As of June 2015 I’ve completed the fourth level of Visceral Manipulation™ (VM4) training through the Barral Institute. In VM 4 we learned techniques for the thoracic cavity (lungs, heart, pleura, diaphragm) as well as the cervical fascia, ribs, clavicles, esophagus, trachea and bronchus.

Ribcage Visceral Manipulation

Visceral Manipulation™ was developed by world-renowned French Osteopath Jean-Pierre Barral. VM assists functional and structural imbalances throughout the body including musculoskeletal, vascular, nervous, urogenital, respiratory, digestive and lymphatic dysfunction. It evaluates and treats the dynamics of motion and suspension in relation to organs, membranes, fascia and ligaments. VM aims to increase proprioceptive communication within the body, thereby addressing symptoms of pain, dysfunction, and poor alignment. It’s a low force way of working with the bodies own intelligence.

There are 150 articulations in the thorax alone and a single restriction in one area can disrupt the complex web that runs through us. The thorax protects the contents but also acts as a superhighway of communication, blood, nutrient and oxygen exchange between the neck, abdominal and pelvic organs.

Each day, from normal respiration alone, the thoracic articulations collectively undergo more than three million movements. In addition, the heart by itself undergoes over one hundred thousand daily movements. The Thorax

Jean-Pierre Barral


I was fortunate enough to be the demo person for the pericardium lab. The pericardium is the membrane that encloses the heart. Dr Ron Marriotti (my VM instructor) gently but firmly compressed through my sternum to about a 40% depth into my body. My tissues led him to a specific spot on my phreno- pericardial ligament (the ligament connecting the pericardium to the diaphragm). From there he worked in partnership with my body- listening, following and nudging until he felt an expansion and opening.

My chest cavity felt light and spacious afterwards. It was easier for me to breath fully.  Emotionally I felt softer and “open-hearted”. Prior to the treatment, I felt irritable and tired. I was yawning every few minutes, all of that subsided after the treatment. The interesting thing is that since a young teen, I would get random INTENSE sharp stabbing pains in my chest that would freeze me in my tracks and make it difficult for me to take in a breath. My doctor told me the pain was probably caused by scar tissue in my lungs. Now I wonder if it were the restrictions in my phreno-pericardial ligament causing the stabbing pain. I haven’t had the pain since the VM treatment, so I’ll keep my fingers crossed.

One of the many ah-ha moments I had during my training was the fact that internal organ restrictions can influence the individual ribs. Take for instance a rib that keeps “going out”. The chiropractor has to adjust it back into place every so often, but it doesn’t stay. The cause is not the rib itself, but most likely is restrictions in the parietal pleura that attaches to the chest wall…or restrictions in the liver, stomach or other organ depending on which rib is affected. For instance, restrictions in the pleural dome can cause the first rib to be pulled out. Google an image for costo-pleural ligament and you will see why. The Costo-pleural ligament undergoes movement with every breath. If it is restricted, it’s easy to see how it can interfere with natural rib function.

Once again, the root of the problem is not always where the pain is.

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