Abdominal pain is a very common complaint and can range from mild discomfort to serious medical conditions. Many people think abdominal pain is not a PT matter. However, manual therapy provided by physical therapists can often help the symptoms.
This case report highlights how visceral mobilization, when used appropriately and safely, can help reduce abdominal pain after careful screening and follow-up.
Visceral mobilization for GERD patient
Patient Presentation
A patient presented with:
- Acute abdominal (stomach) pain
- Insidious onset of the abdominal pain
- Pain with back extension motion
- Mild accompanying low back discomfort
The patient expressed a moderate level of anxiety, worrying that the pain might be related to kidney stones or another serious internal organ condition.
Importance of a Thorough Assessment
Given the nature of abdominal pain, a detailed subjective assessment was conducted before any treatment. The evaluation included questions about:
- Changes in appetite
- Urinary symptoms
- Bowel movements
- Blood pressure history
- Current medications that could contribute to stomach irritation or pain
The goal of this screening was to rule out immediate red flags that would require urgent medical referral.
After the assessment, no signs suggested an acute medical emergency. However, the patient was informed that symptoms would require further medical investigation if physical therapy does not help reduce the symptoms.
Clinical Reasoning
Based on the assessment, I suspected that the abdominal pain was influenced by:
- Increased tension in the thoracolumbar fascia
- Restricted mobility of the abdominal tissues (superficial fascia, abdominal muscles, psoas and organ mobility)
- Heightened anxiety, which can amplify pain perception, especially in the abdominal region
It is well recognized that the abdomen and lower back are functionally connected through fascial, muscular, and nervous system pathways. Restrictions in one area can influence symptoms in the other.
The fact that the pain increased with back extension suggested that the source was more likely related to fascial or musculoskeletal structures, rather than an internal organ issue.
For these reasons, I explained to the patient that we would attempt visceral mobilization, reassess symptoms afterward, and closely monitor his response.
Intervention
Treatment consisted of:
- Gentle visceral mobilization to improve tissue mobility and reduce protective tension in the abdomen
- Spinal structure mobilization, which plays a key role in the relationship between abdominal tension and spinal mechanics
These techniques were applied carefully and within the patient’s tolerance.
Outcome
Following the session:
- The patient reported reduced abdominal pain
- Overall discomfort, including low back tension, also improved
- The patient felt calmer and less fearful about his symptoms
At the end of the session, the patient was instructed to:
- Monitor symptoms over the following days
- Seek medical care if sharp, persistent, or worsening abdominal pain returned
Follow-Up
A follow-up email was sent several days later.
The patient reported:
- Continued improvement
- No recurrence of acute abdominal pain
- Overall well-being and return to normal daily activities
Discussion: Abdominal Pain and Physical Therapy
Abdominal pain is common and is not always caused by internal organ disease. When medical red flags are ruled out, symptoms may be influenced by:
- Fascial restrictions
- Myofascial abdominal pain
- Breathing and postural dysfunction
- Stress and anxiety
Physical therapists trained in visceral mobilization can help manage symptoms associated with conditions such as:
- GERD-related mechanical tension
- Functional or myofascial abdominal pain
- Gastritis-related discomfort (in coordination with medical care)
Conclusion
This case highlights the importance of:
- Careful screening and assessment
- Clear communication regarding medical referral
- A conservative, patient-centered approach
Visceral mobilization may be an effective option for managing abdominal pain when used appropriately and safely within the scope of physical therapy.
