Have you ever considered what happens to the your abdominal organs when you bend forward at the waist?  This is a movement that is evaluated during a course of physical therapy for low back pain. Most physical therapists are primarily focused on the movement of the spine, pelvis, muscles and nerves.  But, when your skeletal body moves, your organs (viscera) move as well.  So why are most therapists not paying attention to what’s between your abdominal muscles and your spine? Can your organs and their fascia be the source of your pain or dysfunction? This question piqued Jean Pierre Barral’s interest in studying the viscera and their facial environments, and ultimately led to his therapy called Visceral Manipulation (VM).

What is Visceral Manipulation?

Visceral Manipulation is “organ-specific fascial mobilization” performed by a skilled physical therapist or osteopathic physician. Jean Pierre Barral DO, PT became interested in the biomechanics of the body when working at the Lung and Disease Hospital in Grenoble, France. In the cadaver lab, he identified patterns of stress in the visceral system of cadaver tissues and noticed how they correlated with his living patients’ symptoms or reversal of symptoms from his manual treatment. He called his therapy Visceral Manipulation. According to Dr. Barral, when an organ is restricted, the body is forced to compensate, which may create abnormal tension and chronic irritation that can be transmitted through the tissues throughout the body. Organs can lose mobility due to trauma, surgery, infection, posture, diet and pregnancy etc.  Early on in the development of VM, Dr. Barral noted a connection between the viscera (lung) and spinal pain and dysfunction. One of his first patients to experience Visceral Manipulation reported a resolution of his back pain after the “old man pushed on something in my abdomen”. 

Who Benefits From Visceral Manipulation?

Patients who have the following conditions:

  • Whiplash and seatbelt injuries
  • Sports Injuries
  • Lower back pain and sciatica- chronic
  • Spinal dysfunction
  • Thoracic Outlet syndrome
  • Carpal Tunnel Syndrome
  • Digestive Disorders
  • Acid Reflux
  • Post-operative scar tissue pain
  • Chronic Pelvic Pain
  • Women’s Men’s Health Issues
  • Headaches and Migraines

How Does Visceral Manipulation Work?  

Visceral Manipulation is a hands-on therapy technique that identifies abnormal motion patterns and the source of the compensatory pattern. The source of the dysfunction is the key that directs the treatment plan and will guide which tissues will be treated. VM can be a light or firm touch with compression, mobilization and or elongation of the affected tissues. The patient will be sitting, lying, or kneeling for the treatment. Often VM is incorporated into the existing treatment plan in which the patient actively participates.

visceral manipulationWhen you bend forward at the waist…The LIVER, a large abdominal organ below the diaphragm on the right side of your abdomen, slides forward and down over the small intestine and the colon when you bend forward.  It also moves as result of the diaphragmatic movements during respiration. The average adult takes 16-20 breaths in a minute and thus the diaphragm moves 22,000 times per day. With each breath, the diaphragm descends and ascends pushing and/or pulling on the lungs, heart, liver, stomach and spleen. Any restriction in visceral (organ) motion can lead to compensations in the body and can be a source of the dysfunction manifesting in pain, neuromuscular dysfunction and/or joint restriction.

How Many Sessions Does It Take?  

Each patient’s situation is unique, so the amount of sessions may vary.  The general rule is that the majority of patients feel improvement within three to five visits but others may require additional treatment.

Will There Be Home Exercises or Homework?  

Visceral Manipulation is a fascial technique. Stretching exercises, breathing exercises and/or postural reeducation compliment the manual treatment.  You may be asked to keep a journal of symptoms, diet, and/or elimination practices since sessions may be spaced out over 2-3 weeks.

About The Author

Mary Beth Verlander - One on One Physical Therapy - Atlanta Physical TherapyMary Beth Verlander, MPT, PT has over 25 years clinical experience and is a highly skilled manual therapist. She began her career in medicine as a nurse.  She is a teaching assistant for Visceral Manipulation for the Barral Institute and is a candidate for Visceral Manipulation Certification. To schedule an appointment with Marybeth, call 770-500-3848. 




  1. Barral JP, Mercier P. Visceral Manipulation. Seattle, WA,USA: Eastland Press; 2005.
  2. On Overview of Visceral Manipulation, (n.d) The Barral Institute.