Abstract
Working on the diaphragm muscle and the connected diaphragms is part of the respiratory-circulatory osteopathic model. The breath allows the free movement of body fluids and according to the concept of this model, the patient's health is preserved thanks to the cleaning of the tissues by means of the movement of the fluids (blood, lymph). The respiratory muscle has several systemic connections and multiple functions. The founder of osteopathic medicine emphasized the importance of the thoracic diaphragm and body health. The five diaphragms (tentorium cerebelli, tongue, thoracic outlet, thoracic diaphragm and pelvic floor) represent an important tool for the osteopath to evaluate and find a treatment strategy with the ultimate goal of patient well-being. The two articles highlight the most up-to-date scientific information on the myofascial continuum for the first time. Knowledge of myofascial connections is the basis for understanding the importance of the five diaphragms in osteopathic medicine. In this first part, the article reviews the systemic myofascial posterolateral relationships of the respiratory diaphragm; in the second I will deal with the myofascial anterolateral myofascial connections.
Highlights
BackgroundOsteopathic manual medicine (OMM) was founded by Dr AT Still in the late nineteenth century in America [1]
In 2012 the five models were recognized by the osteopathic international alliance (OIA) [1]
The thoracic outlet or upper thoracic diaphragm is in myofascial continuity with the tentorium and the lingual complex through some structures, such as the trapezius muscle and all the deep muscles of the cervical tract; the superficial and deep muscles of the posterior column fall within the system of the thoracolumbar fascia [25]
Summary
Osteopathic manual medicine (OMM) was founded by Dr AT Still in the late nineteenth century in America [1]. The thoracic outlet or upper thoracic diaphragm is in myofascial continuity with the tentorium and the lingual complex through some structures, such as the trapezius muscle and all the deep muscles of the cervical tract; the superficial and deep muscles of the posterior column fall within the system of the thoracolumbar fascia [25]. The parietal pericardium touches the posterior endothoracic fascia of the sternal body and some ribs (fourth to the sixth in the left area), the endothoracic fascia that covers the diaphragm muscle or the phrenopericardial ligament; it continues posteriorly to merge with the endothoracic fascia at the level of D10-D11, enveloping the aorta and esophagus [41]. The thoracolumbar fascia that communicates with the muscular portion of the respiratory diaphragm posteriorly, continues, involving the lumbosacral and posterior pelvic muscle area (biceps femoris, piriformis, gluteus maximus, multifidus, longissimus thoracis, iliocostalis lumborum, erector spinae) [4548]. The posterior-lateral myofascial continuum connects all the mentioned diaphragms, constituting an important tool for osteopathic medicine for the resolution of dysfunction or the maximum clinical help that a patient can obtain [2, 49,50]
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