OMT for GI Concerns

1. OMT for GI Concerns UPPER MIDWEST OSTEOPATHIC HEALTH CONFERENCE May 2, 2014 Kate Heineman, DO and Shannon Crout DO

2. Treatments • Doming the diaphragm • Mesenteric Lift • Linea alba release • Colon induction • Cisterna chyli pump

3. Indications • Post surgical • Ileus • SBO • Abdominal adhesions • s/p “-itis” • IBS • Constipation/diarrhea • GERD • Abdominal pain • Anxiety • Hiatal hernia

4. Contraindications • Local infection • Local thrombus • Metastatic disease

5. Initial evaluation • OA • AA • T spine • Gut rotation • Iliac and dorsalis pedis pulses

6. Doming the diaphragm • Patient seated, erect and not slumped • Physician behind the patient • Pass hands around thoracic cage (under patient’s arms) and gently but firmly introduce fingers underneath costal margin • Test for motion by passively rotating thorax to L and R • With fingers on the diaphragm, carry the thorax in the direction of disease. Hold. Follow as it goes through fascial release and continue until it finally settles down into free, gentle, rhythmic, vertical motion • Retest ROM

7. Mesenteric Release • Patient supine with knees bent (can also be done lateral recumbent) • Physician stands on opposite side of area being treated • Use ulnar edges of fingers or fingerpads to contact mesentery to be treated (cecum, ascending, descending, sigmoid colon) • Gently move intestines with scoop-like motion at right angles to mesenteric attachment until restriction of motion is felt • Patient takes partial breath in and holds, during exhale physician takes up slack and moves to next barrier • After removing restrictions, allow colon to recede and move to the next segment

8. Linea Alba Release • Patient supine • Physician spreads fingerpads along midline between xiphoid and umbilicus • Sink posteriorly, applying equal pressure from each finger • Pressure of contact is gradually increased to match the tension of the soft tissue under fingerpads • Patient takes long, slow, deep breaths; as tissues relax, find the balance of tension again (keep in mind patient’s comfort level) • Technique complete when no resistance is felt in soft tissues under the fingerpads

9. Linea Alba Release

10. Colon Induction

11. Colon Induction • Patient supine • Physician L hand on ascending colon and R hand on descending colon • During expir, both hands simultaneously move clockwise • Reverse the direction of hand motion during inspir • Follow and encourage each part of the cycle until the direction with the most restriction releases

12. Cisterna Chyli

13. Cisterna Chyli Pump • Patient supine • Physician stand dominant eye side • Place non dominant hand just below diaphragm midline-this is sensing hand • Place other hand on top and add vibratory force, choose rhythym that seems to push through the barriers • Continue until desired smoothness in lymphatic system

14. Recheck • Iliac and dorsalis pedis arteries

15. Resources • Barral JP, Mercier P. Visceral Manipulation. Seattle, WA: Eastland Press, Inc.; 2005. • Hruby RJ. The Abdominal Region. Ward, RC, ed. Foundations for Osteopathic Medicine. 2nd ed. Philadelphia, PA: Lippincott Williams and Wilkins; 2003. 751-761. • Wallac, E. et al.. Lymphatic System: Lymphatic Manipulative Techniques. Ward, RC, ed. Foundations for Osteopathic Medicine. 2nd ed. Philadelphia, PA: Lippincott Williams and Wilkins; 2003. 1066. • http://pubs.rsna.org/doi/full/10.1148/rg.243035086 • http://www.infohow.org/science/biology-ecology/hb-abdominal-viscera-anterior/