OMM in Renal and Genitourinary Cases

00:00 Clinical Application of OMM in Renal and Genitourinary Cases. So before we start talking about the application of OMM, we need to review some of the basics. So remember facilitated segments come from a viscerosomatic reflex. So our autonomic nervous system is an efferent system and there's visceral afference that carry impulses from the organ to the cord. From the cord, there might be actions of interneurons which then lead to a facilitation at the spinal cord leading to a somatic change. So, the steps are facilitated segments come from facilitation of a spinal segment and there is increased activity of the synapses in the spinal cord. The threshold level is lowered and is more easily stimulated by impulses of sublevel intensity. The spinal cord segments may fire sympathetic outburst to the related organ and to the somatic structures and that's when we feel those acute changes in the soma. Hypersympathetic activity could present in many different diseases due to facilitated segments. Viscerosomatic and somatovisceral reflexes. Visceral dysfunction may result in somatic dysfunction and vice versa. If we could improve visceral function, that might decrease the amount of somatic dysfunction and if we treat somatic dysfunction that could also potentially improve related to visceral function. This cross talk of systems at the spinal cord level helps to provide diagnostic clues of viscerosomatic dysfunction and allows a way to treat the musculoskeletal system to affect the organ's sympathetic hyperactivity. Chapman reflexes are a form of viscerosomatic dysfunction. Dr. Frank Chapman discovered these reflex points throughout the body, their ganglia formed contractions and what they are thickened parts of fascia that feels a little bit like a small bead of tapioca and is very sensitive to pressure. These reflex points could resolve with some inhibitory pressure for treatment. So, Dr. Chapman discovered these viscerosomatic reflexes early in the 20th century. This was prior to any discovery or written explanation of the neuroendocrine immune system and how the lymphatics and the neurologic system integrate together and potentially could cause these viscerosomatic reflexes. So, as we continue to further discover and learn more about how these systems are all intertwined, we could get a better understanding of how these Chapman reflexes form and why they exist. Prior to treating any specific point, you want to treat the pelvis first. Dr Chapman was quoted to teach "Your first act should be to replace the innominate." So you want to make sure that any somatic dysfunctions of the sacrum and pelvis are treated first before you treat the actual Chapman points. You want to treat the significant anterior points first and then lastly the posterior points. Treatment again is a rotatory motion with one finger usually for approximately 10 to 15 seconds. You don't want to try to push as hard as you can but you want to try to stay about the same depth as the point, you don't want to use excessive pressure because you don't want to cause more pain or injury and you will get results quicker by being less painful and being more gentle. So here is a schematic of the anterior Chapman points for the GU system. This is a good area to screen around the umbilicus, around the pubic symphysis and along the legs for any potential Chapman points related to your patient presentation. A quick review of the lymphatic drainage for the GU system. The lymph of the GU system drains from the internal iliac and external iliac to the common iliac vessel and then to the lateral aortic, to the lumbar trunk, to the cisterna chyli and then all the way up to the thoracic duct.

04:04 Then that enters into the subclavian vein. So, this is the path of lymphatic drainage of our GU system. Any sort of restrictions along this could impede proper lymphatic drainage. Overall osteopathic treatment goals. We want to try to treat facilitated segments first to normalize sympathetics, screen for any viscerosomatics, balance the sympathetics. You could use ganglion inhibition or use rib raising. You want to normalize parasympathetics by treating the sacral region.

04:34 Most of the GU system is innervated by the pelvic splanchnic for parasympathetic innervation so treat the sacrum, treat the pelvis. If it is the kidneys, you want to treat the vagus, so you want to treat the base of the skull, treat the suboccipital region, treat the OM sutures to help decrease any possible compression on the vagus nerve. You want to improve circulatory and lymphatic flow and also we want to try to treat the thoracic, lumbosacral spine, the rib cage or diaphragms and pay close attention to the pubic bone and the pelvic diaphragm since a lot of GU considerations might affect those structures.