OMM: Neurological Model Approach to GU

00:00 So when applying osteopathic manipulative medicine to a cardiac patient, the neurologic model calls for treating the rib cage focusing on the rib heads. So techniques such as gentle rib raising, direct inhibition over T1 to T6, myofascial release; these will help with defacilitating sympathetic segments and normalizing autonomic function. It will also help to decrease arterial vasospasm.

00:26 The neurological approach also takes into account perhaps looking for Chapman points. Remember for the cardiac, the Chapman point for the heart anteriorly is going to be on the left 2nd intercostal space. So that's another region to look for potential viscerosomatic and to treat utilizing gentle OMM. Treatment of the cranial base and suboccipital region could potentially help improve vagal stimulation. So utilizing suboccipital release, base spread, myofascial release to the upper cervical region could help with balancing parasympathetic innervation to the heart. The vagus nerve provides parasympathetic innervation to the heart. It's important to understand how the different branches of the vagus nerve innervate different aspects of the heart. So, the right vagus innervates the SA node. If you have hyperstimulation of the parasympathetic tone there, that could potentially lead to bradyarrhythmias. The left vagus goes to the AV node and so if you have hyperstimulation of the left vagus that could potentially lead to AV blocks. So when we utilize OMM following the biomechanical model, we need to consider the anatomy of the heart and the structural relationship it has where it resides. So the heart resides in the thorax between the thoracic vertebrae and the sternum anteriorly. Any sort of change to the thorax could potentially influence the functioning of the heart. Taking a look at the fascial attachments, the heart is related fascially to the diaphragm and the anterior cervical fascia. These relationships could have an influence on total body function. Looking at the fibrous pericardium which surrounds the heart, that pericardium becomes the mediastinal fascia and then comes up into the neck and attaches firmly to the sternum, manubrium and the clavicles. So, any dysfunction of the structures that the fascia attaches to could potentially influence the structure surrounding the heart. In the neck, that fascia is called the pretracheal or anterior cervical fascia. This attaches firmly to the cranial base. So, any sort of strain between the diaphragm all the way up to the base of the skull could potentially affect the function of the heart. Biomechanically, the thoracic cage also plays an important role with the functioning of the heart. Our thoracic cage protects the heart and lungs.

03:02 The motion of the thoracic cage is necessary for respiration and all the muscles attached to the thoracic cage could also be involved with posture, head and neck and extremity control and motion and movement. We need to consider the thoracic cage and its effects on viscerosomatic reflexes. Also, we have to look at the lymphatic system and how the thoracic cage is vitally important with proper lymphatic flow and looking at how nervous structures which are protected by the spine could also be potentially compressed and irritated by somatic dysfunction of the thoracic cage. So, when looking at the rib cage itself, rib cage motion affects many different things. Rib cage motion exists with motion of the respiratory system, arterial supply, venous drainage, lymphatic drainage as mentioned, our musculoskeletal system, our nervous system and potential viscerosomatic reflexes. So, following the biomechanical model, we have to try to reduce musculoskeletal restrictions and fascial strains that may affect the heart through treatment of the thoracic cage, sternum, clavicles, ribs and spine. Techniques such as rib raising, balanced ligamentous tension, gentle articulatory techniques, myofascial, even FPR or counterstrains could be potentially useful for treating the somatic dysfunctions. The goal is to try to improve thoracic cage compliance and to reduce somatic dysfunctions that might be restricting proper thoracic cage motion and flow. You want to asses and treat any sort of abdominal diaphragm restrictions because again the heart sits right on top of the diaphragm, any restrictions of the diaphragm may also potentially influence the fascia surrounding the heart and reduce its function.