Surprising Causes of Chronic Bloating

The role of the vagus nerve, lymphatic system, and adhesions in bloating with Dr. Debora Chasse.

On today’s podcast episode, Dr. Debora Chasse shares her insights into a few surprising causes of chronic bloating and distention, including vagus nerve damage, lymphatic system blockages, and adhesions. We cover how to identify these issues, and techniques for healing.

In This Episode

Intro … 00:00:45
Bloating and Distension Treatment … 00:03:57
Adhesions and Visceral Work … 00:13:00
Treating Trauma-Based Injuries … 00:21:51
The Role of the Lymphatic System … 00:27:53
Imagery and Movement … 00:36:55
The Pelvic Floor … 00:45:56
Episode Wrap-Up … 00:52:00

Surprising Causes of Chronic Bloating - Podcast301a DeboraChasse

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Hey everyone. Today I speak with Dr. Debora Chasse on a few underappreciated causes of bloating and distension. Namely, we talk about the Vagus nerve, and we kind of outlined that a bit more thoroughly. We also discussed the lymphatic system and how problems with lymph may actually cause bloating. I do a quick fact check while we’re on the episode, and there is some evidence to support this, even though it’s somewhat of a newer concept for me. Additionally, we discuss adhesions and go a little more in-depth on that aspect, and some techniques for increasing activation of muscles, including those of the pelvic floor. So hopefully for those who are still not satisfied with the level of bloating and distension they’re experiencing, these would be a few other techniques or disciplines to consider integrating into your gut healing plan. By the way, if you need advice and guidance on your gut health journey, I would recommend checking out Healthy Gut, Healthy You, which of course is the book that I’ve written to provide you all the evidence in one place in a clear roadmap for how to improve your gut health. Alrighty, we will now go to the show.

➕ Full Podcast Transcript

Intro:

Welcome to Dr. Ruscio radio, providing practical and science-based solutions to feeling your best. To stay up to date on the latest topics as well as all of our prior episodes, make sure to subscribe in your podcast player. For weekly updates visit DrRuscio.com. The following discussion is for educational purposes only and is not intended to diagnose or treat any disease. Please do not apply any of this information without first speaking with your doctor. Now let’s head to the show.

DrMichaelRuscio:

Hey everyone. Today I speak with Dr. Debora Chasse on a few underappreciated causes of bloating and distension. Namely, we talk about the Vagus nerve, and we kind of outlined that a bit more thoroughly. We also discussed the lymphatic system and how problems with lymph may actually cause bloating. I do a quick fact check while we’re on the episode, and there is some evidence to support this, even though it’s somewhat of a newer concept for me. Additionally, we discuss adhesions and go a little more in-depth on that aspect, and some techniques for increasing activation of muscles, including those of the pelvic floor. So hopefully for those who are still not satisfied with the level of bloating and distension they’re experiencing, these would be a few other techniques or disciplines to consider integrating into your gut healing plan. By the way, if you need advice and guidance on your gut health journey, I would recommend checking out Healthy Gut, Healthy You, which of course is the book that I’ve written to provide you all the evidence in one place in a clear roadmap for how to improve your gut health. Alrighty, we will now go to the show.

DrMR:

Hey everyone. Welcome back to another episode of Dr. Ruscio radio. This is Dr. Ruscio here today with Dr. Debora Chasse, and we’re going to be discussing in short what could be underlying from a muscular perspective, using that term loosely, bloating and abdominal distension. I wanted to bring Debora on to help me better understand what other items could be underlying this chronic bloating and distension that a subset of patients struggle with. So I’m going to use the rough rubric of muscular, but we’re going to go a little bit beyond that. However, I don’t know exactly where, because I haven’t had the chance yet to really pick Deborah’s brain. So Debora, welcome to the show.

DrDeboraChasse:

Thank you. I’m glad to be here and thanks for inviting me.

DrMR:

It’s great to have you here. I guess before we launch in, can you just tell our audience a little bit about you, your background, and what you’re doing in practice?

DrDC:

I’m a doctor of physical therapy and I’ve practicing for about 26 years. I’ve always had an interest in more of an alternative approach. You’ll probably be able to see that as I talk about some different things. I’m also a pelvic floor specialist, which includes the abdomen. I do see a lot of people with abdominal discomfort, whether it be bloating, constipation, SIBO, there’s just so many things. The pelvic floor is related to it, but it’s also kind of a distinctive, separate topic to the pelvic floor, but it includes the pelvic floor. And I’m also a lymphedema specialist, which means I know a lot about the lymphatic system. So that’s part of it too. And I mean, I just love therapy. I love making changes in people’s lives and helping them to regain their independence and their own health.

Bloating and Distension Treatment

DrMR:

Awesome. So you’ll fit in well with this crowd. Let’s start high level, because the main question that I have, and I’m not sure where this is going to lead us within your skillset, is when you see someone who has somewhat chronic or recalcitrant bloating and/or distension who is doing some of the internal things correctly, they’re eating a healthy diet, perhaps they’ve used probiotics, perhaps they’ve done some sort of treatment for SIBO, when someone’s gone through and satisfied those starting points, are there a few key things that you’re suspecting could underlie that chronic bloating and distension?

DrDC:

Yeah, there are. First of all, it’s really good that they’re doing those things because if someone comes to me and they’re already doing all the things that they should be doing at home, that makes it much easier and we can progress a lot faster. One of the things that I notice is that oftentimes when there’s abdominal dysfunction, then there’s also an issue with the Vagus nerve. So I like to start there with the Vagus nerve and look at what does the Vagus nerve do. The responsibility of the Vagus nerve is to slow down the heart rate, increase digestion and decreased the immune response. So if they’re having some bloating or any type of discomfort in the abdomen, then what’s going on with that? Is there something underlying causing it, something that put them in a survival mode?

DrMR:

So kind of a chronic stressor. This does tie in with the conversation we had with clinician and researcher Dr. Erik Peper from several months ago now. He was essentially finding that when people did meditation and breath work, which would be a way of getting you out of this sympathetic lock, more into the parasympathetic because it’s a way of having this Vagus stimulation, that was actually quite helpful in reducing bloating and abdominal distension. Even so much so to the point where they were able to publish this in a peer-reviewed journal and document that this wasn’t just placebo, these were real quantifiable improvements through breath work and meditation. So we’ve touched on that tangentially, but is there anything you would follow up on with either the breath work and meditation piece, or anything else that you’re finding helpful in particular for the Vagus nerve? I know that may be a broad question, but whatever you can offer.

DrDC:

So the Vagus nerve is pretty much your parasympathetic nervous system nerve. It supports that. So that’s going to be really important to do things that will support the parasympathetic nervous system. And of course, the things that he’s suggesting are right on, and I did listen to some of your previous podcasts on the abdomen, and that was one of the things that was mentioned. So that’s very important, but you know, one of the things that we’re looking at is what happens when there’s decreased digestion and when there’s bloating and so forth. So think about inside the abdomen, there’s fluids all around the organs and it starts to get sticky, or if there’s scar tissue from previous surgeries or adhesions that could be related to muscles or fascia, then anytime a person moves, it’s going to irritate the Vagus nerve.

DrDC:

The abdominal distension, where there’s bloating, will also stretch on the Vagus nerve. So the key is what can you do to calm that down? That’s pretty much what you’re asking. Some of the things that people can do at home is humming, singing, gargling, even wearing a scarf around your neck is really beneficial. So maybe when you go to bed, put a scarf around your neck. There is a tool that I use, it’s called the frequency specific microcurrent. Have you ever heard of that?

DrMR:

Yes, but we haven’t discussed it here on the podcast, so if you wouldn’t mind telling people a touch about that, that’d be great.

DrDC:

Yeah, so basically every tissue in the body has a specific frequency. So the frequency for the Vagus nerve is 109, and then you pair that up with what you’re trying to correct in the body. So let’s say you’re trying to decrease inflammation of the Vagus nerve or infection of the Vagus nerve or toxicity, there’s a frequency. For example, inflammation, the frequency is 40. So you pair those up and you put the FSM, it’s basically graphite gloves, or some sort of electrodes that you connect to the body, and usually you do it along wherever the Vagus nerve is, so say neck to the lower colon. Then you run it on that to help restore the normal frequency to that nerve. So that’s one of the approaches that I use.

DrMR:

Coming back to the singing for a moment, is there something in particular about the use of those muscles that will stimulate the Vagus nerve? The question I’m asking here, and I’m trying to articulate this as precisely as I can, sorry if it’s a bit vague, but I’m wondering if people just having time for leisure and pursuit of the arts, boiling down to have a balanced life, all those things tend to hit the Vagus nerve. So I’m trying to picture myself in giving someone a recommendation of singing every night, or maybe they don’t like singing, but they like painting. In your estimation, is there a big difference between the two of those as they impact the Vagus nerve?

DrDC:

Well singing has to do with the pharynx. There’s motor innervation to the pharynx. And then of course we also have sensory innervation for the Vagus nerve too. So it’s both sensory and motor. Because the Vagus nerve innervates the pharynx, that’s why you do humming or singing or gargling to actually stimulate that Vagus nerve. When you’re talking about something artistic is where you’re getting more grounded, you’re enjoying life, walking in the water. My favorite thing to do is twice a week go down to the ocean. It’s like a mile down there and I’m walking and then I walk in the water for another hour. So that’s grounding, right. And there’s so many therapeutic benefits. So I’m totally supportive of all of these therapeutic benefits just for well-rounded health, but specifically humming, singing, and gargling. That has to do with specifically stimulating the Vagus nerve.

DrMR:

That makes sense. Okay. With frequency specific microcurrent, has this been studied in any particular model? Maybe it’s been most studied for X, but it’s also used for Y. I’m just wondering if you could give us a snapshot of whatever evidence base is available for this.

DrDC:

There is some evidence for frequency specific microcurrent, not necessarily specific yet to SIBO or abdominal discomfort, but Dr. Carolyn McMakin has written a couple of books, and also at the Institute they’re doing a lot of research on it. So you could actually find some research on frequency specific microcurrent.

DrMR:

Gotcha. Was this initially used for one condition in particular?

DrDC:

Well, there’s so many frequencies, so it’s really not used for one condition, but the first book that she wrote had to do with fibromyalgia. What she found was that by using frequency specific microcurrent for the dura, so decreasing inflammation, which is 40, and then the dura, which is 10, those are the frequency pairs. Running that from the base of the cranium or the neck to say, the sacrum, or you could even go to the feet, it would actually improve people who had fibromyalgia related to a motor vehicle accident or some injury.

Adhesions and Visceral Work

DrMR:

Okay. So we’ve touched on the Vagus nerve. You also had mentioned earlier about adhesions, and I’m assuming maybe some sort of visceral work or manipulation ties in there. I’d love to hear more about that. And also for our audience, remember that we’ve had both Jayson Masaki on the podcast discussing this topic, and two times we’ve had on Larry and Belinda Wurn from Clear Passage. So there’s some background and context there. It’s definitely some exciting stuff that especially the folks at Clear Passage are publishing. Tell us more about what you’ve noticed regarding adhesions and any kind of visceral work.

DrDC:

There’s actually two schools that I’m aware of that are teaching visceral work. I’m sure there’s many more, but these are the two that I’ve worked with. One is matrix repatterning and the other is the Barral Institute. So let’s first look at matrix repatterning because that’s treating the bone. If a person say had some sort of a fall and maybe landed on their butt, or fell on their back or fell on their arm, but it hit their ribs, then of course that causes an impact to the organ. So any of those types of injuries can cause basically a concussive effect to the organs. Let me first explain a little bit more about matrix repatterning too because that’ll help people understand more where I’m coming from on it.

DrDC:

We’re looking at impact and at the cellular level. So if we can picture a cell, in the cell has its own cytoskeleton. There’s different substances within the cell that give it a shape, and basically tells it what to do aside from the nucleus of the cell. But if that cell is changed, then it changes the function of the cell too. So let’s go back to an injury where bone gets injured. You fall on a bone, and how many people haven’t fallen on their butt, right? Just look all the way back to when you were born. If you picture the cell being distorted, being enlarged because of this impact, it’s the same idea of if you drop a water balloon, what happens to the balloon?

DrMR:

Yeah, it contorts based on the impact or it explodes.

DrDC:

It explodes, and it does that because water is a non-compressible substance. That’s actually what’s causing the balloon to explode. So in the same way, the cell actually expands. So now picture an area, let’s just say the tibia for example, falling on the knee or getting a door slammed into your tibia or something like that. Imagine the bone expanding, and what’s going to happen to the fascia connected to that? What’s going to happen to the muscles, the blood vessels, the lymph vessels, and any other tissue that’s around there? It’s kind of like a puzzle piece that isn’t sitting quite right because it’s distorted. So the same thing happens with an injury to, let’s say the rib cage, or to the lumbar spine or to the pelvis, how it can affect the organs. So imagine the bone expanding, but then what happens to the fascia around the bladder or the uterus or the rectum or the stomach or the intestines. You see you could just start naming all of the internal organs and then there’s a concussive effect. So you get the injury to the bone, but then you get the injury to the organ, which then goes back and injures the bone again. So what we found with matrix repatterning is to treat the bone first, then you go and specifically treat the visceral structures.

DrDC:

So when talking about the visceral structures, the way I like to look at it is there’s fluid around the organ, there’s fascia around the organ. They have kind of like a double layer. You have the fascia around the organ, then you have a layer of fluid and then you have another layer of fascia. All of these organs are meant to be able to move together smoothly without any stickiness, without any adhesions. And so what visceral manipulation does, you have to know what you’re doing of course, but it allows you to find where these restrictions are and then improve the movement of that organ, which will then also improve the function of the organ.

DrMR:

So without enough movement, there can be this buildup of pressure. And so said, crudely, you’re kind of restoring movements so there’s not so much of a feeling of pressure or bloating.

DrDC:

Right. There’s six digestive valves that we often work with in visceral manipulation. The popular one is the ileocecal valve, which many patients who have SIBO are quite familiar with. Those are the ones when patients are coming like, “Will you correct my ileocecal valve?” But I like to look at all of the valves and make sure that the digestive system is flowing in the right direction and then it’s not getting backed up in any way or blocked. One of the things I like to do is teach people how to find where those are at and then just tap on them. So that’s something that they could do at home, and they could do it on a daily basis just to help them to function better and improve the digestive flow.

DrMR:

So another way of potentially looking at this, because my perspective on this has always been a bit skeptical of being able to adjust the valve open or closed. But I think the way I’ve been looking at this is slightly off the mark, and correct me if I’m wrong, but I believe what you’re saying is it’s more about loosening some of the fascial restrictions that may be altering the valve function than it is literally massaging the valve open or closed, but rather it’s working on the fascial level.

DrDC:

Right, yeah. So when I’m using the Barral technique, you’re testing to see is the valve open or closed. You’re also testing to see which valve is a priority for being treated. So do you treat the ileocecal valve first or do you treat the cardiac sphincter first? And so you have to test to see which one you want to treat first. What usually happens is the valve is closed, and so then you just go into the motility, which really has to do with the fascial system like you’re saying. You go into the motility of that valve and get it to relax and open.

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Treating Trauma-Based Injuries

DrMR:

How often are you seeing some discernible trauma in the history for these individuals, whether it be surgery or maybe they’ve done martial arts or they had a car accident? Is that something that is fairly tightly associated to the need for this therapy?

DrDC:

It is. Actually, I use injuries for all of my patients. When I’m doing my evaluation, I like to look and see, have you ever been in any type of an accident? What kind of surgical history have you had? What about dental treatment, whether it’s braces, wisdom, teeth, teeth being pulled. There’s a lot of people now that have had teeth pulled and then get implants. So all of this is traumatic for the whole body. I see a lot of people that come in, maybe not specifically like, “Oh, I have this injury,” but it’s more like, “I’m having this problem, and I don’t know what’s causing it.” So on almost everybody, I do a matrix repatterning scan to see where that injury occurred. And a lot of times they’ll say, “I didn’t even tell you that. How did you know that?”

DrDC:

Doing that assessment procedure to determine it allows me to find where those areas of restriction are. And then on top of that, once I find that, then I can look at what objective measures we took, whether it be range of motion or decreased tone or joint instability, or even just the tightness in their breath, and look at that to compare it. So if I treat this area, let’s just say, lumbar spine or lower ribs or pelvis, how is that going to change these other symptoms or these other objective measures? They can see on the first visit exactly what it is.

DrMR:

Well, my personal experience with bodywork hasn’t been too intensive. Although I will say Mike T. Nelson does a combination of a few different techniques, but one of them that he uses is called reflexive performance reset. He got in and dug and mobilized for a good hour, and it was painful at times. But when I got off the table, I succinctly remember going for an hour walk. I couldn’t stop walking because I had never felt so much openness in my hips. So for whatever it’s worth for our audience, that was a pretty eye-opening experience for me. I’m sure Debora, you probably see that fairly frequently in your practice.

DrDC:

Oh yeah, absolutely. That’s kind of the joy for me, getting to see the changes. Just for example, I treated a lady this week who did have some head injuries, but I think she’s had more than she realizes, because her cranial bones were just very tight, very restricted in movement. Her biggest complaint was that her teeth didn’t line up when she chewed. So when I tested and checked the structure inside her mouth, one side of the maxilla was expanded quite a bit, the other side of the mandible was expanded and thickened and so forth. And so, there’s things that you have to do first, areas that you have to treat first before you actually get to that. But so far I’ve done two treatments on her and the response after her last treatment was, “I can swallow now. I can clear my throat. I can breathe better. My whole body feels relaxed, and my teeth are lining up.” And she says, “Thank you so much.” So those kinds of things just bring joy to me to be able to help people and, bring back some normal function for them, just like your experience with the guy on the table.

DrMR:

Yeah absolutely. What about the Barral technique? How does that look different than the matrix repatterning?

DrDC:

Well, matrix repatterning includes visceral. My journey is quite interesting. Nearly all the people that I have studied with just kind of fell into my lap, so to speak. Sometimes I think that’s the best way for it to work. But the developer for matrix repatterning is Dr. George Roth. He was at the Upledger Institute with Jean-Pierre Barral, Gail Wetzler, Bruno Chikly, Sharon Weiselfish, so many of these scholars that we now know that have now left and gone to develop their own technique. When he’s teaching a course, he openly says, “I learned this from Dr. Jean-Pierre Barral.” I’ve taken both of the training programs, and I would say that there’s some specificity with visceral manipulation that you get with the Barral Institute, but when you do it with matrix repatterning, it’s a little bit more general. And like I said, you get a lot of it with the bone. So it’s more about vectoring with matrix repatterning, but there’s vectoring with visceral manipulation too when you study the Barral Institute.

DrMR:

And when you say vectoring, are you meaning providing a directional force that’s corrective?

DrDC:

Yes.

The Role of the Lymphatic System

DrMR:

Gotcha. So you had also mentioned lymph, and this is something we haven’t talked too much about. I’m not sure if there’s anything else before we leave the topic, but I’m also curious to get your thoughts on lymph and how that ties in.

DrDC:

Right. The thing about the lymph system is it supports the immune system.

DrMR:

Let’s give people an the overview of the lymphatic system in case they are a little bit hazy.

DrDC:

Good idea, thank you. The lymph system is kind of like the garbage disposal of the circulatory system. When fluid is going through the vessels, the arteries, there’s fluid that then comes into the capillary bed. That’s where all the blood vessels end. It goes from an arterial to venial. It’s where the exchange takes place. So at that point is where lymph fluid or excess fluid goes into the lymph capillary and then goes through the lymph system. So it goes from lymph vessels to lymph nodes, to lymph trunks and then to lymph ducts. The goal is to get the excess lymph fluid, which is basically a waste product, to go to the lymph node so all of the bad things that are in that fluid can be eaten up by the lymph node, and then the good fluid that’s remaining to go back to the circulatory system.

DrDC:

So if there is inflammation within the body, so let’s say within the abdomen, then within that area there’s going to be a backup of lymph fluid. The goal is, well, how do you get that excess to empty out and get it back to the circulatory system? But keep in mind too, one of the things I want to keep going back to is we’re trying to increase the parasympathetic nervous system. So by stimulating or increasing lymph flow in the body, you’re also increasing the parasympathetic nervous system, which is what we want.

DrMR:

I just ran a quick query while you were saying this for some of our audience who may be more skewed on the conventional side of things and might be wondering if there’s evidence for this sort of therapy, which is a totally understandable question that we should be asking. Not to say that all helpful therapies have evidence yet. It’s one thing for there to be evidence showing no benefit, it’s another thing if there’s no evidence yet. But just with a quick here on PubMed, I did find that in a model of constipation, manual lymphatic drainage actually did improve bowel frequency. So there is some evidence for this. Again, just in case this is something that maybe from your background you haven’t heard much of, I think it’s helpful to remain open-minded. And in this case, even a quick query in the PubMed is showing that, at least in the model of constipation, lymphatic drainage was helpful in improving bowel frequency.

DrDC:

Initially I learned lymphatic drainage, actually completely descongestive therapy for lymphedema patients. So all of this information has to be applied to lymphedema patients, but you can take it, extrapolate it and then apply it to pelvic pain and abdominal distension. Years ago one of my colleagues came to me and says, “You’re doing women’s health, pelvic floor dysfunction, and visceral manipulation. Why don’t you combine this information and help people with pelvic floor dysfunction too?” So I did. I wrote a course on lymphatic strategies and pelvic floor dysfunction. And so I actually created a protocol on how to do manual lymph drainage for people with pelvic floor dysfunction.

DrDC:

Well, within that protocol, you have to do manual lymph drainage on the abdomen, and you have to have a place where the fluid is going to go to and have that be clear so it can receive the fluid, which is the neck, thorax and inferior ribs. If those are blocked with congestion, like lymph fluid congestion, then how are you going to move the fluid from the abdomen back to the circulatory system? So you have to unblock everything along the way in order for there to be good flow. So you can still apply the same principle to the abdomen, bloating and distension.

DrMR:

Are there any hallmarks of someone who may be, for lack of a more precise term, suboptimal from a lymphatic perspective?

DrDC:

Sometimes you can see it just looking at their neck and they know themselves that their neck is puffy. I’m talking between the clavicle, the collar bone and the base of the neck. A lot of times there’ll be swelling there.

DrMR:

Is that typically something that comes and goes? Because I’ll see some patients in the clinic who have that. And of course, one of the things I’m thinking is potential Epstein-Barr reactivation, although I’m a little bit suspicious of that. I think that’s sometimes a red herring. But will it be more fixed or will you see a kind of wax and wane?

DrDC:

It can wax and wane, but one of the things that I do at the evaluation anyway, is I palpate their abdomen and see what it feels like. You can feel abdominal bloating during the evaluation. That’s what I do every time. So that already is a red flag to me. And then I’m examining the whole body. I’m looking for any areas where there’s excess inflammation. It could be excess inflammation in the legs or anywhere in the body. So those are red flags. Looking at how they breathe, are they breathing with their scalene muscle. I know that sounds a little bit diverted here, but having good breath flow helps the lymph system.

DrMR:

It’s kind of a pump for the lymphatics.

DrDC:

Exactly.

DrMR:

So you’re saying that bloating could be one symptom and there’s this lymphatic sticking point, so to speak?

DrDC:

Yeah. Bloating. Definitely.

DrMR:

Okay. And this is because of the abdominal lymph nodes?

DrDC:

So there’s 100 to 200 lymph nodes in the abdomen, in the pelvic area, and some of them go really deep. Usually we’re working with superficial lymph nodes when we’re doing manual lymph drainage, but when it comes to the abdomen, some of them go all the way back to the sacrum. And then on top of that, the abdomen or the digestive system has its own lymph system, and that ends up joining up with the thoracic duct. So you’ve got the lymph vessels going to the lymph nodes and then from the lymph nodes to the lymph trunks. And then the last place it goes is to either the thoracic duct or the right lymphatic duct, depending on its location. And so what happens is the lumbar trunk coming up from the legs and the pelvic region, and then you have the intestinal trunk for the lymph nodes. Together those join and then start the thoracic duct. So that’s where the cisterna chyli is. That’s where the two meet up.

DrMR:

And would someone be able to tell from palpating their stomach, if there could be some sort of lymphatic obstruction in their abdomen?

DrDC:

Well, actually rather than calling it obstruction, I would just say inflammation. If there’s scarring or scar tissue, that could cause problems. Adhesions, yes, that would be more obstructive, maybe some pre-surgical incident, but someone could be anxious and they could be causing their lymph system to be stagnant, or a lot of negative self-talk could be causing that too.

Imagery and Movement

DrMR:

Kind of that sympathetic tone. You had also mentioned something before we started the recording about imagery and movement. Can you tell us a little bit more about how that ties into chronic nonresponsive bloating and distension?

DrDC:

I love this, imagery and movement, because you’re able to use your brain to make changes in your brain and in your body. I just love the effect that it has for my own life and what I see with patients. So just as an example, let’s say someone comes in and maybe I’ve already seen them before. They say to me, “I’m having a really bad day today, or this is going on, that’s going on.” They’re just not feeling quite right in their bodies. And I say, “Let’s do this.” I have them stand up and I stand with them. I do this with them because I love it so much. I have them stand up and I say, “First, let’s do a check-in. Let’s just take a minute, close your eyes and just notice your body. I don’t need you to tell me what’s going on, I just want you to notice.”

DrDC:

And of course, what I’m looking for is a before and after type of effect too. So they do that, and then I start having them tap their body. So you can start by tapping the abdomen. So by tapping, you’re actually increasing proprioceptors by stimulating these little tiny sensory organs that are found under the skin. Proprioception is basically your body’s awareness of itself in space. It then increases the receptors and they are what gets increased when you stimulate the lymphatic system, which stimulates the parasympathetic nervous system. So do you start seeing how it’s all tied in together? So we’ll start tapping the abdomen and then move up to the chest. I even have them make some “uhhh” type sounds with their chest vibrations, tap their low back and around the diaphragm.

DrDC:

And while they’re doing this, I’m having them just kind of gently move their body to what’s comfortable for them. So tap their pelvis, up and down their legs and all the front, besides the back, and then the arms and the neck and the head, and even the face. Very gentle on the neck and face. And just after doing that and having them compare how they move and how they feel in their body is just such a big turnaround for them. And then I’m encouraging them. This is something that you can do every day. You could do it twice a day. It actually improves clarity and focus and changes the negativity that they’re feeling into something so much more positive.

DrMR:

This sounds akin or similar to EMDR. Do you have any familiarity with that technique?

DrDC:

Yes, I do. EMDR works more with eye movement. EMDR is more where you’re actually making changes to something that happened in the past. So then it’s kind of like you get to take a new direction.

DrMR:

Is there a component of tapping with EMDR or am I kind of conflating temporal tap?

DrDC:

Yes. You’re confusing it. There is something called tapping that people do for their emotions. So this is something different. You can do it with your hands, you could do it with, we use these Franklin balls, and you just start tapping and it doesn’t have to be a specific area. When you do tapping for emotions related to EMDR, those are specific areas that you tap to make changes in your emotions. They’re specific for each emotion that you’re doing. And that’s awesome, I love that technique too, but I like the Franklin Method. It’s called the Franklin Method, that I’m talking about. I like it because you can do certain movements, and use imagery along with it to help improve the efficiency of that movement. For example, we have a study group once a week, and last week we worked on the knees. And so after doing the technique treatment on the knees, which probably took about 15 minutes, we just stood and checked in, noticed our body. I could feel increased tone in my abdomen. So not only did it give me flexibility in my knees and I could walk better and climb stairs better, but I noticed this tightness in my abdomen, which was tone. Well, that’s what we need to support the abdominal contents and to help with the digestive flow.

DrMR:

So is there a degree of this that could be bloating distension that’s in part just deconditioning or deactivation of the muscles of the abdominal wall?

DrDC:

You could actually say that. I’ve done the Franklin Method on other parts of my body, where I noticed the same thing. It’s probably because I need to increase my abdominal muscular tone. So I would say that there is a component because your abdominal muscles need to basically hold everything in. And then when you think about breathing related to the abdominal muscles, for example, we all know we’re supposed to breathe into our abdomen, not into our chest, not into our scalene muscles, that’s our neck muscles. So when you breathe into the abdomen, the diaphragm is coming down, it’s compressing the organs. So where do the organs go? Are they going to go down? They don’t go to the back because the spine is there.

DrDC:

If they go down, that’s how we end up with pelvic organ prolapse, so we don’t want that. Some of it will go down, but we want it to come forward. So a lot of us are trying to protect our beautiful figures and not have a gut, but when we breathe, it’s natural to breathe into our abdomen and have it come forward. So looking at the muscles, you have the abdominal muscles that have to lengthen to allow for that excursion. Then when you exhale, the abdominal muscles actually contract and then allow the air to come back out, and it brings the organs back to where it’s supposed to be. What’s so amazing is at the same time when those organs are being compressed by the diaphragm, it’s stimulating the lymphatic vessels in the lymph nodes.

DrMR:

Well, everything has to move, I guess, in order for things to function. And then when things stop moving, things stop functioning.

DrDC:

Exactly.

RuscioResources:

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The Pelvic Floor

DrMR:

Obviously there’s a lot here on this topic, but relative to what we’ve been discussing, anything else that you think is important for people to know?

DrDC:

I think we’ve hit on some of the highlights. Maybe let’s talk about the pelvic floor just a little bit too. I can tie that in with breathing. So we talked about the diaphragm, the diaphragm comes down during inhalation, but how about when you breathe to imagine breathing into the pelvic bowl. Imagine the sit bones floating apart. And then as you exhale, imagine the sit bones coming together, and then of course the air is coming out. So that’s a great way to relax the pelvic floor. Usually people have a tight pelvic floor more than a weak pelvic floor, or it’s both tight and weak, so tight on one side, weak on the other. What we want is symmetry and balance, and usually I’m teaching people how to relax the pelvic floor more than I am how to strengthen it. You have to teach how to relax it before you teach how to strengthen it.

DrMR:

That’s interesting. You know, way back when I was doing this study for exercise rehab, they used to say, “Before you exercise, bring in your abdominal wall.” Contract your transverse abdominis for a more technical term, and what you should notice, for women it would feel like you’re kegeling, and then for men, your boys should kind of come up a little bit. That would tell you that you’re getting contraction not only of the transverse abdominis, but also the pelvic floor. So that makes me think that more often people would have a weakness there, but it’s interesting that it seems like the tightness is more of a common factor than is weakness. I wouldn’t have thought that.

DrDC:

Yeah, it really is. So think about when you go to sit in a chair. You go to sit in a chair and your sit bones go apart. You can put your hands on your butt and feel that. And so if the sit bones are going apart andthe pelvic floor muscles are attached to it, wouldn’t it be right to say then that the pelvic floor muscles are lengthening. So if you do the opposite and you keep your pelvic floor muscles tight while you try to sit in a chair, it’s going to be difficult to sit. So you have to let the pelvic floor muscles expand in order to sit, and then when you stand up, sit bones come together, which means that also the pelvic floor muscles are going to contract. And it’s a great exercise to do, to practice pelvic floor lengthening and strengthening.

DrMR:

When you do an assessment for the pelvic floor, I’m unclear on is this something that gets fairly intimate, because we actually have someone that wants to start a referral relationship with our clinic, and I went over to her website and was kind of looking around and I wasn’t sure if this was somewhat invasive of a workup. Just generally what does that look like?

DrDC:

It is, yes. So if someone is a board certified women’s health clinical specialist in physical therapy, that designation is WCS, then yes, they do internal pelvic floor exams. Or it could be someone who says that they are a pelvic floor specialist who will most likely be doing a pelvic floor exam too, meaning that we’re looking at the function of the muscles to see if there’s trigger points, to see how they’re breathing into the pelvic floor to see if they can they essentially lengthen their muscles. So that means to relax, let go. So yes, it is internal, but sometimes people aren’t comfortable with an internal pelvic floor exam. So I use an external exam too, where I don’t even have to work internally and I can tell what is going on. Are their muscles too tight, are they too weak? Are they asymmetrical?

DrMR:

So there’s options. And for men, would the most invasive version look kind of like a prostate exam?

DrDC:

It’s similar to a prostate exam. It’s a rectal exam, and you can palpate the muscles that way too. And you could with women as well, but usually women would prefer a vaginal exam versus a rectal exam.

DrMR:

Right. But for either sex, there’s also this external option.

DrDC:

Yeah, it’s palpating the transverse abdominis muscle. This is one technique that I like to use where I have their knees bent, and I put my finger on the transverse abdominis muscle, which you can find between the ASIS and the pubic bone. This would be for the healthcare practitioners to understand. And so just put my fingers there to feel the activation of the muscle. And then I say to them, “Without actually doing it imagine that your pelvis are the ends of a book, and your sacrum is a bookbinder, and imagine closing the book.” You can feel under your fingers just a very slight contraction. It’s actually better than doing an internal exam. You can feel the contraction of the muscles, if they’re symmetrical, which one’s contracting first and so forth.

DrMR:

Well, great. I’m glad I asked, because that makes me less reticent about referring someone over in case they didn’t express an overt need. If it was a subtle need, it’s nice to know what I’m committing someone to essentially.

Episode Wrap-Up

DrMR:

I’m grateful for all this information. I think it’s going to help people who maybe are doing all the right stuff from a diet, lifestyle, probiotic, SIBO treatment perspective, but I want to always try to make sure that we don’t have blind spots, or at least we’re having the most minimal blind spots possible. So I think this is a good chance for people to look into this other world of therapeutics and hopefully it’s resonating with some people and you’ll take the appropriate action. And I guess to the point of taking appropriate action, is there a certain website? Please give people your website and/or professional type they should be looking for or directory they can go to if they need help.

DrDC:

Yeah, there is. So my website has a lot of information on it and that is functionabilityPT.com. And if you Google my name, it’ll show up. The matrix repatterning website matrixrepatterning.com has a lot of really, really good information. If someone wanted to work more with say, manual lymph drainage, then I would suggest that they go to the Lymphatic Association of North America, cit-lana.org. And on there, they have a list of people who are LANA certified in lymphedema and then the other is the Franklin Method. People can sign up for, I think it’s either a weekly or monthly newsletter type thing where they get a video of maybe five minute imagery and movement to do following the Franklin Method. But people teach workshops on the Franklin Method. So with all of these, you’re able to find practitioners that do this type of treatment. And for the frequency specific microcurrent, they also have a list of practitioners that use the FSM. FSM is what we call it for short.

DrMR:

That’s on that same website, or a different site?

DrDC:

A different site. Each of them has a different site. You have frequency specific microcurrent, matrix, repatterning, Lymphatic Association of North America and Franklin Method. And then of course, my website.

DrMR:

And I’m assuming, but I don’t want to assume too much and also ask for clarification for our audience, PTs are going to have a vast difference in how they’re trained. So it’d be safe to say you couldn’t assume that every PT is going to have the same level of training that you do, right?

DrDC:

No, absolutely not. Yeah. And as a matter of fact you wouldn’t go to any PT for pelvic floor therapy.

DrMR:

Right. Well, Debora, thank you so much. This has been an insightful conversation. I’m hopeful that this has resonated with some people, and if you’re floundering, you’ll take some steps to look into this other component that may be underlying some of your bloating and distension. So I really appreciate it, thank you again.

DrDC:

Thank you for having me.

Outro:

Thank you for listening to Dr. Ruscio radio today. Check us out on iTunes and leave a review. Visit Dr. Ruscio.com to ask a question for an upcoming podcast, post comments for today’s show, and sign up to receive weekly updates.

 

➕ Dr. Ruscio’s Notes

Vagus nerve 

  • Controls/impacts digestion and immune system 
  • To improve 
    • Ensure you are not overly stressed 
    • Humming, singing or gargling
    • Scarf around neck
    • Frequency specific microcurrent tool

 

Visceral manipulation & adhesions 

  • 2 schools of visceral work: 
    • matrix repatterning 
      • treats bone – after impact trauma, and fascia and lymph that can distort post trauma
      • treat bone and then visceral structure
    • Barral institute 

 

Imagery and movement 

  • Franklin Method
➕ Resources & Links

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