Working with the Mesentery

By Til Luchau
[Myofascial Techniques]

Have you ever had a gut feeling about something? A sense of knowing something, without knowing how you knew? As body-oriented practitioners, we might wonder: why is this called a “gut” feeling, anyway?
An instinctual sense of certainty has long been associated with our bellies, and not just in the English-speaking world. The French also say this kind of knowing is viscéral, the Japanese speak of hara-gei,1 and the German use Bauchgefühl (literally, a belly feeling).
Along with instinctual certainty, the gut is associated with many other body-mind phenomena. Why do we say our stomach gets “tied up in knots” by stress? We don’t say we get “butterflies in the arm” when we’re excited or anxious—why are there butterflies in the stomach? Along with the heart, the belly is probably more often linked to emotional, mental, and psychological states than any other part of the body. Understanding the significant role of the viscera in the body’s emotional responses can only help manual therapists in their work.

The Enteric Nervous System
It turns out that the viscera’s complex neurology might help explain why we associate so many body-mind phenomena with this part of the body and why hands-on work here can be either emotionally settling or emotionally evocative. The enteric nervous system, our viscera’s neural network, contains some 100 million neurons, more than either the spinal cord or the rest of the peripheral nervous system.2 The enteric system also uses more than 30 neurotransmitters, more than anywhere outside of the central nervous system.3 In fact, more than 95 percent of the body’s serotonin is found in the gut, which is one reason why drugs that alter this neurotransmitter’s balance, such as some antidepressants, can also cause gastric disturbances.
The size and intricacy of the belly’s enteric nervous system have led some science writers to call it the “second brain.”4 Though not capable of thought, the enteric nervous system is far more complicated than what is required for digestive functions alone.5 It seems to contribute a great deal to our emotional state, sending information to the brain that constantly informs our felt sense of ourselves, as a kind of predisposition or background mood for the brain’s mental processes.6
Neurologically, the digestive viscera are innervated by the dorsal branch of the vagus nerve—a key part of the parasympathetic nervous system. It is the parasympathetic “rest-and-repair” system that calms and regulates the sympathetic “fight-or-flight” activation of stress, fear, and trauma. The relaxed, sleepy feeling after a meal is an example of the vagus nerve at work.
Because the vagus nerve’s axons are about 80 percent sensory (that is, carrying information from the viscera up to the brain), our gut affects our brain much more than the brain affects the gut. This might be why hands-on work with the abdomen seems particularly sedative, at least when done noninvasively and gently. Skilled work with the belly can literally, and very effectively, calm an upset mind.

The Mesentery’s Mysterious Anatomy
The intestines are suspended in the abdominal cavity by the mesentery, a folded fascial membrane connected to the anterior aspect of the lumbar region. As well as providing structural support for the intestines, the mesentery encases the many nerves and rich vasculature of the digestive tract.
The mesentery’s anatomy can be difficult to visualize. Picture a weighted fishing net hanging from its center: the intestines would be analogous to the weights around the net’s periphery, with the mesenteric root being the net’s point of suspension on the front side of the low back.
It is because of the mesentery’s attachment to the fascia anterior to the lumbars that the pull of the intestines’ weight can be implicated in low-back pain.
The mesentery is itself part of a larger fascial continuity that includes the parietal peritoneum, a sac of thin, resilient fascia that surrounds the abdominal viscera. Not only does the mesenteric “net” hang from the posterior abdominal wall, it is also continuous with a net (the peritoneum) that covers the wall, and lines the entire room.

Mesentery Technique
Because of the very personal nature of the abdomen, the body-mind dimensions we mentioned earlier, or the fact that our abdomens are rarely touched by others outside of very intimate contexts, working with the abdomen is most appropriate when rapport and good client-practitioner communication have already been established.
Fortunately, the complexities of the belly’s nervous system, fascial anatomy, and interpersonal dimensions are all balanced by the extreme simplicity of the technique itself.

Rolling the Peritoneal Bubble
With your client on her side, gently cradle the abdominal contents, one hand in the space between the pelvis and the rib cage, and the other on the upper lumbars, behind the mesenteric root.
Your intention at this stage is simply to support and ease the organs encased in the peritoneal sac. The type of touch required is different than the touch used for other purposes. We are not trying to release or stretch the fascia; nor are we massaging the viscera. Because of its very sophisticated, sensitive neurology, and its looser, softer tissues, the belly responds well to very light, patient, and perceptive touch. Your client’s enteric nervous system is sensing you, perhaps even more than you’re sensing it. With this in mind, hold the peritoneum as if you were holding a large, delicate, sentient soap bubble.
Before moving or manipulating, let your client become accustomed to your touch. You might invite slow, full breathing into the belly, and even slower, easy exhalation (which gently activates a parasympathetic response). Without stressing, stretching, or bursting the soap bubble, begin to roll the visceral sac in various directions: medially up off the table, cranially toward the head, and so on, all in extra-slow motion. Your hand remains soft, without sliding, poking, or exerting effort. Your intention is gentle, whole-abdomen mobilization and relaxation. Working with the breath, monitor your client’s ability to rest and let you have the weight of her viscera. If you feel your client tensing or holding the breath, stop or back up, and invite your client to relax the belly even more.

Easing the Mesenteric Net
In the same patient, sensitive manner, you can now feel for the mesentery itself. It is important to emphasize we are not trying to touch the mesentery directly, nor are we using direct techniques to stretch or lengthen it. Because of the belly’s extreme sensitivity, we use an indirect technique here, slackening rather than stretching the mesenteric tissues, by gently supporting the abdominal contents cranially and medially in the direction of the mesenteric root.
We can be a bit more directive than we were with the soap-bubble peritoneum, but still very delicate and soft in our touch. On a client with a smaller belly (Image 7), a light touch is all that is needed. On a person with a larger gut, we can use some strength to take the actual weight of the viscera and relieve the mesentery’s pull on the spine. In both cases, as you support the intestines toward the mesenteric root, feel for a gentle easing in the lumbars with your posterior hand. This may take the duration of several breaths and will be most apparent when there is mesenteric involvement in low-back lordosis or discomfort.
Wait for this easing of the posterior hand, or a quieting of the breathing rhythm, or another sign of autonomic nervous system shift, such as a sigh, twitch, or eye flutter. Then, slowly release the hold and continue with other aspects of your treatment.

The mesentery, as the structural connector of the spine, intestines, and the neural complexes associated with both, can be thought of as a key access route for working with a variety of client complaints. Consider including the Mesentery Technique when working with these client conditions, among others:
• Digestive distress, irritable bowel syndrome, and related gastric complaints, because of direct mechanical effects on the intestines, the interoceptive (sensory) refinement from the focused attention of hands-on work, and, especially, from the calming, palliative effects of touch itself.
• Low-back pain, disc issues, and axial sciatic pain, due to the mechanical pull of the mesenteric root on the anterior lumbars, especially in obesity. (For a discussion of axial versus appendicular sciatica, see “Assessing Sciatic Pain,” Massage & Bodywork, July/August 2011, page 110.)
• Pregnancy and postpartum recovery, since peritoneal and mesenteric work can help ease displaced and crowded viscera.
• Recovery from abdominal surgeries and injuries, due to the capacity of gentle manipulation to reduce adhesions and inflammation of the abdominal fascia, and improve postoperative intestinal functioning.7
• Sacroiliac (SI) joint pain, particularly of the right-side SI joint, since the slightly diagonal mesenteric root crosses the anterior aspect of the right sacroiliac joint.8
• Stress, depression, anxiety, and the effects of unresolved trauma, due to the enteric nervous system’s role in regulating serotonin levels, as well as the role of the parasympathetic nervous system and the vagus nerve in the body’s responses to trauma.

What Are We Accomplishing?
Although the peritoneum and mesentery are visceral connective tissue structures, the technique applied here is not Visceral Manipulation Therapy, the method developed by French osteopath Jean-Pierre Barral. Practitioners and teachers of his sophisticated system of subtle organ manipulation emphasize caution and sensitivity, and warn against untrained attempts at organ manipulation.9
If we aren’t trying to stretch fascia, or massage organs, what are we accomplishing with such a gentle, indirect technique?
Keep in mind the “second brain” nature of the gut. Your simple touch can have profound effects, based on quieting and calming, awakening sensation, and inviting ease.
A gentle touch can have surprisingly tangible effects on tissue as well. A 2012 Medline-listed study of surgery-induced abdominal adhesions in rats showed that gentle abdominal massage, performed only to a depth that “did not elicit flinching or biting” by the rat subjects, reduced and prevented adhesions, as well as decreased intraperitoneal inflammation. Interestingly, the investigators noted that during manipulation “the rats became calm and allowed deep palpation.”10
As you experiment with this gentle technique, keep in mind you’re affecting both the tissues of the body and the processes of the nervous system across the entire body-mind spectrum.

1.    James Day Hodgson, Yoshihiro Sano, and John L. Graham, Doing Business with the New Japan: Succeeding in America’s Richest International Market (Lanham, Maryland: Rowman & Littlefield Publishers, 2008), 238.
2.    Michael D. Gershon, The Second Brain: The Scientific Basis of Gut Instinct and a Groundbreaking New Understanding of Nervous Disorders of the Stomach and Intestines (Harper, 1998).
3.    Ibid.
4.    Ibid.
5.    Adam Hadhazy, “Think Twice: How the Gut’s ‘Second Brain’ Influences Mood and Well-Being,” Scientific American, 2010, accessed January 2015,
6.    Ibid.
7.    G. M. Bove and S. L. Chapelle, “Visceral Mobilization Can Lyse and Prevent Peritoneal Adhesions in a Rat Model,” Journal of Bodywork and Movement Therapies 16, no. 1 (2012): 76–82.
8.    Jeffrey P. Burch, “Interdisciplinary Structural Integration: Finding the Balance,” Massage & Bodywork, April/May 2001, 22–31.
9.    Jean-Pierre Barral and Pierre Mercier, Visceral Manipulation (Revised Edition) (Seattle, WA: Eastland Press, 2006).
10. Bove and Chapelle, “Visceral Mobilization Can Lyse and Prevent Peritoneal Adhesions in a Rat Model.”

Til Luchau is a member of the faculty, which offers distance learning and in-person seminars throughout the United States and abroad. He is a Certified Advanced Rolfer and originator of the Advanced Myofascial Techniques approach. Contact him via and’s Facebook page. His book Advanced Myofascial Techniques, Volume 1 has just been released, with Volume 2 slated for publication by the end of 2015.