The Five Diaphragms in Osteopathic Manipulative Medicine: Neurological Relationships, Part 1

Abstract

In osteopathic manual medicine (OMM), there are several approaches for patient assessment and treatment. One of these is the five diaphragm model (tentorium cerebelli, tongue, thoracic outlet, diaphragm, and pelvic floor), whose foundations are part of another historical model: respiratory-circulatory. The myofascial continuity, anterior and posterior, supports the notion the human body cannot be divided into segments but is a continuum of matter, fluids, and emotions. In this first part, the neurological relationships of the tentorium cerebelli and the lingual muscle complex will be highlighted, underlining the complex interactions and anastomoses, through the most current scientific data and an accurate review of the topic. In the second part, I will describe the neurological relationships of the thoracic outlet, the respiratory diaphragm and the pelvic floor, with clinical reflections. In literature, to my knowledge, it is the first time that the different neurological relationships of these anatomical segments have been discussed, highlighting the constant neurological continuity of the five diaphragms.

The Most Common Functional Disorders and Factors Affecting Female Pelvic Floor

“…Thus, appropriate cooperation of diaphragms ensures proper nourishment and cleansing of tissues by blood and lymph. The functional problems should be approached holistically, and not by looking for dysfunction in a single area, as the body, fascia, and systems constitute an integral continuum [25].…”

“…Through their functional connections and in synergy with other muscles and fascia, PFM aid in maintaining an upright body position, ensure balance, and participate in activities such as walking and breathing [1,21]. The functioning of PF depends on many factors, including correct myofascial tone of the entire chain system and proper functioning of the internal organs, and thus appropriate hormonal balance [21,24,25]. Figure 5 illustrates the connections of PF with other regions.…”

“…optimal intra-abdominal pressure [8,15,22]. Any disturbance in the synchronicity of the diaphragm and PF will result in pressure changes and subsequently dysfunction of other areas (e.g., disturbances in peritoneal drainage or postural stability) [21,25]. (II) The figure depicts the role of PF in stabilizing the body posture.…”

A Missing Voice: The Lingual Complex and Osteopathic Manual Medicine in the Context of Five Osteopathic Models

“…To give an example, the posterior and lateral movements of the lingual body activate the anterior cingulate cortex, which is activated for the management of pain information, the emotional and cognitive sphere, as well as to process visceral and sensitive sensations [16]. Through connections with the pharyngeal plexus and the ansa cervicalis, the innervation of the tongue is related to the peripheral neurological area of the occipitocervical tract [57,58]. The tongue is richly structured with mechanoreceptors and proprioceptors (corpuscles similar to those of Meissner, and corpuscles of Krause) to discern the mechanical sensations in the presence of solid structures (bolus, saliva, teeth) and movements of the lingual musculature, with sensitivity equal to that of touch [59].…”

“…The tongue is an integral part of the body system; its functional alteration can be expressed with weakness of the trunk muscles and cause back pain [96]. This event can probably be linked to the myofascial and neurological relationships that affect the lingual complex and the rest of the body [16,57,97]. The pelvic floor muscle contractions involve not only the neurological areas connected to these districts but also involves the brain areas corresponding to the activation of the tongue muscles, such as the M1 area, without overlapping.…”