John P. Tortu, DO, C-NMM/OMM
Welcome This presentation attempts to supply a framework for the integration of the basic principles of Western and Eastern philosophies of the evaluation and treatment of pain Evaluation combining Osteopathic palpation, the Autonomic nervous system and the Meridian system Treatment using Osteopathic Balanced Fascial/ligamentous tension techniques
Trauma and Pain
Unrecognized Trauma
Inversion Ankle Strain/Sprain
What actually occurs
Autonomic Nervous System Overview
Osteopathic Chapman s Reflex Points
TCM Overview
Seems to function as a living nervous system Sensory receives energy from surroundings passes it along the meridian to the organ, restoring and maintaining its function Motor responds to the condition of the organ initiates fascial change along the meridian at specific locations on the extremities causes pain and joint restriction locally at these points An early warning system to evaluate unseen visceral disease before it becomes untreatable
Fascial Continuity
Fascia is the Constant
Unification of Two Systems The Autonomic and Meridian systems linked at organ Example Kidney dysfunction via: Ankle inversion injury, causes torsional fascial multi-regional somatic dysfunction: Compression of neurovascular bundle, lymphatics and meridians Restricts N/V flow to, Lymph flow away from foot as well as attenuating the energy flow along meridian to the kidney fascially-mediated strain alters structure and free movement of all regions along meridian alters free floating nature of kidney in its space, restricting its movement, blood flow and function
organ dysfunction triggers reflex changes in ANS tone into CNS reflex changes in spinal fascia and related somatic region (dermatomal guarding) Chapman s reflex changes in the associated fascia, the viscero-somatic reflex arc for kidney, lateral to the L1 spinous process triggers fascial changes along the meridian, creating hot acupuncture points along extremity a somato-viscero-somatic reflex arc, from the ankle to the kidney and back to the foot with pain
Much More than Just an Ankle Sprain
Fascia Transmitting Injury to Viscera
Torsional strain transferred onto fascia investing the capsule: possible long term implications: slow decline of organ function over years leading to frank organ failure in later decades increasing blood levels of toxins related to dysfunctional organ system
Capsule has Fascial Connections
Viscero-Somatic Reflex
Fascial Continuity into CNS
Palpation of the Affected Viscus
Palpation of related extremity
When Dysfunction is Present
Palpation and Treatment
Connect the two hands using your intention Feel the fascial continuity in the space between your hands A loading effort is introduced into the fascia the space between your hands creates an additional fulcrum activation of the fascial ability to move toward normal addresses the overall fascial strain pattern
This activation guides the balancing effort taking the origin of the injury toward the visceral deposition from the foot and ankle along the injury vector toward the affected organ allows the body to release fascial tension along meridian creates a general state of balanced fascialligamentous tension between the two hands the capsule of the organ and the overlying somatic structures soften and warm the dysfunctional extremity dysfunctions resolve
Merging concepts of Osteopathic Medicine and Traditional Chinese Medicine
In the example given, the kidney softens and opens The kidney is able to accept the nominal flow of blood required for homeostasis This flushes the substance of the kidney of stagnant waste buildup restores its function of filtering waste and excess fluids from the blood The afferent signal that triggered the guarding reflex has resolved Abnormal efferent tone is normalized, causing relaxation of overlying somatic structures, releasing the guarding reflex
The paraspinal Chapman s reflex points around L1 resolve The unrestricted kidney triggers resolution of the hot acupuncture points The torsional fascial strain on the lower extremity resolves through vectoring along the injury pathway Overall improved ranges of motion and blood flow through the affected kidney, pelvis and lower extremity is observed
Evaluation and Treatment Overview Evaluation testing motion across major transverse regions to identify the overall pattern of dysfunction Palpation overlying visceral regions, posterior/anterior structures of associated extremity regions based upon the following: Findings hardness, coldness, bogginess, absence, etc. Treatment balancing dysfunctional fascial-ligamentous tensions along the path of the meridian End Point non-dysfunctional organ findings of warmth, fluidity, softness, fullness, etc. and restoration of extremity dysfunction
Research Possibilities