Notes from day 1 of 4 days from Barral’s Visceral Manipulation 2 taught by Ron Mariotti, ND; including Kidneys, Spleen and Pancreas. Email me directly if you want the rest of the classes notes.
kidneys
LISTENING
General listening is about Where
The tissue hugs the lesion and tells you exactly where the right spot is
• The body does not lie
• There is a fine variation between emitting (treating) and listening
o The person will respond when you push into them while emitting and this will disturb your listening diagnosis
o You must keep a clear boundary of where you are and where they are. Otherwise we cannot be effective
• Let the body speak to you without putting any healing or shifting input
• General Listening – Sagittal suture is warmer so this is where your middle finger should be
• The feel good spot is where you should be listening from (in regards to standing near client)
o If you feel bad – that’s your energy getting in the way.
o Is it anterior or posterior, left or right, above or below diaphragm
o Use other hand to inhibit where you think it is. If listening line goes away – then this is the spot.
o No shoes, no watches, no Q-links. Client’s feet should be close together so they are destabliized. IF really unstable they should spread their feet wide so you can get an acurate read. Open and close eyes to get a better reading.
o Load the tissue, and read
• If its rapid and urgent – could involve a few structures
• If it feels very deep – have client sit down to take the legs out of the equation.

Local listening is about What
Keep your hand parallel in local listening. Feel with palm more then fingers.
• You must inhibit listening line first with fascial loading and as you slowly lighten up feel the direction of pull. Once you get a sense move a few centimeters in that direction.
• As you get to the spot the pull will slow. When you inhibit the restriction, the line of tension should dissappear.
• You must use your mind and visualization to project into the body to see the organ or spot. IF you can’t see it, you can’t treat it. – Barral
• You must know anatomy and physiology for deeper organs.

VM promotes balance in the tissues in the body
• Neurophysiology creates an internal environment for better health
o The organ that can move better can communicate better with the central nervous system.
• Organs need to displace other organs for there to be communication with CNS
o When organ is restricted there is a lack of communication
• Better communication – better function
o “An organ in good health has physiological motion”
o Gross motor movement
• Organs must slip and slide in their space
• Voluntary muscle activity
• Autonomic Nervous System
o We breath 24,000 times a day
o Heart beats 120,000 times a day
o Peristalsis
• Evaluating Organ
o ROM – range of motion in ligaments
o Shock absorbency factor (softness)
o Slide and glide slipperiness
o Surrounding structures (how do they relate to one antoher)
o Function occurs in 3 dimensions
• Restrictions occur in 3 dimensions
• Motility
o Increases neurological connection
o Kinetic sense of ogran from inside
• How happy is this organ
o Has a rhytm to it – a good amplitude, not jerky, no hesitancy
o Has syncronicity – the phases of movement are equal
• Something is wrong if this is off
o Embryological migration
• Organs mimic this original migration from fetal development
o Motility is energetic, its subtle
o 7-8 cycles per minute
o 3.5-4 seconds per phase
o Less amplitude then mobility
• Direct Stretch
o Taking two tissues away from on another
o Moving tissues closer towards one another (shearing tissues across one another, twisting the tissues in relation to one another, the tissues may roll over one another)
• Induction
o You are listening and following the tissues in mobility induction
o The inherent motion is motility induction
• Treatment
o 3 dimensions
o Shear and Glide
o The body is expressings its tensions as you line up the long levers
o Treat in a functional position
o Recoil – not as effective
o Induction
• Evaluation and treatmen protocol – in handout
o With motility, follow direction of ease and take further. If you unwind and dance with organs varied movement you have done very little.
o If you are having a hard time – visualize. And lighten up. You should only be using the weight of your hand.
o “Only the tissues know.”
• Don’t worry about their story or their perception
o “Let the body speak.”
o The body is the system of intelligence and we are “waking up a little something”
o VM has been called the missing link to the neuro-musculoskeletal system. “Liquid osteopathy”.
o “organ-specific fascial mobilization” for western diagnostic codes
pancreas
Pancreas
• When you eat: Insulin is released to break down carbs, proteins and fats.
o Glucose is stored as Glycogen which is stored in liver
o Insulin causes fat cells to store lipids
• Alpha cells make Glucogon, hormone of starvation
o Blood sugar drops to a lower level
o Endocrine Hormone that’s primary target is liver cells that causes long chain glycogen to breakdown to
o CentroAcinar cells excrete bicarbonate ions through pancreatic ducts to neutralize HCL from stomach
o Pancreas needs higher pressure so that bile does not relux into pancreatic ducts. This triggers autodigestion of pancreas itself
• To help out say this to yourself, “How do these tissues want to create a relationship?” and this will encourage them to move

• General Steps
o Motility
o LL/ inhibition to find associated organ (structure)
o The inhibition point for the pancrease is medial border of D2
o Function of sphincter of Oddi (inhibit here)
o Choose body position
o Contact both organs, LL, line up tension with both
o Motility induction of pancreas
o Mobility induction
• Location
o Outline D1,D2,D3,D4 and oddi
o Pancreas reaches up to Ribs 9-11 to contact spleen
o Inspir in pancrease moves it away from midline in both directions. (embryological development of spleen as it grows from 2 lobes into one).
o Head of Pancreas:
• Inspir: Anterior and to right. Wave starts in fingertips
• Expir: Posterior and left. Wave starts in palm
o Where there is no motility? Head, Tail or Body
• When you work with motility you work with endocrine hormones insulin, glucagon and somatostatin.
• When you work with mobility you work with exocrine system
Now What?
• Stabilize (anchor) the pancreas (be gentle)
o Let the 2 places (the other restriction discovered by doing local listening) have their way with each other
• Take up the 3-dimensions on your associated organ
• Put some oscillation in the other organ…if needed.
• Kidney and Pancreas connection
o Supine
o Posterior palm on left kidney (envelop L3 up to 11th rib)
o Anterior palm on pancreas
o Listen and follow
• Stomach/Duodenum/Transverse Colon and Pancreas
o Stomach and pancreas
• Seated (goal is to encourage stomach off of pancreas)
o Stomach & Duodenum (head of pancreas)
• Line up D2 (+oddi)
• Line up D1/D2 interchange
o Stomach & Pancreas
• Supine
• Anterior hand contacts Pancreas
• With posterior hand “suction” the pancreas into your hand, toward the table.
• The pancreas is very delicate so its better to work on the surrounding structures rather then the pancreas itself.

Spleen
• Draw a line from sternoclavicular joint to tip of 11th rib. Spleen is posterior and obliquely above this the size of a small fist.
• Hilum is the central anterior portion of spleen that blood vessels come in
• Spleen has impressions on it for the surrounding organs
o Stomach, Colic (splenic flexure), Renal, Pancreas connection
• Gleasons Capsule
• Functional part is red (where blood vessels feed into and are filtered after 120 days) and white pulp (lymphatic follicles that create beta cells –creates antibodies and obsinans). Help them bind to targets. Prepardin helps in inflammation and phagocytosis. Tuffsin helps macrophages have a tumorcidal and bacterialcidal properties.
• Spleen is not attached to phrenicocolic ligament but sits on top of it like a sling. It attaches colon to diaphragm. This is an important piece of freeing spleen.
o Reach up towards 8th rib (think it don’t push all the way through) and contact this ligament.
• General Steps
o Motility evaluation
o LL/ inhibit to find associated structure (organ)
o Choose body position
o Contact both organs, LL, line up tension with both hands
o Choose induction or direct stretch
o Re-eval: motility, LL
• Options: Spleen mb sitting or right side lying
• Left phrenicocolic ligament
• Evaluation
o Person is supine, stand on right side
o Palm is posterior to mid-axillary line at ribs 9-11
o Motility follows the stomach (some subtle differences). Keep it simple and think of it as similar to the stomach and then feel for the subtle differences).
o Inspir (superior, post, lat.)
o Expir (inf, and, med).
o Where do you feel a drag on motility, which can be an indication of the location of the restrictions?
• Local Listening
o First, go to the depth of the spleen.
o Add a gentle pressure through the ribs
o Once there LL to see where it takes you
o Notice if it is the same as the indication with motility
• Mobility testing
o Mb test superior, posterior, and lateral directions:
o Mb ant/ post
o Compress slightly towards the pancreas
o Slide over the colon
o Slide in relation to the stomach
o Slide in relation to kidney
o If you compress and it feels like a rock it’s the space between the spleen and the diaphragm
stomach