Visceral Manipulation in the Chronic Pain Patient
Janice Webber, BScPT, Janice Webber Physiotherapy Services
Chronic pain patients typically show altered patterns of breathing such as apical with little to no lateral costal expansion. When assessed via capnography they often present with low CO2 values and have a difficult time in recovery of their breathing with stressed such as hyperventilation and talking.
They also show high autonomic nervous system levels such as sympathetic arousal of sweaty palms, increased pilomotor response, and easily irritated skin showing erythema. The vagal tone of the body has become altered.
The vagus nerve as part of the autonomic nervous system supplies the internal organs of the body. The internal organs are covered by a thin connective tissue membrane system which act as an interconnecting link from one organ to another. The internal organs are suspended from the diaphragm via this connective tissue membrane. The organs of the liver and stomach have direct connection to the diaphragm. The serous fluid with runs between the layers of connective tissue in the abdomen becomes more viscous after trauma such as motor vehicle accidents and surgery. As this fluid thickens, adhesions are formed. The adhesions restrict the movement of the organs in the abdomen. The organs such as the liver, stomach, duodenum, and large intestine can directly restrict the movement of the diaphragm. These organs are suspended are linked to the diaphragm via the connective tissue membrane system.
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