To complement the MASSAGE Magazine article, “How to Quiet the Mind and Body: Work with the Adrenal Glands to Address the Fight-or-Flight Response,” by Suzanne Scurlock-Durana, in the April 2011 issue. Article summary: In today’s world, many people feel pushed to move at a pace that is far quicker than is healthy for them. Working with the adrenal glands can deeply relax a client who is stressed or depleted, and can help release tension in the spine. It takes patience on your part, coupled with an ability to meet the client where he is, without judgment.

by Jean-Pierre Barral, D.O., M.R.O.(F.)

Skeletal motion results from voluntary muscular activity originating in the central nervous system. Muscles mobilize contiguous skeletal structures, which are unified by a system of articulations. The nature of these articulations determines the axes and the amplitudes of voluntary movements.

There are also defined axes and amplitudes for the motions of visceral structures. Visceral articulations have, in common with skeletal articulations, sliding surfaces and a system of attachments. The sliding surfaces of visceral joints are the serous membranes. An organ can be contiguous with a muscular wall (liver-diaphragm), with the skeleton (lung-thorax) or with another organ (liver-kidney).

A visceral restriction occurs when an organ loses, part or all, of its ability to move. A restriction may arise at the level of any of these sliding surfaces, as well as in relation to the many connective tissues attached to the viscera.

There is an inherent axis of rotation with the mobility of each organ. The mobility of the viscera under the influence of the piston-like movement of the diaphragm is a familiar phenomenon, easily documented by simple radiology. What a surprise to discover that the axes of motion reproduce exactly those of embryological development. The discovery of this phenomenon tends to confirm the idea that “cells do not forget.”

My work began by looking at pulmonary pathology, and its effect on other viscera and the musculoskeletal system. I saw the progression of diseases, as well as their sequelae, and in some cases, was able to participate in the post-mortem.

My observations demonstrated that whenever the pleuropulmonary unit (pleura and lung) is restricted, the axes of motion of the thoracic cavity and viscera change. The direction forces of intrathoracic pressure change, and all the musculoskeletal structures related to the thorax then move along different axes.

I was able to observe the changes in the elasticity to which the connective tissues were subjected. Some tissue double or tripled in thickness in adapting to abnormal tension. When the possibility of adaptation was exhausted, fibrosis then set in. These disordered changes are visible and easily palpable, and these changes have many repercussions. The gastroesophageal axis is deviated greatly, increasing the risk of hiatal hernia.

The pleuropulmonary attachments pull on the lower part of the cervical spine resulting in neck pain. Costovertebral articulations lose their elasticity, and adaptive scoliosis can occur. In the end the whole body is involved. This illustrates that the forces generated by changing visceral mobility are significant, and over time, able to grossly deform the musculoskeletal structures. By applying precise organ-specific fascial mobilization to treat the original soft-tissue restriction, normal mobility can be restored, and the secondary repercussions are able to resolve.

*”Manipulation of the Anterior Sternoclavicular Ligament: Supine Position,” reprinted from The Thorax by Jean-Pierre Barral, R.P.T., D.O., with permission from Eastland Press, Inc., P.O. Box 99749, Seattle, WA 98119. Copyright 1999. All rights reserved.

Jean-Pierre Barral, D.O., M.R.O.(F), P.T., developer of Visceral Manipulation, serves as director and faculty of the Department of Osteopathic Manipulation at the University of Paris School of Medicine in France. He holds a diploma of the Faculty of Medicine of Paris North, one of only four osteopaths in the world to hold such a diploma. For more information, visit The Barral Institute’s website at