1. OMT for GI Concerns UPPER MIDWEST OSTEOPATHIC HEALTH CONFERENCE
May 2, 2014
Kate Heineman, DO and Shannon Crout DO

2. Treatments Doming the diaphragm Mesenteric Lift Linea alba release
Colon induction
Cisterna chyli pump

3. Indications Post surgical Ileus SBO Abdominal adhesions s/p “-itis”
IBS
Constipation/diarrhea
GERD
Abdominal pain
Anxiety
Hiatal hernia

4. Contraindications
Local infection
Local thrombus
Metastatic disease

5. Initial evaluation OA AA T spine Gut rotation
Iliac and dorsalis pedis pulses

6. Doming the diaphragm Patient seated, erect and not slumped
Physician behind the patient
Pass hands around thoracic cage (under patient’s arms) and gently but firmly introduce fingers underneath costal margin
Test for motion by passively rotating thorax to L and R
With fingers on the diaphragm, carry the thorax in the direction of disease. Hold. Follow as it goes through fascial release and continue until it finally settles down into free, gentle, rhythmic, vertical motion
Retest ROM

7. Mesenteric Release
Patient supine with knees bent (can also be done lateral recumbent)
Physician stands on opposite side of area being treated
Use ulnar edges of fingers or fingerpads to contact mesentery to be treated (cecum, ascending, descending, sigmoid colon)
Gently move intestines with scoop-like motion at right angles to mesenteric attachment until restriction of motion is felt
Patient takes partial breath in and holds, during exhale physician takes up slack and moves to next barrier
After removing restrictions, allow colon to recede and move to the next segment
This addresses mesenteric plexuses and mobility of colon;

8. Linea Alba Release Patient supine
Physician spreads fingerpads along midline between xiphoid and umbilicus
Sink posteriorly, applying equal pressure from each finger
Pressure of contact is gradually increased to match the tension of the soft tissue under fingerpads
Patient takes long, slow, deep breaths; as tissues relax, find the balance of tension again (keep in mind patient’s comfort level)
Technique complete when no resistance is felt in soft tissues under the fingerpads
This largely addresses the mesenteric plexuses-especially the celiac, superior and inferior mesenteric ganglia

9. Linea Alba Release

10. Colon Induction

11. Colon Induction Patient supine
Physician L hand on ascending colon and R hand on descending colon
During expir, both hands simultaneously move clockwise
Reverse the direction of hand motion during inspir
Follow and encourage each part of the cycle until the direction with the most restriction releases
Give definitions of expir, inspir

12. Cisterna Chyli
Anterior to L1 body

13. Cisterna Chyli Pump Patient supine Physician stand dominant eye side
Place non dominant hand just below diaphragm midline-this is sensing hand
Place other hand on top and add vibratory force, choose rhythym that seems to push through the barriers
Continue until desired smoothness in lymphatic system

14. Recheck
Iliac and dorsalis pedis arteries

15. Resources
Barral JP, Mercier P. Visceral Manipulation. Seattle, WA: Eastland Press, Inc.; 2005.
Hruby RJ. The Abdominal Region. Ward, RC, ed. Foundations for Osteopathic Medicine. 2nd ed. Philadelphia, PA: Lippincott Williams and Wilkins;
Wallac, E. et al.. Lymphatic System: Lymphatic Manipulative Techniques. Ward, RC, ed. Foundations for Osteopathic Medicine. 2nd ed. Philadelphia, PA: Lippincott Williams and Wilkins;