Visceral Manipulation Enhances Structural Integration

Jeffrey Burch, Certified Advanced Rolfer

Osteopathic principles are the foundation of structural integration. On the way to developing structural integration Ida Rolf read Osteopathic literature and studied with Osteopaths. In her unique evolution of Andrew Taylor Still’s work, Ida Rolf emphasized the interaction of the human body with gravity.   Other derivatives of Osteopathy emphasized and developed other facets, for example Fritz Smith’s Zero Balancing and Lawrence Jones’ Counterstrain. Marriages between structural integration and its Osteopathic cousins are particularly fortuitous. In the next article in this series I will explore about the bigger picture of our lineage, going back before Osteopathy to the Bone Setters.   In the present article I describe how structural integration and one Osteopathic derivative, Visceral Manipulation, enhance each other.  

Fascial Continuity

The human body is held together and given its shape by connective tissue. Developing early in fetal growth, all of the connective tissue in the human body is continuous. There is a lot of it: about 20% of the weight of the human body is connective tissue. Collectively this connective tissue matrix is the Organ of Support.   As structural integrators we work with the Organ of Support to assist our clients to a better relationship to gravity and to life.

My experience with unpreserved cadavers has shown that our manipulative techniques are effective on the physical properties of the connective tissue matrix even after death. .   The Organ of Support also contains a vast network of peripheral and autonomic innervations. Much of what we do as structural integrators is a conversation with the nervous system particularly the gamma loops and the autonomic nervous system.


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A crucial bodily balance is that between surface and core.   A surface is easy to describe, the nature and location of core has been an ongoing debate for all of structural integration’s half century of development.   Currently, advanced Rolfing® instructor Jan Sultan and others describe core as ‘the visceral space’, not referring to the organs themselves, but to the membranous container of the organs and its inherent pressure system.

The membranes supporting the internal organs have multiple and extensive connections with the rest of the Organ of Support.   French Osteopath Jean-Pierre Barral has demonstrated that manipulation of the visceral support system has profound and lasting effects on the organization of the rest of the body.   To leave the visceral support system out of structural integration is to ignore a large and literally central part of the Organ of Support.   The visceral support membranes have rich autonomic innervation: the number of neurons in the visceral support system exceeds the number of neurons in the spinal cord and brain stem. The several nerve plexi of the visceral support system are literally another brain, named the Enteric brain, and function as a crucial entry point for our conversation with the nervous system.

Here are two examples of how the visceral support system affects structure, one in the abdomen and one in the thorax.  


The 25 feet of the small intestine are supported by a membrane called the mesentery. If the small intestines are removed with the mesentery attached, and the small intestine is stretched out in a line, the mesentery appears as a 6 inch long curtain hanging from one edge of the intestine.   In the body the edge of the mesentery not attached to the intestine is collected and attached along a 6 inch long line running from the duodenojejunal junction in the upper left quadrant of the abdomen to the illiocecal valve in the lower right quadrant.   Between these two end points the mesenteries attach to the back wall of the abdomen crossing the lumbar spine at a diagonal and also crosses the superior portion of the right sacroiliac joint attaching to both sacrum and ilium.   The diagonal line of attachment of the mesenteries to the back wall of the abdomen is called the Roots of the Mesenteries.

Tension in the mesenteries, and particularly tension in the Roots of the Mesenteries, will rotate the lumbar spine and fixate the right sacroiliac joint. It is a routine demonstration in Visceral Manipulation classes to first assess lumbar and sacral position and mobility, then free the mesenteries.   Post testing of the lumbars and sacroiliac joints shows that a very few minutes of light visceral manipulation makes profound change in Lumbosacral position and mobility.


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The lungs are surrounded by two layers of pleural membranes. The pleura are essentially fascial sheets associated with organs. The inner or visceral pleura forms the surface of the lungs. The outer or parietal pleura invests the inner surface of the chest cavity.   Between the two layers is a small amount of serous fluid.   This lubricant and the potential space it occupies are maintained at slight negative pressure by the lymphatic system.   This negative pressure means the two pleural surfaces cannot move away from each other, just like two sheets of wet glass can slide on each other but cannot be pulled apart.

The top of the parietal pleura forms a dome 2-3 cm above the first rib.   The apex of this dome is suspended in part from the bottom side of the middle scalene muscle by the Suspensory Ligament of the Lung.   In addition, Sibson’s Structure attaches the pleural apex to the anterior surface of the transverse process of C7, sometimes C6, and occasionally also C5.   Sibson’s structure contains highly variable proportions of collagen, elastin, smooth muscle fiber and striated muscle fiber.   This variability has led to this same structure to be named a fascia, ligament or muscle in different texts.

Contractures and adhesions of the pleura are easy to come by. Hard coughing can break ribs.   Everyone has had colds and the flu. Most of us have had blows to the chest.   Pleural adhesions and contratures accumulate through life and are so common as to be considered a ‘normal’ feature of aging.   Pleural restrictions are easily visible during surgery or dissection. We take more than 20,000 breaths per day. If there are pleural adhesions and contractures, these 20,000 aberrant breaths are a fine opportunity for repetitive strain injuries.   Since the lungs are suspended from the cervical vertebrae, this puts a tremendous strain on the neck.   The cervical paraspinal musculature becomes tight in its attempt to resist this pull.

When we feel scalenes which are not only tight but also pulled inferior this is a sign of strong pleural restrictions.   Freeing the pleura often quickly relieves neck strain and improves head position.   The brachial plexus passes adjacent to or through the middle scalene: pleural pulls on the middle scalene routinely impinge on these nerves supplying the arm and hand.   The vasculature supplying the arm and hand courses as a bundle with the brachial nerves and are similarly compromised by pleural restrictions transferred to the scalenes by the suspensory ligament of the lung     History of respiratory illness is a documented risk factor for carpel tunnel syndrome.

Folk Healers have manipulated organs since antiquity.   These folk traditions continue today throughout the world.   In Europe folk healers who work with the biomechanics of the body are known as Bone Setters. Andrew Taylor Still MD, founder of Osteopathy, mentions manipulating organs in his writings, however this remained a small part of Osteopathy until the last quarter of the 20th century when French Osteopath Jean-Pierre Barral learned that some of his patient’s biomechanical problems were getting better because they were visiting bone setters in the French Alps, who were manipulating their organs.   Barral studied the rather rough manipulations these Bone Setters were using. He applied his Osteopathic knowledge to the organ support system and over the years made large developments in the art and science of Visceral Manipulation.   He has published seven books on Visceral Manipulation and teaches it worldwide. Visceral Manipulation is the cutting edge of Osteopathy today.

Incorporating Visceral Manipulation into structural integration provides the keys to fuller and more efficient core / sleeve integration. The manipulative strategies used for visceral manipulation were originally developed by Osteopaths for use on fascia and ligaments.   Now we can learn these efficient, low force methods in Visceral Manipulation classes and then apply them to other connective tissue as well.   The assessment methods taught with Visceral Manipulation allow us to quickly prioritize what to do first, so the body can unfold easily and naturally.   The end result is better integration for our clients with less effort from us.   For a more detailed discussion of how Visceral Manipulation enhancesstructural integration, see Massage and Bodywork magazine April/May 2001.

I highly recommend the Visceral Manipulation training offered by the Upledger Institute. 1-800-530-8875.   Alternatively I offer Visceral training tailored specifically to the background and needs of structural integrators.

Caution: Do not attempt visceral manipulation without thorough training. Organ support membranes are delicate and highly reactive tissues.


Barral, Jean-Pierre & Mercier, Pierre; Visceral manipulation, 1988 Eastland Press


Barral, Jean-Pierre; Visceral manipulation II, 1989 Eastland Press 0-939616-09-2

Barral, Jean-Pierre; The Thorax, 1991 Eastland Press 0-939616-12-2

Burch, Jeffrey P, “Interdisciplinary Structural Integration: finding the balance”; Massage & Bodywork April/May 2001 pp 22-31.

Feitis, Rosemay, & Schultx, Lewis, Remembering Ida Rolf, 1996 North Atlantic Books 1-55643-238-0

Gevitz, Norman; The D.O.’s, osteopoathic medicine in a America, 1982 John Hopkins University Press 0-8018-4321-9

Hood, Wharton; On bone-setting (so called) and its relation to the treatment of joins crippled by injury, rheumatism, inflammation, &c. &c. 1871 Macmillan.

Lederman, Eyal; Fundamentals of manual therapy physiology neurology and psychology, 1997 Churchill Livingstone 0-443-05275-1-8

Patterson, M.M. & Howell, J.N. eds; The central connection:somatovisceral and viscerosomatic interaction 1989 international symposium, 1992 University Classics, Ltd. 0-914127-29-2

Still, Andrew; The Philosophy and mechanical principles of osteopathy, 1902 Hudson-Kimberly

Copyright 2002 Jeffrey Burch

Originally published in ‘Structural Integration / June 2002