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Connective Tissue (CT) is continuous throughout the entire body, connecting all of its various components and layers together.  It is viscoelastic, with fluid,  elastic and collagen components.

Tendons, ligaments, fascia, bone, and the membranes lining the body’s three interior compartments are made of Connective Tissue.

  • Tendons connect Muscle to Bone.
  • Ligaments connect Bone to Bone.
  • Meninges are the membranes that line the skull and spinal column, wrapping the brain and spinal cord.
  • Peritoneum is the membrane that lines the abdominal cavity, wrapping the abdominal organs.
  • Pleura is the membrane lining the rib cage, wrapping around the lungs.
  • Pericardium is the membrane enveloping the heart, and allowing it to move between the lungs.

Tendons, ligaments and fascia support and define the body’s movement from the outside in, so to speak.  By comparison, the meninges, peritoneum, and pleura/pericardium support and define the body’s  movement from the inside out.

That the body is a closed system meshed together by connective tissue means that a limitation of movement in one area will affect movement in another.  Musculoskeletal problems can have an important visceral and/or cranial connective tissue component.  A basic principle of treatment is to work with all layers of connective tissue that relate to the presenting problem.


Connective Tissue is involved in a variety of functions:

  • Support
  • Transport
  • Storage
  • Immune Defence and
  • Temperature regulation


Connective tissue takes many different forms. It can be either Connective Tissue Proper or Specialised Connective Tissue. Connective Tissue Proper can be loose or dense, varying in structural organisation.

Tendons, ligaments and fascia are made of Connective Tissue Proper.  Ligaments and tendons are dense, with very high collagen-low elastin/fluid components.  Fascia is variable but in general is more fluid and elastic.  Fascia forms the wrapping around/between individual structures, and the membranes that line each body compartment.

All Connective Tissue Proper has a support function – defining, guiding and delineating the body’s movement.  Different forms have different functions:  Ligaments and tendons are strong to support weight bearing. Whereas meninges, peritoneum and pleura/pericardium each secrete a little serous fluid, which permits sliding of internal organs against each other, at the same time as supporting them in their place.

Specialised Connective Tissues includes the liver, bone, cartilage, fat, blood, and lymphatic fluids.


Restricted movement in one part of an interconnected system will change axes of movements, thereby resulting in compensations both locally and at a distance. However, the body has a great capacity to adapt and compensate, and dysfunctions can be mild or inconsequential. If the body ‘runs out of room’ to adapt and to compensate for lost mobility, dysfunctions become problematic, and perhaps injuries arrive or persist.

A basic principle of treatment is to restore mobility so that the body can regain adaptability.  Another basic principle is that to improve the mobility of any part of the body will help to improve its function.


The more I learn about anatomy, and the relationships that exist within the body, the more interesting it becomes. Let’s consider:

  • The connective tissue sling that anchors the small intestine to the back wall of the body effectively connects to the front of the lower back vertebrae.
  • Tissue that connects the liver and stomach to the diaphragm is continuous with fascia lining the central area of the chest to the front area of the neck, connecting with the front of the thoracic & cervical (neck) spine and to the base of the skull.
  • Connective tissue covering the top of the lung anchors to the 6th and 7th cervical (neck) and 1st Thoracic vertebrae, to the 1st Rib, and also to the meninges.
  • The oesophagus passes just in front of the thoracic spine, sitting against T4,5
  • The kidneys tuck up under the lower attachment of the diaphragm, sliding down and up along the upper psoas muscle with each breath.

And there’s more…

  • The diaphragm tendon anchors to the front of not only T12, but also L1, 2, 3 and 4. It has fibres that support part of the duodenum.
  • The pleura attaches itself to the inside surface of each rib.
  • The cecum (first part of the large intestine) and the sigmoid colon (last part of the large intestine) lie in front of the greater pelvis adjacent to the sacroiliac joints (SIJ).  Appendix scars if adhered have the potential to reduce the mobility of the cecum.
  • Ligaments that support the heart connect it in front to the breastbone, and in back to the thoracic spine.
  • The heart attaches to the central tendon of the diaphragm, providing stability so that the diaphragm can flare the lower ribs during inhalation.
  • Continuation of the fascia connecting the bladder to the pelvis can be traced via the obturator (hip rotator cuff muscles) to the hip joint, and via the tailbone-hamstrings-peroneal muscles to the central arch of the foot (navicular bone)


Visceral Manipulation aims to improve the freedom of movement of internal organs, how they move in relationship to each other, and to the muscles and skeleton to which they connect

Neural Manipulation aims to improve the freedom of movement of the nerves along their trajectories where they should slide and glide.  It also aims to improve the subtle mobility of skull sutures, Sacro-iliac joints (SIJ), and the spine. Craniosacral Therapy also touches on these same structures, using a slightly different approach.

Vascular Manipulation aims to improve the elastic environment of arteries

Manual Articular Approach considers joints as an integrated unit and aims to improve mobility of their connective tissue elements (capsule, ligaments, tendons), arteries and nerves that supply them, and the sites where information receptors are concentrated (e.g. golgi tendon organs at muscle-tendon junctions)

Lymphatic Drainage Therapy aims to improve the ease of flow of lymph through the lymphatic system