Palpating and Improving Circulation with Manual Therapy by Kimberly Burnham, PhD (Integrative Medicine)

            Trauma, compression, atherosclerosis can all contribute to decreased abdominal blood flow, which can contribute to back pain, radiating shoulder pain, dysmenorrhea [menstrual dysfunction], cysts, hematomas [pooled blood] and cancers of the abdominal organs. Circulation problems related to trauma are especially common among athletes. (Holt, J. 2004)
            Hypovascularized sites or areas of compromised blood flow are particularly common in the celiac artery. Stenosis of the celiac artery, a branch off of the aorta (the main artery leaving the heart), is found in up to 24 percent of the general population. Many of these people have no symptoms. (Park, 2001)
            The most common cause of celiac axis stenosis or a narrowing of the celiac artery is external compression on the artery, according to Park, 2001 in "Celiac axis stenosis: incidence and etiologies in asymptomatic individuals." Atherosclerosis is the second most common cause. Often the compression is caused by the median arcuate ligament, a ligament that comes off of the respiratory abdominal diaphragm. Because the ligament is attached to the diaphragm, the tension on the celiac artery can be release on inhalation or breath in. The arcuate ligament starts as a thickening of the connective tissue of the psoas muscle at the lumbar spine and hip. The medial arcuate ligament goes from either side of the first lumbar vertebrae to the respiratory abdominal diaphragm. A compression in this area can lead to decreased blood flow and back pain.
            Massage and manual therapy is often used to decrease pain and tension in the area of the low back, spine, hip muscles, including psoas and the respiratory abdominal diaphragm. Breathing exercises can also help decrease tensions in this area. The most common symptoms of decreased blood flow in the abdomen is back pain and abdominal pain right after eating. Vomiting is another common symptom.
            Caution is wise when treating the abdomen as the most common reason for find an asymptomatic stenosis or narrowing of the celiac artery is a scan or diagnostic procedure for some kind of abdominal cancer, liver, stomach, gallbladder, or pancreas. The literature is not clear about whether the lack of blood flow proceeded or in any way influenced the development of the cancer.
            Manual therapists use palpation to feel for areas of tissue density, temperature changes and rhythms reflective of circulation. They can use this diagnostic information to treat the soft tissue area of dysfunction. Advanced Strain and Counterstrain (Wheeler, L. 2004 in Massage Therapy Journal) and Myofascial Release (Weiselfish-Giammatteo, S., J. B. Kain, et al. 2005. Integrative manual therapy for the connective tissue system : myofascial release) are two ways to decrease tensions and normalize circulation through the tissue.
            In 2000, Arutiunian in "Effects of manual therapy on pain reflex syndromes and various hemocoagulation parameters in patients with ischemic heart disease after surgical treatment", recommended manual therapy after coronary artery bypass surgery (CABS). The researchers concluded, "the addition of manual therapy to the complex of rehabilitation measures in coronary patients early after CABS eliminates postoperative anginal attacks in 70% cases." A year earlier, researchers noted, "pressure on acupoints can significantly influence the cardiovascular system" (Sudmeirer, 1999). A placebo controlled study using a color doppler sonograph, found that reflexology, positively influenced blood flow in the kidneys. Researchers found a "significant decrease of the resistive index during foot reflexology in the verum group indicates a decrease of flow resistance in renal vessels and an increase of renal blood flow."
            A 2006 study on vascular surgery concluded, "low back pain was improved by merely performing treatment for the vascular system and might provide support for the presence of vascular backache." (Takeyachi and Yabuki, 2006). Another study recommended manual therapy as part of an intensive rehabilitation program. They concluded, "intensive rehabilitation in combined treatment is shown to improve external respiration function, central hemodynamics, tissue blood flow, sleep, appetite, healing of bedsores, and to enhance cough reflex." (Kachesov, Kartavenko, et al. 2004).
 
—Originally published at Burnham, K. (2008). "Palpating and Improving Circulation with Manual Therapy." Health and Goodness.  healthandgoodness.com/Therapies/imt_circulation.html.