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Frozen shoulders, sciatic pain and Visceral Manipulation

Journal: Osteopathy Inc.
Date: 12 / 2011
Author: Cameron Moffatt D.O.(MP)

For patients with frozen shoulders and sciatic pain that are not responding to your treatment protocols, consider visceral manipulation as an adjunct treatment.

In particular, the liver, when dysfunctional, can have a negative impact on the left and right shoulder girdles. Through the fascial attachments of the gastrophrenic and left coronary ligaments, up through the pleurae of the lungs and finally through the suspensory ligaments, a liver lacking in mobility can increase the mechanical load placed upon the muscles of the shoulder girdle.

Neurologically, the gastrophrenic ligament, an extension of the coronary ligament, when restricted, can cause stress upon the diaphragm and hence irritation to the phrenic nerve. Since the phrenic nerve and many of the shoulder muscles share the same C3, 4 and 5 nerve roots, this can lead to irritation of the shoulder muscles resulting in a pathological presentation of the shoulder mechanics.

The sciatic nerve, being the largest in the human body, is most susceptible to venous congestion and systemic toxicity. Sciatic pain can be indirectly caused by a compression of the inferior vena cava in the liver region. The ligamentum vena cava can cause direct compression, while the mobility of the liver in its transverse plane, moving around the vena cava as an axis, can also cause compression of this vitally important flow of blood. The resultant venous congestion then has a negative impact on the toxicity levels of the interstitial fluids, often resulting in increased pain in structures such as the sciatic nerve.