Abstract
There is a lack of published literature in osteopathic manual medicine on how to perform palpation of the lower respiratory tree such as the trachea, main bronchi, and lungs. Several authors have studied the osteopathic effect and respiratory response of palpation but have failed to demonstrate how to perform palpation of the visceral areas involved in breathing, either in the context of a clinical trial or as a case report. This paper reviews the innervation of these anatomical areas, the mechano-metabolic weight of the passage of fluids and air in the respiratory tract, the anatomical topography, and the movements involved in respiration. Drawing from current knowledge, this article illustrates, for the first time, how to place the hands for an effective osteopathic assessment of the tracheal, bronchial, and pulmonary structures. Understanding how to perform palpation of the lower areas is a fundamental tool in the clinic and potential therapy in osteopathic manual medicine.
Highlights
BackgroundThe visceral component of osteopathic manual medicine (OMM) has received scientific interest from the second half of the last century [1,2,3]
Assessing the ability of different tissues to move under the hand is essential for understanding how and with which technique to increase the fascial space using an OMM approach [8]
The present article reviews the anatomical and neurological knowledge of the respiratory system, from the trachea to the lungs and their topographical anatomy, with the aim of defining a palpation OMM approach that is in line with the current literature and fills the gap in osteopathy literature
Summary
The visceral component of osteopathic manual medicine (OMM) has received scientific interest from the second half of the last century [1,2,3]. A difference in pressure has been linked to the pleural fluids, whereby the left lung shows slightly more negative values than the right; a spike in vertebral pressure values has been reported at T7-T9 [44] These pressures affect the position and movement of the thoracic spine (erection and rotation) [44]. The passage of the airflow and its pressure will determine the shape and function of the respiratory tree, as the mechanical stimulus perceived by cells that make up the respiratory tract (trachea-bronchi-lungs) will reflect the morphology and speed of the air itself [49,50]. For palpation of the right lung movement, the clinician should be on the patient’s left side (or on the same side for convenience), with the cranial hand placed vertically on the right anterior rib area, without exceeding the fourth rib. The patient can be placed in the lateral decubitus position for the same palpatory listening
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