several patients, with successful results gradually leading him to develop Visceral Manipulation.Between 1975 and 1982, Barral taught spinal biomechanics at England’s European School of Osteopathy. In collaboration with Dr. Paul Mathiew and Dr. Pierre Mercier, he published Articular Vertebrae Diagnosis.Using his work with Dr. Arnaud as a foundation, Barral continued to investigate how the thickening of tissues in the body creates areas of greater mechanical tension that, in turn, pull on surrounding tissues. That discovery led him to the theoretical and practical development of visceral listening techniques.Barral’s development of manual thermal diagnosis began in 1971 during another treatment session. While turning a female patient, he felt a strong emanation coming from her mammary gland. He learned she had been operated on for a tumor in that area. Researching this phenomenon with other patients, he discovered just how accurately areas of stress in the body could be located by palpating the associated energy, which proved to be thermal. Consequent research has added manual thermal diagnosis to many practitioners’ diagnostic tools.With the help of Dr. Serge Cohen, a Grenoble radiologist, Barral also documented changes in the viscera before and after manipulation. They employed x-ray fluoroscopy and ultrasound to record changes in position, motion, and fluid exchange and evacuation. Later they conducted additional research with a team of electrical engineers and technicians using infrared emissions from the body.Jean-Pierre Barral began teaching Visceral Manipulation in the United States in 1985 through The Upledger Institute, Inc®. He established the Barral Institute to continue his work to educate, train and research Visceral Manipulation, Nerve Manipulation and related Manual Therapies while maintaining a full clinical practice. Dr. Barral has authored numerous textbooks, including: Visceral Manipulation, Visceral Manipulation II, Urogenital Manipulation, The Thorax, Tubo-Ovarian Manipulations, Manual Thermal Diagnosis and Trauma: An Osteopathic Approach (co-authored by Alain Crobier, D.O.).Thanks to his pioneering work, candidates in several European countries must now pass a rigorous test in Visceral Manipulation to earn a diploma in osteopathy.Visceral Origin: An Underestimated Source of Neck Pain. A Systematic Scoping Review Ángel Oliva-Pascual-Vaca 1 , Carlos González-González 1 , Jesús Oliva-Pascual-Vaca 1,2,3,*, Fernando Piña-Pozo 3 , Alejandro Ferragut-Garcías 4 , Juan Carlos Fernández-Domínguez 4 and Alberto Marcos Heredia-Rizo 1 1 Department of Physiotherapy, Faculty of Nursing, Physiotherapy and Podiatry, University of Sevilla, 41009 Sevilla, Spain; angeloliva@us.es (Á.O.-P.-V.); gonzalez.salle@gmail.com (C.G.-G.); amheredia@us.es (A.M.H.-R.) 2 Escuela de Osteopatía de Madrid, 28002 Madrid, Spain 3 Department of Physiotherapy, Universitary School of Osuna, University of Sevilla, 41640 Sevilla, Spain; ferppozo@hotmail.com 4 Department of Nursing and Physiotherapy, University of the Balearic Islands, 07112 Palma de Mallorca, Spain; alejandro.ferragut@uib.es (A.F.-G.); jcarlos.fernandez@uib.es (J.C.F.-D.) * Correspondence: joliva5@us.es Received: 3 October 2019; Accepted: 6 November 2019; Published: 12 November 2019 Abstract: The diagnosis of neck pain is challenging. Many visceral disorders are known to cause it, and clinical practice guidelines recommend to rule them out during neck pain diagnosis. However, the absence of suspicion of any cause impedes one from establishing that specific aetiology as the final diagnosis. To investigate the degree of consideration given to visceral aetiology, a systematic search of trials about neck pain was carried out to evaluate their selection criteria. The search yielded 309 eligible articles, which were screened by two independent reviewers. The PEDro scale score was used to assess the methodological quality of the studies. The following information was retrieved: number of authors affiliated to a clinical or non-clinical institution, number of citations in the Web of Science, study aims, characteristics of participants, and eligibility criteria. The top 15 most cited trials, and the 15 most recent studies about treatment efficacy in neck pain, published in first quartile journals of the Journal Citation Reports, were selected. Females represented 67.5% of participants. A single study was of poor methodological quality (4/10). Based on the eligibility criteria of the articles that were systematically reviewed, it would appear that visceral aetiology was not considered in eighty percent of the trials on neck pain, showing a low level of suspicion both in research and clinical settings. Keywords: referred pain; visceral pain; diagnosis; phrenic nerve; neck pain 1. Introduction Neck pain (NP) constitutes a major health problem. Its prevalence varies from 4.8% to 79.5%, and is more common in females and in high-incomes countries [1]. It is ranked the 4th most disabling condition as measured by years lived with disability [2]; hence, it poses a substantial economic burden due to extended periods of sick leave and high use of health services [3]. Those individuals with a precise pathoanatomical cause for their NP, e.g., radiculopathy [4,5], facet joint pain [6], chronic rheumatic diseases [7], or cancer, are categorized as having specific NP. Yet, patients without a well identified source for their NP are labelled as having idiopathic, mechanical, or non-specific NP, which is the most common type [8]. As a sign of visceral suffering, pain originating in internal organs is amongst the most frequent forms of pain experienced by individuals in the course of life, and pain involving internal organs Diagnostics 2019, 9, 186; doi:10.3390/diagnostics9040186 www.mdpi.com/journal/diagnostics Diagnostics 2019, 9, 186 2 of 23 is a major occurrence in the clinical setting [9,10]. The rule in visceral nociception is that pain is referred to somatic tissues, being felt at a site other than the affected viscera [10]. Visceral referred pain (VRP) occurs, as secondary hyperalgesia, in somatic areas neuromerically connected with the affected organs [10]. The overlap of somatic and visceral afferent information into a shared neural pathway seems to be related to a misinterpretation at peripheral, spinal, or supraspinal