Michael L. Kuchera, DO, FAAO, FNAOMEfiles.academyofosteopathy.org/convo/2016/Handouts/Kuchera_OMTWorkshop.pdfMichael L. Kuchera, DO, FAAO, FNAOME Professor, Department OMM Marian University

Michael L. Kuchera, DO, FAAO, FNAOMEProfessor, Department OMMMarian University College of Osteopathic [email protected]

OMT – Does it Only Enhance ANS balance?◦ Remove somatic dysfunction & Soft tissue OMT (Entire axial system)

(documented to ⇓ sympathetic tone)◦ Suboccipital inhibition (documented to enhance HRV)◦ Condylar decompression, OM Suture V-Spread (esp right), C2 (affects

vagal and ANS balance)◦ Maximize Primary Respiration (changes in Traube-Hering-Meyer;

documented changes in intracranial vascular compliance & drainage; inherent motion synchrony)◦ Collateral ganglion inhibition (linea alba) & Balanced tension at gut

sphincter site – “East meets West”◦ - documented improvements

Lab: Osteopathic Neurovisceral Integration Approach

Neuro-ANS Model: Self-regulation through social engagement & bonding can reduce SNS activation while increasing HRV.

Neuro-ANS Model: From a heart rhythm coherence perspective, emotional self-regulation reduces the SNS activation and/or vagal withdrawal that interfere with physiology, homeostasis and health.

Biopsychosocial Model: Emotional self-regulation strategies can increase resilience and accelerate recovery from stressors

Biopsychosocial Model: The Neurovisceral Integration model predicts that perception of safety will reduce the activation of the amygdala & increase the prefrontal cortex's ability to exercise top-down control of emotional responses.

His Words to the “Wise”“I f you can learn all

of Osteopathy in four years, I w ill buy you a farm and a w ife to run it and boss you.”

--A. T. Still, MD, DO

Lab: OMT Basis from Lecture ◦ Modulating CNX & HRV with

Sub-Occipital Inhibition & OA Decompression◦ Dural Diaphragm (Inion &

Nuchal Line)◦ Shock Release & Linea Alba

(Fulford)◦ Upper GI Sphincter Release ◦ Link PMR with 2nd-ary

Respiration & Heart-Breath Body-Mind Unity

Practical hands-on skills to implement osteopathic treatment paradigm

Vagal Target: Now a paradigm shift in the medical treatment of diverse disorders like depression, epilepsy & pain using vagal nerve stimulation/balance-regulation … adds rich layer to osteopathic understanding in the neurological-ANS model◦ Instead of exclusively targeting sympathetic activities, physicians

should also attempt to modulate/increase myelinated vagal tone. Metaphorically: can no longer base treatment decisions based

solely on the concept of a ‘sticky accelerator’ (sympathetics) while overlooking the possibility of ‘bad brakes’ (parasympathetics).

◦ Behavioral interventions like HRV Biofeedback and emotional self-regulation strategies represent non-invasive methods of restoring homeostasis.

OMT to Implement Polyvagal (Myelinated Vagal) Strategy

Documented to Increase Heart Rate Variability

OMT to Implement Polyvagal (Myelinated Vagal) Strategy

Structures with CNX Innervation

SubOccipital Inhibition & DecompressionGoal: Modulate PNS/SNS Balance (⇑HRV)

Breathing/Rhythm Coherence: This part of the paradigm embraces body unity & unified physiological coherence in inherent forces. Reinforces neurological-biochemical synchrony: Value in pain reduction & markers (eg HRV). Important in social interaction & interpersonal synchrony. It is also … “Intentional”◦ Metaphorically: Links “pneuma” (meaning both “breath” and “spirit”);

“spirae” (root in both spirit and respiration); “anemos/anima” (puts the wind/breath into animation) “Breath of Life” ◦ These represent important body unit principle; inhalation takes in new life

while exhalation breathes out the old negatives

Respiratory intervention represents a non-invasive method of restoring homeostasis and enhancing social engagement by linking biopsychosocial & respiratory-circulatory models.

Andrew Weil’s Yogic 4-7-8 Breathing ExerciseGoal: Access ANS (Vagus) Through Secondary Respiration

Entrain and Modulate Heart Rate Variability (⇑HRV)

3:18 Video

@ https://www.youtube.com/watch?v=gz4G31LGyog

CTRL+Click

Perform 4 Cycles

Twice Daily

Slow Count to

Tolerance

Max of 8 Cycles

3:18 Video @ https://www.youtube.com/watch?v=gz4G31LGyog

• Pt knees bent to relax abdomen

• Contact costal margin on left • Take enough soft tissue to

travel up to diaphragm at Rib 6• Compress to resistance• Have patient breathe slowly (½

breath in; hold; blow out)• As blow out, slightly increase

resistance• Continue until release

• May use Coherence or Yogic (etc) Breathing (Aid & Educate)

• Intention can be important

• Pt with knees up to relax abd• Make all fingers same length

• Contact midline & compress to resistance

• Have patient breathe slowly (½ breath in; hold; blow out)

• As blow out, slightlyincrease resistance

• Continue until release

• Intention can be important• May use Coherence/Yogic

(etc) Breathing (Aid/Educate)

Diaphragm Release & Linea Alba OMTGoal: Release “Shock” (Gasp/Linea Alba/Solar Plexus)

& Augment Secondary Respiration

Gut-Mind: Paradigm recognizes an important gut-emotion / gut-physiological link. Whether linked neurologically through the vagus or linked to GABA (vagal or microflora connection or both), enhancing the function of one is empirically linked to the function of the other◦ Metaphorically: “Gut-wrenching” … “can’t stomach that”…

need to “vent my spleen” “got butterflies in my stomach”

Visceral OMT may help homeostasis of the bowel directly. Vagal innervation of much of bowel (especially mechanoreceptor rich sphincter areas) may play a role a role through the vagus. Visceral OMT may provide a non-invasive method of modulating emotion and psychological health by linking biopsychosocial & neurological-ANS models.

White ring IDs root of mesentery; yellow/red arrows IDs

Sphincter of Oddi (Youtube Link)https://www.youtube.com/watch?v=BMphhbyd1wo

Indirect

Body-Mind-Spirit Coherence: The osteopathic paradigm embraces body unity & unified physiological coherence in inherent forces and both neurological-biochemical and respiratory-circulatory synchrony◦ Metaphorically: We can link “pneuma” (meaning both “breath” and

“spirit”); “spirae” (root in both spirit and respiration); “anemos/anima”(puts the wind/breath into animation) “Breath of Life” … these represent important body unit principle; inhalation takes in new life while exhalation breathes out the old negatives. “That took my breath away.”◦ Metaphorically: “Love you with all of my heart” … “he is hard-hearted” …

“can you find it in your heart to forgive” …

Osteopathy and Body Unity: Progressive focusing from skeletal visceral bioenergic or from physical mental emotional spiritual are strategies that can be useful. Other progressions include bone fluid energy and another is skin outside ”self” inside. Yet another “as above so below.”

Lab: CV4 From the Occiput or Sacrum

Tune into the CRI. Limit flexion & augment extension. Take PRM to a still point & maintain until mechanism strongly tries to move into flexion. Instruct to fully inhale as release the hand-hold.

May support lumbars or use fingertip of 2nd hand to push on 1st hand at appropriate sacral pole

CV4: From Head or SacrumGoal: Pass Through Still Point to

Augment Primary & Secondary Respiration

Choose one or other (not both)

Lab: Sternal/Heart Integration in Craniosternosacral & Body Unity Contexts

Diagnose relation / motion of manubrium-sternal … May treat locally if significant SD.

Tune into the CRI. Focus treatment intent progressively from Chest Cage Structure Heart Function Metaphor Body Unit

Progressively Relate All Triune Meanings of “Heart & Breath” Function

Treat local region triune unit

Diagnose Locally (OMT if needed)

Neurovisceral IntegrationUnity Goal: ANS + Respiratory/Circulatory SynchronyBiomechanical - ANS – Resp/Circ – Metabolic – Biopsychosocial

Osteopathy … Just D.O. It !!!

Progression: CV4 SternumSternum CV4All from sternum

Oath of Hippocrates … “The regimen I

adopt shall be for the benefit of my patients according to my ability and judgement … ”

“Anything I can clean up later?”

MU-COM

2016

[email protected]