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Therapeutic Applications of OMT for Specific Disease Processes Thomas E Therapeutic Applications of OMT for Specific Disease Processes Thomas E. Sabalaske, DO 7/29/2015 Therapeutic Applications of OMT for Specific Disease Processes Thomas E. Sabalaske DO www.doctorsab.com AOCFP Intensive Update and Board Review August 2015 Three Things to Consider in Systemic OMT Autonomic nervous system Lymphatics Local bio-mechanical factors 1 7/29/2015 Autonomic Nervous System Controls subconscious processes Divided into sympathetic and parasympathetic Controlled by the limbic system of the brain through the hypothalamus Sympathetic Nervous System “fight or flight” Enhances cardio-pulmonary system and inhibits GI system Primary neurotransmitter – norepinephrine Sympathetic Nervous System Two major receptors 1. Alpha – vascular smooth muscle and visceral sphincters 2. Beta – cardiac stimulation and visceral smooth muscle inhibition 2 7/29/2015 Sympathetic Nervous System Preganglionic bodies originate from T1 through L2 then synapse with 1. Paravertebral ganglia – vasculature and organs outside the abdomen/pelvis 2. Prevertebral ganglia – abdominal and pelvic organs Prevertebral ganglia 1. Celiac ganglia – combines with SMG 2. Superior mesenteric ganglia – combines with celiac ganglia to form celiac plexus – abdominal organs up to splenic flexure 3. Inferior mesenteric ganglia – descending colon and pelvic organs Paravertebral ganglia spinal segment pathway organ effect T1 along int. carotid pupil mydriasis T2 ext. carotid face sweat glands sweating T2-6 brachial plexus upper ext. skin vasoconstriction, piloerection and sweating T9-L1 lumbosacral lower ext. vasodilatation in muscles plexus T2-T8 cardiac plexus heart stimulation pulmonary bronchi bronchodilation plexus 3 7/29/2015 Prevertebral Ganglia T6-10 celiac plexus GI tract inhibits peristalsis T11-L1 sup. mesenteric GI tract inhibits peristalsis T12-L1 celiac plexus Kidney vasoconstriction, increases renin T10-L1 celiac plexus adrenal gland epinephrine secretion T12-L2 inf. mesenteric rectum/bladder retention feces/urine sex organs ejaculation/lubrication Pregangionic Spinal Levels organ pre-ganglionic spinal cord level heart T1-5 lungs T2-7 stomach T5-9 liver/gall bladder T6-9 pancreas T5-11 small intestine and proximal large T9-11 int. distal colon/rectum T12-L2 kidney/ureters/bladder T10-L1 ovary/fallopian tube T9-10 testicle/epididymis T9-10, L1-2 uterus T10-L1 prostate L1-2 Parasympathetic Nervous System “rest and digest” Inhibits the cardiac and pulmonary systems, enhances the GI system and exocrine/endocrine glands Primary neurotransmitter – acetylcholine Ganglia near end organs to be affected 4 7/29/2015 Parasympathetic ganglia origination nerve ganglion effect midbrain III ciliary pupil constriction/ accommodation pons VII sph.palantine lacrimation submandibular salivation medulla IX otic salivation medulla X end organs bronchoconstriction, ↑GI motility, ↓pulse/cardiac conduction S2-4 pelvic end organs voiding and erection splanchnic Lymphatic System Organized lymph tissues – spleen, tonsils, appendix, about 400 lymph nodes Lymphatic channels Right lymphatic duct – R arm/head Left lymphatic duct – legs/L arm Lymphatic fluid Diaphragms Plantar fascia Popliteal fossa Pelvic diaphragm Abdominal diaphragm Thoracic inlet Tentorium cerebelli 5 7/29/2015 6 7/29/2015 7 7/29/2015 Lymph pumps Rib raising Pectoral traction Miller supine thoracic pump Atelectasis maneuver Liver pump Spleen pump 8 7/29/2015 Chapman’s Reflex Points Frank Chapman DO 1920’s Tenderpoints found to have high correspondence with systemic disease Anterior – diagnostic Posterior - treatment 9 7/29/2015 Case Study #1 44 year old female presents with nine months of abdominal bloating and cramping especially after meals with alternating constipation and diarrhea. Colonoscopy is normal and labwork does not show celiac antibodies or other abnormalities…… 10 7/29/2015 Irritable Bowel Syndrome Abdominal pain, bloating, constipation and/or diarrhea Autonomics – vagus, sacrum, mid thoracics to upper lumbars, prevertebral ganglia Abdominal fascias Abdominal and pelvic diaphragms and lymphatics Supine Mesenteric Release Patient supine Physician contacts the lower abdominal wall, applies pressure and indirectly follows away from the barrier 11 7/29/2015 Prone Mesenteric Release Patient in knee chest position Physician places hands on lower abdomen just above the pubes and lifts the contents out of the pelvis in an oscillatory fashion until a release is appreciated 12 7/29/2015 Liver Visceral Technique Patient supine Physician on right side of patient, appreciating the liver fascias through the rib cage from the anterior and posterior sides Physician engages any barriers to motion and holds for a few respiratory cycles Case #2 47 year old male with 2 weeks of worsening sinus pain and pressure that worsens with neck flexion, purulent nasal discharge, post nasal drip and mild fevers….. 13 7/29/2015 Sinusitis Autonomics – sympathetic T1-4, parasympathetics cranial nerve VII Vagal nerve is important for innervation of musculature of posterior pharyngial muscles Lymphatics of cervical chain and thoracic outlet Allergic/infectious contributions Trigeminal Foramen 14 7/29/2015 Mandibular Drainage (Galbreath technique) Physician contacts the mandible on a supine patient and draws it across the midline and inferiorly Vomer Pump Physician inserts a gloved finger on the intermaxillary suture and provides a gentle pumping motion 15 7/29/2015 Peri-auricular Drainage Physician places hand on side of patient’s head with their ear between 3rd and 4th fingers, gives a gentle rotational motion 16 7/29/2015 Sphenopalatine Ganglion Physician inserts a gloved finger past upper molars, then lateral and posterior to the maxillary ridge, then cephalad over the teragoid plates Patient nods their head forward to stimulate the parasympathetics to thin secretions and decrease congestion Case #3 52 year old woman presents with frequency, urgency and dysuria for 3 days with a mild increase in temperature…. 17 7/29/2015 Urinary Tract Infection Autonomics – sympathetics T10-L2, inferior mesenteric ganglion, parasympathetics vagus and S2-4 Lymphatics – especially pelvic diaphragm Biomechanical – pelvic dysfunction, c- section scars Bladder Fascia Release Physician palpates deeper fascias just above the pubic bones and engages the fascia in either a direct (if tolerated) or indirect manner Kidney Fascial Release Patient supine Physician contacts the lower ribcage on the back in the kidney area Anterior hand just under anterior ribcage with fingers pointing towards xyphoid Hands come together and fascial restriction is appreciated, then treated first indirectly, then directly 18 7/29/2015 In Conclusion Take the basic knowledge gained here in regards to autonomics, lymphatics and biomechanical interaction with the visceral systems and look for more connections with more disease states and help your patients in a way greater than you ever hoped! 19.
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