Lecture 8: OMT for Cardiovascular Disease/Problems

1. Biomechanical model

2. Respiratory-Circulatory model

3. Neurologic model

4. Metabolic-Energy model

5. Behavioral model

what are the 5 physiologic models?

Biomechanical Model

• The structural model and the structural exam is the basic approach we have been teaching you

• This approach may change depending on many patient variables

• Posture and balance

• Motion

• Functional anatomy

• Tensegrity

Respiratory-Circulatory Model

• This is the model we consider when we feel that increasing movement of fluids would be helpful

• Sprained ankle, respiratory illness, pedal edema in CHF, etc

• Getting nutrients to and removing waste products from organs

• Respiratory mechanics

• Junctional areas are key sites

Respiratory-Circulatory Model

Goal of this model is to facilitate venous and lymphatic drainage and help the body mobilize and ultimately remove excess fluids

Cervicothoracic (diaphragm) Fascia

the fascia that covers the thoracic inlet

Sibson's Fascia

-thickened endothoracic fascia above the 1st rib to C7 transverse process (covers the apex of lung, which is prone to injuries)

-final area for obstruction of 2 great lymphatic ducts

Zink's Common Compensatory Patterns (CCP)

Neurologic Model

goal of this model is to de-facilitate viscerosomatic reflexes to help restore parasympathetic dominance to the autonomic nervous system

Parasympathetic

The preferred homeostatic state of the cardiovascular system is under _____________________ dominance.

Sympathetic

Sympathetic or Parasympathetic:

• Decreased coronary blood flow

• Decreased time for diastole

• Cardiac remodeling

• Impaired lymph drainage

Sympathetic

Sympathetic or Parasympathetic:

• Increased catecholamines

• Increased inotropy

• Increased chronotropy

• Increased blood pressure

• Increased O2 demand

Parasympathetic

Sympathetic or Parasympathetic:

• Decreased inotropy

• Decreased chronotropy

• Decreased blood pressure

Parasympathetic

Sympathetic or Parasympathetic:

• Increased coronary blood

flow

• Improved lymph drainage

• Myocardial stabilizing

T1-4

sympathetic innervation to head and neck

T1-6

sympathetic innervation to heart and lungs

T2-8

sympathetic innervation to upper extremities

T5-9

sympathetic innervation to upper GI

T10-11

sympathetic innervation to lower GI

(small intestines, right colon), adrenals, kidneys (include T12), upper ureters, gonads

T11-L2

sympathetic innervation to lower extremities

T12-L2

sympathetic innervation to lowest GI

(left colon), GU (lower ureter, bladder, uterus/prostate, genitals)

Vagus Nerve

Parasympathetics for:

-Heart

-Bronchial Tree

-Esophagus (lower 2/3rds)

-Small Intestine

-Liver

-Gallbladder

-Pancreas

-Kidneys & upper ureter

-Ascending and transverse colon

Pelvic Splanchnics

Parasympathetics for:

-Descending and sigmoid colon, rectum

-Bladder wall and sphincter

-Lower ureter

-Uterus & prostate

-Ovaries & testes

-Genitalia

directly posterior

(tips in the same plane as transverse processes)

location of spinous processes of T1, 2, 3, and 12

pointed slightly downward

(tips in plane that is halfway between own transverse process and the one below it)

location of spinous processes of T4, 5, 6, and 11

pointed downward

(tips are one transverse process level below)

location of spinous processes of T7, 8, 9, and 10

Spinal Facilitation

Self-sustaining loop including the sensory afferents in the periphery, spinal cord interneurons, and either the somatic ventral horn motor neurons or the autonomic lateral horn motor neurons via the sympathetic chain ganglia and white rami communicants

Spinal Facilitation

1. The maintenance of a pool of neurons in a state of partial or subthreshold excitation; in this state, less afferent stimulation is required to trigger the discharge of impulses

2. A theory regarding the neurophysiologic mechanisms underlying the neuronal activity associated with somatic dysfunction.

3. may be due to sustained increase in afferent input, aberrant patterns of afferent input, changes within the affected neurons themselves, or changes in their chemical environment

Chapman's Reflex Points

• A system of reflex points that present as predictable anterior and posterior fascial tissue texture abnormalities

Chapman's Reflex Points

• Reflective of VISCERAL disease or dysfunction via autonomic afferents

• Probable concurrent involvement of sympathetic efferents

Chapman's Reflex Points

• Located in deep fascia or periosteum

• Usually paired: anterior and posterior

• Relatively fixed in anatomic location (not mobile)

• May need to relax the overlying tissues first

• Usually found using a firm rotatory motion, either deep or superficial

• When compressed, response ranges from nonpainful to almost unbearable

Heart

1

Upper Lung

2

Lower Lung

3

Chapman's Reflex Points

• Palpation can aid in determination of presence or absence of visceral dysfunction

• Reduce adverse sympathetic influence on a particular organ or visceral system

• Improved function of the disturbed organ usually follows treatment of Chapman point

-Apply firm pressure

-Slowly move finger in circles

-Continue rotating pressure to 10-30 seconds

-End when mass disappears or is intolerable

How do you treat a Chapman's point?

Metabolic Energy Model

• Energy expenditure

• Energy conservation

• Changes in musculoskeletal system can effect body's energy requirements.

Behavioral Model

• Role of limbic system in perception of pain

• Depression and musculoskeletal pain

Metabolic Energy Model

goal of this model is to reduce energy requirements and to help maintain homeostasis by reduction of impediments to efficient energy use

Behavioral Model

goal of this model is to reduce or eliminate somatic dysfunction which may add to the overall allostatic load

• Inhibition and MFR to upper Thoracic T1-2 and then T3-5

• Then treat OA,AA,C3-5

Post MI OMT

-Improve thoracic compliance

-Enhance venous return to the heart

-Maximize efficacy of the diaphragm

-Normalize autonomic tone

-Treat secondary effects

goals of osteopathic management of CHF

1. Structural Screen

2. Open thoracic inlet

3. Doming abdominal diaphragm

4. Ischiorectal fossa release (Dome Pelvic Diaphragm)

5. Popliteal fossa release

6. Direct Pressure Techniques

7. Lymphatic Pump Techniques

Sequence of lymphatic treatment