographic Relationships . . . . . . . . . . . . . . . . . . 50Circulation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50Movement Physiology according to Barral . . . . . . 50

Physiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51Composition of Bile in the Gallbladder . . . . . . . . . 51

Pathologies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52Symptoms that Require Medical Clarification . . . 52Cholelithiasis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52

Cholecystitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52Gallbladder Carcinoma . . . . . . . . . . . . . . . . . . . . . 52

Osteopathic Practice . . . . . . . . . . . . . . . . . . . . . . . . . . . 52Cardinal Symptom . . . . . . . . . . . . . . . . . . . . . . . . 52Typical Dysfunctions . . . . . . . . . . . . . . . . . . . . . . . 52Associated Structural Dysfunctions . . . . . . . . . . . 52Atypical Symptoms . . . . . . . . . . . . . . . . . . . . . . . . 52Indications for Osteopathic Treatment . . . . . . . . . 53Contraindications for Osteopathic Treatment . . . 53

Osteopathic Tests and Treatment . . . . . . . . . . . . . . . . . 53Murphy Sign . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53Treatment of the Sphincter of Oddi(Major Duodenal Papilla) according to Barral . . . . 53Voiding the Gallbladder in Seated Positionaccording to Barral . . . . . . . . . . . . . . . . . . . . . . . . 54Smoothing Out and Stretching the Biliary Tractaccording to Barral . . . . . . . . . . . . . . . . . . . . . . . . 54Stretching the Biliary Tract by Lifting the Liver . . 55Smoothing Out and Stretching the CommonBile Duct in Supine Position according to Barral . 55De-spasming the Gallbladder according to Barral 55Defibrosing the Gallbladder according to Barral . 56Oscillations on the Murphy Point . . . . . . . . . . . . . 56Test and Treatment of Motility in theCommon Bile Duct according to Barral . . . . . . . . . 56Fascial Treatment according to Finetand Williame . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57Circulatory Techniques according to Kuchera . . . 57Reflex Point Treatment according to Chapman . . 57Recommendations for the Patient . . . . . . . . . . . . 58

7 The Stomach . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59

Anatomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59Anatomy of the Esophagus . . . . . . . . . . . . . . . . . . . . 59

Location . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59Topographic Relationships . . . . . . . . . . . . . . . . . . 59Attachments/Suspensions . . . . . . . . . . . . . . . . . . . 59Circulation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59

Anatomy of the Stomach . . . . . . . . . . . . . . . . . . . . . 60Location . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60Topographic Relationships . . . . . . . . . . . . . . . . . . 60Attachments/Suspensions . . . . . . . . . . . . . . . . . . . 60Circulation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62Movement Physiology according to Barral . . . . . . 62

Physiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63Proximal and Distal Stomach . . . . . . . . . . . . . . . . 63Main Functions of the Stomach . . . . . . . . . . . . . . 63Gastric Juice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63Regulating the Secretion of Gastric Juice . . . . . . . 63Hormones . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64

Pathologies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65Symptoms that Require Medical Clarification . . . . . 65

Hiatus Hernia . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65




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Acute Gastritis . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66Chronic Gastritis . . . . . . . . . . . . . . . . . . . . . . . . . . 66Gastric Ulcer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66Stomach Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . 66

Osteopathic Practice . . . . . . . . . . . . . . . . . . . . . . . . . . . 67Cardinal Symptoms . . . . . . . . . . . . . . . . . . . . . . . . 67Typical Dysfunctions . . . . . . . . . . . . . . . . . . . . . . . 67Associated Structural Dysfunctions . . . . . . . . . . . 67Atypical Symptoms . . . . . . . . . . . . . . . . . . . . . . . . 67Indications for Osteopathic Treatment . . . . . . . . . 67Contraindications for Osteopathic Treatment . . . 67Notes for Clinical Application . . . . . . . . . . . . . . . . 68

Osteopathic Tests and Treatment . . . . . . . . . . . . . . . . . 69Mobilization of the Stomach . . . . . . . . . . . . . . . . . 69Oscillations on the Stomach . . . . . . . . . . . . . . . . . 72Stretching the Lesser Omentum . . . . . . . . . . . . . . 73Pylorus Treatment according to Barral . . . . . . . . . 73Mobilizing the Mediastinum to ImproveEsophageal Mobility according to Barral . . . . . . . 74Test for Deterioration of Hiatus Hernia accordingto Barral . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74Test for Improvement of Hiatus Hernia accordingto Barral . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75Treatment of Hiatus Hernia in the SeatedPosition according to Barral . . . . . . . . . . . . . . . . . 75Treatment of Hiatus Hernia in the SupinePosition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76Mobilization of the Gastroesophageal Junctionvia the Liver according to Barral . . . . . . . . . . . . . . 76Treatment of Gastroptosis according to Barral . . . 77Test and Treatment of Stomach Motilityaccording to Barral . . . . . . . . . . . . . . . . . . . . . . . . 77Fascial Treatment according to Finet andWilliame . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78Circulatory Techniques according to Kuchera . . . 78Reflex Point Treatment according to Chapman . . 78Recommendations for the Patient . . . . . . . . . . . . 79

8 The Duodenum . . . . . . . . . . . . . . . . . . . . . . . . . . 80

Anatomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80General Facts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80Location . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80Topographic Relationships . . . . . . . . . . . . . . . . . . 81Attachments/Suspensions . . . . . . . . . . . . . . . . . . . 82Circulation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82Movement Physiology according to Barral . . . . . . 82

Physiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82Pathologies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83

Symptoms that Require Medical Clarification . . . 83Duodenal Ulcer . . . . . . . . . . . . . . . . . . . . . . . . . . . 83

Osteopathic Practice . . . . . . . . . . . . . . . . . . . . . . . . . . . 83Cardinal Symptoms . . . . . . . . . . . . . . . . . . . . . . . . 83Typical Dysfunctions . . . . . . . . . . . . . . . . . . . . . . . 83Associated Structural Dysfunctions . . . . . . . . . . . 83Indications for Osteopathic Treatment . . . . . . . . . 83Contraindications for Osteopathic Treatment . . . 83

Osteopathic Tests and Treatment . . . . . . . . . . . . . . . . . 83Treatment of the Sphincter of Oddi(Major Duodenal Papilla) according to Barral . . . . 83Treatment of the Duodenojejunal Flexureaccording to Barral . . . . . . . . . . . . . . . . . . . . . . . . 84Mobilization of the Superior Part in the SeatedPosition via the Liver according to Barral . . . . . . . 84De-spasming the Descending and Horizontal Partin Side Position according to Barral . . . . . . . . . . . 85Treating the Angle between the Superior Partand the Descending Part in the Supine Position . . 85Test and Treatment of Duodenal Motilityaccording to Barral . . . . . . . . . . . . . . . . . . . . . . . . 86Fascial Treatment according to Finet andWilliame . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86Circulatory Techniques according to Kuchera . . . 86Recommendations for the Patient . . . . . . . . . . . . 87

9 The Spleen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88

Anatomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88General Facts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88Location . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88Topographic Relationships . . . . . . . . . . . . . . . . . . 88Attachments/Suspensions . . . . . . . . . . . . . . . . . . 88Circulation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88Movement Physiology according to Barral . . . . . . 89

Physiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89Pathologies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89

Symptoms that Require Medical Clarification . . . 89Splenomegaly . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89Hypersplenism . . . . . . . . . . . . . . . . . . . . . . . . . . . 90

Osteopathic Practice . . . . . . . . . . . . . . . . . . . . . . . . . . . 90Cardinal Symptom . . . . . . . . . . . . . . . . . . . . . . . . 90Typical Dysfunctions . . . . . . . . . . . . . . . . . . . . . . . 90Associated Structural Dysfunctions . . . . . . . . . . . 90Atypical Symptoms . . . . . . . . . . . . . . . . . . . . . . . . 90Indications for Osteopathic Treatment . . . . . . . . . 90Contraindications for Osteopathic Treatment . . . 90Notes for Clinical Application . . . . . . . . . . . . . . . . 90

Osteopathic Tests and Treatment . . . . . . . . . . . . . . . . . 91Test and Stretch of the Phrenicocolic Ligament . . 91Stretch of the Gastrosplenic Ligament . . . . . . . . . 92Spleen Pump . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92Fascial Treatment according toFinet and Williame . . . . . . . . . . . . . . . . . . . . . . . . 93Circulatory Techniques according to Kuchera . . . 94Reflex Point Treatment according to Chapman . . 94Recommendations for the Patient . . . . . . . . . . . . 94

10 The Pancreas . . . . . . . . . . . . . . . . . . . . . . . . . . . 95

Anatomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95General Facts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95Division . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95Location . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95Topographic Relationships . . . . . . . . . . . . . . . . . . 95




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Attachments/Suspensions . . . . . . . . . . . . . . . . . . 96Circulation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96Movement Physiology according to Barral . . . . . 96

Physiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96Insulin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96Glucagon . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97Somatostatin . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97

Pathologies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97Symptoms that Require Medical Clarification . . 97Acute Pancreatitis . . . . . . . . . . . . . . . . . . . . . . . . 97Chronic Pancreatitis . . . . . . . . . . . . . . . . . . . . . . 97Pancreatic Cancer . . . . . . . . . . . . . . . . . . . . . . . . 98

Osteopathic Practice . . . . . . . . . . . . . . . . . . . . . . . . . . 98Cardinal Symptoms . . . . . . . . . . . . . . . . . . . . . . . 98Typical Dysfunctions . . . . . . . . . . . . . . . . . . . . . . 98Associated Structural Dysfunctions . . . . . . . . . . 98Atypical Symptoms . . . . . . . . . . . . . . . . . . . . . . . 98Indications for Osteopathic Treatment . . . . . . . . 98Contraindications for Osteopathic Treatment . . 98Notes for Clinical Application . . . . . . . . . . . . . . . 98

Osteopathic Tests and Treatment . . . . . . . . . . . . . . . . 100Fascial Stretch of the Pancreas in LongitudinalAxis according to Barral . . . . . . . . . . . . . . . . . . . 100Test and Treatment of Pancreatic Motilityaccording to Barral . . . . . . . . . . . . . . . . . . . . . . . 100Fascial Technique according toFinet and Williame . . . . . . . . . . . . . . . . . . . . . . . 101Circulatory Techniques according to Kuchera . . 101Reflex Point Treatment according to Chapman . 101Recommendations for the Patient . . . . . . . . . . . 102

11 The Peritoneum . . . . . . . . . . . . . . . . . . . . . . . 103

Anatomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103General Facts . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103Location . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103Topographic Relationships . . . . . . . . . . . . . . . . . 104Attachments/Suspensions . . . . . . . . . . . . . . . . . . 104Circulation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104Movement Physiology according to Barral . . . . . 105

Physiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105Pathologies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105

Symptoms that Require Medical Clarification . . 105Peritonitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105

Osteopathic Practice . . . . . . . . . . . . . . . . . . . . . . . . . . 105Cardinal Symptom . . . . . . . . . . . . . . . . . . . . . . . 105Typical Dysfunctions . . . . . . . . . . . . . . . . . . . . . . 105Indications for Osteopathic Treatment . . . . . . . . 106Contraindications for Osteopathic Treatment . . 106Notes for Clinical Application . . . . . . . . . . . . . . . 106

Osteopathic Tests and Treatment . . . . . . . . . . . . . . . . 106Test and Treatment of Mobility accordingto Barral . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106Test and Treatment of Motility according to Barral 107Local Listening Test . . . . . . . . . . . . . . . . . . . . . . . 107Indirect Mobilization of the PeritoneumwithLong Arm Lever according to Barral . . . . . . . . . . 108

General Relief Technique according to Barral . . 108Mobilization of the Posterior Peritoneumaccording to Roussé . . . . . . . . . . . . . . . . . . . . . . 109Mobilization of the Caudal Peritoneumaccording to Roussé . . . . . . . . . . . . . . . . . . . . . . 109

12 The Jejunum and Ileum . . . . . . . . . . . . . . . . 110

Anatomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110General Facts . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110Location . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110Topographic Relationships . . . . . . . . . . . . . . . . . 110Attachments/Suspensions . . . . . . . . . . . . . . . . . . 111Circulation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111Movement Physiology according to Barral . . . . . 111

Physiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111Microscopic Wall Structure . . . . . . . . . . . . . . . . 111Regional Differences in Wall Structure betweenthe Jejunum and Ileum . . . . . . . . . . . . . . . . . . . . 112Processes of Absorption in the Jejunumand Ileum . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112Digestion of Carbohydrates . . . . . . . . . . . . . . . . . 112Digestion of Fats . . . . . . . . . . . . . . . . . . . . . . . . . 113Digestion of Proteins . . . . . . . . . . . . . . . . . . . . . . 113

Pathologies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114Symptoms that Require Medical Clarification . . 114Crohn Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . 114Celiac Disease/Sprue . . . . . . . . . . . . . . . . . . . . . . 114


Osteopathic Tests and Treatment . . . . . . . . . . . . . . . . 116Test and Treatment of the Intestinal Loops inthe Supine Position according to Barral . . . . . . . 116Test for Ptosis of the Small Intestine in theSeated or Standing Position according to Barral . 116Test and Treatment of the Mesenteric Root inthe Side Position according to Barral . . . . . . . . . 117General Relief Technique of the Peritoneumand Intestinal Loops in the Supine Positionaccording to Barral . . . . . . . . . . . . . . . . . . . . . . . 117Treatment of Intestinal Ptosis . . . . . . . . . . . . . . . 118Treatment of the Ileocecal Valve accordingto Barral . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119Test and Treatment of Motility accordingto Barral . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119Fascial Treatment according toFinet and Williame . . . . . . . . . . . . . . . . . . . . . . . 120Circulatory Techniques according to Kuchera . . 120Reflex Point Treatment according to Chapman . 121Recommendations for the Patient . . . . . . . . . . . 121




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Contents XIII

13 The Colon . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 122

Anatomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 122General Facts . . . . . . . . . . . . . . . . . . . . . . . . . . . 122Location . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 122Topographic Relationships . . . . . . . . . . . . . . . . . 123Attachments/Suspensions . . . . . . . . . . . . . . . . . . 124Circulation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 124Movement Physiology according to Barral . . . . . 126

Physiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126Pathologies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126

Symptoms that Require Medical Clarification . . 126Appendicitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126Ulcerative Colitis . . . . . . . . . . . . . . . . . . . . . . . . . 126Irritable Bowel Syndrome . . . . . . . . . . . . . . . . . . 127Diverticulitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127Colorectal Cancer . . . . . . . . . . . . . . . . . . . . . . . . 127

Osteopathic Practice . . . . . . . . . . . . . . . . . . . . . . . . . . 127Cardinal Symptoms . . . . . . . . . . . . . . . . . . . . . . . 127Typical Dysfunctions . . . . . . . . . . . . . . . . . . . . . . 127Associated Structural Dysfunctions . . . . . . . . . . 127Atypical Symptoms . . . . . . . . . . . . . . . . . . . . . . . 127Indications for Osteopathic Treatment . . . . . . . . 128Contraindications for Osteopathic Treatment . . 128

Osteopathic Tests and Treatment . . . . . . . . . . . . . . . . 128Mobilization of the Cecum according to Barral . 128Combined Treatment of the Cecumwith LegLever according to Barral . . . . . . . . . . . . . . . . . . 130Mobilization of the Sigmoid Colon accordingto Barral . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 130Treatment of the Sigmoid Mesocolon . . . . . . . . . 131Combined Treatment of the Sigmoid with LegLever according to Barral . . . . . . . . . . . . . . . . . . 132Mobilization of the Ascending Colonaccording to Barral . . . . . . . . . . . . . . . . . . . . . . . 133Lengthwise Stretch of the Ascending Colonaccording to Barral . . . . . . . . . . . . . . . . . . . . . . . 133Treatment of the Toldt Fascia according to Barral 134Test and Treatment of the Colic Flexuresaccording to Barral . . . . . . . . . . . . . . . . . . . . . . . 134Stretching Both Flexures Simultaneouslyaccording to Barral . . . . . . . . . . . . . . . . . . . . . . . 135Mobilization of the Flexures in the SagittalPlane according to Barral . . . . . . . . . . . . . . . . . . 135Treatment of Motility according to Barral . . . . . 136Fascial Treatment according toFinet and Williame . . . . . . . . . . . . . . . . . . . . . . . 136Circulatory Treatment according to Kuchera . . . 137Reflex Point Treatment according to Chapman . 138Recommendations for the Patient . . . . . . . . . . . 138

14 The Kidneys . . . . . . . . . . . . . . . . . . . . . . . . . . . 139

Anatomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139General Facts . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139Location . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139Topographic Relationships . . . . . . . . . . . . . . . . . 140

Attachments/Suspensions . . . . . . . . . . . . . . . . . . 140Circulation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 140Movement Physiology according to Barral . . . . . 141

Physiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141Functions of the Kidney . . . . . . . . . . . . . . . . . . . 141

Pathologies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141Symptoms that Require Medical Clarification . . 141Nephrolithiasis . . . . . . . . . . . . . . . . . . . . . . . . . . 141Acute Pyelonephritis . . . . . . . . . . . . . . . . . . . . . . 141Nephrotic Syndrome . . . . . . . . . . . . . . . . . . . . . . 141Renal Cell Carcinoma . . . . . . . . . . . . . . . . . . . . . 142


Osteopathic Tests and Treatment . . . . . . . . . . . . . . . . 144Palpation of the Kidney according to Barral . . . . 144Mobilization of the Kidney . . . . . . . . . . . . . . . . . 145Treatment of Grynfeltt Triangle accordingto Barral . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147Test and Treatment of Kidney Motility accordingto Barral . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 148Fascial Treatment according toFinet and Williame . . . . . . . . . . . . . . . . . . . . . . . 148Circulatory Treatment according to Kuchera . . . 148Reflex Point Treatment according to Chapman . 149Recommendations for the Patient . . . . . . . . . . . 149

15 The Urinary Bladder . . . . . . . . . . . . . . . . . . . 150

Anatomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 150Anatomy of the Urinary Bladder . . . . . . . . . . . . . . 150

General Facts . . . . . . . . . . . . . . . . . . . . . . . . . . . . 150Location . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 150Topographic Relationships . . . . . . . . . . . . . . . . . 150Attachments/Suspensions . . . . . . . . . . . . . . . . . 152Circulation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 153

Anatomy of the Ureter . . . . . . . . . . . . . . . . . . . . . . 153General Facts . . . . . . . . . . . . . . . . . . . . . . . . . . . . 153Location . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 153Topographic Relationships . . . . . . . . . . . . . . . . . 154Attachments/Suspensions . . . . . . . . . . . . . . . . . . 154Circulation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 155Movement Physiology according to Barral . . . . . 155

Physiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 155Mechanism of Bladder Filling and Voiding . . . . . 155Micturition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 155

Pathologies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 155Symptoms that Require Medical Clarification . . 155Cystitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 155

Osteopathic Practice . . . . . . . . . . . . . . . . . . . . . . . . . . 156Cardinal Symptoms . . . . . . . . . . . . . . . . . . . . . . . 156Typical Dysfunctions . . . . . . . . . . . . . . . . . . . . . . 156




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Associated Structural Dysfunctions . . . . . . . . . . 156Atypical Symptoms . . . . . . . . . . . . . . . . . . . . . . . 156Indications for Osteopathic Treatment . . . . . . . . 156Contraindications for Osteopathic Treatment . . 156Notes for Clinical Application . . . . . . . . . . . . . . . 156

Osteopathic Tests and Treatment . . . . . . . . . . . . . . . . 158Test and Treatment of Bladder Mobility Craniallyin the Supine Position according to Barral . . . . . 158Mobilization Cranially in the Seated Positionaccording to Barral . . . . . . . . . . . . . . . . . . . . . . . 159Mobilization of the Pubovesical Ligamentaccording to Barral . . . . . . . . . . . . . . . . . . . . . . . 160Combined Technique for the Median UmbilicalLigament, Medial Umbilical Ligament, andPubovesical Ligament in the Supine Positionaccording to Barral . . . . . . . . . . . . . . . . . . . . . . . 160Combined Technique for Stretching the Ureterin the Seated Position according to Barral . . . . . 161Ureter Mobilization via the Peritoneum . . . . . . . 161Obturator Foramen Technique . . . . . . . . . . . . . . 162Test and Treatment of Motility . . . . . . . . . . . . . . 162Circulatory Techniques according to Kuchera . . 163Reflex Point Treatment according to Chapman . 163Recommendations for the Patient . . . . . . . . . . . 164

16 The Uterus / Fallopian Tubes /Ovaries . . . 165

Anatomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 165Anatomy of the Uterus . . . . . . . . . . . . . . . . . . . . . . 165

General Facts . . . . . . . . . . . . . . . . . . . . . . . . . . . . 165Location . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 165Topographic Relationships . . . . . . . . . . . . . . . . . 165Attachments/Suspensions . . . . . . . . . . . . . . . . . . 165Circulation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 165

Anatomy of the Ovaries . . . . . . . . . . . . . . . . . . . . . 166General Facts . . . . . . . . . . . . . . . . . . . . . . . . . . . . 166Location . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 166Topographic Relationships . . . . . . . . . . . . . . . . . 166Attachments/Suspensions . . . . . . . . . . . . . . . . . . 166Circulation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 166Movement Physiology according to Barral . . . . . 167

Physiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 167Hypothalamus . . . . . . . . . . . . . . . . . . . . . . . . . . . 167Hypophysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 167Hormones of the Ovaries . . . . . . . . . . . . . . . . . . 167Ovarian Cycle . . . . . . . . . . . . . . . . . . . . . . . . . . . 168Cycle of the Uterine Mucosa . . . . . . . . . . . . . . . . 168Menopause . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 168

Pathologies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 169Symptoms that Require Medical Clarification . . 169Myoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 169Endometriosis . . . . . . . . . . . . . . . . . . . . . . . . . . . 169Salpingitis/Oophoritis . . . . . . . . . . . . . . . . . . . . . 169

Osteopathic Practice . . . . . . . . . . . . . . . . . . . . . . . . . . 170Cardinal Symptoms . . . . . . . . . . . . . . . . . . . . . . . 170Typical Dysfunctions . . . . . . . . . . . . . . . . . . . . . . 170Associated Structural Dysfunctions . . . . . . . . . . 170

Atypical Symptoms . . . . . . . . . . . . . . . . . . . . . . . 170Indications for Osteopathic Treatment . . . . . . . . 170Contraindications for Osteopathic Treatment . . 170Notes for Clinical Application . . . . . . . . . . . . . . . 170

Osteopathic Tests and Treatment . . . . . . . . . . . . . . . . 171Test and Treatment of the Fundus of theUterus according to Barral . . . . . . . . . . . . . . . . . 171Test and Treatment of the Ovaries and BroadLigament of the Uterus according to Barral . . . . 172Mobilization of the Uterus via the Medianand Medial Umbilical Ligaments in the SupinePosition according to Barral . . . . . . . . . . . . . . . . 172Combined Mobilization of the Uterus with LegLever in the Supine Position according to Barral 172Obturator Foramen Technique . . . . . . . . . . . . . . 173Test and Treatment of Motility according toBarral . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 173Circulatory Techniques according to Kuchera . . 174Reflex Point Treatment according to Chapman . 174Recommendations for the Patient . . . . . . . . . . . 175

17 The Thorax . . . . . . . . . . . . . . . . . . . . . . . . . . . . 176

Anatomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 176Anatomy of the Heart . . . . . . . . . . . . . . . . . . . . . . . 176

General Facts . . . . . . . . . . . . . . . . . . . . . . . . . . . . 176Location . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 176Topographic Relationships . . . . . . . . . . . . . . . . . 177Attachments/Suspensions . . . . . . . . . . . . . . . . . 177Circulation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 178

Anatomy of the Lung . . . . . . . . . . . . . . . . . . . . . . . 178General Facts . . . . . . . . . . . . . . . . . . . . . . . . . . . . 178Location . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 178Topographic Relationships . . . . . . . . . . . . . . . . . 180Attachments/Suspensions . . . . . . . . . . . . . . . . . . 180Circulation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 180

Anatomy of the Mediastinum . . . . . . . . . . . . . . . . 181Movement Physiology . . . . . . . . . . . . . . . . . . . . 183

Physiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 183Physiology of the Heart . . . . . . . . . . . . . . . . . . . . . 183

Systole . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 183Diastole . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 184

Physiology of the Lung . . . . . . . . . . . . . . . . . . . . . . 184Pathologies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 185

Symptoms that Require Medical Clarification . . 185Coronary Heart Disease . . . . . . . . . . . . . . . . . . . 185Obstructive Pulmonary Disease . . . . . . . . . . . . . 185Restrictive Pulmonary Disease . . . . . . . . . . . . . . 186

Osteopathic Practice . . . . . . . . . . . . . . . . . . . . . . . . . . 186Cardinal Symptoms . . . . . . . . . . . . . . . . . . . . . . . 186Typical Dysfunctions . . . . . . . . . . . . . . . . . . . . . . 186Associated Structural Fixations . . . . . . . . . . . . . . 186Atypical Symptoms . . . . . . . . . . . . . . . . . . . . . . . 186Indications for Osteopathic Treatment . . . . . . . . 186Contraindications for Osteopathic Treatment . . 187Notes for Clinical Application . . . . . . . . . . . . . . . 187

Osteopathic Tests and Treatment . . . . . . . . . . . . . . . . 188




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Contents XV

Test and Treatment of the Ligaments of theCoracoid Process according to Barral . . . . . . . . . 188Test and Treatment of the CostoclavicularLigament according to Barral . . . . . . . . . . . . . . . 189Compression and Decompression of theClavicle Along the Longitudinal Axis accordingto Barral . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 189Fascial Mobilization of the Clavicle . . . . . . . . . . . 190Compression and Decompression of theSternum according to Barral . . . . . . . . . . . . . . . . 191Mobilization of the Corpomanubrial Junction ofthe Sternum . . . . . . . . . . . . . . . . . . . . . . . . . . . . 192Mobilization of the Corpoxiphoid Junction ofthe Sternum . . . . . . . . . . . . . . . . . . . . . . . . . . . . 192Mobilization of the Sternocostal Joints . . . . . . . . 193Sternal Lift according to Barral . . . . . . . . . . . . . . 193Mobilization of the Subclavius according toBarral . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 194Mobilization of the Transversus Thoracisaccording to Barral . . . . . . . . . . . . . . . . . . . . . . . 194

Mobilization of the Clavipectoral Fasciaaccording to Barral . . . . . . . . . . . . . . . . . . . . . . . 195Mobilization of the GreaterSupraclavicular Fossa . . . . . . . . . . . . . . . . . . . . . 195Pectoral Lift according to Barral . . . . . . . . . . . . . 196Mobilization of the Mediastinum according toBarral . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 196Sternocostal Fascial Release in Prone Position . . 197Fascial Mobilization on Top of theCoronary Arteries . . . . . . . . . . . . . . . . . . . . . . . . 197Treatment of the Lung and Pleura . . . . . . . . . . . 198Circulatory and Reflexive Treatment accordingto Kuchera . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 198Reflex Point Treatment according to Chapman . 198Recommendations for the Patient . . . . . . . . . . . 199The Five Exercises according to Fulford . . . . . . . 199

Bibliography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 200

Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 201




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XVI Contents

Introduction

Explaining the Conceptsof Jean-Pierre Barral, Georges Finetand Christian Williame, William andMichael Kuchera, and Chapman

The following chapters offer a description of the osteo-pathic manipulation of the internal organs. I will intro-duce you to four treatment concepts that have onefeature in common: all of them use the anatomy of thebody as the foundation for the development of each par-ticular concept. In the following paragraphs, I would liketo explain the differences between these concepts.

The manipulation of the internal organs according toJean-Pierre Barral, DO, is the standard method of visceralosteopathy in Europe. In this method, Barral views theorgans from a mechanical perspective: organs form vis-ceral joints with another organ or a part of the locomotorsystem, e.g., the diaphragm. Similar to joints in the loco-motor system, the partners of a joint move against eachother in fixed directions and ranges. To ensure that thismovement is executed with as little friction as possible,the partners of a parietal joint are characterized by asmooth surface and by the synovium, which producessmall amounts of joint fluid. Likewise, the organs have asmooth surface as their external surface is sealed off by alayer of serous skin. This layer is the peritoneum, thepleura, or the endocardium. Furthermore, we find a smallamount of fluid in the serous cavities between theorgans. The organs do not move against each other hap-hazardly but are subject to certain laws: they are fastenedto each other and to the locomotor system by the mesen-teries, omenta, or ligaments. This limits their range ofmotion. We also find this feature in the joints of the loco-motor system. Ligaments permit and limit the extent anddirection of movement.

Barral hence constructs his theory parallel to the pari-etal joints. His treatment techniques are also, to a largeextent, informed by them. Similar to the parts of a joint,the organs are tested for their ability to move and directlytreated to increase mobility, until a normal range ofmotion is restored. It is only his concept of visceral motil-ity that follows a more energetic approach, which I willtreat in more detail below.

Georges Finet, DO, and Christian Williame, DO, twoBelgian osteopaths, carried out extensive radiograph- andultrasound-supported studies in the 1980s, to examinethe movements of the abdominal organs in relation todiaphragmatic breathing. In the course of their research,they discovered organ movements that follow certainrules. For the organs that they studied, they defined

movement directions and extents, which largely concurwith Barral’s results. In addition, they developed a treat-ment method to influence disturbed organ movementsand were also able to control their method using X-raysor ultrasound waves. In contrast to Barral, who palpatesthe organs and moves them directly in his mobilizingtechniques, Finet and Williame utilize the anterior parie-tal peritoneum in their therapy. By moving the perito-neum, they achieve a mobilizing effect without palpatingthe organ itself. They call their method fascial becausethe peritoneum is seen as fascia and connects all abdomi-nal organs with each other. If you pull on one part of theanterior peritoneum, this also has an effect on a distantregion, e.g., the peritoneum of the pancreas. You couldcompare the peritoneal cover to a balloon: if you push orpull on one part of the balloon, this pull spreads through-out the entire balloon and deforms it.

Ultimately, both treatment concepts succeed in restor-ing the physiologic mobility of an organ, with the onlydifference being that Finet and Williame do so a little lessinvasively. The indication for this method thus alsoextends to organs that, because of a disorder, should notbe palpated and mobilized directly. In this book, I intro-duce what I believe to be the most effective techniquefrom the treatment concept according to Finet and Wil-liame, namely expiratory dysfunction. I consider it partic-ularly successful because the mobilizing effect is hereinachieved by the diaphragm in the context of respiration,meaning that the patient’s body is thus carrying out thereal “work” itself.

In the circulatory movements according to William A.Kuchera, DO, and Michael L. Kuchera, DO, the osteopathdoes not aim at contact with the affected organ, butrather analyzes which arteries, veins, vegetative nerves,and lymphatic vessels supply an organ and dispose of itswaste, using special techniques to influence the circula-tion of the organ. In this technique, the mobilization ofthe organ is not of primary importance. This concept isthus an excellent complement to the mobilizing conceptsof Barral and Finet/Williame. These manipulations areless invasive and far too little known in some countries.For didactic reasons, I have recorded the appropriatetechniques for each organ, knowing full well that an exactseparation of its circulation and therefore an isolatedtreatment of an individual organ is not possible. The tech-niques themselves are described all together in the gen-eral section of the book.

The fourth treatment concept is the reflex therapyaccording to Frank Chapman, DO. The Chapman pointsare a valuable diagnostic tool, can provide follow-upresults after treatment with visceral manipulation, and




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VIII

take advantage of the vegetative nervous system to influ-ence the internal organs. Reflex therapy should be foundin every therapeutic tool kit. The Chapman points havebecome highly valued tools for me.

These treatment techniques are supplemented by con-cise information about the physiology and clinical pathol-ogy of the individual organs. This information is notintended to be exhaustive but rather as a quick referencesource in one’s daily work.

While reading this book, you will encounter the term“central tendon” again and again. This is not to be con-fused with the “core link.” That term is used in the Eng-lish literature to refer to the connection between the baseof the skull and the sacrum or coccyx via the dura mater.The central tendon, by contrast, refers to a fascial stringthat also runs through the body from the base of the skullto the pelvic floor, but is located anterior to the spinalcolumn in the superficial and deeper-lying fascial layersof the body and does not include the dura mater. This fas-

cial continuum works together as a functional unit: if adysfunction is present in the body that should be pro-tected in a global chain of protection, the central tendoncan collaborate in this effort. The ability to carry out a fas-cial contraction is therefore of great importance. The fas-cia contracts towards the location of the dysfunction,thereby contributing to the protection of this area. As thefascial organ coverings (peritoneum, pericardium, pleura)are integrated into this system, compensatory increasesin tension are also found in this fascia. As circulationpasses through the fascia, elevated fascial tension disturbsthe circulation of the tissue behind it. In concrete terms,this means that pathologic tension in the central tendondisturbs the circulation in the organs and can be the trig-ger point for impaired organ function or result in areduced ability of the organ to compensate for biological,physical, or chemical noxa. Restoring normal tension inthe central tendon is hence of vital importance for undis-turbed organ function.




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Introduction IX

95

10 The Pancreas

Anatomy

General Facts

The pancreas is 14–18cm long and weighs 70–80g. It is agland with exocrine and endocrine features.

Division

● head of pancreas with the uncinate process● body of pancreas● tail of pancreas● pancreatic duct (Wirsung)● accessory pancreatic duct (Santorini)

Location

The pancreas is a secondarily retroperitoneal organ. It lieson the median line roughly at the level L1–L2, with thehead lower than the tail: the axis of the body is inclinedtoward the upper left approximately 30° to the horizontalline.

The accessory pancreatic duct, if present, enters theduodenum 2–3cm above the major duodenal papilla.

Topographic Relationships

● duodenum● L2–L3 (head of pancreas), covered by the right crus of

the diaphragm● common bile duct● aorta● inferior vena cava● left renal vein




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Urinary bladder

Sigmoid colon

Ureter

Inferior mesenteric artery

Superior mesenteric artery

Kidney

Portal vein

Pancreas

Suprarenal gland

Common iliac arteryand vein

Testicular artery and vein

Aorta

Duodenum

Common bile ductHepatic ductCystic duct

Inferior vena cava

Celiac trunk

Hepatic veins

Common hepatic artery

Fig.10.1 Topographic relationships of the pancreas.

96 10 The Pancreas

● pylorus● superior mesenteric artery and vein● duodenojejunal flexure● omental bursa● stomach● kidneys● transverse mesocolon (divides the pancreas into a

sub- and a supramesocolic part)● transverse colon● left colic flexure● splenic vein● peritoneum● spleen● lesser omentum● portal vein

Attachments/Suspensions

● organ pressure● turgor● attachments of connective tissue in the retroperito-

neal space● pancreaticosplenic ligament● retropancreatic fascia (Treitz)● transverse mesocolon● duodenum

Circulation

Arterial

● superior mesenteric artery● gastroduodenal artery (from the common hepatic

artery)● splenic artery

Venous

● superior mesenteric vein● portal vein (from the splenic vein and pancreaticoduo-

denal veins)

Lymph Drainage

● direct lymphatic connections to nearby organs (duo-denum)

● via celiac lymph nodes to the gastric and hepaticlymph nodes on the left side of the body

● mediastinal and cervical lymph nodes● pancreaticolienal lymph node and pylorus● mesenteric and periaortal lymph nodes

Innervation

● sympathetic nervous system from T5 to T9 (sometimesalso T10 and T11) via the major splanchnic nerve, withswitching in the celiac plexus

● vagus nerve

Organ Clock

Maximal time: 9–11a.m.Minimal time: 9–11p.m.

Organ–Tooth Interrelationship

For basic information, see page 34.

● First back tooth in the lower jaw, right side● First molar in the upper jaw on the right side

Movement Physiology according to Barral

Mobility

Due to the good fascial anchoring in the retroperitonealspace, it is impossible to detect a separate mobility.Nevertheless, the movements of the neighboring organsand the diaphragm cause pushing and pulling on the pan-creas.

Motility

With a hand that rests on the projection of the pancreason the abdomen (fingers pointing to the tail, thenar liesabove the head), we can detect a wave from the heel ofthe hand to the fingertips during exhalation. During inha-lation, the wave runs in the opposite direction.

Physiology

The pancreas is a gland with exocrine and endocrine fea-tures. The endocrine parts, the islets of Langerhans, aredistributed throughout the entire pancreas with accumu-lations in the body and tail. The cells in the islets of Lan-gerhans produce the hormones that are responsible forregulating blood sugar: insulin, glucagon, and somatosta-tin.

Insulin

Insulin is synthesized in the β cells of the islets of Langer-hans (approximately 2mg/day) and lowers the bloodsugar level by making the cell wall of each body cell per-meable to glucose. In addition, insulin assists in theuptake of different amino acids into the cell.




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Pathologies 97

In the liver, it initiates a variety of metabolic pro-cesses:● glycogen synthesis and inhibition of glycogenolysis● synthesis of lipids and inhibition of lipolysis● inhibition of protein breakdown

Glucagon

Glucagon is produced in the α cells of the islets. It is the“insulin antagonist”: by promoting glycogenolysis andgluconeogenesis in the liver, it raises the blood sugarlevel.

Somatostatin

The δ cells synthesize this hormone. It suppresses therelease of insulin and glucagons, and decreases digestiveactivity by reducing intestinal peristalsis and inhibitingthe secretion of digestive juices. Its function is to maintainthe glucose level as much as possible.

The exocrine gland part of the pancreas secretes juiceinto the pancreatic duct. As a result of its activity, approx-imately 1–1.5L of “abdominal saliva” thus reaches theduodenum per day.

This secretion consists of:● bicarbonate to neutralize the acidic chyme from the

stomach● trypsinogen and chymotrypsinogen (enzymes for

digesting protein)● α-amylase (also present in the saliva of the mouth) for

cleaving carbohydrates● lipase (enzyme for cleaving fat)

The enzymes of this “abdominal saliva” are not yet acti-vated in the pancreas. It is only after contact with bile orthe enterokinase in the duodenal juice that they are acti-vated and begin working. If this activation takes place inthe pancreas, it results in autodigestion and the symp-toms of acute pancreatitis.

Pathologies

Symptoms that Require Medical Clarification

● Icterus● Pain in the depth of the upper abdomen with back

pain in the area of the lower thoracic spinal column,radiating beltlike from the back to the front

● “Rubber stomach”

Acute Pancreatitis

Definition. Inflammation of the pancreas with disturb-ance of exocrine and endocrine functions.

Causes● biliary tract disorders (40–50%)● alcohol abuse (30–40%)● idiopathic (10–30%)

Rare causes include:● medications (diuretics, β blockers, glucocorticoids,

antibiotics, nonsteroidal antirheumatics)● trauma● infections (mumps, Coxsackievirus)● hypercalcemia (e.g., hyperparathyroidism)● hyperlipoproteinemia● papillary stenosis

Clinical● guiding symptom: severe upper abdominal pain, aris-

ing approximately 8–12hours after a large meal oralcohol abuse, with pain radiating into the back andringlike to the left around the torso

● shock

Chronic Pancreatitis

Definition. Chronic inflammation of the pancreas is char-acterized by persistent or recurrent pain with usuallyirreversible morphologic changes in the pancreaticparenchyma and functional disturbances in the pancreas.

Causes● alcohol (70–90%)● idiopathic (10–25%)

Rare causes include:● anomalies in the pancreatic duct system● hyperparathyroidism● trauma● abuse of analgesics




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100 10 The Pancreas

Osteopathic Tests and Treatment

Fascial Stretch of the Pancreasin Longitudinal Axis according to Barral

Fig.10.2

Starting PositionThe patient is in the supine position, legs bent. The prac-titioner stands on the patient’s right side at the height ofthe pelvis.

ProcedurePlace your left hand on the abdomen, with the fingers onthe projection of the head of the pancreas. The right handis placed with the thenar on the projection of the tail ofthe pancreas. Now apply gentle pressure posteriorly withboth hands, compressing the superficial tissue on top ofthe pancreas. When you have reached the fascial plane ofthe pancreas, stretch with both hands simultaneouslyalong the longitudinal axis of the pancreas and hold thepull until you notice a fascial release.

Test and Treatment of Pancreatic Motilityaccording to Barral

Fig.10.3

Starting PositionThe patient is in the supine position, legs stretched out.The practitioner sits by the patient’s right side.

ProcedureThe right hand of the practitioner rests without pressureon the projection of the pancreas on the abdomen—thethenar on the head, the fingertips on the tail. The forearmalso rests on the abdomen.

During exhalation, you will notice a wavelike move-ment from the heel of the hand to the fingertips, duringinhalation it is in the opposite direction.

Testing SequenceDetect the motility motion and evaluate the amplitudeand direction of the inspiratory and expiratory move-ments as well as the rhythm of the movement as a whole.If a disturbance is present in one or both aspects of themotility movement, treat the patient.

TreatmentMotility is treated indirectly by following the unimpairedmovement, remaining at the end-point of this movementfor several cycles, and then following the impaired move-ment to the new end-point.

You can also try to increase the range of the freemovement (induction), afterward checking whether thelimited movement direction has improved.

Repeat this movement again and again until the motil-ity has returned to normal in terms of rhythm, direction,and amplitude.




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Osteopathic Tests and Treatment 101

Fascial Technique according toFinet and Williame

Fig.10.4

Starting PositionThe patient is in the supine position, legs stretched out.The practitioner stands on the patient’s right side.

ProcedurePlace your right hand on the projection of the pancreaswith the heel of the hand on the head and the fingertipson the tail. Place your left hand on the posterior projec-tion of the pancreas with the heel of the hand on thehead and the fingertips on the tail.

TreatmentDuring inhalation, pull caudally with both hands at thesame time; during exhalation hold the position reached.Repeat this procedure until you have reached the end ofthe fascial movement. In the next exhalation, release thepull.

Repeat the whole treatment four or five times.

Circulatory Techniques according to Kuchera

Arterial Stimulation

● stimulation of the celiac trunk and superior mesen-teric artery by working on the spinal column

● diaphragm techniques

Venous Stimulation

● liver pump● stretching the hepatoduodenal ligament● diaphragm techniques

Lymphatic Stimulation

● lymph drainage on thorax and abdomen● diaphragm techniques

Vegetative Harmonization

Sympathetic nervous system:Stimulation of the sympathetic trunk T5–T9 by:● rib raising● inhibiting the paravertebral muscles● vibrations● manipulations● Maitland technique● stimulation of the celiac plexus● diaphragm techniques

Parasympathetic nervous system:Stimulation of the vagus nerve by:● craniosacral therapy● laryngeal techniques● thoracic techniques (recoil)● diaphragm techniques

Reflex Point Treatment according to Chapman

Location

Anterior. Intercostal space between ribs 7 and 8 on theright side, near the rib cartilage.

Posterior. Between the two transverse processes of T7and T8, halfway between the spinous process and the tipof the transverse process; present only on the right side!

Treatment Principle

Make contact with the reflex point. For this purpose, verygently place a finger on the point and press only lightly.Reflex points are often very sensitive, and it is thereforeimportant to proceed with caution.

The finger remains on the point and treatment is bygentle rotations.




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182 17 The Thorax

Lateral. Both halves of the lung.In this space, we find a large number of important

structures that are essential for the vitality of the entirebody:● heart with pericardium● the major arteries and veins of the body:

– aorta– pulmonary artery– SVC– pulmonary veins

● esophagus● trachea● main bronchi● vagus nerve● phrenic nerve● sympathetic trunk● thymus● azygos vein● hemiazygos vein● thoracic duct

These organs and circulatory structures are linked to eachother by connective tissue. This ensures good fixation inthe mediastinum. However, sufficient mobility must bepresent to follow the movements of the torso, arm, andhead and neck, e.g., the esophagus and other organs

must be able to stretch in a craniocaudal direction duringa neck extension.

Another factor that requires mobility is the expansionof the lung and the movements caused by diaphragmaticbreathing. The mediastinum thus experiences alternatingpushing and pulling.

Lastly, heartbeats, in the sense of oscillations, alsohave an impact on the mediastinal structures.

Thus we can see that continuous, even if partly onlyminor, movements in this apparently motionless spaceaffect the organs of the mediastinum. This fact is particu-larly significant for the blood flow back into the heart,which is influenced by the suction effect of respiration,and for the nerve structures that are stimulated in theosteopathic sense by this constant movement.

The mediastinum is tied into the fascial system of the“central tendon.” It constitutes the thoracic aspect of afascial pull that reaches from the base of the skull downto the lesser pelvis. As a result, we can see fascial struc-tural adaptations in the mediastinum that could lead tosymptoms in the thorax but have their cause in a differ-ent location in the body.

As a result of the vital importance of the mediastinalstructures, abnormal fascial pulls can lead to significantfunctional changes. Here, we might consider the vagusinnervation or the clinical picture of a hiatus hernia.




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Bronchi

Aorta

Left lungHemiazygos vein

Pulmonary vein

Left atrium

Left ventricle

Mitral valve

Right ventricle

Tricuspid valve

Thoracic duct

Inferior venacava

T8

Esophagus

Oblique sinusof the pericardium

Pulmonary vein

Pericardium

Sternum

Azygos vein

Fig.17.6 Topography of the mediastinum: transverse view.

Physiology 183

Movement Physiology

Respiration is the motor for the regular movement of thethorax. An average of 12–14 breaths/min require thechest to expand and contract rhythmically in its sagittaland transverse diameters.

In biomechanical terms, we distinguish between twomovement directions of the ribs: the rotational axis ofthe upper ribs that runs through the costotransverse andcostovertebral joints lies almost parallel to the frontalplane—during inhalation, the result is mainly an expan-sion of the sagittal diameter of the chest.

The rotational axis of the lower ribs lies almost in thesagittal plane. By raising the ribs during inhalation, theresult is thus primarily an enlargement of the transversediameter of the thorax.

The central ribs have a movement axis that forms a45° angle to the sagittal plane. Inhalations here lead to anexpansion in the sagittal and transverse diameters.

In the sternum, the movement of the ribs causes a risecranially and an increase in the distance to the spinal col-umn—the sternum moves anteriorly and superiorly dur-ing inhalation. Movements therefore occur in both thesternocostal and the chondrocostal joints.

In the chondrocostal junction, the rib cartilages expe-rience a torsion that is of great significance for the elasticand passive return of the thorax from the inhalatory posi-tion to the respiratory rest position.

Inhalation is a process that is directed by respiratorymuscles: easy respiration involves the diaphragm and thescalene and intercartilaginous muscles. These extend—asdescribed above—the chest in its sagittal and transversediameters; the diaphragm increases the thorax diametercaudally and raises the lower ribs.

The contraction of the diaphragm causes a movementcaudally while pushing the abdominal organs inferiorlyand anteriorly. The movement anteriorly results from thesoft abdominal wall, which does not provide active resist-ance against the displacement of the abdominal organsduring inhalation.

In easy respiration, exhalation is a passive process,directed by the elastic restorative force of the thorax.

In deep inhalations, additional muscles assist in theexpansion of the thorax. These accessory inhalatorymuscles include the:● external intercostals● serratus posterior superior● serratus anterior● greater pectoral● smaller pectoral● sternocleidomastoid● erector muscle of the spine

Deep inhalations cause an extension in the spinal column,as a result of which the extensors of the spinal columncan also be included indirectly among the inspiratorymuscles.

Forced exhalations likewise involve further accessoryexpirators:● abdominal muscles (internal and external oblique, rec-

tus abdominis, transversus abdominis)● internal intercostal muscle● subcostal muscle● transversus thoracis● serratus posterior superior● latissimus dorsi

Physiology

Physiology of the Heart

Here, we describe the mechanical heart action of the leftheart. The same processes take place in the right heart.

Systole

Contraction Phase

● ventricle is filled with blood● phase starts when the contraction of the ventricle

starts

As a result of the contraction of the ventricle, intra-ventricular pressure rises. When this pressure is greaterthan the pressure in the atrium, the AV valves close (thesemilunar valves are still closed). Tendinous fibers andpapillary muscles prevent the AV valves from blowingthrough into the atrium. The surfaces of the individualflaps are greater than the opening to be closed. Bybroadly juxtaposing the edges of the flaps, closure of thevalve is ensured even when the ventricular size changes.In the ventricle, no change in volume occurs, but only areshaping of the ventricle into the form of a ball (= iso-volumetric contraction). All muscle fibers change theirlength actively or passively.

Duration of this phase: 60ms when the body is at rest.

Ejection Phase

This phase starts when the pressure in the left ventricle isgreater than the diastolic pressure in the aorta(80mmHg). The semilunar valves open and pressure con-tinues to rise until it reaches the systolic blood pressurevalue (approximately 120–130mmHg). Finally, the ven-tricular contraction is released and the pressure dropsback down. When the pressure is lower than the aorticpressure, the semilunar valve closes and systole isthereby concluded.

During rest, approximately half the contents of theventricle (130mL) is ejected (= stroke volume).




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Osteopathic Tests and Treatment 189

Test and Treatment of the CostoclavicularLigament according to Barral

Fig.17.8

Starting PositionThe patient is in the supine position. The practitionerstands on the side to be treated.

ProcedurePalpate the costoclavicular ligament for sensitivity.

To treat, apply frictions or inhibitions to the sensitiveareas until the pain has disappeared. Pressure on the sen-sitive areas should therefore be just strong enough tobarely cross the pain threshold. Treatment success canthen be evaluated sufficiently.

Compression and Decompression of theClavicle Along the Longitudinal Axis accordingto Barral

Fig.17.9

Starting PositionThe patient is in the supine position. The practitionerstands on the side to be treated.

Procedure in CompressionWith the lateral hand, hold the acromial end of theclavicle between the thenar and hypothenar. With themedial hand, hold the sternal end of the clavicle in thesame way. Place the fingers of both hands on top of eachother over the clavicle.

Testing Sequence in CompressionCompress the clavicle simultaneously with both hands.Take note of intraosseous and fascial tensions as well asof sensitivity to the compression. In a second step, trans-late the clavicle laterally and medially.

Treatment in CompressionTranslate the clavicle mediolaterally.

For an additional treatment option, you can apply fas-cial unwinding to the clavicle under compression.

You can conclude treatment with a recoil: increase thecompression for one or two breaths during exhalationsand maintain during inhalations. When you have reachedthe greatest possible compression, abruptly release it atthe start of the next inhalation.




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201

Index

Page numbers in italics refer to illustrations

A

abdomen 18acute 16

abdominal vibrations 25, 25abscess 90, 114adenoma 127gallbladder 52

adhesions 4, 39, 52, 67, 83, 105,114–115, 127, 142–143, 156,169–170, 186

adiposity 38adventitia 111, 112aflatoxin poisoning 39Alcock canal 21alcohol abuse 38, 39, 66, 97anemia 38, 127, 142angina pectoris 185, 187angioma, spider 38antrum 60aorta 22, 59abdominal 155thoracic 181

aortic aneurysm 16appendicitis 126appendix, vermiform 122, 123appetite loss 66arm pull 10, 10arterial stimulation 19bladder 163colon 137duodenum 86gallbladder 57kidney 148liver 47ovaries 174pancreas 101small intestine 120spleen 94stomach 78uterus 174

arteriosclerosis 169see also atherosclerosis

artery(ies)bronchial 59coronary 178, 198fascial mobilization 197, 197left 178right 178

cystic 50gastric 59, 62gastro-omental 62gastroduodenal 62, 82, 96hepatic 26, 34, 50iliac, common 155internal 153, 155

intercostal 181mesenteric, inferior 19, 124, 137superior 19, 82, 86, 96, 101,

111, 120, 124, 137obturator 153ovarian 155, 165, 166pancreaticoduodenal, inferior 82phrenic, inferior 59pudendal, internal 153pulmonary 180renal 140, 155splenic 88, 96testicular 155thyroid, inferior 59uterine 155, 165, 166vesical, inferior 153, 155

articular restrictions 4ascites 38aspiration 185asthma 186atherosclerosis 185prevention 175, 199

automatism 3

B

belching 66, 67bicarbonate 63bile 51biliary congestion 39bilirubin 36, 51bladder see urinary bladderBlumberg sign 126Boas sign 52bronchial tubes 198bronchitis 186bursa, omental 104

C

cachexia 36, 38, 39calculi see stonescanal, pudendal 21cancercolorectal 127pancreatic 98stomach 66see also carcinoma

caput medusae 38carbohydrates, digestion of 112carcinoma 16gallbladder 52hepatocellular 39pancreatic head 37renal cell 142see also cancer

cardia 60cardiac insufficiency 38cecum 122, 123, 124combined treatment of 130, 130fascial treatment 136, 136mobilization 128–129, 128, 129

celiac disease 114cervicobrachialgia 67cesarean section 170Chapman points see reflex pointtreatment

cholangitis 37cholecystitis 52, 53cholecystokinin 64cholelithiasis 52circulatory techniquescolon 137–138duodenum 86–87gallbladder 57kidneys 148–149liver 47objective 18ovaries 174pancreas 101principle 19small intestine 120spleen 94stomach 78thorax 198urinary bladder 163uterus 174




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202 Index

cirrhosis of the liver 38, 39, 52claviclecompression 189, 189decompression 190, 190fascial mobilization 190, 190

colic 52, 141biliary 53

colic flexuresfascial treatment 137, 137left 123, 124mobilization 135, 135right 123, 124stretching 135, 135testing and treatment 134, 134

colitis, ulcerative 126–127colon 122–138anatomy 122–126, 122, 125ascending 122, 123, 124lengthwise stretch 133, 133mobilization 133, 133

descending 123, 124mobility 126motility 126organ clock 126organ–tooth interrelation-ship 126

osteopathic treatment 128–138circulatory treatment 137–138contraindications 128fascial treatment 136–137, 136,

137indications 128motility treatment 136, 136reflex point treatment 138

pathologies 126–127symptoms 127

physiology 126recommendations for patient 138sigmoid 123, 124mobilization 130–131, 130, 131treatment of 131–132, 131, 132

transverse 123, 124colorectal cancer 127completed tests 12, 12concavity 6constipation 5, 98, 128convexity 6coronary heart disease 185craniosacral therapy 47, 57, 78, 87,94, 101, 120, 138, 149, 163, 174,198

Crohn disease 114cruralgia 39cystic fibrosis 38, 186cystitis 155, 156, 170

D

depression 98diabetes mellitus 38, 52, 98, 141,155, 185

diagnosis 5–8diaphragm 27treatment technique 27, 47, 57,78, 86, 87, 94, 101, 120, 137, 138,148, 149, 163, 174, 198

diaphragmatic breathing 3diarrhea 5, 66, 98, 114, 127digestion 112–113carbohydrates 112fats 113proteins 113

diverticulitis 127dizziness 5, 40, 83double-leaf system 4Douglas pain 126ductbile, common 26, 50, 99thoracic 22, 140

duodenal ulcer 83duodenum 80–87anatomy 80–82, 80, 81, 99mobility 82motility 82organ clock 82osteopathic treatment 83–87angle between superior and

descending parts 85, 85circulatory techniques 86–87contraindications 83de-spasming 85, 85duodenojejunal flexure 84, 84fascial treatment 86, 86indications 83mobilization 84, 84sphincter of Oddi 83–84testing and treatment 86, 86

pathologies 83symptoms 83

physiology 82recommendations for patient 87

dysmenorrhea 5, 127, 142, 170dyspnea 185, 186dysproteinemia 141dysuria 155

E

echinococcal cyst 90edema 98, 141, 142ankle 38

emphysema 186encephalopathy 38endometriosis 169episiotomy 170erythema, palmar 38esophagusanatomy 59mobilization 74, 74gastroesophageal junction 76,

76reflex point treatment 78

estrogen 167–168deficiency symptoms 169dominance 38

Euler–Liljestrand mechanism 185exercise for thorax mobility 199expiratory dysfunction tech-nique 15–16contraindications 16

F

fallopian tubes 174, 175tubal pregnancy 169, 170see also ovaries

fascia 15clavipectoral, mobilization 194,194

diagnosis 15dynamic 15pelvic 151renal 139retropancreatic (Treitz) 96, 104sternocostal, fascial release 197,197

Toldt 104, 124treatment 134, 134

fascial induction test 16–17, 16, 17fascial treatment 15–17clavicle 190, 190colon 136–137, 136, 137coronary arteries 197, 197duodenum 86, 86gallbladder 57, 57liver 46–47pancreas 100, 100, 101, 101small intestine 120spleen 93, 93stomach 78, 78

fatigue 38, 39fats, digestion of 113fatty liver 37, 38fever 36, 38, 52, 67, 98, 114, 115,127, 141, 169intermittent 142




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fistulae 114fixations 4, 52, 67, 83, 105,114–115, 127, 142–143, 170, 186

flatulence 66follicle-stimulating hormone (FSH)167

follicular maturation 168food intolerance 52, 66, 127foreign body aspiration 185fractures 187fundusstomach 60uterus, test and treatment 171,171

G

gallbladder 49–58anatomy 49–50, 49, 50mobility 50motility 51organ clock 50organ–tooth interrelationship 50osteopathic treatment 53–57circulatory techniques 57defibrosing 56, 56despasming 55–56fascial treatment 57, 57oscillations 56, 56reflex point treatment 57smoothing out the biliary

tract 54, 54, 55, 55, 56sphincter of Oddi 53, 53stretching the biliary tract 54,

54, 55, 55, 56testing and treatment 56–57,

56voiding 54, 54

pathologies 52symptoms 52


gallstones 16, 53ganglionaorticorenal 140, 155stimulation 149

cervical/stellate, superior 59impar 166mesentericinferior 126, 166stimulation 87, 120, 137, 163,

174superior 62, 111, 126, 166

renal, posterior 140, 155sacral 166

gastric juice 63regulation 63–65

gastric ulcer 66recommendations for patient 79

gastrin 64gastritis, acute 66chronic 66

glucagon 97gluten intolerance 114gout 141grand maneuver 25, 25greater supraclavicular fossa mobili-zation 195, 195

Grynfeltt triangle 147treatment 147, 147

gynecomastia 38

H

head tilt 6–7headache 52, 67, 141heart 176–178, 187, 198action 3anatomy 176–178, 178organ clock 178organ–tooth interrelationship 178pathologies 185symptoms 185, 186

physiology 183–184diastole 184systole 183

sounds 184heart attack 185, 187heartburn 65, 66Helicobacter pylori 66, 83

hematuria 141, 142, 143, 155, 156hemodynamic test 16, 16hemorrhoids 38, 170hepatitis 37–38acute 37chronic 37–38hepatitis A 37hepatitis B 37, 38, 39hepatitis C 37, 38, 39hepatitis D 37, 38hepatitis E 37steatosis 38

hepatomegaly 38, 40hiatus hernia 65, 67deterioration test 74, 74improvement test 75, 75recommendations for patient 79treatment 75–76, 75, 76

human chorionic gonadotrophin(hCG) 167

hydrochloric acid 63hypercalcemia 97hyperextension test 12hyperkyphosis 186hyperlipoproteinemia 97, 141hyperparathyroidism 97, 141hypersplenism 38, 90hypertension, portal 38, 66, 90hypertonicity 142hypophysis 167hypoproteinemia 141hypothalamus 167

I

icterus 36–37, 52, 53, 97, 98intrahepatic 36posthepatic (obstructive) 37, 52prehepatic 36scleral 52

ileocecal valve treatment 119, 119ileum 110, 112absorption process 112, 113see also small intestine

iliosacral joint techniques 138, 149,163, 174

incontinence 156, 169inhalation 183inspection 5–6interpretation 6–8

insulin 96–97intracavitary pressure 4intrinsic factor 63irritable bowel syndrome 127, 128ischemia, stress-related 66ischialgia 39ischiorectal fossa 21treatment technique 21, 21, 138,149, 163, 174

J

jejunum 110, 112absorption process 112, 113see also small intestine

K

kidneys 139–149anatomy 139–140, 139, 140cystic 143




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digestive kidney 142, 143genital kidney 142, 144mobility 141motility 141organ clock 140organ–tooth interrelation-ship 140

osteopathic treatment 143,144–149circulatory treatment 148–149contraindications 143fascial treatment 148, 148Grynfeltt triangle 147, 147indications 143mobilization 145–147, 145,

146, 147motility test and treat-

ment 148, 148reflex point treatment 149

palpation 144–145, 144, 145pathologies 141–142symptoms 142, 143

physiology 141recommendations to patient 149

L

lactose intolerance 114laminaDelbet 157prerenal 139retrorenal 139

laryngeal techniques 47, 57, 78, 87,94, 101, 120, 138, 149, 163, 174,198

larynx mobilization 22, 22leg pull 9, 9ligamentary elasticity, loss of 5ligamentary system 4ligament(s) 104bladder 152broad, of the uterus 104, 165,175test and treatment 172, 172

cervicopericardial 177coracoid process, test and treat-ment 188, 188

coronary 34, 104costoclavicular, test and treatment189, 189

costopleural 180cystoduodenal 124falciform 34gastrocolic 60, 124gastrolienal 60

gastrophrenic 60, 104gastrosplenic 88, 104stretch 92, 92

hepatocolic 124hepatoduodenal 26, 34, 82stretch 26, 26, 47, 57, 78, 86,

94, 101, 120, 137hepatogastric 26, 34hepatorenal 34of Treitz 82, 96, 104pancreaticosplenic 88, 96, 104phrenicocolic 60, 88, 104, 124test and stretch 91, 91

phrenicopericardial 177phrenoesophageal 59pleural, transverse 180proper, of the ovary 165, 166pubovesical 152mobilization 160–161, 160, 161

pulmonary 180rectouterine 165round, of the liver 34, 104of the uterus 165

sacrouterine 165splenorenal 88sternopericardial 177suspensory, of the ovary 165, 166triangular, left 34right 34

umbilical, medial 152, 159,160–161median 152, 158, 160–161

vertebropericardial 177vertebropleural 180vesicouterine 165visceropericardial 177

listening testslocal 10, 10, 107seated position 9standing position 9, 9supine position 9–10, 107arm pull 10, 10leg pull 9, 9

liver 33–48anatomy 33–34, 33microscopic anatomy 36

mobility 35, 35motility 35, 35organ clock 34organ–tooth interrelationship 34osteopathic treatment 41–48circulatory techniques 47contraindications 40direct mobilization 41–42, 41,

42fascial treatment 46–47, 46, 47indications 39

indirect mobilization 42–44,42, 43, 44

motility testing and treat-ment 46, 46

oscillations 26, 26, 45, 45reflex point treatment 47–48



liver pump 45, 45, 47, 57, 78, 86,94, 101, 120, 137, 148, 163, 174

lumbalgia 169, 170lung 178–181, 187, 198anatomy 178–181, 179organ clock 181organ–tooth interrelationship181

osteopathic treatment 198pathologies 185–186symptoms 185, 186

physiology 184–185luteinizing hormone (LH) 167luteinizing hormone-releasinghormone (LHRH) 167

lymph nodesceliac 62, 82, 88, 96, 111, 124cervical 96gastric 88, 96hepatic 88, 96iliac 153, 155external 166

inguinal, superficial 166intercostal 59lumbar 111, 124, 140, 155, 166mediastinal 96, 178mesenteric 96inferior 124superior 111, 124

obturator 166pancreatic 62pancreaticolienal 88, 96paracardial 62paratracheal 59periaortal 96renal 155splenic 62tracheobronchial 59Virchow 65, 66, 67

lymphatic stimulation 19bladder 163colon 137duodenum 87gallbladder 57kidney 148liver 47ovaries 174




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pancreas 101small intestine 120spleen 94stomach 78techniques 24–25thorax 198uterus 174

M

Maitland technique 47, 57, 78, 87,94, 101, 120, 137, 149, 163, 174,198

manipulations 47, 57, 78, 87, 94,101, 120, 137, 149, 163, 174, 198

mediastinum 22, 181–182, 181,182, 187–188mobilization 22, 22, 74, 74, 196,196

medical history 5menopause 168–169, 170menstruation 168mesenteric root 110, 110, 111test and treatment of 117, 117

mesenteries 4, 104small intestine 104stomach 104

mesoappendix 138mesocolonsigmoid 104, 124treatment of 131–132, 131, 132

transverse 104, 124see also colon

meteorism 98microhematuria 142micturition 155dysfunctions 155, 156

miscarriage 170mobility 3disturbed 4–5treatment 13see also specific organs

motility 3disturbed 5treatment 13–14see also specific organs

motricity 3mucous membrane 111mucus 63Murphy sign 52, 53, 53muscle(s)biceps brachii 41brachialis 41deltoid 40infraspinatus 40

levator scapulae 40paravertebral, inhibition 47, 57,78, 87, 94, 101, 120, 137, 149,163, 174, 198

rhomboid 40scalene 40, 41subclavius 40, 41supraspinatus 40teres major 40minor 40

muscular restrictions 5myoma 169, 175

N

nausea 5, 38, 40, 52, 66, 67, 83, 98,141, 185

nephrolithiasis 141nephrotic syndrome 141–142nerve(s)hypogastric 126, 153phrenic 34, 50, 104, 178posterior, of the penis/clitoris 21pudendal 21segmental, lumbar 104thoracic 104

splanchnic 166greater 34, 50, 59, 62lesser 34, 50, 62, 140, 155lowest 140, 155lumbar 140, 155major 89, 96minor 82, 111pelvic 126

vagus 22, 34, 50, 59, 62, 89, 96,111, 126, 140, 155, 166, 178, 181stimulation 198

nitrosamine 66nodes see lymph nodes

O

obstructive pulmonary disease185–186

obturator foramen technique 162,162, 163, 173, 173, 174

omenta 4, 104omentumgreater 60, 104, 105, 124lesser 34, 60, 104stretch 73, 73

oophoritis 169oral contraceptives 52

organ movementpathology 4–5physiology 3see also specific organs

organ–tooth interrelationship 34see also specific organs

oscillationsgallbladder 56, 56liver 26, 26, 45, 45sacrum 23, 23sternum 24, 24stomach 72, 72

osteoporosis 169, 187prevention 175

ovarian cycle 168ovarian cysts 169ovariesanatomy 166motility 167osteopathic treatmentcirculatory techniques 174reflex point treatment 175test and treatment 172, 172tubo-ovarian motility test and

treatment 174, 174pathologies 169symptoms 169, 170

physiology 167–168ovulation 168

P

pain 6abdominal 65, 97, 98, 114, 127,141, 169, 170

back 98chest 185epigastric 65, 66, 67, 83, 126eye 52flank 141hunger 66, 83interscapular 52, 67kidney area 141, 142knee 143thoracolumbar junction 98

pallor 185palpation 6interpretation 6–8

pancreas 95–99anatomy 95–96, 95mobility 96motility 96organ clock 96organ–tooth interrelationship 96osteopathic treatment 98–102




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206 Index

circulatory techniques 101contraindications 98fascial stretch 100, 100fascial technique 101, 101indications 98motility testing and treatment

100, 100reflex point treatment 101–102

pathologies 97–98symptoms 97, 98

physiology 96–97recommendations for patient102

pancreatic cancer 98pancreatitis 37acute 97, 98chronic 97–98

pancytopenia 38papillary stenosis 37, 97pectoral lift 196, 196pelvic floor 165treatment technique 138, 149,163, 174

pelvis 150–152, 151, 156–158female 150, 150male 151, 152

pepsinogen 63periarthritis, humeroscapular 39,52, 67, 128

pericardium 177, 178, 187peritoneum 103–109, 124, 152,154, 187anatomy 103–104, 103local listening test 107mobility 105motility 105motricity 105osteopathic treatment 106–109contraindications 106general relief technique 108,

108, 117–118, 117, 118indications 106mobility test and treatment

106–107, 106mobilization 108, 108, 109, 109test and treatment 107, 107

pathologies 105physiology 105symptoms 105

peritonitis 105, 114, 115Peyer patches 112pleura 179, 180, 187osteopathic treatment 198

plexuscardiac 178celiac 34, 50, 59, 82, 89, 96, 140,155

stimulation 47, 57, 78, 87, 94,101

hypogastric 166inferior 126, 153, 166superior 126, 140, 155

intermesenteric 153Meissner 112mesenteric, inferior 126superior 82

pharyngeal 59preaortic, treatment 21, 21pulmonary 181renal 140, 155, 166uterovaginal 166vesical 153, 155

plica lata 165pneumothorax 186pollakiuria 155pregnancy 38, 52, 156, 167, 170tubal 169, 170

premenstrual syndrome 175progesterone 168prostate gland 175proteins, digestion of 113proteinuria 141pseudocroup 186ptosis 5, 67bladder 156, 169gastroptosis treatment 77, 77kidney 142–143degree of 142–143left 142right 142

small intestine 114–115, 170self-treatment 121test for 116, 116treatment 118, 118

uterus 169, 170pulmonary disease 185–186pyelonephritis 141pylorus 60, 79

R

rebound technique 13rebound test 11–12, 11rectum 123, 138reflex point treatment 13bladder 163–164Chapman points 28, 29, 30location and shape 28significance of 28treatment principle 28

colon 138gallbladder 57

kidney 149liver 47–48ovaries 174–175pancreas 101–102small intestine 121spleen 94stomach 78–79thorax 198–199uterus 174–175

reflux, gastroesophageal 65, 66vesicoureteral 141, 155, 156

relative exocrine pancreatic insuffi-ciency 99

respiration 183regulation 185

restrictive pulmonary disease 186ribslower rib mobilization in trans-lation 27, 27

rib-raise technique 20, 20, 47, 57,78, 87, 94, 101, 120, 137, 149,163, 174, 198

Rovsing sign 126

S

sacrumintraosseous technique 23, 23motility test and treatment 163,163

oscillations on 23, 23salpingitis 169sarcoma 90scoliosis 186secretin 65serosa 111, 112sinus, coronary 178small intestine 110–121anatomy 110–111mobility 111motility 111organ clock 111organ–tooth interrelation-ship 111

osteopathic treatment 114–121circulatory techniques 120contraindications 115fascial treatment 120, 120general relief technique

117–118, 117, 118ileocecal valve treatment 119,

119indications 114–115motility testing and treatment

119–120, 119




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reflex point treatment 121tests and treatment of intestinal

loops 116, 116pathologies 114symptoms 114

physiology 111–113recommendations for patient 121

somatostatin 97Sotto–Hall test 11, 11spasms 52, 67, 83, 114, 127, 156,170, 185

sphincter of Oddi treatment 53, 53,83–84

spinal columncervical (CSC) 7lumbar (LSC) 8rotation 199stretch 199thoracic (TSC) 65

spleen 88–94anatomy 88–89, 88, 89mobility 89organ clock 89organ–tooth interrelationship 89osteopathic treatment 90–94circulatory techniques 94contraindications 90fascial treatment 93, 93gastrosplenic ligament

stretch 92, 92indications 90phrenicocolic ligament

stretch 91, 91reflex point treatment 94spleen pump 92–93, 92, 93



splenomegaly 38, 40, 89–90sprue 114staphylococci 66steatorrhea 98, 114steatosis hepatitis 38stenoses 114papillary 37, 97

sterility 169sternocostal joint mobilization 193,193

sternumcompression 191, 191corpomanubrial junction mobiliza-tion 192, 192

corpoxiphoid junction mobiliza-tion 192, 192

decompression 191, 191oscillations on 24, 24

sternal lift 193, 193sternal pump and recoil 24, 24

stomach 59–79anatomy 60–62, 60, 61, 62attachments 60, 68–69

mobility 62–63motility 63organ clock 62organ–tooth interrelationship 62osteopathic treatment 69–73circulatory techniques 78contraindications 67–68fascial treatment 78, 78gastroptosis 77, 77indications 67mobilization 69–72, 69, 70, 71,

72, 76, 76oscillations 72, 72pylorus treatment 73, 73reflex point treatment 78–79stretching the lesser omen-

tum 73, 73testing and treatment 77, 77

pathologies 65–66symptoms 65, 67

physiology 63–65, 64recommendations for patient 79rubber stomach 97, 98

stomach cancer 66stones (calculi)bladder 155, 156gallstones 52kidney 141

stools, bloody 114, 115, 126, 127subclavius mobilization 194, 194sweating 5, 40, 67, 83, 141

T

tachycardia 5, 40, 83, 185tela submucosa 111, 112thoracic techniques 47, 57, 78, 87,94, 101, 120, 138, 149, 163, 174,198

thorax 177movement physiology 183osteopathic treatment 188–199circulatory treatment 198contraindications 187indications 186reflex point treatment 198–199

recommendations for patient 199see also heart; lung

thrombophlebitis 98thrombosis, portal vein 38

Toldt fascia 104, 124treatment 134, 134

toxins 37, 38transversus thoracis mobilization194, 194

Treitz fascia 96, 104Treitz ligament 82, 96, 104trunkceliac 19, 59, 86stimulation 47, 57, 78, 94, 101

lumbar 124, 140sympathetic 20, 22

tubal pregnancy 169, 170turgor 4

U

ulcerduodenal 83gastric 66recommendations for patient

79ulcerative colitis 126–127uremia 66ureter 153–155, 153, 154, 163female 154male 154mobilization 161stretching 161, 161

urinary bladder 150–164anatomy 150–153, 152mobility 155self-mobilization 164

motility 155organ clock 153organ–tooth relationship 153osteopathic treatment 156–164circulatory techniques 163contraindications 156indications 156mobility test and treatment

158–159, 158, 159mobilization 159–161, 159,

160, 161motility test and treat-

ment 162–163, 162, 163obturator foramen technique

162, 162pathologies 155, 156symptoms 155, 156

physiology 155recommendations for patient 164reflex point treatment 163–164

uterusanatomy 165–166




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208 Index

mobility 167motility 167osteopathic treatmentcirculatory techniques 174contraindications 170fundus test and treatment 171,

171indications 170mobilization 172–173, 172motility test and treatment

173–174obturator foramen technique

173, 173reflex point treatment 174–175

pathologies 169symptoms 169, 170

physiological cycle 168

V

vaginal bleeding 169varicesesophageal 38varicose veins 170

vegetative harmonization 19bladder 163colon 137–138duodenum 87gallbladder 57

kidney 149liver 47ovaries and fallopian tubes 174pancreas 101small intestine 120spleen 94stomach 78techniques 20–23thorax 198uterus 174

vein(s)azygos 59bronchial 181cystic 50gastric 59hemiazygos 59iliac, internal 153, 155, 165, 166mesenteric, superior 96ovarian 155, 166portal 26, 34, 62, 82, 96, 111, 124hypertension 38, 66, 90thrombosis 38

pudendal, internal 21pulmonary 180renal 140splenic 88testicular 155thyroid, inferior 59uterine 165, 166

vena cava, inferior (IVC) 34, 166,176superior (SVC) 176

venous stimulation 19bladder 163colon 137duodenum 86gallbladder 57kidney 148liver 47ovaries 174pancreas 101small intestine 120spleen 94stomach 78techniques 26uterus 174

ventilation test 12vibrations 47, 57, 78, 87, 94, 101,120, 137, 149, 163, 174, 198abdominal 25, 25

Virchow node 65, 67visceral joint 3–4visceral manipulation possibilities13–14

viscerospasms 5vomiting 5, 40, 52, 66, 83, 98, 141,185

W

weight loss 66, 98, 114, 127, 142




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