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Osteopathic Medicine
The Spleen
Luc Peeters & Grégoire Lason
The Spleen
Luc Peeters & Grégoire Lason
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ISBN: 9789074400336
The International Academy of Osteopathy – I.A.O.
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Content
Content ....................................................................................................................... 3
1. Introduction ............................................................................................................ 5
2. Anatomy ................................................................................................................. 6
2.1. Position ............................................................................................................ 6
2.2. Anatomical Fixations .................................................................................... 10
2.3. Innervation ..................................................................................................... 10
3. Physiology ............................................................................................................ 12
3.1. Reserve and Filter Function ......................................................................... 12
3.1.1. Red Pulp ................................................................................................... 12
3.1.2. Diver’s Reflex and other Phenomena ....................................................... 12
3.1.3. Baroreceptors and the splenic Volume ..................................................... 13
3.2. Immune Function .......................................................................................... 14
3.2.1. White Pulp ................................................................................................ 14
4. Mobility ................................................................................................................. 16
5. Working Diagnosis and Physical Diagnosis ..................................................... 17
6. Clinical Diagnosis ................................................................................................ 20
6.1. Palpation ........................................................................................................ 20
6.1.1. Palpation of Muscle Tone ......................................................................... 20
6.1.2. Palpation of the Spleen in Sitting Position ................................................ 20
6.1.3. Palpation of the Spleen in Supine Position ............................................... 21
6.2. Tests ............................................................................................................... 21
6.2.1. Test of the lower Ribs in the frontal Plane ................................................ 21
6.2.2. Test of the lower Ribs in the sagittal Plane .............................................. 22
6.2.3. Test of the lower Ribs in the horizontal Plane .......................................... 22
7. Osteopathic Techniques ..................................................................................... 23
7.1. General Techniques ...................................................................................... 23
7.1.1. Apnoea ..................................................................................................... 23
7.2. Mobilisations ................................................................................................. 24
7.2.1. Mobilisation of the lower Ribs in the frontal Plane .................................... 24
7.2.2. Mobilisation of the lower Ribs in the sagittal Plane .................................. 24
7.2.3. Mobilisation of the lower Ribs in the horizontal Plane .............................. 25
7.3. Drainages ....................................................................................................... 25
7.3.1. Drainage of the Spleen in Sitting Position ................................................ 25
7.3.2. Drainage of the Spleen in Supine Position ............................................... 26
7.3.3. Drainage of the Spleen Lying on the Side ................................................ 26
7.4. Inductions ...................................................................................................... 27
7.4.1. Induction of the Spleen ............................................................................. 27
7.5. Reflexes ......................................................................................................... 27
7.5.1. Neurolymphatic Reflexes .......................................................................... 27
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8. Bibliography ......................................................................................................... 29
9. About the Authors ............................................................................................... 31
10. Acknowledgment ............................................................................................... 32
11. Visceral Osteopathy .......................................................................................... 33
11.1. Introduction ................................................................................................. 33
11.2. Motion Physiology ...................................................................................... 34
11.2.1. The Motions of the Musculoskeletal System .......................................... 34
11.2.2. The Motions of the Visceral System ....................................................... 34
11.2.2.1. The Diaphragm ................................................................................ 34
11.2.2.2. The Heart ......................................................................................... 35
11.2.2.3. Peristalsis ......................................................................................... 35
11.3. Visceral Interactions ................................................................................... 35
11.3.1. General ................................................................................................... 35
11.3.2. Relationships .......................................................................................... 36
11.3.2.1. Gliding Surfaces ............................................................................... 36
11.3.2.2. Ligamentous Suspensory System ................................................... 36
11.3.2.3. The Mesentery ................................................................................. 36
11.3.2.4. The Omenta ..................................................................................... 37
11.3.2.5. The Turgor Effect and the Intracavitary Pressures .......................... 37
11.4. Mobility Loss ............................................................................................... 37
11.4.1. Diaphragm Dysfunction .......................................................................... 37
11.4.2. Adhesions ............................................................................................... 37
11.4.3. Retractions ............................................................................................. 38
11.4.4. Trophic Tissue Changes ......................................................................... 38
11.4.5. Congestion ............................................................................................. 38
11.4.6. Postural Disorders .................................................................................. 38
11.4.7. Visceral Mobility Loss ............................................................................. 39
11.5. Visceral Hypermobility ............................................................................... 40
11.6. Osteopathic Visceral Examination ............................................................ 40
11.7. Bibliography Visceral Osteopathy ............................................................. 41
12. Abbreviations ..................................................................................................... 42
13. Specific Terms ................................................................................................... 43
14. All Videos ........................................................................................................... 44
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1. Introduction
The spleen is an organ that is all too often neglected in the clinic, most likely because
conditions of the spleen do not tend to present a defined clinical picture.
Furthermore, it has long been thought that the spleen, like the tonsils, is an organ
that is superfluous in the adult.
The spleen is actually the largest lymphoid organ in the body and is implicated within
the blood circulation. In the foetus it is an organ involved in haematogenesis while in
the adult it produces lymphocytes. The spleen is for the blood what the lymph nodes
are for the lymphatic system. The spleen also purifies and filters the blood by
removing dead cells and foreign materials out of the circulation.
The function of red blood cell reserve is also essential for the maintenance of human
activity. Osteopaths often identify splenic congestion under the influence of poor
diaphragm function.
Some of the symptoms that can be associated with dysfunction of the spleen are:
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Anaemia in children.
•
Disorders of blood development.
•
Gingivitis, painful and bleeding gums.
•
Swollen, painful tongue, dysphagia and glossitis.
•
Fatigue, hyperirritability and restlessness due to the anaemia.
•
Vertigo and tinnitus.
•
Frequent colds and infections due to decreased resistance.
•
Thrombocytosis.
•
Tension headaches.
The osteopath also considers the spleen an important organ as it plays a role in the
immunity, the reaction of the circulation and oxygen transport during effort as well as
in regulation of the blood pressure.
For readers not yet familiar with the osteopathic visceral concept, there is chapter 11
included at the end of this e-book.
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2. Anatomy
(Dalley and Agur 2004, Gray 2000, Netter 2006)
2.1. Position
The spleen is an organ that is located under the left dome of the diaphragm (Figure
1) and is 12 to 15 cm long, 4 to 8 cm wide and 3 to 4 cm thick. The spleen weighs
between 140 and 180 grams.
It is found between the 9th and 11th left ribs (Figures 3 and 6).
In newborns the spleen is small but the volume increases rapidly during the first 3
years to 4 - 6 times the birth size. The position therefore progressively becomes more
lateral in place of the original epigastric position.
The spleen is found postero-latero-superior from the stomach; its arterial supply is via
the splenic artery and the left gastroepiploic artery (Figure 2).
The venous drainage is via the splenic vein into the portal vein (Figure 2).
Right
Left
Figure 1 - The spleen
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6. Clinical Diagnosis
6.1. Palpation
6.1.1. Palpation of Muscle Tone
Palpation of hypertonic paravertebral muscles around T7 together with increased tone
of the left transverse abdominal muscle indicate a possible problem of the spleen.
6.1.2. Palpation of the Spleen in Sitting Position
The patient is sitting and the osteopath stands behind the patient. Both hands are
used to palpate under the left dome of the diaphragm in a cranial/left direction. If the
patient is allowed to slump into kyphosis a normal spleen can sometimes be palpated
but usually this is not possible. If the spleen is clearly palpable then it indicates a
likely swelling.
This is usually associated with congestion of the liver and of the entire upper
digestive system as it drains via the portal system into the liver.
Video 1 - Palpation of the spleen
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7.2. Mobilisations
7.2.1. Mobilisation of the lower Ribs in the frontal Plane
The patient is sitting with the thorax upright. The osteopath contacts laterally on the
lower ribs using both hands and lifts the ribs superiorly during the patient’s inhalation
and inferiorly during exhalation. During inhalation the thoracic spine is extended and
during exhalation it is flexed. Mobilisation is applied in the direction of mobility loss.
Superior mobilisation is most effective during inhalation and inferior mobilisation
during exhalation.
Video 6 - Mobilisation of the lower ribs
7.2.2. Mobilisation of the lower Ribs in the sagittal Plane
The patient is lying on the side and the osteopath places one hand posterior and the
other hand anterior upon the lower ribs. The ribs are mobilised into inhalation and
exhalation. Care must be taken that the patient is correctly positioned in the sagittal
plane with the lower thoracic region in neutral. Superior mobilisation is most effective
during inhalation and inferior mobilisation during exhalation.
Video 7 - Mobilisation of the lower ribs
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9. About the Authors
Grégoire Lason
Gent (B), 21.11.54
Luc Peeters
Terhagen (B), 18.07.55
Both authors are holders of university degrees, namely the Master of Science in
Osteopathy (MSc.Ost. – University of Applied Sciences), and are very active with the
promotion and academic structuring of osteopathy in Europe. In 1987 they began
The International Academy of Osteopathy (IAO) and are, to this day, the jointprincipals of this academy. The IAO is since several years the largest teaching
institute for osteopathy in Europe. Both osteopaths are members of diverse
professional organisations, including the American Academy of Osteopathy (AAO),
the International Osteopathic Alliance (IOA) and the World Osteopathic Health
Organisation (WOHO), as part of their mission to improve osteopathic development.
This osteopathic encyclopaedia aims to demonstrate the concept that a proper
osteopathic examination and treatment is based upon the integration of three
systems: the musculoskeletal, visceral and craniosacral systems.
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