Visceral OMT Flashcards
Visceral dysfunction
impaired or altered mobility or motility of visceral system and related fascial, neuro, vascular, skeletal and lymphatic elements
Visceral manipulation
system of diagnosis and tx directed to viscera to improve physiologic fx
When did Charles Sherrington publish “The Integrative Action of the NS”
1905
Louisa Burns’ research
early in 1900s, showed that stimulation caused contraction and steady pressure inhibited contractions
Significance of somatovisceral neuro
neuro interconnection allows for adaptations when demands on body change
Viscerovisceral
neuro stimulation in one area, causes neuro stimulation in another
Viscerosomatic patterns discovered…
JN Eble in 1960
Viscerosomatic patterns
visceral structure excites somatic structure
visceral pain
diffuse and poorly localized and is often referred to somatic structures
Indications for visceral treatment
primary dysfx-trauma or disease
Secondary dysfx-automatic input changing visceral fx, structural changes that affect visceral support, chapman points
Contraindications for visceral treatment
patient unable to tolerate tx
Order of treatment for visceral OMT
- biomechanical
- neurologic
- lymphatics
Indications for large intestine visceral OMT
constipation, IBS, post injury, viscerosomatic reflex findings
Relative contraindications for large intestine visceral OMT
active infection, colon obstruction, recent abdominal surgery, splenomegaly
Portions of colon that are retroperitoneal
ascending, descending, sigmoid
The mesentary is continuous with…
parietal peritoneum
Location for sigmoid colon release
anteromedial of L pelvic brim with force towardRUQ
Location for descending colon release
L posterolateral flank with medial force
Location for transverse colon release
inferior to costal margin with inferior force
Location for ascending colon release
right posterolateral flank with medially directed force
Sympathetic innervation for proximal colon
Lesser splanchnic via superior mesenteric
Parasympathetic innervation for proximal colon
Vagus
Sympathetic innervation for distal colon
least splanchnic via inferior mesenteric
Parasympathetic innervation for distal colon
sacral splanchnic
location of superior mesenteric ganglia
midway between xiphoid and umbilicus
location of inferior mesenteric ganglia
midway between superior mesenteric and umbilicus
Collateral ganglia release
force directed posteriorly and engages the “feather’s edge” of restrictive barrier
Posterior Chapman reflexes for colon
triangular area reaching from TP of L2-4 reaching to crest of ilium
Treating Chapman reflexes
slow circular massage with medium to firm pressure for 10-30 seconds
Indications for small intestine visceral OMT
indigestion, delayed gastric emptying, cholestasis, functional disorders, viscersomatic reflex findings
relative contraindications for small intestine visceral contact OMT
splenomegaly, active infection, colon obstruction, recent abdominal surgery
Mesenteric root release
starts 1 inch inferior and lateral to umbilicus, ends at cecum, medial to right ASIS
Sympathetic innervation of duodenum
greater splanchnic
Sympathetic innervation small bowel
lesser splanchnic
SI chapman points anterior
R on 8th, 9th and 10th intercostal space
Spleen anterior chapman
L 7th ICS
Indications for liver visceral OMT
passive congestion, immune incompetence, parenchymal dz, capsule or suspension dysfx
Contraindications for liver visceral OMT
fractures or dislocations in thorax, lymph malignancy, traumatic disruption of liver or adjacent organs, acute hepatitis, friable hepatomegaly
Fascial attachments of liver
falciform ligament, coronary and triangular ligaments
Fascial attachments of liver
falciform ligament, coronary and triangular ligaments
Activating force of liver pump with recoil activation
release during early inhalation
Liver chapman point
R 5th ICS
GB chapman point
R 6th ICS
Indications for renal visceral OMT
renal failure, nephrolithiasis, cystitis, interstitial cystitis, incontinence, prostate or uterine disease, pelvic floor sx
Constipation effects on bladder
can cause reflexive bladder spasms, prevent complete emptying of gall baldder
Bladder ligaments in female
pubic fascia, broad ligament, psoas fascia, sacral fascia
Releasing external visceral strain
patient supine, one hand at lumbosacral junction and other hand on low abdomen
Sympathetic innervation of ureters, bladders, pelvic organs
least splanchnic
Parasympathetic innervation of ureters, bladders, pelvic organs
sacral splanchnic
Adrenal chapman reflexes
2” above and 1” lateral to umbilicus; between T11 and T12
Kidney/Ureters chapman reflexes
1” above and lateral to umbilicus; b/n L1 and T12, L1, L2
Bladder chapman reflexes
periumbilical or umbilical; superior edge L2
Urethra chapman reflex
inner edge pubic ramus, superior edge L2
Lymphatic drainage of low pelvis
external iliac
Psoas release
supine or prone muscle energy
QL lateral recumbent
proximal forearms on iliac crest and inferior shoulder
Motion restrictions for thoracic visceral strain
L/R, superior/inferior, sidebending, torque
Reduce visceral strain on kidney
palpate for kidney and treat with indirect fascial release
Spinal levels of celiac ganglion
T5-T9
Spinal levels of superior mesenteric
T10-T11
Spinal levels inferior mesenteric
T12-L2
Goal of rib raising
sympathetic inhibition
Goal of sub-occipital release
parasympathetic inhibition
Goal of sacral rocking
increase parasympathetic tone
Goal of sacral inhibition
decrease parasympathetic tone