I wanted to post some of my notes to this class I took. I absolutely loved this class taught by Ken Frey through the Barral Institute. This is only 1 day of 4 days of notes. If you would like the remainder of the notes please email me.

Sequence of diagnostics
• General Listening
• Local Listening
• Inhibition
o Thermal diagnosising works with inhibition
o 1/10 of a degree celsius can be measured through the hand
o Energetically off the body there are layers of “energy”
• These layers can be manipulated

Mobilitiy: Movement is Life
• Position doesn’t matter, mobility does
o Leg length discrepancy doesn’t matter, it’s the abnormality of restrictions that’s the key
o An organ in good health moves in all planes of physiologic motion
• 3-D movement in the coronal, sagittal and transverse
• Body rotates around specific axis
• When under stress there will be a lack of motion in at least one plane

Why VM?
• 90% of musculoskeletal dysfunctions involve viscera
o Not necessarily “caused” by viscera
o Restriction could come from ANS telling organ to restrict
• 70-80% cranial system, cns restrictions are caused by something extra durally in the body
• All organs surrounded by connective tissue
o Body constructed by concentric circles of connective tissue
o Structures must slide and glide – if not restricted
o We learn about muscles but they are given the orders from the adhesion point of view – not giving the orders
• All manual therapies are based on the fact that there is an inherent normal movement in the body and when something restricts this normal function there is a pathobiomechanical and or pathophysiological affect to the person.
o All manual therapies are based on releasing the hypomobile areas or adverse biomechanical restrictions in the body
• Pathophysiological dysfunction – when visceral movement is impaired the function of the organ is impaired
o i.e. chemistry, blood, etc
• Pathobiomechanical problems can cause pain, dysfunction: in joint muscle, nerve, blood vessel, lymph structure, potentially any anatomical structure
• “Mobility is the key to understanding pathology.” – Barral

viscera
Liver
• Connected to the diaphragm, which is connected and associated to lungs (and up into mediastinum, pleura, neck, phrenic nerve) moving 24,000 times a day. If there is a 1-ounce restriction this chain of events is being pulled over and over again 24,000 times a day and drives strain up into the cranium. Shoulder problems, headaches, etc could result. All signs point to liver.

The art in VM is bringing the person to the point of the restriction and letting them self correct. We can easily press through restrictions but there is no art in that.
• VM have the potential to affect normal physiological function of the individual organs, the systems they function within, and the structural integrity of the entire body.
o Gail Wetzler, “Organ specific fascial manipulation”
• The purpose of VM is to recreate, harmonize, and increase proprioceptive communication in the body to enhance its internal mechanism for better health.
o “I am just waking up a little something in the body”, Barral

Principles and Concepts
• Know your anatomy
• Precision, specificity of palpation
• Listening to the tissues of the body
• “Only the tissues know, the body hugs the lesion” –Barral
o The whole body organizes around the lesion – the kink in the sweater organizes around where the pull is coming from

5 physiological systems affecting visceral mobility
• CNS
• ANS
• Craniosacral system
• Lymph
• Motility

CNS provides voluntary skeletal movement function
• Walking, running resulting in involuntary passive sliding/gliding of organs and surrounding tissues essential for normal body movement
ANS has a significant role in
• Diaphragm, 24,000 motions day
• Cardiovascular activity, 120,000 motions a day
• Vascular affects portal system (venous return)
o That blood flows back to the liver (problems in lowback, pelvis, legs)
• Peristaltic Activity
o All hollow organs are around ANS smooth muscle control
o Hypertonicity or spasm are associated with decreased peristalsis, digestion, nutrient re-absorption and fluid evacuation
CSR has affect on organs,
• Still points reset system to facilitate chaos to reorganization (reset itself)
Lymph system
• Dr. Chikly believes freedom of motion of the viscera and its associated CT is essential for lymph tissue housed in CT with nerves and blood vessels
Motility
• Intrinsic motion comes from within the organ and is the inherent movement/ energetic on a cellular level within the organ that affects the viscera.
• A cellular memory that persists in the movement of the viscera
• 2 Phases of motility
o Inspir = active stage of moving away from midline
o Expir = passive stage coming back to midline
• Viscera moves 7-8 cycles per minute
o Actually 7.7 cycles hertz per minute
o All DNA vibrates at this frequency
o 3.9 seconds widening in inspir and 3.9 sec in passive expir contraction
• Inherent motion of embryological development (migration)
o A cellular memory of migration of organ as it grows and moves from the midline out. It did this in pulses as it grew into its proper position.
o The evolutionary embyrological path
• Motility is subtle, use 5 to 20-25 grams to palpate
• Reflects the inherent health and mobility of an organ
o Lack of vitality can be sensed
• Motility has less amplitude (ROM) than mobility
o 2-3 millimeters, very subtle

Visceral Ligaments
• Unlike the musculoskeletal system where a ligament supports a joint and motion and in VM the sliding and gliding of a an organ is guided by visceral ligaments, however visceral ligaments do not maintain support
o 3 exceptions
• Lesser omentum, digastric, splenic lig
• Forget the image of the visceral lig system
• 5 systems that support abdominal organs
o 1. Double layer pertioneum system,
• Visceral pertitoneum right around the organ itself
• Adheres to the organ and provides structure shape and support and protection and importantly is very elastin
o Around this is a parietal layer, continuous with visceral layer that connects one organ to another and is a bridge (called an omentum). Parietal peritoneum that connects organs.
• Posterior messentery is a sling and has elasticity
• It is the reciprocal tension membrane in the abdominal cavity
 If you are restricted you will feel it.
o 2. Intracavity pressure system
• +30 in lower region, +15 cm H2O middle, up to +5 in upper region
• -37.5 centimeters H2O in thoracic cavity
• Everything is being pulled up by pressure so the weight of the organs is being mitigated by this system
o 3. Turgor swelling system
• Pressure inside the organ – intraorgan pressure
• This pressure is pushing out and the place where organs meet needs to slide and glide – can be restrictions here
• Lungs increase 70% when taken outside the body
o 4. Abdominal Muscle Tone
o 5. Fluid Dynamics
• Serous fluid of 50 ml protects and slides and glides between layers. With infections it gets sticky and creates the adhesion.
 Antibodies here

Restriction refers to any loss of motion
• No mobility, no motility
• Adhesion – mobility with restricted motility
Visceral Restriction occurs when an organ looses part or all of is ability to move.
Causes of restrictions:
• Bacterial, viral infection (any inflammatory process)
• Repetitive stress and movements
• Physical trauma
• Chemical: diet, smoking and drinking
• Emotions – non processed emotion becomes a fulcrum
• Stress, eg. gall bladder specifically affecting motility
• Environmental toxins – mercury, lead, aluminum
• Surgery – serous fluid hardens
Contraindications
• Bleeding or hemorrhage – any risk of causing vascular injury, bleeding ulcer
• Fracture
• Pregnancy “absolute contraindications” – Barral
• Abdominal aneurysm “red flag” strong tympanic pulse to aorta, feels like a tight drum skin, leathery, hard
• Acute visceral problems and flare-ups of an inflammatory process (RA, colitis, fever) send to MD.
• Severe pain
• Your hands get pushed off the body
• Swollen painful lymph nodes (cancer)
• If you are not sure, then don’t
• We work with chronic issues not acute so much
Precautions – use lighter touch cause tissue is more fragile
• Female 1-2 days following menstruation due to increased congestion and ligament laxity
• Infants/children do motility until crawling stage (2 years) then mobility mobilization okay
• Diabetes
• Patients on anticoagulate drugs or cortisone
• After radiation therapy or chemo
• Dialation of superficial veins (varicosities)
• Foreign body: IUD, pacemaker, stints, screens
• Stones