Autonomics and Somatic Reflexes: 1/7 Flashcards
ganglia
collections of cell bodies outside of the CNS
PS nervous system
- “craniosacral ANS”
- Rest and Digest
- Four CNS: III, VII, IX, X
- Sacral segments S2-4
- long preganglionic neurons synapse in terminal ganglia
- ACh NT
PS Dumbbells
diarrhea/defecation urination meiosis (pupils contract) bradycardia bronchospasm emesis lacrimation salivation
Occipto-Atlantal joint
- head resting on cervical spine
- treatment of PS, think about treating the OA, and treat the vagus
- provide balance of autonomics
Jugular foramen
- where the vagus nerve comes out of the skull
Sympathetics
- “thoracolumbar ANS”
- fight/flight
- T1-L2
- short preganglionics (Ach) with Long Postganglionics (NE)
- paraspinal and prevertebral ganglia
- excite organs stimulated during physical exercise, and inhibit organs that are activated at rest
- cell bodies of of sympathetics are found in the IMLCC
sympathetic ganglia
- chain ganglia
- white ramus: myelinated: preganglionic (T1-L2)
- gray ramus: demyeliniated : postganglionic
- ganglionic impar: termination of ganglia at coccyx
Enteric NS
“the brain of the gut”
- submucosal plexus (secretions)
- myenteric plexus (contractions and peristalsis)
Visceral affarents
- nociceptive fibers that travel with sympathetics
this is the basis of referred pain and facilitation - non-nociceptive affarent fibers travel with the PS (i.e. Vagus n.)
four reflex interactions
- somato-somatic reflex: skeletal muscle affecting skeletal muscle. i.e withdraw reflex, gallbladder referral to right shoulder
- viscero-visceral reflex: - gut distension –> gut contraction.
- baroreceptor reflex –> decreased HR and vasodilation
* **3. viscero-somatic: cardiac disease –> somatic dysfunction T1-5 F/E RSL - Somato-Visceral: spinal manipulation –> changes in HR, BP, and sympathetic activity to kidney and adrenal medulla
convergence projection theory
“referred pain”
- visceral and somatic afferents converge on the same or associated neurons or interneurons on the spinal cord
- can follow a viscero-somatic pattern (MI –> left arm)
- or a somato-somatic pattern (gallbladder–> diaphragm–> phrenic n. –> right shoulder)
make slides for the “crux of the matter”
Visceral pathology creates somatic changes/dysfunction within the distribution of an organ’s sympathetic innervation because the small caliber visceral afferent nociceptors travel with the sympathetic nerves. The resulting overlap with somatic neurons in the spinal cord allows for viscero-somatic interaction and the production of associated somatic dysfunction. This is important both as a diagnostic tool and as a portal to access and treat visceral dysfunction.
visceral somatic reflexes are often seen in what type of lesion?
more often cause non-neutral Type II lesion
- will often have a “rubbery” end feel and may not be responsive to HVLA b/c they are maintained by muscular restriction rather than articular restriction
facilitation
- indicates an area of impairment or restriction that develops a lower threshold for irritation and dysfunction when other structures are stimulated
- facilitated segments are hyper-irratable and hyper-responsive
- if have heart irritation, pain fibers of heart are hypersensitive, and will result in a somatic dysfunction
- muscles are maintained in a hypertonic state due to viscero-somatic reflex
- facilitation raises the baseline resting membrane potential, action potentials are generated more easily
SOB due to asthma, what segment is facilitated?
T4 FRSR: look for Type II lesions
stomach ulcer, which segment facilitated?
T5 ERSL
Pupils
symp: T1-2
PS: CN III
Facilitation T1-4
Sinuses
S: T1-4
PS: CN VII
Fac: T1-4
carotid body, sinus
S: T1-4
PS: CN IX, X
F: T1-4
lacrimal, salivary glands
S: T1-4
PS: CN VII, IX
F: T1-4
trachea, bronchi
S: T1-6
PS: CN X
F: T1-6
heart
S: T1-4/5
PS: CN X
F: T1-6
upper extremity
S: T2-5/6
no PS
F: T2-6
Lungs/Visceral Pleura
S: T2-6
PS: CN X
F: T1-6
esophagus
S: T2-8/10
PS: CN X
F: T1-6
Gallbladder
S: T5-9
PS: CN X
F: T5, R
stomach
S: T5-9
PS: CN X
F: T5-9 L
liver
S: T6-9
PS: CN X
F: T 5 R
spleen
S: T6-8
PS: CN X
F: T7 L
Pancreas
S: T6-9
PS: CN X
F: T7 R
Adrenal glands
S: T6-9
PS: CN X
F: T10-11
small intestine
S: T8/9 - 11/12
PS CN X
F: T10-11
ascending transverse colon
S: T10/11-L1/2
PS: CN X
F: T10-11
urinary bladder
S: T10/11-L1/2
PS: CN X
F: T12 - L2
Kidneys
S: T10-L1
PS: CN X
F: T10-11
Ureters, proximal
S: T10-L1
PS: CN X
F: T10-11
Testes/Ovaries
S: T10-L1
PS: CN X
F: T10-11
Uterus
S: T10/11-L2
PS: S2-4 Pelvic splanchincs
F: T10-L2
LE
S: T10/11-L2/3
PS: none
F: T10-L3
Appendix
S: T10
PS: CN X
F: T12
ureters, distal
S: T12-L1/2
PS: S2-4 Pelvic splanchincs
F: T12-L1
descending, sigmoid colon, and rectum
S: L1-2
PS: Pelvic splanchnics
F: T12-L2
prostate
S: L1-2
PS: S2-4
F: T12-L2
Large caliber myelinated Primary affarent fibers
ex. Type A, beta
- conduct low-energy stimuli (light touch, vibration, proprioception)
- terminate in specialized encapsulated endings
small caliber unmelinated primary affarent fibers
ex: type C fibers
- conduct high-energy stimuli, i.e. nociception
- have naked nerve endings
- can experience sensitization
what changes can facilitation bring about?
With prolonged stimulation of nociceptive fibers (visceral or somatic):
1. Increased dynorphin production = increased excitability
2. Destruction of inhibitory interneurons with the proliferation of excitatory interneurons.
3. Activation of Glial Cells amplifies inflammation
4. Neuropeptide and amino acid neurotransmitters
5. Spinal memory—pain patterns can be reactivated by milder
stimuli later
* facilitated segments can result in increased baseline, thus closer to threhold, more APs fired*
Jone’s definition of tender points?
Small, hypersensitive points in the myofascial tissues of the body used as diagnostic criteria and treatment monitors
- they are used to help diagnose, but are not THEMSELVES a diagnosis
- Initial injury causes sudden unanticipated lengthening of the antagonistic muscle to the originally strained and painful agonist muscle
What is a Jone’s tender point?
- the location of tenderpoints is consistent b/w patients
- exists w/in myofacial structures (tendons, ligaments, muscle bellies)
- sensitive to palpation (b/c of nociceptive activity)
- localized WITHOUT RADIATION
- treat w/ CS
Travell’s Points
“hyperirritable spot in skeletal muscle that is associated with hypersensitive palpable nodule in a taught band”
- painful on compression w/ referred pain, tenderness, motor dysfunction, and autonomic phenomena
- THESE DO RADIATE
- viscerostomatic/somatovisceral interplay
2 classifications of travell points?
Active: refer pain at rest, with muscular activity, or with palpation
Latent: produce pain only when probed with more steady pressure
How do you treat Travell’s points?
Treat with inhibitory soft tissue, deep massage, injection, isometric MET, vapocoolant spray with myofascial stretch
How to find “travell’s points”
- “jump sign” pt. response to pain is to wince or withdraw
- “local twitch” transient contraction of taught band of fibers with the trigger point engaged. this presence differentiates b/w trigger point and fibromyalgia syndrome
Tender points vs. trigger points
= Jones points vs. Travell’s points
Tender point:
- finger tip size, discrete, small, tense
- NO REFERRED PAIN OR RADIATION
- location is usuallly in tendinous attachment or belly of muscle
- tx; CS
Trigger Point:
- hyperirritable spot w/ hypersensitive palpable nodules
- REFERRED PAIN PATTERN
- location: in a taut band w’n skeletal mm.
- tx: : inhibitory soft tissue, deep massage, injection, isometric MET, vapocoolant spray with myofascial stretch
A pt comes in with pain in the posterior thigh. What characteristic would be best treated with injection?
A point that radiates in the posterior aspect of the thigh
Chapman’s points
- gangliform contraction may block lymphatic drainage, causing inflammation in distal tissues
- believed it was a part of sympathetic dysfunction
- points are found in regions which overlap with visceral symp. efferent innervation
- these points can be used for dx, tx, and evaluation b/c they are part of the viscero-stomatic reflex
Ex. of Chapman’s pt
Anterior points don’t radiate
Ex: Excessive input from a viscera of the head or neck produces facilitation of the upper thoracic cord segs and results in reflex stim 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 incr functional activity of the sympathetic nervous system in this region.
What is Chapman’s clinical use?
- for dx
- for influencing motion of fluids, mostly lymph
- For influencing visceral function through the peripheral nervous system
description/findings of Chapman’s points?
- 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 DO NOT RADIATE
- tx: firm, circular pressure (flatten 10-30 seconds)
memorize chapmanns points slide
slide at end of lecture
