VISCEROSOMATIC REFLEXES VISCEROSOMATIC REFLEXES
System/Organ Sympathetic Parasympathetic System/Organ Sympathetic Parasympathetic
head and neck T1-T5 head and neck T1-T5 Upper respiratory tract: T1-T5 Trigeminal: final common pathway, Upper respiratory tract: T1-T5 Trigeminal: final common pathway, temporalis muscles, occiput, C1, C2. temporalis muscles, occiput, C1, C2. Cardiac Cardiac
myocardial T1-T5 left occiput, C1, C2. myocardial T1-T5 left occiput, C1, C2. coronary artery C3-C5 (sympathetic?) coronary artery C3-C5 (sympathetic?) Pulmonary Pulmonary
lung T1-T4 occiput, C1, C2 lung T1-T4 occiput, C1, C2 bronchomotor reflex T1-T3 occiput, C1, C2 bronchomotor reflex T1-T3 occiput, C1, C2 “asthma reflex,” T2 left occiput, C1, C2 “asthma reflex,” T2 left occiput, C1, C2 bronchial mucosa reflex T2-T3 occiput, C1, C2 bronchial mucosa reflex T2-T3 occiput, C1, C2 lung parenchyma reflex T3-T4 occiput, C1, C2 lung parenchyma reflex T3-T4 occiput, C1, C2 pariatal pleura T1-T12 occiput, C1, C2 pariatal pleura T1-T12 occiput, C1, C2 Upper G.I. Upper G.I.
esophagus T3-T6 right occiput, C1, C2 esophagus T3-T6 right occiput, C1, C2 stomach T5-T10 left occiput, C1, C2 stomach T5-T10 left occiput, C1, C2 duodenum T6 -T8. right occiput, C1, C2. duodenum T6 -T8. right occiput, C1, C2. Lower G.I. Lower G.I.
small intestine T8-T10 bilateral occiput, C1, C2 small intestine T8-T10 bilateral occiput, C1, C2 appendix and caecum T9-T12 right occiput, C1, C2 appendix and caecum T9-T12 right occiput, C1, C2 ascending colon T11-L1 right occiput, C1, C2 ascending colon T11-L1 right occiput, C1, C2 descending colon/rectum L1-L3 left S2-S4 descending colon/rectum L1-L3 left S2-S4 Pancreas T5-T9 right or bilateral occiput, C1, C2 Pancreas T5-T9 right or bilateral occiput, C1, C2 Liver/gallblader T5-T10 right occiput, C1, C2 Liver/gallblader T5-T10 right occiput, C1, C2 phrenic nerve C3-C5 right phrenic nerve C3-C5 right somatosomatic reflex somatosomatic reflex
Spleen T7-T9 left Spleen T7-T9 left Urinary tract Urinary tract
Kidney T9-L1 ipsilateral occiput, C1, C2 Kidney T9-L1 ipsilateral occiput, C1, C2 proximal ureter T11-L3 ipsilateral occiput, C1, C2 proximal ureter T11-L3 ipsilateral occiput, C1, C2 distal ureter T11-L3 ipsilateral S2-S4 distal ureter T11-L3 ipsilateral S2-S4 bladder T11-L3 bilateral S2-S4 bladder T11-L3 bilateral S2-S4 Urethra: T11-L2 bilateral Urethra: T11-L2 bilateral Genital tract Genital tract
Fallopian tubes T10-L2 bilateral S2-S4 Fallopian tubes T10-L2 bilateral S2-S4 (and seminal vesicles) (and seminal vesicles)
external genitalia T12 bilateral external genitalia T12 bilateral Prostate T10-L2 bilateral S2-S4 Prostate T10-L2 bilateral S2-S4 Ovaries (and testis) T10-T11 ipsilateral Ovaries (and testis) T10-T11 ipsilateral Uterus T9-L2 bilateral S2-S4 Uterus T9-L2 bilateral S2-S4 Adrenal glands T8-T10 ipsilateral Adrenal glands T8-T10 ipsilateral
Adapted from: Somatic Dysfunction in Osteopathic Family Medicine. Nelson KE, Adapted from: Somatic Dysfunction in Osteopathic Family Medicine. Nelson KE, Glonek T, eds., ACOFP: Lippincott, Williams & Wilkins; 2007; Chapt. 5, Glonek T, eds., ACOFP: Lippincott, Williams & Wilkins; 2007; Chapt. 5, “Viscerosomatic and somatovisceral reflexes.” Pages 33-55. “Viscerosomatic and somatovisceral reflexes.” Pages 33-55.
VISCEROSOMATIC REFLEXES VISCEROSOMATIC REFLEXES
System/Organ Sympathetic Parasympathetic System/Organ Sympathetic Parasympathetic
head and neck T1-T5 head and neck T1-T5 Upper respiratory tract: T1-T5 Trigeminal: final common pathway, Upper respiratory tract: T1-T5 Trigeminal: final common pathway, temporalis muscles, occiput, C1, C2. temporalis muscles, occiput, C1, C2. Cardiac Cardiac
myocardial T1-T5 left occiput, C1, C2. myocardial T1-T5 left occiput, C1, C2. coronary artery C3-C5 (sympathetic?) coronary artery C3-C5 (sympathetic?) Pulmonary Pulmonary
lung T1-T4 occiput, C1, C2 lung T1-T4 occiput, C1, C2 bronchomotor reflex T1-T3 occiput, C1, C2 bronchomotor reflex T1-T3 occiput, C1, C2 “asthma reflex,” T2 left occiput, C1, C2 “asthma reflex,” T2 left occiput, C1, C2 bronchial mucosa reflex T2-T3 occiput, C1, C2 bronchial mucosa reflex T2-T3 occiput, C1, C2 lung parenchyma reflex T3-T4 occiput, C1, C2 lung parenchyma reflex T3-T4 occiput, C1, C2 pariatal pleura T1-T12 occiput, C1, C2 pariatal pleura T1-T12 occiput, C1, C2 Upper G.I. Upper G.I.
esophagus T3-T6 right occiput, C1, C2 esophagus T3-T6 right occiput, C1, C2 stomach T5-T10 left occiput, C1, C2 stomach T5-T10 left occiput, C1, C2 duodenum T6 -T8. right occiput, C1, C2. duodenum T6 -T8. right occiput, C1, C2. Lower G.I. Lower G.I.
small intestine T8-T10 bilateral occiput, C1, C2 small intestine T8-T10 bilateral occiput, C1, C2 appendix and caecum T9-T12 right occiput, C1, C2 appendix and caecum T9-T12 right occiput, C1, C2 ascending colon T11-L1 right occiput, C1, C2 ascending colon T11-L1 right occiput, C1, C2 descending colon/rectum L1-L3 left S2-S4 descending colon/rectum L1-L3 left S2-S4 Pancreas T5-T9 right or bilateral occiput, C1, C2 Pancreas T5-T9 right or bilateral occiput, C1, C2 Liver/gallblader T5-T10 right occiput, C1, C2 Liver/gallblader T5-T10 right occiput, C1, C2 phrenic nerve C3-C5 right phrenic nerve C3-C5 right somatosomatic reflex somatosomatic reflex
Spleen T7-T9 left Spleen T7-T9 left Urinary tract Urinary tract
Kidney T9-L1 ipsilateral occiput, C1, C2 Kidney T9-L1 ipsilateral occiput, C1, C2 proximal ureter T11-L3 ipsilateral occiput, C1, C2 proximal ureter T11-L3 ipsilateral occiput, C1, C2 distal ureter T11-L3 ipsilateral S2-S4 distal ureter T11-L3 ipsilateral S2-S4 bladder T11-L3 bilateral S2-S4 bladder T11-L3 bilateral S2-S4 Urethra: T11-L2 bilateral Urethra: T11-L2 bilateral Genital tract Genital tract
Fallopian tubes T10-L2 bilateral S2-S4 Fallopian tubes T10-L2 bilateral S2-S4 (and seminal vesicles) (and seminal vesicles)
external genitalia T12 bilateral external genitalia T12 bilateral Prostate T10-L2 bilateral S2-S4 Prostate T10-L2 bilateral S2-S4 Ovaries (and testis) T10-T11 ipsilateral Ovaries (and testis) T10-T11 ipsilateral Uterus T9-L2 bilateral S2-S4 Uterus T9-L2 bilateral S2-S4 Adrenal glands T8-T10 ipsilateral Adrenal glands T8-T10 ipsilateral
Adapted from: Somatic Dysfunction in Osteopathic Family Medicine. Nelson KE, Adapted from: Somatic Dysfunction in Osteopathic Family Medicine. Nelson KE, Glonek T, eds., ACOFP: Lippincott, Williams & Wilkins; 2007; Chapt. 5, Glonek T, eds., ACOFP: Lippincott, Williams & Wilkins; 2007; Chapt. 5, “Viscerosomatic and somatovisceral reflexes.” Pages 33-55. “Viscerosomatic and somatovisceral reflexes.” Pages 33-55.
VISCEROSOMATIC REFLEXES VISCEROSOMATIC REFLEXES
Viscerosomatic reflexes are diagnostic tools. They are somatic Viscerosomatic reflexes are diagnostic tools. They are somatic dysfunction that develops in response to visceral pathology. A modification dysfunction that develops in response to visceral pathology. A modification of Van Buskirk’s nociceptively initiated model for spinal somatic of Van Buskirk’s nociceptively initiated model for spinal somatic dysfunction offers a description of the physiology of the viscerosomatic dysfunction offers a description of the physiology of the viscerosomatic reflex as follows reflex as follows
1. A peripheral focus of irritation, in this case from the inflammation 1. A peripheral focus of irritation, in this case from the inflammation associated with visceral pathology, results in activation of associated with visceral pathology, results in activation of nociceptive, general visceral afferent, neurons. nociceptive, general visceral afferent, neurons. 2. These primary afferent neurons return to the spinal cord and 2. These primary afferent neurons return to the spinal cord and synapse in the dorsal horn with internuncial neurons. synapse in the dorsal horn with internuncial neurons. 3. The ongoing afferent stimulation results in the establishment of a 3. The ongoing afferent stimulation results in the establishment of a state of irritability (facilitation) of the internuncial neurons of that state of irritability (facilitation) of the internuncial neurons of that spinal segment. spinal segment. 4. Additional afferent activity, from any source, results in a segmental 4. Additional afferent activity, from any source, results in a segmental response to significantly fewer stimuli than would normally be response to significantly fewer stimuli than would normally be required. This results in tenderness when the area is palpated. required. This results in tenderness when the area is palpated. When the amount of afferent activity from the offending organ is When the amount of afferent activity from the offending organ is sufficient enough to cause internuncial firing referred pain results. sufficient enough to cause internuncial firing referred pain results. 5. Such activity from internuncial neurons, which synapse with ventral 5. Such activity from internuncial neurons, which synapse with ventral horn motor neurons, results in segmentally related myospasticity horn motor neurons, results in segmentally related myospasticity and palpable tissue texture change. and palpable tissue texture change. 6. The degree of segmental irritability that is directly proportionate to 6. The degree of segmental irritability that is directly proportionate to the severity of the visceral pathology, and the anatomic relationship the severity of the visceral pathology, and the anatomic relationship between the involved organ and the paravertebral soft tissues that between the involved organ and the paravertebral soft tissues that makes the location of the reflex changes consistent from individual makes the location of the reflex changes consistent from individual to individual allows viscerosomatic reflexes to be of diagnostic to individual allows viscerosomatic reflexes to be of diagnostic value. value.
VISCEROSOMATIC REFLEXES VISCEROSOMATIC REFLEXES
Viscerosomatic reflexes are diagnostic tools. They are somatic Viscerosomatic reflexes are diagnostic tools. They are somatic dysfunction that develops in response to visceral pathology. A modification dysfunction that develops in response to visceral pathology. A modification of Van Buskirk’s nociceptively initiated model for spinal somatic of Van Buskirk’s nociceptively initiated model for spinal somatic dysfunction offers a description of the physiology of the viscerosomatic dysfunction offers a description of the physiology of the viscerosomatic reflex as follows reflex as follows
1. A peripheral focus of irritation, in this case from the inflammation 1. A peripheral focus of irritation, in this case from the inflammation associated with visceral pathology, results in activation of associated with visceral pathology, results in activation of nociceptive, general visceral afferent, neurons. nociceptive, general visceral afferent, neurons. 2. These primary afferent neurons return to the spinal cord and 2. These primary afferent neurons return to the spinal cord and synapse in the dorsal horn with internuncial neurons. synapse in the dorsal horn with internuncial neurons. 3. The ongoing afferent stimulation results in the establishment of a 3. The ongoing afferent stimulation results in the establishment of a state of irritability (facilitation) of the internuncial neurons of that state of irritability (facilitation) of the internuncial neurons of that spinal segment. spinal segment. 4. Additional afferent activity, from any source, results in a segmental 4. Additional afferent activity, from any source, results in a segmental response to significantly fewer stimuli than would normally be response to significantly fewer stimuli than would normally be required. This results in tenderness when the area is palpated. required. This results in tenderness when the area is palpated. When the amount of afferent activity from the offending organ is When the amount of afferent activity from the offending organ is sufficient enough to cause internuncial firing referred pain results. sufficient enough to cause internuncial firing referred pain results. 5. Such activity from internuncial neurons, which synapse with ventral 5. Such activity from internuncial neurons, which synapse with ventral horn motor neurons, results in segmentally related myospasticity horn motor neurons, results in segmentally related myospasticity and palpable tissue texture change. and palpable tissue texture change. 6. The degree of segmental irritability that is directly proportionate to 6. The degree of segmental irritability that is directly proportionate to the severity of the visceral pathology, and the anatomic relationship the severity of the visceral pathology, and the anatomic relationship between the involved organ and the paravertebral soft tissues that between the involved organ and the paravertebral soft tissues that makes the location of the reflex changes consistent from individual makes the location of the reflex changes consistent from individual to individual allows viscerosomatic reflexes to be of diagnostic to individual allows viscerosomatic reflexes to be of diagnostic value. value.