Visceral Elective.
Autumn Term 2013 - Weekly sessions of osteopathic visceral techniques.
Having had experience with visceral approaches to dysfunction previously (e.g. from courses at the Barral institute), I considered myself lucky to take this elective course at the BSO. We're being taught by a great team of osteopaths under the supervision of Valeria Ferreira.
This site will provide an summary of our progress with the course and some reflections on my experiences there and with the application of the techniques in clinic.
Having had experience with visceral approaches to dysfunction previously (e.g. from courses at the Barral institute), I considered myself lucky to take this elective course at the BSO. We're being taught by a great team of osteopaths under the supervision of Valeria Ferreira.
This site will provide an summary of our progress with the course and some reflections on my experiences there and with the application of the techniques in clinic.
25/11 Lymphatics and kidneys Well, if I said last week that the obturator membrane was difficult - try feeling the kidneys! But I guess it is time for a summary: This course has done two things. It has really challenged and, I hope, improved my palpation skills; and it has given me some handy tools to apply on patients and to elaborate on. We finished on a high, with some really useful lymphatic techniques. Something we can always use on patients and that will potentially combine harmonics and lymphatics. Out of interest, I have dedicated myself to teaching myself lymphatic techniques last year, and remember having done them on a patient once who was about to get a cold... At the time she was enjoying it a lot and full of praise; But then, fortunately, she wasn't my own patient, when she came back the week after she reported feeling terrible the day after. So careful - it's not as harmless as it looks and can really stir things up for a while! 18/11 Bladder, obturator membrane Moving on to the pelvis, we got quite intimate today. Even though this is always a bit of an issue, by now we are so used to things like that, that no one really cares. I think this is reflected in an increased professionalism towards such techniques and also in dealing with patients. I noticed in clinic that when I am confident about what I am doing, patients generally don't mind. And if they do, I am always able to explain to them exactly what I'd like to do and why. With this, the key is probably not to become too complacent or even to assume consent. At the end of the day it all comes down to communication. With a little bit of empathy, trying to understand where the patient is coming from and what they are about, it is often clear whether or not such techniques are worth considering or whether it's best to look for something else instead. Often, I feel that I know my patients well enough to judge whether they are open to particular techniques or not. If they are not, it's only if I think that there really is no alternative that I'd try to convince them of something like intra-oral or pelvic work. But to be fair, most patients don't mind. As to the techniques learned today,in particular the one for the obturator membrane release wasn't easy and I think I'll have to practice that one a lot in our technique study group. Luckily, both of my study group mates are doing the visceral elective, so that we always practice that a lot. 11/11 Small intestine and sigmoid On our journey through the bowels, we're quite literally moving towards the end. We did some techniques where you get into close contact with the mesenteric attachments to the posterior abdominal wall and almost 'lift' the intestines off their attachment. Also, we learned how to palpate and release restrictions between the loops more specifically. We did similar techniques for the sigmoid colon. 04/11 Colon The session began with a recap of last week's material. I always appreciate this opportunity to get some additional input and guidance as to my palpation. Anyway, this is probably the biggest reason why I like these classes: They really challenge your palpation. How often do you find yourself in clinic, just doing what your doing, but with your mind not really with your hands?! Today we covered the colon and also had a little go at the small intestine. Funny enough, when I first into contact with osteopathy as a teenager it was for low back pain that the practitioner at the time reasoned was due to a restriction of the descending colon. The pain I had for months before was gone after just one session of what felt like him just poking my stomach. 28/10 Stomach and sphincters Not sure if I mentioned it further down, but I have done the visceral course of the Barral institute in my third year, so that I have actually been practising some visceral techniques in cinic. One thing I found was that there's almost always something to do at the sphincters if visceral techniques are indicated at all. I must say, however, that the Barral way of: one way around it's good, the other way around is bad - doesn't make any sense to me. I guess you can really only justify it with anecdotal evidence, and unfortunately Valeria's course, too, didn't really offer any new explanations. Nonetheless, this was another really good class and well challenging for our palpation skills. 21/10 I had liver for lunch About a year ago I attended the first of a series of courses run by the Barral institute. Then, we covered the viscera of the abdomen on two rather intense weekends. Today our class focused solely on the liver and with Valeria this obviously turned into a major palpation exercise. I wonder when I will get to a level where I simply assume a position where I am able to get the most out of my hands, without some tutor first guiding me towards it. Because once you found that right position everything seems so easy and you think 'of course!'. By position I mean more than just the positioning of my body. It is also about tensions within yourself, your body-weight, depth of palpation, simultaneous relaxation of your hands and an inner attitude of candour and curiosity; and this list is not an exhaustive list. I have had similar great experiences with an osteopath who I visited regularly in Hamburg. With your hands on a patient a good tutor enters your palpation and is able to guide you. If you then trust yourself and allow things to happen under your hands... - my hope is that eventually my own advantageous set-up for palpation will develop and just feel natural to me. Time and experience. 14/10
Getting to the heart of it: The heart. Again, this is a beautiful example how there should be no distinction made between 'musculoskeletal' and 'visceral': A number of proper ligaments binding the heart to the sternum, the vertebrae, this massive muscle the diaphragm and even via the thyroid cartilage to the mandible and cranium! And how often do we stretch ribs, move the sternum and don't even think of this automatism which is pumping away so reliably under our hands. It does take a bit to overcome the hesitance to sink so deeply into the thorax, past skin, intercostals and ribs, to finally feel the presence of the cardium. By comparing the palpatory experience from different models, we learn to trust our hands, acknowledge that indeed there are differences and that we have felt those subtleties. And, yes, what we felt could be explained by a tightness of the inferior sternopericardial ligament, or the superior one... The one thing I struggle with is finding the time to practice all those techniques. I need to make a bit more of an effort with that in clinic. At the end of the day I am so occupied with my exam-style training that I forget to allow time for development of my essential palpatory skills. This will have to change; Exclamation mark. 30/09
The importance of the diaphragm. It seems to me that the diaphragm is a bit like the unloved stepchild, which some BSO-style osteopaths have to look after on occasion. To most others it is the beloved baby which deserves all kinds of attention. Taking up such a central position both in the physical body and in the physiological muddle of the human chemistry, there is no osteopathic reasoning where the diaphragm won't fit in. Up until now my repertoire of techniques for the diaphragm was relatively limited and, admittedly, often characterised by a lot of fingernails. The first lessons in this new course equipped us with a whole range of very subtle but effective techniques. This subtlety is a feature of this elective which I very much appreciate. I think that by this stage of our osteopathic education our palpatory skills are advanced enough to also embrace subtlety in examination and treatment. I feel, however, that many of my colleagues still struggle to trust their perception and thus find it hard to engage with this approach. Since the beginning of these lessons, I have made it a custom to at least have a brief look at the diaphragm in every single patient in the clinic - even if it's just to build up a data base with my hands. I have noticed, though, that the diaphragm changes rapidly during the treatment and that this change is quickly integrated into the functioning of the entire spine. However, the actual breathing pattern of the patient is difficult to affect with manual techniques. And how many patients do we see who either breath with not much more than their first three ribs or who gasp for air like fish! I have tried working with exercises for breathing re-education before, and have had some success, too, but I feel that I haven't found the most effective exercise yet. Currently, I am trailing a new one with another patient. This exercise combines diaphragmatic breathing with activation of intrinsic lumbar musculature. I am curious to see the results we get with this. I will see how this fits in with my osteopathic manual treatment, too. |
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