4 IntroductionClearly antibiotics have become the mainstay for reducing morbidity due to pulmonary infections. Supportive care, however, can still play a significant role in recovery. Manipulative treatment is often seen as an alternative to pharmaceuticals, but both are more likely to be effective as complementary treatments.
5 PneumoniaAlthough this disease process may be the result of any of a wide spectrum of pathogens… the primary agent, for community acquired pneumonia (CAP), is still Streptococcus pneumoniae. This chapter mostly addresses the treatment of patients with uncomplicated cases of CAP.
6 Respiratory FunctionThe lungs are usually viewed as organs of O2 exchange, driven by their ability to expand and contract with pressure changes. They also play a large role in the circulatory system, assisting both venous return and lymphatic drainage. Circulatory issues are as important as oxygenation in function and dysfunction of the respiratory system.
7 Osteopathic Correlations in Pneumonia Classical Considerations:Still saw the problem as one of vascular stasis to be solved primarily by rib raising.1Charles Hazzard describes a more general treatment beginning with cervicals and moving on to scalenes, ribs, segments and abdominal release.2McConnell preferred regional treatment with attention to the thoracoabdominal diaphragm.3
8 Osteopathic Correlations in Pneumonia Contemporary Considerations:Kuchera and Kuchera recommend a staged application of OMT to complement conventional medical care aimed at maximizing comfort and the individual’s ability to self-heal.4Rib raising with paraspinal muscle stretching.Segmental treatments and myofascial release of accessory respiratory muscle fascias.Continued rib raising and segmental treatment with addition of lymphatic pump.
9 Treatment: Mechanisms of Action Neuroreflexive:Sympathetic – hypertonicity leads to tachypnea, tachycardia and vasoconstriction. Proximity of sympathetic chain ganglia to rib heads allows for external inhibition of this hypertonicity.Facilitation – segmental dysfunction can lead to viscero-somatic or somato-visceral reflexes.
10 Treatment: Mechanisms of Action Biomechanical:Articular – the costovertebral contacts and intervertebral facet joints must have full mobility for full lung expansion to occur.Myofascial – For optimal respiration distensibility of the horizontal diaphragms; tentorium cerebellae, thoracic inlet, throracoabdominal, pelvic floor and the fascial elements of the accessory muscles of respiration is essential.
11 Treatment: Mechanisms of Action Vascular :Lymphatic – primary lymph drainage from the lower body is to the left subclavian vein, dependent primarily upon respiration pressure gradients.Venous – much venous return relies on activities of daily living, which illness suspends.Interstitial – tissue edema must be cleared through the vascular system. External pressure may assist in this process.
12 DiagnosisSpecific diagnosis of somatic dysfunction is mandatory for effective OMT. Begin with a global assessment of the thoracic region. Assess for rib and spinal segmental restrictions. Assess other regional influences, including the throracoabdominal diaphragm and pelvic floor.
14 Treatment Considerations Rib Raising:can be accomplished in several positions.fingertips are used as a fulcrum.treat all ribs.increased restriction requires increased focus.Rib Articulation:performed seated.combines translation/sidebending and rotation.gentle, rhythmic and repetitive.a good alternative to HVLA treatments.
15 Treatment Considerations Paraspinal Muscle Stretch:performed with the patient in the lateral-recumbent.a simple but effective soft tissue procedure.Lymphatic Pump:pedal pump is excellent for the hospital setting.Thoracic pump is more specific for the lungs.Occipitoatlantal Release:normalizes tensions surrounding the vagus.is a relatively quick technique (one - two minutes).
16 Treatment Considerations Cervical Paraspinal Muscle Release:relaxes accessory muscles of respiration.maximizes phrenic nerve function.excellent for hospital setting.Cervical Articulatory Release:treat dysfunction of the C3-C5 segments to affect the phrenic nerve.performed with patient seated.may add oscillation to enhance the procedure.
17 Treatment Considerations Diaphragmatic Release:generally performed with patient supine.may use direct or indirect approach.performed in all three planes.highly effective.
19 ReferencesStill AT. Research and Practice. Kirksville, MO: Author, Reprinted in Seattle: Eastland Press, 1992;83-89Hazzard C. Pneumonia. In: The Practice of Applied Therapeutics of OsteopathyJordan T, Schuster R, eds. Selected Writings of Carl Philip McConnell, DO. Columbus, OH: Squirrel’s Tail, 1994;90.Kuchera M, Kuchera W. Osteopathic Considerations in Systemic Dysfunction. 2nd ed. Columbus, OH: Greyden, 1994;45.