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Analysis and Correction of Locomotor Dysfunction as It Applies to Autonomic
Nervous System Dysregulation
Lab
Lino Cedros ATC, MT, CAMTC
Neal O’Neal PT
Test leg for loss of femur internal rotation – Mechanical or Chapman’s
Obturator internus
Piriformis
Quadratus Laborum
Illiopsoas
Test groin glands for pelvic congestion
GG-The lowest 2/5ths of the Sartorius muscle and its tendinous attachment
on the
tibia and just above the inner condyle of the femur.
Chapmans drainage - Rectum and Hemorrhoids
R-Lesser trochanter of the femur downward.
H-Just medial and above the tuber ischii.
Indicates congestion of the glands draining the rectal walls and tissues – in the
rectum just below the sigmoid flexure
Deep rotatory movement
Reach from back for femoral points
Drainage area-At angles of 7th and 8 rids on left side is a very sensitive reflex about
3 inches from the spine.
Indicates a variant of rectum and colon close to the sigmoid flexure.
Deep pressure between 5-6 sacral nerves for tight anal sphincter.
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Page 1
Test heel sign
Test Hypogastic plexus
Midline
Sided
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Test foot shake
Test great toe movement on first cuneiform
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Test muscles of the foot related to fluid drive
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Test talus for glide- Fred Mitchell Jr test.
Test fibula for glide
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Page 5
Test posterior lateral knee
Check pubes/correct
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Muscles to treat for venous pump
Soleus / Medial head of the gastrocnemius
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Vastus lateralis.
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Flexor Hallicus longus
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Iliopsoas
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Superior Thoracic inlet
With deep breathing check for asymmetry of end range
Find presence of rotation, Drive the bus
Check manubrium/sternum
Diaphragm
Side glide with tension to see if there is a difference hands on abdomen pointing
toward Zyphoid
Deep breath / look for motion restriction.
Breathing: in men and children, is abdominal respiration.
But in women the breathing is thoracic respiration.
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Pelvic floor
With deep inhalation look for marked tension on the side of dysfunction
Coordinating the diaphragm to the pelvic floor
Patient supine/Knees flexed
Operators hand on pelvic floor
Inhale less/exhale more
Have the patient take a deep breath/ as they inhale increase the pressure
With the next deep breathe /hold the pressure and release with exhalation
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Abdominal Tension
Just below the attachment of the inguinal (Poupart’s) ligament
along the upper edge of the body and ramus of the pubic bone to
a point near the symphysis.
Dr Ada – anterior medial and inferior to ASIS bilaterally
Contraction of the inguinal ring
Orchitis- Epididymitis
Deep firm rotatory movement
Leucorrhea
Most often used for pelvic drainage by Chapman but not Owens
Inner condyle of the femur and upwards from 3-6 inches on the
posterior aspect.
Thigh and groin glands, ovaries are also involved
Rotatory movement
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P.T.A.S.
(Pelvic-Thyroid-Adrenal-Syndrome)
Broad ligament
Anterior
On the outer aspect of the femur to 2” above knee
Posterior
Between PSIS and L-5
The Broad Ligament


This is a fold of peritoneum with mesothelium on its anterior and
posterior surfaces.
It extends from the sides of the uterus to the lateral walls and floor of
the pelvis.

The broad ligament holds the uterus in its normal position.

The 2 layers of the broad ligament are continuous with each other at a
free edge.
This is directed anteriorly and superiorly to surround the uterine tube.


Laterally, the broad ligament is prolonged superiorly over the ovarian
vessels as the suspensory ligament of the ovary.
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
The ovarian ligament lies posterosuperiorly and the round ligament of
the uterus lies anteroinferiorly within the broad ligament.


The broad ligament contains extraperitoneal tissue (connective tissue
and smooth muscle) called parametrium.
It gives attachment to the ovary through the mesovarium.

The mesosalpinx is a mesentery supporting the uterine tube.
The Broad Ligament
Venous Drainage of the Uterus

The uterine veins enter the broad ligaments with the uterine arteries.

They form a uterine venous plexus on each side of the cervix and its
tributaries drain into the internal iliac vein.
The uterine venous plexus is connected with the superior rectal vein,
forming a portal-systemic anastomosis.

Lymphatic Drainage of the Uterus

The lymph vessels of the uterus follow three main routes:
1. Most lymph vessels from the fundus pass with the ovarian vessels to
the aortic lymph nodes, but some lymph vessels pass to the external
iliac lymph nodes or run along the round ligament of the uterus to the
superficial inguinal lymph nodes.
2. Lymph vessels from the body pass through the broad ligament to the
external iliac lymph nodes.
3. Lymph vessels from the cervix pass to the internal iliac and sacral
lymph nodes.
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Page 15
UTERUS
TREATMENT OF THE UTERUS
SUPINE:
For the treatment of the uterus in the supine position, start with the patient
resting comfortable on the table.
1.
Knees bent to 45º or with a pillow beneath the knees.
2.
Practitioner sitting or standing beside the table facing
patient’s feet.
3.
Starting with the hands on the abdomen supra-pubically,
allow the fingers to sink into the tissue just above the
symphasis to that the bladder can be felt.
4.
Glide the fingers superiorly until they can be directed
behind the urinary bladder and into the
tissue between the bladder and the uterus. With a rolling
motion of the fingers, lift the uterus
toward the head and hold the tissue until a relaxation is felt.
5.
Repeat the procedure until the tissue in the area felt relaxed and
does not resist your hands beyond normal tension.
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ALTERNATE SUPINE TREATMENT
1.
For this technique, you will need an adjustable table or
some form of pillows or other supporting device.
2.
The end of the table is raised to approximately 45º so that
an angle is formed with the rest of the table.
3.
The patient is placed so that their knees are over the end
of the table and their head and back lying on the flat
portion of the table.
4.
This position will allow the patient’s uterus to “float “ away
from the bladder to a slight extent thereby increasing your
ability to relax the tissues in the area.
5.
The treatment procedures are as outlined above.
NOTES:
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Page 17
Uterus/Prostate
Anterior
Anterior medial aspect of the obturator foramen
Posterior
Between PSIS and spine of L-5
Innervation of the Uterus


The nerves of the uterus arise from the inferior hypogastric plexus,
largely from the anterior and intermediate part known as the
uterovaginal plexus.
This lies in the broad ligament on each side of the cervix.

Parasympathetic fibres are from the pelvic splanchnic nerves (S2-4),
and sympathetic fibres are from the above plexus.


The nerves to the cervix form a plexus in which are located small
paracervical ganglia.
One of these are large and is called the uterine cervical ganglion.

The autonomic fibres of the uterovaginal plexus are mainly vasomotor.

Most the afferent fibres ascend through the inferior hypogastric plexus
and enter the spinal cord via T10-12 and L1 spinal nerves
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The Prostate


This is the largest accessory gland of the male reproductive system.
The prostate (prostate gland) is partly glandular and partly
fibromuscular.

It is about the size of a walnut and surrounds the prostatic urethra.

It is enveloped in a thin, dense fibrous capsule (true capsule), which is
enclosed within a loose sheath derived from the pelvic fascia called the
prostatic sheath (false capsule).
It is continuous inferiorly with the superior fascia of the urogenital
diaphragm.


Posteriorly, the prostatic sheath is part of the rectovesical septum.

This separates the bladder, seminal vesicles, and prostate from the
rectum.

The prostatic venous plexus lies between the fibrous capsule and the
prostatic sheath.

The prostate has a base, apex, and 4 surfaces (posterior, anterior, and
2 inferolateral surfaces
Arterial Supply of the Prostate


The arteries are derived mainly from the inferior vesical and middle
rectal arteries.
They are branches of the internal iliac artery.
Venous Drainage of the Prostate




These for the prostatic venous plexus around the sides and base of the
prostate.
This plexus is located between the capsule of the prostate and its
fascial sheath.
It drains into the internal iliac veins.
It also communicates with the vesical venous plexus and the vertebral
venous plexus.
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Lymphatic Drainage of the Prostate


The lymph vessels terminate chiefly in the internal iliac and sacral
lymph nodes.
Some vessels from its posterior surface pass with the lymph vessels of
the bladder to the external iliac lymph nodes.
Innervation of the Prostate


Parasympathetic fibres arise from the pelvic splanchnic nerves (S2,
S3, and S4).
The sympathetic fibres are from the inferior hypogastric plexuses.
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Ovaries Or Testies
Anterior
The round ligaments from the Upper border of pubic bone
in grove lateral
Symphasis Pubes
Posterior
Inner ½ -
9th thoracic vertebral gutter
Outer ½
10th thoracic vertebral gutter
Arterial Supply of the Ovaries



The ovarian arteries arise from the abdominal aorta around the level of
L2 vertebra.
They descend along the posterior abdominal wall.
On reaching the pelvic brim, the ovarian arteries cross over the
external iliac vessels and enter the suspensory ligaments.

At the level of the ovary, the ovarian artery sends branches through
the mesovarium to the ovary and continues medially in the broad
ligament to supply the uterine tube.

It anastomoses with the uterine artery.
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Venous Drainage of the Ovaries


The ovarian veins leave the hilum of the ovary and form a vine-like
network of vessels, called the pampiniform plexus (L. pampinus,
tendril + forma, form), in the broad ligament near the ovary and
uterine tube.
This plexus of veins communicates with the uterine plexus of veins.

Each ovarian vein arises from the pampiniform plexus and leaves the
pelvis minor with the ovarian artery.

The right ovarian vein ascends to the IVC, whereas the left ovarian
vein drains into the left renal vein.
Lymphatic Drainage of the Ovaries

The lymph vessels follow the ovarian blood vessels and join those from
the uterine tubes and the fundus of the uterus as they ascend to the
aortic lymph nodes in the lumbar region.
Innervation of the Ovaries




The nerves of the ovary descend along the ovarian vessels from the
ovarian plexus.
It is formed from the aortic, renal, and superior and inferior
hypogastric plexuses.
These nerves supply the ovaries, broad ligaments, and uterine tubes.
The parasympathetic fibres in the ovarian plexus are derived from the
vagus nerves.
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Page 22
Thyroid
Anterior
2nd- 3rd intercostal space close to sternum
Posterior
T-2 vertebral gutter
Venous Drainage
There is a venous plexus on the anterior surface of the gland which is
drained by three pairs of veins.
The superior and middle thyroid veins drain the superior and lateral aspects
of the thyroid, respectively, and converge to drain into the internal jugular
veins.
The inferior thyroid veins drain the inferior poles of the gland and go to the
brachiocephalic veins. These inferior thyroid veins lie on the anterior surface
of the trachea inferior to the isthmus, and thus are a potential source of
bleeding during tracheotomy.
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Lymphatic Drainage
The lymphatics that run in the interlobular connective tissue around arteries
of the thyroid communicate with a capsular network of lymphatics. These
vessels drain the the prelaryngeal, pretracheal, and paratracheal lymph
nodes.
Laterally, the lymphatics are located along the superior thyroid veins and
pass to inferior deep cervical lymph nodes. Some lymph vessels may also
drain to brachiocephalic lymph nodes or directly to the thoracic duct.
Nervous Innervation
Nerve supply of the thyroid gland is derived from the superior, middle, and
inferior cervical sympathetic ganglia reaching the gland via the cardiac and
laryngeal branches of the vagus nerve which run along the arteries. These
nerves are postganglionic fibers and are vasomotor, affecting the gland
indirectly through their action on blood vessels.
The thyroid gland produces two hormones of significance: thyroxine (T4)
and triiodothyronine (T3), in a ratio of 9:1, respectively.2 T4 is converted to
T3 in the blood and peripheral tissues. T3 is thought to be the active form,
and T4 may be predominantly a storage form, as T3 persists for only a short
time. It is believed the true intracellular hormone is principally T3, rather
than T4.2
Thyroid hormones control metabolism and virtually all other processes in the
body. Without thyroid hormones, the body cannot form RNA, which is
needed for the process of transcription necessary to produce proteins and
enzymes.2 Consequently, without thyroid hormones, the body cannot
produce proteins to repair damaged tissues, or enzymes, which catalyze
virtually all reactions within the body. The release of thyroid hormones by
the thyroid gland is initiated when thyroid stimulating hormone (TSH) is
secreted by the anterior pituitary gland. Thyroid releasing hormone (TRH),
secreted by the hypothalamus, initiates the release of TSH. Most of the
thyroid hormones in the blood are bound to thyroid-binding globulin. The
free portion of the thyroid hormone is the true determinant of the thyroid
status of the patient.1
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Page 24
Adrenals
Anterior
1” lateral and 2 ½ “ above umbilicus
Posterior
11th intertransverse space vertebral gutter
but unilateral with single involvement
Arterial Supply of the Suprarenal Glands

These glands has a profuse supply from 3 sources:
1. The aorta (one or more middle suprarenal arteries);
2. The inferior phrenic artery (6-8 superior suprarenal arteries);
3. The renal artery (one or more inferior suprarenal arteries).
Venous Drainage of the Suprarenal Glands



These glands are drained mainly be a single, large suprarenal vein.
The right one drains into the IVC.
The left one joins the left renal vein.

There are also many small veins that accompany the suprarenal
arteries.
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Lymphatic Drainage of the Suprarenal Glands


The lymph vessels arise from a plexus deep to the capsule and from
one in the medulla.
Many lymph vessels leave the suprarenal glands and most of them end
in the superior lumbar (lateral aortic) lymph nodes.
Innervation of the Suprarenal Glands

These glands have a rich innervation from the adjacent coeliac plexus
and the greater thoracic splanchnic nerves.
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Page 26