chapman's points
TRANSCRIPT
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Patricia Kooyman, D.O.OMM Department
August 16, 2011
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Viscerosomatic Reflexes
�Inflammation is a powerful stimulator of local nociceptors.
�The convergence of visceral nociceptorswith the nociceptorsfrom all somatic tissues produces several clinical effects:�Referred pain�Segmental facilitation at
the spinal cord level
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Primary Afferent
Nociceptors (PANs) Can be activated by stretch or
by chemicals in the
surrounding media
Factors activating
PANs:Bradykinins
Histamines
Prostaglandins
Serotonin
H+ and K+
Cytokines
ATP
Neuropeptides
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Primary Afferent
Nociceptors (PANs) Can be activated by stretch or
by chemicals in the
surrounding media
Factors activating
PANs:Bradykinins
Histamines
Prostaglandins
Serotonin
H+ and K+
Cytokines
ATP
Neuropeptides
Neurosecretoy Function of: Primary Afferent
Nociceptors(PANs)They release these (dilatory)
peptides:Substance P
Calcitonin Gene-Related Polypeptide
Somatostatin�Normally, a basal release of
these peptides; they are targeting the resistance arterioles, to act as a counterbalance to the SNS (since
NO PNS to the extremities)� However, can have a NeurogenicInflammatory Response, if a lot of
these are released vs. the basal release.
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Primary Afferent
Nociceptors (PANs) Can be activated by stretch or
by chemicals in the
surrounding media
Factors activating
PANs:Bradykinins
Histamines
Prostaglandins
Serotonin
H+ and K+
Cytokines
ATP
Neuropeptides
Neurosecretoy Function of: Primary Afferent
Nociceptors(PANs)They release these (dilatory)
peptides:Substance P
Calcitonin Gene-Related Polypeptide
Somatostatin�Normally, a basal release of
these peptides; they are targeting the resistance arterioles, to act as a counterbalance to the SNS (since
NO PNS to the extremities)� However, can have a NeurogenicInflammatory Response, if a lot of
these are released vs. the basal release.
Results of PAN activation:Lowering
thresholdsClinically, the
development of hyperalgesia
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Primary Afferent
Nociceptors (PANs) Can be activated by stretch or
by chemicals in the
surrounding media
Factors activating
PANs:Bradykinins
Histamines
Prostaglandins
Serotonin
H+ and K+
Cytokines
ATP
Neuropeptides
Neurosecretoy Function of: Primary Afferent
Nociceptors(PANs)They release these (dilatory)
peptides:Substance P
Calcitonin Gene-Related Polypeptide
Somatostatin�Normally, a basal release of
these peptides; they are targeting the resistance arterioles, to act as a counterbalance to the SNS (since
NO PNS to the extremities)� However, can have a NeurogenicInflammatory Response, if a lot of
these are released vs. the basal release.
Results of PAN activation:Lowering
thresholdsClinically, the
development of hyperalgesia
To spinal cord:
increased afferent
drive, due to this
sensitization of the
primary afferent
fibers
Descriptive model from
Frank Willard, PhD
Then �TART findings occur: muscle spasm, sensitivity to
touch
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Spinal cord facilitation/
Segmental facilitation�Reduced threshold for firing of the interneurons receiving
nociceptive input� interneurons = a neuron between a primary sensory neuron and a final
motorneuron, or any neuron whose processes are entirely confined within a specific area
� internuncial neurons = transmitting impulses between two different parts.
�Then - a change occurs at the level of the genes – of those interneurons/internuncial neurons.
�Exaggerated segmental autonomic and alpha-motor response occurs; produces boggy spasm, increased temperature, increased sweat.
�Exaggerated ascending tract input to higher centers, produces hyperasthesia, and referred pain
�Alters autonomic outflow to viscera
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From Frank Willard, PhD
discussion of: Research by and
Mary F. Anderson and Barbara
J. Winterson of UNECOM -
Brain Research 678:140-150,
1995. After making a cut at the
area of the green pointer, 85% of
the facilitation remained.
Therefore, the muscle spindle
alone isn’t sustaining the
somatic dysfunction. The small-
caliber system is necessary for
the initiation of this spinal
facilitation, but then once
initiated, this afferent drive is
not needed to sustain the spinal
/segmental facilitation.
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Visceral Sympathetics �Thyroid T1-4
�Mammary T1-6
�Esophagus T1-6
�Lung T1-6
�Heart T1-6
�Stomach T5-9 Left
�Liver T5-9
�Gallbladder T5 Right
�Pancreas T7 Right
�Spleen T7 Left
�Small intestine to right colon T10-11
�Left colon to rectum to pelvic organs T12-L2
�Appendix T10 (T9-T12)
�Ovary/Testes T10-11
�Kidney T10-11
�Uterus T12-L2
�Bladder T12-L2
Levels cited from Kuchera, Osteopathic Considerations in Systemic Dysfunction
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Osteopathic treatment
considerations - Diagnosis�First and foremost is to treat the underlying
pathology responsible for the reflex.�Somatic dysfunction resulting from a visceral
pathology generally has an acute, boggy, rubbery end feel.
�Reflexes can be palpated and distinguished through tissue texture changes. (+ red reflex secondary to inc. erythema, + skin drag secondary to inc. moisture )
�Beal’s compression test – gently lift up in the paravertebral area bilaterally to detect changes to tissue texture
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Osteopathic treatment considerations�Prolonged hyperactivity of the autonomic
nervous system can lead to facilitation of the spinal cord and lower thresholds for autonomic firing.
�Treatment is directed towards breaking the facilitation, and restoring balance between the sympathetic and parasympathetic systems.
�Understanding the anatomy of the SNS and PSNS will assist in treatment.
�Reflexes are acute changes. Treatments are generally more effective and better tolerated utilizing gentle, indirect and passive techniques.
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Treatment techniques - SNS�Addresses T1-L2 along
sympathetic chain ganglion corresponding to the level of the reflex
- Inhibitory pressure
- Soft tissue myofascial release
- Rib raising
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Rib Raising�“initially stimulates regional sympathetic
efferent activity to organs related to that level of sympathetic innervation, but in the long run, rib raising results in a prolonged reduction in sympathetic nervous system outflow from the area treated.”
�p. 53 Nelson
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Treatment techniques - PSNS�Vagus – CN X – Address the occipital and upper
cervical region as reflex can lead to dysfunctions of the OM suture, OA, C1-3.
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Treatment techniques - PSNS�Parasympathetic fibers arise
from roots S2,3,4 and are distributed as the pelvic splanchnic nerves to the pelvic viscera.
�Treatment to address PSNS of the lower GI and GU systems target the sacrum and pelvis.
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Treatment techniques - PSNS�For Vagus – OA decompression, sub-occipital
release techniques, balanced ligamentous tension (BLT), FPR, myofascial releases, inhibition
�For Pelvic splanchnics (S2-4) – lumbosacral myofascial, sacral rock, BLT, inhibition
�The above list is just a sample of techniques; as long as the treatment is gentle, indirect, and passive it would be better tolerated.
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Chapman’s Reflexes�Chapman’s reflexes are a system of reflex points
originally used by Frank Chapman, D.O.
�These reflexes present as predictable anterior and posterior fascial tissue texture abnormalities.
�Gangliform contraction that blocks lymphatic drainage.
�Sympathetic nervous system dysfunction and lymphatic pathology following viscerosomatic reflexes.
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Chapman’s Reflexes
�On palpation, Chapman reflexes are located deep to the skin, most often lying on the deep fascia or periosteum.
�Usually found paired on both the dorsal and ventral parts of the body.
�Small, smooth, firm nodules approximately 2-3mm in diameter and exquisitely tender to palpation but non-radiating.
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Key Chapman’s Points�Tip of the 12th rib for appendix reflex.
�Colon reflex reflected onto the iliotibial fascial tract.
�Upper respiratory system (pharynx/nasal sinuses) points around the clavicle and 1st intercostal space.
�Myocardium point in 2nd intercostal space.
�GI and GU points to help differentiate causes or source of visceral pain.
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Chapman’s Reflexes Treatment�Primarily a diagnostic tool.
�Find the dysfunction anteriorly but treat posterior points since they are generally less tender.
�Treat somatic dysfunctions of the pelvis first.
�Apply firm pressure with finger pad of one finger in a circular fashion, and attempt to flatten the mass. Treatment usually requires 10 to 30 seconds.
�Treatment ends when the mass disappears.
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Application of OMM
Diagnostic
AdjunctiveTherapeutic
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Treatment�Hospital based – any disease state will have an
effect on the sympathetic tone and respiratory excursion of the patient. Gentle manipulation can help facilitate the body towards recovery.
�Ambulatory care – osteopathic physicians have a unique qualification to utilize osteopathic manipulation as a therapeutic or adjunctive treatment for many disease states.
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Effects of Osteopathic Treatment�Develop a unique relationship with the patient by taking
the time to talk, listen, and touch them.�Provide pain relief and increased range of motion for
musculoskeletal dysfunctions.�Break viscerosomatic cycles to facilitate healing. �Reduce the need for medication and potential side
effects.�Improve circulation to enhance healing by removing
tissue restrictions and allowing proper circulatory and lymphatic flow.
�Treating dysfunctions of the body to promote optimal functioning, and permit the body’s inherent ability to heal itself.
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Questions???"To find health should be the object of the doctor. Anyone can find disease."- Dr. A.T. Still