The Mediastinum Matters More Than You Think
In this episode of the Unreal Results podcast, I dive into the bronchus, trachea, pleura, and mediastinum, breaking down how these “tubes” influence pain, movement, and posture in ways you might not expect. You’ll hear why addressing the bronchus can help with everything from shoulder and neck pain to foot pain, and why the mediastinum is one of the most powerful areas to assess and treat for whole-body changes.
I share practical, immediately applicable insights on how to approach the bronchus and mediastinum in treatment, what anatomical connections you can’t afford to miss, and why restoring the thoracic curve is crucial for improving dynamic alignment and breathing in your clients.
Whether you’re working with complex pain cases, high-level athletes, or the everyday person, this episode will help you see the lungs and bronchus as powerful tools in your treatment approach. Tune in to learn practical ways to create change beyond local symptoms and elevate your outcomes with a true whole-body lens.
Resources Mentioned In This Episode
Episode 9: Left Side Sciatica or Right Side Shoulder Pain?
Episode 61: The Lung Connection To Foot Pain You Didn't Know About
Episode 91: Diaphragm Details That Unlock Thoracic Mobility
Get the Visceral Manipulation Book by Jean-Pierre Barral
Get the Coregeous Ball, & Other Tools I Talk About HERE*
Treatment Video: Root of Tongue Self-Massage
Treatment Video: Hyoid Stretch
Treatment Video: Bronchial Tube Stretch
Learn the LTAP™ In-Person in one of my upcoming courses
*This link is an Amazon affiliate link, meaning I earn a commission from any qualifying purchases that you make
Considering the viscera as a source of musculoskeletal pain and dysfunction is a great way to ensure a more true whole body approach to care, however it can be a bit overwhelming on where to start, which is exactly why I created the Visceral Referral Cheat Sheet. This FREE download will help you to learn the most common visceral referral patterns affecting the musculoskeletal system. Download it at www.unrealresultspod.com
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Anna Hartman: Hey there and welcome. I'm Anna Hartman and this is Unreal Results, a podcast where I help you get better outcomes and gain the confidence that you can help anyone, even the most complex cases. Join me as I teach about the influence of the visceral organs in the nervous system on movement, pain and injuries, all while shifting the paradigm of what whole body assessment and treatment really looks like.
I'm glad you're here. Let's dive in.
Hello. Hello. Welcome back to another episode of the Unreal Results Podcast, um, for this little movement, movement snack. It's not a movement snack, it's podcast snack. Um, we're talking about the bronchus and, and mainly the bronchus. Um, the trachea, the bronchi. The tubes of our breathing apparatus and maybe touching a little bit on the pleura of the lungs and the mediastinum, um, to sort of like bring it all practical and functional.
So the reason I want to talk about this is shout out Julie Arriola, my favorite massage therapist here in San Diego, um, and one of the certified LTAP. Providers, um, she requested for these podcast snacks to each episode be a quick on one specific organ and all the things. And so I'm like, yeah, sure.
That'll be easy. No, I don't know if this is gonna be easy, but I'm gonna try and, of course, what I do forever podcasts when I. I want to share information on the anatomy. I go back to the books and I read and look at pictures and as if I need more information in my head, I gather more information. And really it's more to be like, am I missing anything?
Is there anything else to say? And is there a better way to assimilate this all together? Um, so I just read the chapter on the thoracic cavity in. The original visceral manipulation book. I'll have Joe link that in the show notes. Um, I think you can buy those on Amazon, but it's gonna be cheaper and easier to just go directly to the Barral Institute than using Amazon for those.
Um, but anyways, um, why I wanna talk, bro, the bronchus is 'cause um, the last few patients I've had, it's come up a lot. Oftentimes the right bronchus will come up. Um, when there's been a history of allergies or asthma, I see it a lot during the springtime. I will say here in San Diego, we are having, actually, even in Annapolis, when I was in Annapolis for the last, for the month of May, we're having a late spring.
Um. I'm like, maybe that's why I am seeing these things now. Because really when spring started in March, um, I didn't see as many of these, um, the body directing me into this area as I have in past years. So I'm starting to see this now. A lot of right bronchus and lung. I have a whole podcast episode on that called Right Shoulder Pain and Left Sciatica, I believe is the podcast.
I'll have Joe link that in the show notes too. Um. But anyways, so I'm wondering if that's sort of like why I'm seeing all this right bronchus things. Um, just because we're having a little bit of a late spring. So with that said, um, let's talk about the bronchus. So the, the bronchus are the large tubes that come off the trachea.
Uh, trachea obviously is what connects our nose and our mouth. To our airway. Um, they are large tubes. They have cartilage rings from the whole way down from your, um, neck, you know, your mouth neck, um, all the way into the, um, tubes that go into the different lobes of the lung, the, a little to orient yourself.
So it comes straight down and a. Slightly, I wanna say slightly to the right, um, of midline typically on people, and then it bifurcates at the sternum ubal junction. The sternum ubal junction is the junction between the manubrium and the sternum. It's sometimes called the angle of Louis. It's right at the second rib posterior.
That would be at the level of T four, T five, so thoracic fourth or fifth vertebrae. So at that spot, it bifurcates into the right bronchus and the left bronchus. The right bronchus is more vertical as a more oblique angle, um, as it goes down into the right loaves of the lung and that tube goes. As it goes inferior, it goes from being more anterior to more posterior.
So the end of the tube is more posterior, then the beginning of the tube is more anterior. And then on the left bronchus, the left bronchus has a flatter angle because it um. Needs to allow for the room for the heart. And actually it's pretty flat in the, um, some of the tubes of the heart go right over the top of it.
So it is actually the longer tube, um, but it is not as oblique and it still goes from anterior to posterior as it descends. So there is definitely three dni, 3D ness to this. I love treating the bronchus. In a more three-dimensional way. Um, I'll do it laying on the table. But the, actually, the benefit of doing treatment on the bronchus, lying on the table is you have the table acting as some hands for you.
So the pressure from the back side of the table in, in your mind's eye, you're just wanting to find some 3D ness. If I don't have them lying on the table, I love to have them in three dimension. Excuse me. In a seated position, so I can have one hand anterior and one hand posterior, finding that tube and stretching it from a three dimension.
That way. You've heard me say many times on the podcast, if it's a tube, it loves to be stretched. So most of the time when we're doing treatment in this area, we're stretching the tubes away from each other. So. Anterior to posterior, superior to inferior on the lines of those oblique angles. So on the right it's gonna be more vertical.
On the left, it's gonna be a little bit more horizontal, and then we're going this way, three dimensional. From that bifurcation point, bifurcation points tend to be very powerful spots for treatments as well. So that sternomanubrium junction is gonna be a really powerful spot to treat too, which brings us back to the mediastinum.
The mediastinum is interesting. I, it is one of my favorite treatment things. To do on people and to give out to people. And it makes a huge difference for the whole body. And I, and this is probably like the gem I learned from reading the chapter this morning or today is on the thoracic cavity and the visceral manipulation book is the thought process, not the thought process.
The way the ligamentous system works in the mediastinum that holds the lungs like that, that connects the lungs together, that maintains the space for the pericardium. And the, um, in relationship to the diaphragm is very important because the old, I don't know what the, say, the old way of thinking, but there's this thought process as of when we take an inhalation, our diaphragm drops down.
That's what changes the pressure on the visceral organs and brings the air in, which is not wrong, but. In the area of the mediastinum, it actually is a fixation, like a, a, a fixed point that maintains what they call phrenic center, and it maintains the center of where the diaphragm is to maintain the space and re maintain the structure, structure of the mediastinum more than likely for the heart.
And so. Why am I sharing this? Why is this like so profound? Because the mobility of the diaphragm is dependent then on the mediastinum being able to function really well and maintain that phrenic, central phrenic center for the function of the visceral organs. So if you're dealing with diaphragm, stiffness, diaphragm, I'm just gonna say diaphragm stiffness.
Or you're wanting to improve people's three-dimensional breathing, diaphragm function, diaphragm as a postural stabilizer. Why? Whatever reason you're focusing on the diaphragm. And we talk about that a lot in an episode. I'll have Joe link in the show notes I did not too long ago, all about the diaphragm.
Um, but you better be addressing the mediastinum and the mediastinum is that space where the tubes. Live in the pericardium legs lives. So tubes, meaning trachea, bronchial, um, pulmonary arteries and veins, uh, aorta, vena, cva, um, esophagus, all of those tubes that lives in the mediastinum. It is a very high payoff spot for all treatment.
And so, so often if I'm working on someone that has any sort of visceral, I hate using the word restriction, but any sort of like visceral disinformation leading to pain or osteoarticular issues or, uh, musculoskeletal stuff or movement patterns, whatever it may be. We want to restore the curve of the thoracic spine because that is intimately the same as making the mediastinum happy.
So, um, that sternomanubrium junction, that's a really important spot to do. That means going back to the relationship on the spine, that area of T four to T five, really between T one and T six, I would say is the sweet spot. If you're not looking for and addressing normal mobility at the intervertebral discs, the cost of vertebral joints, the costotransverse joints in this area, you're missing a huge piece in treating the whole body, treating the diaphragm, treating the neck, treating the upper extremity.
Affecting the tubes of the bronchus, which is the whole reason I started this talk. So it really needs to be addressed. And on that note, not only understanding how powerful the mediastinum is, is maintaining this space and mobility of the diaphragm. And whenever we maintain mobility of the diaphragm, this means that we're also optimizing mobility of and therefore motility of the lungs.
Um. In the heart, in the pericardium, but we're also affecting the whole body. And um, I. The cool thing is too, when you look at even the bronchus, the trachea, the related spinal segments, right, the visceral somatic reflexes are gonna be between T two and T five, so you should be checking those areas anyways as a way to improve the information to these visceral structures or from these visceral structures to the spinal card and the brain itself.
So it's also one of those things, and I've talked about this a lot whenever I've talked about the thoracic cavity or any organs that live within the thoracic cavity because they are in such a hard frame, it is really important to do treatment on that container. If we want to affect the contents. This, this idea of the relationship between content
and container I talk about a lot inside the ltap level one course. Inside the mentorship, just when I'm working with people, we always have to look at the whole body. It's almost like looking at the body as structure and function is like container and contents. How can we affect the container? And how affecting the container would affect the contents, and then how can we affect the contents and how does what's going on with the contents then affect the container.
It is like a very symbiotic, integrated relationship. Therefore, we can choose treatment techniques to affect either and have an effect on both, which is what opens up so many opportunities for you, especially if you're not trained in visceral manipulation. If you're here, if you're a physical therapist or an athletic trainer, you probably know how to affect the hard container, the, the joints of the thoracic spine, the joints, uh, or the ribs, the relationships of the ribs to the intercostals, right?
So, um, that's something that we should be checking. And on that too, one of the places that we can really palpate the, these visceral organs that are in the thorax that we're talking about, the, the lungs. The pleura, sorry. The lungs of pleura in the bronchials is in the neck. The pleural dome comes the, the fascia, the like fibrous, fascial container that connects the pleural dome, the sack that the lungs live inside attaches to the first rib.
The. The cervical spine at C six and C seven, as well as the scalings, so that means all the way to C two. The entire bulk of the scalenes can affect the viscera. This is why probably a lot of people end up wanting to work on people's scalenes, but taking a step back and maybe addressing the mediastinal space first, or the tubes within the thorax first.
Or at least at posterior mep, spinal sti mediastinal space, you might find that the scaling sort of melt because again, they're the muscle. And even though those ligaments attached to it, if they're going to be tight, it's often from a reflexive reason. Okay. Um, so the other thing to think about too is just the.
Affecting the trachea and the fascia in the neck. I'm not a big, like, let's go to the neck, but if I'm gonna go to the neck, it's gonna be in a very specific way affecting the cervical fascia to affect the cranium or affect the thorax. And so, um, Jill Miller's neck anew, the Coregeous ball and neck nar with the yoga tune-up balls, those are two
correctives that I think are really high bang for your buck, especially if you don't know visceral manipulation to affect the entire container of the neck and the pleural dome, especially when you pair that with mediastinum and stretching in the bronchus. So I'll make sure, I think I have videos of all of that.
I'll make sure that Joe links it in the show notes for you. Um, but man, treating this area of the body is. So powerful. So powerful. I even too, have a video somewhere I'll find for you all of stretching. The hyoid bone, the hyoid bone, um, connects the mid cervical fascia, which extends down into our mediastinum and into actually into our clavicular pectoral fascia.
But it is a way to affect the trachea because the backside of the mid cervical fascia attaches to the prevertebral fascia, which is the fascia that is around the trachea. So that is another way that we can affect it. So root of tongue massage, hyoid stretch, these are all really great ways to affect this.
The, these structures in the upper thoracic cavity. When you really start learning the anatomy and you're seeing how everything connects, it really is like, I have so many tools to treat it. I don't know, like, and when I'm talking about so many tools, like I'm not even talking about a lot of visceral manipulation, but like you're just like, you should feel excited about how to treat this area.
So, and like I said, this has been coming up a lot. Anything for people that have foot pain. To back pain, to neck pain, to thoracic outlet symptoms like it's been kind of across the board. The most traditional referral for bronchus lungs in general is gonna be shoulder pain, neck pain, upper back pain. So, um, but remember, just because there's a somatic referral.
Doesn't mean there's always going to be that relationship. And then also remember the way our body organizes itself around these areas of protection or proprioceptive, disinformation, um, changes our dynamic alignment. And that's why like so many of my athletes come in with foot pain and like I treat their lung and then their foot feels better.
There's not a direct visceral, somatic reason for that, but there's definitely a biomechanical one. Of when we change our dynamic alignment around a different structure, right? And this occurs in the lungs quite a bit. So happy lung exploration. See you next time.