Therapeutic Applications of OMT for Specific Disease

Processes Thomas E. Sabalaske, DO

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Therapeutic Applications

of OMT for Specific

Disease Processes

Thomas E. Sabalaske DO

www.doctorsab.com

AOCFP Intensive Update and Board Review

August 2015

Three Things to Consider in

Systemic OMT

Autonomic nervous system

Lymphatics

Local bio-mechanical factors

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Autonomic Nervous System

Controls subconscious processes

Divided into sympathetic and

parasympathetic

Controlled by the limbic system of the

brain through the hypothalamus

Sympathetic Nervous

System

“fight or flight”

Enhances cardio-pulmonary system

and inhibits GI system

Primary neurotransmitter –

norepinephrine

Sympathetic Nervous

System

Two major receptors

1. Alpha – vascular smooth muscle and

visceral sphincters

2. Beta – cardiac stimulation and

visceral smooth muscle inhibition

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Sympathetic Nervous

System

Preganglionic bodies originate from

T1 through L2 then synapse with

1. Paravertebral ganglia – vasculature

and organs outside the

abdomen/pelvis

2. Prevertebral ganglia – abdominal

and pelvic organs

Prevertebral ganglia

1. Celiac ganglia – combines with SMG

2. Superior mesenteric ganglia –

combines with celiac ganglia to form

celiac plexus – abdominal organs up

to splenic flexure

3. Inferior mesenteric ganglia –

descending colon and pelvic organs

spinal segment pathway organ effect

T1 along int. carotid pupil mydriasis

T2 ext. carotid face sweat glands sweating

T2-6 brachial plexus upper ext. skin vasoconstriction,

piloerection and sweating

T9-L1 lumbosacral

plexus

lower ext. vasodilatation in muscles

T2-T8 cardiac plexus

pulmonary

plexus

heart

bronchi

stimulation

bronchodilation

Paravertebral ganglia

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T6-10 celiac plexus GI tract inhibits peristalsis

T11-L1 sup. mesenteric GI tract inhibits peristalsis

T12-L1 celiac plexus Kidney vasoconstriction, increases

renin

T10-L1 celiac plexus adrenal gland epinephrine secretion

T12-L2 inf. mesenteric rectum/bladder

sex organs

retention feces/urine

ejaculation/lubrication

Prevertebral Ganglia

organ pre-ganglionic spinal cord level

heart T1-5

lungs T2-7

stomach T5-9

liver/gall bladder T6-9

pancreas T5-11

small intestine and proximal large

int.

T9-11

distal colon/rectum T12-L2

kidney/ureters/bladder T10-L1

ovary/fallopian tube T9-10

testicle/epididymis T9-10, L1-2

uterus T10-L1

prostate L1-2

Pregangionic Spinal Levels

Parasympathetic Nervous

System

“rest and digest”

Inhibits the cardiac and pulmonary

systems, enhances the GI system and

exocrine/endocrine glands

Primary neurotransmitter –

acetylcholine

Ganglia near end organs to be

affected

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Parasympathetic ganglia

origination nerve ganglion effect

midbrain III ciliary pupil constriction/

accommodation

pons VII sph.palantinesubmandibular

lacrimation

salivation

medulla IX otic salivation

medulla X end organs bronchoconstriction, ↑GI

motility, ↓pulse/cardiac

conduction

S2-4 pelvic

splanchnicend organs voiding and erection

Lymphatic System

Organized lymph tissues – spleen,

tonsils, appendix, about 400 lymph

nodes

Lymphatic channels

Right lymphatic duct – R arm/head

Left lymphatic duct – legs/L arm

Lymphatic fluid

Diaphragms

Plantar fascia

Popliteal fossa

Pelvic diaphragm

Abdominal diaphragm

Thoracic inlet

Tentorium cerebelli

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Lymph pumps

Rib raising

Pectoral traction

Miller supine thoracic pump

Atelectasis maneuver

Liver pump

Spleen pump

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Chapman’s Reflex Points

Frank Chapman DO 1920’s

Tenderpoints found to have high

correspondence with systemic

disease

Anterior – diagnostic

Posterior - treatment

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Case Study #1

44 year old female presents with nine

months of abdominal bloating and

cramping especially after meals with

alternating constipation and diarrhea.

Colonoscopy is normal and labwork

does not show celiac antibodies or

other abnormalities……

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Irritable Bowel Syndrome

Abdominal pain, bloating, constipation

and/or diarrhea

Autonomics – vagus, sacrum, mid

thoracics to upper lumbars,

prevertebral ganglia

Abdominal fascias

Abdominal and pelvic diaphragms and

lymphatics

Supine Mesenteric Release

Patient supine

Physician contacts the lower

abdominal wall, applies pressure and

indirectly follows away from the barrier

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Prone Mesenteric Release

Patient in knee chest position

Physician places hands on lower

abdomen just above the pubes and

lifts the contents out of the pelvis in an

oscillatory fashion until a release is

appreciated

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Liver Visceral Technique

Patient supine

Physician on right side of patient,

appreciating the liver fascias through

the rib cage from the anterior and

posterior sides

Physician engages any barriers to

motion and holds for a few respiratory

cycles

Case #2

47 year old male with 2 weeks of

worsening sinus pain and pressure

that worsens with neck flexion,

purulent nasal discharge, post nasal

drip and mild fevers…..

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Sinusitis

Autonomics – sympathetic T1-4,

parasympathetics cranial nerve VII

Vagal nerve is important for

innervation of musculature of posterior

pharyngial muscles

Lymphatics of cervical chain and

thoracic outlet

Allergic/infectious contributions

Trigeminal Foramen

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Mandibular Drainage

(Galbreath technique)

Physician contacts the mandible on a

supine patient and draws it across the

midline and inferiorly

Vomer Pump

Physician inserts a gloved finger on

the intermaxillary suture and provides

a gentle pumping motion

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Peri-auricular Drainage

Physician places hand on side of

patient’s head with their ear between

3rd and 4th fingers, gives a gentle

rotational motion

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Sphenopalatine Ganglion

Physician inserts a gloved finger past

upper molars, then lateral and

posterior to the maxillary ridge, then

cephalad over the teragoid plates

Patient nods their head forward to

stimulate the parasympathetics to thin

secretions and decrease congestion

Case #3

52 year old woman presents with

frequency, urgency and dysuria for 3

days with a mild increase in

temperature….

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Urinary Tract Infection

Autonomics – sympathetics T10-L2,

inferior mesenteric ganglion,

parasympathetics vagus and S2-4

Lymphatics – especially pelvic

diaphragm

Biomechanical – pelvic dysfunction, c-

section scars

Bladder Fascia Release

Physician palpates deeper fascias just

above the pubic bones and engages

the fascia in either a direct (if

tolerated) or indirect manner

Kidney Fascial Release

Patient supine

Physician contacts the lower ribcage

on the back in the kidney area

Anterior hand just under anterior

ribcage with fingers pointing towards

xyphoid

Hands come together and fascial

restriction is appreciated, then treated

first indirectly, then directly

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In Conclusion

Take the basic knowledge gained

here in regards to autonomics,

lymphatics and biomechanical

interaction with the visceral systems

and look for more connections with

more disease states and help your

patients in a way greater than you

ever hoped!