Autonomics

Question 1

Sympathetics

Answer 1

“Fight or Flight”
T1-L2 (aka thoracolumbar)
The sympathetics excite organs that are stimulated during physical activity, but inhibit organs whose activity increases at rest.
Sympathetics innervate the limbs
Upper limb: T2-5(6)
Lower limb: T10(11)-L2(3)

Question 2

Parasympathetics

Answer 2

“Rest and Digest”
Cranial nerves:
CN III, VII, IX, X
Sacral segments:
S2-4
The parasympathetics excite organs that are stimulated while the body is at rest, but inhibit organs stimulated by physical activity.
The parasympathetics do not have significant innervation to the extremities

Question 3

Parasympathetic DUMBBELS

Answer 3

Diarrhea/Defecation
Urination
Meiosis--Pupils Contract
Bradycardia
Bronchospasm
Emesis
Lacrimation
Salivation

Question 4

Appreciate the OA

Answer 4

OA = occipito-atlantal joint
Movement of the occiput on the atlas (C1)
Similarly, the AA is the atlanto-axial joint
Movement of the atlas (C1) on the axis (C2)
When treating the autonomics, never forget the OA
We “Balance” the autonomics. We do not turn one side on and one side off.

Question 5

Why do the Osteopaths Care?

Answer 5

The body has self-healing, self-regulatory mechanisms:
The body is always striving for autonomic balance – that’s why there is negative feedback and checks & balances in our neuroendocrine system.

Structure and function are interrelated:
By optimizing the structures that affect the autonomic nervous system, we can optimize the function.

Question 6

Reflex

Answer 6

Def: An involuntary and nearly instantaneous movement in response to a stimulus.

Question 7

Visceral Afferents

Answer 7

Visceral irritation
Message of irritation travels back on bifurcating neuron
Synapses on somatic motor neurons and causes muscle contraction
Releases proinflammatory polypeptides at that level
Prolonged stimulation can lead to facilitation

Question 8

Facilitation: A Key Phenomenon

Answer 8

“Facilitation indicates an area of impairment or restriction develops a lower threshold for irritation and dysfunction when other structures are stimulated.”
Facilitated segments are hyper-irritable and hyper-responsive.
Muscles are maintained in a hypertonic state.

Question 9

four reflex interactions

Answer 9

somato-somatic
somato-visceral
viscero-visceral
viscero-somatic

Question 10

Somato-Somatic

Answer 10

localized somatic stimuli producing patterns of reflex response in segmentally related somatic structures.
DTRs
Withdrawal Reflex
T5 dysfunction caused by tight linea alba

Question 11

Somato-Visceral

Answer 11

localized somatic stimulation producing patterns of reflex response in segmentally related visceral structures.
Spinal Manipulation  changes in HR, BP, and sympathetic activity to kidney and adrenal medulla

Question 12

Viscero-Visceral

Answer 12

localized visceral stimuli producing patterns of reflex response in segmentally related visceral structures.
Gut Distention  Gut Contraction
Baroreceptor Reflex  Blood vessel stretch change causes change in heart rate

Question 13

Viscero-somatic

Answer 13

localized visceral stimuli producing patterns of reflex response in segmentally related somatic structures.
Cardiac Disease  Somatic Dysfunction at T1-5

Question 14

non-neutral (type II mechanics) are often

Answer 14

viscero-somatic reflexes

Question 15

referred pain

Answer 15

aka reflexive pain

Convergence-Projection Theory
Visceral and somatic afferents converge on the same or associated neurons or interneurons in the spinal cord
Can follow a viscero-somatic pattern (MI –> Left Arm)
Or a somato-somatic pattern (Gallbladder –> Diaphragm –>Phrenic Nerve –> Right Shoulder

Question 16

Trigger Points

Answer 16

Def: Hyperirritable spot in skeletal muscle that is associated with hypersensitive palpable nodule in a taut band.
Painful on compression with radiating or referred pain, tenderness, motor dysfunction, and autonomic phenomena
2 classifications
Active: refer pain at rest, with muscular activity, or with palpation
Latent: produce pain only when probed with more steady pressure
Treat with inhibitory soft tissue, deep massage, dry needling, injection with steroids and/or anesthetic, isometric MET, vapocoolant spray with myofascial stretch

Question 17

“Jump sign”

Answer 17

Pt response to pain: wince or voluntary withdrawal

Question 18

“Local twitch”

Answer 18

Transient contraction of the taut band of fibers with the trigger point
Presence differentiates between trigger point and fibromyalgia syndrome

Question 19

Tender Points

Answer 19

Def:
Small, hypersensitive points in the myofascial tissues of the body.
Can be used as diagnostic criteria and treatment monitors.
Initial injury causes sudden unanticipated lengthening of the antagonistic muscle to the originally strained and painful agonist muscle.

Question 20

finding and treating tender points

Answer 20

Location of tender points is consistent between pts
Suggests anatomic basis
Within myofasical structures
Tendons, ligaments, muscle bellies
Sensitive to palpation
Related to nociceptive activity
Localized without radiation
Treat with counterstrain
Resets proprioception via golgi tendon organs and muscle spindle fibers

When the optimal position of comfort is established, the tenderness disappears or becomes insignificant. Indicates a neural relationship b/w the tender point and SD.

Question 21

Chapman’s points

Answer 21

Def: A system of reflex points that present as predictable anterior and posterior fascial tissue texture abnormalities (plaque-like changes or stringiness of involved tissue) assumed to be reflections of visceral dysfunction or pathology.
Multitude of mechanisms explaining
Lymphatic abnormalities, inflamed lymph vessels passing over bone, fibrositis deposits, inflamed nerve endings, and inflamed sympathetic nerve filaments around terminal arterioles

Question 22

more on chapman’s points

Answer 22

Dr. Chapman called them gangliform contraction due to congestion within fascia due to lymphatic stasis secondary to visceral dysfunction
Part of a viscero-somatic reflex
Believed to be part of sympathetic dysfunction
Found in regions which overlap with visceral sympathetic efferent innervation

Overall, there is a general consensus that a Chapman’s reflex involves the lymphatic and neurologic systems and the tissue texture changes associated with visceral dysfunction

Question 23

gangliform vs ganglion

Answer 23

Gangliform vs. ganglion

• gangliform – not a nerve and not a cyst; but it is a rounded contraction
• ganglion – part of a nerve, or ganglion cyst

Ex: Excessive input from a viscera of the head or neck produces facilitation of the upper thoracic cord segments and results in reflex stimulation of somatic tissues innervated by T1-4 (viscero-somatic reflex). Palpatory changes in the upper thoracic and cervical paraspinal tissues as well as traditional Chapman’s reflex locations therefore indicate increased functional activity of the sympathetic nervous system in this region. Pg 3 Kuchera Osteopathic Considerations in System Dysfunction

Question 24

chapman’s points again

Answer 24

Small, smooth, firm, discrete nodules in fixed anatomic locations
Deep to skin and subcutaneous areolar tissue on deep fascia or periosteum
Feel like a BB or split pea
Usually paired anterior and posterior
Anterior points often painful with light compression

Often tender, but don’t radiate
“Tenderness is not the sole criterion for a Chapman’s point; rather, it is lymphatic congestion and altered myofascial texture”
Treatment: firm, circular pressure
Attempt to flatten
10-30 sec

Question 25

diagnosis, treatment and evaluation w/ chapman’s points

Answer 25

Used for diagnosis, treatment, and evaluation:
For diagnosis - Presence of CP could indicate visceral pathology (ex: gallbladder disease)
For influencing the motion of fluids, mostly lymph
For influencing visceral function through the peripheral nervous system