The Five Diaphragms in Osteopathic Manipulative Medicine: Neurological Relationships, Part 2

Abstract

The main objective of the osteopath and that of osteopathic manipulative medicine (OMM) is to create space between the different tissues. The sliding capacity of the various tissue layers and between the different body components, up to the possibility of movement between cells is the salutogenic stimulus to allow the circulation of fluids, the biochemical exchange, and the adequate management of the multiple internal and external stimuli that perturb the body living. Movement is allowed by space and space is life. In this second part, the exposure of the anatomical neurological relationships of the five diaphragms continues, highlighting the relationships of the thoracic outlet, the respiratory diaphragm, and the pelvic floor. Finally, there will be clinical reflections to further corroborate the existence of the anatomical continuum and to lay the scientific foundations for an OMM approach to body diaphragms.

Osteopathic Principles: The Inspiration of Every Science Is Its Change

“…The sliding capacity of the various tissue layers and between the different body components, up to the possibility of movement between cells is the salutogenic stimulus to allow the circulation of fluids, the biochemical exchange, and the adequate management of the multiple internal and external stimuli that perturb the body living. Movement is allowed by space and space is life" [ 44 ]. Space or position is used for movement and to give the possibility to all the structures in that anatomical area to be able to function, respecting the purpose with which they were positioned in that specific area.…”

Osteopathic Palpation of the Heart

“…With palpation, it is necessary to keep present the passive tensions of the pericardium and the tensions produced by the neighboring tissues in fascial connection with the pericardium; we do not have to hear the heartbeat but how the heart moves inside the pericardium and how the latter behaves inside the mediastinum. The osteopath must search the space of movement and evaluate the available entities [ 43 ]. The custom of imagining an organ moving on three planes, during the palpatory act, can be a mistake, as the organ is a three-dimensional structure and as such, it moves on all planes.…”

Palpation of the Respiratory System in Osteopathic Manual Medicine: From the Trachea to the Lungs

“…This means that manual evaluation does not simply take machine-readable data into account; very often, tactile data allow the movement of one motor area to be compared with that of another. Assessing the ability of different tissues to move under the hand is essential for understanding how and with which technique to increase the fascial space using an OMM approach [ 8 ]. Increasing the space of movement between different layers of tissues makes it possible to manipulate the local metabolic framework and the activity of afferent pathways, which can change a patient’s clinical and/or symptomatic status [ 8 ].…”

“…Assessing the ability of different tissues to move under the hand is essential for understanding how and with which technique to increase the fascial space using an OMM approach [ 8 ]. Increasing the space of movement between different layers of tissues makes it possible to manipulate the local metabolic framework and the activity of afferent pathways, which can change a patient’s clinical and/or symptomatic status [ 8 ]. Space allows for more movement, and movement allows for adaptation to one’s environment.…”

“…The main goal of osteopathy and manual therapy is to create space between different tissues. The sliding capacity of the various tissue layers and between the different body components, which allows for movement between cells, is considered as a salutogenic factor that facilitates the circulation of fluids, biochemical exchanges, and the adequate management of multiple internal and external stimuli that can disturb the body [ 8 ]. To our knowledge, no previous studies on the OMM approach have described the manual evaluation on respiratory tissues in any detail and have instead focused on structural and/or instrumental examination [ 7 , 9 - 12 ].…”