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Total Body Adjustment for Children
with Neurological Conditions
Beyond the Treatment Table
Jorge Aranda
BSc (Hons) Ost Med
MSc Ped Ost
DO (UK)
THE POLYGON
OF FORCES
Postural control is centered
in the spinal column.
Cranial, dorsal and sacral
curves are primary
embryonic curves.
Lumbar and cervical curves
are due to physical
development and appear
with the upright posture.
All postural conditions of the
posture center in the activity
of the cervical and lumbar
segments.
During childhood spine development we are looking for the 4
arches to develop which provides the greatest amount of
strength and elasticity with the least amount of shock
transmission.
Vulnerable areas to assess that carry the burden of the arch
to arch formation and developments are:
• D4 and corresponding ribs
• D9 ad corresponding ribs
• L3
1
Anteroposterior Line
• Born in the occipital foramen
• Crosses D11-D12 bodies.
• Through the back of the joints L4-L5 and S1
body.
• It ends at the top of the coccyx.
• Determines the drive to spinal mechanics.
2
Line posteroanterior
•
It originates from the anterior margin of
foramen magnum.
•
Through the anterior border of the L2-L3.
•
Eventually dividing into the acetabulum.
•
This line complements the anteroposterior line,
both confluyen through the body of L3.
•
It is therefore the center of gravity of the spine.
3
The line of gravity
•
Born in the posterior third of the cranium
•
Passing through the dens
•
For the transverse C3, C4, C5 and C6
•
Ahead of the D4;
•
Across the bodies of L1, L2, L3, L4 and
sacral promontory.
•
It is divided in two through the hips,
knees and ends at the talus-navicular
joint.
D4 represents the terminus of downward pressure and
torsion of head movements and the point of greatest strain.
Lesions at D4 will tend to destroy the correlation of the
triangles to each other and is a critical point in terms of
normal postural development or failure.
D9 is a keystone / a stress point and a pivot. Three parts to
play rolled into one. The strength of the arch between D5L2 will depend particularly on the inter-articulation above
and below D9. If they fail to articulate properly the arch is
considered weak not strong and you will find the entire arch
between D5-L2 segmentally broken down into a series of
short lateral curves.
L3 is where the centre of gravity line passes through and
this becomes the centre of gravity for the entire spine and
body. It is a point of greatest strain because all the postural
conditions of the body depend on this point either for a base
or for support. It is the weakest point, because weight and
tension antagonise each other here.
OSTEOPATHIC CENTRES
The Spinal Column is
divided, for convenience
sake, into six divisions: The
Cervical, Brachial, Dorsal,
Lumbar, Sacral and
Coccygeal.
OSTEOPATHIC CENTRES
OSTEOPATHY bases its claim
to rank as a science of healing
upon the fact that there exists
a definite and fixed relation
between an organ and the
central nervous system.
This relation is secured
through the segmented
arrangement of the spinal
nerves or through the
sympathetic system, by means
of rami communicantes.
OSTEOPATHIC CENTRES
The order of this innervation is
fairly constant, though, as in
the case with other portions of
the body, it may vary.
This variation in no wise
invalidates the claim of
Osteopathy to rank as a
science, but it emphasizes the
necessity of our searching for
lesions even in regions
relatively remote from the
center.
OSTEOPATHIC CENTRES
Specific treatment in the sense of
work exclusively upon a region
said to be a center is rarely
indicated.
Owing to the diffusion of pain and
its attendant conditions, it is
necessary to remove any
contracture which may be
associated with it.
Again, it sometimes occurs that
disease of an organ produces no
effect on its usual center, and in
such an event it is necessary to
carefully examine other regions
for the trouble.
OSTEOPATHIC CENTRES
Know the location of the
centers. Know also that
occasionally a lesion causing
the trouble must be found
elsewhere.
"Touching the button" is
fascinating, both in theory and
in practice, but the operator
must be broad enough to
expect it to be difficult
occasionally to locate the
button.
The Cervical division C1-4
C1 is directly concerned with disturbances to the vasomotors of the eye and ear, and with diseases of the face.
C2-3 is a general vasomotor center, through the superior
cervical ganglion. It is a center for the side of the head, face,
eye, nose, pharynx, tonsils and vessels of the brain.
The Brachial division C4-D1
C3-5 is the center for hiccoughs, as it is the origin of the
phrenics.
C5-6 is the middle cervical ganglion and is the center for the
thyroid gland. It also augments the heart action.
C7-D1 control the heart, thyroid gland, inferior cervical
ganglion, the vertebral and basilar arteries.
The Dorsal division D1-12
D2-3 is the center for the ciliary
muscle also the center for vomiting
and for the bronchial tubes and
bronchi.
D2-5 are where the fibres
augmenting the heart action.
D2-6 are vaso-constrictors to the
pulmonary blood vessels.
D3-7 are vaso-motors to the arms,
through the brachial plexus.
D4 on the right is location for the
stomach center.
D6-10 is the origin of the great
splanchnic where is the inhibitory,
vasoconstrictor and secretary fibres
are distributed to the stomach & small
intestines.
D8-10 on the right is the center for the
liver.
D9-10 on the left side is the center for
the spleen is at the ninth and tenth
dorsal on the left side. This is also the
center for the uterus, through the
hypogastric plexus.
D11-12 is the center for small
intestine, kidney and ovary control.
The Lumbar division L1-5
L2 contains the center for parturition, micturition and the uterus.
L2-4 is the center for diarrhea.
L4-5 is where the pelvic plexus is formed by the separation of the
hypogastric plexus into two halves on either side of the rectum.
The fibres are distributed to the pelvic organs.
The Sacral division S2-5
The anterior divisions of the sacral nerves are distributed to the
rectum, bladder, sphincter ani, vagina and uterus.
S2-3 center controls the bladder.
S4 controls the vagina.
S4-5 control the sphincter ani.
1900 - Littlejohn College of Osteopathy and Hospital in Chicago
1917 - British School of Osteopathy in London
johnwernhamclassicalosteopathy.com
John Wernham study Osteopathy at the invitation of J.M. Little john in 1928
In 1984 founded the Maidstone College of Osteopathy.
The College was renamed The John Werham College of Classical
Osteopathy in 1996.
He passed away in 2007 at 99 years of age
TOTAL BODY ADJUSTMENT
They key to adjusting the
body is by way of a process
of integration.
The Total Body Adjustment is
the treatment that enables us
to appeal to the lines of force
i.e. The Polygon of Forces.
The application of the
treatment occurs through the
body lines and triangles so
the individual vertebrae and
spinal arches function in
relation to the polygon of
forces.
Asses and treat the pelvis as an
integrated unit:
•
Two hips joints
•
Coccyx
•
Two SI joints
•
L5
This is the baseline of the polygon.
In the biomechanics of the
spine is important to
understand the natural
curves that has the spine,
which function to cushion
and distribute the axial
pressure on the disc and
bodies, and determine the
static and balance.
Throughout the developmental
milestone of a child we look far
any segmentation of vertebral
groups or arch to arch
breakdown.
Bearing in mind that a child
aged between 0-7 years is
erecting its centre of gravity line
and the mechanism that provide
balance structurally and
functionally in relation to this
line.
The structural and
functional stability of D4
to the occiput and L3 to
the pelvis depends on
the mechanical form
and function of the
central arch D5-L2.
Asses and treat the
central arch D5-L2 this is
a double arch with a
balance of alternate
tension and compression
forces and the strength of
this region.
Asses and treat the
condition and position
of L3 bearing in mind
that is the centre of
gravity and point of
maximum strain.
From 7-14 years if the
balance mechanism is
not secure and
struggling to develop
and mature,
compensatory
mechanism take over, so
at puberty and beyond
the body begins to
harden with all its lesion
patterns and
irregularities.
Frequency of treatment will
vary from child to child
depending on the acute
nature, chronicity and
severity of the child´s
condition. John Wernham
used to advocate for the
chronic case, approximately
a year of treatment for every
10 years of life.
The lumbar
curvature is
determined by static
lines of force.
Asses all parameters
of the range of
movement of the
spinal column
including the side
bending component
The lateroflexion at the
level of the dorso-lumbar
region can be restricted
due to the obligatory
muscles of respiration
Quadratus Lumborum and
the hip flexors Ilio-psoas
Dysfunction of the 12th
Rib can limit the mobility
of the ilium and interfere
the distribution of forces
from the lower limbs to
the upper extremities
through the
thoracolumbar fascia.
Lower ribs
mechanics express
the respiratory
function of the
diaphragm and the
cavity dynamics of
the corresponding
visceral column.
Viscero spasm can
interfere with upper
pelvis and lumbar
mechanics through
the visceral fascia
attaching to the
posterior abdominal
wall.
Told´s fascia provides
support to the ascending
and descending colon
having a profound
influence in the mobility
of the sigmoid colon and
the range of movement
of the left sacro-iliac
joint.
From a mechanical point
of view L3 is a key
vertebra for the
interconnection between
the abdominal cavity
through the 2nd portion of
the duodenum, the lower
ribs through the diaphragm
and the lower extremities
through the posts
The distribution of
forces from the pelvis
to the spinal column
occurs by the
connective tissue of the
ilio-lumbar ligaments
which connect the
fourth and fifth lumbar
vertebrae with the
ilium.
The superior triangle
converges at the level of
D4 and therefore
addressing the cranial
structures need to be
done before aiming to
restore normal function of
that segment.
Normal rib function
cannot be restored
before adjusting the
normal mechanics
of the dorsal
vertebrae.
Reverse curvature of the
dorsal segments are
usually due to anterior
restrictions from the
internal structures of the
thoracic cavity through
the vertebro-pericardic
ligaments and the central
tendon.
Lateral expansion of
the lower ribs might be
limited due to visceral
congestion of the liver
or the spleen.
Vasocongestion to
these organs must be
address through the
related dorsal
segments.
Liver pump and
lymphatic pumping
techniques are crucial
to maintain propper
physiological levels of
blood and lymph
through the body
structures to achieve
normal levels of pH.
Oscillatory axis of rotation must be remembered when
adjusting lumbar segments once the soft tissues has been
normalized.
BIBLIOGRAPHY
1. Campbell C., A Review of Spinal
Mechanics, IPR 1996
2. J. M. Littlejohn., Chart of the Osteopathic
Centres & of the Somatic & Autonomic
Nervous System, The Maidstone College
of Osteopathy
3. J. M. Littlejohn., The Mechanics of the
Spine, Lecture Notes
4. J. Wernham., Mechanics of the Spine,
I.A.O. Year Book 1985
THANK YOU
FOR YOUR
ATTENTION
[email protected]
Total Body Adjustment for Children
with Neurological Conditions
Beyond the Treatment Table
Jorge Aranda
BSc (Hons) Ost Med
MSc Ped Ost
DO (UK)