Casey's Blog

Ligament of Treitz and Visceral Manipulation

Mar 12, 2021

The ligament of Treitz is a suspensory structure from the right crus of the diaphragm and celiac artery, wraps around the esophagus and anchors onto the duodenojejunal junction. It contains contractile fibers, 30% are smooth muscle and 70% are skeletal. Many people ask me why they have tension in this muscular ligament and it could be any number of things - a car accident (because of the upper part of a the seatbelt), surgeries, pathologies and illness, back injury, chronic heartburn (this is chicken or the egg) or the psychosomatic aspect of feeling chronically powerless (it’s the home of the solar plexus) or stressed, frustrated or anxious with work or one’s social life (which is where such things manifest in the body.)

Common symptoms of ligament of Treitz issues are:

  • pain just below the ribs in middle area of the abdomen

  • esophageal problems - heart burn, throat/neck issues, similar symptoms of hiatal hernias

  • pulling into the left lower belly in women and left testicle in men

  • upper lumbar pain

  • restriction of T12/L1

  • psoas and quadratus lumborum problems that won’t go away

  • chronic anxiety and frustration, especially socially


    The ligament of Treitz can affect the following directly:

    • celiac artery

    • small intestine (duodenum and jejunum)

    • esophagus

    • diaphragm

    • L1

    • left psoas

    • abdominal aorta

    • pancreas

    • transverse colon

    • mesenteric root

    • left renal vessels

    The ligament of Treitz can indirectly impact:

    • the head, neck and jaw (by way of the esophagus)

    • all five of the digestive system’s sphincters, which play a huge role in digestion

      • cardiac sphincter (because of the esophagus)

      • pylorus, Sphincter of Oddi and duodenojejunal junction (because of the positioning of the duodenum)

      • iliocecal valve (because of the fascial attachment to the mesenteric root)

    • the left ovary or testicle (because of it’s attachment to the left renal blood vessels)

    • every other organ in the abdomen because the ligament of Treitz affects the position of the duodenum which is attached to everything but the spleen

    I know it sounds scary. You’ll survive tension in the ligament of Treitz, but you may want to get on the ball (literally!) and get yourself sorted out. If you suspect there’s something going on with this ligament, book an appointment with me or another clinician trained in visceral manipulation. You can also try the rolling on a Coregeous ball right below where your ribs meet and explore abdominal breaths with spinal extension and a slight rotation to the right.

    To dive deeper into gut fascia and learn how to self treat, sign up for my Gut Fascia Masterclass.