How The Duodenum Impacts Movement & Pain
In this episode of the Unreal Results podcast, I dive into the duodenum and how this area can be a powerful lever in your treatment outcomes.
You’ll hear why the duodenum can influence everything from hip mobility and lower back pain to breathing mechanics and even emotional states like frustration and anxiety. I break down the anatomy in a clear, practical way to help you understand how the duodenum connects to the lumbar spine, diaphragm, and core function, and why treating it can make such a difference in your clients’ movement and pain. I also share practical ways to assess and address the duodenum, including simple self-treatments, skin lifts, and positional strategies you can try immediately with clients.
Whether you’re working with athletes, chronic low back pain, or clients with stubborn hip restrictions, this episode will help you expand your treatment lens and get better results.
Resources Mentioned In This Episode
Episode 45: The Kidneys - Visceral Connections To Movement
Episode 48: Small Intestine and Mesenteric Roots
Episode 91: Diaphragm Details That Unlock Thoracic Mobility
Learn the LTAP™ In-Person in one of my upcoming courses
Considering the viscera as a source of musculoskeletal pain and dysfunction is a great way to ensure a more true whole body approach to care, however it can be a bit overwhelming on where to start, which is exactly why I created the Visceral Referral Cheat Sheet. This FREE download will help you to learn the most common visceral referral patterns affecting the musculoskeletal system. Download it at www.unrealresultspod.com
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Anna Hartman: Hey there and welcome. I'm Anna Hartman and this is Unreal Results, a podcast where I help you get better outcomes and gain the confidence that you can help anyone, even the most complex cases. Join me as I teach about the influence of the visceral organs in the nervous system on movement, pain and injuries, all while shifting the paradigm of what whole body assessment and treatment really looks like.
I'm glad you're here. Let's dive in.
Hello. Hello. Welcome back to another episode of the Unreal Results Podcast. We're doing the summertime little podcast snacks, so hopefully this will be about 15 minutes. But, uh, before I just wanna jump on and like thank you to everyone who reached out. Um, let me know how much you liked the, um, podcast episode two episodes ago about what happens when I don't
get results in one to three visits. Really appreciate the feedback. I'm glad it resonated with so many of you. And just a quick update. The athletes I was talking about, they're both doing well. We have, we're not like fully a hundred percent, but we're like, I think out of the, we, we out of the weeds and on a good track with them.
So, um, I am looking forward to sharing more about, um, at least one of the cases with you all. Um, 'cause it's been super interesting and, um, yeah, definitely wanna share it. So, um, yeah. I just wanna give a little update. The other update is we are officially two months away from the next in-person LTAP level one course.
It will be in San Diego. Uh, there's only five spots left in that course. So, and that kicks off the sort of like end of the year, third, fourth quarter, um, in-person courses. So, um, if. You've been wanting to come to an in-person course, now is the time to register to make sure you save your spot. So, like I said, only five spots left in that San Diego course.
And then in October we've got a course in Toronto, Canada, and then in November course in San Antonio, Texas. So there are still, I think, quite a few spots available on both of those as well. Um, and then that's it for 2025. So, um, once the summer starts winding down those courses fill up really fast, so definitely no drag your feet because I don't want you to miss, I don't want you miss not getting in the course until 2016 or 2026.
Um. So, yeah, that's my, oh, my other update too is uh, 'cause somebody recently asked me, I will be doing a, uh, the annual birthday flash sale on all of the self-paced online courses. That will be January 29th to August 1st. So if you're not on the email list, that's gonna be the best place. To find out about the sale and be reminded of the sale and have access to the sale.
Because this day and age, you cannot count on social media to show you the content always. I don't know about you, but lately I feel like on Instagram, like the majority of my feed is ads, which is annoying for me as a consumer. Um. I guess as someone who runs ads, I'm okay with that, but sheesh, so many ads and um, I know y'all don't always see the posts on social, so, uh, being on the email list is really the best way to stay up to date with all the content, all the education, all the sales, all the things.
So that. You can always sign up for the email list that is always in the show notes, so make sure you're there. All right, so today's episode we're gonna be talking about the duodenum or duodenum. Everybody pr, everybody pronounces it differently. Duo denim. Duodenum. Duodenum. I like duodenum. It sounds cooler.
Uh, duo denim. Duodenum makes. More sense in terms of like exactly how it's spelled, regardless of what you call it. The duodenum is the very beginning of the small intestine. And why I wanna talk about the duodenum is because I've had, um, a handful of athletes come to me and uh, the body is directed me to the duodenum.
So I'm like, okay, guess we're talking about the duodenum. And interestingly enough, these athletes, um, they all had. Different main complaints, but all interestingly in the left lower extremity. And we're gonna learn that that is not a common choral referral for the duodenum, but it's gonna make sense of why, why the body lead us there.
Well main, maybe not why the body lead us there, but it's gonna make sense of why once we were led there, treating the duodenum made such a difference for their complaints. Um. So, yeah, that's what we're gonna do. Um, so let's just dive into it. The duodenum, like I said, the beginning of the small intestine, so it starts as soon as we exit the stomach.
So the exit of the stomach is called the pylorus. That is the beginning of the duodenum. There is a sphincter there, sphincter muscle there that, you know. Is in charge of regulating how often the stomach dumps into the small intestine. Uh, that is the pyloric sphincter. The pyloric sphincter. You can find it, it changes based on how full your stomach is, where it's at, but in general, it tends to be fairly midline.
The easiest way to find it is to fi find your xiphoid process and then slide your finger down and it's like the first. From the xiphoid process, the first little mound that you run into that is usually right where the pylori is. And then from there, the small intestine tube, it's fairly, um, superficial, like anterior there, I don't wanna say superficial.
It's fairly anterior there. And then it dives obliquely posterior to the edge of the lumbar spine. So. I'm getting ahead of myself. The duodenum is the most fixed part of the small intestine. The rest of the small intestines, which is the jejunum and the ileum, are loops. That is like the bulk of the small intestine.
Those are very loose. I have a whole podcast episode on the loops of the small intestine and the root of the small intestine. And I'll have Joe link that in the show notes. Um, I think the title of that was like something about the mesenteric roots, but so the duodenum, the beginning of the small intestine is the most fixed part of the small intestine.
And so, um.
It is going to be kind of a high payoff area, but once you learn the anatomy, you're also gonna be like, oh, no wonder treating the duodenum can be so powerful. So they're the, the fixed sections of the duodenum, they're kind of in like an incomplete circle, and so they're referred to in four sections. I guess an incomplete circle in four sections could also call the incomplete square.
Uh, with rounded edges, you know, tomato, tomato, I, I don't care what shape you wanna call it. Um, but that's what the duodenum is. And so we refer to those sections as, um, D one, D two, D three, D four. So D one is this section I'm describing first. So it starts at the pylorus. It goes from anterior to posterior, so it runs three dimensionally oblique.
Slightly lateral, right? 'cause it starts midline, or even on the left. So it's either midline or left of midline anterior, and it goes posterior to the right side of the lumbar spine. Then that is section D one, and then section D two is vertical and it goes along the right side of the lumbar spine. Then D three crosses
the front, it's almost like U shaped. The beginning of D three is more posterior than the middle of D three, and so it kind of curves around the front of the spine, crosses the body of L four as it goes from the right side of the spine to the left side of the spine, and then it goes again vertical D four and a little bit.
More left to the beginning of the loops, which is called the duodenal-jejunal flexor the DJ junction. Um, and it, it, it flexes, it, it bends. A flexor is a bend in the tube and it, uh, bends in the tube and it goes back and it gives rise to all of the loops of the small intestine. So, um, to give you a little bit more visual context, if you're watching on YouTube, I got my spine here, so L five, L four, L three, L two, L one.
It starts out. Around that area of L one. And it goes from the left side to the right side, just like this and a little bit anterior. 'cause remember we're talking about three dimensions. This is not just all flat, but it goes this way. And then as we go to D two, it comes along the lumbar spine. So down here to the body of L four, crosses the body of L four and then comes back up to.
The D four segment. Now, if that feels very low down on you on the model, it's because yes, on models it does look very low down. But to give us a more context of where we are in space, if we take the top of the iliac crests, that's gonna be L four. So it's going to be. L three L four kind of depends on the person, but in general that's like L three, L four, so it's going to be in the space above the pelvis.
And if you, we talk about this a lot in the missing link course and the results cheat code and the LTAP level one course. The area above the sacrum, the area above the ileum, that is the lumbar spine. And if we are looking at it from the front side of our body, it's more upper abdominal area, not. Lower down, it's more umbilicus and above.
In general, our obi umbilicus, our belly button tends to be around the level of L three, so it's like right at or slightly below the umbilicus. And then above, um, obviously everybody's anatomy's a little bit different, but those are some general landmarks. The D two, the vertical part of the tube is deep.
It's to the depth of the spine. So even though we palpate it from the front, um, and we locate it from the front, we have to think deep, not superficial. The parts of the duodenum, I think that are easiest to treat and going to be sort of like where you really palpate them and really treat them is on the flexors, on the bends between like D one, D two, D one two, D one as well is more mobile than D two.
D four is more mobile than D two and D three, though. D two and D three parts of the duodenum are fairly fixed, fairly fixed. D one, D four, they are more mobile, they're, which makes sense 'cause they're attached to things that are very mobile. D one is attached to the stomach. It's pretty darn mobile. D four is attached to the loops, also very mobile.
Now with that said. That means that with food in our stomach and with breathing where we find these structures can be anywhere between one and four centimeters away from these normal locations. But why I wanted to show you the 3D ness of this is 'cause I also wanted you to appreciate how much this affects
all the structures in our abdomen. So that is one of the cool things about the duodenum, is the duodenum interacts or connects, or is influenced by just about every single visceral organ in the abdomen in the per peritoneum. And so, um, because of the way the dispensary ligaments are, it is like very much connected to our function of our core control, of our breathing mechanics, of our hip flexor function.
It flexor tightness and blood flow throughout the body. So again, like, like I said at the beginning, very high payoff spot. The dispensary ligament that holds the duodenum and especially the more mobile parts of the duodenum to the spine is called the ligament of trites, and I've talked about the ligament of trites in that episode on the mesenteric root as well as maybe the kidney episodes, so I'll make sure Joe links those in the show notes as well.
Um, and then I think I recently even did one on the colon and talked a lot about the ligament of Treitz in the relationship to fascia of tot. And so this is gonna come in here too, so. All of these tubes on the posterior abdominal wall share these fascial borders, these dispensary ligaments and specifically the dispensary ligaments of the ligament of trites connects us to the gastroesophageal sphincter and around the diaphragm.
And so it really also sort of affects diaphragm function, which is going to mean that it's gonna affect our thax, our thoracic organs, our sub di subdiaphragmatic organs. Just our general breath capacity, our thoracic mobility, so many things. This is also likely part of the reason why when we look at the duodenum, a classic, um, associated skeletal fixation pattern is going to be at T seven and the cost of vertebral junction of rib seven.
So those are things to look for in this area. Um, in general, the visceral somatic reflexes that are going to be associated with the duodenum, right? I told you the anatomical location of the duodenum is between L one and L four. That means L one, L two, L three, L four. Any of any facet issue, any intervertebral disc issue, any like.
Lumbar spine mobility thing can also be affected by the duodenum or V or vice versa, affect the duodenum. This is why one of the most common things to come up when somebody comes in with like legit lumbar low back pain is the duodenum. But also the visceral somatic piece, which has more to do with what nerves, where the nerves come from and where the vascular structures come from, that innervate, these organs, this is gonna be from T six to T 10.
So you're gonna wanna check the mid to lower thoracic spine for any facet restrictions cus of vertebral joint restrictions as well, because these can all influence the mobility and function of the duodenum as well and vice versa, the duodenum function and mobility can influence T six through T 10. And so we wanna make sure we're always sort of.
Covering our bases. This is why when we look at the direct visceral referral patterns of the duodenum, typically they're going to be right shoulder pain, scapular pain, um, mid thoracic pain and upper abdominal or umbilical region pain. Those are the typical associated pains with the duodenum visceral somatically.
Seeing a lot in just this world. Low back pain. That's a number one, like I said, which makes sense knowing that anatomy and how it relates to the lumbar spine, and then also it can be anywhere else, right? I talk about this a lot and so many episodes I talk about, like, you know, why having assessment like the LTAP is important because.
When our body is protecting a visceral organ like the duodenum, it's going to affect things throughout the spine from a like lumbopelvic control, from a dynamic alignment standpoint. I started this episode by telling you I've had a few athletes all in a row come up with the duodenum as where the LTAP was directing me.
These athletes had left knee pain. Um, left and left hip pain, not normal. Associated referrals from the duodenum, but man, I treated their duodenum and their hip mobility on the left side changed a ton. And it's crazy too because even though the duodenum does have parts that are towards the left side, right, the beginning of D one can be towards the left side.
The end of D four is on the left, but the majority of the DI is on the right. So that is even so interesting that there is this left sided component. But when we look at the census dispensary, ligaments, and the relationships between the ligament of Treitz fascia ult. In the posterior abdominal wall. We also see that there is a direct relationship between the duodenum and the portal vein.
So this oftentimes is a, a reason for left hip, left lower extremity issues, swelling issues. There is a connection to the right lobe of the liver, the vena cva. So again, blood flow, um, both the left and the right psoas. The kidneys on the right as well as the left. So, so many structures that then we already know for me, the previous episodes or here, I'm telling you right now when we have things that are affecting blood flow, kidneys, hip flexors, we're gonna have lower extremity issues all day long.
So now you can see how the duodenum though, typically associated with lumbar. Spine problems, lumbar back pain and upper extremity stuff, or neck, right? Mid thorax, traditional visceral, somatic referrals from that upper abdominal peritoneum. Relationship that I've talked about in so many episodes, but you also see how it's going to be relating to the lower extremity from this connection via the pelvic bowl, the, the, um, distension of the fluid balance, the tightness of the hip flexors, the QL tightness that's associated with it, right?
This relationship to the posterior abdominal wall, and even the diaphragm. So. So many connections. I have them all. I'm like, I don't even know. Do I read all the connections? I'm kind of telling you all of them, but it's like, like I said at the beginning, it's literally connected to everything and each section of the duodenum is related, two different things.
So instead of talking more about the anatomy, let's make it practical. So it's like, how do you treat? Treat the di well. Like many things in the viscera, a really great way to treat them is through that connection to the colon. That's why I did a whole episode on the colon connection. The colon is easy access to affect the fascia of tot, and then many of the things that connect to the fascia tot much like small intestine, especially when we're trying to mobilize or affect the D two segment of the.
Duodenum, um, going in from the lateral side, so doing the sideline, visceral self massage or the cortisol is a really great way to do that, especially utilizing the right side and then also being able to find these various or flexors with anatomical alignments and do skin lifts in the area. Do a general lift of even the mesenteric root and the small, the loops of the small intestines, like pulling it out from our belly, letting our belly descend, affecting the area of the posterior lateral, like breathing, like diaphragm stuff, right?
I have all episode on the diaphragm, um, practical application, um, like mobility too. So, um, these can all affect the duodenum quite a bit. Addressing any sort of skeletal fixations between T six, T 10, and L one and L four, it's gonna have an effect on the small intestine as well. So treating through the skin a above the area of the duodenum is really powerful due to the effect of Hilton's law as well as just
treating from a diaphragm standpoint or a general visceral standpoint? Super powerful. I think most of the time, practically the hardest thing is like why I created it is like knowing when to treat the di. Like how do I know that someone's left hip pain? Or left hip function is being affected by the dum, how do I know that their back pain is being affected by the dum?
Using the inhibition test that I teach in the LTAP is a great way. You know, starting even like with the free course, I teach the, the, the missing link. You know, learning how to assess the SI joint and utilizing the breath hold to let us know when there's a visceral issue. Like then we just start targeting the visceral organs that are going to be more associated with these things.
But spoiler alert, hopefully these episodes, when I talk about all these connections, show you why even very general things. Focus on the viscera can be so powerful. So, um, yeah, di so powerful. Let me take a real quick look to make sure we're not missing anything I wanted to say. Oh. The other thing that I think is important and a lot of people love kind of seeing this piece is like the emotional piece that sometimes is connected to our organs.
So often people with um, di waal stuff, especially people with low back pain that happen to be di adal tends to be a very high level of anxiety or frustration associated with them. But then two, some other emotions that can be associated with the duodenum and stomach is the relationship of you. Yourself to society.
And so like, that is just like some, like societal social anxiety or social, um, concerns, you know, of like who you are, who you are to everyone else. Um, but frustration is a big one for the duodenum. So that's it. Beginning of the small intestine, real powerful spot. Along the lumbar spine, if you see someone with like very limited lumbar mobility, think, hmm.
I wonder how their duodenum is doing and like, how can we stretch the duodenum? How can we give some space in there? Maybe it is like going into left side bending to really stretch the tube on the right. Maybe it's. Right sided visceral mobilization. Maybe it's a little bit of added rotation to get the lower part of the duodenum.
Maybe it's going into extension, just exploring, maybe doing skin stretch or skin stimulation just around those areas. So around the umbilicus, underneath the xiphoid process. A little bit more right-sided than left. Those are all really great places to start and be curious, how does it change someone's hip mobility?
How does it change someone's lumbar spine mobility? How does it change someone's diaphragm function and thoracic mobility? That's what it's all about. Hopefully this is helpful for you. Sorry it's a little longer than I wanted, but it's 'cause I did those updates at the beginning. See you next week. Have a great week.
Bye.