Total Body Adjustment for Children

with Neurological Conditions

Beyond the Treatment Table

Jorge Aranda

BSc (Hons) Ost Med

MSc Ped Ost

DO (UK)

THE POLYGON

OF FORCES Postural control is centered

in the spinal column.

Cranial, dorsal and sacral

curves are primary

embryonic curves.

Lumbar and cervical curves

are due to physical

development and appear

with the upright posture.

All postural conditions of the

posture center in the activity

of the cervical and lumbar

segments.

During childhood spine development we are looking for the 4

arches to develop which provides the greatest amount of

strength and elasticity with the least amount of shock

transmission.

Vulnerable areas to assess that carry the burden of the arch

to arch formation and developments are:• D4 and corresponding ribs

• D9 ad corresponding ribs

• L3

• Born in the occipital foramen

• Crosses D11-D12 bodies.

• Through the back of the joints L4-L5 and S1

body.

• It ends at the top of the coccyx.

• Determines the drive to spinal mechanics.

Anteroposterior Line

1

• It originates from the anterior margin of

foramen magnum.

• Through the anterior border of the L2-L3.

• Eventually dividing into the acetabulum.

• This line complements the anteroposterior line,

both confluyen through the body of L3.

• It is therefore the center of gravity of the spine.

Line posteroanterior

2

• Born in the posterior third of the cranium

• Passing through the dens

• For the transverse C3, C4, C5 and C6

• Ahead of the D4;

• Across the bodies of L1, L2, L3, L4 and

sacral promontory.

• It is divided in two through the hips,

knees and ends at the talus-navicular

joint.

The line of gravity

3

D4 represents the terminus of downward pressure and

torsion of head movements and the point of greatest strain.

Lesions at D4 will tend to destroy the correlation of the

triangles to each other and is a critical point in terms of

normal postural development or failure.

D9 is a keystone / a stress point and a pivot. Three parts to

play rolled into one. The strength of the arch between D5-

L2 will depend particularly on the inter-articulation above

and below D9. If they fail to articulate properly the arch is

considered weak not strong and you will find the entire arch

between D5-L2 segmentally broken down into a series of

short lateral curves.

L3 is where the centre of gravity line passes through and

this becomes the centre of gravity for the entire spine and

body. It is a point of greatest strain because all the postural

conditions of the body depend on this point either for a base

or for support. It is the weakest point, because weight and

tension antagonise each other here.

The Spinal Column is

divided, for convenience

sake, into six divisions: The

Cervical, Brachial, Dorsal,

Lumbar, Sacral and

Coccygeal.

OSTEOPATHIC CENTRES

OSTEOPATHY bases its claim

to rank as a science of healing

upon the fact that there exists

a definite and fixed relation

between an organ and the

central nervous system.

This relation is secured

through the segmented

arrangement of the spinal

nerves or through the

sympathetic system, by means

of rami communicantes.

OSTEOPATHIC CENTRES

OSTEOPATHIC CENTRES

The order of this innervation is

fairly constant, though, as in

the case with other portions of

the body, it may vary.

This variation in no wise

invalidates the claim of

Osteopathy to rank as a

science, but it emphasizes the

necessity of our searching for

lesions even in regions

relatively remote from the

center.

Specific treatment in the sense of

work exclusively upon a region

said to be a center is rarely

indicated.

Owing to the diffusion of pain and

its attendant conditions, it is

necessary to remove any

contracture which may be

associated with it.

Again, it sometimes occurs that

disease of an organ produces no

effect on its usual center, and in

such an event it is necessary to

carefully examine other regions

for the trouble.

OSTEOPATHIC CENTRES

OSTEOPATHIC CENTRES

Know the location of the

centers. Know also that

occasionally a lesion causing

the trouble must be found

elsewhere.

"Touching the button" is

fascinating, both in theory and

in practice, but the operator

must be broad enough to

expect it to be difficult

occasionally to locate the

button.

The Cervical division C1-4

C1 is directly concerned with disturbances to the vaso-

motors of the eye and ear, and with diseases of the face.

C2-3 is a general vasomotor center, through the superior

cervical ganglion. It is a center for the side of the head, face,

eye, nose, pharynx, tonsils and vessels of the brain.

The Brachial division C4-D1

C3-5 is the center for hiccoughs, as it is the origin of the

phrenics.

C5-6 is the middle cervical ganglion and is the center for the

thyroid gland. It also augments the heart action.

C7-D1 control the heart, thyroid gland, inferior cervical

ganglion, the vertebral and basilar arteries.

The Dorsal division D1-12

D2-3 is the center for the ciliary

muscle also the center for vomiting

and for the bronchial tubes and

bronchi.

D2-5 are where the fibres

augmenting the heart action.

D2-6 are vaso-constrictors to the

pulmonary blood vessels.

D3-7 are vaso-motors to the arms,

through the brachial plexus.

D4 on the right is location for the

stomach center.

D6-10 is the origin of the great

splanchnic where is the inhibitory,

vasoconstrictor and secretary fibres

are distributed to the stomach & small

intestines.

D8-10 on the right is the center for the

liver.

D9-10 on the left side is the center for

the spleen is at the ninth and tenth

dorsal on the left side. This is also the

center for the uterus, through the

hypogastric plexus.

D11-12 is the center for small

intestine, kidney and ovary control.

The Lumbar division L1-5

L2 contains the center for parturition, micturition and the uterus.

L2-4 is the center for diarrhea.

L4-5 is where the pelvic plexus is formed by the separation of the

hypogastric plexus into two halves on either side of the rectum.

The fibres are distributed to the pelvic organs.

The Sacral division S2-5

The anterior divisions of the sacral nerves are distributed to the

rectum, bladder, sphincter ani, vagina and uterus.

S2-3 center controls the bladder.

S4 controls the vagina.

S4-5 control the sphincter ani.

1900 - Littlejohn College of Osteopathy and Hospital in Chicago

1917 - British School of Osteopathy in London

johnwernhamclassicalosteopathy.com

John Wernham study Osteopathy at the invitation of J.M. Little john in 1928

In 1984 founded the Maidstone College of Osteopathy.

The College was renamed The John Werham College of Classical

Osteopathy in 1996.

He passed away in 2007 at 99 years of age

TOTAL BODY ADJUSTMENT

They key to adjusting the

body is by way of a process

of integration.

The Total Body Adjustment is

the treatment that enables us

to appeal to the lines of force

i.e. The Polygon of Forces.

The application of the

treatment occurs through the

body lines and triangles so

the individual vertebrae and

spinal arches function in

relation to the polygon of

forces.

Asses and treat the pelvis as an

integrated unit:

• Two hips joints

• Coccyx

• Two SI joints

• L5

This is the baseline of the polygon.

In the biomechanics of the

spine is important to

understand the natural

curves that has the spine,

which function to cushion

and distribute the axial

pressure on the disc and

bodies, and determine the

static and balance.

Throughout the developmental

milestone of a child we look far

any segmentation of vertebral

groups or arch to arch

breakdown.

Bearing in mind that a child

aged between 0-7 years is

erecting its centre of gravity line

and the mechanism that provide

balance structurally and

functionally in relation to this

line.

The structural and

functional stability of D4

to the occiput and L3 to

the pelvis depends on

the mechanical form

and function of the

central arch D5-L2.

Asses and treat the

central arch D5-L2 this is

a double arch with a

balance of alternate

tension and compression

forces and the strength of

this region.

Asses and treat the

condition and position

of L3 bearing in mind

that is the centre of

gravity and point of

maximum strain.

From 7-14 years if the

balance mechanism is

not secure and

struggling to develop

and mature,

compensatory

mechanism take over, so

at puberty and beyond

the body begins to

harden with all its lesion

patterns and

irregularities.

Frequency of treatment will

vary from child to child

depending on the acute

nature, chronicity and

severity of the child´s

condition. John Wernham

used to advocate for the

chronic case, approximately

a year of treatment for every

10 years of life.

The lumbar

curvature is

determined by static

lines of force.

Asses all parameters

of the range of

movement of the

spinal column

including the side

bending component

The lateroflexion at the

level of the dorso-lumbar

region can be restricted

due to the obligatory

muscles of respiration

Quadratus Lumborum and

the hip flexors Ilio-psoas

Dysfunction of the 12th

Rib can limit the mobility

of the ilium and interfere

the distribution of forces

from the lower limbs to

the upper extremities

through the

thoracolumbar fascia.

Lower ribs

mechanics express

the respiratory

function of the

diaphragm and the

cavity dynamics of

the corresponding

visceral column.

Viscero spasm can

interfere with upper

pelvis and lumbar

mechanics through

the visceral fascia

attaching to the

posterior abdominal

wall.

Told´s fascia provides

support to the ascending

and descending colon

having a profound

influence in the mobility

of the sigmoid colon and

the range of movement

of the left sacro-iliac

joint.

From a mechanical point

of view L3 is a key

vertebra for the

interconnection between

the abdominal cavity

through the 2nd portion of

the duodenum, the lower

ribs through the diaphragm

and the lower extremities

through the posts

The distribution of

forces from the pelvis

to the spinal column

occurs by the

connective tissue of the

ilio-lumbar ligaments

which connect the

fourth and fifth lumbar

vertebrae with the

ilium.

The superior triangle

converges at the level of

D4 and therefore

addressing the cranial

structures need to be

done before aiming to

restore normal function of

that segment.

Normal rib function

cannot be restored

before adjusting the

normal mechanics

of the dorsal

vertebrae.

Reverse curvature of the

dorsal segments are

usually due to anterior

restrictions from the

internal structures of the

thoracic cavity through

the vertebro-pericardic

ligaments and the central

tendon.

Lateral expansion of

the lower ribs might be

limited due to visceral

congestion of the liver

or the spleen.

Vasocongestion to

these organs must be

address through the

related dorsal

segments.

Liver pump and

lymphatic pumping

techniques are crucial

to maintain propper

physiological levels of

blood and lymph

through the body

structures to achieve

normal levels of pH.

Oscillatory axis of rotation must be remembered when

adjusting lumbar segments once the soft tissues has been

normalized.

1. Campbell C., A Review of Spinal

Mechanics, IPR 1996

2. J. M. Littlejohn., Chart of the Osteopathic

Centres & of the Somatic & Autonomic

Nervous System, The Maidstone College

of Osteopathy

3. J. M. Littlejohn., The Mechanics of the

Spine, Lecture Notes

4. J. Wernham., Mechanics of the Spine,

I.A.O. Year Book 1985

BIBLIOGRAPHY

Total Body Adjustment for Children

with Neurological Conditions

Beyond the Treatment Table

Jorge Aranda

BSc (Hons) Ost Med

MSc Ped Ost

DO (UK)

THANK YOU

FOR YOUR

ATTENTIONjorgeosteo@gmail.com