The first area that we examine
is the craniocervical junction
and that’s because it’s where the
brain and spinal cord are.
It’s where there’s a lot of nervous
system activity going on.
And it’s a focus of not just assessment
but it’s a place we come back to quite a bit.
30% of all of our proprioceptors
nerves in the body
are in the upper cervical spine.
And it gives us a sense of
the health of the body.
It’s also where a lot of our stress focuses.
And it’s a good place to look
at postural maintenance
and how people are doing with
standing straight, standing tall,
and when they’re going to start to slump.
We also talk a lot about the connection
to the brain, the tentorium cerebri,
and the cranial nerves that exit
the skull where they exit
because of its effect on the sympathetic
and hypersympathetic nervous systems.
So again, just taking a minute
and focusing on the skull,
on the nervous system, and where
things enter and exit the brain.
The tentorium cerebri
is an extension of the dura mater.
It’s in the brain, in the skull area, enclosed.
And we do talk about it a lot
as potentially having areas of interest.
While we can’t feel it and don’t know
which area we’re feeling or
what’s having the motion,
we do know that there is some brain motion.
Actually, at least 3 different
pulses in the brain.
One—that’s about 60 to 80—that’s
correlated with heart activity
and then you’ve got some lymph activity
that may be the cranial rhythmic impulse.
And then you’ve got other vibratory
activity in the cerebellar area.
We’re still trying to understand
all these motions,
how we assess them, and what
we can do to moderate them.
So with the tentorium cerebri –it’s
an extension of the dura mater.
It stretches to the foramen magnum
in the C2-C3 area
and goes all the way down to the sacrum.
It is effected with respiration,
and we do know that the motion of the
brain and the sacrum are connected.
And it’s another way of being
able to tell what’s going on.
And the osteopathic technique that’s
used to free up this area
is one that you’re going to be
taught and need to know
in order to help people with headaches,
imbalance, and other different
areas of disease.
The cervicothoracic junction, again,
it’s another one of the areas
identified by Zink
as needing to be referred to a lot.
It’s another one that you’re going
to have to examine in depth.
And the thoracic inlets and outlets
and other structures going through here
are ones you’re going to have to focus on.
He felt this had a lot of significance
the drainage of the lymphatic system
through the thoracic outlet area.
And then an impingement on the
brachial plexus can cause
congestion in the lymphatic systems.
And again, lymph is still in its
infancy of understanding.
We don’t understand where
lymph is at any one time,
where the majority of lymph is,
and how it flows.
We do feel that it could affect the GI
system and the nervous system.
Here’s a picture of the thoracic inlet,
just so you can appreciate the structures
going through the thoracic inlet
and paying specific attention
to where the lymph flows, the
thoracic duct, and other areas
where lymph is dumped back into
the circulatory system
and then mixes with the blood.
So you’re going to focus on thoracic
inlet and thoracic outlet.
Focusing on supraclavicular edema
which could be a sign of impended drainage.
We do have hundreds of lymph
nodes throughout the body.
A significant number of them being in the
upper part of the chest and neck area.
And should be examined for signs
of impeded drainage,
and also as a focus for us when we
want to make people feel better.
How do you enhance lymphatic return?
We do talk a lot about the
thoracic lymphatic pump.
We talk about vibratory techniques
and other things we can do with the lymph
to make people feel better.
And, again, there are as many questions,
if not more questions than answers here.
But philosophically it fits into
the body as a single unit,
ideology, and the structure-function
and how things are all connected.
We’re next going to go to the
Particularly, when you have restrictions
that effect the abdominal diaphragm.
We talk a lot about the abdominal diaphragm,
what enters and exits, and what goes
through the abdominal diaphragm.
And how to focus on this and picture this
when doing manipulative treatments,
particularly in people who focus
on visceral manipulation
or somatovisceral issues,
when tightness or dysfunction
of musculoskeletal system
affects how the organs are functioning
because we feel that a decrease
in diaphragmatic excursion
effects the work of breathing and lymphatic
return and venous return.
There’s some good preliminary evidence
that it is effecting venous return
and we’ll get more into that later.
We also look at the structures where the
lymph is coming back into circulation,
going through the thoracolumbar junction,
and going through the lymphatics that
are going through the junction.
So here’s a picture of the diaphragm
and this is meant to get you to think of
the diaphragm as not only a muscle
but as a ligamentous and a
more fascial-type structure.
You can see the crura attachments.
You can see the white thickened
area in the center
and you can see the muscular area
that helps with movement.
The mnemonic we give people
is “I ate 10 eggs at 12.”
So when you’re thinking of the diaphragm—
I ate—the inferior vena cava comes out at T8,
10 eggs—the esophagus
goes through the diaphragm at T10,
and at 12—
the aorta comes through
the diaphragm at T12.
So just some ways of thinking
about what’s going on
as you work on the body from the outside,
picturing what’s inside.
You also have muscles coming
up to the diaphragm—
he quadratus lumborum and iliopsoas—
effecting the motion of the diaphragm
as well as the motion of the
lumbar spine and below.
So again, this is meant
to give you opportunity
to think about what techniques you can use,
how you can get at these areas,
and what can be done
to treat a lot of these dysfunctions.
It also brings in the thinking
about vibratory treatments
and other treatments that are part of the
armamentarium of osteopathic medicine.
As we work our way down
the lumbosacral junction,
will give you an idea of what’s going on
with restrictions in the lumbosacral area
and the pelvic diaphragm.
Separate from thoracolumbar,
we get down there—
not a diaphragm that we have focused
on or thought about much
in osteopathic medicine
but definitely one of the diaphragms
that exist in the body
that can impede lymphatic flow
and connection in the body.
So as you think of the motion
of the diaphragms,
there’s motion in the thoracolumbar
and lumbosacral diaphragms.
And restrictions in this area can effect
nervous system functioning
as well as flow of lymph,
blood and plasma.