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VISCEROSOMATIC REFLEXES System/Organ head and neck Upper respiratory tract: Cardiac myocardial coronary artery Pulmonary lung bronchomotor reflex “asthma reflex,” bronchial mucosa reflex lung parenchyma reflex pariatal pleura Upper G.I. esophagus stomach duodenum Lower G.I. small intestine appendix and caecum ascending colon descending colon/rectum Pancreas Liver/gallblader phrenic nerve somatosomatic reflex Spleen Urinary tract Kidney proximal ureter distal ureter bladder Urethra: Genital tract Fallopian tubes (and seminal vesicles) external genitalia Prostate Ovaries (and testis) Uterus Adrenal glands Sympathetic Parasympathetic T1-T5 T1-T5 Trigeminal: final common pathway, temporalis muscles, occiput, C 1, C 2. T1-T5 left C 3-C 5 (sympathetic?) occiput, C 1, C 2. T1-T4 T1-T3 T2 left T2-T3 T3-T4 T1-T12 occiput, occiput, occiput, occiput, occiput, occiput, T3-T6 right T5-T10 left T6 -T8. right occiput, C 1, C 2 occiput, C 1, C 2 occiput, C 1, C 2. T8-T10 bilateral T9-T12 right T11-L1 right L1-L3 left T5-T9 right or bilateral T5-T10 right C 3-C 5 right occiput, occiput, occiput, S2-S4 occiput, occiput, C 1, C 1, C 1, C 1, C 1, C 1, C2 C2 C2 C2 C2 C2 C 1, C 2 C 1, C 2 C 1, C 2 C 1, C 2 C 1, C 2 T7-T9 left T9-L1 ipsilateral T11-L3 ipsilateral T11-L3 ipsilateral T11-L3 bilateral T11-L2 bilateral occiput, C 1, C 2 occiput, C 1, C 2 S2-S4 S2-S4 T10-L2 bilateral S2-S4 T12 bilateral T10-L2 bilateral T10-T11 ipsilateral T9-L2 bilateral T8-T10 ipsilateral S2-S4 S2-S4 VISCEROSOMATIC REFLEXES System/Organ head and neck Upper respiratory tract: Cardiac myocardial coronary artery Pulmonary lung bronchomotor reflex “asthma reflex,” bronchial mucosa reflex lung parenchyma reflex pariatal pleura Upper G.I. esophagus stomach duodenum Lower G.I. small intestine appendix and caecum ascending colon descending colon/rectum Pancreas Liver/gallblader phrenic nerve somatosomatic reflex Spleen Urinary tract Kidney proximal ureter distal ureter bladder Urethra: Genital tract Fallopian tubes (and seminal vesicles) external genitalia Prostate Ovaries (and testis) Uterus Adrenal glands Sympathetic Parasympathetic T1-T5 T1-T5 Trigeminal: final common pathway, temporalis muscles, occiput, C 1, C 2. T1-T5 left C 3-C 5 (sympathetic?) occiput, C 1, C 2. T1-T4 T1-T3 T2 left T2-T3 T3-T4 T1-T12 occiput, occiput, occiput, occiput, occiput, occiput, T3-T6 right T5-T10 left T6 -T8. right occiput, C 1, C 2 occiput, C 1, C 2 occiput, C 1, C 2. T8-T10 bilateral T9-T12 right T11-L1 right L1-L3 left T5-T9 right or bilateral T5-T10 right C 3-C 5 right occiput, occiput, occiput, S2-S4 occiput, occiput, C 1, C 1, C 1, C 1, C 1, C 1, C2 C2 C2 C2 C2 C2 C 1, C 2 C 1, C 2 C 1, C 2 C 1, C 2 C 1, C 2 T7-T9 left T9-L1 ipsilateral T11-L3 ipsilateral T11-L3 ipsilateral T11-L3 bilateral T11-L2 bilateral occiput, C 1, C 2 occiput, C 1, C 2 S2-S4 S2-S4 T10-L2 bilateral S2-S4 T12 bilateral T10-L2 bilateral T10-T11 ipsilateral T9-L2 bilateral T8-T10 ipsilateral S2-S4 S2-S4 Adapted from: Somatic Dysfunction in Osteopathic Family Medicine. Nelson KE, Glonek T, eds., ACOFP: Lippincott, Williams & Wilkins; 2007; Chapt. 5, “Viscerosomatic and somatovisceral reflexes.” Pages 33-55. Adapted from: Somatic Dysfunction in Osteopathic Family Medicine. Nelson KE, Glonek T, eds., ACOFP: Lippincott, Williams & Wilkins; 2007; Chapt. 5, “Viscerosomatic and somatovisceral reflexes.” Pages 33-55. VISCEROSOMATIC REFLEXES VISCEROSOMATIC REFLEXES System/Organ head and neck Upper respiratory tract: Cardiac myocardial coronary artery Pulmonary lung bronchomotor reflex “asthma reflex,” bronchial mucosa reflex lung parenchyma reflex pariatal pleura Upper G.I. esophagus stomach duodenum Lower G.I. small intestine appendix and caecum ascending colon descending colon/rectum Pancreas Liver/gallblader phrenic nerve somatosomatic reflex Spleen Urinary tract Kidney proximal ureter distal ureter bladder Urethra: Genital tract Fallopian tubes (and seminal vesicles) external genitalia Prostate Ovaries (and testis) Uterus Adrenal glands Sympathetic Parasympathetic T1-T5 T1-T5 Trigeminal: final common pathway, temporalis muscles, occiput, C 1, C 2. T1-T5 left C 3-C 5 (sympathetic?) occiput, C 1, C 2. T1-T4 T1-T3 T2 left T2-T3 T3-T4 T1-T12 occiput, occiput, occiput, occiput, occiput, occiput, T3-T6 right T5-T10 left T6 -T8. right occiput, C 1, C 2 occiput, C 1, C 2 occiput, C 1, C 2. T8-T10 bilateral T9-T12 right T11-L1 right L1-L3 left T5-T9 right or bilateral T5-T10 right C 3-C 5 right occiput, occiput, occiput, S2-S4 occiput, occiput, C 1, C 1, C 1, C 1, C 1, C 1, C2 C2 C2 C2 C2 C2 C 1, C 2 C 1, C 2 C 1, C 2 C 1, C 2 C 1, C 2 T7-T9 left T9-L1 ipsilateral T11-L3 ipsilateral T11-L3 ipsilateral T11-L3 bilateral T11-L2 bilateral occiput, C 1, C 2 occiput, C 1, C 2 S2-S4 S2-S4 T10-L2 bilateral S2-S4 T12 bilateral T10-L2 bilateral T10-T11 ipsilateral T9-L2 bilateral T8-T10 ipsilateral S2-S4 S2-S4 Adapted from: Somatic Dysfunction in Osteopathic Family Medicine. Nelson KE, Glonek T, eds., ACOFP: Lippincott, Williams & Wilkins; 2007; Chapt. 5, “Viscerosomatic and somatovisceral reflexes.” Pages 33-55. System/Organ head and neck Upper respiratory tract: Cardiac myocardial coronary artery Pulmonary lung bronchomotor reflex “asthma reflex,” bronchial mucosa reflex lung parenchyma reflex pariatal pleura Upper G.I. esophagus stomach duodenum Lower G.I. small intestine appendix and caecum ascending colon descending colon/rectum Pancreas Liver/gallblader phrenic nerve somatosomatic reflex Spleen Urinary tract Kidney proximal ureter distal ureter bladder Urethra: Genital tract Fallopian tubes (and seminal vesicles) external genitalia Prostate Ovaries (and testis) Uterus Adrenal glands Sympathetic Parasympathetic T1-T5 T1-T5 Trigeminal: final common pathway, temporalis muscles, occiput, C 1, C 2. T1-T5 left C 3-C 5 (sympathetic?) occiput, C 1, C 2. T1-T4 T1-T3 T2 left T2-T3 T3-T4 T1-T12 occiput, occiput, occiput, occiput, occiput, occiput, T3-T6 right T5-T10 left T6 -T8. right occiput, C 1, C 2 occiput, C 1, C 2 occiput, C 1, C 2. T8-T10 bilateral T9-T12 right T11-L1 right L1-L3 left T5-T9 right or bilateral T5-T10 right C 3-C 5 right occiput, occiput, occiput, S2-S4 occiput, occiput, C 1, C 1, C 1, C 1, C 1, C 1, C2 C2 C2 C2 C2 C2 C 1, C 2 C 1, C 2 C 1, C 2 C 1, C 2 C 1, C 2 T7-T9 left T9-L1 ipsilateral T11-L3 ipsilateral T11-L3 ipsilateral T11-L3 bilateral T11-L2 bilateral occiput, C 1, C 2 occiput, C 1, C 2 S2-S4 S2-S4 T10-L2 bilateral S2-S4 T12 bilateral T10-L2 bilateral T10-T11 ipsilateral T9-L2 bilateral T8-T10 ipsilateral S2-S4 S2-S4 Adapted from: Somatic Dysfunction in Osteopathic Family Medicine. Nelson KE, Glonek T, eds., ACOFP: Lippincott, Williams & Wilkins; 2007; Chapt. 5, “Viscerosomatic and somatovisceral reflexes.” Pages 33-55. VISCEROSOMATIC REFLEXES VISCEROSOMATIC REFLEXES Viscerosomatic reflexes are diagnostic tools. They are somatic dysfunction that develops in response to visceral pathology. A modification of Van Buskirk’s nociceptively initiated model for spinal somatic dysfunction offers a description of the physiology of the viscerosomatic reflex as follows Viscerosomatic reflexes are diagnostic tools. They are somatic dysfunction that develops in response to visceral pathology. A modification of Van Buskirk’s nociceptively initiated model for spinal somatic dysfunction offers a description of the physiology of the viscerosomatic reflex as follows 1. 1. 2. 3. 4. 5. 6. A peripheral focus of irritation, in this case from the inflammation associated with visceral pathology, results in activation of nociceptive, general visceral afferent, neurons. These primary afferent neurons return to the spinal cord and synapse in the dorsal horn with internuncial neurons. The ongoing afferent stimulation results in the establishment of a state of irritability (facilitation) of the internuncial neurons of that spinal segment. Additional afferent activity, from any source, results in a segmental response to significantly fewer stimuli than would normally be required. This results in tenderness when the area is palpated. When the amount of afferent activity from the offending organ is sufficient enough to cause internuncial firing referred pain results. Such activity from internuncial neurons, which synapse with ventral horn motor neurons, results in segmentally related myospasticity and palpable tissue texture change. The degree of segmental irritability that is directly proportionate to the severity of the visceral pathology, and the anatomic relationship between the involved organ and the paravertebral soft tissues that makes the location of the reflex changes consistent from individual to individual allows viscerosomatic reflexes to be of diagnostic value. 2. 3. 4. 5. 6. A peripheral focus of irritation, in this case from the inflammation associated with visceral pathology, results in activation of nociceptive, general visceral afferent, neurons. These primary afferent neurons return to the spinal cord and synapse in the dorsal horn with internuncial neurons. The ongoing afferent stimulation results in the establishment of a state of irritability (facilitation) of the internuncial neurons of that spinal segment. Additional afferent activity, from any source, results in a segmental response to significantly fewer stimuli than would normally be required. This results in tenderness when the area is palpated. When the amount of afferent activity from the offending organ is sufficient enough to cause internuncial firing referred pain results. Such activity from internuncial neurons, which synapse with ventral horn motor neurons, results in segmentally related myospasticity and palpable tissue texture change. The degree of segmental irritability that is directly proportionate to the severity of the visceral pathology, and the anatomic relationship between the involved organ and the paravertebral soft tissues that makes the location of the reflex changes consistent from individual to individual allows viscerosomatic reflexes to be of diagnostic value. VISCEROSOMATIC REFLEXES VISCEROSOMATIC REFLEXES Viscerosomatic reflexes are diagnostic tools. They are somatic dysfunction that develops in response to visceral pathology. A modification of Van Buskirk’s nociceptively initiated model for spinal somatic dysfunction offers a description of the physiology of the viscerosomatic reflex as follows Viscerosomatic reflexes are diagnostic tools. They are somatic dysfunction that develops in response to visceral pathology. A modification of Van Buskirk’s nociceptively initiated model for spinal somatic dysfunction offers a description of the physiology of the viscerosomatic reflex as follows 1. 1. 2. 3. 4. 5. 6. A peripheral focus of irritation, in this case from the inflammation associated with visceral pathology, results in activation of nociceptive, general visceral afferent, neurons. These primary afferent neurons return to the spinal cord and synapse in the dorsal horn with internuncial neurons. The ongoing afferent stimulation results in the establishment of a state of irritability (facilitation) of the internuncial neurons of that spinal segment. Additional afferent activity, from any source, results in a segmental response to significantly fewer stimuli than would normally be required. This results in tenderness when the area is palpated. When the amount of afferent activity from the offending organ is sufficient enough to cause internuncial firing referred pain results. Such activity from internuncial neurons, which synapse with ventral horn motor neurons, results in segmentally related myospasticity and palpable tissue texture change. The degree of segmental irritability that is directly proportionate to the severity of the visceral pathology, and the anatomic relationship between the involved organ and the paravertebral soft tissues that makes the location of the reflex changes consistent from individual to individual allows viscerosomatic reflexes to be of diagnostic value. 2. 3. 4. 5. 6. A peripheral focus of irritation, in this case from the inflammation associated with visceral pathology, results in activation of nociceptive, general visceral afferent, neurons. These primary afferent neurons return to the spinal cord and synapse in the dorsal horn with internuncial neurons. The ongoing afferent stimulation results in the establishment of a state of irritability (facilitation) of the internuncial neurons of that spinal segment. Additional afferent activity, from any source, results in a segmental response to significantly fewer stimuli than would normally be required. This results in tenderness when the area is palpated. When the amount of afferent activity from the offending organ is sufficient enough to cause internuncial firing referred pain results. Such activity from internuncial neurons, which synapse with ventral horn motor neurons, results in segmentally related myospasticity and palpable tissue texture change. The degree of segmental irritability that is directly proportionate to the severity of the visceral pathology, and the anatomic relationship between the involved organ and the paravertebral soft tissues that makes the location of the reflex changes consistent from individual to individual allows viscerosomatic reflexes to be of diagnostic value.
