A Manual of Osteopathic
Manipulations and Treatment
Wilfred L. Riggs, D. O.
OSTEOPATHY bases its claim to rank as a science of
healing upon the fact that there exists a definite and fixed relation between
an organ and the central nervous system. This relation is secured through
the segmented arrangement of the spinal nerves or through the sympathetic
system, by means of rami communicantes. The order of this innervation is
fairly constant, though, as in the case with other portions of the body,
it may vary. This variation in no wise invalidates the claim of Osteopathy
to rank as a science, but it emphasizes the necessity of our searching
for lesions even in regions relatively remote from the center. Specific
treatment in the sense of work exclusively upon a region said to be a center
is rarely indicated. Owing to the diffusion of pain and its attendant conditions,
it is necessary to remove any contracture which may be associated with
it. Again, it sometimes occurs that disease of an organ produces no effect
on its usual center, and in such an event it is necessary to carefully
examine other regions for the trouble. Know the location of the centers.
Know also that occasionally a lesion causing the trouble must be found
elsewhere. "Touching the button" is fascinating, both in theory and in
practice, but the operator must be broad enough to expect it to be difficult
occasionally to locate the button.
Our use of the term center is in the sense of a convenient
and advantageous place to reach fibres to or from a certain organ. We now
point out some of the more important of these centers:
The atlas is associated with disturbances to tile
vaso-motors of the eye, ear, and with eczema and other diseases of the
The axis and third cervical is a general vaso-motor
center, through the superior cervical ganglion, and also a center for side
of head, face, eye, nose, pharynx, tonsils and vessels of the brain.
Third, fourth, and fifth cervical, origplain of phrenics,
center for hiccoughs.
Fifth and sixth cervical, middle cervical ganglion,
center for thyroid gland, also augmentors to heart through middle cervical
The general function of the cervical region is that
of (1) vaso-constrictor effect through sympathetic fibres passing into
it from below through the second, third, fourth and fifth dorsal, and vaso-dilator
fibres in the cervical spinal nerves, thus affecting all parts of the body;
and (2) local vaso-motor effects on the neck, head and face of the same
side. That the upper
cervical region is sometimes said to be a center for the kidney is
its influence over the general vaso-motors of the entire body.
Second to sixth dorsal are vaso-constrictors to the
pulmonary blood vessels.
Third to seventh dorsal, vaso-motors to arm via the
Seventh cervical and first dorsal, inferior cervical
ganglion, heart, thyroid gland, vertebral and basilar arteries.
Annulus of Vieussens and second, third, fourth, and
fifth dorsal, augmentory fibres to the heart. The first three give regularity
Fourth and fifth control regularity and strength
Fourth dorsal, sometimes third or fifth, stomach
center on rigplaht side usually. General effect as low as the eighth.
Second and third dorsal, center for ciliary muscle.
Center for vomiting. Center for bronchial tubes and bronchi.
Sixth to tenth dorsal, origplain of the great splanchnic,
carrying viscero-inhibitory fibres and vaso-constrictor and secretory fibres
to the stomach and small intestine.
Eighth, ninth and tenth dorsal on rigplaht side,
center for the liver. This gives us the center for chills, as the
liver and spleen are implicated in malarial attacks.
Ninth and tenth dorsal on the left, center for the
spleen. In treatment of chills the general condition must be controlled
through cardiac and vaso-motor centers, directing especial attention to
the liver and spleen. Also center for uterus via hypogastric plexus.
Eleventh and twelfth dorsal and upper lumbar,
the small intestine and kidney.
Eleventh and twelfth dorsal, center for ovary.
Second lumbar, center for parturition, micturition
Second, third and fourth lumbar, center for diarrhea.
Fourth and fifth lumbar, hypogastric plexus, which
with fibres from the aortic plexus forms the pelvic plexus, distributing
fibres to the pelvic organs.
The anterior division of the sacral nerves arc splanchnic
in function and are distributed to the rectum, to the bladder, sphincter
ani, vagina and uterus. These seem to be chiefly viscero-motor in
Second and third sacral, bladder.
Fourth sacral, vagina.
Fourth and fifth sacral, sphincter ani.
After a general view of the centers along the spine
it is necessary to form a resume of their location by mentioning the chief
organs of the body and with them the regions in which they may be affected
through their vaso-motor, viscero-motor, inhibitory and secretory nerve
supply. Generally speaking the circulation is controlled through the great
vaso-motor centers, reached in the upper cervical region. It is further
controlled through the region from which the augmentor fibres make their
exit -- the second to the fifth dorsal. It is also affected by treatment
in the splanchnic region controlling the vaso-motors to the great capillary
network of the mesenteries.
In case of a disturbance in any of the following
organs or members look for your spinal lesions as follows:
Eye: Atlas, third cervical and second or third dorsal.
Ear: Second to fifth cervical.
Brain: From first cervical to first dorsal.
Pharynx, larynx and tonsils: Second and third cervical.
Thyroid gland: Fifth and sixth cervical, general
vaso-motor and cardiac center; seventh cervical and first dorsal -- head
of first rib, clavicle.
Arm, motion, vaso-motor and nutrition: Brachial plexus
in fifth, sixth, seventh, eighth cervical and first dorsal; also vaso-motors
in third to seventh dorsal.
Lungs and bronchi: Second to sixth or eighth dorsal;
also vagus nerve.
Heart: Fibres from second to fifth dorsal especial
attention to fifth dorsal.
Heart may also be reached through middle and inferior
cervical ganglion, and at first rib, or annulus of Vieussens.
Stomach: Third to fifth dorsal specific on rigplaht
side; third to eighth generally; also vagus.
Liver: Ninth and tenth dorsal, vaso-motor, vagus
Spleen: Eighth to eleventh dorsal, vaso-motor vagus
Duodenum: Great splanchnic, sixth to tenth dorsal.
Jejunum and ileum: Lower dorsal and lumbar to fourth,
and fibres from solar plexus.
Colon: Second to fifth lumbar; also fibres from solar
Rectum: Second to fifth lumbar via inferior mesenteric
Sacral via hypogastric plexus, motor; also third
and fourth dorsal.
In treatment of the abnormal viscera in addition
to specific treatment it is always beneficial to give direct treatment
to the abdomen, paying particular attention to the region of the solar
plexus. This has the effect of changing the blood by compression, thus
relieving venosity and allaying increased peristalsis; or in case of sluggishness
of any organ it stimulates the plexuses of Auerbach and Meissner to motion
and secretion. It may, also, break up masses of fecal matter lying within
the abdominal canal.
Uterus: Second to fifth lumbar, ninth and tenth dorsal.
Genitalia generally: Second to fifth lumbar.
Bladder: Second, third and fourth sacral.
Sphincter ani: Fifth sacral.
The knowledge of the location of these centers is
of incalculable advantage to the Osteopath since it is upon this knowledge
that the accuracy of his diagnosis and treatment depends. An osseous lesion
in the area which we have designated as a center for a certain organ may
lead to a diseased condition of that organ; while a lesion of an organ
may manifest itself in tenderness within its center along the spine. This
tenderness may be found in the following localities:
First. On the ends of the spinous processes,
usually indicating an anterior condition.
Second. Above the spinous processes and about
an inch lateral at the articulation of the rib with the transverse process
of the vertebra, indicating a lateral movement and often a tipping forward
of the body of the vertebra.
Third. The soreness may be manifested at the
angle of the rib, indicating a rotation of the rib upward or downward on
the axis connecting it two extremities.
Fourth. Associated with any of these three
conditions may be found soreness in the muscles lying in that region on
either side of the spinous process.
To determine these conditions the patient may be
sitting or lying.
Gentle pressure will determine any sensitiveness. To examine
the angles of the ribs in the interscapular region the arm on the same side
should be grasped at the elbow and firmly passed across the chest. This will
tighten the muscles and expose the rib from the covering of the scapula. In
all these cases the muscular contraction must be released; to do this the patient
should be placed upon the table and a firm and steady pressure applied to the
muscles, the skin being lax, passing either upward or downward. This will release
the pressure and may be sufficient in acute cases. In addition to this, an oscillation
of the body from side to side, bending at the lesion, will prove helpful, as
will rotation around the same point. Springing the spine forward will produce
a good effect by releasing muscular and ligamentous contractures.