So the big goal of therapy is that we
can move and function freely.
So the fascial strains can
affect ones well-being.
Each transitional zone in
the body is associated
with a horizontal diaphragm
where many structures
are going to go through
and it allows for functioning.
You can diagnose restrictions
by identifying changes
in the fascial pattern
and how the fascial patterns
relate to each other.
And OMT is useful in promoting health
by affecting the lymphatic drainage
and the functioning of the diaphragm.
A.T. Still brought our attention
to the fascia as well
and he said, “The fascia is the place
to look for the cause of disease
and the place to consult and
begin the action of remedies
in all diseases.”
The body is a single unit.
It’s all connected
and the fascia is the thing
that connects it.
So let’s go ahead with an example.
Here’s a case where we’re going
to talk about respiratory issues
and this is a 3-year-old male,
who was brought into the office by
his mom, with difficulty breathing
and wheezing for 3 hours.
What questions do you have for this patient?
And what things do you think about?
So a 3-year-old with difficulty breathing
and wheezing for 3 hours.
You’re scared they may have
It could be an obstructed airway.
It could be an infection.
It could be something congenital
still. They’re still young.
It could be that they’ve got
some genetic disorder.
So we’ve got a broad differential.
What tests do you want to do
to further narrow your differential
and start focusing?
Well, you want to know how serious it is.
You want to get a measure
of the oxygenation.
You want to get a peak flow.
You want to see if it’s anatomic, if it’s
functional, and where you are.
You may want to get an x-ray run,
peak flow, or pulmonary function testing.
And here’s a schematic representation.
Because you’re going to look, listen, and feel.
You’re going to test for functioning.
You’re going to see if the
breathing is something
that’s affecting the musculoskeletal system
as well as if oxygenation is occurring.
Is there bronchospasm? Can you hear
anything out of the ordinary?
Are you seeing a lot of secretions
Could this possibly be secondary
to nervous activity,
in the vagus, or sympathetic
Is inflammation going on?
And what do the secretions look like?
Does it look infectious? Does
it look dehydrated?
What is going on?
And you can actually look at the fluids
you’re seeing to get a better sense.
From a muscular aspect,
you want to see which muscle
the patient is using.
Is the breathing normal and healthy?
Is the diaphragm going out in
the normal pump handle
and bucket handle motion
of the ribs occurring?
Is there an excessive work of breathing?
Have they started using
the accessory muscles,
or the sternocleidomastoid,
and the rib muscles?
Are they splinting or doing other
mechanical aids to breathing?
Does it look like the diaphragm
is working well
or does it look like the diaphragm
is out of sync with the body?
So what is going on that’s helping
increase interthoracic pressure
so breathing occurs
or hurting interthoracic pressures?
That’s what the examination
of the musculoskeletal system
is going to tell you.
And I want you to stop and take a look
at the muscles of respiration—
the intrinsic muscles,
the extrinsic muscles, the accessory muscles
and what’s going on.
So if you look at the chest cavity,
what’s going to be expected
and what’s going to be recruited
when things are not going well?
So take a moment and check out this image.
One thing that I want to talk about
is the diaphragm—huge muscle,
many attachments, front and back,
and a huge player in respiration.
All of the muscular portions
are going to converge in the
aponeurotic central tendon.
And it’s going to be a dome-shaped muscle
with 2 lateral hemidiaphragms on each side.
And the shape is going to be
influenced by the viscera,
the weight, and other things as well.
It’s also important in other functioning
of the body as well.
So, it’s an important muscle.
And it helps aid in the return
of blood and lymph.
So from a mechanical perspective,
what are we focusing on?
We’re focusing on the interaction
of the muscles and the viscera,
and what happens to the
muscles of respiration
when the patient starts having
This is a viscerosomatic issue.
If you’re having trouble breathing,
what does it do to the muscles?
Could it be a somatovisceral issue?
Sure, it could be.
You could have a disruption
of the diaphragm
that’s causing the breathing not to occur.
But in this situation, where you have a 3
year old who’s having trouble breathing,
we’re going to look more
at the viscerosomatic,
and what happens to thoracic compliance
when the muscles go out of sync,
and when the ribs are no
longer able to function.
And what happens to the
diaphragm early and late
in this kind of problem
and how it differs with different issues.
So as we take a deep breath in,
the diaphragm comes down.
It pulls the ribs up a little bit.
It creates a negative interthoracic
that helps pull the air in through
the mouth and breathing occurs.
So there are going to be some
viscerosomatic signs you can find
when a patient is having
And you can relate these
to the sympathetics
and parasympathetic innervations.
So what happens with increased
We’ll see that in just a minute.
And what structures do you have to focus on?
This is relating ourselves
to the connection
of the viscera and the musculoskeletal
and how the autonomics are
going to be that bridge.
So when we talk about viscerosomatic
inflammation is what is going to be
mediating what is going on.
It’s going to be the communication
that’ll be both positive communication
because it’s communication—let’s
people know what’s going on—
but also can affect the functioning itself.
So the convergence of the
and the nociceptors from
the somatic tissues
are going to be found distally
to the spinal cord.
And this will also affect
other feelings as well.
So we’re going to talk a little bit about
and how the lungs are going to
be effecting the body
because you’re going to get input
from the upper thoracics
which are then going to effect
some of the functioning
of the thorax as well.
And viscerosomatic findings
in pulmonary disease—
once you have one system going wrong,
other systems are going to follow.
You can have early indicators
in the musculoskeletal system.
We talk a lot about Chapman’s points
which are fibrous findings
deep to the muscles—small,
and can refer you back to certain areas.
So if you find heart points or lung points,
you can get a sense that that’s where you’re
going to have to look for disease.
And these are going to be important
areas to remember,
both so you can refer yourself
and have clues and foreshadowing
and also give you a full sense of what’s
going on with the person’s health.
When a person has increased
you’re going to notice that there’s
increased mucus production,
thicker mucus production,
and you’re going to start to
have congestion occurring.
You may have an overall decrease
in lung secretions
but you’re going to have an increase in
the vasoconstriction to the lung tissue.
So this is an important concept
to be aware of.
We also always relate the sympathetic
to the parasympathetic activity
and see whether they’re antagonistic
and what they’re doing to each other.
What happens when you have increased
parasympathetic tone to the lungs
and how it differs from increased
and which is going to effect which organs?
So with the lung, you do have some
which is going to occur through
the vagus nerve.
And that’s where the information
is going to occur.
In the normal state, the parasympathetic
is going to be happening
continuously and with feedback to the lung.
In the increased parasympathetic
nervous system tone,
thinning of secretions,
but profuse secretions, and you may have
some constriction of the bronchi.
And here’s a diagram
giving you all of the parasympathetic
effects on the body.
Take a minute, study this,
and go through it, make sure
you read all of them.
We will hit the major ones later on.
When you’re examining this patient,
we’re doing a lot of checking of
the musculoskeletal system
looking for somatic dysfunctions
and looking at the transitional
zones and the diaphragms.
You want to pay attention as
well to the jugular foramen
and C2 where the vagus is going to enter.
And here’s an anatomic orientation
of the vagus nerve.
It exits the skull through
the jugular foramen.
And this is going to be treated
through OA and C2 treatment.
What role does lymph drainage
play in this case?
We know that the lymph is getting congested.
We know that there are zones
filling with lymphatic fluid
and there’s some impediment to return
of the lymph into the circulatory system.
And how is the lung tissue affecting this?
Is it going to be more affected
on one side or the other?
And what findings are going to affect
lymphatic drainage to point
you in that direction?
Well here’s an example of the lymphatics
and lymphatic drainage
different vascular system.
It is extrapleural so you’re having
the lymph occur in the body
and then dump into the central circulation.
And we do notice that the
right lymphatic duct
is going to be a key piece
of what’s going on
because it runs above the apex of the lung
and is an area that can get occluded.
The thoracic ducts from below
because of the lymph flows up
with a majority of lymphatics being
in the top part of the body
and draining back in through
the cisterna chyli
into the circulation.
Restrictions in the lymphatic
system are going to cause
when you get good, you can tell when
there is lymphatic congestion
from the musculoskeletal exam
with different depths of pressure
on the body.
Some doctors like to examine the
areas of entry of the lymph
back into the circulation.
I have trouble feeling those
but it is an area to focus—
once people are very sick it
becomes a lot easier.
Increased sympathetics are going to cause
constriction of the large lymph vessels
and decrease the drainage in the return.
Just something to be aware of.
And again, the lymph drains from peripheral
and distal towards the central region.