Autonomic Nervous System

by Tyler Cymet, DO, FACOFP

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    00:00 The other concept to pay attention to is the autonomic nervous system and the sympathetics and parasympathetics because these are going to affect breathing and can help or hurt breathing.

    00:13 When you think about the sympathetics, those are thoracic segments T1 through T5. They innervate the lungs, they're going to cause bronchodilation and they're going to affect the mucous secretions both the amount and the thickness. So, you want to make sure you have optimal viscosity so they can bath the lungs, enhance oxygen exchange but not block oxygen exchange. The autonomic nervous system is critical for monitoring what's going on with breathing. You have nociceptors which tell you about the pressure and what's happening within the lungs and they feedback into the autonomic nervous system through the upper thoracic communication pathways. And again a lot of the information is coming from the upper thoracic region. The vagus nerve is what's going to moderate the parasympathetic innervation of the lungs and that's what's going to cause bronchoconstriction and increased mucous production in the lungs. And the nociceptors from the smaller airways which go through the vagus are going to moderate what's going on in asthma and small airway disease and let the body know what needs to be done. The vagus has been shown to reflex with the upper cervical spine and that pathway is through C2 and the sensory ganglion of the vagus are found at the OA and jugular foramen. When you treat segmental dysfunction, it's important to focus on those areas because that will enhance physiologic function and prevent spiraling down and deterioration in the area. The other goal is to decrease the use of inhalers and most studies of OMM and pulmonary disease. Use that as a secondary end point which is hospitalizations and the medications used.

    01:59 Lymphatics also need to be taken into consideration as a secondary system for bathing the lung and returning fluids to the lung and in asthma and pneumonia you may want to check the lymphatic return and understand what's going on with pulmonary lymphatics both in the chest wall cavity and make sure that you address that issue as well because pulmonary lymphatics dump into the vasculature but have their own system for distribution. The airways are drained by the lymphatics but they also have blood supply as well and this is moderated by mucociliary mechanisms.

    02:38 The mucociliary mechanism doesn't extend to the terminal bronchioles or the alveoli so the drainage is going to be a separate system in discrete. Paying attention to pulmonary lymphatics particularly in asthma and pneumonia will help you understand what needs to be treated and how drainage is occurring through the lymphatics. So the pulmonary lymph is enhanced with respiration. With excursion, you're going to have return to the lymph and dumping of the lymph into the vascular system. So, pay attention to the respiratory excursion and make sure that adequate return is being allowed. When you treat the pulmonary patient, make sure you pay attention to positions of comfort, examine them for paradoxical versus fluid motion, do what you can to improve the efficiency of the respiratory musculature so that they can breathe comfortably, reduce segmental facilitation as a way of allowing communication to occur and the body to heal itself and do what you can to improve lymphatic drainage. I pay a lot of attention to the ribs making sure that you do have good pump handle and bucket handle motion and secondarily to the vertebrae where the ribs attached because that is going to eventually become a problem as well. So, that's my talk on the respiratory effects on the musculoskeletal system and the role of OMM in pulmonary conditions. Thank you.

    About the Lecture

    The lecture Autonomic Nervous System by Tyler Cymet, DO, FACOFP is from the course Osteopathic Treatment and Clinical Application by System. It contains the following chapters:

    • Autonomic Nervous System
    • Pulmonary Lymphatics

    Included Quiz Questions

    1. T1–T6
    2. T5-T9
    3. T10–T12
    4. T10–L2
    1. Improve compliance and excursion of the thorax.
    2. Improve the efficiency of respiratory muscles.
    3. Improve lymphatic drainage.
    4. Reduce segmental facilitation.
    5. Increase respiratory rate and drive.

    Author of lecture Autonomic Nervous System

     Tyler Cymet, DO, FACOFP

    Tyler Cymet, DO, FACOFP

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