OMM Pulmonary System

by Tyler Cymet, DO, FACOFP

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    00:00 There's good data that osteopathic manipulative medicine is effective in some respiratory conditions particularly in pneumonia and asthma. 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 we're treating pulmonary conditions with OMM. So, the science of osteopathy is the application of loss 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. The pulmonary system is a good example of a viscerosomatic response responding to the manipulation. 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 and the work of breathing can be anywhere from 2% to 30% of your energy expenditure as a human being 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. What's the role of somatic dysfunction or myofascial tension on the thorax and spine that can affect the rib cage contribution to lung compliance. So, medical treatment particularly OMM, lymphatic pump and treatment of the ribs can be used to improve lung compliance. Again, the work of breathing in the normal individual it's going to be 2% to 3% of your metabolic energy. In somebody with pulmonary issue, 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, but this can affect body function and both the lung system and the other systems further away from the lung. We talk about the work of breathing, yes the majority of the work of breathing is the thoracic cage and it is the trunk of the body but we know that the accessory muscles, the scalenes and levators are also going to be pulled into the work of breathing in expanding the lung capacity and expanding the lung cage.

    03:15 This is also going to reflect in the occipital area as well as low back as well. So these are just different areas to pay attention to when thinking about the work of breathing. 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. 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 disorder breathing or secondary to the visceral being diseased, you're going to reduce the compliance of the thorax and increase the work of breathing. 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. We talked about asthmatics, we talked about the different chest wall configurations. Some people with asthma develop three-role asthma or three roles of fat on the thoracic cage that will affect the work of breathing and they are treated differently than those who don't have the separation of the areas of the thoracic cage but will need help as ell. 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. The ribs are attached to the vertebrae both on the transverse process and to the body of the vertebrae itself on different segments 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. So the orientation of the vertebrae and the ribs are going to determine the movement and it can be affected by rotation or other discoordinated movements. The ribs are attached to the vertebrae as well and not just the transverse processes but the rib itself and if you have rotation of the vertebrae it's going to affect the functioning of the ribs and can affect the functioning of the diaphragm as well. When you breathe, you have motion of the whole body. It's going to go all the way down to the pelvis. You can use the pelvis to monitor the breathing and I often do this when I'm examining the pelvis and examining respiration and feeling the effect 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. So this is just a break time to take a look at the muscles of the thoracic cage, notify the intrinsic muscles, the interosseous muscles, identify the accessory muscles and the other muscles involved in respiration.

    About the Lecture

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

    • OMM Pulmonary System
    • Skeletal Consideration

    Included Quiz Questions

    1. Anterior and middle scalenes
    2. Posterior scalenes
    3. Internal intercostal muscles
    4. External intercostal muscles
    5. Diaphragm
    1. Intercostal muscles
    2. External costal muscles
    3. Diaphragm
    4. Anterior and middle scalenes
    5. Posterior scalenes

    Author of lecture OMM Pulmonary System

     Tyler Cymet, DO, FACOFP

    Tyler Cymet, DO, FACOFP

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