2. OMM | Spinal Facilitation and Autonomic Nervous System

What is the function of the Autonomic Nervous System (ANS)?

Motor system for involuntary control over cardiac muscle, smooth muscle, and glands.

What are the divisions of the ANS?

Sympathetic (SNS) and Parasympathetic (PNS).

What do efferents exit via?

Ventral root

What do afferents exit via?

Dorsal root ganglia

Is the ANS under voluntary control?

No, it is largely involuntary, though modulation is possible (e.g. slowing heart rate via breathing).

Compare Somatic vs Autonomic Nervous System.

Somatic: voluntary, skeletal muscle, joints, skin. Autonomic: involuntary, viscera, glands, vasculature.

What are the efferent targets of the ANS?

Smooth muscle (e.g. vasculature), cardiac muscle, exocrine/endocrine glands.

What are the parasympathetic pathways of the ANS?

Mostly from cranial nerves III, VII, IX, X and S2-S4 spinal nerves.

What are the sympathetic pathways of the ANS?

Originate in T1-L2 spinal cord segments and exit via sympathetic chain (trunk).

List components of a reflex arc.

Receptor → Afferent nerve → Spinal cord → Efferent nerve → Effector

What is the afferent/efferent pattern and example of somatosomatic reflex?

Afferent: Somatic, Efferent: Somatic; e.g. withdrawal reflex, patellar reflex.

What is the afferent/efferent pattern and example of viscerovisceral reflex?

Afferent: Visceral, Efferent: Visceral; e.g. gastrocolic reflex, vasoconstriction in inflamed organ.

What is the afferent/efferent pattern and example of somatovisceral reflex?

Afferent: Somatic, Efferent: Autonomic; e.g. vertebral dysfunction at T5-T8 causing GI symptoms.

What is the afferent/efferent pattern and example of viscerosomatic reflex?

Afferent: Visceral, Efferent: Somatic & Autonomic; e.g. lung inflammation (T1-T6) causing paraspinal spasm.

What is the mnemonic for somatovisceral reflex?

S to V = Spinal dysfunction to Viscera (somatovisceral).

What is the mnemonic for viscerosomatic reflex?

V to S = Visceral problem to Spine (viscerosomatic).

What are cardiac muscle reflex changes under sympathetic vs parasympathetic tone?

Sympathetic: rapid HR, palpitations. Parasympathetic: slow HR, dizziness, low energy.

What are smooth muscle reflex changes?

Airway constriction, altered intestinal motility, poor digestion, decreased blood flow/poor visceral function.

What are gland reflex changes?

Mucous production in airways, blood sugar regulation (pancreas), epinephrine/stress response (adrenal).

What is facilitation in spinal reflexes?

A segment stays hyperexcitable due to chronic afferent bombardment.

What is the clinical impact of reflex facilitation?

Chronic pain, visceral dysfunction, persistent somatic dysfunction.

How does OMM treat reflex facilitation?

OMM breaks pathological loop, normalizes segment, removes barrier to homeostasis.

What is the clinical correlate of pneumonia regarding reflexes?

Viscerosomatic → Somatovisceral at T1-T6 causing paraspinal spasm, poor ventilation, cough, red/warm back.

What is the clinical correlate of GERD/indigestion regarding reflexes?

Somatovisceral at T5-T8 causing abdominal bloating, reflux, rib tenderness.

What is the clinical correlate of asthma regarding reflexes?

Parasympathetic via CN X at cranial base causing bronchoconstriction, SOB.

What is the clinical correlate of sympathetic chain compression?

Somatic visceral dysfunction near rib heads at T2-T3 causing abnormal tone to viscera.

What is the clinical correlate of cardiac irritability?

Facilitated T1-T5 causing palpitations, tachycardia from somatic dysfunction.

Describe the somatovisceral reflex mechanism and effect.

Somatic input (e.g. muscle/joint) → autonomic efferent output to organ → Trauma at T5-T8 sympathetic activity to GI → indigestion

Describe the viscerosomatic reflex mechanism and effect.

Visceral afferent input → autonomic + somatic motor response → pneumonia → T1-T6 back pain, spasm.

Explain layered feedback in reflexes.

Visceral-somatic reflex triggers somato-visceral reflex, creating a perpetuating loop.

Describe the case example of GI reflex facilitation.

Trauma → T5-T8 somatic dysfunction → sympathetic surge → acid reflux → OMM treats dysfunction, resolves GI symptoms, decreases sympathetic tone.

Describe the case example of pneumonia reflex facilitation.

Lung inflammation → T1-T6 muscle spasm → shallow breathing → OMM + antibiotics improve breathing and reduce sympathetic input.

What are the afferent signals in pneumonia case?

Nociceptors and chemoreceptors.

What are the efferent signals in pneumonia case?

Parenchymal vasoconstriction, mucous thickening (viscerovisceral); muscle spasm at T1-T6 paraspinals (viscerosomatic).

What are the TART changes seen in acute somatic dysfunction?

Increased blood flow → red, warm, boggy, swollen tissue.

What are the TART changes seen in chronic somatic dysfunction?

Decreased blood flow → pale, cool, doughy, ropy, fibrotic tissue.

How can rib head somatic dysfunction affect autonomic output?

Rib dysfunctions near sympathetic chain (T2-T3 rib heads) can compress the chain, altering visceral tone.

What is the sympathetic innervation to the head/neck?

T1-T4

What is the sympathetic innervation to the heart?

T1 -T5

What is the sympathetic innervation to the lungs?

T1 -T6

What is the sympathetic innervation to the esophagus?

T2 -T8

What is the sympathetic innervation to the stomach/liver/spleen?

T5 -T9

What is the sympathetic innervation to the midgut (jejunum, ileum)?

T10 -T11

What is the sympathetic innervation to the hindgut (distal colon, rectum)?

T12 -L2

What is the sympathetic innervation to the appendix?

T12 (right)

What is the sympathetic innervation to the kidney?

T10 -T11

What is the sympathetic innervation to the adrenal?

T10 -T11

What is the sympathetic innervation to the gonads?

T10 -T11

What is the sympathetic innervation to the upper ureter?

T10 -T11

What is the sympathetic innervation to the lower ureter?

T12 -L1

What is the sympathetic innervation to the bladder/prostate?

T12 -L2

What is the sympathetic innervation to the uterus/cervix?

T10 -L2

What is the sympathetic innervation to erectile tissue?

T11 -L2

What is the sympathetic innervation to the arms?

T2 -T8

What is the sympathetic innervation to the legs?

T11 -L2

What is the parasympathetic innervation to the head/neck?

CN III, VII, IX, X

What is the parasympathetic innervation to the heart?

CN X

What is the parasympathetic innervation to the lungs?

CN X

What is the parasympathetic innervation to the esophagus?

CN X

What is the parasympathetic innervation to the stomach/liver/spleen?

CN X

What is the parasympathetic innervation to the midgut (jejunum, ileum)?

CN X

What is the parasympathetic innervation to the hindgut (distal colon, rectum)?

S2 -S4

What is the parasympathetic innervation to the appendix?

CN X

What is the parasympathetic innervation to the kidney?

CN X

What is the parasympathetic innervation to the adrenal?

None

What is the parasympathetic innervation to the gonads?

None

What is the parasympathetic innervation to the upper ureter?

CN X

What is the parasympathetic innervation to the lower ureter?

S2 -S4

What is the parasympathetic innervation to the bladder/prostate?

S2 -S4

What is the parasympathetic innervation to the uterus/cervix?

S2 -S4

What is the parasympathetic innervation to erectile tissue?

S2 -S4

What is the parasympathetic innervation to the arms?

None

What is the parasympathetic innervation to the legs?

None