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Mobilization of Visceral Fascia: The Gastrointestinal System Satellite Lab Course - Self-Hosted - November 13-15, 2020

Ramona
  • Description

  • Schedule

  • Objectives

  • Self-Hosted Course Info

  • Instructors

Price: $600 ($575 Early Registrant Price
one month before the course)
Experience Level: Intermediate
Contact Hours: 18.25

This is a satellite lab course, which means the course meets in specific satellite locations or small groups and the instructor presents on Zoom. Registrants must sign up for a specific satellite location, or in a group or two or more using the "Self-Hosted" option.  

This satellite lab continuing education course provides comprehensive knowledge concerning the relationship between the connective tissue surrounding the visceral structures of the gastrointestinal system as it relates to normal function of the musculoskeletal system. Students will log onto the remote course in pairs or small groups to learn a variety of manual therapy techniques for mobilizing the fascial structures of the gastrointestinal viscera as they relate to the somatic frame., which they can practice on each other while receiving feedback from the observing instructor. 

  • The fascial system consists of four concentric layers, with the visceral layer, which is the most complex, beginning at the naso-pharynx and ending at the anal aperture (1) .
  • The abdominopelvic canister is “A functional and anatomical construct based on the components of the abdominal and pelvic cavities that work together synergistically” (2).
  • The walls of the canister, although part of the musculoskeletal system, are intimately connected to the visceral structures found within via fascial and ligamentous connections (3).
  • In order to function optimally the viscera must be able to move, not only in relationship to one another, but with respect to their surrounding container (4).
  • Most importantly, the viscera are subject to the same laws of physics as the remainder of the locomotor system with solid structures such as the liver and spleen particularly affected by blunt force trauma (5, 6).

Information is presented on embryology of the viscera and connective tissue system as it applies to associated visceral and fascial anatomy. The science behind and evidence supporting visceral and fascial-based manual therapy for patients with a variety of diagnoses related to musculoskeletal and pelvic health physical therapy is incorporated into each lecture.

This manual therapy course emphasizes clinical reasoning with the goal of immediate implementation of an extensive number of treatment techniques into an existing musculoskeletal and pelvic health practice. The material presented has applications for diagnosis such as abdomino-pelvic pain, gastroparesis, GERD, constipation, abdominal adhesions, and urinary issues. Additionally, the solid organs of the GI system play a profound effect on the thorax contributing to spinal issues and breathing pattern dysfunction (Bordoni & Zanier ,2013). Course work is geared toward the pelvic health therapist who wishes to integrate advanced manual therapy skills into their treatment regime for their pelvic and orthopedic clientele.

This course includes extensive lab work, all attendees should come prepared to participate as both clinician and patient. Male course attendees may participate fully in the entire course. Pregnant attendees may participate in a limited capacity, as deep palpation to the abdomen is illadvised for pregnant women. Seminar content is targeted to licensed health care professionals working within the field of pelvic health. Content is not intended for use outside the scope of the learner's license or regulation.

Special Considerations:

As this continuing education course includes extensive lab work, which will be demo'd and guided by the instructor. Participants should plan on partner with another registered therapist or a small group in order to get the full learning experience from this course. More information on partnered and group labwork can be found here: Guidelines for Remote Learning for Visceral/Fascial Manual Therapy Courses.

Audience:

This continuing education seminar is targeted to physical therapists, occupational therapists, physical therapist assistants, occupational therapist assistants, registered nurses, nurse midwives, and other rehabilitation professionals. Content is not intended for use outside the scope of the learner's license or regulation. Physical therapy continuing education courses should not be taken by individuals who are not licensed or otherwise regulated, except, as they are involved in a specific plan of care.

Prerequisites:

1) Pelvic Floor Level 1 at a minimum. For Pediatric therapists, completion of training such as Pediatric Incontinence and Pelvic Floor Dysfunction live course. It is also highly recommended the participant have experience with assessing and treating patients with bowel dysfunction. Exceptions to this policy may be granted on a case-by-case basis, to inquire about such exceptions please contact us

PreReadings:

1) Horton (2015) Clinical Review: Visceral Mobilization and Pelvic Floor Dysfunction


References

1. Willard, F. H. (2012) Visceral fascia. In: Schleip R, Findley TW, Chaitow L, Huijing P (Eds.) Fascia-The Tensional Network of The Human Body. (pp. 53-56). Elsevier, Edinburgh.

2. Lee, D., Lee, L., McLaughlin, L. (2008). Stability, continence and breathing: The role of fascia following pregnancy and delivery. Journal of Bodywork and Movement Therapies, 12(4), 333-348.

3. Bordoni, B. & Zanier, E. (2013). Anatomic connections of the diaphragm: influence of respiration on the body system. Journal of Multidisciplinary Healthcare, 6, 281–291.

4. Uberoi, R., D'Costa, H., Brown, C., & Dubbins, P. (1995). Visceral slide for intraperitoneal adhesions? A prospective study in 48 patients with surgical correlation. Journal of clinical ultrasound, 23(6), 363-366.

5. Cheynel, N., Serre, T., Arnoux, P-J, Ortega-Deballon P., Benoit L. ,Brunet, C. (2009). Comparison of the biomechanical behavior of the liver during frontal and lateral deceleration.

6. Cox, E. (1984). Blunt abdominal trauma. A 5-year analysis of 870 patients requiring celiotomy. Annals of Surgery. 199(4), 467-474The Journal of Trauma, 67(1), 40-44

All times below listed in Pacifc Time.

Day One:

Three hours of pre-recorded lectures will be available via Teachable before the course. Once enrolled, participants should look for an email invitation to Teachable, an online learning platform, roughly ten days prior to their course start date. 


1:00 Registration, Introduction (arrive and log on early for Zoom basics and troubleshooting) 
1:30 Review of recorded lectures and questions Concepts of Visceral Mobilization Embryology and the fascial system
2:30 Lab I – Three Dimensional Fascial stacking exercise
3:30Lab II – Layer palpation, abdominal palpation and auscultation
4:15 Lecture - Liver anatomy and fascial connections
5:15 Adjourn

Day Two:

8:00 Lab III - Liver - mobilization of fascial attachments Triangular ligaments, Side lying mobilization with trunk movement, Self-treatment
9:00 Visceral Palpation and Evaluation, (Lab II) Palpation Stations, Local Listening Technique
9:00 Lecture - Stomach anatomy and fascial connections
10:00 Lab IV- Esophagus - mobilization of fascial attachments Cricoid cartilage, Lower esophageal sphincter, Esophagus mobilization with trunk, Vagus nerve
11:00 External Bladder Techniques: Demo and labs (Lab III) Lateral Mobility Testing & Treatment, Median and Medial Umbilical Ligament (Urachus), Abdominal Scar Mobilization
12:00 Lunch
1:00 
2:00 Lecture – The spleen anatomy and fascial connections
3:00 Lab VI – Spleen - mobilization of fascial attachments: Gastrosplenic ligament,
4:00 Lecture – Small intestine/Peritoneal cavity
5:00 Adjourn

Day Three

8:00 Lab VII – Upper peritoneal cavity, Duodenum, Ligament of Trietz, Root of mesentery of small intestine, Motility of small intestine
9:00 Lab VIII –Parietal wall of the peritoneal cavity Posterior parietal peritoneum, Abdominal wall/parietal peritoneum, Loops of small intestine/adhesions, fascial decompression
9:00 Kidney/Ureter Techniques: Demo and lab (Lab VII) Anterior & Posterior Renal Fascia Ureter Mobilization
10:00 Lecture – Colon, fascial attachments and dysfunction
11:00Lab IX – Colon - mobilization of fascial attachments Cecum, Ileocecal valve, Facia of Toldt, sigmoid, flexures
12:00 Lunch
1:00 Lab X – Rectum mobilization of fascial attachments Valves of Huston, Internal (vaginal) approach for rectal fascia
2:00 Documentation, Q&A
3:00 Adjourn

Upon completion of this course, participants should be able to:

1. Describe the neurophysiology of fascial based manual therapy

2. List the basic fascial structures and functions of all four fascial layers and describe how they interrelate within the systems of the body

3. Describe the biological plausibility of how alteration of the normal mobility of visceral fascial structures can contribute to multiple diagnoses related to pelvic dysfunction

4. Cite potential causes for development of restrictions in the visceral fascia of the abdominal, pelvis, and thoracic cavity

5. Describe the theory and application of mobilization of visceral fascial structures as they influence the somatosensory system within the scope of a physical therapy practice

6. Differentiate between direct and indirect mobilization techniques and understand the proper application of each

7. List the visceral structures within the peritoneal cavity and describe how their normal mobility is related to somatic and autonomic function

8. Identify visceral structures within the GI system via abdominal and pelvic landmarks

9. Apply the technique of three-dimensional fascial mobilization to visceral structures, utilizing external approaches.

10. Recognize and treat fascial restrictions throughout the pelvis, and abdomen as they may relate to diagnoses of dysfunction within the gastrointestinal system

11. Describe the contribution of chronic G-I distention to central sensitization and the visceral-somatic reflex

12. Implement fascial mobilization techniques within a comprehensive treatment program for the patient with varied diagnoses to include orthopedic, urologic, gynecologic, gastrointestinal, and pelvic pain as they relate to the scope of physical therapy treatment

This is a "self-hosted" option for attending a satellite lab course. Registrants who would like to pursue this option must:

  1. Locate another therapist or small group of therapists who would like to register together as a unit
  2. Find a suitable location from which the pair/group can all view the zoom lectures together
  3. Practice hands-on lab techniques on the other therapists in their pair/group without a lab assistant or instructor physically present at their self-hosted location. The instructor will provide remote direction via zoom.

Those who wish to take this course, but cannot meet the above requirements should register for a satellite location or in-person version of this course


What to have on hand for self-hosted labs

Your partner! You will need at least one person to work with during labs. This person must be a licensed professional who is also registered for the course.
The printable portion of your manual from Teachable if you choose to print. * You are not required to print your full manual, please check for any sections specifically asking you to print prior to the event.
Your Mask- Please wear a mask while participating in this course to keep your colleagues safe.
A computer with a Wifi connection that your group will be using to view the course.
The following supplies:
Non Latex, Non-Powder Vinyl Gloves MEDIUM (box of 100)
Hand Sanitizer (8 fl. Oz.)
Lube for labs

Ramona Horton, MPT, DPT

Ramona Horton

Ramona C. Horton MPT, DPT completed her graduate training in the US Army–Baylor University Program in Physical Therapy in San Antonio, TX. She exited the army at the rank of Captain and applied her experience with the military orthopedic population in the civilian sector as she developed a growing interest in the field of pelvic dysfunction. A desire to expand her knowledge of evidence-based practice and research was the impetus to further her academic pursuits, receiving a post-professional Doctorate in Physical Therapy from A.T. Still University in Mesa, AZ. In 2020, Ramona received the prestigious Academy of Pelvic Health Elizabeth Noble Award for her contributions to the field of pelvic health.

Ramona serves as the lead therapist for her clinics pelvic dysfunction program in Medford, OR. Her practice focuses on the treatment of men, women, and children with urological, gynecological, and colorectal issues. Ramona has completed advanced studies in manual therapy with an emphasis on spinal manipulation, and visceral and fascial mobilization. She developed and instructs the visceral and fascial mobilization courses for the Herman & Wallace Pelvic Rehabilitation Institute, presenting frequently at local, national, and international venues on topics relating to women’s health, pelvic floor dysfunction, and manual therapy.