what is visceral manipulation?When I mention to people that I do visceral manipulation in my physical therapy practice, I often receive a quizzical look.  “What’s that?” I am often asked.

When I tell them that it is a gentle way of mobilizing the organs in the body, that quizzical expression often turns to surprise, if not outright alarm.  “Ok…but why would you do that?”.

The reason, I say, is that the organs (our viscera) need to be able to move freely in the body just as our joints and muscles do.  And when they don’t, the body can start to have problems: digestive issues, trouble swallowing, difficulty taking a full breath, or pelvic dysfunctions like urinary frequency.  But beyond that, visceral movement restrictions can be a key factor in puzzling orthopedic conditions or even stress/emotional problems.  Often, more than one  of these issues is occurring at once, and they usually come about gradually or with no obvious cause.  


what is visceral manipulation?

Mobilization of Large intestine

It’s not that visceral manipulation is the end-all be-all panacea for any ailment out there.  But it is a very important piece of the puzzle because the organs are so central in our bodies physically and functionally.  They are also highly innervated, meaning they are plugged into the system that governs our body’s functions and sensations (more on this below).  Everything in our bodies that we take for granted each day depend on good visceral movement and health, even if that relationship isn’t apparent on the surface.


Visceral manipulation is a gentle, physical, hands-on therapy, and it has been developed out of the osteopathic tradition by French osteopath Jean-Pierre Barral (For more info on this, please visit the Barral Institute). Like the musculoskeletal system, the organs are surrounded by an endless web of tissues called fascia, that supports and connects them to everything else in the body.  Visceral manipulation isn’t so much about imparting a force on an organ as it is about easing and balancing the tensions in the fascial network surrounding it.  The idea is that when the organ moves better, it functions better.

Lobes of the lung, for example, must be able to glide on one another and expand with every breath. For this, the pleural membranes must be free of restrictions from stressors such as prior respiratory infections.

“So what is it like?” you might ask. 

Compared to conventional physical therapy, it’s different in a few important ways. 

Like other forms of therapy, it starts with the evaluation of the body to find areas that are restricted, with different tests to determine which organs are moving well and which aren’t.  But the primary tool with visceral work is feeling, or  “listening” to, the tissues with a light touch to find where the tension is the greatest [What is Listening?]  This is how the practitioner knows where to start working, and a good amount of time goes toward this step to ensure accuracy and precision. 




From there, treatment begins, and once the involved structures have been determined, the practitioner gently, and slowly sinks his/her hands into the skin to the appropriate depth in the body to engage the structure, whether it’s the stomach, the lung, bladder, etc.  Then the practitioner can determine how well the organ can move, whether there is symmetry in its mobility, and what other structures of the body might be involved in the restriction.  We ask our patients/clients to wear loose, comfortable clothing, and to be prepared to temporarily remove shirts or strip down to underwear if needed so we can have the best organ contact possible when treating.   



“Interesting,” you’re thinking.  “But what causes these restrictions in the first place?” 

Several things can cause visceral restrictions: physical trauma (i.e. a car accident, fall, pregnancy, or surgery), diet, lifestyle, infections, and mental/emotional stressors.  All of these factors could be issues the person is dealing with at that moment, or commonly, many years old (i.e. from an old physical or emotional trauma).  

We are still trying to understand how exactly this happens, but the nervous system plays an important role.  When we encounter an overload of stressors of any kind (emotional, environmental, physical, etc) the organs appear to receive the overflow of what we can handle. It’s the nervous system that is directing the tissues to tighten, and from the brain through the complex network of nerve fibers running throughout the body, it is constantly communicating with the area being treated.  Very often, as a visceral restriction is released, not only are there far-reaching physical effects in the body, but one’s spirits and attitude are improved as well.  It’s truly a holistic intervention for body and mind.


About the author:

Tim Newton, PT, DPT, OCS, CFMM  and a board-certified Orthopedic Clinical Specialist who specializes in manual, osteopathic techniques to help pain and movement dysfunction.  His expertise is in visceral manipulation, gentle spinal manipulation, and craniosacral therapy.  He is the owner of Inspire Movement Physical Therapy in Columbia, MD.


Tim Newton, DPT, OCS