Abstract
The purpose of this paper is to highlight one of the numerous ways to clear recurring fixations and provide the reader with a new tool to use in clinical practice when faced with recurring fixations. Fixations in Applied Kinesiology (AK) refer to at least two vertebrae stuck in place, in contrast to the traditional chiropractic verbiage, that uses “fixation” interchangeably with “subluxation”, which refers to a vertebra that has lost its proper position in relations to the vertebrae above or below. The author used traditional AK and Manual Muscle Testing (MMT) to diagnose the patient with several Fixations and the malposition of the stomach organ. Visceral Manipulation (VM) was used as treatment to correct the malposition of the stomach and, to my surprise, also resolved the associated fixations.
KeyIndexingTerms
Applied Kinesiology, Fixation, Subluxation, Manual Muscle Testing, Visceral Manipulation, Therapy Localization, Primary Indicator Muscle, Limbic Fixation, Chiropractic Manipulative Technique, Gastric Ptosis, Neurolymphatic Reflex, Neurovascular Reflex, Injury Recall Technique
Introduction
Vertebral fixations are a prevalent matter in all practices of Applied Kinesiologist. This product of dural torquing can interfere with anything in the patient’s life, from their sleep to their gait. Fixations are diagnosed in Applied Kinesiology (AK) with corresponding bilateral muscle weakness, that only strengthens with therapy localization (TL) over their related area of the vertebral column or when a primary indicator muscle (PIM) weakens to TL with induced motion of the targeted.
The Fixation levels and their bilateral muscle weakness patterns are as follows:
1. Occipital fixation – bilateral psoas muscles
2. Upper cervical fixation – bilateral gluteus maximus muscles
3. Lower cervical fixation – bilateral popliteus muscles
4. Cervicodorsal fixation – bilateral deltoid muscles (occasionally bilateral serratus anticus muscles)
5. Thoracic fixations – bilateral teres major muscles
6. Dorsolumbar fixation – bilateral lower trapezius muscle
7. Lumbar – neck extensors test weak when tested together bilaterally
8. Sacral fixation – neck extensors test weak when tested individually or as a group
9. Sacroiliac fixation – neck extensors test weak on one side only
Fixations can also mask other fixations and won’t show themselves until one is corrected. This can occur when there are two fixation patterns present but one bilateral muscle imbalance covers the other in an agonist-antagonist relationship. If one group is exceptionally weak, the other overcompensates by strengthening, and will remain strong until the first fixation is corrected, then they will reveal themselves. One specific fixation that could mask all others is the limbic fixation. The limbic fixation is characterized as a fixation between the 7th cervical vertebrae and the 1st rib and can be looked at as the structural component to the left brain, right brain sequence. The limbic system is the “emotional” part of the brain and is the seat of anxiety and tension. The limbic fixation is named accordingly as there could be an emotional component to it. This could potentially be a look at the emotional side of the triad of health (thoughts, traumas, toxins), and should be investigated more. There is no muscle correlation as previously listed above, but the frequency of bilateral weakness from most common to least is peroneus tertius, peroneus longus and brevis, tibialis anterior, and tibialis posterior. This, like all other fixations, is corrected with chiropractic manipulative technique (CMT) of your choosing.
Visceral Manipulation is a gentle manual therapy, founded by Jean-Pierre Barral, which aims to improve both the mobility and function of internal organs by releasing adhesions in the articulating connective tissues, and can lead to profound effects on the neuromusculoskeletal system. According to Barral, “The purpose of Visceral Manipulation is to recreate, harmonize and increase proprioceptive communication in the body to enhance its internal mechanism for better health.”. It has been observed that perturbations in specific organs can cause associated musculoskeletal restrictions, which would excite any chiropractor. During a seminar on Visceral Manipulation, it was highlighted that the stomach can be associated with restrictions between the seventh cervical vertebra (C7) and the first rib, consistent with the characteristics of the limbic fixation.
The stomach serves as a large grinding pouch, primarily responsible for both chemical and mechanical digestion, and shares several important visceral and fascial connections with surrounding structures. Some direct ligamentous articulations are the gastrophrenic ligament, an extension of the coronary ligament, connects the fundus of the stomach to the diaphragm. The lesser omentum, composed of the hepatogastric and hepatoduodenal ligaments, connects the lesser curvature of the stomach to the liver and duodenum, and also encloses important structures such as the common bile duct, hepatic artery, and portal vein. The greater omentum connects the greater curvature of stomach to the transverse colon, while the gastrosplenic ligament, an extension to the greater omentum, connects the stomach to spleen.
The stomach also has many anatomical relationships, although there are no direct ligamentous connections. Posteriorly, the stomach articulates with the omental bursa, pancreas, left kidney, left adrenal gland and the duodenojejunal flexure. Laterally, the stomach relates to the spleen and left colic flexure. Indirectly, due to the ligamentous connection to the diaphragm, there is a relationship between the stomach and the pericardium, heart, left pleura and left lung. In rare cases of stomach ptosis, there may be a relationship with the loops of the jejunoileum and the pelvic organs.
Due to its numerous direct and indirect connections, the stomach can become restricted in several planes of motion. This case study explores restrictions in transverse motion, vertical motion, a combination of the previous two, adhesions with the liver and lesser omentum, and inferior restrictions or gastric ptosis. Each identified restriction informed a specific manual therapy, developed by Jean Pierre-Barrall, to address the corresponding dysfunction. To address the stomach’s transverse motion restriction, the patient was positioned in a seated and forward flexed posture, with the practitioner standing behind with the right hand on the lesser curvature and the left on the greater curvature of the stomach. The treatment is a gentle glide in the transverse plane until all adhesions are removed, and a release is felt. For Vertical motion restrictions, the patient remained seated, with the practitioner standing behind them with their left thumb on the body of the stomach and right hand under the elbows of the patient to apply a long lever traction. Treatment is for the left thumb to anchor the stomach as the right hand extends trunk slightly until tension is felt, hold until you perceive a release. For combined transverse and vertical motion restrictions, the patient is supine with the doctor standing to their right side with their right thumb on the lesser curvature and right finger-pads on the greater curvature, while the left hand is over the fifth to sixth ribs at the mid-clavicular line to push the stomach off the pancreas and slack the gastrophrenic ligament. Treatment is for the left hand to compress the ribs as the right thumb glides the stomach inferior and lateral, while the right finger pads glide the stomach superior and medial to make a J-hook motion. This is repeated 3-7 times, until the stomach moves freely. To release restrictions with the liver and lesser omentum, the patient is sitting and forward flexed, with the doctor standing behind them with their right hand under the left lobe of the liver and the left thumb on the body stomach, lateral to the lesser curvature. Treatment is to move your hands apart, following the direction the two organs take encouraging the tissues further until a softening at the barrier is felt. For inferior restrictions, the patient is sitting with the doctor standing behind with both hands subcostal on the superior aspect of the body of the stomach near the greater curvature. Treatment is to gather the stomach superior and lateral toward the left shoulder with added extension and slight left rotation until a release is felt. For a more comprehensive explanation of the techniques applied, readers are referred to Visceral Manipulation Volumes I and II by Jean-Pierre Barral, which provide detailed descriptions of diagnostic and therapeutic approaches.
Visceral problems can be diagnosed in applied kinesiology on the bases of MMT. Goodheart observed that every muscle relates to different organs in the body. This observation was based on how certain reflex points such and Neurolymphatic (Chapman’s reflex) and Neurovascular (Bennett’s reflex) Reflexes could strengthen certain muscle groups. Such treatment to the Small Intestine points could strengthen a previously weak quadriceps, treatment to the colon points could strengthen the tensor fascia lata, and treatment to the stomach points could strengthen the pectoralis major clavicular division. There was also a research paper presented as part of the requirement for graduation from the England European College of Chiropractic, by Drs. Mendell, Hoffman, and Carpenter, where they described an experiment using a non-operator strain gauge measurement of muscles before and after contact with a variety of substances. For example, the subject ingested a liter of ice water and shortly after the pectoralis major clavicular was significantly weakened compared to other muscles in the body. They did similar tests on many other organ systems introducing a noxious stimulus and noting a weakening of a specific muscle. If there is weak pectoralis major clavicular division there won’t always be a stomach problem, but if there is a stomach problem there will always be a weak pectoralis major clavicular division. We can confirm that the weak pectoralis major clavicular division is coming from the stomach if therapy localization over the organ itself or even a reflex related to the organ strengthens the muscle. In this case, I used the rectus femoris muscle as a PIM (but any normo-tonic muscle of the lower extremity would work), and had the patient do an interlinked finger therapy localization, which provides a “high-gain” therapy localization and adds a possible “mass action effect” since the right hand-left brain and left hand-right brain sequential pathways are effectively doubled. This is very effective in diagnosing the need for visceral manipulation. Going off the positive TL, that weakened the PIM, we can determine the correct vector for visceral manipulation by having the patient use their interlinked fingers to move the organ around until the indicator is PIM is strong.
Discussion
A 24 year old male presented to clinic on several occasions for spinal wellness. Over the course of care, I found myself finding and treating several fixations including the limbic, occipital, upper cervical, lower cervical, thoracic, and thoracolumbar fixations. Knowing the limbic fixation could potentially bring about other fixations throughout the spine, I tried many applied Kinesiology techniques to make the adjustment hold, including muscle balancing, Injury Recall Technique (IRT), Pitch Roll Yaw Tilt (PRYT), and Filum Terminale Cephalad Lift. These would all clear the fixation during the appointment but to my dismay would return the next visit. I learned about the structural correlations between the stomach and the seventh cervical vertebrae and the first rib at a seminar for Visceral Manipulation held by the Barrel Institute. On the next visit, I used AK techniques to find and diagnose different fixations and stomach malposition, including limbic fixation by using TL with induced motion, lower cervical fixation by bilateral weak popliteus muscles that strengthen to TL to the lower neck, thoracolumbar fixation by bilateral weak lower trapezius muscles that strengthen to TL to the thoracolumbar junction, and stomach malposition by a weak pectoralis major clavicular division that strengthen to TL to the stomach organ. Before treating the fixations, I had the patient use the interlinked finger TL and that caused weakening of a PIM, the rectus femoris. We then challenged the vector and found the stomach was restricted in the transverse, vertical, and inferior motions, along with adhesions between the liver and lesser omentum, and inferior. Corrections for these restrictions were made with the techniques listed above. After corrections were made, the interlinked finger TL over the stomach was negative, the limbic fixation TL with induced motion was negative, the bilateral popliteus and lower trapezius were now strong, which indicated there wasn’t, respectfully, a lower cervical or thoracolumbar fixation anymore, and the pectoralis major clavicular division was also now strong. I had the patient follow up the next day, to which he reported that he “slept good” indicating some symptoms from the fixations were gone and the AK test were still all negative, and stay that way for the duration of our care. So far, I followed this up on four other patients, and visceral manipulation of the stomach also cleared the limbic fixation when present.
Conclusion
In conclusion, there is a noticeable relationship between restrictions in the stomach and fixations in spine, specifically in the cervicothoracic junction between the seventh cervical vertebrae and the first rib. This was clearly displayed using Applied Kinesiology and Manual Muscle Testing and is also repeatable on patients. I encourage Chiropractors and other manipulative practitioners to explore this on their own, as well as the possible emotional correlation between the “seat of tension” limbic system and the stomach which has an emotional connection with their neurovascular reflexes being the same as the emotional neurovascular reflexes.
.
References
1. Walther DS. Applied kinesiology: Synopsis. Pueblo, Colo: Systems DC; 2000.
2. Goodheart GJ. You’ll be better: The story of applied kinesiology. Geneva, OH: AK Printing;
3. 1. Barral JP. Visceral manipulation. II. Seattle: Eastland Press; 2007.