00:01
There's good data that osteopathic
manipulative medicine is effective in some
respiratory conditions, particularly in
pneumonia and asthma.
00:08
For that reason, we want to talk about why
it's effective and the
pathways that we go through and what needs
to be done and why for treating
pulmonary conditions with OMM.
00:20
So the science of osteopathy is the
application of the laws of physiologic
functioning to the body with particular
attention to the biomechanics of the
musculoskeletal system.
00:29
So we're going to talk about the mechanical
principles of the musculoskeletal system that
help you breathe.
00:36
The pulmonary system is a good example of a
visceral somatic response
responding to manipulation.
00:43
So if you look at the chest wall cavity, if
you look at the thorax, we know that as
the diaphragm comes down and the ribs go up,
you're going to create a larger negative
intrathoracic pressure and allows air to be
exchanged in the lung
, so the lung parenchyma can be thought of as
being passive here with its filling and
emptying occurring from the musculoskeletal
system.
01:07
We also know that some people take a lot of
work to breathe, and some people just don't
pay attention to it at all.
01:13
And the work of breathing can be anywhere
from 2% to 30% of your energy
expenditure as a human being.
01:20
And that depends on how easily your muscles
work, how well the
lungs are functioning in terms of airway
resistance and the need for pressure to pull
air in. And what kind of resistance in the
lungs is occurring
because of disease like COPD, parenchymal
disease
or reversible obstructive airway disease?
How is this affecting the tissues?
One of the things we have to think about is
compliance and
how the compliance is affecting lung
functioning and what can we do to
reduce lung compliance and enhance oxygen
exchange in the lung.
01:59
What's the role of somatic dysfunction or
myofascial tension on the thorax and
spine that are going to affect the rib cage
contribution to
lung compliance?
So medical treatment, particularly on
lymphatic pump
and treatment of the ribs, can be used to
improve lung compliance.
02:20
Again, the work of breathing and the normal
individual, it's going to be 2 to 3% of your
metabolic energy in somebody with a
pulmonary issue.
02:29
It can go up to 30 to 35% of the total work
of our bodies and
functioning. Obstructive disease and
restrictive disease both increase
the work of breathing for different reasons.
02:42
But this can affect body function and both
others.
02:46
Both the lung system and other systems
further away from the lung.
02:51
We talk about the work of breathing.
02:53
Yes, the majority of the work of breathing
is the thoracic cage, and it is
the trunk of the body.
03:00
But we know that the accessory muscles, the
scalenes and
levators are also going to be pulled into
the work of breathing and expanding
the lung capacity and expanding the lung
cage.
03:15
This is also going to reflect in the
occipital area as well as the low back
as well. So these are just different areas
to pay attention to when thinking
about the work of breathing.
03:26
The other thing we want to add is that focus
on the myofascial structures as
well. It's not just the thoracic cage that's
being affected, it's the
muscles and the fascia as well.
03:38
We are going to start with the skeletal
considerations because the most obvious part
is the thoracic cage and the ribs.
03:46
When you do get somatic dysfunction, either
because of disordered breathing or secondary
to the visceral being diseased, you're going
to reduce the compliance of the thorax
and increase the work of breathing.
03:58
The shape change of the thoracic cage is
going to accompany pulmonary disease, and
as disease gets worse, you're going to see a
change.
04:06
We talk about asthmatics.
04:07
We talk about the different chest wall
configurations.
04:11
Some people with asthma develop three role
asthma or three roles of
fat on the chest, on the thoracic cage that
will
affect the work of breathing.
04:22
And they're treated differently than those
who don't have the separation of
the areas of, of the thoracic cage.
04:30
But we'll need help as well.
04:32
And again, somatic dysfunction is going to
have an effect on the functioning of the
respiratory mechanisms that go beyond just
the changes to the skeletal
system. When we talk about the rib cage, and
we talk about the
thoracic cage, we do know that the
orientation of the vertebrae affects the
orientation of the ribs.
04:51
The ribs are attached to the vertebrae, both
on the transverse
process. And to the thoracic, the body of
the
vertebrae itself, on different segments.
05:04
And the fact that it's attached to the
vertebrae on one segment and the transverse
process on another is going to affect the
work of breathing.
05:11
So the orientation of the vertebrae and the
ribs are going to determine the movement
and can be affected by rotation or other
dyscoordinated
movements. The ribs are attached to the
vertebrae
as well, not just the transverse processes,
but the rib itself.
05:29
And if you have a rotation of the vertebrae,
it's going to affect the
functioning of the ribs and can affect the
functioning of the diaphragm as well.
05:39
When you breathe, you have motion of the
whole body.
05:41
It's going to go all the way down to the
pelvis.
05:44
You can use the pelvis to monitor the
breathing.
05:47
And I often do this when I'm examining the
pelvis and examining respiration and
feeling the effect.
05:53
And we often use the respiratory force in
treating somatic
dysfunction because the respiratory force
induces motion in other parts of the
body as well.
06:04
So this is just a break.
06:05
Time to take a look at the muscles of the
thoracic cage.
06:08
Notify the intrinsic muscles, the
intercostal
muscles. Identify the accessory muscles and
the other
muscles involved in respiration.