How The Gallbladder Creates Musculoskeletal Pain
The gallbladder can influence more than just digestion?! This week on the Unreal Results podcast, I talk about how the gallbladder can have a profound impact on the body including including shoulder pain, sciatica, and even anxiety. You’ll learn about gallbladder anatomy & function, musculoskeletal referrals, the gallbladder’s association with springtime, and its connection to traditional Chinese medicine. I also talk about practical techniques to assess and treat gallbladder-related symptoms. This episode is packed with insights that you can start using in your practice to integrate a whole-body approach with your clients.
Resources Mentioned In This Episode
4-Day Pre-Sale! Get It Here - LTAP™ Level 1 Waitlist
Episode 9: Left Side Sciatica or Right Side Shoulder Pain?
Episode 45: The Kidneys - Visceral Connections To Movement
Episode 65: Liver Love
Episode 75: The Colon Connection
Episode 91: Diaphragm Details That Unlock Thoracic Mobility
Mobility Video: Resisted Exhalation With The Coregeous Ball
Mobility Video: Side Lying Over The Coregeous Ball
Coregeous Ball by TuneUp Fitness
Franklin Ball by The Franklin Method*
Learn the LTAP™ In-Person in one of my upcoming courses
*This link is an Amazon affiliate link, meaning I earn a commission from any qualifying purchases that you make
Considering the viscera as a source of musculoskeletal pain and dysfunction is a great way to ensure a more true whole body approach to care, however it can be a bit overwhelming on where to start, which is exactly why I created the Visceral Referral Cheat Sheet. This FREE download will help you to learn the most common visceral referral patterns affecting the musculoskeletal system. Download it at www.unrealresultspod.com
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Anna Hartman: Hey there and welcome. I'm Anna Hartman and this is Unreal Results, a podcast where I help you get better outcomes and gain the confidence that you can help anyone, even the most complex cases. Join me as I teach about the influence of the visceral organs and the nervous system on movement, pain, and injuries, all while shifting the paradigm of what whole body assessment and treatment really looks like.
I'm glad you're here. Let's dive in.
Hello, hello! Welcome to another episode of the Unreal Results Podcast. I'm on the road, um, in a friend's beautiful casita, and, um, but still gonna record podcast, so here we are. I hope the audio will be good. I'm using my earphones today, uh, because the door's open. I don't have a, my mic with me, so hopefully Hopefully it'll work out.
Honestly, the editing software we use is really good at cleaning up sound, so it should be fine. Um, knock on wood. Speaking of wood. Speaking of wood, in Chinese medicine, um, springtime is associated with the liver and gallbladder, and it is considered a wood element. Uh, now I'm out of my wheelhouse a little bit because I have not studied Chinese medicine in depth.
Um, obviously I know a little bit. Um, some of the, what we learn in the Barral Institute about the organs in relationship to emotions and things like that. Um, come from Chinese medicine and there's like a lot of overlap sometimes. So Um, and like, surprise, that's what I want to talk about today. Um, before I get into it though, just to let you know, this podcast will drop on Wednesday, March 12th, and that is day three of a four day pre sale to the waitlist.
For the spring cohort of the LTAP Level 1 course. So if you're on the waitlist and you haven't been looking at the emails I've been sending, go to your email right now, as long as you're not driving and listening to this. And, um, read the emails. I'm offering a lot of bonuses if you enroll during this waitlist pre sale, as well as I have a special VIP offer that I've never offered before.
Um, probably only going to be available for people on the waitlist. Yeah, it ends to it ends Thursday the 13th at the end of the day Pacific Times, so if you're not on the waitlist, and you don't have any interest in going and signing up for it. It's hard to find but I will tell you if you go to the in person course sales page and scroll under the dates of the in person courses.
Um, there's a box that you can sign up for the waitlist and that will get you in the next emails that I send. And, um, the other benefit of being on the waitlist is I've announced the next two course locations for the in person classes. So you get first dibs on those course locations and we'll be first to know when they come out.
Um, the rest of the world, uh, the public will not know until the public sale, which is, um, April 7th. The week of April 7th is when the public sale will be. So, um, yeah, you get early access when you're on the wait list. So anyways, um, let's just dive into it because I don't have a ton of time today, so this might be a short episode, but yeah, so I, I already said like spring is sneaking up on us and um, with that comes an influx of a lot of shoulder pain, rib pain, um.
Some left leg sciatica. When I first started the podcast two years ago, one of the first episodes I did was called right shoulder pain and left sciatica and or left sciatica. And it was all about how in the springtime, it is a very high load on the liver and that can result in things like right shoulder pain and left sciatica.
So if you haven't Listen to that podcast. That would be a great compliment to this podcast. So I'll make sure that Joe links that in the show notes. Um, and Also, we're gonna have some other podcasts linked in the show notes too because there's a lot of connections in this area. So, um, With, along with the liver, um, is the gallbladder.
So the gallbladder, and the liver, they are very intimately connected. Uh, the gallbladder lives right underneath the liver. And it's duct system goes into the liver. Um, and then also is out of the liver, right? The duct system from the gallbladder. The gallbladder, um, secretes bile into the ducts. And the ducts distribute that bile within the liver.
Distribute that bile to the small intestine and to the pancreas. And so, um, the liver is, or the gallbladder is very connected to those organs. The liver, the pancreas, and the duodenum of the small intestines. So, um, it is a like, um, what shape is it? It's kind of like a balloon, like an oblong balloon shaped, um, organ that lives under the liver.
The fundus of it, the, which is like the, the body of it, um, it sits anterior and you can actually even palpate it, especially on inhale breath and you can palpate it, um, At the intersection of rib 9 and midclavicular line, sometimes when we're having some gallbladder overload, some gallbladder issues, um, that area can be pretty tender on people.
And that's the bottom of the bladder of the gallbladder. The neck of the gallbladder, which is the top of the organ as it drops down into the ducts, that is, um, more posterior and then also higher up if we're looking at the spine. Right, so, we're looking at the spine, the level of the spine. The, the level of the neck of the gallbladder is like T11 12, and the fundus of the gallbladder is down like L1.
So, um, Yeah, and then of course, you know, nothing is like two dimensional. It's not just like straight up vertical. There's an oblique angle to it It follows the bait the bottom of the liver. So the liver has an oblique sort of bottom side to it. Same thing with the orientation of that organ, much like the orientation of the stomach.
So I've done some podcast episodes on the stomach, and I try to emphasize the 3D-ness of it, and how the top of the stomach is actually posterior, where the bottom of the stomach is a little bit more anterior, so there's this oblique angle to it. The gallbladder is very similar in that sense. So, um, why, the other reason we're talking about the gallbladder is not just because it was spring.
In fact, I was like thinking about talking about a different organ on this podcast episode, but um, I've had multiple people in my life reach out with me, reach out to me with issues that are gallbladder issues. And so I'm like, this is coming up a lot. Maybe I should talk about it. And then I'll also, as I'm helping them navigate their gallbladder issues, I'm realizing that Some of my issues that I associated with my indigestion probably have a gallbladder component to it.
And so I'm realizing that, um, hmm, yeah, I could benefit from this stuff too and this knowledge, so. The gallbladder, so I talked to you about where it is. Um, let's talk about the musculoskeletal symptoms that are associated with the gallbladder. It's going to be commonly shoulder pain, neck pain. It can be right sided or left sided. Um, costovertebral joint pain or dysfunction. specifically between the thoracic, um, levels of T7 to T9.
The cervical levels are going to be, um, typically between C4 and C6. And, um, but you know, they're the relationship to from where the nerves innervate the organ. It's going to be sympathetic from T7 to T9, just like the liver. And then parasympathetic, well not even parasympathetic, but, um, parasympathetic, I'm going to be vagus nerve, but then also sensory, sensory relationship from the phrenic nerve.
So that's going to affect C, the levels of C3-5, in the neck, which is why, right? This is why we get so many like shoulder and upper extremity issues with these organs is because of that phrenic nerve relationship. So, um, the restrictions. That you can see, like I said, T7-9 costovertebral C4-6, typically left sided in the, in the cervical spine.
Uh, as well as, you can get restrictions lower down, like T12 to L3. And this is more due to the relationship between the gallbladder and the duodenum. So these are actually a little bit more associated with duodenal restrictions, but, um. They're very intimately connected because of the common bile duct and where it drains into the duodenum, as well as the suspensory ligaments between the bladder, the liver, the kidney, the duodenum.
some non musculoskeletal, but symptoms that you might also have. Well, actually also musculoskeletal. You could have just pain in the right upper quadrant of your abdomen. Um, a heavy feeling on your ribs, kind of like a chest heaviness or chest tightness over your, under your ribs at the left side.
Sometimes, um, a gallbladder attack almost even acts like a heart attack on the other side of the body. Um, Shoulder blade pain and then levator scapula as well in addition to this, the general sort of like visceral referral of like that general shoulder pain. So some other symptoms that are not necessarily musculoskeletal, but you might be feeling, um, left sided sinus issues, headache, irritability, nausea or vomiting, even like morning sickness, morning tiredness, um, constant worry.
Daily stress, um, and also just really this isn't a symptom that you would feel, though it may be something that you know, is excessive estrogen tends to cause some of these symptoms too with the gallbladder because the excessive estrogen has to get, um, almost sort of like clogs up the liver function. So the bile
production decreases and so you get sort of an unhappy scenario with this relationship between the liver and the gallbladder and the duodenum and pancreas. Um, the, um, this is also sort of like when we look at the traditional Chinese medicine, the motions that are associated with the gallbladder, it's going to be, you know, when it's out of optimal function, it's going to be, um, dissatisfaction, anxiety, frustration, um, stress, annoyance, like, and you, you might have this constant habit of like
accepting overflow in your life, like taking on too much, um, but then being sort of like paralyzed by how much you have going on in your life. The opposites of those when the gallbladder is in good optimal function would be courage, motivation, initiative. So like if you're finding that you don't have the courage, you don't have the motivation, you have a hard time taking initiative, like you're feeling sort of like heavy, weighed down, that's, you know, an indication of sort of um, Gallbladder not functioning super well.
Um, the Gallbladder activity on the traditional Chinese medicine clock is most active between the hours of 11 p. m. And 1 a. m. now this is important because oftentimes when an organ is sort of struggling and creating symptoms we have We often wake up in these times of the night when it's very active, so between 11 and 1 a. m. is going to be when you kind of tend to wake up. Between 1 and 3 a. m. is the liver, so really even between 11 p. m. and 3 a. m. This is prime time for liver and gallbladder function, and so one, if you're waking up at these times, Repetitively over and over you might this might be an indication of these issues but then also if you're not getting in bed until late like if you tend to not go to bed till like 12 a. m. 1 a. m. Like you're Really challenging your body's function of these organs during that time because these organs that have high activity in the times of day when we're supposed to be resting, this is when they're almost like doing their high function to like detoxify and cleanse and like stay vibrant and healthy for the times during the day when they need to be, take a role in digestion of our foods and balancing our hormones and all that kind of thing.
So, those are all, um, good information, so you can get what's called a gallbladder attack. When you have a gallbladder attack, it is more acute symptoms and very aggressive symptoms. This is what can sometimes feel like that heart attack feeling, but on the right side, it can also be immediate or within hours of eating like fatty foods or just eating food.
Um, nausea, vomiting, extreme abdominal pain, um, a fever can even be part of it. Um, This gallbladder attack can be because of the diminished function, or it can be because of gallstones, um, preventing or affecting the bile being excreted into the duodenum and the pancreas. And so it can also sort of create like a pancreatitis type of symptom as well, that mid back pain and the nausea, vomiting, um, Fevers, chills, those kind of things.
Obviously that can be an emergency situation. Um, I find that I tend to get this gallbladder attack feeling, um, you know, along with times where my heartburn, my GERD is real bad. My, um, just general bloating and gas is real bad. So, um, which are all duodenal symptoms as well. Um, I get them at night. After eating foods that I know I'm, not know I'm sensitive to that, but that tend to bother me a little bit.
Um, or tend to be really high fat. And so usually how I, how I deal with it is when it's really bad. I mean, I'm not gonna lie. I take an anti inflammatory. Um, because it's painful and that often is helpful to relieve discomfort. And then also I tend to lie on my right side with a pillow under my right side.
And so this is kind of what I want to talk about too because what's interesting about the gallbladder, and I've talked about this. If you've ever heard me talk about the pancreas too, some of our organs are very sensitive to the pressures within our abdominal cavity and do not like it when it's getting squished or, like, compressed too much.
The gallbladder is one of those, along with the pancreas. And so, Oftentimes what I think that does by lying on a bolster or like a pillow on my right side and bringing my liver towards the midline is you actually sort of like take up slack of the tissues in the area and it almost is like, again, like a knot in a necklace, right?
When you're pulling it a part, the knot gets tighter, but if you bring the ends of the necklace together, the knot gets looser, there's more space. Our body's kind of like that too, so creating some external compression, even though you would think that increases the pressure, often times provides space in the tissues so that those organs that are sensitive to pressure feel like they have a little bit more room.
You know, that is, this is like, a theory that I have, this is not proven, I'm not measuring the pressures, I don't know, for all I know, it could be increasing the pressures, but for whatever, for whatever it, Whatever is going on, it tends to always be very relieving and helpful, even when you're even just doing manual therapy, is to start into that protective pattern a little bit, that supported side bending, and bringing the, the, the suspensory ligaments of the, um, liver and the colon and the kidney and the duodenum, like, on slack a little bit.
So super important there. With that said, since pressures are a part of it, this means that any way we can change the pressures within our cavities is a, is probably going to be helpful for managing gallbladder. So from a just general movement mobility standpoint, this brings us back to the thorax. The thorax is always going to be the cavity that we have a high potential for changing the pressures within because of how many joints there are in the thorax, right?
We have a great opportunity for improving mobility because of all the articulations, as well as because at the end of the day, this is sort of where our pressure is regulated normally because of our breathing. So when, if, if we have pressure issues, no matter if it's in the gallbladder, the pancreas, or like the, the, the urinary bladder or the uterus or the rectum, like pelvic organ pressure prolapse type problems, we're always going to like need to address the thoracic pressures because as the thoracic pressures change, the abdominal and the pelvic cavities pressure change as well.
So it is an area that we're often like high payoff for exercises when we're dealing with pressure issues. Um, and then also making sure that as we're addressing mobility of all those joints of the thorax, we're also addressing mobility in function of the diaphragm. The diaphragm muscle, and I did, I'll have Joe link the diaphragm episode in the podcast notes, but the diaphragm muscle.
Um, because it's a muscle, it tends to also splint the organs when they're not happy, so we can get a concurrent, like, stiffness of the diaphragm, the right side of the diaphragm, when the gallbladder and the liver duodenum are not happy, and this can further affect the pressures in the thorax because it changes our breathing capacities, and then have this cascade effect on the pressure component of the gallbladder, and so, um, even though, as we treat the organs, the diaphragm should reflexively let go, it's good to, you know, it's good to especially consider doing very specific diaphragm mobility things as well as thoracic mobility things to ensure that you're sort of, um, touching all your bases, if that makes sense.
Especially if you're treating the organs generally. And what I mean by that is if you're treating the organs through the skin, through the um, somatic, the visceral somatic reflexes at the spine versus like creating more mobility and space around this area of the container versus really specific visceral manipulation, you want to kind of cover all your bases.
When you're using specific visceral manipulation, you can stand to not have to cover so many bases because your assessment and treatment is so precise To the organ itself that it needs support, right? And so you have a more reflexive bigger outcome versus if you don't have the skill set to treat like the gallbladder itself but you have the skill set to treat the diaphragm stiffness treat the thoracic mobility between t7 and t9 treat the Um, skin area that's associated with the gallbladder and like the right kidney and the duodenum, right?
Like do these more musculoskeletal based treatments with this visceral lens of view,
you can have a similar impact, right? But this is also like when I teach in the LTAP, like I, I really also want to like, well, I want to encourage people to learn more specific visceral work, but if you, Before you learn it, or if you don't want to learn it, like, you have to realize that there is a value in the specific work.
So it's like, if you're doing all these musculoskeletal things and people are still having symptoms, then it's like, you got to refer out. You got to refer out to someone that specializes in visceral manipulation, or even to a doctor to figure out, like, what is going on? Do they have gallstones? And, like, do they have a blockage?
Like, is this, like, an emergency situation that needs to be dealt with? Because,
you know. At the end of the day, movement and visceral manipulation can be very powerful and support the function of the gallbladder, but sometimes when the gallbladder is completely full of stones and has, um, occlusions of the bile getting through, like, this, this is not good and the, you know, um, manual therapy can only do so much.
So this is why it's important even to recognize these symptoms. So when you know to refer back to a doctor, when you know when you need more functional support, or when you know it's an emergency and the, and your patient needs to go to the hospital, right? So, um, without having the visceral manipulation tools, tools to assess and treat.
Specifically the gallbladder. I think the best way to then treat the gallbladder is to change the pressures as well as use some of the bigger organs as sort of levers. So anyway, so that means I'm going to use the liver. I'm going to use the duodenum. And I'm going to use the kidney. And the Fascia of Tolt, which means I'm going to use the large intestine as well.
So both colon, ascending colon, and duodenum. I'm going to use those relationships of the organs, those bigger organs, almost as handles to pull on the ligaments that are going to also connect to the gallbladder and affect the pressures and space around it. Because two, those All of those organs are easier to palpate on your own, even without a very specific skill set, right?
Um, this is when, like, using the Coregeous ball in the ribs, the area of the liver, is going to be really powerful. Down between the ribcage and the pelvis. Using the Coregeous ball there to shear the colon, medial. It's going to be really powerful because that's going to be sort of impacting the Fascia of Tolt using a Franklin ball or cups On the area of the right kidney that's also going to affect the fascia of Tolt and the suspensory ligaments to the liver that will influence the sort of biliary sling of the gallbladder the duodenum and like knowing where the different parts of the duodenum are to affect the tubes of the gallbladder.
Tubes love to be stretched. So the tubes of the gallbladder, which is the common bile duct, um, as well as the tubes of the duodenum, love to be stretched. And it basically makes a vertical line from that ninth rib and, you know, midclavicular spot down to the sphincter of Oti. The sphincter of Oddi is lower down on the long vertical tube of the duodenum called D2.
And you can find it if you go two fingers, two to three fingers, from the umbilicus. On a diagonal line towards the mid clavicular line, you'll find kind of like a harder spot. That's like, that is the sphincter. That's the sphincter of Oddi. If you play around in that area and like get the skin to soften, but then like pull it down with your thumbs, like this, and then use your breathing, right, as we take an inhale breath, the, the duodenum and the colon, the colon especially, gets um, moves laterally.
And everything gets pushed down and then when you exhale and the diaphragm comes up, you maintain this inferior glide on that sphincter of Oddi and you, you maybe even feel a very specific stretch between that sphincter of Oddi and the edge of your ribcage. That is that common bile duct. And be gentle.
You don't want to just come right out of it. Like, you start inflection, right? We start with slack. Use your breath, see how it changes, pull down, and then big exhale. You feel it want to pull up and you don't let it. That creates this lengthening stretch. So that's a great way to stretch out the tubes in that area.
The side lying Coregeous ball work, both in the liver and in the abdomen, as well as this, identify where the sphincter You know, do some real nice, gentle skin lifting, soft tissue in that area, and then try this longitudinal stretch of it with the breath. All great. That area of the skin right at the intersection between the ninth rib and the midclavicular line, that also happens to be the skin dermal reflex zone for the gallbladder.
So, just gentle, dynamic lifting cups in that area can be very reflexive for the gallbladder itself too. So, Hopefully that's helpful. I know I'm giving you kind of a lot of information, but um,
I'll link the Exercises in the show notes, also in those other podcast episodes, there's great exercises to do, so I'll make sure the podcasts that are linked in this episode, that liver one, I actually have multiple liver ones, so the springtime one, the um, liver love, I'm going to link the colon connection, I'm going to link the kidneys episode.
And, I don't think I have any specifically on the duodenum. So, there is a small intestine one, but it's not quite, it won't be quite as helpful as these other ones. So, to keep it simple, we'll just link those. So, I'll have to link those in the show notes, as well as I'll provide you the Coregeous ball link and the Coregeous ball videos.
Creating some slack. And, I'll, um, At some point this week, check out Instagram, um, and YouTube. I will demonstrate this sphincter of Oddi technique with the common bile duct as well. Hopefully that's helpful, and, um, we'll see you next week.