I’m excited about our Visceral Techniques curriculum. I believe working with the viscera is of increasing importance and I want people to be able to access this potent region. The viscera can feel remote, these soft squishy structures under layers of tissue with weird names – peritoneum and omentum and with a beguiling array of anatomical relationships – “How could we ever palpate this region meaningfully?” seems a reasonable question. But we can.
In this brief anatomy wander-about I want to illustrate how what seems remote and far away is actually connected in tangible and accessible ways to structures that are easily contacted and treated.
True Story #1
In a fresh cadaver dissection course, we dissected an epic pathway from the hyoid through the thorax (rt lobe of lung removed through a window we cut in the ribs), to the diaphragm. There were many aspects of this that blew my mind, i.e. watching the anterior neck myofascia (near impossible to separate into specific muscles, more a flowing river of tissue) meet up with the clavicle and appear more riverine than structural. The tissue moved like water around the solid form of the clavicle. Some of the myofascia remained superficial to the ribs and some dove deep – and, with our little cut window you could see that the tissue that went deep became the fascial lining of the thorax!
What really changed things for me was performing a simple hyoid release on our blessed cadaver. I love the hyoid. So, with it all fresh and exposed I couldn’t help but want to touch it. I approached tentatively and cupped the hyoid between my thumb and first finger just like on a patient and then gently moved it around, as the hyoid moved I watched the fascia of the thorax move in response. I then applied traction superiorly and I watched as the diaphragm lifted in response to my ministrations! It was beautiful and stunning. It impressed upon me the profound truth of how connected seemingly disparate structures are, and if this was true here, then it has to be a truth throughout the body. We just have to map these truths of the body through touch and feel and by engaging with the community of dedicated and curious people planet-wide exploring our form.
Why Hyoid to Viscera?
The hyoid release can be one beginning for performing visceral techniques. The tone of the diaphragm is crucial to healthy digestion and free moving viscera. It is the movement of the diaphragm that establishes the overall mobility of the viscera. And, strangely enough, working with the hyoid is a way of helping to establish proper diaphragmatic tone.
If we peer onto the inferior surface of the diaphragm we can see a large shaded white surface, this is where the stomach and liver are attached to the underside of the diaphragm via tendinous structures formed out of the parietal peritoneum. The stomach and liver ride a wave formed by the rhythmic (or non-rhythmic) movement of our diaphragms.
A deep dive into diaphragmatic anatomy illustrates intimate relationship between the superior surface of the diaphragm àpericardium àpericardial ligaments reaching up into the myofascial of the anterior neck and connecting to the hyoid via the various hyoid muscles. It is interesting to note, that here we are also essentially mapping the vagal pathway. The vagus and hypoglossal nerves combine to innervate the muscles of the throat.
So, as the mouth and throat are the entryway into the digestive process in a sense then this region is, from a manual therapy perspective, integral to performing visceral work.
True Story #2:
I have had multiple patients describe a direct connection between work in throat-hyoid region with work in the abdomen and vice-versa. These patients knew nothing of anatomy and were just tracking their interoception and commenting on what they noticed. Perceptive patients are incredible teachers for us!
Visceral techniques give us the opportunity to take our myofascial and/or cranial listening skills and our indirect and direct techniques and apply them to the realm of the viscera. As we study the anatomy, giving our hands and imaginations images and concepts to work with we can make meaningful contact with the structures responsible for assimilating so much of our experience of the world.
The beautiful thing about this work is that it is accessible to anyone with the desire to engage and listen and follow. Patients will be grateful the more their practitioners learn to contact them skillfully and meaningfully in the profound realm of the viscera.