Visceral Restriction Obstructing Motility
In visceral work, making sure the main digestive/abdominal sphincters have appropriate movement and function is a foundational part of the skill set, with such function having a high impact when it goes wrong. Most of the time it looks fairly simple…do we detect vibrant and even rotational movement, with a clockwise bias at first contact or release? And if not, we have mostly straight forward options for attending to ccw rotation, lack of movement or more lethargic motility. But, sometimes we get something a bit odder, which I feel makes a lot of sense but also presents with a range of its own common to less common patterns.
By this I mean that sometimes we have enough of a mobility problem with the tissue around our target sphincter that its motility is absent or masked by the strong pull into its protective restriction. If it's being pulled hard enough that we can't feel the circular motility, we can probably make some safe guesses about the health and capability of that sphincter's motility regardless of what we can or can't feel.
Some of our most common restrictions of this kind affecting sphincter motility are not especially surprising, such as the mesenteric root which spans from the housing of the duodenojejunal junction in D4 and the ileocecal valve between the end of the ileum and the cecum. Significant restriction on the mesentery as the body tries to stabilize/avoid tensioning some relevant line of tissue can lead to either or both the DJ/ileocecal valve appearing to lose motility, with a local listening pulling you off into the mesentery/mesenteric root. The DJ also occasionally loses motility as the D4 gets pulled towards its connection to the lumbar spine (which can cause some pretty disruptive effects to the sympathetic chain).
The pyloric sphincter most often has restrictions up into the gallbladder and liver via the lesser omentum/hepatoduodenal ligament with the direct sphincter listening direction usually being a superior glide/roll when this is the case instead of it's circular motility movement.
Oddi is most commonly pulled medially to the pancreas, and sometimes to the ascending colon and through that to the back body wall, but the sphincter of oddi ends up surprisingly being a hub of tension throughout the abdomen (or more realistically it's just so sensitve to being impacted because of the fragility of the common bile/hepatic duct and it's connections with the pancreas), so may have a range of tension lines we may have to address.
Our more consistently odd one is the cardiac sphincter. What I most frequently see is a strong tension connection with the right sided mediastinal pleura, which has a strong medial roll on the cardiac sphincter/esophagus, which is not coming from the ribs you're feeling through as one might expect. If you feel this almost posterior, medial roll/glide while checking for cardiac sphincter motility, try to inhibit at the right medial intercohondral space, sinking into the pleura and see if that inhibits that pull. If so, time to get to some lung work before returning to reassess the esophageal line.
In the end, you may run into some distinctly other structures and lines of tension that the patients body draws you to, and sometimes you'll even see it so severe that the sphincter may not be in the normal anatomical place (one of our TA's found a post-appendectomy migration of the ileocecal valve of a couple inches!).