Chiropractic manipulation of the spine is well documented, and evidence strongly supports its benefits for many musculoskeletal conditions of the neck, midback, low back, pelvis, and extremities. Less evidence has been published about visceral manipulation. So what are there benefits of visceral manipulation, if any?
A 2013 study reported that females with lower urinary tract symptoms responded favorably to manipulation. The authors cited two studies that compared manipulation to pelvic floor muscle training and documented similar therapeutic benefits. Appropriately, the authors reported the need for further studies to firm up these positive conclusions.
Another interesting study by a massage therapist and a chiropractor using a rat model evaluated the effects of visceral massage on postoperative ileus. This is a condition that is common following abdominal surgery where normal bowel function slows down or stops entirely and is highly uncomfortable and potentially dangerous. Forty subjects were divided into four groups (two surgical and two treatment groups) and transabdominal massage was used on ten surgical and ten control subjects in the first twelve hours following surgery. Ileus was measured after 24 hours using several reliable outcome measures (fecal pellet discharge, gastrointestinal transit, and measuring inflammatory markers). Ileus occurred in all of the surgical subjects and comparing those that received no visceral massage to those receiving it, the group that received the treatment showed increased transit time, less time to first pellet discharge, and fewer inflammatory cells and proteins. A similar study design was recommended for a hospital setting to assess the potential role of visceral massage as part of an integrated care model for postoperative ileus.
Visceral manipulation (VM) research can be found in osteopathic, physical therapy, chiropractic, massage therapy, (and more) literature and yet, controversy surrounds this subject. A French osteopathic physician and physical therapist, Dr. Jean-Pierre Barral has written a book and offers seminars on visceral manipulation and these courses are attended by MDs, DOs, DCs, PTs, OTs, RMTs, Naturopaths, doctors of Oriental medicine, and others. His website offers many references for the procedures utilized. The critics of VM speak out calling it a pseudoscience and worse. They claim there is no evidence to support its tenants and criticize the American Physical Therapy Association (APTA) for sponsoring educational courses of VM.
In chiropractic, VM is available as a technique within the Sacro Occipital Technique (SOT) organization which is called Chiropractic Manipulative Reflex Technique (CMRT). This is well described in Wikipedia and at their website (http://soto-usa.com/?s=visceral). A list of peer reviewed studies is available and includes the management of gastroenteritis, diabetes mellitus, GERD, infantile colic, infertility, chronic colitis, dyspepsia, asthma, chronic constipation, and more. Another chiropractic-based approach to treating visceral conditions is called Applied Kinesiology. Here, muscle testing is used to assess the patient and areas on the skull and over the body are stimulated to balance faulty reflexes that relate to the organ system and some specific VM techniques are included. This can be further reviewed at their website (http://www.appliedkinesiology.com/). Though visceral manipulation may not be considered “mainstream chiropractic,” options exist with some level of support and if your doctor of chiropractic can’t help you with this, he or she can try to find someone within the profession who can.
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