Stress points all along the human body
Stress points all along the human body

Massage & Stress: Understanding Viscerosomatic Reflexes

By Dale G. Alexander , LMT, MA, PhD

Massage & Stress: Understanding Viscerosomatic Reflexes

By Dale G. Alexander , LMT, MA, PhD

This article series started by identifying the possible and most probable visceral organ(s) related to a client’s chronic pain, along with any associated joint(s). Next, we considered how addressing the protective soft tissue components may yield quicker and more sustained results.

Now, we are ready to move toward understanding the role viscerosomatic reflexes play in your ability to more effectively help your clients who suffer from chronic dysfunction and pain.

Viscerosomatic Reflexes: Early Thinking and Continued Growth

As massage therapists, our primary goal is to help our clients feel better, help their bodies more effectively tap into its own healing process. The viscerosomatic reflexes are part of this process.

Sir Zachary Cope published “Cope’s Early Diagnosis of the Acute Abdomen” in 1921, a book that helps correlate how the visceral organs signal their damage or progression toward disease within the neural net of the spinal cord(4). Cope’s work was updated in 2010, Dr. William Silen.

The notion of progression toward disease is my language, and a phrase I developed because of what I was noticing in my own clients. As massage therapists, we of course are not diagnosing disease, but careful assessment can reveal visceral problems that require we refer a client to their physician for evaluation.

My interest in this style of critical thinking was further cemented during my seven years of training at the Upledger Institute. Drs. John Upledger, Richard MacDonald, and Jean Pierre Barral—all osteopathic physicians—inspired me to include these reflexes into my treatment perception and strategies.(2) 

Additionally, 30 years of study with Lansing Barrett Gresham and 25 years of working in daily collaboration with Dr. Debra Flynn, D.C., further assisted my comprehension of this important principle. Balancing and re-calibrating the anatomical, neurophysiological, and energetic relationships inside the human body are necessary skill sets to aid the healing of stubbornly chronic problems. (1,2,3) 

Additionally, my clients’ successful recoveries also taught me just how important understanding these reflexes are to helping them return to normal activities. In fact, in my experience, knowledge of these reflexes has actually saved the lives of more than a few who I encouraged to seek additional medical testing when my best efforts failed.

Viscerosomatic Reflexes: What They Can Tell Massage Therapists

Chronic somatic problems often originate from within our bodies, unless they are an obvious result of a previous traumatic incident. Even then, I pay attention to the viscerosomatic reflexes because I know that chronic problems can have multiple causes.

It is commonly accepted, for example, that the left shoulder can serve as an indicator of heart-related distress.(5) Another accepted referral pattern is reflected by a band of pain just below the inferior scapular angle, which may serve as a tip off to pancreatic dysfunction and usually relates to vertebral and rib dysfunction between T5–T9.(6) 

In my experience, the pancreas most often refers to the left shoulder, as its mooring is to suspensory ligaments that also interconnect the stomach, spleen, the suspension of the descending colon and, of course the left hemi-diaphragm muscle itself. Thus, any of these left-sided organs—and even the aorta—may be related to the left upper extremity dysfunction or to the left-sided myofascial structures between the shoulder blades. 

The right shoulder and upper back serve as medically verified referral sites for liver and gall bladder distress and disease.(6) Additionally, my clinical experience evidences that neurological referral along the same pathway conveys the congestive tensions of the common bile duct, and many difficulties that may afflict the uterus.(7)

Certain organs, too, more commonly influence lower back and lower extremity dysfunction and pain, especially chronic hip and knee troubles. These include the small and large bowel, appendix, ovaries, uterus, bladder, testes and the prostate. Any of these visceral organs may be afflicted with genetic anomalies, infections of all sorts, cyst formations, blockages, or even cancer.

Let’s now shift our attention to the kidneys. The most frequently evidenced viscerosomatic indications of kidney troubles relate to somatic complaints of low back, groin, knee, and persistent ankle/foot pain. Questioning clients about their blood pressure is an especially important as the kidneys both play a functional role in maintaining blood pressure and may be adversely affected by uncontrolled hypertension. When blood pressure remains elevated, the extremely small blood vessels within the filtering units of the kidney are destroyed which can lead to kidney dysfunction or failure over time. (8,9)

The present focus on regional pain relief has overshadowed the need for massage therapists to understand and develop the skill sets, including the capacity to mobilize the viscera and joint structures, to restore systemic homeostasis. Studying and understanding the matrices of viscerosomatic reflex arcs has been an invaluable tool toward my capacity to assist clients with stubbornly chronic difficulties.


The next article in this series on stress will further illustrate these themes with case studies of a few clients’ paths toward recovering their quality of life. The body is an integrated whole, especially when viewed from the inside to the outside.    



1.     Lansing Barrett Gresham, founder of Integrated Awareness®,

2. /

3.     Dr. Debra Flynn D.C., collaboration with mutual patients/clients…1980-2003.

4.     Cope’s Early Diagnosis of the Acute Abdomen, William Silen M.D., Oxford University Press, 2000


6. Atlas of Human Anatomy, Frank Netter M.D., Ciba-Geigy, 1989. Plates 313 - 14.

7 Dr. Jean Pierre Barral D.O., Developer of Visceral Manipulation. All books, Eastland Press,                                  Course notes 1986-93. Excellent instructors.

8 How the Kidneys Work in Maintaining Blood Pressure   

9. High Blood Pressure & Kidney Disease | NIDDK