What is visceral manipulation?
Over the last three decades, French osteopath Jean-Pierre Barral has pioneered the practice of “visceral manipulation” as a distinct branch of osteopathy.
According to Barral’s estimates: “In a single day, your internal organs move 30,000 times” and “Your liver alone travels 600 meters. But when one organ cannot move in harmony with its viscera due to abnormal tone, adhesions or displacement, it works against the body’s other organ’s and muscular, membranous, fascial and osseous structures” [Skari, 2001].
His key insight was that each internal bodily organ has a capacity to cause spinal pain, whereas conventional osteopathic thinking had assumed the opposite:
“At the time nobody was talking about manipulating organs but I kept seeing patients with aches and pains that I could relieve simply by kneading their organs” [Skari, 2001].
In the March 2013 issue of Osteopathy Today, Barral outlined his approach to diagnosis:
“I use a lot of listening which means you put your hands on the body and your hand is attracted to the tissues which have a density or express a tension and then it is up to your medical knowledge to know what kind of tissue you have found. It is to let the body express itself.”
As to the question of diagnosis, Barral claimed to be able to locate areas of “stress” in the body by palpating the associated (thermal) energy.
The therapeutic approach is then to coax “traumatised” or malfunctioning organs (e.g. kidneys, liver, stomach and other soft tissues) back to their natural movement by applying soft pressure to the respective abdominal, thoracic and urogenital areas:
“The goal is to help the body’s normal forces remove abnormal effects, whatever their sources. Those effects can be global, encompassing many areas of bodily function. These gentle manipulations can potentially improve the functioning of individual organs, the systems the organs function within, and the structural integrity of the entire body.”
In relation to fibromyalgia, visceral manipulation is included in the list of manual therapy techniques that are said to possess the extraordinary capacity to “help to calm down the autonomic nervous system, decrease inflammation in soft tissue, release adhesions of the organs, and calm down irritation of the spinal cord.”
There are at least three threads in the history of Medicine that can be teased out to uncover the origins of some of the remarkable ideas behind visceral manipulation.
1. Glénard’s disease
The idea that a wandering uterus could cause health problems is an ancient one, and is allied to that of mischief being caused by other “wandering organs” [Desvoeux, 1752].
During the 19th century there was a body of authoritative surgical opinion that excessively movable abdominal organs could be held responsible for abdominal pain and for even more widespread symptoms [Treves, 1896; Daly, 1996].
Some thought that descent of the stomach could result in neurasthenia, the 19th century counterpart of fibromyalgia and chronic fatigue syndrome. Gastropexy (fixation of the stomach) was deemed to be an effective and safe procedure [Daly, 1996].
Colenard, a French physician practicing in Lyons, was the first to describe, in a paper published in 1885, the condition of enteroptosis, or falling of the viscera, due to relaxation of their supporting ligaments [Lund, 1897].
Frantz Glénard (1848-1920), a French physician who for health reasons left Paris to live at Vichy, wrote a number of papers on the subject of visceroptosis (“sinking of abdominal viscera”) [Glénard, 1899].
He devised a simple test wherein the examiner, standing behind the patient, places his arms around the patient so that his hands meet in front of the patient’s abdomen; he squeezes and raises the viscera and then allows them to fall suddenly. If the patient feels relieved by the raising pressure and experiences distress upon release, the condition is probably one of visceroptosis.
2. The Irish stroker
Valentine Greatrakes [1628-1666] was a soldier who served as a lieutenant in the ranks of Cromwell’s army. By harnessing the popular belief in the efficacy of “the king’s touch” – the belief that illness could be cured by the touch of a divinely inspired leader – he is said to have practiced a lay form of psychotherapy [Alexander & Selesnick, 1967].
Greatrakes became known as the “Irish stroker” when, after the beheading of Charles I in 1649, it was widely believed that the healing power of the king’s touch had been passed on to him and that through this method he could cast out evil spirits causing disease. Thousands of patients came to be touched by him, and “his barns and outhouses were crammed with innumerable specimens of suffering humanity [Laurence, 1910].”
Franz Anton Mesmer [1734-1815], who had studied medicine in Vienna, claimed that he too could cure, initially by using a horseshoe magnet and later on by simply touching his patient with his bare hand.
Mesmer and his followers believed that obstacles to the free flow of this fluid caused illness, and that skilled healers or “sensitives” could remove these obstructions by making passes over the patient’s body with their hands.
Mesmer thought he had discovered a specific magnetic force in humans and that this force could be transferred through the laying on of hands [Lanska & Lanska, 2007].
Like many other therapists of all times, Mesmer was unable to appreciate that his successes were due, not to his non-existent magnetic force, but to powerful suggestion [Ackerknecht, 1968].
When assessing the place of visceral manipulation as a form of therapy, perhaps the words of Ecclesiastes 1:9 still ring true:
“What has been will be again, what has been done will be done again, there is nothing new under the sun.”
Ackerknecht EH. A Short History of Medicine. New York: The Ronald Press Company, 1968: 208-209.
Alexander FG, Selesnick ST. The History of Psychiatry. London: George Allen and Unwin Ltd., 1967: 71-88.
Daly A. Fantasy Surgery 1880-1930: with special reference to Sir William Arbuthnot Lane. Clio Medica 38/The Wellcome Institute Series in the History of Medicine. Amsterdam: Editions Rodopi B.V 1996.
Desvoeux V. The Compendious Library: or, Literary Journal Revived. For November and December, 1751. Dublin: S. Powell, 1752.
Glénard F. Les Ptoses Viscérales: Diagnostic et Nosographie. Paris: Ancienne Libraire Gemmer Balliere & Co., 1899.
Lanska DJ, Lanska JT. Franz Anton Mesmer and the rise and fall of animal magnetism: dramatic cures, controversy and ultimately a triumph for the Scientific Medicine. In: Whitaker H, Smith CUM, Finger S. Brain, Mind and Medicine. New York: Springer Science, 2007: 301-320.
Laurence RM. Primitive Psychotherapy and Quackery. Boston: Houghton Mifflin, 1910: 255.
Lund FB. Enteroptosis. Boston Med Surg J 1897; 1(8): 7-11.
Skari T. Has your liver been liberated? Time 2001; 157 (15): 64.
Treves F. The treatment of Glenard’s disease by abdominal section. Brit Med J 1896; i: 1-4.