The Five Diaphragms in Osteopathic Manipulative Medicine: Myofascial Relationships, Part 1

Abstract

Working on the diaphragm muscle and the connected diaphragms is part of the respiratorycirculatory osteopathic model. The breath allows the free movement of body fluids and according to the concept of this model, the patient's health is preserved thanks to the cleaning of the tissues by means of the movement of the fluids (blood, lymph). The respiratory muscle has several systemic connections and multiple functions. The founder of osteopathic medicine emphasized the importance of the thoracic diaphragm and body health. The five diaphragms (tentorium cerebelli, tongue, thoracic outlet, thoracic diaphragm and pelvic floor) represent an important tool for the osteopath to evaluate and find a treatment strategy with the ultimate goal of patient well-being. The two articles highlight the most up-to-date scientific information on the myofascial continuum for the first time. Knowledge of myofascial connections is the basis for understanding the importance of the five diaphragms in osteopathic medicine. In this first part, the article reviews the systemic myofascial posterolateral relationships of the respiratory diaphragm; in the second I will deal with the myofascial anterolateral myofascial connections.

Phylogenetics of the Fascial System

“…Our species is the only one that has five connective tissue structures anatomically arranged in a transversal form forming the five diaphragms of the body. They are, from cranial to caudal, as follows: the tentorium cerebelli, tongue (floor of the mouth), upper thoracic diaphragm, muscular diaphragm, and pelvic diaphragm (pelvis floor) [ 28 ]. These structures have a mechanical and neural connection, enabling several important functions for the bipedal position.…”

“…They form limits of interdependent body cavities that, at the same time, need autonomy to perform various individual functions at different times. The five diaphragms provide us with control and synchronization of the intracavitary pressures, acting on the fluidic circulation between the cavities and also in the interstitium of the visceral parenchyma [ 28 ].…”

“…The pelvic diaphragm is formed by the muscles and fasciae: ilium, ischium, and pubococcygeus, together with the piriformis fascia and obturator fascia being innervated by the sacral nerves [ 12 ]. Brainstem nuclei coordinate constant reflexes for synchronism, seeking to orchestrate the optimization of the body's functioning [ 28 ]. In the cranial fasciae session, we will detail the cerebellum tent more.…”

The Five Diaphragms in Osteopathic Manipulative Medicine: Neurological Relationships, Part 1

“…The founder of osteopathy, Dr Andrew Taylor Still, in 1874 described a fundamental concept for OMM, that is, that an injury arises when there is an interruption of fluids; this event can materialize as a somatic, visceral, and behavioural symptom [4]. The five diaphragms are part of the respiratory-circulatory model, where the latter's philosophy is based on the optimal circulation of body fluids through functional relationships between some segments of the body considered as diaphragms: tentorium cerebelli, tongue, thoracic outlet, diaphragm, and pelvic floor [5,6]. The nourishment and cleansing of all tissues by the blood and lymph, as well as their free circulation are fundamental for physical and mental health.…”

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

“…In the first part, we discussed the neurological relationships of the tentorium cerebelli and the muscular complex of the tongue; the latter two constitute with the thoracic outlet, the respiratory diaphragm, and the pelvic floor what in osteopathic manipulative medicine (OMM) is called the model of the five diaphragms [1]. The five diaphragms reflect the concept of another historical model with which the clinician guides the evaluation and the clinical decision, that is, the respiratory-circulatory model.…”