Yudu - sportEX dynamics - 1999-2010

THE ROLE OF THE VISCERA

its medial and lateral borders and to the vertebrae, and intervertebral discs (Fig.1). Superiorly the renal fascia blends with the diaphragmatic fascia (Fig.2). Medially it extends to merge with the connective tis- sue enclosing the aorta and vena cava, psoas minor, renal vessels, ureter, testicu- lar/ ovarium vessels and genitofemoral nerve. The kidney sits directly anterior to quadratus lumborum and psoas major, while its fascia merges with the transver- salis fascia.

The ascending colon The ascending colon is covered by the peri- toneum except where its posterior surface is connected by areolar tissue to the iliac fascia and to the iliolumbar ligament (which forms a hood over the L4 and L5 nerve roots, capable of compressing these roots)(2), quadratus lumborum, transver- salis fascia and the perirenal fascia on the front of the inferolateral area of the right kidney. The lateral femoral cutaneous nerve, usually the fourth lumbar artery and sometimes the ilio-inguinal and iliohy- pogastric nerves, cross behind it. Superiorly it attaches to the diaphragm, via its attachment to the renal fascia (Fig.3).

The pleura The pleura (the covering of the lungs) attaches to the posterior surface of the sternoclavicular joint and the inner margin of the first rib, at which point its contin- uation superior is known as cervical pleu- ra or the pleural dome. It is strengthened by a suprapleural membrane that attaches to the interior border of the first rib and the anterior border of the seventh cervical transverse process (Fig.4).

A fascial expansion from the pre-vertebral lamina of the deep cervical fascia merges with this membrane. By this connection the pleura is related to the deep cervical fascia (which invests the deep cervical flexors); and by its fascial attachment to the first rib, is continuous with the aponeurosis of

the subclavius muscle,

which in turn is continuous with the mid- dle cervical aponeurosis above and clavipectoral fascia below.

Quadratus lumborum muscles

Iliopsoas muscles

Figure 1: Position of quadratus lumborum and iliopsoas muscles

Figure 2: Kidneys and surrounding fascia lying on top of quadratus lumborum and iliopsoas

Parietal pleura

Ascending colon

Figure 3: Position of ascending colon relative and surrounding fascia

SOME INTERESTING NEURO- ANATOMICAL RELATIONSHIPS Stimulation of phrenic nerve and associated structures The phrenic nerve, originating predomi- nantly at C3-5 spinal segments, is a path- way for visceral afferents from the diaphragm, liver, gallbladder, parietal vis- cera, stomach(1,3), and pericardium and pancreas. Therefore any stimulation of these structures could, in theory, lead to an increase in afferent barrage and there- fore to what Korr (4) describes as the “facilitated segment,” in particular cervi- cal segments 3, 4 and 5.

SO WHAT DOES THIS ALL MEAN? I have successfully treated neck pain, back pain, hip pain, thoracic pain, knee pain, shoulder pain and groin pain with-

Figure 4: Parietal pleura surrounding the lungs

out addressing the musculoskeletal struc- tures. So how can that be?

The first thing to clarify when assessing the viscera is that we are assessing the three dimensional matrix of connective tissue in which the viscera sits. We then have to identify if there are any restric- tions within this matrix which are impact- ing on the skeletal structures.

Take the example of a rugby player who sustains a rib fracture from a head-on tackle. Does the force that created the musculoskeletal damage just stop at the skeletal system or would that force be transmitted to the internal structures and the three dimensional matrix of connec- tive tissue that support the viscera?

THE CONNECTIVITY AND The real voyage of discovery

consists not in seeking new lands but in seeing with new eyes Marcel Proust

www.sportex.net 11