Melissa Stendahl, PT, DPT
In June, my colleague Ryanne and I had the opportunity to attend the American Physical Therapy Association’s Gynecological Visceral Manipulation Course, taught by Gail Wetzler, PT, DPT, EDO, BI-D.
Gail is well known for her visceral (organ) mobilization skills and teaching worldwide with Jeanne-Pierre Barral of the Barral Institute. She is a leader in the physical therapy field and in education for women’s health, manual diagnostics, visceral structures and disorders, and integrative therapies for animal health. She is dedicated to techniques to help balance the body’s systems for optimal function. Gail is considered an excellent and sought-after instructor in advanced manual therapy techniques for PTs.
In class, we learned how to assess the biomechanics and mobility of the pelvic organs (including reproductive organs, the urinary system, and the rectum). We learned treatment techniques for these structures, and how to integrate these findings and techniques into PT treatment for injuries and disorders affecting posture, core stability, spinal mechanics, and overall movement. Having these skills helps the PT to more successfully and specifically treat pelvic conditions that affect bowel, bladder, reproductive and sexual function. It takes hard work and practice to develop the sensitivity to feel the organs and their potential restrictions, and the PTs at Beyond Basics have all taken advanced training to enhance this skill because of its importance for our specialty in returning patients to good bowel, bladder, and sexual health and reducing pelvic pain.
We did a detailed anatomy review and excellent hands-on time with lab partners to refine these techniques for our own individual practice! Did you know: neighboring structures “talk” to each other within the body? For example: the liver is a large organ located within the parietal peritoneum. This peritoneum is a membrane (a thin covering) that wraps around the liver and many other organs in the abdomen. It travels just next to, but does not enclose, the pelvic organs. This membrane becomes neighbors with the bladder, uterus, and rectum. If the liver is damaged, injured or restricted, the peritoneum membrane enclosing it can tighten in response, kind of like how your arm muscles might tighten up or spasm to help protect you after a shoulder dislocation. But since the peritoneum is also neighbors with the pelvic organs, this tight restriction at the liver can also result in tension all the way down to the bladder, uterus, or rectum, contributing to urinary or bowel dysfunction or pain! So it may be possible that assessing and treating these lines of tension can help get rid of lingering pain or incontinence, and is a great example of how structures near or even far from the original site of dysfunction can be involved.
So what is a PT really treating when they do “visceral manipulation”? Good question. PTs do not take the place of physicians who specialize in organ function and hormones, like urologists, colorectal, GI or Endocrinologists. But PTs can influence the mobility and positioning of the organs in the abdominal and pelvic cavities, so that they can move and glide as you bend over, run, poop, pee and ovulate, and to reduce inflammation from injuries, or adhesions like scar tissue from surgery. This can be a very valuable treatment option to promote better organ function for digestion, bowel, bladder, sexual and reproductive health.
Link to Gail’s site (https://wetzlerptcenter.wordpress.com/