The Hands-on Approach—Manual Therapy (cont.)

We have posted several articles on manual therapy techniques in the past couple weeks. Many of these we use in our everyday practice.  One technique that is new to us is visceral manipulation.

We have never heard much about it or used it until one of our clinicians, Sarah Levitt, went to a continuing education course on the therapy.  She has found it very useful in her practice, and we thought we would touch on the subject a bit.

What is Visceral Manipulation? 

“Viscera” relates to the internal organs of the body, such as the liver, kidneys and intestines. Visceral Manipulation (VM) is a manual therapy developed by French physical therapist and osteopath, Jean-Pierre Barral.  He believes that this delicate manual therapy is the missing link in the treatment of recurring musculoskeletal pain, postural distortions and biomechanical dysfunction.

Jean-Pierre Barral first became interested in the movement of the body (biomechanics) while working at the Lung Disease Hospital in Grenoble, France with Dr. Arnaud, a recognized specialist in lung diseases and a master of cadaver dissection. Barral was able to follow patterns of stress in the tissues of cadavers as he studied biomechanics in living subjects. This introduced him to the visceral system, its potential to promote lines of tension within the body, and the notion that tissues have memory.  Barral’s clinical work with the viscera led to his development of this form of manual therapy that focuses on the internal organs, their fascial environment and the potential influence on structural and physiological dysfunctions. The term he coined for this therapy was Visceral Manipulation.

Jean-Pierre Barral began teaching Visceral Manipulation in the United States in 1985. Since then he has trained a team of international instructors that teach Visceral Manipulation seminars around the world. He has authored numerous textbooks for healthcare professionals, and has also authored a book for the general public.

How does the treatment work?

VM aids your body’s ability to release restrictions and unhealthy compensations that visceral manipulationcause pain and dysfunction.  VM does not focus solely on the site of pain or dysfunction, but evaluates the entire body to find the source of the problem.  Many times, the dysfunction and pain are far from the site that actually needs treatment.  The VM therapist feels for altered or decreased motion within the viscera, as well as restrictive patterns throughout the body, and then applies VM techniques.  These techniques consist of gentle compression, mobilizations and elongation of the soft tissues.  As the source of the problem is released, the symptoms will start to decrease as the body returns to greater health.

Visceral Manipulation can benefit:

  • Chronic musculoskeletal pain
  • Headaches and Migraines
  • Sciatica
  • Back, hip and knee pain
  • Repetitive strain injuries, e.g. Carpal Tunnel Syndrome
  • Whiplash and other physical trauma
  • Shoulder periarthritis and capsulitis
  • Restricted range of motion
  • Post-surgical pain and Scar tissue
  • Pelvic floor health issues, e.g. bladder incontinence

How Can Organs Cause Pain and Dysfunction?

Your organs are in perpetual motion, such as your lungs as you are taking a breath in and out.  This movement of organs is transmitted through fascia to other structures of the body. When you are healthy, all the structures move with an interconnected fluidity. All of this movement is important as it influences activities throughout the body from the tiniest cellular pulsations to rhythmic contractions of the heart and blood flow. Optimum health relies on a harmonious relationship between the motions of the organs and other structures of the body.

There are many reasons for an organ to lose its mobility: physical traumas, surgeries, sedentary lifestyle, infections, pollution, bad diet, poor posture and pregnancy/delivery. When an organ is no longer freely mobile but is fixed to another structure, the body is forced to compensate. This disharmony creates fixed, abnormal points of tension and the chronic irritation gives way to functional and structural problems throughout the body – musculoskeletal, vascular, nervous, urinary, respiratory and digestive, to name a few.


Sarah Levitt, MPT, PRPC is our pelvic floor rehabilitation practitioner practicing out of our Clarkston location.  If you would like to know more about this treatment or how it could help you, contact her at or call (248) 620-4260.


The Hands-on Approach – Manual Therapy (cont.)

What is Strain and Counter-strain?

Strain and counter-stain is a non-traumatic manual therapy technique that can be used on a large population of musculoskeletal pain patients.  Strain and counter-strain, originally called “positional release technique,” was developed in 1955 by an osteopathic physician named Lawrence Jones. In observing a skilled Strain and counter-strain practitioner you will immediately be impressed with how gentle and non-traumatic this technique is for treating the painful patient. A clinician is quickly able to assess the entire body for areas of pain and dysfunction and the involvement of the patient in assisting to guide the clinician’s movement of their body enhances the therapeutic benefit of the treatment. Let’s explore how this innovative system works and who can benefit from this gentle technique.

How does it work?

Strain and counter-strain is a manual therapy technique, meaning the clinician uses onlyStrain-Counterstrain-lumbars their hands, to treat muscle and joint pain and dysfunction. It uses passive body positioning of spasmed muscles and dysfunctional joints toward positions of comfort or tissue ease that compress or shorten the offending structure. The purpose of movement toward shortening is to relax aberrant reflexes that produce the muscle spasm forcing immediate reduction of tone to normal levels. This allows the joints influenced by the now relaxed muscle to function optimally increasing its range of motion and easing muscle pain. Strain and counter-strain is an effective but extremely gentle technique because its action for treatment moves the patient’s body away from the painful, restricted directions of motion.

Who can benefit?

Strain and counter-strain has an extremely broad application for physical ailments and can be used for the very acute traumas (i.e., sports injuries, motor vehicle accidents, ankle sprains, post-surgical, etc.) to the more chronic (i.e., osteoarthritis, fibromyalgia, TMJ pain, headaches, etc.). Its value with the acute patient is unmatched because it is so gentle and non-traumatic. The clinician is guided by what feels good to the patient and often dramatic changes are made in decreased pain, muscle guarding, and swelling. These changes facilitate the patient’s healing processes for a faster and complete recovery. The gentleness of strain and counter-strain makes it safe and effective for treating fragile patients (i.e., infants with torticollis, elderly patients with osteoporosis, stress fractures, pregnancy or pelvic pain patients, post-operative pain, etc.) and the pain associated with excessive joint motion or hyper-mobility. Strain and counter-strain is valuable for the chronic pain patient because it will treat out a longstanding neuromuscular problem reducing the tone of a muscle in spasm. By diminishing the spasm, muscle pain is abated and joint function is normalized.


Get to Know Kelly Lubera, PT, DPT

Kelly Lubera, PT, DPT has been in the physical therapy field since she was in her teens.  She started her career as an aide at an outpatient physical therapy clinic, and after suffering an ankle injury, she was sent to physical therapy for the first time.  “I really enjoyed the therapy team that worked with me.  They helped me get back to the activities I wanted to do.  I knew I wanted to do the same thing someday,” said Kelly.  And, she did just that.  Kelly graduated from the University of Michigan–Flint with a doctorate in physical therapy in 2009.

Kelly McCarthyKelly’s post-graduate focus has been on the use of functional training, where she teaches patients to exercise in ways that help them get back to their day-to-day activities.  To ensure she is providing the best care for her patients, Kelly has attended several continuing education courses including Anthony DiMaggio’s Strategic Orthopedics for the Spine, which is an educational course for the purpose of resolving complex and unresolved back pain; the Graston Technique for instrument-assisted soft-tissue mobilization; LSVT-BIG for the treatment of Parkinson’s Disease; and manual therapy courses, such as Muscle Energy Technique.  Kelly is an excellent therapist for the treatment of sports-related injuries, lower extremity injuries and gait analysis.  In fact, she helped one man, who was having sharp pain in his shoulder, compete in a bodybuilding competition with one-hundred percent function and no symptoms of pain.

Kelly is the clinic director for Advanced Physical Therapy Center’s Goodrich facility.  When she is not treating patients, she enjoys spending time with her family, practicing yoga, and has a love for traveling and camping.  Another passion of hers is sailing. She and her husband own a 30 foot catamaran and love taking long day trips sailing around the Detroit area and Harson’s Island.

If you ask Kelly what she loves about her job, she will tell you, “I love the diversity of the staff at APTC.  Everyone is very knowledgeable.  Most of all, I like how everyone works as a team.  When it comes to patients, I like to incorporate humor anywhere appropriate.  I love working with so many different people.  I think for physical therapists, you always feel successful when your patients get back to their normal lives.”


The Hands-on Approach—Manual Therapy (cont.)

Muscle Energy Technique & the Stanley Paris Technique

As physical and occupational therapists, our approach is to be “hands-on” with patients, to create personalized treatment plans and to achieve the best results.  At Advanced Physical Therapy Center, we utilize several different types of manual therapy techniques.  In previous posts, we touched on a couple other manual therapy techniques. In this post, we would like to feature Muscle Energy Technique (MET) and the Stanley Paris Technique (mobilization of the joints).

What is MET and what does it do?    

Muscle Energy Technique (MET) is a direct hands-on therapy originally developed by Dr. Fred Mitchell, Sr., Osteopathic Physician.  It utilizes the patient’s own gentle muscle contractions and body positioning to normalize joint motion.  It can be used to lengthen a shortened contracted or spastic muscle; to strengthen a physiologically weakened muscle or group of muscles; to reduce localized edema to relieve passive congestion and to mobilize an articulation with restricted mobility.

Who can benefit?

People who are restricted in their movements or have recently experienced a trauma.  Conditions include:

  • Back pain
  • Sciatica
  • Scoliosis
  • Muscle shortening
  • Pelvic imbalance
  • Somatic dysfunction
  • Limited range of motion
  • Headaches
  • Edema


What is The Stanley Paris Technique (mobilization of the joints) and what does it do?

 Joint mobilization is a treatment technique used to manage musculoskeletal dysfunction.  Mobilizations are used to restore joint play that has been lost due to injury or disease.  Stanley Paris, PT, PhD, FAPTA, FNZSP was the first to introduce manipulative physical therapy into the United States, and he is one of the most recognized figures in physical therapy today.  APTC therapists use a variety of his mobilization techniques.

Who can benefit?

Joint mobilization can be performed on any articulation in the body from the temporomandibular joint to the spine and from the fingers to the toes.  Therefore, it can be used on any patient where range of motion is lacking in a joint.


Creating Success Stories – One Patient at a Time

In March of 2016, Kevin Ronan woke up with pain going down the side of his back.  As the days progressed, he noticed his back was getting weaker and weaker, to the point that he couldn’t stand up.  He went to his doctor, but his doctor was baffled.  After several tests, his doctor couldn’t find what was causing the back pain and weakness.  Then the pain moved to the other side of Kevin’s back.  Being worried about her husband, Kevin’s wife, Katherine, took him to the emergency room.  Kevin was later sent home after being treated for what they thought was pneumonia.  The symptoms worsened from there.  The weakness Kevin felt in his back started moving into his right leg. That is when he was sent in for surgery.  In May, the surgeons found an epidural abscess on Kevin’s spine.  Infectious disease doctors from all over the area tried to figure out what caused the abscess.  No one could figure it out.

Kevin endured months of inpatient rehabilitation.  During this time is when doctors told him that he would never walk again.  “I remember thinking to myself, ‘I can’t be in a wheel chair the rest of my life.  I’ve got to prove them wrong.  We are going to fight this.’  So, they decided to send me to physical therapy.  I tried a couple of places, but I wasn’t getting results.  My wife started looking for new places for me to try, and we came across Advanced Physical Therapy Center,” stated Kevin.

Kevin Ronan

From left to right: Dane Potochny, MPT; Kevin’s wife, Katherine; Kevin; and Holly Clark, PTA

Kevin started physical therapy with Dane Potochny, MPT and Holly Clark, PTA in November.  As his visits went by, Kevin started getting the strength back in his legs.  Once wheelchair bound, Kevin can now walk around APTC’s gym three times with a walker.  “When Kevin came in he was unable to stand.  He is now able to walk with a walker and starting to go up and down stairs.  It’s great to see his determination and progress!” stated physical therapist assistant, Holly Clark, when asked about working with Kevin.  “Kevin is an extremely driven individual and has worked hard to go from immobility to ambulatory,” said Dane, Kevin’s physical therapist.

When asked about how physical therapy has changed his condition, Kevin replied, “I can lift my legs up into the bed without help.  I can put on my socks and shoes by myself.  I can get in and out of the car, and no one needs to help me.  I am taking showers on my own now. I am so happy!  I couldn’t do those things before I came here.”

When asked about his experience with his therapy team, Kevin responded, “Dane and Holly are excellent to work with.  I love them both.  They push you just enough to get you where you need to be without making it too hard or discouraging.    I wish I would’ve come here first instead of the other physical therapy clinics, but I am here now and doing well.”

Kevin has taken an early retirement and lives with his wife in Fenton.  He sees Dane and Holly for his therapy twice a week.  His next goal is to walk independently all the time with his walker.  “I am feel like I am so close to my goal.  If I keep working with Dane and Holly, I know I will get there,” said Kevin.


The Hands-on Approach—Manual Therapy (cont.)

Low-Back-Pain-BLUE_02Continuing in our series on the topic of manual therapy techniques, the next we would like to discuss is spinal mobilization.

Spinal mobilization has been a therapy that has been used for centuries dating back to the time of Hippocrates and the physicians of ancient Rome.

What is spinal mobilization?

Mobilization is a hands-on manual therapy designed to restore joint movement, power and range of motion.  The therapist gently coaxes joint motion by passive movement within or to limit a joint’s normal range of motion.  The therapist’s movement of the joint is very precise and is limited by the amount of joint play.

What part of the spine can be treated?

Any part of the facet joints and the articulations between the bones may become stiff causing joint dysfunction.  Therefore, any part of the spine can be treated with spinal mobilization.

What type of patient can benefit?

Any patient that has joint dysfunction, which can be caused by poor posture, muscular imbalance, trauma, spinal disease or congenital problems.    

What is the benefit of spinal mobilization?    

The goal of mobilization is to restore normal joint function, including the surrounding soft tissue.  The benefits are decreased pain, increased range of motion and reduced muscle spasm.