Visceral Manipulation: Working With Organ Movements

Dr.Elena Stoeva treating Susan Evanse through a technique called Mobilization of Duodenum to the Spleen (Alan Spearman,The Commercial Appeal, July 2013) 

Dr.Elena Stoeva treating Susan Evanse through a technique called Mobilization of Duodenum to the Spleen (Alan Spearman,The Commercial Appeal, July 2013) 

 What is Visceral Manipulation ?

Visceral manipulation is a form of manual therapy using gentle manipulations of the internal organs (viscera) to improve the functioning of the individual organ, the systems the organ functions within and the structural integrity of the entire body. The goal is to help the organism's normal forces remove abnormal effects, whatever their sources.

Our organs are in perpetual motion. When you breathe, when you walk, when you run, when you stretch, your organs move in your thorax, chest and abdomen.

During normal activity, your diaphragm moves 24,000 times a day to accomplish breathing exerting impact on the organs in the abdominal cavity. The abdominal organs can move a minimum of 2,000 feet a day.

The kidneys move about one inch during inhalation, and they do that in three dimensions. With a deep breath they can move four inches, and that is only in an up and down motion. In reality, they also rotate and move sideways. What this translates to in a day is moving a distance just over a mile. Through your entire life, your kidneys will each move a distance of approximately 19,000 miles. That is not quite the distance around the world(25,000 miles), but close.

All of our organs move but in different speeds, in various directions, and with variable timing. The lungs, liver, spleen, pancreas and intestines are all moving with the diaphragm. The pelvic organs move with the diaphragmatic excursions, too, but they are more dependent on the activity of our legs. This includes the activities of the bladder, rectum, the urinary and intestinal filling and evacuating, and for women the menstrual cycles, pregnancy and delivery.

The heart has a small movement on its own - it 's a kind of torsion where the lower part rotates on itself. At the same time, it beats 100,000 times a day!

The brain has tiny movements as well. It glides a little when you bend forward.

These motions are linked to many levels of activity, from cellular pulsations to rhythmic contractions of the heart, diaphragm, even the cranio sacral system.

In 1981, french osteopath Jean-Pierre Barral published his first monograph Visceral Manipulation, in which he described for first time the mobility and motility of the internal organs. This publication followed extensive clinical work and research using x-ray fluoroscopy, ultrasound and infrared emissions from the body to document changes in the organs before and after manipulation, changes in position, motion, fluid exchange and evacuation.

Mobility is our organs' capacity to move around the surrounding tissues. Motility is their active, intrinsic, motion independent of the surroundings, around an axis coinciding with the axis of their migration during embryogenesis. Organs migrate during embryogeny. For example, the stomach rotates to the right in the transverse plane and clockwise in the frontal plane. This is exactly the trajectory of its motility which has a rhythm - very slow - of 7-8 cycles per minute and a low amplitude in two phases . This oscillating is perceptible but requires an educated sense of touch. Under normal conditions the organs move in synchrony, i.e.,they undergo the same phase at the same time. 

Jean-Pierre Barral, DO, Developer of Visceral Manipulation performs a short Visceral Manipulation evaluation and treatment session.


VM relies on palpating normal and abnormal forces within the body. It encourages your own natural mechanisms to improve the functioning of your internal organs, dissipate the negative effects of stress, enhance mobility of the musculo skeletal system through connective tissue attachments, and influence general metabolism.


VM is based on the specific placement of soft manual forces to encourage the normal mobility and motility of internal organs and their connective tissues. Harmony and health exist when motion is free and excursion is full - when motion is not labored, over excited, depressed or conflicting with neighboring structures and their mobility.

Due to the delicate and often highly reactive nature of the visceral tissues, gentle force precisely directed reaps the greatest results. As with other methods of manipulation that affect the body deeply, VM works only to assist the forces already at work.

This requires a lot of knowledge, educated and trained perceptual skills on behalf of the clinician.

Today, a wide variety of healthcare practitioners use VM - osteopathicand allopathic physicians, physical and occupational therapists, massage therapists, doctors of chiropractic and oriental medicine, naturopathic physicians, etc. Methods like VM and CST have long been a component of some therapeutic systems in oriental medicine and parts of medicinal cultures in Europe and Asia since pre-recorded times. So, it is not a surprise that they are mandatory in the curriculum of Manual/Musculoskeletal Medicine in Europe, Australia, New Zealand and Japan. Find more information on this postmodern medical specialty on the website of the International Federation of Manual Medicine.

I am proud to be one of Barral Institute alumni, to have studied and continue studying personally from J.P. Barral and to be able to use VM in my work.