upper lungs chapman’s point
anterior: b/w ribs 3-4 close to the sternal border
posterior: b/w T3-T4 near spinous processes
lower lungs chapman’s point
anterior: b/w ribs 4-5 close to sternal border
posterior: b/w T4-T5 near spinous processes
bronchus chapman’s point
anterior: b/w ribs 3-4 close to sternal border
posterior: midway b/w TP and SP of T2 on posterior aspect of TP
nose chapman’s point
anterior: costochondrol junction of 1st rib
posterior: place finger under the jaw angle, like you are drawing a line across the face to parallel the line of the mouth and pushing the finger backward until you come in line with the TP of the vertebrae
tonsils chapman’s point
anterior: 1st and 2nd intercostal space closer to sternum
posterior: surface of C1 TP, midway between the median line of the neck and the tip of the TP
sinuses chapman’s point
anterior: 3.5in from the sternum, on the upper edge of 2nd rib and in the 1st intercostal space above
posterior: midway b/w TP and SP of C2 on the superior aspect of the TP
middle ear chapman’s point
anterior: upper edge of the clavicle, just beyond where it crosses the 1st rib
posterior: upper edge of the posterior aspect of the tip of C1 TP
pharynx chapman’s point
anterior: front of the 1st rib 3/4-1in toward the sternum from where the clavicle crosses the rib
posterior: midway b/w the SP and TP of C2, on the posterior aspect of the TP
larynx chapman’s point
anterior: upper surface of the 2nd rib, 2-3in from the sternum
posterior: midway b/w the TP and SP of C2 on the superior aspect of the TP
5 treatment models
- biomechanical, postural, structural
- neurological - symp and PS
- resp/circulatory/lymph
- metabolic, nutritional, bioenergetic
- psychobehavioral - influences perceptions of pain, illness, disability
upper thoracic dysfx with resp problems (viscerosomatic changes)
extended segments palpatory changes at T2-T4 on the left
cervical dysfx during resp problems affects?
superior, middle, and inferior cervical ganglia
pertinent autonomics for resp problems?
T1-6: synpases occurs in the upper thoracic and/or cervical chain ganglia
SD at the thoracolumbar junction (esp flexed T10-L2) can cause?
increased sympathetic tone to the adrenal gland which can lead to weakening of the immune system if chronically present, can also impair toxin excretion via the kidneys and intestines with chronic SD
scoliosis >75 degrees can affect?
can compromise resp function
vagus nerves run through which structures in the cranium?
OA
AA
cranial base
occipitomastoid sutures
SD in which structures can alter drainage of the sinuses and function of the diaphragm?
- cranium (SBS compression, occipitomastoid compression affecting jugular foramen)
- occiput
- atlas
- remainder of cervical spine
SD in which structures can affect production of mucus and nasal congestion?
superior, middle, and inferior cervical ganglia
sphenopalatine ganglia
clavicles affect?
anterior cervical fascia
impairment in sacrum/coccyx/ganglian causes?
increased sympathetic tone in the thoracic spinal region
immune triangle
sternum - thymus
right lower ribs - liver
left lower ribs - spleen
CI for resp OMT
- no forceful direct treatments
- no HVLA to thoracic spine due to initial increase in sympathetic activity
- do not overtreat and tire the patient
- do not use treatment positions that aggravate patient’s breathing or pain (relative caution)
- thoracic pump technique in COPD patients
- visceral techniques in the acute phase
what affect does opening sibon’s fascia have on URI?
drain anterior and posterior cervical regions to enhance drainage of lymph
layers of cervical fascia
- subQ tissue
- masticator fascia, submandibular fascia, SCM-trap fascia
- strap mm fascia and prevertebral fascia
- visceral fascia and carotid sheath
how to address sinus pressure in URI?
address the superior cervical ganglion (OA and AA) because it affects nasal congestion and mucous production
OMT on peds with otitis media
- biomechanical - cranial base, upper cervical
- resp/circulatory - anterior cervical musculature and fascia, diaphragms, thoracic outlet, Galbreath, auricular drainage
what is the key muscle in eustachian tube function and key player in children with ET dysfx?
tensor veli palatini
muscular dysfx affecting eustachian tube?
- tensor veli palatini spasm causes extrinsic obstruction
2. medial pterygoid contraction causes compression of the tube
goal of OMT in otitis media
- improve lymphatic drainage from middle ear
- decrease effusion from middle ear
- improve function of the Eustachian tube
- improve cranial base and temporal bone motion
- decrease pain
Galbreath technique’s purpose for otitis media
increase blood flow through the pterygoid plexus of veins and lymphatics, drainage of Eustachian tube, stretching of the peripharyngeal mm (tensor veli palatini) and fascia
techniques parents can do for otitis media
- upper thoracic lymphatic drainage
- galbreath
- auricular drainage
- lots of warm water
Acute otitis media (AOM) definition
inflamm or infection of the air-filled middle ear space
otitis media with effusion (OME) definition
development of fluid (effusion) in the middle ear during inflammatory process
acute otitis media patient presentation
- hx of acute onset of signs and symptoms (fever, irritability, ear pulling)
- presence of middle-ear effusion
- signs and symptoms of middle-ear inflammation
sympathetic from sinuses and other head structures synapse at?
T1-4
sympathetic from bronchial tree synapses at?
T1-6
hypersympathetic activity upon the resp epithelium results in?
epithelial hyperplasia - increased numbers of goblet cells in relation to ciliated cells -> increased production of profuse, thick, sticky, tenacious, slow-moving resp mucosal discharge
resp-circulatory model order of implementation
- open the pathways
- improve diaphragmatic function
- augment the rate of lymphatic return
- mobilize lymph locally
if patient has pain and congestion in face and sinus regions, where should you place your fingers to relieve pain and congestion? and what nerves are you affecting?
- infraorbital and supraorbital foramen
2. branches of trigeminal nerve as they emerge from maxillary and frontal sinuses
how to perform releasing of frontal nasal suture
providing a gentle distraction with slight side-to-side mobilization of the nasal bones. those with prior trauma to the nose may benefit from this simple manuever to return motion to this site
which structure should be treated to influence parasympathetic outflow to the sinus and nasal resp epithelium? and what’s the main effect of the treatment?
- L and R sphenopalatine ganglia
2. immediate functional effect and long-term structural effect
how to treat L and R sphenopalatine ganglia
indirectly through the open mouth of the patient by applying tension through fascias of the lateral pterygoid mm
auricular drainage tech
V hand (spread middle and ring finger) on affected ear. move in clockwise and then counter-clockwise motion
cervical FPR tech on peds
- hand one used to monitor tissue response and other hand is placed on head
- flex head to bring C-spine into neutral position
- axial compression to head until softening of tissue
- bring monitored segment into position of ease
- hold for 3-5 seconds, release, and reassess
thoracic inlet MFR tech in peds
- physician contacts 1st and 2nd ribs anteriorly, costotransverse junction of T1 posteriorly
- area is engaged by gently lifting superiorly, then bring area into ease
- when breath is easily felt coming through the tissues, position is held until correction of the mechanical strain or improvement in tissue motion is noted
Sibson’s fascial release tech
- patient is supine
- stand on R side facing the head
- curl R hand fingers into Sibson’s fascia
- L hand and arm support the R UE
- rhythmically abduct and flex the RUE while increasing pressure over Sibson’s fascia
treating posterior compartment
- stand on side of supine patient
- rest cephalad hand on their forehead
- gently grasp the posterior aspect of the neck
- rhythmically turn their head toward the same side while pulling the musculature toward you
- repeat on opposite side
treating vascular compartment
- seat behind supine patient
- place one hand on the mandible and the other on the ipsilateral clavicle to stretch the vascular compartment
- use rhythmic stretch