Visceral Manipulation in Structural Work: Liz Gaggini, M.A

Visceral Manipulation in Structural Work
Liz Gaggini, M.A.

First published in the 2005 Yearbook of the International Association of
Structural Integrators. Copyright 2003 by Liz Gaggini, M.A.
In structural work we are usually trying to effect the alignment, balance and
kinetic behavior of the structure. We try to solve problems in all of these areas.
Visceral restrictions (restrictions in the fascia of and around the organs) will
impact all of these structural issues. A visceral restriction may be the cause
and/or a part of a problem of misalignment, imbalance or kinetic dysfunction.
When our work is not being successful we need to be able to assess for a
visceral component. If we find restrictions, we need to be able to correct them.
There are two very significant ways in which the viscera affect the structure.
One, is that the body will shape itself, even to the point of misalignment and
restricted movement, to protect and assist an internal organ. It is as if the body
honors visceral ease first and structural wellness second. Secondly, the viscera
reside in the center of the body. Any restrictions in visceral fascia are directly
transferred to the myofascial and body structures of the torso. This is especially
true of the pelvic, respiratory and thoracic diaphragms. The brain is also a
visceral organ. The relationship of restrictions in the intra-crania fascia to the
structure of the cranium has the same local and global consequences for the
structure. The major diaphragm of the cranium is the spheno-basiler junction.
The organs are designed to cooperate with the body’s needs for alignment,
balance and movement. In general there is a high elastic component to the
visceral fascia and the visceral ligaments. This allows the viscera to move with
the myofascial and bony structure without injury or inhibition. When there is a
restriction in an area of the visceral fascia it will interfere with that area’s
capacity to move with the body. Any forced movement through the visceral
restriction could injure or greatly inhibit the function of the viscera. It is rarely
the case that the body will allow the viscera to be affected in this way. Instead,
the body will inhibit the myofascial and bony structure to protect the viscera.
The body will go even further in its protection of the viscera. It will actively use
the structure to create ease and assist with the function of a restricted organ.
One common instance of this active use of the structure for the benefit of the
viscera is seen when there is tremendous restriction in the stomach. The
myofascial and bony structure will bend and twist to put the stomach into a
position that creates ease for the stomach tissue and creates an optimum
position for the stomach’s function. It is a hierarchy in the effort for survival –
stomach function is more important than joint alignment.
As structural workers who work to align the myofascial and bony structure, we
are often frustrated when all of our good work to resolve the side bends and
rotations or to create support and transmission seems of no avail. We are often
working against the survival hierarchy. Until the visceral problem is resolved,
the structural changes will not hold.
Copyright Liz Gaggini, M.A. 1

The horizontal structures of the torso – the diaphragms – are in direct
relationship with the viscera. Many most organs are attached in some way to
these structures. The viscera also has attachments to the sheaths of fascia that
border the visceral cavities. These sheaths are then attached to the internal
surfaces of the muscles and bones of the torso. This is truly the core of the
body. This part of the core is bounded by the pelvic floor and thoracic outlet,
and is transected by the respiratory diaphragm. Restrictions, misalignments
and inhibitions in the visceral fascia directly transfer into the structure of the
torso and then indirectly into the rest of the body. As with all structural issues,
the longer the problems remain untreated the further and more completely the
single issue of a visceral restriction will be patterned into the entire structure.
In the body’s efforts toward equilibrium, there is a resonance that happens in
the horizontal structures. This resonance is all happening with horizontal fascia
in the appendicular and cranial structure as well. It is very frequent that
opening the visceral core also produces and opening in the appendicular and
cranial core.
Visceral restrictions
What creates visceral restrictions? Most fundamentally, it is inflammation.
When there is inflammation in the tissue, the body lies down more connective
tissue fibers. Essentially, this is scar tissue. This produces a local tightness and
reduces local elasticity. When the visceral fascia is torn or bruised, there is
inflammation. When there is illness there is also inflammation. So, when we are
assessing visceral problems we are interested in accidents and injuries that
might have affected the viscera. For instance, whiplash is potentially more
damaging to visceral tissue than it is to the muscles and joints. Another
common injury that strongly affects the pericardium is anaerobic exercise. This
stresses the heart and will create restrictions in the pericardial fascia. But, we
are also interested in what illnesses a person has had. Hepatitis, pneumonia,
stomach troubles, etc will all create restrictions in the viscera. These visceral
restrictions will, in turn, create problems for the entire structure.
As structural workers, we are not addressing the visceral fascia to cure illness
and disease. We are working with the viscera to help with structural wellness.
We might have to correct the effects of an illness, just as we would correct the
effects of a broken leg. Our work might also improve the overall health and
function of the viscera. However, we are best to keep our legitimate goals in
mind.
Working with the viscera

The main work with the visceral fascia is done with indirect techniques. There
are a few instances when direct work can be used. Indirect work is done by
taking the tissue into its restriction. Direct work is done by taking the tissue
away from its restriction. Indirect techniques seem most successful when there
is a high ratio of elastin in the tissue. In a few areas, the visceral tissue can be
less elastic. The mesentery of the small intestine can be one such area. This is
an area where direct work can be effective.

Assessment
There are several ways to assess visceral restrictions. One is to deduce their
presence by looking at the structure and at movement. The organs can also be
gently mobilized (moved around) and any restrictions will inhibit the natural
motion of the tissue. If you know what the natural mobility should be, then you
will be able to assess the general location of restrictions.
The most accurate way to assess visceral restriction is to read an organ’s

pattern of inherent motion, also known as motility. The motility pattern of an
organ is prescribed by the organ’s shape, its attachments to the structure and
its arrangement with other organs. Within a healthy visceral system the organs
move back and forth in predictable patterns, with a steady amplitude and full
range of motion. Any restrictions will change the expected pattern, disrupt the
amplitude and decrease the range of motion. These diversions from the normal
all give information about the location and nature of the visceral restrictions.
The nature of inherent motion

The back and forth of inherent motion is the same motion as is found with the
long tide in cranial assessment. The long tide, first written about by
William Garland Sutherland in Teachings in the Science of Osteopathy is actually
a motion of expansion and contraction. A full cycle, composed of one full
expansion and one full contraction, takes between 100 to 120 seconds – so
about 2 minutes.
There are many speculations about what this motion is, where it comes from
and why it is here. These speculations range from the spiritual to the
physiological. Sutherland had a quasi-spiritual idea and called the long tide,
“The Breath of Life”. Jean Pierre Barral, who has written several books on visceral
manipulation, has speculated that the motion is established by the activity of
development in the embryo. My own belief is that the long tide is the
kinesthetically palpable effects of gravitation. This would not preclude a
correlation with the activity of embryological development. And, a full grasp of
the nature of gravitation is a metaphoric correlate with Sutherland’s Breath of
Life. If you are interested in this topic, there is a section at the end of this
manual that has two articles and some other writings of mine on gravitation and
motility.
With the long tide, the body will widen and shorten in the expansion part of the
cycle and narrow and lengthen on the contraction side. The patterns of motility
of all of the organs will naturally move with this cycle. Jean Pierre Barral labeled
the expansion inspir and the contraction expir. His idea is that the organs are
moving as they would from the effect of respiratory inhalation and exhalation.
This is not a good direct correlate to the actual motion of the viscera However,
the terms are so widely used that they have moved beyond their original
conception.
There is a unity and harmony of this inherent motion within the construction
and the function of each organ. For instance, the structure of the bronchi, and

the function of their passing air into and out of the lungs, is harmonious with
the inherent motion of inspir and exspir. There is also a harmony in the way the
shapes of the organs are arranged inside the body with the ways that they will
move with the cycle of widening and shortening and narrowing and lengthening.
Because the organs are tightly packed in the visceral cavities, if one organ is
restricted and not moving naturally, it will interfere with the natural motion of
other organs. Finally, the way that various physiological process work is
harmonious with the cycle of motility. One very clear example of this is the
movement of matter through the digestive tract. With expir there is a motion
down the tract from the stomach through to the rectum and with inspir the
motion reverses, assisting the churning, squeezing and peristaltic actions of
digestion. In releasing restrictions in the visceral fascia we help restore the
organs to not only to their natural pattern, amplitude and range of inherent
motion, but also to their natural function.
When this natural pattern, amplitude and range is restored in the viscera, the
myofascial and bony structure no longer has to inhibit or misalign itself to
protect and assist the organs. In the process of correcting the structural
misalignments that relate to visceral restrictions, it is still necessary to realign
the extrinsic fascia. It is usually best to address the extrinsic fascia first. Then,
when the viscera are released, the openness that is created with this work will
allow the full expression of the inherent motion. If the extrinsic structure is still
bound up in its response to the original visceral restriction then, when the
viscera is released, it will not be able to express its full range of motion. This
can be uncomfortable and seemingly disconcerting for the system. Any
extrinsic limitations will usually become obvious within a few moments of
walking about after the visceral work.
Receiving the visceral work can be a more parasympathetic (relaxing) event.

Receiving direct extrinsic work can be more sympathetic (arousing) in nature. If
both intrinsic and extrinsic work is to be done in one session, it is usually best
to do the extrinsic work first. The system will integrate the work better in this
order. However, if there is good preparation, it is possible to bring a client’s
system back to the more sympathetic experience and do a little extrinsic work
to help the body adapt better to the visceral changes.
Induction – the primary indirect technique

The primary indirect technique is induction (also called facilitation) To use
induction with the organs, after sensing the whole pattern of motility follow the
strongest, fastest and most undisturbed motion in the pattern to its end point.
This is the point of greatest excursion. There will be a pause until the opposite
motility motion begins. This will produce an exactly opposite direction motion
to that which was followed in. Hold a barrier at this point against the direct
reversal. This barrier needs to be as strong as needed to prevent opposite
direction motion, but light enough to allow further excursion. Fairly quickly
there will be motion other than the direct opposite. There may be a motion
further along the same original line. Or, it could move in any new direction. If
the barrier is too strong there will be no new motion. Any new motion is
followed to its point of greatest excursion. Any directly opposite motion is

again sensitively blocked. Any new motion is followed. This activity of
follow/barrier is repeated until there is a release. A release feels like a general
opening and softening in the organ. This release should always be followed by
another assessment of the organ’s motility pattern. If there are still restrictions
then further inductions can be done. Restrictions will always express
themselves as a faster and slicker segment of the entire pattern.
This way of working is deceptively powerful. There can be tremendous change

in the position and range of motion in the organs from just a small amount of
work. Care needs to be taken to integrate these changes through out the
viscera. Generally there is more than one restricted organ. And often several
organs are involved in an area of old illness or injury. Strain and restriction can
also be through out an entire system such as the urinary or digestive. It will be
a great disservice to the person if only one organ is tremendously freed while
others are not. Discomfort and a reversion back to the restricted nature is the
least that could happen. It is better to get just 30% improvement in several
restricted organs or through out a system than it is to get 100% improvement of
just one organ.
There is a lot to become familiar with in working with the visceral fascia. It
seems to be a work needing great patience. However, because such
tremendous transformations can result from the work, it is actually a work for
the impatient. The real patience that is required is in taking the time to learn to
do the accurate and integrative work that produces these benefits. I wish you
the best in this endeavor.
Copyright Liz Gaggini, 2003
Liz Gaggini is an Advanced Rolfer who has a clinical practice in New York.
She teaches classes on biomechanics and on including visceral manipulation
into structural work. She has published several articles on visceral manipulation,
biomechanics and the role of gravity in subtle motion. Information on her
classes and on obtaining publications can be found on her web site,
www.connectivetissue.com.

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Visceral Manipulation in Structural Work

Liz Gaggini, M.A.

Copyright Liz Gaggini, M.A. 1

Working with the viscera

Copyright Liz Gaggini, M.A. 2

The most accurate way to assess visceral restriction is to read an organ’s

The nature of inherent motion

Copyright Liz Gaggini, M.A. 3

Receiving the visceral work can be a more parasympathetic (relaxing) event.

Induction – the primary indirect technique

Copyright Liz Gaggini, M.A. 4

This way of working is deceptively powerful. There can be tremendous change

Copyright Liz Gaggini, 2003

Copyright Liz Gaggini, M.A. 5

Copyright Liz Gaggini, M.A. 6

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