Week 1 - 08/01/2013
"The Organ of Form" Ida Rolf (1977)
Today we started with a discussion on the Fascial network and the diaphragm. We looked at fascial pull on different morphologies and how it doesn't necessarily correlate with muscular bulk or "tight" muscles.
We palpated the quality of the skin on each others' torsos to determine areas of tension and pull.
Techniques focused on releasing the diaphragm either using a sidelying technique or with the patient seated upright and using their breathing and flexion / extension to roll the fascia at the costal margins.
Today we started with a discussion on the Fascial network and the diaphragm. We looked at fascial pull on different morphologies and how it doesn't necessarily correlate with muscular bulk or "tight" muscles.
We palpated the quality of the skin on each others' torsos to determine areas of tension and pull.
Techniques focused on releasing the diaphragm either using a sidelying technique or with the patient seated upright and using their breathing and flexion / extension to roll the fascia at the costal margins.
Week 2 - 15/01/2013
Diaphragm and Thorax.
We started this week with the listening test and re-assesment of the diaphragmatic movements before moving on to the diaphragmatic release techniques that we learnt last week. An additional technique that Valeria showed us was for releasing the crura at the border of the 12th rib and the quadratus lumborum.
I have not practiced the listening test for quite a while so it was initially quite difficult to re-train myself to think in this way. It is definitely a method of assessment (like all methods!) that improves with continual practice and you have to trust your instincts, almost no over-think what you are feeling. I do feel however that just gently assessing the rib and diaphragm via breathing is really helping with my palpation skills.
We started this week with the listening test and re-assesment of the diaphragmatic movements before moving on to the diaphragmatic release techniques that we learnt last week. An additional technique that Valeria showed us was for releasing the crura at the border of the 12th rib and the quadratus lumborum.
I have not practiced the listening test for quite a while so it was initially quite difficult to re-train myself to think in this way. It is definitely a method of assessment (like all methods!) that improves with continual practice and you have to trust your instincts, almost no over-think what you are feeling. I do feel however that just gently assessing the rib and diaphragm via breathing is really helping with my palpation skills.
Week 3 - 22/01/2013
Continuation of the thoracic cage.
Visiting Australian osteopath Kylie talked to us regarding her experience in osteopathic research in Australia, particularly in visceral research.
As well as encouraging us to keep on practicing the listening test as much as possible, Valeria demonstrated the following techniques:
- release of subclavius muscle
- release of intercostal muscles (individually) both anteriorly and posteriorly
- sternal release
These techniques are particularly useful for anyone who has upper ribs held in inspiration. The subclavius muscle also has important relationships with the brachial plexus and its route to the upper extremity so this is an important technique to consider in anyone with thoracic outlet impingement type symptoms.
Visiting Australian osteopath Kylie talked to us regarding her experience in osteopathic research in Australia, particularly in visceral research.
As well as encouraging us to keep on practicing the listening test as much as possible, Valeria demonstrated the following techniques:
- release of subclavius muscle
- release of intercostal muscles (individually) both anteriorly and posteriorly
- sternal release
These techniques are particularly useful for anyone who has upper ribs held in inspiration. The subclavius muscle also has important relationships with the brachial plexus and its route to the upper extremity so this is an important technique to consider in anyone with thoracic outlet impingement type symptoms.
Week 4 - 29/01/2013
Still on the thoracic cage this week, the last week I think.
Techniques we focused on this week included revision of the sternal release and articulation / release of the ligaments around the sternum and ribs: anteriorly the sterno-clavicular ligament, costo-clavicular ligament and costo-transverse ligament posteriorly.
Although I really enjoy the look of all the techniques this week and they feel effective when I am being practiced on, I struggled this week actually doing the techniques myself. All of the the techniques this week involve using an extended thumb as a fulcrum or applicator and I am finding this quite painful. I think that I over-use my thumbs too much and have noticed them aching after some treatments. I need to start trying to adapt my techniques so that I don't use my thumbs and if I have to that it is reinforced wherever possible.
We also watched a Gil Hedley video on the thoracic viscera which was fascinating.
Techniques we focused on this week included revision of the sternal release and articulation / release of the ligaments around the sternum and ribs: anteriorly the sterno-clavicular ligament, costo-clavicular ligament and costo-transverse ligament posteriorly.
Although I really enjoy the look of all the techniques this week and they feel effective when I am being practiced on, I struggled this week actually doing the techniques myself. All of the the techniques this week involve using an extended thumb as a fulcrum or applicator and I am finding this quite painful. I think that I over-use my thumbs too much and have noticed them aching after some treatments. I need to start trying to adapt my techniques so that I don't use my thumbs and if I have to that it is reinforced wherever possible.
We also watched a Gil Hedley video on the thoracic viscera which was fascinating.
Week 5 - 05/02/2013
Moving on to the abdominal viscera.We mapped out various junctional areas and visceral landmarks which Valeria called the Transitional Zones:1) Cardiac Sphincter - in the 7th intercostal space just left and superior to the ziphoid. We were told that this is often a tender and emotive zone.2) Pylorus - found by placing 3 fingers from the umbilicus in the midline - often can feel area of heat at this area3) Sphincter of oddi - the true junction between the pancreas and the duodenum, found by placing 3 fingers from the umbilicus in the mid clavicular line on the right.4) DJ junction! Duodenum/Jejunum junction - in the mid clavicular line on the left, 3 fingers from the umbilicus.5) Ileocaecal valve - 3 fingers from the ASIS (anterior superior iliac spine)
Techniques focused on finding areas of tension and releasing
Techniques focused on finding areas of tension and releasing
Week 6 - Release the stomach!
It was really good palpatory practice mapping out our partner's stomachs today. My stomach seemed to be really long and narrow and come much further down my abdomen than I would have thought possible. Valeria said that normally the stomach anatomy tends to mirror the morphology of the person, so as a tall narrow(ish!) person I would expect to have a similar shaped stomach. We mapped the stomachs out by palpating with one hand and blotting with the other to feel the border of the stomach - really good!
All of the techniques for this, which are either sidelying or seated involve getting under the diaphragm and lifting the stomach which is so much harder said than done! Valeria makes it look very eay and I was struggling at first but with some practice I felt that I was relaxing in to the techniques and managing to palpate a change in the tissues on my partner.
All of the techniques for this, which are either sidelying or seated involve getting under the diaphragm and lifting the stomach which is so much harder said than done! Valeria makes it look very eay and I was struggling at first but with some practice I felt that I was relaxing in to the techniques and managing to palpate a change in the tissues on my partner.
Week 7 - Moving on to the liver
Like the stomach, it's all about palpating the borders! It is hard to "get a grasp" of the liver, so to speak and I did struggle to know if I was actually palpating much. It actually made me feel a bit queasy performing the liver lift techniques, I'm not sure why, but thinking about lifting the liver just seemed strange. I also did not like having my own liver palpated or lifted, so maybe I'm just transferring my own feelings on to someone else.
I am really enjoying visceral so far however, I think I could definitely imagine working on more patients with these techniques once I have become more adept at them.
I am really enjoying visceral so far however, I think I could definitely imagine working on more patients with these techniques once I have become more adept at them.
Extra Visceral Practice
Kylie Fitzgerald offered some extra visceral classes which I thought sounded like a great idea as it would reinforce what we have already learnt and provide some focused practice under guidance.
The first session was on Monday 30th April for 2 hours, 18:30 until 20:30 and we focused on the upper GI tract, including stomach and pylorus and the theory behind visceral work in general. We looked for areas of tension and then Kylie showed us some simple short and long lever techniques to improve function in these areas. The key to palpation was keeping a flat hand where possible and working your way slowly in to the viscera.
The first session was on Monday 30th April for 2 hours, 18:30 until 20:30 and we focused on the upper GI tract, including stomach and pylorus and the theory behind visceral work in general. We looked for areas of tension and then Kylie showed us some simple short and long lever techniques to improve function in these areas. The key to palpation was keeping a flat hand where possible and working your way slowly in to the viscera.
Practicing visceral techniques
Here I am working on the pylorus. Remember to keep the hands flat and approach the tissues gently.