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Inside-Out Paradigm

By Dale G. Alexander, LMT, MA, PhD

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Functional Thinking for Improved Outcomes

Most of us as bodyworkers have been taught to believe that structural shifts support the functional improvement of our organ systems toward physiological homeostasis. In contrast, my clients have taught me over three decades that enhancing the functioning of our internal organs by mobilizing them directly has evidenced far quicker and more enduring improvements for those suffering from chronic somatic dysfunction.

Additionally, there is a commonly accepted belief that one needs to follow established treatment regimes that have shown themselves to be effective. However, it is surprising how often our hands "just do the right thing to help our clients."

Balancing the Elements

My clinical experience suggests that it is best to hold both of these notions with equal value: addressing both functional and structural elements as well as the application of time-tested therapeutic protocols while remaining open to the "instinctual wisdom of our hands." With this balanced perspective, let's review the functions of our filter organs: lungs, liver, and kidneys. We can analogize them as our air, blood, and water filters.

The all-important lung is the organ that puts oxygen into the blood and removes carbon dioxide. The alveoli are the functional units where this magical transformation occurs. We are born with about 700 million of them.1 The liver is often considered as our primary blood filter, yet it also processes what we eat and drink into energy and nutrients that the body can use. As Dr. Oz describes, "Your liver does three main things: helps digest stuff, make proteins and gets rid of bad stuff."2

Lobules are the functional units of the liver. We are born with about 100,000 of them.3 Within them, the various functions of the liver are carried out by the liver cells, called hepatocytes, which act as stem cells and are responsible for the organ's unique ability to regenerate tissue.

Functional Thinking for Improved Outcomes - Copyright – Stock Photo / Register Mark The kidneys' chief function is to regulate the concentration of water and soluble substances like sodium salts by filtering the blood, reabsorbing what is needed and excreting the rest as urine. Nephrons are their primary functional units. Nephrons further regulate blood volume and pressure, levels of electrolytes and metabolites, and blood pH via hormones of the endocrine system.4 We are born with an overabundance of these nephrons, approximately 1.2 million in each kidney.5


Focusing on how these organs accomplish their tasks and their functional structures can assist us to help our clients more comprehensively. Directing our attention and intention toward improving the functioning of these filter organs supports movement toward normalizing systemic physiological function. It is, in and of itself, a therapeutic treatment strategy.

Pressure Gradients

Consider this as an orientation to treatment which creates localized pressure gradients within and around these organs. Stretching, pumping, and stimulating blood flow in and out of organs all create such pressure gradients.6 Imagine how stretching the pleural sacs of the lungs might assist their internal function. Or visualize techniques that pump the liver, or still others that stimulate blood flow in and out of the kidneys that supports their normal functioning. The possible ways to do this are probably endless. Seek to discover your own.

Your Creativity

Thinking functionally can also fuel your individual creativity and instinctual intelligence to invent spontaneous techniques which assist your clients. Most of you are familiar with that sense of self reflection in a moment when you notice, "interesting, never did that before" or "that was a different way to access the tissues, wonder how that might help?" Especially, when clients return for their next appointment exclaiming, "I hope you remember what you did the last time, I felt better for days."

This is how functional thinking can support you as a practitioner to remain curious, satisfied, and committed to your daily work with clients. It is not always about being able to describe your intent ahead of time, though it can be quite useful, but also, being responsive to the ability of your nervous system to sync into and with your clients' subconscious, allowing them to draw from the library of your skill sets and breadth of clinical experience. So often we are the "means by which," clients are able to slip out of the shackles of their chronic somatic difficulties and we don't even realize why.

Chronic Somatic Dysfunction

Few of us fully recognize just how large the population is who suffer with chronic somatic dysfunctions and pain. According to Wikipedia's review of the literature into chronic pain there are between 70 and 116 million people in our nation who live each day with chronic pain.7 This is a great number of people who are seeking solutions from practitioners who have the perceptual and hand skills to deliver them.

What is needed is your curiosity and your willingness to keep learning. Expand your perception toward thinking functionally and very soon you will notice the difference in your client's progress toward enhanced quality of life.

Note: All credit is given to Dr. Jean Pierre Barral DO, developer of Visceral Manipulation, for his teachings, books, and for inspiring me to think functionally.


  1. Pulmonary alveolus, Wikipedia; Jan 2018.
  2. Oz M. "What Does the Liver Do?", Jan 2018.
  3. Liver Lobule, Structure of the Liver - Webnode; Jan 2018.
  4. What is the functional unit of the kidney?, Yahoo Answers; Jan 2018.
  5. Andrews M. "How can you live without one of your kidneys?" Scientific American, Jan 2018.
  6. Pressure gradient, Wikipedia; Jan 2018.
  7. Chronic Pain, Wikipedia; Jan 2018.
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