The Practice and Applied
Therapeutics of Osteopathy
Charles Hazzard, D. O.
GENERAL OSTEOPATHIC POINTS IN REGARD
TO THE ABDOMEN AND ITS PARTS
Many of the specific lesions affecting the abdomen
and its contained viscera occur in the spine and thorax and are of kinds
already described. Much of the treatment for diseases of these parts
is upon such lesions. The subject of examination and treatment of
the various organs will be considered more in detail in relation to their
specific diseases. The aim of this chapter is to give general methods
of examination and general osteopathic points concerning these parts.
POSITION: he patient lies supine; the thighs are
flexed and the feet rest upon the table; the head and chest are slightly
elevated by the inclined head of the table. In this position the
abdominal muscles are relaxed. The sides of the body are disposed
alike to avoid unequal tension upon the tissues.
Inspection, palpation, percussion and auscultation
are the physical methods employed.
INSPECTION reveals enlargement due to gas or fluid,
tumor, muscular contraction, etc.; color; distended or retracted walls;
restricted or increased motion; pulsation or engorgement of blood-vessels,
PALPATION reveals change in temperature; tumors,
superficial or deep, fluid or solid; tenseness or flabbiness of the abdominal
walls; enlargements and displacements of organs, etc. Pulsations,
also, are to be noted. A marked pulsation of the abdominal aorta
is common in nervous people, but generally indicates liver, stomach, or
Deep palpation of the abdomen in thin persons readily
reaches the bodies of the lumbar vertebrae rising quite prominently under
the touch. They should not be mistaken for tumor.
The examiner should grasp the abdominal walls in
the fingers and raise them up away from the abdominal viscera, thus enabling
him to tell whether tender places, growths, etc., lie in or beneath these
PERCUSSION reveals the limits of organs, presence
of tumors, fluids or gases, etc.
AUSCULTATION reveals the gurgling of gases, fetal
sounds, lubrication of the bowel, etc.
I. A general treatment of the abdomen is sometimes
necessary for general relaxation of the abdominal walls, often as a preliminary
step toward further examination. With the patient in position as
above, the practitioner stands at the side of the table and with the palm
of the hand manipulates the tissues to relax them. Care should be
taken to avoid pressure with the tips of the fingers or other rude work
which causes the tissues to contract. The hand should be warm and
the manipulation gentle but thorough.
II. Direct manipulation, including pressure
and various movements, is often made upon the various abdominal organs.
Specific directions for the treatment of any given organ are reserved until
diseases of these organs are considered. But, speaking in general
of abdominal manipulation as one of the methods in the repertoire of the
Osteopath, care must be taken to make clear the difference between such
manipulation and massage. Here the mode of motion is relatively insignificant.
The manipulation is not for the general effect following a thorough abdominal
massage, but is corrective; directed to the specific end of restoring to
proper mechanical relations an organ or organs definitely ascertained to
be in need of mechanical adjustment. Here, as elsewhere in the body,
this work removes pressure from, or interference with, blood-vessels and
nerves. For example, osteopathic treatment of the colon is not made
for general manipulative effect, but is directed to raising and straightening
a sigmoid too much bent or folded. Thus it removes a mechanical obstruction
to bowel action, but also lets free pelvic circulation and nerve-action
impeded by such a condition.
Or, manipulation of the colon raises from its unnatural
position the gut which has prolapsed and become wedged down among the pelvic
viscera, where it has destroyed harmony of the functions. Osteopathic
manipulation in this way is specific and corrective, based upon mechanical
principles, and is applied by a practitioner who knows what causes such
abdominal conditions and how to correct them.
III. With the patient in position as
above, or standing or sitting bent well forward, the fingers are inserted
deeply beneath the viscera in each iliac fossa. They are now drawn
directly upward, raising all the pelvic and abdominal viscera, freeing
the action off the femoral and pelvic vessels and nerves.
In case the patient has bent forward he straightens the body again
at the time the viscera are raised.
IV. With the patient lying upon the right
side, the practitioner stands behind the pelvis and presses the fingers
deeply into the iliac fossa upon the side of the sigmoid nearest the median
plane of the body. He now raises the sigmoid flexure upward and slightly
outward over the flaring inner surface of the ilium. This raises
the gut from the pelvis, relieves kinking, and frees the circulation of
The movement may be repeated for the caecum.
The knee-chest position is very important and effective
in all conditions requiring the elevation of pelvic and abdominal viscera.
The patient gets upon his knees, and, turning his head to one side, lays
the upper part of the chest upon the table (still remaining on his knees.)
While he is in this position manipulations are made to draw abdominal and
pelvic contents down away from the pelvis. Gravitation aids this
V. With the patient in the dorsal position,
the practitioner stands at the side and places the palms of the hands over
the false ribs and cartilages, one on either side, heel out and fingers
directed toward the median plane of the body. Pressure is now made
evenly upon the sides, springing the ribs and cartilages down upon the
viscera beneath. As the pressure is directed inward the ribs are
forced toward the mid-line and pressed down upon the viscera. Repeating
this motion at intervals of a few seconds thoroughly tones the nerve-plexuses
and blood flow of the upper abdominal viscera.
VI. Deep pressure is made upon the solar plexus
as follows: The patient lies supine, the practitioner stands at the side
and lays the palmar surface of the distal phalanges of one hand over the
pit of the stomach, at the level of the tips of the seventh and eighth
ribs. Pressure with the second hand upon the first is gradually applied,
the hand sinking deeper into the tissues until very deep pressure has been
made. The plexus may now be manipulated by a slight circular movement
of the hand. This treatment tones the action of the solar plexus,
etc. It should be gently and gradually applied, but the pressure
must be considerable
VII. Deep pressure as above at any point will
cause a purely nervous pain to lessen or disappear, while it increases
a pain due to inflammation.
VIII. Displaced ribs sometimes mechanically
depress viscera, and must then be replaced by methods already described.
IX. The fundus of the gallbladder is reached
by deep pressure beneath the tip of the ninth rib on the right side.
Thence the course of the bile duct to the duodenum is somewhat in the shape
of a reversed "S," opening into the duodenum from one to two inches below
the umbilicus. Manipulation aids in emptying the bladder and in passing
gall-stones along the duct.
Abdominal treatment is generally in conjunction with treatment
upon the specific lesion occurring in the spine, thorax, etc. It must be
given carefully, as there are many diseases, e. g., typhoid, in which rough abdominal
treatment might cause serious injury. It is directed to a specific end and
restores mechanical relations of parts, frees nerve and blood-mechanisms, removes
muscular contracture, etc.