Overview of Osteopathic Manipulative Treatment: 5 Diaphragm Procedure
In osteopathic medicine, which focuses on the whole body and its interconnected system, there are five key areas, or “diaphragms”, that occupy horizontal spaces within the body. These are areas closely connected to each other, found throughout the body: the tentorium cerebelli in the brain, the tongue, the thoracic outlet at the base of the neck, the main diaphragm near the stomach, and the pelvic floor.
An osteopath – a type of doctor who focuses on manual readjustments in the body, similar to a chiropractor – aims to create more space between these anatomical structures. This is because the body needs this space for proper movement. However, they cannot manually change the shape of these structures. They review the connections between these five areas, determine how these areas are functioning, and provide appropriate hands-on treatment. Manuel treatments can help address different health issues that might arise from problems in these areas.
In essence, creating this space within the body is analogous to bringing life into the body. As famed artist and inventor Leonardo da Vinci once said, “space is life”.
Anatomy and Physiology of Osteopathic Manipulative Treatment: 5 Diaphragm Procedure
Osteopathic medicine, or OM, is a type of medical practice developed by Dr. A. T. Still in the late 1800s in America. It utilizes five different models related to the body’s structure, blood and air circulation, neurological system, nutrition and metabolism, and the way behavioral and psycho-social factors affect health. These models give an understanding, but it’s still crucial to look at the big picture by combining them. One important aspect comes from the circulation model, aimed at promoting the flow of bodily fluids to enhance one’s health.
Let’s mention the “five diaphragms” related to this model: the tentorium cerebelli (a kind of membrane in the brain), the tongue, the thoracic outlet (the space between your collarbone and your first rib), the diaphragm (the main muscle that helps you to breathe), and the pelvic floor.
Firstly, the tentorium cerebelli is a sort of half-circle-shaped sheet structure in the back of the head. It separates the bigger part of the brain from a smaller part, the cerebellum, which is in charge of balance and coordination. It’s interesting because it involves certain bones and areas of the head and aids in the flow of blood and lymph (a fluid that helps in fighting off infections).
In contrast, the tongue, besides being essential for speaking, eating, and breathing, can influence our physical posture, specifically, the neck and head. It works closely with other muscles controlling the above-mentioned functions.
Moving on to the thoracic outlet, this consists of a mix of bones and muscles inside the upper chest and shoulder area, providing a passageway for some vital blood vessels and nerves. Crucial nodes of our stress response system (the sympathetic nervous system) and our rest-digest system (parasympathetic) also exist here.
The diaphragm is a large muscle located just below the lungs, playing a principal role in breathing. Some of the body’s main vessels, including the aorta (main artery) and the vena cava (primary vein), pass through it, along with certain elements of the lymphatic system.
Last but not least, the pelvic floor consists of muscles at the bottom of the pelvis that support organs like the bladder, uterus in women, and intestines. It’s also essential for functions such as urination and bowel movements.
All these parts of the body create a complex system working together and affecting several aspects of our health and well-being. Understanding how they individually and collectively function helps in diagnosing and treating various health issues in osteopathic medicine.
Why do People Need Osteopathic Manipulative Treatment: 5 Diaphragm Procedure
Chronic illnesses often involve repeated similar issues and symptoms. People struggling with obstructive sleep apnea (OSA), for instance, might experience frequent headaches, abnormal tongue behavior, morphological alterations in the rib cage, and problems with pelvic floor muscles.
Patients with chronic obstructive pulmonary disease (COPD) often encounter issues like unrelenting headaches, OSA, and abnormal diaphragm and pelvic floor muscle functions. Those suffering from chronic neck pain may have associated symptoms like headache, changes in tongue behavior, breathing issues, and postural changes in the pelvic area. Similarly, someone who has chronic kidney disease will often also deal with different health problems including habitual headaches, OSA, impaired diaphragm function, and weakness in the pelvic floor muscles.
The causes of these issues can differ greatly and are often specific to the underlying disease. The idea here is that everything in the human body is interconnected. Understanding the relationships between the body’s systems enables us to view the body as a network rather than isolated areas.
It’s also important to understand the osteopathic approach of treating the body as a whole, including the five diaphragms. A professional osteopath puts emphasis on finding the cause of your symptoms, like shoulder pain can be due to an issue within your diaphragm, rather than just treating the symptom itself. This is because your diaphragm, just like any nerve structure, carries electrical and biochemical information. Frequent diaphragm complications can lead to the production of inflammation-causing cytokines and other substances which can result in shoulder dysfunction or pain.
For example, continuous strain on the muscles at the back of your neck can cause unusual mechanical and metabolic tensions in the dural area, a thick membrane covering the brain and spinal cord, leading to headaches. Chronic inflammation can also follow an abnormal stimulation of mechanical receptors residing near blood vessels, and may affect all nearby nervous structures. As a result, a distant issue like trauma to the sacrum at the base of the spine can cause unusual tension in cervical muscles, and effect these relationships via fascial tracts, which are networks of connective tissue spanning throughout the body.
When dealing with chronically ill patients, considering the interconnectedness of body’s five diaphragms is vital. But, it also needs to be noted that during the acute phase of an illness, these techniques should be used with care, particularly if touching the affected area could cause discomfort or be ineffective due to a wound that’s not yet healed.
When a Person Should Avoid Osteopathic Manipulative Treatment: 5 Diaphragm Procedure
Research does not list any reasons why the five diaphragms used in osteopathic medicine should not be used. Osteopathic medicine involves treating the whole body, not just specific symptoms. The only time certain techniques should not be used is when joint techniques are involved, like a high-velocity low amplitude (HVLA) technique, which involves quick, targeted movements.
These osteopathic techniques we’re discussing are typically very gentle and not harmful. Think of them like a light stretch or pressure, rather than anything abrupt or forceful.
Equipment used for Osteopathic Manipulative Treatment: 5 Diaphragm Procedure
The essential thing you need is a table and all the previous health information that’s been collected about you.
Who is needed to perform Osteopathic Manipulative Treatment: 5 Diaphragm Procedure ?
A method called the osteopathic approach can be done by a medical professional who has specifically studied osteopathic medicine. If you’re the patient getting this treatment, it’s important to understand what the medical professional is going to do. This is only done after they’ve evaluated your health condition beforehand.
Preparing for Osteopathic Manipulative Treatment: 5 Diaphragm Procedure
Before a doctor or osteopath can carry out a hands-on treatment, they need to examine certain areas in your body. These include five regions called “diaphragms”. Here’s how the two-step examination process works:
General Examination
First, you would lie on your back and the doctor would sit at the head of the treatment table. With their little fingers touching the back of your skull (the ‘external occipital protuberance’), they would feel for the contour and condition of the tentorium cerebelli – a covering protecting your brain. This examination involves feeling for any unusual and painful spots, changes in temperature or other abnormalities. The doctor would also try to ‘listen’ to the movement of the tentorium by lightly pressing down with their fingers and seeing how your body responds. This response isn’t usually linked to the rhythm of your heartbeats or your breaths; it is slower.
Next, the doctor would place their fingers under your jaw to feel for any abnormal tensions in the region of your tongue called the ‘lingual complex’. They may also try to evaluate your tongue by holding part of a bone in your neck called the hyoid bone.
In a similar seated position, the doctor would then evaluate a region of your body called the thoracic outlet. They would do this by placing their fingers above and below your collar bone or clavicle, and the thumb near a spot in your neck (C7). Through this, they would assess the tissue, look out for any painful areas, changes in temperature, or unusual signs. The movements they would try to feel here involve an opening and closing movement of the thoracic outlet.
To carry out a general evaluation of your diaphragm muscle (the large dome-shaped muscle that aids in breathing), the doctor would then stand beside you. They would place their hands on the sides of your back as this region tends to move more during breathing. In this step too, they would look for painful areas, changes in temperature, or any abnormalities. They’d also see how your diaphragm moves; generally, the right side doesn’t move as much as the left because of the presence of your liver.
Lastly, the doctor would evaluate your pelvic floor while still standing. They would do this by placing the palms of their hands on your hip bones and gently rocking them towards the bed, like they’re trying to “open” your pelvis. This would allow them to identify any motion restrictions or pain in your pelvis and assess the muscle and joint movement.
The general examination helps the doctor to identify troubled areas in terms of movement or pain. To identify the main troubled area, they conduct simple tests. For example, if they find issues in your diaphragm and tongue, they would focus on these areas and see how these feel when pressure is applied. The area where the previously noticed issues do not change is likely the one that needs treatment.
Detailed Evaluation
For a more specific analysis, the doctor would examine several things, such as the tension in your neck muscles, whether your first few neck vertebrae (bones) move freely, and how well the bones around your temples are moving. They would also test the strain in your cerebellum’s covering by gently pulling on your earlobe in a certain direction.
After examining your tongue’s movement, they would test this further by getting you to turn your head to the sides and bringing your tongue out, and also while flexing your neck. They would also test your balance with a ‘Fukuda’ test. This involves you keeping your eyes closed and touching your front upper teeth with your tongue. This test is important for your balance as this part of your tongue has important connections with your posture. They would also observe your muscle movements when you smile or pout.
This comprehensive examination prepares the doctor to treat you effectively, ensuring the right areas receive attention and treatment.
How is Osteopathic Manipulative Treatment: 5 Diaphragm Procedure performed
The unwinding approach is an advanced technique used in osteopathy, a type of alternative medicine that emphasizes physical manipulation of the body’s muscle tissue and bones. This technique was developed by an American osteopath, Dr. Frymann. It can be safely used on both adults and children, because it doesn’t involve putting any manual force onto the patient, rather it works with the natural movements and forces within the patient’s body.
An osteopath using this technique can decide to focus on one particular area of the body, known as a diaphragm, if it’s not functioning properly, or they may decide to deal with multiple diaphragms at once. This could involve treating each diaphragm separately or all together. The exact approach and technique used would be dependent on the osteopath’s judgement.
Sometimes, an osteopath may choose to use the unwinding technique on more than one diaphragm at a time, especially if they’ve identified two areas that are not functioning properly. This might involve focusing on one area first and then moving to the next, or it could mean simultaneously having contact with one area (with one hand) and another area (with the other hand). This could be true even if the areas are far apart on the body, like the tentorium (an area in the brain) and the pelvic floor.
If the osteopath decides that all the diaphragms need attention, they may use a specific manual grip for each diaphragm, moving from one to another. The time it takes to do this largely depends on the osteopath’s experience and how effectively the patient responds to the procedure.
Throughout the procedure, the osteopath’s hands will be in contact with the patient’s body, but they won’t apply any strong force or proactively cause any movement. The hands will follow the natural movements within the patient’s tissues. At first, these movements may seem disorganized or uneven, but the procedure is completed once the osteopath observes a symmetrical pattern in the movement’s scope and length. The hands will appear to move around, but they are only responding to the patient’s tissues. This can be compared to a seagull on sea waves; even though the seabird seems to be moving, it’s really the waves that are causing the seagull to move.
Possible Complications of Osteopathic Manipulative Treatment: 5 Diaphragm Procedure
Current research shows that a technique called ‘unwinding’ doesn’t cause any problems in patients. This technique can even be used on wounds that are still healing.
What Else Should I Know About Osteopathic Manipulative Treatment: 5 Diaphragm Procedure ?
The tongue being in trouble can cause pain in other parts of the body like the area around it or even within your head. This is because the nerve connections between the tongue and the nerves in your skull (trigeminal system) can transmit pain-causing signals to the brain when something is not right with the tongue. These signals can also result in the dilation of blood vessels, that can further intensify pain.
Manual treatment of different muscle sections within the body can help improve the circulation of fluids in the body. When any tension is present in these muscle sections, it can alter the flow of body fluids, and contribute to inflammation and pain. This inflammation can interfere with the tongue’s function, due to altered nervous signals and changes in the transport of necessary substances to the tongue.
Pins and needles in your little finger could be a result of pressure on the ulnar nerve, which can be caused by abnormal tension in the diaphragm muscle. This tension can cause inflammation that is then transported to your spinal cord. Any issue with the diaphragm, like during a heart attack, can cause inflammation that can affect the nerves in your arm and hand.
There is a nerve called the vagus nerve, which can be close to a muscle called the omohyoid muscle. This muscle is active when we move our tongue and thus, probably plays a role in shoulder movement. If the tongue’s position remains towards the hard palate, it can result in muscle activation which can alter the environment around the passage of the nerve, leading to complications.
Pelvic floor muscle tension can cause pain in the pelvic area, which can hamper breaths in and result in chronic lower back pain. An osteopath, a doctor who specializes in muscle and joint pain, needs to be aware of the entire muscular system and always look beyond just the obvious symptoms. In this situation, instead of treating the diaphragm, they would focus on the pelvic floor muscles.
Previous heart surgery can cause complications for the phrenic nerve, a nerve that plays a major role in breathing, resulting in a partial or complete injury. In the event of an extensive injury, the patient may need to undergo another operation to fix the issue.
