A massage therapists pushes with two hands into a client's abdomen, doing visceral manipulation

Massage therapists trained in visceral manipulation, a type of soft tissue manipulation of and around the organs, are beginning to take the lead in helping clients shift out of chronic discomfort and into health.

Trained therapists are surpassing the quick-fix therapies that people commonly seek and are discovering that behind the forever-returning symptoms are strains found in the visceral spine. This quickly growing trend of manual therapy is changing traditional massage practices and is catching the attention of top educational institutes in the U.S.

As they recognize how profoundly this modality is changing lives, these institutes are incorporating visceral manipulation into their undergraduate and continuing education programs. The good news is visceral manipulation categorizes under massage therapy in most U.S. states as soft tissue manipulation, making massage therapists potential leaders in this specialization.

A Brief History

Historically, visceral manipulation stems back over 125 years to the traditional osteopathic applications discovered by the founding father, Andrew Taylor Still, MD, DO, (1828–1917), a surgeon who lost three of his biological children to meningitis and his wife by death in childbirth. He proclaimed that there must be another way to help the body heal itself.

Still began to study the function of homeostasis and the body’s innate ability to self-regulate. He analyzed the systems in the body and studied their anatomical interrelationships. Still was often philosophical in his writings and on one occasion related the organ of the stomach to Jupiter in how it relies on the balance of the gases in order to function as a system verses just an organ.

Modern Use

The objective of visceral manipulation today, as it was in the late 1800s, is to regain not only proper alignment of the organ, surrounding tissues, vessels, and neural pathways, but also to restore the proper nourishment and fluidity around the organs since they rely on opposing gliding movement with their neighboring structures to mobilize properly.

Bones just do what they are told, whereas fascia, ligaments, tendons, and muscles actually influence how the body translates force in the action of gait. Fascia is the inelastic connective tissue that holds the body together as one unit, so scar tissue remaining from surgical interventions can cause major compensations.

For example, a shoulder might pull down towards the liver following a cholecystectomy or a vertebra might favor rotation to one side each time the individual takes a step. Over time these compensatory movements could result in herniation. Still’s philosophy that the body is a functional unit of body, mind and spirit is still supported today by the tenets of the American Osteopathic Association.

As visceral manipulation has grown, people are realizing this technique helps resolve the deep sources of strain.

Today, visceral manipulation is becoming one of the fastest growing commercialized modalities, as cranial sacral therapy was in the early 1990s. Visceral manipulation categorizes as a type of soft tissue manipulation, allowing massage therapists to seek training. Full training usually takes a maximum of two years. Prestigious educational institutes understand the importance of such a modality and are offering visceral manipulation in both their undergrad curriculums as well as in their continuing education programs.

Surgical Bypass

Visceral manipulation has offered clients of massage therapists and trained manual therapists the ability to bypass the need for surgery in some cases. Visceral manipulation often surpasses results achieved from other modalities including chiropractic high-velocity low-amplitude spinal alignment and classic physical therapy. 

In the case where high-velocity low-amplitude adjustments are being applied again and again to specific areas of the bone, we can hypothesize that the vertebra is simply is not the primary issue. The culprit of the continuous spinal strain is often linked to whatever structure is actually pulling on the spine.

Organs connect to the spine by way of connective tissue. For example, the prostate can pull lumbar vertebra four through its attachments. Rarely is the vertebra itself the problem unless a direct trauma was imposed there.

This discovery is changing standard clinical approaches to care as we know it. If a client is guided to build muscle on top of a strain, then the strain may set deeper. If a client receives repetitive corrections that bypass the barrier of the tissue, the body tends to build up tissue to stabilize the vertebra, making it more difficult to reach and resolve.

The Visceral Spine

The visceral spine was named and discovered by the founder and president of the College d’Études Ostéopathiques, Philippe Druelle, DO, in Montreal, Ontario, Canada. Adjustments to the visceral spine, a determined chain of connective tissues from the vertex of the cranium to the central tendon of the perineum, is only taught now at Bastyr University in the U.S.

This visceral spine, consisting of specific organs and connective tissue, can be more influential on the posture than the position of the osseous spine. The body must be able to properly translate the ascending and descending forces of gravity with each step.

The organs should not weight bear or be overly influenced by these forces. When they do, pathology and dysfunction may occur in addition to structural discomfort and improper patterning of gait.

The entire system of the fascia begins and ends on the head of the pancreas at the level of dorsal vertebra nine. If the pancreas is stuck in a spiraled torsion favoring the direction of the liver, then the clinician might resolve issues found at T8/T9 by correcting the position of the pancreas instead of applying osseous corrections to the vertebra.

The Organs Move

Practitioners who apply soft tissue visceral manipulation techniques recognize that the organs rely on the breathing mechanism to move around specific axes of motion that are set during embryological development. As the breathing diaphragm descends in inspiration and ascends in expiration, the organs move with it.

An organ can go out of alignment, just as bones can. Misalignment can slow down or hinder nutrient delivery and waste transport, and stagnate the lubricating interstitial fluids that allow the surface areas of the organ to glide.  What results is dryness around the organ, sometimes triggering a buildup of tissue density that slows down the motion of the organ.

With surgeries, especially laparoscopic, it is also apparent that adhesions and scar tissue can affect the motion of the organ. Since the viscera do not move from the beat of the heart like arteries and arterioles do, the viscera rely on their own ability to move.

Mechanically, when a person breathes in, the thoracic diaphragm descends, guiding the stomach to roll anteriorly, side bend to the left and rotate to the right. At the same time, the liver in thoracic inspiration rolls anteriorly, side bends to the right, rotates left.

This motion also allows the movement of the organs to massage structures like the cisterna chili, the largest lymph node in the body, and so systemic regulation continues.

A Gentle Alternative

Visceral manipulation offers a gentle alternative and respects the barrier of the tissue and can be beneficial when the client has received approval from their medical doctor to apply before and after surgery­ to prepare and integrate. A pulled organ can also influence directly the cervical and lumbar spine that are the most compensatory areas and often face the structures that are in torsion patterns.

Oftentimes, the boney spine will compensate to relieve the influence of gravity off of the visceral spine that should not weight bear in standing. If the heart is not referring to its axes of motion, the head can shift into an anterior compensation and pull on the cervical spine all the way up to thoracic vertebra three by way of the pericardial ligaments that attached to the spine.

Perhaps the massage therapist might help relieve some of those chronic upper thoracic issues visceral manipulation techniques were applied to the surrounding tissue of the heart.

Massage therapists can now offer solutions to release strains in the capsular joints, such as shoulders and knees, by aligning the organs to which they are related.

For example, the menisci of the knee and the patellar fat bodies have a great influence on the mechanism of the capsular joint. If we consider that the kidneys do not have fixed connective tissue to hold them in place, and if we consider that the kidneys use the rail of the psoas muscle as an axis of motion, then perhaps the chronic hip and knee discomfort can be resolved if the connective tissue of the kidney would be released properly to bring the kidney back into its axis.

If the kidneys are positioned lower than normal—common with runners—the psoas muscles can pull the knees into a valgus strain and the lumbar back can lose degrees of the lordotic curve. Adhesions of the sigmoid colon to the fascia iliaca can create often an always-returning short leg on the left side, causing lumbar and sacroiliac dysfunction.

This is outlined in the classical teachings. If other abdominal organs such as the liver are found to be in a ptosis pattern in the case of extreme falls or pelvic surgery, it can cause the right shoulder and coccyx femoral joint (hip) to chronically favor nonphysiological patterns.

If we see that the pleura holding the lungs attach to the level of the lower cervical spine, perhaps we might offer tools to help with some of the chronic neck discomfort found clinically today.


With the fast-growing sector of infertility treatments, visceral manipulation offers manual and massage therapists the ability to potentially reinstate the fluidity and function of the sex organs.

Uterine and gonadal function has the potential to return if the viscera of the pelvis are externally adjusted gently with ethical touch. Freeing the position of the round and broad ligaments in women, the pelvic floor in men, and the mesocolon tissue that attaches to the disc of lumbar vertebra four, can all have a profound effect.

If the renal fascia of the kidneys is released on the left side with the renal artery sharing arterial pathways with the left ovary, the repositioning of the interrelated structures may offer solution to struggling couples.

Results from gentle hands-on techniques are sending clients back to their physicians in amazement, and many integrative teams are now working in conjunction with manual and massage therapists to incorporate visceral manipulation into their practices to offer better regulatory options in addition to supplemental regiments and genetic testing.

Compensation Patterns

We are seeking to understand how a history of chronic bronchitis or even history of childhood insults such as measles, mumps, mono, tuberculosis and rubella, might impact the parenchymal tissue of the liver and lungs.

Clinically, it is proving to be important to investigate how childhood illnesses can result in a build up of fibrotic tissue within the organs that influence posture and movement in space.  These densities can create false axes of motion over time and cause clients to develop non-physiological compensation patterns.

Old injuries as well might create poor compensatory patterns. For example, a football player who was knocked repetitively in the breathing diaphragm on the left side might find 20 years later to have shoulder problems on the left as well as issues with the esophagus and digestive acidity.

Injuries to the abdomen may even extend to the throat or jaw over time as head injuries may extend to the abdomen as digestive stagnation.

Autoimmune Conditions

We learn from the writings of Still that the rule of the artery absolute; if blood flowing into an area is hindered by an unresolved strain or injury, the health potential is affected, since blood carries the building blocks needed to restore and repair tissue. If we consider that the majority of the lymphatic fluid drains back into the left clavicle and the tonus is built around that area, the immune system may be impacted.

In a world full of specialists—and with an estimated million Americans suffering from autoimmune conditions today—finding tools that help the entire system are becoming essential in the sector of massage therapy.

If a massage therapist could influence the commanders of the immune system by aligning the thymus, spleen, and liver properly, what type of change would be possible?

Rib heads can go out from the position of a spleen in torsion. Seventy percent of the immune system stems from the gut, and with the recent studies of inflammation being linked to the biome of the gut and to the vagal pathways, what kind of influence could a therapist make if they were to have tools to align the vagus nerve properly?

What if they could align the small intestine that absorbs all nutrients from our food helping with lower back pain at the same time? Visceral manipulation is not only this effective—it could potentially change the dynamics of massage therapy, as we know it.

About the Author:

Carey Taussig DO (MP), is a certified graduate of Boston University and the College d’Etudes Osteopathique. She specializes in visceral manipulation in her practice in Santa Fe, New Mexico, and is known for developing an effective manual therapy protocol to relieve symptoms related to Lyme Disease.