Autonomics Flashcards
(25 cards)
Sympathetics
“Fight or Flight” T1-L2 (aka thoracolumbar) The sympathetics excite organs that are stimulated during physical activity, but inhibit organs whose activity increases at rest. Sympathetics innervate the limbs Upper limb: T2-5(6) Lower limb: T10(11)-L2(3)
Parasympathetics
“Rest and Digest”
Cranial nerves:
CN III, VII, IX, X
Sacral segments:
S2-4
The parasympathetics excite organs that are stimulated while the body is at rest, but inhibit organs stimulated by physical activity.
The parasympathetics do not have significant innervation to the extremities
Parasympathetic DUMBBELS
Diarrhea/Defecation Urination Meiosis--Pupils Contract Bradycardia Bronchospasm Emesis Lacrimation Salivation
Appreciate the OA
OA = occipito-atlantal joint
Movement of the occiput on the atlas (C1)
Similarly, the AA is the atlanto-axial joint
Movement of the atlas (C1) on the axis (C2)
When treating the autonomics, never forget the OA
We “Balance” the autonomics. We do not turn one side on and one side off.
Why do the Osteopaths Care?
The body has self-healing, self-regulatory mechanisms:
The body is always striving for autonomic balance – that’s why there is negative feedback and checks & balances in our neuroendocrine system.
Structure and function are interrelated:
By optimizing the structures that affect the autonomic nervous system, we can optimize the function.
Reflex
Def: An involuntary and nearly instantaneous movement in response to a stimulus.
Visceral Afferents
Visceral irritation
Message of irritation travels back on bifurcating neuron
Synapses on somatic motor neurons and causes muscle contraction
Releases proinflammatory polypeptides at that level
Prolonged stimulation can lead to facilitation
Facilitation: A Key Phenomenon
“Facilitation indicates an area of impairment or restriction develops a lower threshold for irritation and dysfunction when other structures are stimulated.”
Facilitated segments are hyper-irritable and hyper-responsive.
Muscles are maintained in a hypertonic state.
four reflex interactions
somato-somatic
somato-visceral
viscero-visceral
viscero-somatic
Somato-Somatic
localized somatic stimuli producing patterns of reflex response in segmentally related somatic structures.
DTRs
Withdrawal Reflex
T5 dysfunction caused by tight linea alba
Somato-Visceral
localized somatic stimulation producing patterns of reflex response in segmentally related visceral structures.
Spinal Manipulation changes in HR, BP, and sympathetic activity to kidney and adrenal medulla
Viscero-Visceral
localized visceral stimuli producing patterns of reflex response in segmentally related visceral structures.
Gut Distention Gut Contraction
Baroreceptor Reflex Blood vessel stretch change causes change in heart rate
Viscero-somatic
localized visceral stimuli producing patterns of reflex response in segmentally related somatic structures.
Cardiac Disease Somatic Dysfunction at T1-5
non-neutral (type II mechanics) are often
viscero-somatic reflexes
referred pain
aka reflexive pain
Convergence-Projection Theory
Visceral and somatic afferents converge on the same or associated neurons or interneurons in the spinal cord
Can follow a viscero-somatic pattern (MI –> Left Arm)
Or a somato-somatic pattern (Gallbladder –> Diaphragm –>Phrenic Nerve –> Right Shoulder
Trigger Points
Def: Hyperirritable spot in skeletal muscle that is associated with hypersensitive palpable nodule in a taut band.
Painful on compression with radiating or referred pain, tenderness, motor dysfunction, and autonomic phenomena
2 classifications
Active: refer pain at rest, with muscular activity, or with palpation
Latent: produce pain only when probed with more steady pressure
Treat with inhibitory soft tissue, deep massage, dry needling, injection with steroids and/or anesthetic, isometric MET, vapocoolant spray with myofascial stretch
“Jump sign”
Pt response to pain: wince or voluntary withdrawal
“Local twitch”
Transient contraction of the taut band of fibers with the trigger point
Presence differentiates between trigger point and fibromyalgia syndrome
Tender Points
Def:
Small, hypersensitive points in the myofascial tissues of the body.
Can be used as diagnostic criteria and treatment monitors.
Initial injury causes sudden unanticipated lengthening of the antagonistic muscle to the originally strained and painful agonist muscle.
finding and treating tender points
Location of tender points is consistent between pts Suggests anatomic basis Within myofasical structures Tendons, ligaments, muscle bellies Sensitive to palpation Related to nociceptive activity Localized without radiation Treat with counterstrain Resets proprioception via golgi tendon organs and muscle spindle fibers
When the optimal position of comfort is established, the tenderness disappears or becomes insignificant. Indicates a neural relationship b/w the tender point and SD.
Chapman’s points
Def: A system of reflex points that present as predictable anterior and posterior fascial tissue texture abnormalities (plaque-like changes or stringiness of involved tissue) assumed to be reflections of visceral dysfunction or pathology.
Multitude of mechanisms explaining
Lymphatic abnormalities, inflamed lymph vessels passing over bone, fibrositis deposits, inflamed nerve endings, and inflamed sympathetic nerve filaments around terminal arterioles
more on chapman’s points
Dr. Chapman called them gangliform contraction due to congestion within fascia due to lymphatic stasis secondary to visceral dysfunction
Part of a viscero-somatic reflex
Believed to be part of sympathetic dysfunction
Found in regions which overlap with visceral sympathetic efferent innervation
Overall, there is a general consensus that a Chapman’s reflex involves the lymphatic and neurologic systems and the tissue texture changes associated with visceral dysfunction
gangliform vs ganglion
Gangliform vs. ganglion
- gangliform – not a nerve and not a cyst; but it is a rounded contraction
- ganglion – part of a nerve, or ganglion cyst
Ex: Excessive input from a viscera of the head or neck produces facilitation of the upper thoracic cord segments and results in reflex stimulation of somatic tissues innervated by T1-4 (viscero-somatic reflex). Palpatory changes in the upper thoracic and cervical paraspinal tissues as well as traditional Chapman’s reflex locations therefore indicate increased functional activity of the sympathetic nervous system in this region. Pg 3 Kuchera Osteopathic Considerations in System Dysfunction
chapman’s points again
Small, smooth, firm, discrete nodules in fixed anatomic locations
Deep to skin and subcutaneous areolar tissue on deep fascia or periosteum
Feel like a BB or split pea
Usually paired anterior and posterior
Anterior points often painful with light compression
Often tender, but don’t radiate “Tenderness is not the sole criterion for a Chapman’s point; rather, it is lymphatic congestion and altered myofascial texture” Treatment: firm, circular pressure Attempt to flatten 10-30 sec
