In Chapter 3 there was discussion of the phenomenon in which organ dysfunction reflects reflexogenically to the soma particularly as areas of segmental facilitation (sensitization) in the spinal region. These are, of course, the viscerosomatic reflexes. Later in this chapter possible variations on causes of viscerosomatic reflex pain will be outlined.

Simons et al (1999) reverse the consideration when they report details of somatovisceral responses, particularly arising from abdominal musculature, influencing internal visceral organs and functions.

They note that injection of the trigger affecting an organ may offer symptomatic relief. This is not meant to suggest that local changes (such as trigger points) in the soma, muscles, etc. are necessarily the cause of such dysfunctions and diseases (see list below), but that there exists a strong possibility, in any given case, that the conditions/disease processes may be aggravated and/or maintained by reflexogenic activity associated with myofascial trigger points:

• projectile vomiting

• anorexia

• nausea

• intestinal colic

• diarrhoea

• urinary bladder and sphincter spasm

• dysmenorrhoea

• pain symptoms mimicking those of appendicitis and cholelithiasis

• symptoms of burning, fullness, bloating, swelling or gas (Gutstein 1944)

• heartburn and other symptoms of hiatal hernia

• chest pain that is not cardiac in origin

• abdominal cramping

• colic in infants as well as adults.

Junctional tissues

Simons et al (1999) have discussed the sites of trigger points as falling largely into two categories:

1. close to attachments

2. close to motor end-points near the bellies of muscles.

These guidelines also apply when treating abdominopelvic, and related areas, where, in addition, the author’s clinical experience suggests that particular attention should be given to specific junctional tissues, such as:

• The central tendon

• Lateral aspect of the rectal muscle sheaths

• Attachments of the recti muscles and external oblique muscles to the ribs

• The xiphisternal ligament, as well as the lower attachments of the internal and external oblique muscles

• Intercostal areas from 5th to 12th ribs are equally important

• Scars from previous operations may be the site of formation of connective tissue trigger points (Simons et al 1999). After sufficient healing has taken place, these incision sites can be examined by gently pinching, compressing and rolling the scar tissue between the thumb and finger to examine for evidence of trigger points, as discussed in earlier chapters (Chaitow & DeLany 2000).

Assisting organ dysfunction

Specific general areas are worthy of consideration in treating conditions that affect particular organs or functions, based on the evidence of the different reflex systems described in Chapter 4 (see also notes on percussive methods, such as spondylotherapy, in Chapter 8) (Baldry 1993, Chaitow & DeLany 2000, Fitzgerald et al 2009, Kuchera & Kuchera 1994, Wallace et al 1997):

• Liver dysfunction and portal circulatory dysfunction calls for special attention to the right-side intercostal musculature, from the 5th to the 12th ribs. Especially important are the various muscular insertions into all these ribs.

• Gall bladder dysfunction involves similar areas, with extra attention to the area on the costal margin, roughly midway between the xiphisternal notch and the lateral rib margins.

• Spleen function may be stimulated by attention to the intercostal spaces between the 7th and 12th ribs on the left side.

• Digestive disorders in general may benefit from NMT applied to the central tendon, between the recti, and directly to the rectal sheaths.

• Stomach pain is treated via its reflex area to the left of the xiphisternal notch and to the tendon and rectal sheaths.

• Colonic problems and ovarian dysfunction may benefit from reflex NMT application to both iliac fossae as well as to the midline structures.

• Dysfunction of the kidneys, ureters and bladder requires attention to the inguinal borders of the internal and external oblique insertions, the suprapubic insertions of the recti, the overlying muscles and sheaths of the area, and the internal aspects of the upper thigh.

• In pelvic congestion relating to gynaecological dysfunction, NMT should be applied to the hypogastrium and both iliac fossae. This appears to relieve congestion and stimulates pelvic circulation.

• Ileitis and other functional disturbances of the transverse colon and small intestine may benefit from NMT applied to the umbilical area.

• Prostatic dysfunction may benefit from NMT to the central hypogastric region. Internal drainage massage of the prostate should also be considered.

The above brief indications should be considered in conjunction with other reflex systems and points (see below), as well as attention to the appropriate spinal areas (see notes on facilitation in Ch. 3), which may also benefit from NMT.

More on abdominal reflex areas

Gutstein (1944) noted ‘trigger areas’ in the sternal, parasternal and epigastric regions, and in the upper portions of the recti muscles, all relating to varying degrees of retroperistalsis. He also noted that colonic dysfunction related to triggers in the mid and lower recti muscles. These were all predominantly left-sided.

Other symptoms that improved or disappeared with the obliteration of these triggers include excessive appetite, poor appetite, flatulence, nervous vomiting, nervous diarrhoea, etc.

The triggers were always ‘tender spots’, easily found by palpation, and situated mainly in the upper, mid and lower portions of the recti muscles, over the lower portion of the sternum and the epigastrium, including the xyphoid process and the parasternal region. The parasternal region corresponds to the attachments of the rectus muscles into the 5th, 6th and 7th ribs.

Fielder & Pyott (1955) described a number of reflexes occurring on the large bowel itself. These could be localized by deep palpation and treated by specific release techniques (see Chapter 8, and Figure 8.21). These reflexes palpate as areas of tenderness, and may include a degree of swelling and congestion resulting from adhesions, spasticity, diverticuli, chemical or bacterial irritation, etc.

In considering the reflexes available for therapeutic intervention, in the thoracic and abdominal regions, the neurolymphatic points of Chapman are worthy of close attention (see Chapter 4 for more detail). When applying NMT in its evaluative mode, to the anterior thorax and abdomen (as described later in this chapter), an awareness of the reflexes described by Chapman (Owen 1980) is a distinct advantage, especially if there is a need to take account of visceral or thoracic organ dysfunction.

Kuchera (1997) notes:

Palpate for tender anterior Chapman’s [neurolymphatic] points as an indication to specific visceral irritation … Abdominal viscera, because of their innervations, have their first Chapman’s [neurolymphatic] points at the level of the fifth intercostal spaces. If an anterior Chapman’s [neurolymphatic] point is tender, ask the patient questions relating to dysfunction of the organ most likely to produce the tender point.

Anterior neurolymphatic reflexes for the upper lungs are found between the 3rd and 4th ribs, and between the 4th and 5th ribs (lower lung), close to the costal cartilage and the sternum.

See Figure 7.1 for the location of common abdominally related reflexes noted in this region (and also Figs 5.8A,B).

Figure 7.1 Common neurolymphatic points.

From Ward (1997), with permission.

Discussion

To what extent Gutstein’s myodysneuric points are interchangeable with Chapman’s, or Fielder’s, reflexes, or other systems of reflex study (e.g. acupuncture or tsubo points or Travell’s trigger points), and to what extent these involve Mackenzie’s work (Mackenzie 1909) as illustrated in Figure 5.4, is a matter for further research.

What is certain is that, within the soft tissues of this region, there abound palpable, sensitive, discrete areas of dysfunction that, on a local basis, interfere with or modify functional integrity to a greater or lesser degree, and reflexively are capable of massive interference with normal physiological function on a neural, circulatory and lymphatic level, to the extent of producing or mimicking serious pathological conditions. As these areas of dysfunction often yield to the simple, soft tissue manipulative techniques that are incorporated into Lief’s NMT, the value of these techniques becomes apparent.

Many of Jones’ (positional release/strain/counterstrain) tender points (see Figure 4.5A) are located in the abdominal region, specifically relating to those strains that occur in a flexed position (Jones 1981).

Bennett’s neurovascular points (see Chapter 4 and Figure 5.9A) are located mainly on the anterior aspect of the body, and may be located during abdominal NMT work. This may be a link with the work of Mackenzie and others, who have demonstrated a clear relationship between the abdominal wall and the viscera. This and other reflex patterns provide the rationale for NMT application to the abdominal and sternal regions.

These reflex patterns vary in individual cases, but it is clear that the majority of the organs are able to protect themselves by producing contraction, spasm and hyperaesthesia of the overlying, reflexively related, muscle wall – the myotome – which is also often augmented by hyperaesthesia of the overlying skin – the dermatome.

Baldry (1993) details a huge amount of research that validates the link (a somatovisceral reflex) between abdominal trigger points, and symptoms as diverse as anorexia, flatulence, nausea, vomiting, diarrhoea, colic, dysmenorrhoea and dysuria.

Pain of a deep aching nature, or sometimes of a sharp or burning type, is reported as being associated with this range of symptoms, which mimic organ disease or dysfunction (Fitzgerald et al 2009, Melnick 1954, Ranger et al 1971, Travell & Simons 1983).

Baldry (1993) has further summarized the importance of this region as a source of considerable pain and distress involving pelvic, abdominal and gynaecological symptoms. He says:

Pain in the abdomen and pelvis most likely to be helped by acupuncture is that which occurs as a result of activation of trigger points in the muscles, fascia, tendons and ligaments of the anterior and lateral abdominal wall, the lower back, the floor of the pelvis and the upper anterior part of the thigh. Such pain, however, is all too often erroneously assumed to be due to some intra-abdominal lesion, and as a consequence of being inappropriately treated is often allowed to persist for much longer than is necessary.

If we replace the word acupuncture with the term ‘appropriate manual methods’, we can appreciate that a large amount of abdominal and pelvic distress may be remediable via the methods outlined in this book.

What activates these triggers? – similar factors that produce ‘stress’ anywhere else in the musculoskeletal system: postural faults, trauma, environmental stressors such as cold and damp, surgery (another form of trauma) and so on.

Differential diagnosis is obviously important in a region housing so many vital organs, and attention to the overall pattern of symptom presentation is critical.

If in doubt, obtain expert opinion.