OMM: Parasympathetic Innervation to the GI System

00:00 So, let's take a look at the Parasympathetic Innervation to the GI System. So, it is important to remember that parasympathetic innervation of the GI system primarily comes from the vagus nerve and from our pelvic splanchnics. So, based on the different organs, we need to really understand what is supplying the parasympathetic innervation to that region. So, our left vagus supplies the esophagus, the greater curvature of the stomach and the proximal duodenum.

00:31 Our right vagus supplies the lesser curvature of the stomach, the entire small intestine, the right side of the colon to the mid transverse colon and the kidneys where the pelvic splanchnics will supply the mid transverse colon to the rectum and also the pelvic organs. So, it is really important to understand which organs are being supplied by parasympathetic innervation from either the left vagus, the right vagus or the pelvic splanchnics. So, remember that parasympathetic innervation is responsible for rest and digestion. So, its function is to increase peristalsis, relaxes sphincter tone, increases enzyme secretion and increases blood flow to the organs. So, the vagus nerve provides parasympathetic innervation all the way down to the right side of the colon. So if someone has right colon dysfunction, we want to take a look and treat any sort of somatic dysfunctions in that upper cervical region, in the occipito-atlanto, the AA, occipitomastoid sutures. Also, we want to take a look at possible increase somatic dysfunctions on the right suboccipital area. There might be some condylar compression and we want to utilize cranial techniques to try to treat the regions and also try to address any somatic dysfunctions of C3-C5, which is the phrenic nerve which also could be irritated by diaphragmatic irritation from the colon in its proximity to the diaphragm. So, the pelvic splanchnic nerves, S2, S3, S4 supply parasympathetic innervation to the left half of the colon and the pelvis and so if a patient comes in presenting of left colon dysfunction we need to be able to diagnose and treat the sacrum, the innominate and the lumbosacral region and also just double check to make sure that the patient does not have more of a pathologic unilateral sacral shear. So, parasympathetic hypoactivity of the lower GI tract will result in decrease bowel motility, decrease glandular secretion and constipation. So, patients who have more of a hypersympathetic state may complain of having increased cramping, headaches, nausea, vomiting and diarrhea.

02:55 So, there are also mechanical considerations that we have to look at when we look at the GI tract and how osteopathic manipulation could affect the structure. The abdomen and pelvis is a container which holds all of the viscera. There is an osseous frame, myofascial walls, a roof and a floor, and fascial mesenteric support system. So, the function of the contents really depends on the integrity and relationship of the container. So if we have anything that is affecting the shape of that container, it could potentially decrease the functioning of the GI tract. There are fascial and musculoskeletal restrictions that need to be considered when applying osteopathic manipulation. So, let's take a closer look at this osseous framework. So even though the myofascial tissues are really supporting the viscera, the myofascial tissues are connected to the osseous structures. So any dysfunctions of the lower thoracic or lumbar spine, the lower ribs, the sacrum and pelvis and the hips will have an impact on the visceral support and function.

03:59 So, all these myofascial structures are connected and hang from the osseous skeleton and we could use that as a contact when we are applying our treatments to affect the GI system. So, the myofascial tissues which enclose the abdomen include a roof, the floor and the walls and so this container directly supports and influences the viscera so the thoracic diaphragm and the pelvic diaphragm, the thoracic diaphragm is that roof, the pelvic diaphragm is the floor and the container will shift and move with breathing. So the pelvic diaphragm functions together with that anterior abdominal wall and controls the descent of the abdominal diaphragm. So if there is restrictions of the anterior abdominal wall, of the pelvic diaphragm that would also influence how the abdominal diaphragm descends during respiration. So, here we could see how the pelvic organs are supported with the diaphragm on top as a roof, the pelvic floor on the bottom and the posterior wall and the anterior wall then sandwiches and creates the cylinder for which all these organs reside in. All our mesentery hang from the diaphragm and so it is critical that there are no restrictions of the diaphragm and its attachments because any of those restrictions could potentially translate to increase tension along the mesentery and does into the GI tract.

05:33 Also the aorta prevents support of the mesentery from the lumbar spine and so the mesentery comes up and attaches all from the abdominal diaphragm. The mesentery also attaches to the posterior abdominal wall, so the sigmoid colon hangs from like an oblique attachment and these attachments are relevant when we are performing different lifts, so we want to always lift towards the attachment. So, understanding the container of the abdomen we could see how something as simple as posture could potentially influence visceral function. Having any sort of increased lordosis or increased adipose tissue anteriorly could cause increased abdominal drag and does also influence the GI tract. Having faulty body posture and mechanics could be associated with a wide range of disorders of the GI system and the neuromuscular system is ultimately also tied into those and so we have a basis for utilizing osteopathic manipulation to treat the structural dysfunctions to potentially help with the GI system. So finally, we have reached circulatory and lymphatics. Remember that the abdomen has the largest lymphatic circulation in the body. This is because it is intricately involved with digestion and the lymphatics has to screen all the products that are being absorbed through the GI tract. All the abdominal lymph is being absorbed and collected at the cisterna chyli and the cisterna chyli also receives all the lymphatics from the lower extremities. So that dilatation of the thoracic duct is a very important point to take a look at and its relationship to the abdominal diaphragm allows it to be pumped with respiration and so the lymphatic system does not have a true pump in itself and respiration really helps to clear and help move the lymphatics along. So, proper circulatory and lymph flow is vital to healing. Our healing rate depends on the ability of the body to remove waste products from the tissues and deliver oxygen and other nutrients to area of tissue dysfunction, injury or sites of surgical intervention. So, when we have poor circulation and poor lymph flow that will result in the infections taking longer than usual to heal. So, when we want to promote lymphatics, we want to remove restrictions, optimize breathing and improve motions of the different diaphragms.