Referred Musculoskeletal Pain From Heartburn: Connections & Treatments
In this episode of the Unreal Results podcast, I talk about my personal journey dealing with GERD and eosinophilic esophagitis. I discuss the surprising visceral connections related to these conditions including the esophagus and the ligament of Treitz and the various symptoms including referred musculoskeletal pain, dysphagia, and chest pain. I also provide treaments and solutions for GERD beyond medication including manual therapy and dietary adjustments. This episode is packed with insights for anyone struggling with and/or treating complex gut health issues!
Resources Mentioned In This Episode:
Episode 48: Small Intestine & Mensenteric Roots
Episode 35: Tongue Twister
Episode 30: Using the LTAP to Guide Treatment of Costovertebral Joint Dysfunction
Neck Pain & GERD Home Treatment | Esophagus Manual Therapy - YouTube Video
CRAZY Link Between Neck Pain & Reflux | Neck Pain Home Treatments - YouTube Video
Anita Nall Richesson on IG
5D Alive on IG
Blog post about Gastroesophageal Reflux Disease
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. Here we are. Took another week off last week. It feels like a longer break than it really has been. Um, but that's good because I needed a break. Um, I came home after three weeks on the road and actually by the time I landed, I had a feeling that I was getting sick and sure enough, I was sick.
So I'm not sure if it was sinus infection or But, uh, I had a sore throat. Not sure if I had a fever, but my body ached pretty bad like I did. Um, just real tired. And, uh, yeah. So. It, uh, knocked me out, uh, but I've had a long extended time at home that I was able to rest and relax and, so here we are, new week, I'm traveling again this week, but not till the end of the week, so I have time to do some work while I'm at my house.
And I wanted to record another episode. So, the episode I'm going to do today is not what I had planned, but it's sort of, like, a little bit more on my mind right now, and I wanted to do it. Plus, it is much needed. I don't think I've recorded an episode on this before, but I have a lot of content about it on YouTube.
And, um, it's actually some of my most, um viewed things on YouTube, and that is all about, um, reflex and esophagus like gastro esophageal sphincter, that kind of thing. I do know that I have a couple, um, podcast episodes that were, will relate to this. So I'll make sure that Joe links those in the show notes.
Um, one of them about, one of them was about costovertebral joint dysfunction. Um, it was like sharing a case actually. And, um, That might be the only one, but I will make sure if there is another episode besides that one that really relates to this, I'll make sure it's linked in the show notes, and I will make sure that all the Relative YouTube videos are linked as well, because those have a lot of practical, like, things to do for your reflux.
But, what I want to talk about in this episode is not just reflux, not just esophagus. Um, I'll touch on those, but it's a little bit, um, well, it's more about a piece of anatomy in relationship to it, but then also a little bit about the esophagus and reflux in general. So, um, I was thinking, I was reflecting, I was reflecting on the journey with the esophagus
Just all the little bits and pieces I've shared on this and, and part of it was like, I was thinking, I was like, wow, like, I've really, in all the Barral work that I've done, the Barral Institute classes I've gone to, I've gone to 20 classes or more, at least 20, maybe more. I've been through a lot of their curriculum and.
In each course, maybe not each course, but there's been multiple courses along the way that I got a little bit of information that can like go into the toolbox around the esophagus, around reflux, and all the related things. And it's interesting to me that they don't just present it all at one setting. I get why they don't, because it is such a beast of a topic, and it's such a Even from an organ standpoint, because it's such a long tube and affected by so many things because it's in multiple different containers of our body, like there's just a lot going on and there's a lot that could influence it, which I think too is why some people like me can be on the struggle bus a little bit when it comes to reflux.
Now, um, let me give you a little bit of history, personal history, personal medical history on my journey with Reflex and, um, because, you know, full disclaimer too is like a lot of what I present to you is like thoughts I've had about my, like my own body and like how can I support healing and like things in my own body.
And, um, also like. understanding, experiencing the connections from the visceral things to the orthopedic or to the musculoskeletal things in my own body. Um, you know, I, I think our own bodies are our best teachers, um, in terms of like when we can pay attention to what we feel, but also like the experiences that we've had in our body, for example, not related to viscera, but related to orthopedics and sports medicine, I've had.
multiple knee surgeries, torn both my ACLs, had back surgery, right? And so my experience with those orthopedic injuries and then rehabs, I think makes me a better clinician when it comes to treating my athletes when they're going through those things because I've experienced it. Like, I know what they're feeling and I know what they've been through like intimately in my own body.
And so I think that gives us an advantage. Now, same thing, same thing from a visceral standpoint. I think is, um, it gives us an advantage. So my personal journey, medical journey on Reflex goes back a long time ago. Um, really, really, it was a big piece of like why I originally went gluten free. Um, why I got into food sensitivities, like why I got into like, just like clean food in general.
And this was back in like the early 2000s. So in like 2004, 2005, maybe 2004, It was definitely 2004. Um, I was, I had two things going on. One, when I was running, I would get really bad diaphragm cramps. Um, like extremely painful diaphragm cramps when I was running. And, um, to the point that I was like, something's wrong.
This is not just like a stitch in my side. And at the same time, I I was also suffering from some sort of thing, which at the time I didn't know what it was, but um, basically I would eat foods and the food would get stuck in my throat and nothing could go down, like not even water. If I do, if the food got stuck and I couldn't swallow it, I would drink some liquid, like some water to try to swallow it.
And basically the water would go down to the level of where the food was stuck in my esophagus. And then I would just throw it back up. And so I was having what medically is called dysphagia, right? The inability, difficulty swallowing. And it was like, no consistent, like, type of food that was causing it.
Sometimes it was like, breads, sometimes it was rice, sometimes, like, it was just kind of like, once I was like, irritated, I was irritated. And I kind of feel it come on, but there was really nothing to change, like, you know, the ability to swallow until I like threw up and like let the response go through and then I continued on.
So I ended up going to this doctor, oh my god, this is a story in itself, this doctor, I'm not even gonna say, not say who it is, Dr. Richburg in San Diego. Because I was a fellow at the Olympic Training Center at the time and I went to see him about it and I was like, Hey, I've got two things going on. They might be related.
They might not. I'm not really sure. Granted too, like, this is really early in my career. I'm like two years in being an athletic trainer, two years in being certified. I knew nothing about the connection of the viscera to musculoskeletal. Like, I didn't even think about it. But, there was something intuitive in him that I was like, maybe this Stitch in my side that I get while I'm running and this like inability to swallow thing like maybe they're related like are they related?
they seem to be happening all of a sudden around the same times and So when I went to see him this angers me so much and I told him my symptoms he accused me His medical diagnosis for me was that I was a subconsciously bulimic I'm like, what? He said I was subconsciously bulimic because I was a little overweight.
At the time, let me, at the time, I thought I was really overweight. Like looking back, I weighed like 150 pounds. For my height, you know, technically for my height, BMI, um, my height, I should be like 125. I haven't been 125 since like maybe the 6th grade. 140 is probably like An ideal even actually 150 where I was at was like a very reasonable weight for me I was not overweight at all of course I thought I was like extremely fat and overweight and I wouldn't say I was obsessed with losing weight but I was like working out and like Dieting, like changing my food intakes to try to lose weight.
And so I'm probably, I'm sure I probably told him that, right. But by no means was I bulimic and I was definitely not subconsciously bulimic. He basically was like, well, you know, since you're fat and since you don't like that and you want to lose weight, like maybe you can't swallow food because it's foods, you know, you shouldn't be eating.
And so you like subconsciously make yourself throw up. And I was like, What the fuck? I remember leaving his office and being like, what the actual fuck? I cannot believe that he just said that to me like you're subconsciously Think you're a good doctor and you're not so Needless to say I didn't get any answers from him And um, I think maybe he sent me for like an ultrasound and like nothing came up, right?
So it took me a couple years Um, that was 2004, 2000, by 2007 I was living back in Arizona working with a good doctor and also working with my friend Anita Richeson, shout out Anita Richeson, um, 5D Athlete is her company. She still does, like, a lot of stuff around food and, like, holistic health. Um, I'll link, Joe, let's link her company in the show notes.
But it was Anita originally who helped me discover what was really going on. And that was because she was going through this holistic health program and she was like, Anna, can I practice my like food planning with you? And I was like, yeah, sure. And so she created a food plan with me, which, um, not on purpose.
Basically eliminated a lot of, like, common allergies from my diet. Specifically, eliminated wheat and dairy from my diet. And within the first week of being on that diet, I noticed I felt much better. I wasn't having any episodes of dysphagia. Um, the diaphragm spasming kind of went away, but also I had stopped running and so like, who knows?
Uh, and then also I had had this like skin rash on my legs um, and that went away when I was on that diet too and Reflecting back on that. I was like, wow, like I wonder what's going on. Like maybe I have some sort of food sensitivity and so Me and her worked with my doctor at the time and, um, got my food sensitivities taken.
Sure enough, I was super sensitive to wheat, and dairy, and like a couple other things. Um. And I started taking those out of my diet and I felt much better, but at the same time this other doctor was like, we still need to kind of figure out what's going on with your esophagus, what, you know, your, your dysphagia.
So she sent me to a gastroesophageal specialist in Arizona and they did a, um, endoscopy on me and, um, I was diagnosed with eosinophilic esophagitis. So eosinophilic esophagitis is basically, it's actually considered an autoimmune disease. And, um, it's basically like inflammation of the esophagus, but a very specific type of white blood cell.
And, um, that type of white blood cell is what's more associated with more of an autoimmune response versus like a normal sort inflammation of the esophagus. But basically, that eosinophilic esophagitis was causing the symptoms of GERD. Um, it is a form of inflammation that can cause GERD, GERD being the acronym for gastroesophageal reflex disease.
And the big deal about GERD, really, is that GERD When you have prolonged GERD that is untreated, your incidence for being at risk for esophageal cancer goes up significantly. Um, because the cells of the esophagus actually start to change, um, like into a hyperplasia type state that leads to what's called Barrett's esophagus and eventually can be a precursor or like kind of set you up to be more likely to get esophageal cancer.
So that was like the big deal because actually I didn't have a ton of GERD symptoms, um, other than the dysphagia. So anyways, this took me on this whole, you know, rabbit hole of like dealing with the eosinophilic esophagitis and I basically managed it through my eliminating my food sensitivities and then, um, corticosteroid was given to me, of course, from the gastroesophageal Sorry, the gastroenterologist and I used it for a while and I do think that was helpful over time actually like a few years ago I had a upper endoscopy redone and I have actually healed the eosinophilic esophagitis, which is great Um, I still have GERD, but it's like regular GERD not eosinophilic esophagitis.
And so that's really positive Um, but with that so that's like my history now. I know Thanks to the Brawl Institute and learning everything about the visceral connections to the orthopedics, now I also know a lot of the things that I feel in my body that I didn't know were symptoms of GERD. Or actually symptoms of GERD.
And so that's what I want to talk about a little bit, um, and how this relates probably to like some of the videos on my YouTube channel that are doing so well. But some common symptoms or like the visceral referrals, um, to the musculoskeletal system from the esophagus and specifically related to the gastroesophageal sphincter, which is where GERD occurs, um, is.
Upper back pain, I mean neck pain, can actually, chest pain, um, you know, traditionally GERD is called heartburn because it feels like a burning sensation right around the area of your heart. Um, it could be left, um, shoulder, SC joint pain, it can be, um, radicular symptoms into your arm. You know, like numbness and tingling.
It can be left SI joint, um, hypomobility or SI joint pain. It can be left psoas tightness, just like left low back pain. It can be mid back pain. Um, symptoms of GERD also include breathing issues and like can mimic asthma, um, sore throat, especially in the morning. Um, similar to like a post nasal drip scenario, left ear pain upon waking as well, or just in general left ear pain.
Uh, so a lot of those kinds of things that you would like not normally like think about when it comes to GERD, but are very much related to GERD. So, um, just really quick look at the book, make sure I didn't read anything. Oh yeah. And then of course the dysphagia, burping. Indi, you know, common indigestion symptoms like that, pain, acidic breath, headaches, um,
yeah, dryness, throat dryness, ear pain, auditory sensitivity, sensitivity on any part of the left side of the face, so even can kinda like mimic trigeminal, trigeminal nerve neurology on that side, um, asthma attack type of coughing at night. Between the hours of 2 and 4 a. m. Um, asthma attacks just in general around meals, eating quickly.
Um, yeah, so a lot of those kind of symptoms. So, um, Um, where do I want to go with this lecture? Besides this lecture, this podcast, besides like letting you know all the symptoms and sharing my story is recently this week or last week in the LTAP level one online course, somebody asks me a question about, Oh, palpating, um, for the LTAP test, like palpating the duodenum and the small intestine.
And so I drew out this, um, I drew out the anatomy to demonstrate to her, like, where on the body we would be, um, palpating. And when I drew it out and I was talking through it, I was like, Oh man, you know, like, this piece of anatomy here is one that's really important and I never really thought about treating it in my own way.
Like, self treatment of the esophagus in my gastroesophageal reflux disease. And so, so what you'll find in the YouTube videos is I talk through treatments around the esophagus in the cervical. Um, fascia, I talk about treatment of the esophagus from the cervical fascia down around the heart and around, uh, where the stomach is, so like stretching that whole tube.
Um, but what I don't talk a lot about is the role. of the structures around the sphincter itself, besides talking about how it's the diaphragm. Cause there's another structure that is in that area of the diaphragm and in that area that it relates quite a bit to the lower gastroesophageal sphincter and potentially can play a role in, um, reflux, cue the burp that just happened, uh, can play a role in this reflux.
Okay. And, um, also, you know, all the symptoms, orthopedically, that are associated with it. Um, And so that's really why I was like, I'm going to do a podcast about this. And so that anatomical structure is called the ligament of Treitz. So this is really what I want to talk about a lot. Um, but I'll also sort of like share a little bit more fun facts from an orthopedic standpoint of relationships around the gastroesophageal sphincter and GERD and the esophagus in general.
Just thinking too, and I was thinking about this when I was writing down all my notes earlier today is for the last I don't know for the last few months. I've been having more like post nasal drip and like sore throat and that kind of thing and It's easy sometimes to blame allergies and think it's all coming from the nose when it is like symptoms like that but The more I think about it, I'm like, Ooh, it might be my GERD.
So, um, I've been pretty like lax on my food sensitivities lately. And so, um, it, it is a little push towards me to be like, Hmm, maybe I should eliminate I'm going to be doing dairy again, and I'll get a little more strict on the wheat, um, and see if my symptoms feel better too. And that, so, and that kind of thing, so, I want to talk about too, like, of course I'm going to do some of these manual treatments in my body as well.
But, Sometimes, when it comes to, like, visceral organs that are going through a disease process like this, you need to support them functionally as well as structurally. So all the manual work we do, um, that I'll talk about is, you know, what those YouTube videos are. Very helpful. More helpful in conjunction with the functional stuff.
So the functional medicine stuff is going to be eliminating food sensitivities or food triggers You know taking supplements to help and you know, one of the things that always gets recommended in this when you start talking about GERD is Licorice DGL actually Diglycerized licorice is really good really healing to the esophagus Unfortunately, I cannot stand licorice.
Like, I think it's one of the grossest flavors of all time. And so, I don't like taking those supplements. I actually physically can't take those supplements. They make me want to throw up. Um, licorice tea I am more okay with. But, licorice tea also causes a rise in blood pressure. So, it's not always like the best thing to be drinking all the time.
Um, Rose petal tea for me works really well. Rose petal tea can be, um, very good for allergies and like, connecting or blocking histamine receptors. Which, um, for me, my inflammation in general, well everyone's inflammation has a histamine connection to it. And I do think my allergies and some of my bronchial things sort of drive this connection too.
Um, And then also, everyone, all, everyone on the internet, and one of my good friends, Tracy, who I know you'll be listening to this, she recommends a Slippery. Slippery elm root tea and that is supposed to be very healing. It sounds disgusting. I'm a big texture person and the texture of that tea is like, I don't know if i'm gonna be able to do it.
So I haven't quite Pushed myself to that yet But we'll see
so but from a structural standpoint we can do a lot with manual therapy in terms of Making things feel better like getting the body out of that protective mechanism around the viscera and then just supporting the functional thing, too um, but definitely helping a lot of the orthopedic and musculoskeletal symptoms of it, so um Let me Oh, how do I want to organize this?
So I kind of already listed all of the orthopedic things. I said, um, so you can be painful to palpation between ribs six and seven on the left side, usually around the clavicular line, uh, left SI joint, left psoas, left rib seven on the left can be like a little, um, you know, restricted in inspiration or expiration, uh, cost of vertebral junction at T11.
on the left more typically than the right. Pain to palpation on the costovertebral joint on T7. Any sort of like fixation or restriction between T12 and L3 really is fair game for both the gastroesophageal sphincter as well as the duodenum, which the duodenum we're going to talk about how this plays A little bit of a role in this via the ligament of Treitz.
Um, the typical, like, viscerosomatic reflexes are, uh, for the esophagus are between T4 and T6. Um,
interesting. Oh, this is why this was on my mind too. I got a massage last week from Julie Arriola. Um, she's one of the LTAP, um, level one in mentorship alums. She's also one of my teaching assistants. She's a massage therapist here in San Diego area up in Carlsbad and she practices LTAP. And it was so cool.
Um, That is where my LTAP directed her today, or today, uh, this last week was, um, right around the area of my gastroesophageal sphincter, um, kind of stomach, like left upper quadrant area there. And, um, I asked her, one of the things I asked her Besides just to do massage and do the L Tap and like treat wherever she needed to was I wanted my upper back cupped just because since I had been sick too, like that's where like my body aches is and it was really interesting because as she was cupping my back the cup kept sliding over to this area on my body, which Um, from a visceral dermal reflex zone standpoint is exactly the spot of the reflex zone for the cardia of the stomach.
So the cardia of the stomach is the upper part of the stomach that is most related or associated with the area of the gastroesophageal sphincter. So where the esophagus comes into the stomach there. And so it was so interesting. This visceral dermal reflex zone, um, is an area of the skin of the dermis that gets, um, thickened or like more restricted and specifically for the cardia of the stomach, it's going to be left side, upper trap.
posterior like right above your scapula sort of like that supraspinatus upper trap area and the cup just kept going to that area and kind of like sticking and I was like oh yeah this really does confirm where the LTAP was directing you on the front side of the body that it has to do with my gastroesophageal sphincter.
Um, so that's really interesting. So another visceral dermal reflex zone for this is, um, right above the xiphoid process, like mid, like substernal, like right in the sternum, which is real tender on me. Um, and then also it can be on the posterior side between rib six and rib seven, and that is like an area where my diaphragm cramps all the time.
And, um, It just doesn't feel good there a lot and I always feel like I get like a costovertebral joint thing going on in that area too. So I'm like, yep, I match all of these things. So interesting. Um,
all right. The rest of these connections are going to be more about ligament of Treitz. So I'm going to talk about that first before I talk, but all of those things were like, so interesting and helpful because so, you know, from a treatment standpoint, It's helpful to know those visceral dermal reflex zones, which is why I teach them in the mentorship.
They're actually going to be part of LTAP level two, spoiler alert. Um, that's probably going to start in sometime 2025, definitely by 2026. But, uh, in that reflex zone, which this is why I share them on the podcast and some of my social media stuff is because they can be helpful, like doing cupping in the area.
like doing treatment at the area of the skin reflex zones can actually help the viscera as well, even though especially that one seems totally unrelated because it's definitely not in the area of the organ. It should be fairly helpful. Um, all right, so ligamentum Treitz. Let's talk about this. This is a picture I drew for my group the other day, which is like pretty basic.
I like to draw anatomy pictures sometimes when I'm talking about it. Um, but, pelvic bowl, ribcage, basically I'm drawing the stomach and the duodenum. And, as the stomach comes and turns into the small intestine of the duodenum, you have like, the duodenum is like, C curve, and it's very fixed to the abdominal wall, so it's very fixed to the back, very fixed to the lumbar spine, which, often times, low back pain.
And the duodenum kind of go hand in hand, but there's different Basically, the duodenum is named for its different parts. So the beginning of the duodenum where the pylorus starts in the first curve is called D1. The vertical part is called D2. This is the right side of your body, so it's the vertical tube just inside the big vertical tube of your colon.
Um, in this area, D, uh, of D1, um, is the sphincter of OD. It's, the sphincter of OD is where the bile drops into the duodenum from the, uh, gallbladder. It's the comabile duct. Um, and then, um, it comes around this curve here. to the heart, which is called D3, and then D4 is the fourth part of the duodenum, which is the end of the duodenum, which is called the duodenal jejunum flexure.
There's a sphincter right there. There's also a suspensory ligament here. There's a suspensory ligament that wraps around this part of the duodenum and then goes up and attaches. to the spine, the fascia along the spine, the fascia around the aorta, and then interdigitates into the fascia and the muscle of the diaphragm and wraps around It actually goes this direction, lateral.
It wraps around the gastroesophageal sphincter. So the interesting thing, so it's going to be called the ligament of Treitz, the suspensory ligament of the duodenum of the DJ flexor. It goes superior lateral from the DJ flexor to the gastroesophageal sphincter. The DJ flexor is Anatomically, we can find it, it's usually like a dense area of our body, of our abdomen.
It's about two to three fingers above the umbilicus on an oblique line towards the midclavicular line.
Now also a midclavicular line, but more superior between rib five and six is the gastroesophageal sphincter. So the ligament of triets, if I can bring my ignore my papers over here, but the ligament of Treitz then goes from down here in the abdomen up to underneath the diaphragm around the, um, gastroesophageal sphincter.
So the interesting thing about the ligament of Treitz is that actually there's a bunch of interesting things about the ligament of Treitz. Um, it, More than likely, well, depending on the anatomical research that you read or look at, it can be sometimes referred to as a muscle as much as a ligament. And the way that this structure is wrapped around the duodenal jejunum flexure, which, Also has a sphincter muscle in it.
And then it comes up and it wraps around like in a little like tied ribbon way around the gastroesophageal sphincter area too, it does blend in with the muscle of the diaphragm. And so there is a very muscular component of it. And so it is. thought that not only is it a suspensory ligament, it's holding the, the end of the fixed part of the duodenum, end of the fixed part of the small intestine to the spine and the diaphragm.
Because then from there, the jejunum and the ileum start, and that's the like really mobile, free loops of the small intestine. And so that's like a really important like Suspension system there to sort of hold everything, hold all those free flowing loops. And um, so, you could appreciate too, because of all the movement from the loops below it, that if it was just ligamentous, it might not.
work so well as a structure. So to me, it makes sense that there is a muscular component too, because that probably gives it a little bit of elastic ness and that elastic ness not only helps with the suspension component of it, but also more than likely helps with the sphincter control component of it too.
And so it probably provides sphincter to the DJ junction as well as sphincter reinforces the sphincter of the gastroesophageal sphincter. Um, I want to read off of a radiology website on the interwebs about it. This is from Radiopedia. This is almost like Wikipedia but for radiology. So it says, This is the ligament of Treitz.
Also known as the suspensory ligament of the duodenum is a double fold of the peritoneum suspending the duodenal jejunal flexure from the retroperitoneum. It's often used interchangeable, interchangeably, with the DJ flexure. The ligament of the Treitz The ligament of Treitz comprises of two parts. The first part is an accessory muscle known as Hilfsmuscle.
Hilfsmuscle, which is like a German name. This muscle passes from the right crevice of the diaphragm to the connective tissue surrounding the celiac artery. And it's composed of skeletal muscle tissue. The second part of the ligament of traits is a suspensory muscle of the duodenum descends from the connective tissue of the celiac artery to the DJ flexure between the pancreas and the left renal vein.
This is the part that suspends the DJ flexure and it's composed of smooth muscle. And then it goes and continues to talk about some issues with it and um, how it's hard to see on um, imaging. But what's interesting about that Right is we already talked about how it probably plays a sphincter role at the DJ junction and the gastroesophageal sphincter But it also is very much then connected to the blood flow of the upper abdomen.
So, the celiac plexus comes off of the abdominal aorta, aorta right above the superior mesenteric artery. And so they're all sort of in that area. Off of the celiac plexus is also the splenic artery, or splenic artery. Um, All of these arteries in the area, they're going to provide blood flow to the stomach, the duodenum, the pancreas, and the spleen.
All very important,
well, and small intestine, like if you consider superior mesenteric artery part of this whole picture too. But, um, Basically, it's like, when I read that, I was like, whoa, this is important because this means that if there is any sort of tension or adhesions or just lack of mobility or lack of function around the ligament of Treitz and the suspensory ligaments, not only are you going to see decreased sphincter activity at those junctions, right, the gastroesophageal and the duodenal.
DJ junction, but you're also going to have a significant effect on blood flow to the organs. And when we have a lack of blood flow to the organs, we usually have a diminished function. And if you kind of like extrapolate, you can think of things that can also cause issues with digestion. Right issues with function of those organs and it's like a lack of blood flow when we don't have really good blood flow to The organs, we're not going to be able to be digesting our food as well We're going to be more prone to creating excess gas in the area changing this the chemical environment and Potentially even having a functional reason for that increased tendency towards gastroesophageal reflex disease So to me when I saw this You When I read this about ligament of traits, I was like, wow, these, this is important.
And this is a piece that I haven't in my own body really treated much where I've treated the rest of esophagus and it helps, but I feel like there's a piece missing. I think this might be a really important piece. So the, the, some of the other things that's interesting about the ligament of traits is, um, Or I already mentioned it, but just know because of this connection to the abdominal wall and the vertebrae, right, it's important then to be like, oh, I should consider some restrictions at the vertebrae that might be related to this and specifically for the ligament of Treitz and the DJ junction.
That's going to be L1. And so you can actually really do some manual therapy techniques very specific to L1 and specific to the ligament of Treitz at the DJ junction and get a really good, like, stretching of this structure. And so this is another important thing to consider to tubes in the visceral world loves to be stretched.
And then A ligament that has a muscular component that probably likes to be stretched too. And again, knowing that it's a suspensory ligament, like it And it has that, again, going back to like, it has such a mobile loops at the end of it. To me, that's like, yeah, it probably likes to be stretched quite a bit.
And so if we can look at the anatomy, we can consider a good way to stretch this. Maybe I would, I'm going to try it in my own body, um, in a sideline on the right. in a little bit of a flexed position, right? Because I want to go in to the sort of more protection mode around it. I'm going to palpate the DJ junction, and I'm going to palpate my gastroesophageal sphincter in that space between rib 5 and 6, mid calibricular line, kind of up on my nipple area, and I'm going to sort of like move my fingers around until I feel like I'm on a similar structure, and then I'm going to Start to add a little stretch components in it and the way I'm going to do that is I'm going to think about Rotating at that thoracolumbar junction right L1 T12.
I might do some breathing with the diaphragm I might do some rotation with my head or neck knowing that the esophagus goes all the way to my mouth I might do some tongue mobility, I might swallow, I might do cervical extension, I might even go up to T4 and try some very specific rotations around T4 because that's another pivot point of the esophagus.
The esophagus bends right there as it wraps behind the aorta. The, um, arc, the arc, the arch of the aorta, behind the heart. And so I have many different points of contact that I could see, can I change the tension around ligament of tripe. Um, and the cool thing too, knowing that when I'm like very specific in this area around the DJ junction, specific to how the DJ junction then relates to like the diaphragm and breathing, I feel very strongly that I'm probably having a significant effect on the blood flow to these structures too, which is why from a functional standpoint, I think this could potentially be so powerful for me or for my patients when it comes up.
So, um. something to think about. Now, the other thing to think about is like these don't, these structures don't live in a vacuum and you know, there's other parts of the body that might need treatment around it as well. The rest of the duodenum is very much linked to the right kidney. The right kidney is considered the digestive kidney.
And so, you know, I might need to do some right sided stuff. The liver is a big player in any relationship with the stomach. But then also, you know, I talked about how the gallbladder, the common bile duct drops into that duodenum, right? So that's a big part of the function too. But I really liked the idea of like specifically targeting ligament of Treitz in this because of its rule one, the sphincter of the gastroesophageal junction.
relationship to the diaphragm and the connection to the blood flow around the aorta and the specifically the celiac artery. So I'm going to be playing around with that, but hopefully, you know, hopefully this podcast gave you quite a bit of information on connections of the esophagus to the duodenum.
Maybe you now know what ligament of traits is, I would recommend like doing a quick Google search and looking up and seeing where it's at, seeing the different images of it, um, and thinking about how this may help your patients. So, Definitely take a look at all of the links in the show notes. Like I said, all of those YouTube videos about the esophagus have very practical things to do, and the rest of the containers, hopefully in the next day or two, I'll kind of play around and maybe videotape the new technique I'm going to, um, try, uh, when it comes to the specific ligament of train.
But, um, really if you could just palpate the area of the DJ flexure and like do a little bit of like general like skin stretch, skin massage in that area, I think you're good. Gonna not go wrong and then that visceral dermal reflex area um on the left side of the kind of like superior scapula area Would be a good spot too.
That's it. That's all I got for you Interesting curious. Oh, I wanted to share two like all the books I use. Well one I already told you I use Google first first always it starts with a google search on um You The old, uh, interwebs of the anatomical pictures. I look at a bunch of different pictures. And actually, this is an important part.
Looking at more than one picture is important because everybody's anatomy, like, is different. And then, the Like, even the anatomy books are different, and some of them depict it very muscularly, some of them depict it very ligamentous, some of them show the relationship to the aorta, some of them don't at all.
And so it's important to look at more than one picture of the anatomy because it gives you a better appreciation for what's really going on in there. So then from there Um, from online anatomy, um, and usually I like to read a little bit of online anatomy. I like to use Kenhub, it's my favorite to kind of read about the anatomy, and then Radiopaedia is usually good, uh.
resource as well, which is the one I read from, um, and then I go to the big guns. I had to go open my Netter and see what kind of pictures are in Netter, if there's any descriptions from Netter. And then, um, today I also used the Serge Paletti book, uh, The Fascia, um, There was some interesting stuff in there, but not specifically, so I didn't use it a ton.
Um, and then the classic Visceral Manipulation original book and Visceral Manipulation 2 from Jean Pierre Barrault. Um, so a lot of great information, um, in here about GERD. hiatal hernias, which have very similar symptoms to GERD, about the orthopedic and skeletal relationships of the duodenum and the gastroesophageal sphincter and the esophagus to the orthopedics and then some suggested techniques and, you know, all the things.
So multiple different books. Um, but yeah, hopefully that was helpful. Let me know. And we'll see you next week. Have a great day. Thank you for being here.