The body is under the action of different forces at the level of the spinal column. These forces will determine its stability and equilibrium. Specifically, there are two main lines of force:
Therapeutic approaches
There are different approaches through which we can access and treat the body during an osteopathic session.
The following 3 therapeutic approaches could be classified as biomechanical treatment:
1. Gravity lines: Little John.
Postero-Anterior Line:
- Its function is to maintain the tension of the neck, trunk and legs, and to coordinate it with the pressure of the internal body cavities (intrathoracic and intra-abdominal).
- Its path is described from the posterior part of the occipital, passing through T4 and reaching the level of L3, where it bifurcates to the hip joints.
- It is a line that only appears with inspiration, i.e. respiratory, and when the subject is bipedal (standing).
Anterior-Posterior Line:
- It is considered a pivot line and support for the whole body. It gives a mechanical unity to the whole spine.
- Its path is described from the anterior part of the occipital, passing through T4, continues to reach the vertebral bodies T11-T12 and ends at S1 and the coccyx.
- It is a line that always appears and generates a self-extension mechanism, thanks to the spinous-transverse muscles that go from the sacrum to C2.
2. Force polygons
The polygons are generated by combining the AP and PA lines resulting in the three triangles and the three units. The function of the polygons is a joint tension system to maintain the body structure.
Its main feature is to create a constant compensating scale throughout the body.
The three triangles are as follows:
- Superior Triangle: goes from the Occipital to T4. It maintains the pressure conditions and the head support.
- Inferior Triangle: goes from the acetabulum to T4. It maintains the correct abdominal tension.
- Lesser Triangle: goes from the acetabulum to L3.
A variation in the shape of the polygons will alter the position and mechanics of the head, as well as create other dysfunctions in the organism.
3. Pivot model.
It is a work of adjustment of certain vertebral levels with the objective of creating an optimal balance of the body. These pivots are considered points of support that will generate a stability of our entire spine.
The six vertebral pivots are: C2, C5, T4, T9, T9, L3, Iliolumbosacral.
What is the function of each of them?
- C2: is responsible for head position. It allows good balance.
- C5: is a vertebra with greater mobility and pressure, which may be an area of arthritic pathology.
- T4: creates a relationship between the thoracic area and the skull. It is also responsible for the proper functioning of the cervical area. It is a point of great compression due to the passage of both lines of force.
- T9: is the support point of abdominal respiration. It is considered the base of the trunk and is the vertebra that creates the rotation of the pelvic and scapular girdles.
- L3: is the level where the greatest tension is generated. It is considered the center of visceral mobility. And its good mobility is key to maintain a mechanical balance between the spine and pelvis to avoid problems of coxoarthrosis.
- ILIOLUMBOSACRAL: its main integrity depends on the L4-L5-S1 discs. It has a damping function.
This treatment model is mainly focused on athletes.
These last two approaches refer to the tissue, the fluid and the pressure difference between the cavities or diaphragms:
4. Diaphragm Model: Respiratory-Circulatory Model.
DIAFRAGMS are anatomical structures (mainly myofascial) that separate body cavities by regulating pressure changes. Their variability regulates body functionality, which is why they are key players in homeostasis (balance of body fluids).
There are 4 diaphragms that should act in coordination to complement a good pressure balance.
The objective of an osteopathic treatment is to achieve the harmonization of all systems, so it is important to know how to evaluate and treat the diaphragms so that there is a correct interplay of pressures. The four diaphragms are part of the respiratory-circulatory model, where the focus is on improving the circulation of body fluids to improve patient health.
The 4 diaphragms that are part of our organism are:
1. Pelvic Diaphragm
- It is a muscle complex formed by the levator ani muscle, three muscle groups (puborectalis, pubocococcygeus and iliococcygeus muscles) and the ischiococcygeus muscle.
2. Respiratory Diaphragm
- The diaphragm muscle wraps around the terminal portion of the sternum (xiphoid process), the last six ribs, the anterior vertebral bodies of the dorso-lumbar vertebrae (T11-L4), the transverse processes of L1. The vena cava, esophagus and aorta.
3. Thoracic Diaphragm
- This structure contains musculoskeletal components: the sternum, the first two ribs, the clavicle, the scapula, the first two thoracic vertebrae, the trapezius muscle, the subclavian muscle, the pectoralis major and minor muscles, the intercostal and deep musculature of the dorsocervical tract and the scalene muscles
4. Cerebellar tentorium
- This meningeal structure is located in the area of the posterior cranial fossa.
- Its path involves the internal occipital protuberance, the occipital bone, the parietal bone and the temporal bone; within it are the superior petrosal sinuses and the straight sinus for venous outflow and the lymphatic system for lymphatic outflow.
5. Myofascial Model
Fascia is a connective tissue structure. At the anatomical level, it forms thin, fibrous and elastic sheets that envelop, surround and connect all body structures. Therefore, we could define the fascial system as: a three-dimensional continuum of both dense and loose connective tissue that permeates the human body and contains collagen within it.
There are two main types of fasciae:
Superficial Fascia:
- The superficial fascia functions as a “pathway” for the more superficial arteries, veins and nerves.
- When the fascia becomes too tight it can affect the function of these structures.
- It is extensively innervated by proprioceptors, nociceptors and interoceptors and has an important role in proprioceptive control of movement and body schema awareness.
Deep Fascia:
- Deep fascia is a dense, organized connective tissue located deep within the skin and subcutaneous tissue.
- This is also known as muscle fascia and is the layer that covers the muscles, blood vessels, bones and nerves.
Functions of the fasciae:
- At the structural level, it acts as a global protection system and allows the body to adapt to external forces while maintaining physiology and shape.
- The mechanical activity of the individual determines the density of the fascial system, which affects the shape of the fascial system.
- It has a significant influence on the lymphatic system and, therefore, on the drainage of toxins.
- The fascia acts as a “sensory organ”, carrying a multitude of information from all over the body to the brain for processing in the central nervous system.
- It acts as an element of amplification and transmission of the forces generated at muscular level.
