Clinical Integration of the Visceral Field

Clinical Integration of the Visceral Field (thorax, abdomen and pelvis) within the Global Osteopathic Approach. Diagnostic P{athways and Clinical Reasoning.

OBJECTIVES

In this original 3-day master class for osteopaths, Sandra Lois Gutiérrez, DP, MSc, Eur Ost DO, from Spain, will help students develop diagnostic and clinical reasoning pathways in which they are able to visualise, understand and integrate both organs/viscera/glands within the set of elements that make up the human anatomy, as we cannot understand concepts such as health or homeostasis by dividing the body into compartments.

Osteopathy in the visceral field has a shorter history compared to other areas such as musculoskeletal or cranial osteopathy. The way in which it has developed has given rise to multiple ways of interpreting and carrying it out, which has been very enriching and at the same time has generated some confusion and chaos in diagnostic and treatment processes.

Respecting different perceptive abilities - from the mechanical to the rhythmic - and taking into account that there are different "schools" in the visceral field within osteopathy, we will work on guides that allow us to travel from the global to the regional and analytical, and vice versa, establishing chains and functional patterns on which we will have to work individually in each patient.

The different ways of anatomical-physiological relationship (mechanical, neurological, fluidic, metabolic...) present us with paths to explore and allow us to establish an individual narrative for each patient. And it will be these same pathways and this narrative that will allow us to confirm whether our work has been effective in the short, medium and long term, and to modify those parts of our reasoning that may require it.

The target audience is graduated osteopaths

Total CEUs earned: 21h

SKILLS THAT WILL BE ACQUIRED

At the end of the course the student will be able to: 

• Integrate embryological, anatomical-physiological and neuroscientific knowledge to facilitate the clinical reasoning process in a wide variety of cases.
• Develop assessment strategies that allow a more accurate and coherent diagnosis of the visceral system.
• Differentiate local problems from regional and systemic problems.
• Identify the priority anatomical structures to be treated in each situation.
• Build a diagnostic hypothesis in the form of a narrative that involves the organs and viscera of the body.
• Facilitate a therapeutic approach of minimal intervention, effective and in accordance with current knowledge.

COURSE PROGRAM

3 days – 21 hours

Theory and practice will go hand in hand throughout the course and we will go through a series of key topics according to the following programme.

Day 1

· Anatomical considerations from the perspective of embryology

· The body cavities and their associated membrane systems

· The body cavity systems and their anatomo-physiological relationships along the body cavities

· Visceral screening strategies using different diagnostic pathways and inhibition tests I.

· Neuroscientific concepts and clinical application

Day 2

· Cranio-visceral relationships

· Viscera and extremities: a key to both diagnosis and therapy

· Visceral screening strategies using different diagnostic pathways and inhibition tests II.

Day 3

· Visceral therapeutic tools within the global osteopathic approach.

. GALT (Galactose-1-phosphate uridyl transferase) and its connection with metabolism, endocrine system and immunity. . . Gut microbiota.

SPECIFIC EQUIPMENT

Students should come with comfortable, elastic clothing that allows for wide movements and deep grasping in areas such as the ischiorectal fossa.

LEARNING METHODS

- Lectures and introduction to the basic theoretical contents

- Discussion of presentation and the available scientific evidence

- Case review involving different clinical presentations

- Demonstration and practice

SELECTED READINGS

- Kastelein AW, Vos LMC, de Jong KH, van Baal JOAM, Nieuwland R, van Noorden CJF, Roovers JWR, Lok CAR. Embryology, anatomy, physiology and pathophysiology of the peritoneum and the peritoneal vasculature. Semin Cell Dev Biol. 2019 Aug;92:27-36. doi: 10.1016/j.semcdb.2018.09.007. Epub 2018 Oct 9. PMID: 30253239.

- Byrnes KG, Walsh D, Walsh LG, Coffey DM, Ullah MF, Mirapeix R, Hikspoors J, Lamers W, Wu Y, Zhang XQ, Zhang SX, Brama P, Dunne CP, O'Brien IS, Peirce CB, Shelly MJ, Scanlon TG, Luther ME, Brady HD, Dockery P, McDermott KW, Coffey JC. The development and structure of the mesentery. Commun Biol. 2021 Aug 18;4(1):982. doi: 10.1038/s42003-021-02496-1. PMID: 34408242; PMCID: PMC8373875.

- Roncada G. Osteopathic treatment leads to significantly greater reductions in chronic thoracic pain after CABG surgery: A randomised controlled trial. J Bodyw Mov Ther. 2020 Jul;24(3):202-211. doi: 10.1016/j.jbmt.2020.03.004. Epub 2020 Mar 17. PMID: 32825989.

- Cerritelli F, Chiacchiaretta P, Gambi F, Perrucci MG, Barassi G, Visciano C, Bellomo RG, Saggini R, Ferretti A. Effect of manual approaches with osteopathic modality on brain correlates of interoception: an fMRI study. Sci Rep. 2020 Feb 21;10(1):3214. doi: 10.1038/s41598-020-60253-6. PMID: 32081945; PMCID: PMC7035282.

- Guillaud A, Darbois N, Monvoisin R, Pinsault N. Reliability of Diagnosis and Clinical Efficacy of Cranial Osteopathy: A Systematic Review. PLoS One. 2016 Dec 9;11(12):e0167823. doi: 10.1371/journal.pone.0167823. PMID: 27936211; PMCID: PMC5147986.

- D’Alessandro G, Cerritelli F and Cortelli P (2016) Sensitization and Interoception as Key Neurological

Concepts in Osteopathy and Other Manual Medicines. Front. Neurosci. 10:100. doi: 10.3389/fnins.2016.00100

- Jänig, Wilfrid. (2008). Organization of the Sympathetic Nervous System: Peripheral and Central Aspects. 10.1016/S1567-7443(07)00204-9.

- Cerritelli F, Chiacchiaretta P, Gambi F, Ferretti A. Effect of Continuous Touch on Brain Functional Connectivity Is Modified by the Operator's Tactile Attention. Front Hum Neurosci. 2017 Jul 20;11:368. doi: 10.3389/fnhum.2017.00368. PMID: 28775685; PMCID: PMC5517483.

- Jänig, W., Sympathetic nervous system and inflammation: A conceptual view, Auton. Neurosci. (2014), http://dx.doi.org/ 10.1016/j.autneu.2014.01.004

- Fryer G, Somatic Dysfunction: An Osteopathic Conundrum, International Journal of Osteopathic Medicine (2016), doi: 10.1016/j.ijosm.2016.02.002.

- Tyreman, Stephen. (2013). Re-Evaluating ‘osteopathic Principles’. International Journal of Osteopathic Medicine. 16. 38–45. 10.1016/j.ijosm.2012.08.005.

- Esteves JE, Spence C, Developing competence in diagnostic palpation: Perspectives from neuroscience and education, International Journal of Osteopathic Medicine (2013), http://dx.doi.org/10.1016/ j.ijosm.2013.07.001

- Bicalho, Eduardo & Vieira, Leonardo & Makita, Daniel & Cano, Luis. (2020). Inhibitory Tests as Assessment Tools for Somatic Dysfunctions: Mechanisms and Practical Applications. Cureus. 12. 10.7759/cureus.7700.

- Wu Y, Hikspoors JPJM, Mommen G, Dabhoiwala NF, Hu X, Tan LW, Zhang SX, Lamers WH. Interactive three-dimensional teaching models of the female and male pelvic floor. Clin Anat. 2020 Mar;33(2):275-285. doi: 10.1002/ca.23508. Epub 2019 Nov 19. PMID: 31639237; PMCID: PMC7027585.

- Chamié LP et al. Translabial US and Dynamic MR Imaging of the Pelvic Floor: Normal Anatomy and Dysfunction. Radiographics. 2018 Jan-Feb;38(1):287-308.

- Lakhoo J, Khatri G, Elsayed RF, Chernyak V, Olpin J, Steiner A, Tammisetti VS, Sundaram KM, Arora SS. MRI of the Male Pelvic Floor. Radiographics. 2019 Nov-Dec;39(7):2003-2022. doi: 10.1148/rg.2019190064. PMID: 31697623.

- Cenaj, O., Allison, D.H.R., Imam, R. et al. Evidence for continuity of interstitial spaces across tissue and organ boundaries in humans. Commun Biol 4, 436 (2021). https://doi.org/10.1038/s42003-021-01962-0

- Emerich Gordon K, Reed O. The Role of the Pelvic Floor in Respiration: A Multidisciplinary Literature Review. J Voice. 2020 Mar;34(2):243-249. doi: 10.1016/j.jvoice.2018.09.024. Epub 2018 Nov 14. PMID: 30447797.

o Books:

- Helsmoortel, J (2010) Visceral Osteopathy: The Peritoneal Organs

- Stone, C. (2007) Visceral and Obstetric Osteopathy.