2018 © Stylized Osteopathic Seminars| Edward G. Stiles, DO, FAAODist. | estilesdo@omtsos.com
Impact of Somatic Dysfunction

Mechanical dysfunction of the musculoskeletal system is called somatic dysfunction by the osteopathic profession. 

Mechanical/somatic dysfunction can have many possible adverse impacts of the arms of the cell schematic and secondarily impact normal tissue physiology and pathology. 

  • Arterial Arm - Thoracic and rib dysfunction may alter vasomotor tone (SNS function) which can impair circulation to the innervated tissues. This could decrease circulation and lower tissue resistance/health of the related tissues and make them more susceptible to infection, tumor development or other pathological processes. The altered vasomotor tone might also result in suppressed tissue levels of medications even though the blood levels of the medication are at therapeutic levels.

  • Neurological Arm - Alter neurological function (efferent)

    • Innervation role...impulse function

      • The innervation impacted by the somatic dysfunction can be either stimulated or inhibited; the outcome can not be predicted.

      • Asthma could be a good illustration of the role of somatic dysfunction as a risk factor and the related innervation alteration.

        • PNS (parasympathetic nervous system) stimulation of the Vagus could predispose to bronchial constriction. This could be associated with either cranial or cervical somatic dysfunction.

        • SNS (sympathetic/motor contribution ) inhibition could predispose to impaired bronchial dilation and could also be associated with thoracic or rib cage somatic dysfunction.

    • Neurotrophic transport role

      • Trophic substances (neurotransmitter, growth factors, etc.) are produced in the nucleus of the neurons.  These material course down the axons, at various rates of flow, and actually cross the neuromuscular junction and end up the tissues of the innervated end-organ. 30 mm. of Hg pressure is enough to impair the normal flow of these essential trophic substances. Increased muscle tone secondary to somatic dysfunction could produce this detrimental pressure on a nerve. As a result normal tissue function might be impaired and a predisposition to various disease processes might develop if this trophic flow is altered.

 

  • Three vital physiological functions are dependent on a properly functioning rib cage.

    • Ventilation: during ventilation/inspiration, a normal functioning rib cage expands and the thoraco - abdominal diaphragm glides caudad toward the abdominal cavity. This decreases the intra - thoracic pressure and enables air to flow into the lungs. A dysfunctional rib cage, impaired by somatic dysfunction, may result in less than optimal ventilation...the movement of air and secondarily oxygenation.

    • Venous blood is a very viscous fluid and would require a remarkable amount of force to pump this fluid upward against gravity, i.e., upward from our legs (especially when the patient is in the upright position) and back to the right side of the heart.  As the functional rib cage expands and the diaphragm normally descends toward the abdominal cavity, the central venous pressure in the right side of the heart is secondarily decreased and this enables the venous blood to be “sucked” back into the heart.  Thus a functional rib cage plays a crucial role in normal venous circulation and might be impaired if rib cage somatic dysfunction inhibits this pumping potential.

    • Lymphatic fluids also play an important role in normal physiology. Lymph is made up of fluid, protein and electrolytes that have normally migrated out of the vascular tree. If these substances are not reabsorbed or properly circulated, it can have an adverse impact on the related tissues, i.e., edema. The “pump” for lymphatic circulation is again a functioning rib cage and the altering intra - thoracic pressure which again “sucks” the lymph through the lymphatic channels and the lymph re-enters the venous system at the venous/lymphatic junction in the upper thoracic regions.

                                                                                                                                     

Thus a functioning rib cage is crucial for these three normal and essential circulating functions in a healthy person...ventilation, venous and lymphatic circulation. If these normal rib cage “pumping actions” are impaired, could this lower the normal tissue resistance and increase the susceptibility of the poorly oxygenated and congested tissues?

  • Somatic dysfunction could in addition impair the afferent neurological function of both the impulse and trophic roles.

  • Additionally, somatic dysfunction, especially involving the lower extremities, can markedly increase the “energy demands” on every system of the body due to an altered and labored gait.  If the patient also has heart or lung disease, the increased energy demands on the impaired heart or lungs could result in the patient going into cardiac or pulmonary failure by over - working that “weak link” in the total body system.

 

Somatic dysfunction, can impact any one of the arms of the cell schematic, all the arms or in any other possible combination...thus imparing the functions discussed above. This explains why several patients, all diagnosed with the same clinical condition, will each have a distinctive and unique clinical expression (illness). Stated in another way by one of my mentors, "we must remember that 100 patients may all have the same clinical diagnosis but they all got to that end point by a different route" (I.M. Korr, Ph. D). Therefore, for the

health - care provider to attain excellent clinical outcomes, each patient must be evaluated and treated uniquely. Both the uniqueness and the complexity of each,

one of a kind patient, must be honored.