The Shopping Bag Inside the Shopping Bag —
Why Your Back Pain Might Be Your Liver

I attended a two-day seminar on visceral manipulation run by a French osteopath — Paul Prevot — and came away with something I had not expected. Not a new technique, although the techniques were extraordinary. Something more fundamental: the realisation that everything I had studied separately in three years of undergraduate anatomy, physiology, and biochemistry was, in the hands of a skilled osteopath, the same subject.

The anatomy I learned at Glasgow — the serous membranes, the peritoneum, the pericardium, the nine abdominal cavities — had lived in my mind as structural knowledge. The physiology had lived separately. The biochemistry separately again. Paul Prevot spent two days demonstrating that these were never separate to begin with. That the physical position of an organ determines its physiological function. That physiological dysfunction alters the biochemistry. And that the biochemistry shows up on a blood panel as a number that a clinician looks at in isolation, without ever thinking about the shopping bag it lives in.

The Shopping Bags Within Shopping Bags

Your internal organs do not float freely inside an empty cavity. They are contained within a series of nested structural envelopes — serous membranes, fascial sheaths, and peritoneal folds — each with its own integrity, its own tension, its own relationship to the structures adjacent to it.

Think of it this way: your internal organs are the shopping. The peritoneal bags, fascial compartments, and serous membrane envelopes are the shopping bags containing them. And the suspensory ligaments — the coronary ligament of the liver, the broad ligament of the uterus, the mesenteric attachments of the intestines — are the handles by which those bags are suspended from their anchor points.

Those anchor points are your diaphragm and your abdominal wall.

This means that anything that changes the contents of a bag — enlargement, congestion, inflammation, displacement — changes the tension on the handles. Changes the tension on the handles and you change the load on the diaphragm. Change the load on the diaphragm and you change breathing. Change breathing and you change posture. Change posture and you change the load on the spine. And somewhere in this cascade, a client presents with back pain that has, at its origin, nothing to do with their back.

The Liver — Reed Davis's Hoover Bag

Reed Davis — the founder of Functional Diagnostic Nutrition, under whom I trained — described liver congestion with one of the most useful clinical analogies I have encountered. The liver, he said, is like a hoover. It sucks up the dust and debris — the toxins, the metabolic waste, the hormones due for elimination — and processes them, making them safe for excretion. But as a hoover bag fills, it gets bigger. And when it gets too full, it starts to leak — dust back through the bag, polluting the inside of the machine, just as a congested liver recirculates toxins into the bloodstream it was supposed to be cleaning.

This is liver congestion in clinical terms: not liver failure, not hepatitis, not a diagnosis requiring a specialist. The liver is overworked — processing a toxin load greater than its current capacity — and in doing that work repeatedly, it enlarges. The hepatocytes hypertrophy. The organ becomes physically bigger than it should be.

And here is where the anatomy Paul Prevot taught becomes directly relevant. Because a physically enlarged liver does not sit quietly in the right upper quadrant while the rest of the body gets on with things. It sits inside its bag. The bag has handles. The handles attach to the diaphragm and the abdominal wall. And a larger bag exerts more tension on its handles than a smaller one.

Meanwhile, the blood chemistry shows elevated ALT and AST — liver enzymes indicating hepatocellular stress. The clinician who ordered it notes the elevation and considers fatty liver disease, alcohol intake, or medication side effects. Nobody asks: where is this liver sitting? What is its tension doing to the structures attached to it? What is the physical state of the organ as a body part, not just as a set of enzyme numbers?

The Extracellular Matrix — The Environment the Cell Cannot Live Without

Alfred Pischinger was an Austrian histologist who spent his career studying what he called the ground regulation system — the extracellular matrix (ECM) that surrounds every cell in the body. His work was largely ignored by mainstream medicine for decades, partly because it was ahead of the available technology to investigate it and partly because it challenged the cell-centric model that had dominated biology since the nineteenth century.

The ECM is composed of collagen, elastin, proteoglycans, and glycoproteins embedded in a gel-like ground substance. It is continuous throughout the body — not a collection of separate local environments but a single interconnected medium that links every tissue and organ. In this sense the ECM is the biological equivalent of the fascial network: structurally continuous, functionally integrated, and capable of transmitting mechanical, chemical, and electrical signals across distances that direct cell-to-cell communication cannot bridge.

The functions of the ECM that Pischinger documented include:

• Providing the structural scaffolding for cells and organs
• Modulating cell-to-cell communication — including the biophoton emissions I wrote about in the previous post in this series
• Regulating the life cycle of cells — including programmed cell death
• Creating the balance between cell survival and cell death
• Modulating growth factor and cytokine function
• Maintaining the fluid balance and pressure gradients between tissue compartments

When the ECM is compromised — by chronic inflammation, by toxin load, by dehydration, by the mechanical stress of sustained postural compression — none of these functions occurs optimally. The cells within a compromised ECM are receiving degraded signals, eliminating waste into an already-loaded medium, and making growth and death decisions based on distorted environmental information.

This is not separate from the liver story. A congested liver that is recirculating toxins is loading the ECM of every tissue those toxins reach. The systemic ECM becomes the medium through which liver dysfunction is communicated to the whole body — long before any symptom appears, long before any blood marker becomes abnormal enough to flag.

Thomas Myers and the Anatomy Trains

Thomas Myers' Anatomy Trains framework — built on the fascia dissection work that followed from the tradition of Ida Rolf — provides the structural map for understanding how tension transmits through the body along predictable myofascial continuity lines.

The superficial back line runs continuously from the plantar fascia of the foot, up the calf, through the hamstrings, across the sacrotuberous ligament, up the erector spinae, over the cranium, and down to the supraorbital ridge above the eyes. A restriction anywhere along this line — a tight plantar fascia, a restricted hamstring — changes the mechanical environment of every structure along the entire chain. You do not treat the low back in isolation. You treat the line.

The deep front line — Myers' most clinically important myofascial track — runs from the inner arch of the foot, up through the inner leg, through the psoas and iliacus, through the anterior spine, through the pericardium, and into the floor of the mouth and the cranial base. This is the line that connects the hip flexors to the diaphragm to the pericardium to the cervical spine in a single continuous fascial structure. This is the anatomical substrate through which a congested liver, pulling on the right diaphragmatic crus, loads the right psoas, alters the lumbar curve, and generates the back pain that presents to the physiotherapist three months later.

"The fascia is not the packaging material of the body. It is the body's primary communication and tensegrity network — continuous, pre-stressed, and capable of transmitting mechanical forces across distances that the nervous system alone cannot account for."

The piezoelectric properties of collagen — its ability to generate electrical signals in response to mechanical deformation — add a further layer. Fascial compression and tension do not merely transmit mechanical force. They generate bioelectrical signals that communicate with the cells embedded in the ECM, influencing gene expression, cell behaviour, and tissue remodelling. The physical environment of the cell — which Pischinger said could not be separated from the cell itself — is electrically active. It is not passive scaffolding.

The Ileocaecal Valve — Where Biochemistry Meets Anatomy

The ileocaecal valve is the sphincter between the small and large intestine. Its job is directional: to allow the contents of the small intestine to pass into the colon, and to prevent the bacterial-rich contents of the colon from refluxing back into the small intestine. When this valve is dysfunctional — either failing to close adequately or stuck in a closed position — the downstream consequences are both structural and biochemical.

A valve that fails to close allows colonic bacteria and their metabolic byproducts to enter the small intestine and, through a permeable gut lining, into the portal circulation. The portal vein carries blood directly from the intestinal tract to the liver. Every toxin that crosses through a dysfunctional ileocaecal valve arrives at the liver first. This is one of the primary mechanisms through which dysbiosis drives liver burden — not through a systemic route but through a direct anatomical conduit.

What Paul Prevot demonstrated — and what I have never forgotten — is that this valve is a physical structure. It has a position. It has a tension. And it can be directly influenced by hands-on physical contact. The appropriate pressure, applied with knowledge of the valve's anatomical location and orientation, can restore normal valve tone. A physical intervention on an external structure producing a biochemical change in an internal environment.

Visceroptosis — When the Bags Descend

Visceroptosis is the downward displacement of abdominal organs from their correct anatomical position. It is far more common than it is diagnosed, because standard medical examination rarely assesses organ position directly and because the symptoms it produces — lower abdominal distension, poor core function, pelvic floor weakness, altered bowel habit, and the characteristic pot belly that cannot be addressed by abdominal exercise — are attributed to other causes.

The person with visceroptosis who presents to a personal trainer or physiotherapist for their poor core function is frequently prescribed abdominal exercises. If those exercises involve spinal flexion — sit-ups, crunches — they are compressing the already-displaced visceral contents further, increasing intra-abdominal pressure, loading the pelvic floor, and worsening the very problem they are intended to address.

Paul Chek's inner unit / outer unit framework — itself building on the work of Professor Vladimir Janda on phasic and postural muscle patterns — distinguishes between the deep stabilising system (transversus abdominis, multifidus, pelvic floor, diaphragm working together as a pressure canister) and the superficial global system (the visible muscles that produce movement). Visceroptosis disrupts the canister from the inside. The displaced viscera sit against the anterior abdominal wall, preventing the transversus from generating normal resting tone. No amount of external core training resolves an internal structural problem. You cannot crunch your way out of a displaced organ.

From First Principles to Clinical Application — Why the Journey Matters

I studied anatomy, physiology, and biochemistry as an undergraduate and spent the early years of my clinical career thinking about them in sequence: physical first, then physiological, then biochemical. The visceral manipulation seminar was the moment I understood that this sequence was an educational convenience, not a clinical reality. The body does not organise itself by academic department.

An enlarged liver is simultaneously a biochemical event (elevated liver enzymes, impaired phase I and phase II detoxification), a physiological event (altered bile flow, compromised hormone metabolism), and a structural event (increased organ volume, altered ligamentous tension, changed diaphragmatic mechanics). You cannot fully address any one of these without understanding its relationship to the others.

This is why understanding that travels from first principles — from anatomy and physiology and biochemistry at their foundations, through to their clinical integration — produces something qualitatively different from understanding that begins at the clinical application and works backwards. The practitioner who understands why milk thistle supports liver phase II detoxification, why the diaphragm shares fascial continuity with the psoas, why the ileocaecal valve is a direct conduit between the microbiome and the portal circulation, and why a client's back pain and constipation and elevated liver enzymes are three windows into the same problem — that practitioner asks different questions, makes different connections, and arrives at different interventions.

The body you are living in is one connected structure. The most useful thing any practitioner can do is learn to see it that way.