Title: Bone Wizardry / OMM Mastery / 10.Facilitation
Tags: #BW_OMM::Content::Mechanism #BW_OMM::Type::Cloze BoneWizardry bonewizardry-free omm omt
On every note of this deck, unless a note says otherwise:
Review Links: - Bone Wizardry viscerosomatic reflexes
- Practice: Facilitation QBank
Show outside sources
- StatPearls viscerosomatic reflexes
- StatPearls Chapman points
- OMM brief review

Q: [...]: a pool of spinal neurons maintained near, but below, their firing threshold, requiring less incoming stimulation than normal to discharge.
A: Facilitation
Q: With facilitation, less [...] stimulation is required to stimulate the nerve.
A: afferent
Comment: In this state, less afferent stimulation is required to trigger the discharge of impulses. This may be achieved due to sustained increase in afferent input, or changes within the affected neurons themselves.
Comment 2: There is also a higher resting membrane potential and hyper-excitable neural state.
Topic: Facilitation
Bone Wizardry Lock: Facilitation means the spinal segment is already electrically primed. A small visceral or somatic signal can produce an outsized reflex response.

Q: If facilitation occurs at an individual spinal level it is termed [...] facilitation.
A: segmental
Topic: Facilitation
Bone Wizardry Lock: Facilitation means the spinal segment is already electrically primed. A small visceral or somatic signal can produce an outsized reflex response.

Q: A [...] reflex occurs when a localized visceral segment (ex. gallbladder) reflects pain to a somatic structure (ex. mid thoracic region at the tip of the right scapula).
A: viscero-somatic
Q: A [...] reflex occurs when stimulating an external somatic trigger point provokes pain or dysfunction in a connected visceral structure.
A: somato-visceral
Comment: Acute cholecystitis is the example used here. When the gallbladder becomes inflamed, it sends a pain stimulus that is felt at right scapula.
Comment 2: For example, a triggerpoint located in the right pectoralis major muscle, between the fifth and sixth ribs has been known to cause supraventricular tachyarrhythmias.
Topic: Facilitation
Bone Wizardry Lock: Facilitation means the spinal segment is already electrically primed. A small visceral or somatic signal can produce an outsized reflex response.

Q: What kind of reflex is described?
Continued gallbladder dysfunction transmits an abnormal sensory input to the spinal cord. This results in segmental facilitation of T5-9. This in return amplifies the interneurons in between and causes increased tension in the paraspinal musculature of T5-9 resulting in tenderness.
[...]
A: Viscero-somatic
Comment: The reflex arc runs from the viscera to the dorsal horn to the paraspinal musculature. Sustained visceral input keeps the spinal segment in a state of heightened excitability, which is what produces the somatic tissue changes you find on exam.
Topic: Facilitation
Bone Wizardry Lock: The gallbladder-to-T5-9 pathway is the textbook viscero-somatic example. Trace the path: a chronically dysfunctional organ fires into the dorsal horn, the segment facilitates, and you palpate paraspinal tightness and tenderness at that level.

Q: Sympathetic Spinal cord level:
Adrenal medulla = [...]
A: T10
Q: Sympathetic Spinal cord level:
Upper ureters = [...]
A: T10 -11
Q: Sympathetic Spinal cord level:
Lower ureters = [...]
A: T12 - L1
Q: Sympathetic Spinal cord level:
Bladder = [...]
A: T11-L2
Q: Sympathetic Spinal cord level:
Gonads = [...]
A: T10-11
Q: Sympathetic Spinal cord level:
Uterus and cervix = [...]
A: T10-L2
Q: Sympathetic Spinal cord level:
Prostate = [...]
A: T12 - L2
Q: Sympathetic Spinal cord level:
Arms = [...]
A: T2 - 8
Q: Sympathetic Spinal cord level:
Legs = [...]
A: T11 - L2
Topic: Facilitation
Bone Wizardry Lock: Adrenal medulla anchors at T10. From there, pelvic organs range T11-L2. Arms sit at T2-8 and legs at T11-L2. The ureter splits by level: upper at T10-11, lower at T12-L1.

Q: Parasympathetic innervation:
All viscera above the diaphragm = [...] nerve
A: vagus
Q: Parasympathetic innervation:
Entire small intestine = [...] nerve
A: vagus
Q: Parasympathetic innervation:
Ascending and transverse large intestine = [...] nerve
A: vagus
Q: Parasympathetic innervation:
Lower ureter and bladder = [...]
A: pelvic splanchnic
Q: Parasympathetic innervation:
ovaries and testes = [...] nerve
A: vagus
Comment 5: They descend from a higher region in the posterior abdominal wall.
Topic: Facilitation
Bone Wizardry Lock: The vagus handles all parasympathetics above the splenic flexure, including the gonads because they descended from behind the stomach. The pelvic splanchnic nerves cover everything below.

Q: Ligament of Treitz divides the [...] and [...].
A: duodenum; jejunum
Q: Splenic flexure of the large intestine divides the [...] and [...] colon
A: transverse; descending
Comment: Sympathetic memory tool:
anything before the ligament of Treitz = T5-9
Anything between these two landmarks (ligament of treitz and splenic flexure) is innervated by T10-11.
Comment 2: Anything after the splenic flexure = T12-L2
Topic: Facilitation
Bone Wizardry Lock: The ligament of Treitz and the splenic flexure are your two dividing lines for gut sympathetics. Before Treitz = T5-9. Between the two landmarks = T10-11. After splenic flexure = T12-L2.

Q: Purpose of rib raising:
1. [...] sympathetic activity
2. [...] lymphatic return
3. Encourages [...] inhalation
A: Normalize/decrease; Improve; maximum
Q: Rib raising produces a short-lived increase in sympathetic activity in the [...] sympathetic ganglia.
A: thoracic
Q: Rib raising to [...] will thin mucous secretions thus enhance expectoration.
A: T2-7
Q: Rib raising and paraspinal inhibition reduced the incidence of an [...] in post-surgical patients from 7.6% to 0.3%.
A: ileus
Name some of the most common indications for rib raising:
1. Decreased rib excursion
2. Lymphatic congestion
3. Fever
4. Paraspinal muscle spasm
Q: Name some contraindications for rib raising:
1. [...]
2. [...]
A: Spinal or rib fracture; Recent spinal surgery
Comment 2: This is because the thoracic sympathetic ganglia lie anterior to their corresponding rib. Hypersympathetic activity to mucus membranes of the sinuses and bronchial tree promotes the proliferation of goblet cells and produces thick, sticky, tenacious secretions.
Topic: Facilitation
Bone Wizardry Lock: Rib raising accomplishes three things: normalizes sympathetics, improves lymphatic flow, and promotes inhalation. At T2-7 specifically, it thins bronchial secretions. The ileus prevention stat (7.6% down to 0.3%) is board-testable.

Q: Purpose of soft tissue paraspinal inhibition:
[...]
A: Normalize (decrease) sympathetic activity (ileus prevention)
Comment: Main thing to pull from this is to use it mostly to prevent an ileus in a post surgical patient.
Topic: Facilitation
Bone Wizardry Lock: Paraspinal inhibition decreases thoracolumbar sympathetic activity. In post-op patients, reducing that sympathetic drive lets the bowel start moving again, which is why it pairs with rib raising for ileus prevention.

Q: [...] compression may cause [...] difficulties for the newborn.
A: Condylar; suckling
Q: Condylar decompression will help free parasympathetic responses to structures innervated by cranial nerves [...] and [...] by freeing their passage through the jugular foramen.
A: IX; X
Q: What typically causes condylar compression?
[...]
A: Childbirth
Comment 2: (i.e. occipito-mastoid suture)
Topic: Facilitation
Bone Wizardry Lock: Condylar compression narrows the jugular foramen, impinging CN IX and X. A newborn who cannot latch may have occipital condyle compression from the birth process. Condylar decompression restores normal parasympathetic outflow through those nerves.

Q: Purpose of Sacral inhibition:
1. Normalize [...] activity in the left colon and pelvic structures
2. Reduce [...] pain caused by cervical dilation
A: hyperparasympathetic; labor
Q: Indications for sacral inhibition:
1. [...]
2. [...] pain
3. [...]
A: Dysmenorrhea; Labor; Constipation
Topic: Facilitation
Bone Wizardry Lock: Sacral inhibition calms the pelvic splanchnic nerves. Dysmenorrhea, active labor pain, and constipation all benefit from dialing down pelvic parasympathetic drive at the sacral segments.

Q: Nerve Endings:
The [...] picks up light (fine) touch.
A: Meissner Corpuscle
Q: Nerve Endings:
The [...] picks up vibration.
A: Pacinian Corpuscle
Q: Nerve Endings:
The [...] responds to sustained pressure and texture.
A: Merkel Disc
Q: Nerve Endings:
The [...] responds to stretch.
A: Ruffini End Organ
Topic: Facilitation
Bone Wizardry Lock: Meissner at fingertips for fine touch. Pacinian deep in the skin for vibration. Merkel for sustained pressure (holding a pen). Ruffini for skin stretch. Merkel and Ruffini adapt slowly; Meissner and Pacinian adapt quickly.

Q: Which pain fiber is fast, sharp, well-localized, and thinly myelinated?
[...]
A: A-Delta
Q: Which pain fiber carries slow, dull, poorly-localized pain and is completely unmyelinated?
[...]
A: C-fibers
Topic: Facilitation
Bone Wizardry Lock: First pain is A-delta: fast, sharp, localized, gets you to pull your hand away. Second pain is C-fiber: slow, dull, diffuse, the ache that lingers. Both converge in the dorsal horn.

Q: If you are trying to curl a 100 lb dumbbell and you get stuck halfway up the curl, what allows you to finish this rep?
[...]
A: Gamma motor neuron (gamma gain)
Comment: Gamma motor neurons keep the muscle spindle taut as the muscle shortens, so the spindle stays sensitive and the stretch reflex keeps driving the contraction. It sustains spindle feedback; it does not recruit extra muscle fibers.
Topic: Facilitation
Bone Wizardry Lock: Gamma motor neurons keep the muscle spindle taut while the muscle contracts. Without gamma gain, the spindle slackens as the muscle shortens and loses its ability to sense stretch, cutting off the reflex drive needed to finish the movement.

Q: [...]: when something that should not hurt, does in fact hurt.
A: Allodynia
Q: [...]: pain out of proportion
A: Hyperalgesia
Q: [...]: greater stimulus required to get AP to fire, and once fired, the AP goes to max intensity.
A: Hyperpathia
Comment: Ex. Swabbing a cotton ball on the arm produces pain.
Comment 2: Ex. Slight pinch produces excruciating pain.
Comment 3: Ex. Patella reflex won't work, but with a hard bang, there is a hyperreflexic L4 with severe pain.
Topic: Facilitation
Bone Wizardry Lock: Allodynia: innocuous stimulus hurts. Hyperalgesia: noxious stimulus hurts more than expected. Hyperpathia: high threshold to fire, but once it fires the response is exaggerated. All three reflect central sensitization at the dorsal horn.

Q: What type of reflex is being described:
MI pain is felt at the left chest?
[...]
A: Viscerosomatic
Q: What type of reflex is being described:
gastric distension causes an increase in large intestine motility?
[...]
A: Viscerovisceral
Q: What type of reflex is being described:
pain in hand when touching a fire causes you to withdraw that hand?
[...]
A: Somatosomatic
Q: What type of reflex is being described:
TART findings at T1-T5 causes an asthmatic patient to have worse asthma?
[...]
A: Somatovisceral
Comment: First part tells you what you're dealing with (MI) and second part tells you where you are feeling the pain (left chest).
Comment 2: Gut-to-gut: one visceral organ triggers dysfunction in another. Gastric distension driving large bowel motility is the textbook case.
Comment 3: Two somatic structures in sequence. The hand touches fire, the arm muscles yank it back.
Topic: Facilitation
Bone Wizardry Lock: Facilitation means the spinal segment is already electrically primed. A small visceral or somatic signal can produce an outsized reflex response.