The Importance of the Posterolateral Area of the Diaphragm Muscle for Palpation and for the Treatment of Manual Osteopathic Medicine

Abstract

The eupneic act in healthy subjects involves a coordinated combination of functional anatomy and neurological activation. Neurologically, a central pattern generator, the components of which are distributed between the brainstem and the spinal cord, are hypothesized to drive the process and are modeled mathematically. A functionally anatomical approach is easier to understand although just as complex. Osteopathic manipulative treatment (OMT) is part of osteopathic medicine, which has many manual techniques to approach the human body, trying to improve the patient’s homeostatic response. The principle on which OMT is based is the stimulation of self-healing processes, researching the intrinsic physiological mechanisms of the person, taking into consideration not only the physical aspect, but also the emotional one and the context in which the patient lives. This article reviews how the diaphragm muscle moves, with a brief discussion on anatomy and the respiratory neural network. The goal is to highlight the critical issues of OMT on the correct positioning of the hands on the posterolateral area of the diaphragm around the diaphragm, trying to respect the existing scientific anatomical-physiological data, and laying a solid foundation for improving the data obtainable from future research. The correctness of the position of the operator’s hands in this area allows a more effective palpatory perception and, consequently, a probably more incisive result on the respiratory function.

A Missing Voice: The Lingual Complex and Osteopathic Manual Medicine in the Context of Five Osteopathic Models

“…During the act of inhalation, the muscle undergoes an anterior movement in its lower and posterior portion and, at the same time, its posterior and upper portion creates a movement with a caudal and posterior vector; in this way, it moves the pharynx forward and opens the upper respiratory tract [8]. The genioglossus facilitates the protrusion of the tongue during speech (together with the verticalis and transversalis muscles), becoming an agonist of the styloglossus muscle and the hyoglossus muscle (together with the inferior muscles and superior longitudinalis), the latter of which tend to bring the lingual complex into retrusion (Figure 1) [27].…”

“…The tongue is a key muscle of breathing. The central pattern generator (CPG) is responsible for respiratory actions, located in the brainstem, bulb, and spinal cord; the first muscle that contracts and is managed by the CPG is the lingual complex [8]. The neurons of the preBötzinger complex (brainstem) stimulate the activity of the XII cranial nerve, thus opening the pharyngeal space or retroglossal airway; the preBötzinger complex continues its afferent action to start activating the phrenic pre-neurons and the contraction of the diaphragm muscle and the inhalation [8].…”

“…The central pattern generator (CPG) is responsible for respiratory actions, located in the brainstem, bulb, and spinal cord; the first muscle that contracts and is managed by the CPG is the lingual complex [8]. The neurons of the preBötzinger complex (brainstem) stimulate the activity of the XII cranial nerve, thus opening the pharyngeal space or retroglossal airway; the preBötzinger complex continues its afferent action to start activating the phrenic pre-neurons and the contraction of the diaphragm muscle and the inhalation [8]. Another neural area defined as the postinspiratory complex near the bulb, in case of the need to prolong inhalation (cough, phonesis, swallowing), can help stimulate the electrical activity of the XII cranial nerve (and the vagus nerve), lengthening the involvement of the tongue (and the muscles of the larynx) [8].…”

“…The neurons of the preBötzinger complex (brainstem) stimulate the activity of the XII cranial nerve, thus opening the pharyngeal space or retroglossal airway; the preBötzinger complex continues its afferent action to start activating the phrenic pre-neurons and the contraction of the diaphragm muscle and the inhalation [8]. Another neural area defined as the postinspiratory complex near the bulb, in case of the need to prolong inhalation (cough, phonesis, swallowing), can help stimulate the electrical activity of the XII cranial nerve (and the vagus nerve), lengthening the involvement of the tongue (and the muscles of the larynx) [8]. The expiratory phases to inhibit lingual contraction involve other brain areas of the brainstem, such as the Bötzinger neurons, the parabrachial/Kölliker-Fuse complex, and the retrotrapezoid nucleus [8].…”

“…The respiratory-circulatory model orients the clinician on the body's ability to circulate the different fluids and the multiple information transported, providing nutrients and oxygen to all cells [2]. A muscle district that profoundly affects circulation and respiration, as well as a target of medicine osteopathic manual, is the diaphragm [8]. The behavioralbiopsychosocial model takes into consideration how the patient psychically and physically deals with the 1 2 environment in which he/she lives; evaluating and treating the musculoskeletal system can be key to understanding how to stimulate the correct salutogenic responses [2,9].…”