Small Intestine and Mesenteric Roots
In this episode of the Unreal Results Podcast, I talk about the Mesenteric Roots of the small intestines and their significance in cases of low back pain. I dive into the anatomy and function of the mesenteric root, including its relationship with the duodenal jejunal flexure and the ligament of Treitz. I also talk about the reflexive connections between the mesenteric root, blood flow, lymphatic flow, and nervous system tension. Lastly, I provides some insights to treating the Mesenteric Roots, including spinal mobilization and mobilizing the route itself with the use of soft massage tools, such as the coregeous ball.
Resources mentioned:
Janet Yiu's IG: https://www.instagram.com/optimizepelvichealth/
IG Post on Mesenteric Roots: https://www.instagram.com/p/CyL-IcELnmt
Radial breathing: https://vimeo.com/454465809/c8eb8ce5a8
Visceral massage video: https://vimeo.com/manage/videos/348696597/5d7a2f4538
Coregeous ball: https://www.tuneupfitness.com/?rfsn=3901938.c151c3
Other episodes:
Episode 15: Hard No To Hard Tool In The Gut
Episode 9: Left Side Sciatica or Right Side Shoulder Pain?
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: [00:00:00] 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, and welcome to another episode of the Unreal Results Podcast. Um, welcome back to me and my cow. Actually, one of my mentorship alum, she's like, Oh my gosh, I love the cow. Shout out, Brittany, in the, in the background of your [00:01:00] YouTube, your podcast. And I was like so funny. She messaged me and she told me what it was and now maybe she sent me a voicemail but like maybe she said a Shetland cow or something like that.
I have no idea. How random. Now I'm obsessed.
Yes. Shetland cattle, Scottish breed. She's like, I want one. So it's just a picture, but it is really cute. I see why people want them as pets. Anyways. Um, I today, I don't know how it came up, but I think one of my alumni, I think Janet, um, Janet, you, she's a, uh, pelvic floor physical therapist up in San Jose area.
[00:02:00] She. I think recently posted maybe a Instagram post that I did on the mesenteric root of the small intestine. And, um, I just was saying like how helpful it was, I think. And so I was like, Oh yeah, I should, I should do an episode on that because I do think, um, that is such a really actually powerful visceral organ to treat in the abdomen and one that comes up a lot with.
patients, especially with low back pain. And so I was like, yeah, let's talk about that today. Um, the, um, I'm trying to get, you know, I'm trying to look up her Insta handle, which I'll also link in the show notes. Uh, here we go. Optimize pelvic health. So that is her Instagram, um, handle. And, um, she, I love [00:03:00] watching her share what she does.
She, she has integrated this work into her practice so great. And also on that note, just like shout out pelvic floor PTs. Um, I didn't know you were my people, but you're my people. And it makes so much sense because As a pelvic floor PT, you already sort of understand that visceral organs can be a big driver in musculoskeletal pain.
So obviously it's a, it's a pretty easy sell I'd say, um, in diving into my stuff. And so I, I have a lot of pelvic floor physical therapists and I love that. I appreciate that and uh, thank you for being my people and um, let's just change the world and get people to realize how important the visceral organs are.
and the nervous system. So with that said, let's talk about the mesenteric root. So mesenteric root and the small intestines, we'll talk about them both. The small [00:04:00] intestines are tubes, right? Tubes of our digestive system. The, I think there's something like between the jejunum and the ileum, which are the main part of the freely mobile loops of our small intestine.
I mean, it's something crazy like 21 feet. Which is a little insane to me that there's that much in there. Those of you who've seen a c section or any abdominal surgery, it's like a jack in the box a little bit in terms of like when you've got someone abdominal cavity open like the pressure especially just shoves those loops right out.
So I guess then you can appreciate how there's More I think I did reread in my notes from the Barral Institute. Maybe it's 21 feet measured on cadavers 8 feet measured in Live humans. So [00:05:00] here's my question. How is that different? I have no idea So if anybody knows the answer to that, let me know. Um, I, I read it and I was like, that makes no sense to my brain.
So anyways, it doesn't matter. All we know there's a lot of feet of intestines inside of us more than the length of our entire body. So, um, when we're talking about the intestines in the mesenteric root, we talk about them a little bit as separate, but they're all just also together too. And a lot of the times when I'm treating the small intestines, I tend to end up treating the mesenteric root.
I don't want to say exclusively because sometimes I treat the loops too, but really I think the biggest like bang for your buck is treating the root. So, um, let's orient ourselves.
Obviously digestive system, [00:06:00] mouth, esophagus, right? So mouth, esophagus goes down our throat behind our heart into our stomach. Then our stomach goes into our beginning of our small intestines, which is the duodenum or duodenum depending on how you say it. The duodenum is really fixed. It's a pretty fixed tube and it goes from our stomach curves around in like a C shape and then comes up and makes one final curve and right there is the beginning of the mesenteric root.
That final curve is called the duodenal jejunal flexure. They also for short called the DJ flexure. The DJ junction or the DJ flexure is important. As I said, it's the superior part of the mesenteric root. It contains a [00:07:00] sphincter inside of it and abdominal sphincter, which is a muscle, right around muscle that opens and closes the tube.
So it is a point that can get backed up, right? That muscle can get kind of almost like spasmodic and like, stuck closed or even stuck open sometimes. Um, so that's a really good treatment point oftentimes. And I'll tell you where that is anatomically on the body in a second, but around the DJ flexure, not only is at the beginning of the mesenteric root and the beginning of the jejunum, the loops of the small intestine, but there's a ligament there that wraps around the DJ flexure and then goes to the.
esophagus. Well, let's not say the esophagus. It goes through the diaphragm around where the esophagus come, pierces through the diaphragm and that ligament helps reinforce [00:08:00] the sphincter muscle there between the esophagus and the sphincter. stomach at the top of the diaphragm. That ligament is called the ligament of traits.
So there is a direct connection between the gastroesophageal sphincter, the diaphragm and the jejunum flexure. So that's interesting too. And hopefully that makes you think like, when there's something going on in the mesenteric root or the loops of the small intestine, there's a direct connection there to the diaphragm.
and three dimensional breathing or diaphragmatic breathing might be an altered movement pattern that we see. The DJ flexure also is, um, right next to lumbar vertebrae number two. And since the mesenteric root attaches to the posterior abdominal wall, it tends to affect the [00:09:00] vertebrae quite a bit, so oftentimes we might see some vertebral restrictions around L2, typically between T10 and L2 when it is the small intestines or the mesenteric root as a problematic area.
So from that spot it goes Right. We're relatively on the left hand side, so to find the DJ Junction, you find your umbilicus. As long as your umbilicus is where it has always been, meaning you haven't had or your patient haven't, hasn't had some sort of abdominal plasty surgery that has moved the location of the belly button or.
Provided a aesthetic or fake right plastic surgery, belly button, right? So that is a real thing. So you want to make sure of that. But in the normal area of the [00:10:00] umbilicus, the DJ junction, the DJ flexure would be three finger widths. away from the belly button towards the midclavicular line. So it's a little bit of a diagonal.
So the umbilicus is at the midline, midclavicular line is like over here. So it's on that diagonal, three fingers at the end of this finger, you'll, you'll usually feel an area that feels a little bit harder than the rest of the area. That's that sphincter muscle. Those sphincter muscles, those valves tend to have a, um, a little bit more denseness to it, though it's a muscle, it almost feels a little bit more fibrocartilagy.
So that's the first starting point. Then you have all these loops, and the next attachment point, the next root point, is at the um, ileocecal valve. So that means the root runs from the left hand side on a [00:11:00] steep oblique line to the lower right hand side. The ileocecal valve is where the ileum, part of the small intestine, connects into the cecum, the beginning of the Large intestine or the ascending colon.
The ileocecal valve is halfway between your ASIS on your right side and your umbilicus on that oblique line. Very close to McBurney's point. McBurney's point is a diagnostic location for appendicitis. So, um, it's a little bit farther closer to the umbilicus. The appendicide, the appendix is a little, technically a little bit more inferior, though, if you take the Burrell Institute classes, you'll learn that there is many variations to where someone's appendix is, as well as there are many variations to [00:12:00] the location of the ileocecal valve, but for general knowledge, it's right there.
So. Um, that's the line. Those two edges, right, make up the edges of the mesenteric root, but along that whole oblique line is basically root of the small intestine. Because this mesenteric root, why I keep saying mesenteric root, of the small intestine is because it is made up of Um, a anterior leaf and a posterior leaf of the mesentery.
The mesentery is a double fold of the peritoneum. So the peritoneum, the visceral and the parietal peritoneum kind of like fold on itself. And you can imagine that makes a little space that within that space of the fold. And especially as the posterior fold comes up and the anterior fold comes [00:13:00] up, there's a space and that create that what goes through that space is the, um, vascular structures, the nerve structures, and the lymphatic structures to all of those loops of the intestines.
And so the mesentery, the mesentery, um, which makes up this mesenteric root is very, very rich in. Um, circulation and nervous system, and this is why it's such a important thing to do to treat and why it can be so powerful to treat because it has a very reflexive connection to blood flow, lymphatic flow, and nervous system tension or relaxation.
So um, the interesting thing too, is this.[00:14:00]
It's a little bit more on the right side of the body than the left side of the body, right? Even though we started on that left side, it's fairly close to the spine, right? I said it's right in front of the left side of L2. So it's fairly midline on the left, and then it crosses that whole right side. So when it's crossing the whole right side, um, first of all, the ileocecal valve is like almost right in front of the SI joint on the right.
So it's fairly midline on the left. It also crosses the psoas, the right psoas, the right ureter, um, right, which is the tube going from the kidney to the bladder. It crosses the right testicular or ovarian vessel, right, vascular supply to the gonads. Basically, it crosses the abdominal aorta and it crosses the inferior vena cava.
So because that root crosses all those really important things, that means when that root has a lot of tension in it. It sort of [00:15:00] strangles those things, so no wonder this can be a driver of so many issues. So what are the issues that is a driver? Well, I started this whole podcast saying it's a big driver of low back pain.
It's probably the thing that I see the most, but not only is it a driver of low back pain, it can be a driver of SI joint pain. SI joint hypomobility. It can be a just general pelvic pain. It can be sacrum pain. It can be epigastric right around the stomach. I talked about how that it connects to the ligament of Treitz.
So that's part of the stomach connection. It can cause left upper quarter symptoms, so left shoulder, left neck, mid back even as well. Um, this is sort of via the connections of the phrenic nerve as well as the vagus nerve as well as just these anatomical connections of the mesentery being the folds of the peritoneum that attach the posterior [00:16:00] abdominal wall, that ligament that attaches to the diaphragm, right?
There's a lot going on in this area. And, um, it can also cause left sided sciatica. So the left sided sciatica is typically due from the circulation piece. Very similar to the circulation piece that we see between the liver and left sided sciatica. Uh, as well as some general lower extremity joint pain can be kind of driven by that circulatory or lymphatic congestion, uh, because of that as well.
So it's, um, it's, uh, somatic viscerosomatic reflexes, um, you know, in terms of what levels of the spine it relates to, not just L2 because of its location to the posterior abdominal wall there, but because, um, [00:17:00] the. Blood supply to the mesenteric root is the superior mesenteric artery and vein. Those come out around at the level of L1.
So that's a big sort of driver there. Like I said, it's a big like circulatory vascular thing. As well as you have the sympathetics from the level of T5 to T11. Though strongly, mostly with T9 and T10, um, which is right around where like the, I think the superior mesenteric ganglia are right around that area.
So there's going to be the sympathetic nerves, um, that are related to this. Um, and I already said like vagus nerve is the parasympathetic and then there is a phrenic nerve, um, sensory component to it as well. So lots going on. And now like how to treat it. So [00:18:00] this is always the big thing. One, you can treat it through the spinal levels.
So however you like to treat the spine, whether it's mobilization, manipulation, segmental mobility, cupping, regular massage, whatever your specialty, acupuncture, dry kneeling, whatever your specialty. Um, Those levels can be helpful now. Um, the other way you can treat it is by mobilizing the route itself. So a free route allows for improved mobility of the loops so that they, that the route really is what gives the mobility to the loops.
Um, the way I like to describe this. And describe the treatment when I'm teaching it is, I am at, one, I get the [00:19:00]corners of the root, I have an idea of where that is, and then I, it, to me, of course, because I love the ocean, it reminds me of a sea anemone coming out of the floor, right, the edges of the leaf, the leafs of the mesentery come together, and then it attaches to all these loops, That are like free floating in here and so I try to sort of gather up the edges of the root and the leaves and like bunch up all the loops under my hands.
And then you actually just pull them away from the posterior abdominal wall. Sounds crazy, but it feels so good. Now you could imagine, when you're laying, when the patient's laying in supine, depending on how much abdominal tension they have, or fat they have, it may or may not be easier to grab these loops.
So one of the easiest ways to do it is actually in Quadruped have somebody relax their belly in quadruped and you gather them up [00:20:00] and you literally like pull Away, this is actually one time when I feel like not one time. I feel like this is a time when You have a little bit of a belly. It actually makes for an easier, um, experience in getting this pull away from the posterior abdominal wall of the loops, which is great.
This is also the argument in my athletes of why it's so important to have mobility in your abdominal muscles. Because when you have so much tightness across your abdominal muscles, Oh, what happens? You reinforce this lack of mobility of the mesenteric group, this lack of being able to stretch away from the posterior abdominal wall and the function of the small intestines diminish, which is oftentimes why I'm not surprised why so many of my athletes have digestive issues between the high [00:21:00] tendency for a stressed out nervous system, not ever really.
switching into that rest digest mode, but then also this mechanical tension from too stiff of abdominal muscles. And so one of the things that I like to get them to do is the sideline or even prone lying, breathing with the quarters ball, a visceral massage with the gorgeous ball, basically, especially if you can get really specific and precise along the mesenteric route, you can do this mobilization along the, the, the route.
From the side on either side of it on that diagonal, and then you can go in quadruped and relax your belly and pull or sometimes before you go in quadruped and relax your belly and pull, you might need to practice some belly breathing to create a stretch on your abdominal muscles. to create some space in there.
So you, and to decrease some stiffness so you [00:22:00] can pull them away from the posterior abdominal wall. So, um, Phillip Beach has his, uh, breathing, um, his breathing exercise called radial breathing that I teach that I really love for that. So I'll link that in the show notes. As well as I don't actually have a video of the, um, small intestine loops, the sense distension, but, um, hopefully it just makes sense to you.
Um, but I do also have a video of the visceral, um, massage with the gorgeous ball. So I'll make sure to link that as well as the link to where to find a gorgeous ball. It is really important that we use soft. Massage tools in the abdomen. And in fact, I did a whole episode on it called a hard no to hard massage tools.
We'll link that too, because this is like a non negotiable. It has to be soft. And this is why I love the gorgeous ball so much. So, um, [00:23:00] The last couple of things while I'm thinking about it from an emotional, I always like to provide the emotional piece of the organs to, um, the emotional connection to the small intestines tend to be, um, a connection between our social and professional point of view in our family life, which is an interesting.
thing there. And actually, while I'm here on my computer, let's see, from a Chinese medicine standpoint, small intestine,
let's see what it relates to. Um, so it says small intestines role is, this is just literally, this is just like the first thing that came up on Google. So whether it's not right or not, I don't know. Um,
It is associated with fire, which is like, makes sense because it's a [00:24:00] digestive says issues with small intestine manifest and lack of joy, self deprecation, pessimism, and just depression. Um, small intestines role is to take emotions and manifest them through creative pursuits. So very similar to sort of what the Barral Institute said to, um, emotions of joy or agitation is what it says for Chinese medicine and the element of fire.
So always interesting to see these connections and all. Parts of our world, um, the other connection from a Chinese medicine standpoint is it is a paired organ with the heart. So, um, knowing the anatomy, this makes sense and, uh, yeah, hopefully this was helpful. I'll also, actually, I'll also link the, in the show notes, the, Instagram post that this was sort of a [00:25:00] inspiration from, but it basically talks about how I saw a patient who like had pretty intense back pain back for him for two weeks.
Couldn't, wasn't really changing. And I treated him and his LTAP directed me to the small intestines. And I did the mesenteric root mobility. And he like literally like jumped off the table and was like, wait a second. Why don't, why don't I have any back pain anymore? And I was like, yeah, is that cool?
Right? It is that amazing. But it makes so much sense, especially with anatomy of the mesenteric root. All of the things that it crosses, it's influence on the posterior abdominal wall, it's influence on the spine, it's influence on circulation and lymphatic drainage, venous return, when you're congested in your gut.
You almost always have low back pain and leg pain in the morning, [00:26:00] achy joints, all that thing. So now that this is in your head, you might be seeing it more than often. And if you haven't taken the LTAP yet, um, so you're not sure when to treat it or not, it's sort of one of those things. Next person that comes in with low back pain or even left shoulder pain or right SI joint pain.
Check this out. Check how the skin feels above the DJ flexure. Check how the skin feels above the ileocecal valve. Check how that oblique line, like how easily it is to move the tissue back and forth across it. Do a little scoop of all the loops and pull them out in a quadruped or have the patient do it on themselves.
And see what changes, what changes with the diaphragm breath, what changes with the trunk flexion, trunk and trunk extension, trunk rotation, what changes with especially right hip, left sciatica, [00:27:00] right? What's going on? Just be curious. That's all it's about. All it is ever about is be curious and just check it out on multiple people, even if they don't have low back pain, right?
Just. Just make a point, you know, for the next week to Feel these points on everybody and just see how different they feels right? So this is how you practice. This is how you notice connections is Just trying it out and seeing and being curious. So anyways, that's it. That's all I got for you today. I hope you enjoyed it.
And as always, let me know if you have any requests for podcast episodes. I'm always open for new ideas and we'll see you next week.