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Inside-Out Paradigm

By Dale G. Alexander, LMT, MA, PhD

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A New Human Organ, the Mesentery Reclassified: What This Means for You

Anatomist Jean Francois Fernel, who invented the word physiology, wrote in 1542: "Anatomy is to physiology as geography is to history; it describes the theatre of events." What is the mesentery? "It's a double fold of peritoneum — the lining of the abdominal cavity — that attaches our intestine to the wall of our abdomen, and keeps everything locked in place." It keeps the small and large bowel from falling into the pelvic floor.2, 3 For over 100 years the mesentery was thought to be made up of fragmented, separate connective tissue elements; but, recent groundbreaking research has shown that it is actually one, continuous organ.

A New Human Organ, the Mesentery Reclassified: What This Means for You - Copyright – Stock Photo / Register Mark The Mesentery Update

This important discovery is credited to J Calvin Coffey, a researcher from the University Hospital Limerick in Ireland. The evidence for the organ's reclassification was published in The Lancet Gastroenterology & Hepatology.2, 4 This update in anatomical understanding is truly significant because the revelation that the mesentery is one continuous organ implies that the small and large bowel, the rectal region, even the pelvic floor are suspended from the lumbar spine.4

Consider the compression to the lumbar vertebrae when these tubular organs approximating in combination, 28 feet, shorten and narrow and may even twist in response to stress, trauma, bacterial, viral, or parasite influences. This is what I proposed in a previous article "Sacs and Tubes Theory of Stress."5 Now consider the congestion of venous blood and lymph that inevitably ensues when internal structures contract or spasm. Congestion adds weight to this suspension from the lumbar spine, which adds even more compression to the lumbar discs. No wonder that low back dysfunction is the number one reason for missed days at work in our country.

My clinical experience suggests that the far reaching connections of the mesentery is a central player in the frequency of these lost days of productivity. Also, to my perception, what is under-appreciated is that until old blood moves out, new blood filled with oxygen, nutrients, and hormones is reduced in its capacity to feed and heal the tissues and cells that desperately need a fresh supply of resources.

Contraction or spasm of the mesentery promotes varying degrees of ischemia both within the organs and the soft tissues associated with the extensor myofascial structures that brace in response to the forward and downward strain placed upon the anterior lumbar spine. Might this compression and congestion figure into chronic sciatic syndromes and spinal stenosis at L4-5-S1?

What This Means for You

The Lancet article doesn't refer to these structural and functional implications because this is not how medical thinking is focused and prioritized. However, as manual therapy practitioners, I believe it is crucial that ours does. All of us would truly like to understand the origins of our client's dysfunctions and pain. This anatomical update points us in a direction that I invite all teachers in our collective profession(s) to explore and disseminate to participants in their courses.

Coffey and O'Leary's article does not articulate the attachments of the mesentery's root as precisely as the Wikipedia reference (updated February 6, 2017), or as "Gray's Anatomy" has historically described, so I am cautious in stating these elements as facts. Wikipedia did note that "Gray's Anatomy" was being updated in light of this anatomical reclassification. Previously in Gray's and still currently in Wikipedia's, the attachments of the mesenteric root are described to span from the left transverse process of L2 down to the right sacroiliac joint and/or to the ileocecal valve.3, 6, 7

This is a diagonal line from the body's upper lumbar left side to the right side of the pelvic floor. Compress this diagonal in the center of the human bilateral structure and a torque or twisting of the ilia or hip bones will result. Some call this pelvic obliquity, or torsion, and relate it to a long leg on one side and a short leg on the other.

My Prediction

I concluded 25 years ago that this commonly observed torsion was the result of the mesenteric root's attachments and a shortening of the mesentery as a whole. The updated acceptance of the mesentery as a contiguous organ merely confirms what was once intuitive anatomical interpretation. In my clinical experience the implications for viewing the mesentery as the central linkage between the abdomen and the pelvis reach much farther than simply its relationship to the low back.

Any contraction or spasm of the gut tube pulls down upon the moorings of the viscera's suspensory ligaments extending up through the thoracic cavity to both the anterior cervical spine and from the cranium itself.8, 9 This new conception of the mesentery clearly supports a core ingredient of "The Body's Core Line and Central Linkage" and "A New Model for Low Back Dysfunction & Pain" that I published previously and have been teaching for the past few years.

It also has a primary relevance to my more recent published series, "The Aspiration to Prevent Hip, Knee, and Shoulder Replacements." All credit is given to Dr. Jean-Pierre Barral DO, the developer of Visceral Manipulation, for his introduction to the importance of the mesentery and the techniques he taught to normalize its tensions. The potential possibilities of this new discovery go beyond what I can distill within a single article. Others surely will follow.

Congratulations to Coffey and his team of researchers for bringing to light what many of us in the manual therapy field had intuited — that the mesentery is an integral whole, which links many of the organs within the abdomen and pelvis. Also, in my clinical experience the mesentery influences the posture and function of our entire human structure especially as it relates to chronic somatic dysfunction and pain.

References

  1. Hutchinson JR. "The science of anatomy is undergoing a revival." The Conversation, 2014.
  2. MacDonald F. "It's Official: A Brand New Human Organ Has Been Classified." Science Alert, 2017.
  3. Mesentery, Wikipedia; Feb 2017.
  4. Coffey JC. "The mesentery: structure, function, and role in disease." Lancet Gastroenterol & Hepatol, 2016; 1: 238–47
  5. Alexander DG. "The Sacs and Tubes Theory of Stress." Massage Today, Jan 2014; 14(1).
  6. Williams PL, Warwick R, Dyson M, et al. Gray's Anatomy. London: Churchill Livingstone, 1989.
  7. Paoletti S. The Fasciae: Anatomy Dysfunction & Treatment. Seattle: Eastland Press, 2006.
  8. Alexander DG. "The Body's Core Line and Central Linkage." Massage Today, May, 2014; 14(5).
  9. "A New Model for Low Back Pain and Dysfunction." Massage Today, Aug 2013; 13(8).
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