Constipation: An OMM Approach

1. Constipation: An OMM Approach Stuart Williams D.O. Chairman & Associate Professor Osteopathic Manipulative Medicine

2. GOALS • Discuss the role of OMM in constipation. • Relate several OMM techniques that may help constipation.

3. Chapman Reflex: Definition • A system of reflex points that present as predictable anterior and posterior fascial tissue texture abnormalities (plaque-like changes or stringiness of the involved tissues) assumed to be reflections of visceral dysfunction or pathology. Glossary of Osteopathic Terminology, Foundations of Osteopathic Medicine, 3r Ed, 2011

6. Supine Direct Myofascial Release for Tight Iliotibial band • Palpate along iliotibial band for tightest point. • Using pad of thumb (reinforcing with other thumb), press medially and posteriorly on this point, using 10-30 lbs of pressure. • Maintain pressure until release is felt.

7. IT Band & Tensor Fascia Lata Somatic Dysfunction: Myofascial Release • The patient lies supine or lateral recumbent with dysfunctional side up. • The physician palpates the IT band looking for the most restricted area. • The physician gently moves the palpating hands in a linear direction of choice with an appropriate amount of pressure, noting symmetry and asymmetry in the tissues. • The physician slowly moves the myofascial tissues toward the appropriate barrier, holding the tissue at that point without relieving pressure. • The physician follows the change in the tissues until no further evidence of creep occurs. • The physician reevaluates the tissues. The technique may be repeated. Check planes of motion: clockwise or counterclockwise, superior or inferior, medial or lateral External Rotation Somatic Dysfunction = Internal Rotation Restriction

8. Fascia Lata (Method 3) • ( Foundations… p793) • KNEADING TYPE TREATMENT • Stand side opposite extremity to be treated • Flex knee to 90 degrees • Use fingers of cephalad hand to pull IT band towards you • Simultaneously carry foot away from self, increasing tension on IT band • Continue with kneading motion

9. Viscerosomatic Reflex • Localized visceral stimuli producing patterns of reflex response in segmentally related somatic structures. Glossary of Osteopathic Terminology

11. Colon • Segmental Levels • R Colon: T10-T11 • L Colon: T12-L2 • Patients with sympathetic dominant complaints may have the following symptoms: • Constipation, abdominal pain, flatulence, and distention. Addressing the above levels can be accomplished by rib raising(thoracic spinal levels), and soft tissue.

12. Treating T10-L2 • Addressing the sympathetic levels to the colon helps with sympathetic mediated pain. • It also prevents the sympathetics from overriding the parasympathetic activity.

18. Restoring Autonomic Balance • If parasympathetic activity is sluggish, you may wish to address: • OA Joint • R vagus nerve innervates the R colon • Sacrum, Innominates

19. Craniocervical Junction • Patient supine, D.O. at head of table • Contact the medial aspect of the suboccipital muscles with pads of fingers • Draw fingers both superiorly and laterally, applying just enough pressure to carry the muscles with them. • Apply enough force to feel mm relax, but not enough to cause patient discomfort (finesse) • Slowly relax force, reposition fingers and repeat • Continue until maximal response • Recheck

21. Sacral Rocking • Addressing the sacrum addresses the parasympathetics to the L colon: S2-S4 (pelvic splanchnic nerves) • Myofasicial Release: • Both hands on sacrum • Bottom hand pointing cephalad • Top hand pointing caudad

22. Sacral Rocking • As patient takes deep breath, encourage sacral extension by pushing the apex anteriorly • During exhalation encourage sacral flexion by pushing the base anteriorly • Repeat 3-5 times.

24. As patient inhales, bring sacral apex further anteriorly.

25. As patient exhales, encourage sacral flexion, by pushing the sacral base anteriorly.

26. Constipation Treatment with OMM The next 4 slides were provided by Karol L. Gordon, DO, CAQG, CMD

27. Mesenteric Release Redoming the Diaphragm Facilitated Positional Release ( Thoracic) Superficial Deep Constipation-treatment with OMM

28. Pt supine. Physician at side of patient which corresponds to physician's dominant hand. Non-dominant hand of physician is placed under patient contacting L1-3 (posterior attachments of the diaphragm). Dominant hand is placed on the abdomen just below the xiphoid process. Determine if fascia is more restricted clockwise or counter clockwise. With the non-dominant hand (under the patient), rotate in the opposite direction. Use INDIRECT technique. Hold the fascia in the direction of freedom simultaneously with the upper and lower hand Hold until a release is felt. Fascial Treatment of the Abdominal Diaphragm

29. Pt supine. Starting at the RLQ, palpate the tissue to determine the direction of restriction and the direction of ease. (INDIRECT) move the tissue in the direction of ease until a release is felt. Proceed to the RUQ, then the LUQ, LLQ. Mesenteric Release - General

30. Inhibition Pt supine. Physician holds fingers over abdominal midline so that fingers form an even line. Firm pressure is made in a vertebral direction (straight down) . Gentle pressure, follow exhalation, resist inhalation. Continue until release is felt. Abdominal ganglion release