No scientific study, or statistic of the global deplacement of the viscere (internal organs) in the abdomen under the influence of diaphragmatic pressure had been available untill 1985 anywhere.
An estimation of this movement by argumentation based on anatomy and physiology had been proposed, and certain observations had been made, but there was no statistical study!... From an epistemological point of view we would like to stress the fact that this study has been carried out with all objective rigour, thus prohibiting us from inducing the results stripped of all preconceived ideas. We have only wanted to show what it is.
We started this work in June, 1985... Everything still had to be done: to define the imagery which allow an optimal approach of the organs, to establish a strict protocol and methodology; throughout the work we had to register the sources of error, to arrange them into series, to analyse and to circumvent them, to carry out and read the results of exminations to look for the collaboration of a statistician capable of understanding our motivations, as well as setting up a programme and interpreting the results... In short, taking all necessary and sufficient precautions, a condition necessary in order to achieve a trustworthy and scientific work.
All together, three years of research, twenty-four hours of video tapes, three thousand negatives.
The study of the bio-dynamics of gastro-intestinal system has been achieved by X-Ray examinations.
The study of the bio-dynamics of the hepar, of the pancreas, of the reni and the lien has been achieved by using echography.
All the values mentionned refer to a shift from exhalation towards inhalation, the patient standing upright, which presents the avantage of reproducing the conditions of everyday life.
Radiographic and echographic examinations are recorded on video tape.
This video tape is viewed on the screen of the echograph whose camera allows us to capture the pictures (one in inhalation, the other in exhalation).
These pictures are computerized: the computer memorizes the horizontal and vertical shiftings and the variation of the inclination axis in each space plan.
We made error tests submitted to the statistic analysis and set up a protocol of examination taking all precautions in order to cancel the listed sources of error. First of all, we observed oscillations of the patient, involontary shifts of the probe and so on... Recapitulative tables with values calculated in the different error tests had served as a margin of error for the statistical study.
After that, we analysed the dynamics of the same organ during a series of ten respiratory movements. At this stage of the study, the statistic results had enabled us to consider that the movement is repetitive in time and presents the same variations of horizontal, vertical and of inclination shift.
The files put into memory enabled us to achieve a statistical analysis including: averages, variation types, correlations, histograms.
The osteopathic concept maintains, in particular that the bio-dynamics viscero-diaphragmatic is organized in a precise system where anarchy does not belong, where the visceres are shifted under the diaphragmatic pressure according to constant axes and directions and furthermore, the homeostasis of these organs (and of the other systems in general according to the concept of inter-dependency and inter-relation) depends on the diaphragmatic-visceral fonctioning.
The reader can evaluates the CONCLUSIONS of this work, where it appears that in all events a constituted and repetitive dynamics does exist on visceral level.
A. DISTURBANCE OF DYNAMICS AND FUNCTIONAL ORGANIC DISORDERS
As a corollary to the conclusions, we hypothesized that any disruption of the dynamics could lead to functional disturbances and then, in the longer term, to lesions.
Trying to corroborate this idea, a new study was recently carried out.
The visceral mobility of a check sample is compared to patients suffering of definite visceral troubles : gastralgia, gastric burning, gastroesophageal reflux, hiatus hernia, diarrhoea and constipation. To do so, we used the tests of "Student" and "Fischer-Snedecor".
We were able to conclude that a definite organic dysfunction seems to be in correlation with the perturbed dynamics of a definite level.
In gastralgia, even without associated radiological signs, the dynamics of the duodenum are reduced or even reversed in the case of burning.
In the case of diarrhoea, the dynamics are markedly increased in the right colon (except the cecum) as well as in the splenic angle and descending colon. This was a surprise, but it reinforces our desire to speak of "disturbance of the dynamics" and not only of "decrease of the dynamics" as one could have imagined before any study."
In the case of functional constipation, the hepatic angle greatly reduced his mobility. The same is true for the left transverse colon, the iliac colon and the rectum, which have, moreover, reversed the direction of variation of their axis of inclination. There appears to be distortion.
We note that the disturbed levels correspond to the physiological controls of the viscera disturbed in its function. On a practical level, these conclusions do not provide a recipe, as one must always try to determine the possible causes of the changes in dynamics. There may be many reasons: disturbances in the diaphragmatic mechanics, post-operative sequelae, disturbances in the mobility of the pelvis, etc.
B. PRESSIVE MODEL ©
For a long time, osteopaths have thought that the local dysfunctions of the visceral dynamics engender, in a more or less long term, dysfunctions "of nearness". The anatomical links bring, maybe, a part of answer, but the supply of the pressure, generated by the diaphragm, from an internal organ to the other might complete the diagram.
To try to define a possible pressing model, we have looked for the coefficients of correlation of all the dynamic parameters between themselves (vertical and horizontal movements, variation of the angle of inclination) for all the segments of the gastro-intestinal tract and both diaphragmatic coupola during the respiratory act.
At the moment, this study, always current, was only realized on the frontal plane.
We select an element, for example the right diaphragmatic coupola. Its three parameters are compared with each other, then each of them is compared with the parameters of the left diaphragmatic coupola and with all the segments of the digestive tract.
We repeat the same operation for the left diaphragmatic coupola, for the gastric fundus and the body of the stomach (gastric fondus), for every segment of the duodenum, for the jejunum, for the ileum and for each segment of the colon.
Some very interesting notions have appeared. Here are the main ones :
1. We observe the perfect correlations between the dynamics of both diaphragmatic coupola.
2. The gastric fundus presents more correlations with the left diaphragmatic coupola than with the right one.
3. COLUMNS OF PRESSURE seem to be outlined.
The left diaphragmatic coupola presents correlations with the movements of the stomach, of the left transverse colon and of the left colic flexure. Rather curiously, we notice that there are no correlation between the dynamics of the left diaphragmatic coupola and some segments of the left colon (descending and iliac).On the other hand, gastric fundus presents correlations with the movements of all the segments of the left colon (left transverse colon, left colic flexure, descending and iliac colons).We can find a similar organization on the right, as the body of the stomach presents correlations with the movements of part of the right colon. There is not any correlation with the cecum, but there is a correlation with the ascending colon, the right colic flexure and the right transverse colon. Unfortunately, we do not have enough analysis of the right diaphragmatic coupola to be able to compare it with the colon.
4. More surprising are the «CROSSED CORRELATIONS» :
A. - The right diaphragmatic coupola presents the most significant correlations :
With the vertical movement of the distal duodenum (4th duodenum and duodeno- jejunal angle)
With the variation of the angle inclination of the jejunum
- The left diaphragmatic coupola presents the most significant correlations
With the vertical movement of the proximal duodenum (Bulb, 1st, 2nd and 3rd duodenum)
With the variation of axis of the ileum and the ascending colon
B. The left transverse colon and the left colic flexure as well as the gastric fundus present correlations crossed with the ileum, the cecum and the ascending colon.
C. The right transverse colon and the right colic flexure present correlations crossed with the jejunum, the descending and iliac colons.
D. The body of the stomach presents crossed correlations with the jejunum and the iliac colon.