The Thorax

This book is the third volume in the authors widely acclaimed exploration of the osteopathic implications of dysfunction of the trunk. While his previous books focus on the abdomen, here the author turns his unique gaze to the thoracic cage and its contents. This area of the body has been of particular interest to Barrel ever since he started working in pulmonary hospital as a physiotherapist prior to osteopathic school.

Barrel begins by describing the thorax as an area of conflict and contrast: it must protect the organs enclosed within, yet must also allow exchanges with the neck and abdomen. Problems with either of its dual roles of protection and exchange lie at the root of most thoracic disorders. Because many of the conflicting forces come into play at the cervicothoracical junction with its myriad muscular, facial, vascular and nervous tissues, this area is given special attention. A brief overview of the origins of thoracic restrictions is followed by a detailed and superbly-illustrated tour of the applied anatomy of the thorax, including the osteoarticular, muscular, facial, visceral, vascular and nervous systems. The emphasis is on those structures which the author regards as the most important from the standprint of manipulation. After discussing the effect of the plura and myofasical system in the dynamics of respiration, Barrel describes some of the pathologies of the thorax. This material supplements more conventional texts with the author's own perspective on a variety of problems from an osteopathic point of view. A chapter on manual diagnosis elucidates many important and easily-performed tests that help localize restrictions to the precise tissues involved. Among the special test, general and local listening of the thorax, and the utilization of various access points for the phrenic nerve. A final chapter provides detailed instructions for manipulative techniques in treating restrictions of the various structures of the thorax. As in his previous works, the application of these techniques is presented in Barrel's clear and clinically-based style.