Chapman Refelex Network Appendix

A folder of sorts for various writings about the CRN, mostly by me. Lots of these are in an uncompleted state and all subject to revision rare to radical.

I like the presenting of the practice of making the practice available to public withness.

I have to figure out how to make links to documents that can't be imported easily to this web format.

I can only spend limited time in (hyperfocus) edit mode so errors can be found. I gradually work my way through these imported docs and do the editing, starting first with Grammarly's red underlines. Maybe there is something to be learned by someone by seeing the unedited and seeing the process of 'correcting.'

Attention Must Be Paid:

The Role of the Chapman's Reflex System

in Trauma Survival and Recovery

Prologue

“As we hear one piece of bad news after another, you might expect us to feel that we had shifted from a mere ecological crisis into what should instead be called a profound mutation in our relation to the world.”

—Bruno Latour, Facing Gaia

“Illness is the result of a misunderstanding.”

—Dr. Arthur Lincoln Pauls, Founder of Ortho-Bionomy

One could easily argue that the troubled state of life on this planet today is the result of a misunderstanding. We have been working from a profound misunderstanding as to the true nature of the body/person and our relation to the world to other life, to one another.

The Age of enlightenment invented the individual. When we dig down deep into the fabric of the world, to the tiniest micro particles we find, according to quantum physicists, that even these microparticles do not exist as separate entities. The quantum state of each particle cannot be described independently of other particles. The same is true of the mutual relationship of signs and words and it is true of people. Nothing exists but in relation(ship) to other things.

It is relationship that comes first, that makes solidness happen. Philosophers search for and argue about what is real. It may be that the only real ‘thing’ in the universe is this force we call ‘relationship.’ We might also call it love, as Rumi did when he wrote, “All the particles of the world are in love and looking for lovers.”

No ‘thing’ exists but in relation to other ‘things.’ Ours is a world of reflections, we live in a hall of mirrors.

When we feel as if we are perceiving a ‘thing’ we are really only feeling our reaction. I feel a change in my own state but feel as if I am knowing that ‘thing’ that changed my state. Complicating matters more is the fact that the ‘I’ that is sensing/perceiving/feeling is itself but a reflection.

There are what I call ‘first-order things’ and ‘second-order things.’ First-order things are all those things we take to be real objects—potato, dog, rock, water, air—and their actions and interactions—rolling stone, boiling water, rotting potato. Second-order things only exist in our imagination. It may be that humans are the only creatures that create second-order things, certainly the only ones that do this to such an extent. Second-order things are also called ‘concepts.’ Once we create a second-order thing and have some general agreement about it then it becomes real to us, like a rock.

The universe, presumably, has no outside so it can also have no inside. The concepts (second-order things) of inside and outside could only come into existence with the appearance of a cell. The cell maintains a set of values in a discreet portion of the world. Inside the cell is one relatively constant state while outside the cell wall or membrane there may be considerable variation. The cell membrane makes a bubble containing a protected environment.

When multicellular organisms appeared the boundaries expanded so that the whole organism had a protected inside. In the animal kingdom, a basic tube shape (an elongated torus) became a common pattern. With vertebrates (that includes humans) the content of the digestive tract—from mouth to anus—is actually outside the body proper. It is a sort of an inside of the outside. Interestingly within this outside is found a considerable mass of microbial life that is essential to the organism. A vital organ of the body is located outside the body proper.

The brain gets sensory input from outside the body (the outer outside) and from inside the body—exteroception and interoception respectively. Interoception monitors the physiological states of the body.

_____________________________________________________________________________________________________________________________

“Attention must be paid, declares Willy Loman at the close of Arthur Miller’s play Death of a Salesman. Perhaps this line is so resonant and memorable because it is the constant cry that wells up from the deep of the body.

When injury to the body, self, is threatened or inflicted, attention must be paid. Every system of the body is focused on the problem to a degree commensurate with the assessment of the damage. The person, and every necessary subsystem of the person, alters what it is doing in its normal course of events and assumes a stance, an attitude, in relation to the event. This attitude informs its posture. It must hold this contingent posture for the duration of the episode: coast clear, danger passed, tissue repair completed. Then it can let go. Unfortunately holding on persists well beyond its use-by date and this imposes restrictions of the body’s ability to respond and bounce back, its resilience.

By simply looking at how the body responds to trauma it becomes apparent that there must be neural nets involved. We see that computation is being performed. Information comes from the outside and compared to information coming from the inside (as sort of “state of the union” report). These two data sets are compared. A threat or damage assessment on the one hand, a tally of necessary and available resources on the other. From where can we divert attention and to what degree? Turn some systems up, damp some others down. Now hold this pattern as long as needed.

Such complex computations and coordinated commands are the signatures of neural nets. Communication from near the surface (say within or just under the skin) to organ systems deep within the body is evident. Look at any anatomy or physiology text you can readily lay hand on and you will find no mention of Chapman’s Reflex Points or any such network

Much of the story of Chapman’s Reflex System may be fiction but if so it is a fiction that reveals this truth: attention must be paid and attention is paid. How the body organizes itself to apply the needed attention is what this story is about.

The name of this set of points honors their discoverer, an osteopath by the name of Frank Chapman. In his clinical practice in Chattanooga, Tennessee, he noted that function of certain organs could be improved by manipulation of specific areas of tissue felt to be just under the skin, identified by palpation. He (and his wife) did some mapping of these points. In 1920 another DO and Frank’s cousin, took note and later, in 1937, published the Chapmans's finding in a book titled An Endocrine Interpretation of Chapman’s Reflexes.

To understand this story it is necessary to have some understanding of the story of systems, in particular open systems. What is the body but a system of systems?

It is also necessary to tell a somewhat different story of the body itself. Our story of the body is the base of all of our various health care delivery systems.

To tell all of these stories we need to go back to the story I call “How do I Know Anything? This story also goes by the ungainly title of Epistemology, the study of knowing.

And this story includes the story of Sensory Biology.

With all of these interlocking stories it is difficult to know where to begin.

I choose to anchor my story in biology so I will begin it with Sensor Biology, which is also the story of How We Know Anything.

This story has an inside of me and an outside of me. As with any story it is only an approximation and there is another story that says there is no inside nor is there any outside. It too is a very good story. But we are going to imagine a line, a boundary, a membrane separating inner and outer, creating an inner separate from an outer.

For my story I am going to give everything that is on the outside the name Energy. The really tricky part of this plot is that we can only assume that there really is something called Energy (or anything at all) by what effect it has on us. The only thing I can directly feel is myself, on the inside of the membrane. Energy bumps into the membrane and as a result the membrane changes how it is organized and arranged. I “feel” this change and make some guesses about what it is that impinged.

You very likely have heard the old Sufi story of the blind men and the elephant, each on holding a different part of the elephant and making different assumptions of what it is like. This Sufi story is the same story I am telling.

We think we are “seeing” the World (the stuff that is outside) but we are really only looking at a picture we have invented to make sense of a change that has happened on our inside. Some call this a model, some call it a construct, some call it a story.

Before I go on with this story I feel I must point out a plot problem. This is the problem. Everything that the membrane is made out of and everything contained on the inside is made out of this Energy that is all the stuff out there and this body that creates an inside is part of what makes up the Everything that is on the outside. I don’t really know what to do with this plot problem. This plot problem also goes by the name of Philosophy.

Trauma is injury done to the body; it is also the expectation or fear of injury to the body.

The idea of a postraumatic stress disorder has become popularized in recent times creating a cottage industry. This has the inevitable consequence of enlarging the population of people who identify as “traumatized.”

The human body, the human person, is a system. More accurately it is a system of systems. One of the most important characteristics of a system is that it is self-organized.

There are a variety of systems that comprise the body, subsystems we may call them. Some of the more relevant subsystems comprise a network. Neural nets are of particular interest. Neural nets are associated with computation, discernment, and learning.

Neural nets flow through many changes in their state (and I propose that when undisturbed you would find a randomness in the “shape” of it. One piece of evidence that leads me to such a supposition is that analysis of heart rhythm analysis finds that if there is too much regularity and order in the rhythm (of a chaos deficiency) this bodes not well for the heart being watched. When the random cycling gets pulled out of random and toward order this can be seen as an indicator that the larger system has hyper focused the body attention to a particular state. Holding is one of the primary necessary things that a body does. Attention is a holding of natural flux of the neural nets.

Parenthetical thought: Please take a moment to consider that what are called systems of the body (subsystems) are “things” only in the abstract. It is only in the imagination that you can extract any one of them as a stand-alone entity. I would love to have an animated cartoon of a dancing immune system or endocrine system akin to those we have of dancing skeletons. Each of the subsystem overlaps with other systems. A neurotransmitter system can be drawn that makes the immune system, digestive system, and aspects of the brain limbic system one system. System boundaries can be drawn in a variety of ways; there are many ways to cut up and dissect the body. No matter how finely drawn the line between any the process of distinguishing has an inescapable arbitrariness to it.

Now that you have these ideas fully grasped, have spent some time chewing on them (subsystems in the body are abstractions in that they cannot exist as separate, integral, functional entities, whatever ways you cut it, the body depends upon the function of each of the subsystems and there is such overlap both structurally and functionally that you have to hold in one hand the reality that they can only fully be comprehended as one system, while in the other the drifty notion of “parts.” Now that you have done this we will change our scope in looking at the body as a “system of systems.”

There is a base in reality in the urge to identify subsystems. You can hold a bone in your hand, an old dry bone, and feel the heft of it, the texture of it; you can grasp it. Similarly (in a socially correct context), you can carefully dissect out a digestive system and feel its sloppy wet mass, pulling olfaction into action and likely calling up an ancient sense (no matter how clinical the context), that of disgust. The body systems first recognized seem to have, at the gross level, clear and natural an graspable reality.

If we now take a step up and see the body as a whole, as itself a part of a next level up in the system of systems, then the body as a “whole” is now analogous to any one of its “parts,” simultaneously dependent and responsible.

You can hold and hug, pick up and carry, birth and bury a body. structurally and integrally a real thing in a real world. Looked at from a similar gross level as the early explorations of the dissectors, each looks and each feels as s stand-alone. And we have the seeming experience of being somehow more than the sum of those parts. You take them apart and you have no You. But now, at this scope, it is not as easy to see and feel the next level “whole” that the body that seemed to emerge from these parts comprising a whole. I like to visualize a structure of an open system as a sort of three-dimensional spiral but each loop of the spiral we try to turn into a circle. I feel it in my body as an auger-bit turning, moving attention up or down, depending on the direction of spin. It takes some careful looking and and probing with the finest picks possible to discern the next level up with the same sense of reality as you feel of yourself as a unitary body. The body is, though, only at only one point, sensed from a particular scope, of the continuum of a system-of-systems. It is a subsystem of something larger.

Despite the difficulties imposed by the senses throughout the history of Homo sapiens we have identified a feeling and human history can be seen as structured by attempts to reify these feelings from deep within the body; find ways to grasp what they are telling us: those things that pull us together to feel safe and mighty; those shivers (and the feelings of sadness, shame and fear when we are torn asunder; tremors of wonder and awe when confronted by something that could easily destroy us but refrains; feelings of disgust as your gorge rises up from belly to throat to tell you a thing’s despicable, “something’s rotten in the state of Denmark.”.

And here biology plays a trick on us. agreement around a way of telling a story about what exactly it is that calls forth the upwelling of these feelings is the very thing we use to organize ourselves into functioning social body. It is in our biology to feel it and be pulled by it and it is in our biology to not be able to fully comprehend it.

A digression into What is a System?

General Systems Theory (GST)

In theory systems are classified into two types, open or closed. GST examines the nature and characteristics of open systems. Open systems rely on an exchange of energy and/or matter across a boundary. Closed systems do not exist in nature but they are approximated, used by people like engineers to construct things like a closed hydraulic system. It is understood that there are “leakages” in such systems but they are irrelevant to the fulfilling of the function of the closed system.

A system is a pattern that persists over time, it survives.

The Genealogy of System

Think of flow, feel in your body the feeling of flowing. The flow if the world is the constantly coming into being. A every instant it is in a state of creating. The front is a one-dimensional plane. The very instant that it is is the same instant that it is gone. From the instant the flow began (assuming a beginning) it seems to have birthed into a sort of structure we call probability. It immediately had an organization to it we call randomness.”

Though mostly uniform, homogenous, probability insists on some measure of order to be in this larger flow: there will be pattern, repetition. Imagine it as swirls, eddies and clumps. Clumps and swirls may now be seeming as having purpose and that purpose is most simply to endure over time.

Stories that interplay one story against another (e.g. the recent movies Westworld, Nocturnal Animals) are, whether intentionally or not, are usually telling another implicit story on top or below. These stories cited (and there are many many examples) usually have one story to be taken as “reality” and the other as simply a made up story. What I noticed in both of these the made up stories felt more real, had more visceral impact on me than what was supposed to be taken as real. And here is why this meta-story is more interesting to me. This is a story about our basic relation to the world. You see, what we take as the world is in actuality a story we are telling ourselves and others as to what we think the World to be. The World is tis to he real, actual story as the world is to the fictional story. This is as it should be. We can only successfully navigate the World by deeply trusting in the story we are telling ourselves, trusting that the model we have communally constructed says enough important things about World, has selected enough significant samplings to survive. The best access to any awareness of the fact that this is a model of the World is through story itself. This model of story is the best way to sit with one of the abiding questions of philosophy: what is the relation of World (world outside of me but also including me or maybe world without me) to world (world constructed by we, using me—sensing is literally a rearranging of bits of yourself initially then the entirety of your self ultimately. And of course if now it is very clear that in order to perceive/construct/map the world you can only do this by changing your own organization, internal arrangement of parts of you and since you are a part also of the World and so the only way to sense the World is to change the World. Another way to say this is that all you know is a change in your own state.

But we are not to have awareness of ourselves doing this trick. The feeling is that this thing we are holding has appearance and palpability. We must believe this is true. If we could catch ourselves in the act it would question and second guess and doubt in a dangerous kind of way. We would bump into things, fall down, crash and burn. This very fact of the necessity of trust and the walling off of this process from consciousness I think is the strongest argument that there really is World. I can simply know anything about what it is like by reacting to it and observing myself reacting (and then making up post hoc stories of why I did what I did while at the same time convincing yourself that the story of why—your motivation for doing what you did—had occurred to you before doing it.

Chapman's Reflex Network Notes

No man is an island, entire of itself; every man is a piece of the continent, a part of the main.

If a clod be washed away by the sea, Europe is the less, as well as if a promontory were, as well as if a manor of thy friend’s or of thine own were.

Any man’s death diminishes me, because I am involved in mankind. And therefore never send to know for whom the bell tolls; it tolls for thee.

--John Donne

Introduction

One of the more useful ways to look at the Phases of Ortho-Bionomy is to think of them in terms of different levels of connection. Phase 4 is concerned primarily with connection within, to one’s own self. In Phase 5 the focus is on connection with others, principally the connection of the client and Practitioner. Phase 6 casts a wider net and considers connection with one’s surround, the environment. Phase 7 is a kind of completion then, one is not connected to the other, one is the Other, all is One. Because of the number seven’s unique relationship to the other numbers, because of its ancient metaphysical significance, Arthur Pauls chose this number as the name for this phase. Of all the numbers it best expressed for him the spiritual significance of this state. The Phases were originally intended to describe phases in the development of Ortho-Bionomy and he wanted the final Phase to be 7; thus the numbers 1, 2, and 3 did not really fit in.

In Ortho-Bionomy connection comes first and is the thing on which all else depends. Though it is seldom stated in this way, healing is seen is seen as emergent. That is to say it is not externally imposed but arises from within, as a result of the connection, The new science chaos and complexity is presenting a picture of life emerging spontaneously from complex interactions between organic precursors. Life interacts in a great web and self-maintains through connection with this web. The physical integrity of the human organism is deeply dependent on the individual being engaged in social interaction. The human organism is self-tuning when in relationship. It is aspects of this reality that make Ortho-Bionomy so deeply effective.

The fact that connection takes such a central position in Ortho-Bionomy tells us we are concerned primarily with systems. Systems approaches to healing and therapy rely primarily upon the therapist’s relationship to the system, being able to modulate that relationship, to move toward being a non-anxious presence. This then allows clients to modulate their own relationship. Healing is the follow on to moving into right relationship. The system is not directly changed but again the change is emergent as a result of a non-forced, non-hierarchical interaction.

Each one of us can be seen as a system. But if you look within an individual we have identified subsystems operating. Thus we each have a circulatory system, a nervous system, a digestive system, a reproductive system, etc. Of course it is not possible to truly isolate any one of these systems; each one relies on the other. None can be extracted as a stand-alone; if any one were to be removed from the whole organism then life in that individual would cease (the reproductive system is a rare exception on an individual basis though certainly not at the next level up). The notion, an artifact of a previous age, that we are assembled from parts, in the same way that an automobile or a clock is assembled from parts is an illusion. Each person is a whole—almost.

Just as our internal systems do not function independently, cannot stand alone, so with any individual organism. The individual organism, the individual species, exists in a necessary relationship to other kinds of organism in a dazzlingly complex network—the web of life. Social interaction within a group is also fundamental. Aristotle described humans as “social animals.” The significance of this pithy description cannot be underestimated. Our biological well being (not to mention psychological) utterly relies upon our social engagement; it is hard wired. It is estimated that if a person is a smoker and is also lacking in social interaction it is pretty much a toss up which would be the more health promoting thing to do: stop smoking or join a club.

It is beyond the scope of this essay to present all of the evidence to support the idea that my individual consciousness is emergent from my conversational interactions with other people. Suffice it to say that our “inner self” is to be found by looking outward, it is found in the interactional space (the third space). It is also important to realize that the emergent formation of this self is mostly reliant upon a conversational form of interaction. The form of conversation is bidirectional (unlike, say, the Internet) and it is non-hierarchical, no one having a privileged position, no central authority. Conversation allows change without coercion.

There are of course many channels available for human communication and interaction. Some of these we are explicitly aware of, many more we can be aware of but tend to process primarily at some below conscious level. Most of the channels of interaction happen at a level that we are not able to even become consciously aware of. Only a tiny portion of what goes on in the world in which we are embedded are we capable of sensing. An even smaller portion of this small part registers consciously. This is to say an action stimulates a sensory receptor. This stimulation elicits some sort of characteristic internal electrochemical response and a signal goes eventually to the cerebral cortex. This results in our experience of seeing, hearing, tasting, smelling, or feeling something. If we judge it necessary we then send a signal to the motor centers of the brain, saying we must do something. A larger number of stimuli result in signals that entirely bypass the cerebral cortex, going directly to the appropriate motor center(s). This results in action we may or may not be directly aware of. It could be a release of hormones resulting in an emotion then a feeling that we may respond to. In other words things of which we have at best only a shadowy awareness (and usually none at all) trigger a very large part of what we do. Most of our motives are invented after the fact. Most of the important human interaction that results in physiological regulation is of this sort. It is clear that conscious interference with these processes, either by the individual of by a well-meaning therapist, would make the situation farpotchket.

One cannot study systems and emergence without looking at networks. A network is a series of points with each one interacting with several others in the net. Biological function depends on all sorts of networks, both within and without. Neural nets are the subjects of intensive research. Unfortunately most of the research on mind and networks is focused internally, blinkering us to the importance of the social network. Mind and consciousness are dependent not only on internal neural nets but just as much on social nets. The notion of personality in psychology and psychiatry misses this point rather thoroughly, seeing a personality as something residing within the individual. For a better understanding of personality look at the feelings, thoughts, and behaviors of those interacting with the person. Personality is more about how a local region of the system is behaving. One of the few neuroscientists to recognize the importance of the outer connection is Antonio R. Damasio. Much as Michael Servetus in the 16^th century and William Harvey a hundred year later predicted the necessity of capillaries long before they could actually be seen, so has Damasio predicted the necessity of networks located near the skin that serve to interconnect one person to another to achieve conscious mind.

The technology was not available to Servetus or Harvey to allow them to confirm the existence of capillaries. Similarly there is much to be discovered and “proven” in the realm of human connectivity. Since the Age of Enlightenment the focus of human studies has been on the individual, as if each of us is a self-contained unit, not woven into the fabric of everything. In like manner we can see the necessity of structures and mechanisms that we cannot yet fully elucidate. Damasio has posited the necessity of some sort of network distributed over the body that allows the body to directly respond each to another. The Chapman’s Reflex Network, at least in part, answers that need.

Our inner self is found in our skin and outward, not hidden darkly in the innards. In the space between one another, where we overlap, the third space, is where you will find yourself. The philosopher David Hume, generally regarded as the most important philosopher to write in English, spent his youth in a relentless pursuit of the elusive inner self and it nearly killed him, leading him down a rabbit hole of mental and physical illness.

Chapman’s Neurolymphatic Reflexes

The Chapman’s Reflexes were first identified and eponymously named for Frank Chapman, an American osteopath working in the early 20^th century. His work was posthumously written up and published in 1935 by his wife (also an osteopath) and another osteopath by the name of Owens under the title An Endocrine Interpretation of Chapman's Reflexes. Most of Chapman’s work was based on clinical experience with these points as well as some dissection. Chapman thought that each point was a reflex to a particular organ and stimulation of the point resulted in better lymphatic drainage of the target organ. In Chapman’s system the points were useful both for diagnosis and treatment.

An Endocrine Interpretation of Chapman's Reflexes presents a number of difficulties for the modern reader. It is essentially based on a 19^th century understanding of anatomy, physiology and disease. It is regarded with considerable skepticism by modern osteopathy. Zucker referred to the Chapman’s Reflexes as “little known and little used and asked the question: are they “medicine or metaphysics?” A 1983 conference on somatovisceral reflexes (a general category that would include the Chapman’s Reflexes) in discussing these reflexes concluded that the notion that they are “neurolymphatic” is completely unsupported. They further criticized the only text on the subject finding it antiquated.

In spite of the questionable place the Chapman’s reflexes hold in osteopathic regard interest in these points has been undergoing a resurgence. George Goodheart, D.C., founder of Applied Kinesiology, is in some measure responsible for this awakened interest. He made the observation in the 1960s that the Chapman’s Reflexes also had a reflex association to specific muscles. Goodheart describes how he initially made the discovery when working on his secretary, attempting to address a head tilt associated with a sinus problem. Note that Goodheart readily accepts Chapman’s notion that the reflexes are Neurolymphatic in nature.

Then I thought that perhaps what I pressed on was something unassociated with the muscle itself, but possibly associated with some lymphatic circuit breakers postulated by an osteopath named Chapman. Chapman’s reflexes were associated with organs and glands. I stimulated the sinus reflex of Chapman and not only did it improve her sinus condition, it also strengthened the sternocleidomastoid muscle. Investigation soon found specific muscles associated with the different Chapman reflexes. When stimulating the reflex strengthened the associated muscle there was often a change in the associated organ. By now I was becoming convinced of a relationship between muscles and particular organs or glands.

John E. Upledger, D.O., another well-known practitioner of manipulative therapies also reported regular use of Chapman’s Reflexes in his practice even though he noted that“ The use of Chapman’s Reflexes to effect therapeutic modification of visceral dysfunction has been a controversial issue amongst osteopathic clinicians for over 50 years.” He went on to chart a striking correspondence between Chapman’s Reflexes and acupuncture points.

The Chapman’s Reflex points are identified by their specific anatomical location and by the way they feel to palpation. All of this is well described in An Endocrine Interpretation of Chapman's Reflexes. A condensed (and more useful) presentation of the material in this book can be found in Leon Chaitow’s Soft Tissue Manipulation. Chaitow has organized the information in a chart format with the points indicated on a few skeleton diagrams, making it easier to learn the locations of the points.

There is another characteristic of the points that is seldom mentioned in the literature. They tend to be much more tender than other kinds of points. The pain is often described as sharp. It also has a much greater affective component, there will be a greater sense of suffering, a sense of “poor me.” Or the client may become uncharacteristically angry.

There are other characteristics of these points not mentioned in the literature but described by many Ortho-Bionomy Practitioners and their clients. It is often recommended that the practitioner not work on more than three points during any one session. Many practitioners also recommend that a practitioner limit the number people they work on in a day using Chapman’s points. The reason for these warnings is that curious things happen both to the practitioner and the client, particularly if the standard method of “treating” the points is used, which is to gently rub the point in a circular direction. If the practitioner ignores these warnings the practitioner or client or both may have unpleasant reactions, such as nausea, headache, feeling disoriented, fatigue, irritability of other emotional reactions.

We will be looking at ways to address the Chapman’s Reflex points that avoids these peculiar side effects.

The Chapman’s Reflex Network

All of the published literature on Chapman’s Reflexes has one thing in common: each point is considered individually, each point (though most of them are paired, an anterior and a posterior point) referring to its specific organ (and specific muscle in Goodheart’s view. It is an atomistic view of Chapman’s Reflexes. This is of course well in keeping with the Enlightenment tendency to focus on the individual. What is needed to come to a fuller understanding of the role of these somatovisceral reflexes is to view them as a network. That is to say the points are more importantly connected to one another, a meshwork distributed over the subsurface of the body. If we think in terms of systems and emergent phenomena we begin to see many things in terms of networks.

Seeing the Chapman’s Reflexes as a network raises some interesting questions. Is the role of this network motor or sensory? If sensory what is being sensed? Why would it refer to both visceral organs and muscles? Why should it be so shallowly located?

To begin proposing some possible answers to these questions I will return for a moment to Damasio: “Consciousness, as we commonly think of it, from its basic levels to its most complex, is the unified mental pattern that brings together the object and the self (emphasis added).” A network located within the skin, reflecting to the innermost bodily functions could serve such a purpose. But there is something here more basic than consciousness. We must be able to respond to this “object,” this stuff outside of ourselves. It is a matter of survival. We must have a response in out body long before we can consciously sort out what is going on. The Chapman’s Reflex Network, I propose, is part of how we respond.

What else might this network be doing? Why would we need another sensory function separate from the usual five external senses and a host of internal senses? What might be missed? Very likely this network, distributed throughout the skin, is getting system information, information about how we are embedded in the social and geographical systems that are necessary for our biological functioning. Some of this could be electromagnetic in nature, some of it we probably do not even yet know the existence of.

The Chapman’s Reflex Network and Posture

Looking up the word ‘posture’ in Dorland’s Medical Dictionary a misleadingly simple definition is given: attitude. Posture is about something it is your response to something, how you position yourself in relation to the world. Thinking about this it becomes clear that there are two kinds of posture. You have a postural ground (much like the notion of personality) and a contingent posture. The ground posture, how you habitually hold and carry yourself, will inform and limit your contingent posture. Contingent posture has to do with responding to what is going on around you.

As Goodheart has observed, the Chapman’s Reflex points have something to do with postural muscles, clearly having something to do with posture in the way we normally think of it. We seldom think of the penetrance of the idea of posture. We tend not to think, for instance of facial posture, the posture of the voice, for instance. We also have to think then of visceral posture. In what stated does your digestive tract have to hold itself to respond to what is going on in the environment. What is the endocrine posture? To be able to respond the body needs to make a rapid assessment of ones internal state and resources, ones external resources (location in the world, position in society, etc) and make the necessary distribution of resources in order to respond. None of this can be done quickly and neural nets are the only way to do the needed calculations in microseconds.

The Chapman’s Reflex Network and Trauma

When injury has occurred the injury itself becomes the object toward which you must have an attitude. If you cut yourself significantly, break a bone, and so forth, you are forced to maintain a posture toward the injury in order to recover. The hurt part is immobilized; compensations are made. You may hold yourself in an unnatural way, walk oddly, and so forth. Even a fairly small injury like a stubbed or broken little toe reverberates throughout your body as you hold the foot up a bit, perhaps turn it outward a bit. The hips then make a little compensation, your head will be held differently. A large part of contingent posture then is focused on responding to injury. “Attention must be given.”

Eventually, in most cases, this contingent posture is relaxed and released and you return to ground. If the injury is significant and long lasting then the ground posture will be modified. Sometimes the body simply “forgets.” You become so used to holding yourself in this way that it becomes a part of who you are. Ortho-Bionomy is of course exceptionally useful in aiding the release of these long forgotten holding patterns.

Emotional or mental trauma follows essentially the same pattern. Events that are terrifyingly “beyond the range of normal human experience” insist that you pay attention. Because they are so powerful, through a variety of mechanisms that are become increasingly understood, attention becomes locked on to the event. Even after the event has passed attention is held. The effect is that the traumatic event is always either in the present or readily intrudes into the present.

A vivid example of this is a young soldier, who I will call Matt, who had been one of the first sent into Afghanistan. “I was on a plane before the second tower hit the ground,” he related. I will not go into the details of his experience there. When he returned he married, the couple had a baby, and the further away he got from Afghanistan the worse became his difficulties with posttraumatic stress disorder (PTSD). Curiously his symptoms became particularly bad: severe anxiety, always on the watch, not sleeping, getting up to check doors and window, check outside, extreme jumpiness (hyperreflexia): when he was with his family. Realizing this he began avoiding them, staying away, emotionally distant even when with them. Seeing him with them it was obvious he adored them. Why should being with them make matters worse for him? This is counterintuitive. The answer is that though he left Afghanistan, from our point of view, from his own he is still there, or more accurately, he is dragging Afghanistan around with him. When he is with his family, physically and emotionally, they are also in Afghanistan; when he is distant from them he is in Afghanistan and they are safely at home; it is only his own safety he needs to be concerned about, not the added strain of protecting his wife and family. This can only be understood by realizing that Matt is not crazy, crazy though it may sound. He is experiencing a very real distortion of time and space. He has locked on to that time and that place and held on for dear life and that allowed him to survive.

Being held in a state of hyper-alertness, always on the lookout, always ready to respond, involves the entire body holding a posture. The Chapman’s Reflex Network is intimately involved in this process.

Frank Chapman, D.O.

A Possible Class Outline (A Hallucination of a CRN Class)

Introduction: History, Theories

Argument for Systems approach—Chapman’s Reflex Points as a Network, mirror neurons

Our place in the world—Geopractic. Practical exercises.

Review of Phase 7 (as needed)

Isometrics and Chapman’s

Body schema, he “as-if” body

Isometric general release

Specific releases

Circular Isometrics

Chapman Clusters

Managing an Abreaction

As in most things prevention is the best approach. There are two important factors to keep in mind to prevent your client from having an unpleasant reaction to the tuning.

It is most important that you take care of yourself and watch for negative reactions in yourself when focusing on Chapman's Reflex Points. Indeed this is how the work is done. Body mechanics are very important to attend to whenever doing any bodywork; tending to emotional/energetic body mechanics takes on an even greater importance. This is what I mean by 'differentiating.' As when flying on an airline they tell you, when traveling with a child, to first secure your own oxygen mask (if it becomes necessary) before attending to the child. The reason for this is obvious.

The second thing to keep in mind is pacing. Don't move too fast from point to point, give pause in between. If you or your client feel that something important has happened give a longer space; let things sink in, settle down, integrate. It is often useful to break physical contact and sit back a bit to give individual space. Lynn Drummer would advise her students to rest a hand on a large joint, such as a knee, to help settle a person down.

If you are working with someone you know has a tendency to dissociate or have strong reactions, or someone who you know has had significant emotional trauma (or even posttraumatic stress disorder) some advance planning is useful. I use an anchoring exercise. Sitting at the head of the table, client's head cradled on my hands, I ask the client to silently recall some time and place that was particularly peaceful and to remember the feelings associated with that. I feel what is happening in my hands, what tendency of movement I notice. I ask myself to remember the feeling tendency in my hands and to find a gesture in a motor emulation form that I can use to represent that feeling tendency. This is sensorimotor imagery. It is like taking an emotional/energetic snapshot of the client's state of mind. I then ask the client to recall an unpleasant or uncomfortable scene (nothing too drastic) and follow that for a bit. I then recall the "snapshot" feeling into my hands, I emulate the gesture, and ask the client to report any changes in mood. They will typically report that they feel less anxious, calmer, more peaceful, as they recall the unpleasant scene. If you get this response then you now have a means to help bring the client to a more peaceful state if needed.

If in the unlikely event you have someone have a severe emotional reaction while on your table what are some things you can do? Have you ever had this experience? What did you do? Did it work? There are a variety of approaches that can be taken. Once again the first and most important thing for you to do is take care of yourself, differentiate from the panic puddle, put on your own oxygen mask.

One approach that I find particularly effective is derived from the exercises we did at the start of the class yesterday. Have the client slowly come to standing and then orient the client into a direction where you can feel the tension drop.

Stand behind the client with your hands on the client's shoulders. Use motor emulation to determine the preferred direction to turn. Standing behind and slightly to the side slowly rotate the person using your own inner knowing to find a preferred direction to orient to.

Get the client to participate in the process as well, to say what direction feels best.

Techniques to Release Chapman’s Reflex Points—Triangulation

Nearly all the techniques you will learn in this class to release a Chapman’s Reflex point are some version of triangulation. These are different ways in which the Practitioner can, in the words of Whitman, be “both in and out of the game.” That is to say you are connected to the system but not determined by it.

The classic way of releasing Chapman’s Reflex Points is gentle circular rubbing. It is my experience—and that of many others in Ortho-Bionomy—that this can be painful and can lead to unpleasant reactions both for the Practitioner and for the Client. Rubbing on the points treats them (and the client) as an object. What we will be learning instead is to address not the points so much as our own reaction to the points. In other words we will be taking a systems approach. This requires a very gentle contact and no direct manipulation of the points.

Geopractic Release

Make contact in the point and face into your direction of comfort.

Phase 7 Release

Feel the point as an energy vortex, a spiral, and place yourself in relationship to the energy spiral. Combine this with Isometrics and Wow!

Phase 6 Release

With one hand find a Chapman's Reflex Point, either on or about an inch or two off the body surface (don't go too high off the body). Feel the tension in your hand when you are focused on an active CRP. Now take your free hand and move it slowly about to your side, at about shoulder height, until you find a position where your tension drops. You can make fine adjustments by rotating your hand. Your free hand can then find the next CRP. You can move from one point to another alternating hands if you wish.

Working in Tandem

This can usually be done only in a classroom setting though if you have a partner to work with it can be used very effectively in a practice. We will experiment in the class with several ways of doing this. In general one Practitioner will make contact with the person on the table then the second Practitioner will make contact somewhere else and “find” the first Practitioner.

To begin this exercise it is useful to understand the concept of "finding" another hand. This is easiest to practice first by having your two hands find one another. Holly Reed uses this in her classes to teach what is meant by gentle compression. Find a tender point (such as on the neck), move the person into the position of release with your other hand, then allow your two hands to find one another. The result is a very fine compression.

Now you can progress to finding another person's hand. The client lies on the table and one person contacts a CRP. The second person then places a hand elsewhere on the body and "finds" the first person's hand. Notice what happens to the CRP. I strongly recommend that when you get together with other students in peer-directed study groups you spend some time with exercises such as this. Try connecting point-to-point, for instance. Test what happens when one contacts a CRP and the other puts a hand over the presumed target organ listed in the Owens (or Chaitow) book.

Distraction

Such as staring out the window.

Connecting with the World

You can find active CRPs by sitting at the head of the table and again cradling the client's head on your hands. Use motor emulation (rebound) as if you were travelling down the spine (people who have had cranial-sacral training report this as similar to "running the dural tube). You should be able to gradually feel as if you were going a little further toward the sacrum each time. Whenever to come to a place where there feels to be some sort of disturbance, turbulance of some sort, stop and hold there while you move your focus to the outer world. I usually do this with my eyes closed. The sense is that you are reconnecting the person at this point to the here and now. It is also another way of creating a triangle: there is the glitch, there is you, and there is something else.

Inside Out: A variation of Dr. Pauls’s Kundalini Release.

All-In-One or Grandmother

Another Outline Version

Introduction: History, Theories (see other handouts)

Argument for Systems approach—Chapman’s Reflex Points as a Network, mirror neurons

Our place in the world—Geopractic. Practical exercises.

Review of Phase 7 (as needed)

Isometrics and Chapman’s

1. Body schema, he “as-if” body

1. Isometric general release

1. Specific releases

1. Circular Isometrics

1. Chapman Clusters

II.

Managing Emotional Reactions

As in most things prevention is the best approach. There are two important factors to keep in mind to prevent your client from having an unpleasant reaction to the tuning.

Get the client to participate in the process as well, to say what direction feels best.

Techniques to Release Chapman’s Reflex Points—Triangulation

1. Geopractic Release

Make contact in the point and face into your direction of comfort.

1. Phase 7 Release

Feel the point as an energy vortex, a spiral, and place yourself in relationship to the energy spiral. Combine this with Isometrics and Wow!

1. Phase 6 Release

1. Working in Tandem

1. Distraction

Such as staring out the window.

1. Connecting with the World

1. Inside Out

A variation of Dr. Pauls’s Kundalini Release.

1. All-In-One or Grandmother—A Story

The reason I call this "Grandmother" is rather a long story (written in a piece titled Bakersfield). Kay Cavendar (a former Ortho-Bionomy Instructor) introduced me to the Vivaxis concept of Frances Nixon. Out of the experience of meeting with Kay and Lynn Drummer regularly over a period of a year I came to think of aligning with the Earth's field as connecting with Grandmother. The essence of the story is that Kay had structural and metabolic issues she believed to have inherited from her grandmother. There was a very odd series of coincidences linking me to her grandmother. I then assumed the role of her grandmother (you might say I became her grandmother) to address these issues.

A few years ago I was teaching and doing sessions on the island of Kauai. I was just completing a session with an older Hawaiian woman and finished (as I often do) holding her ankles and aligning her in the Field as described below. When done she sat up and with a pensive, far-away look said, "My grandmother was a healer. She died without passing on her knowledge. I have never experienced anyone who worked the way she did until now."

Part of Kay's problems had to do with her ankles and her middle ear, her sense of balance. I had discovered (confirmed by Lynn the neuroanatomist) that there is a very strong reflexive link between the ankle and the middle ear. I therefore became her grandmother while sitting at her feet and holding her ankles and feeling for her fit in the earth's field. Later I realized that what I was doing was very much like Phase 7 while holding the ankles. There are a number of ways to feel or visualize this. The physical body (the "meat body") lies upon the table as you see it. How is the "as if" body aligned? If you could rotate the table with the person, as if on a large turntable, where would the preferred alignment be? You can also think about the "as if" body as a compass needle. Which way is it pointing? Or you can visualize the spiral, originating across the top of the pelvis and ending up encircling the body. Where does the tail end? It would be the same place as the compass point. From a kinesthetic point of view hold the ankles, feel which way the turntable would turn if it would turn, then how far would it turn?

Additional Notes for Chapman’s Reflex Network Workshop with Reference Materials

This workshop will be looking at how Chapman’s Reflexes function as a system, an interconnected network. It is a top-down view of the Chapman’s Reflex Network (CRN). Reflex systems are very complex affairs. One aim of science is to discover the underlying simplicity of things that appear to be complex. The underlying simplicity is also known as a ‘law’ of nature. Something that is usually described as a ‘characteristic’ of open systems could also be stated as a law. Open systems are self-regulating. There are myriad ways in which this is expressed in the human body-system. Another observed characteristic (law?) of open systems is that they have negative entropy. This means that they must become increasingly complex, which is to say they evolve. A third important characteristic is that they resist external pressure to change. Our search is then to consider the role of this system, the CNR, and to find ways to nudge the state of the system in the direction of wellness, with a minimum of external force.

This set of notes contains material excerpted from two of the most current texts of osteopathic medicine. In them you will find a brief history of Chapman’s Reflexes and a summation of the original book, An Endocrine Interpretation of Chapman’s Reflexes (1937) by Charles Owens (Frank Chapman’s brother-in-law). I have also included some information from the texts about reflexes in general and viscerosomatic reflexes. You are encouraged to critically read the Owens book and you may note that little has changed in the hundred years since Chapman identified these reflex points. It is very important though to note how the Chapman’s Reflexes are seen to fit in with the larger practice of Osteopathic Medicine.

In this workshop we will be paying little attention to that which is given all the focus in the osteopathic literature, which is the reductionist point-to-organ specificity. Rather we will be considering the system as a whole, what is it’s larger purpose in the life of the organism, and how can I position myself in relation to it in such a way that we each become a better person. In other words I present this as a practice of ethics rather than as a practice of medicine.

Ortho-Bionomy is a child of osteopathy. Most of the techniques and methods of Ortho-Bionomy come direct from osteopathic manipulation techniques, those that are indirect and lead toward self-correction.

Self-correction is a basic characteristic of open systems. The human body is an open system, which means it exchanges mass and energy and information with the larger system in which it is embedded (environment). The study of systems theory sheds considerable light on much of Ortho-Bionomy to such an extent that Ortho-Bionomy should be considered a systems approach to healing.

The tenets of osteopathy could also be adopted, with little modification, to apply to Ortho-Bionomy.

Tenets of Osteopathic Medicine

The American Osteopathic Association’s House of Delegates approved the Tenets of Osteopathic Medicine as policy which follows the underlying philosophy of osteopathic medicine.

The body is a unit; the person is a unit of body, mind, and spirit.

The body is capable of self-regulation, self-healing, and health maintenance.

Structure and function are reciprocally interrelated.

Rational treatment is based upon an understanding of the basic principles of body unity, self-regulation, and the interrelationship of structure and function.

Note that “structure and function are reciprocally interrelated” as opposed to what is too often repeated in Ortho-Bionomy: “Structure governs function.” This might more properly and completely be stated as structure governs function and function determines structure. It is very much like the old nature vs nurture debate.

Inspired by a paper published by Jones in 1964, Spontaneous Release by Positioning, Arthur Pauls made facilitated positional release the cornerstone of what he named Ortho-Bionomy. Along with this he imported muscle energy techniques (called by him Isometrics) and Chapman’s Reflexes from osteopathy. What he packaged was much of the indirect methods of osteopathy, those techniques that encourage change in the system by means of a reflexive response. Though Pauls never elucidate what he referred to as “the laws of life” (there are no ‘laws of life’ in the sense that there are laws of physics, chemistry, mathematics, etc.) systems theory comes closest to offering such laws.

What Ortho-Bionomy offers is methods to encourage change toward wellness in another with a minimum of meddling and without need of extensive education, osteopathy light one might say. He put together a system that would allow any reasonably able person to help others to relieve pain and improve function. Most of his system had to do with the function of the soma. He brought Chapman’s Reflexes on board as a way to address dysfunction in the viscera.

Chapman’s Reflexes are seemingly a subset of what are called viscerosomatic reflexes. This word simply means that something that is happening in the viscera is being reflected in the soma.

Following are excerpts relevant to Chapman’s Reflexes from two current texts in osteopathic medicine: Manual of Selected Osteopathic Techniques, Prest and Furlano, 2014; and Foundation of Osteopathic Medicine, 3rd Edition, Chila, 2011.

Prest, Lauren; Furlano, Anthony (2014-03-13). Manual of Selected Osteopathic Techniques

Chapter 19: Chapman’s Reflexes (CR)

L. Prest

Chapman’s Reflexes (CR) are palpable tissue changes created by lymphatic and fascial congestion secondary to visceral pathology. These small nodules are found throughout the body (anteriorly and posteriorly), predictably within deep fascia or the on the periosteum. Upon palpation, the overlying tissues may feel granular, while the CR may feel ropy, firm, or edematous. The size of each CR varies from 1mm to 2cm. The patient generally experiences some discomfort (but no radiation of pain) with localized palpation. Some degree of visceral pathology correlation should be present (i.e. a patient with a CR relating to the colon should also manifest some degree of colon pathology). ¹ Points are bilateral unless otherwise noted.

Dr. Chapman, for whom CR are named, considered CR to be neurolymphatic points, because they demonstrated the connection between the lymphatic system and the sympathetic nervous system. However, this has yet to be demonstrated scientifically. Treatment involves vibratory stimulation, deep kneading, or rotatory motions over the stimulation, deep kneading, or rotatory motions over the nodule, depending on the location, for 20-60 seconds. This sequence of treatment is suggested in the event CR are found: ² 1) Treat the lymphatic system to enhance drainage, 2) Treat the pelvis/ sacrum before other regions, not forgetting the axial spine and ribs to decrease sympathetic load, 3) Treat any CR relating to the pelvis-thyroid-adrenal system (see clarification below), 4) Treat any CR related to the organs of elimination, then, 5) Treat any remaining CR.

Dr. Chapman taught that treating anterior points first was preferable because it often led to the resolution of posterior points. If the anterior points are too painful to allow treatment, treating posterior points first is acceptable and will allow the anterior points to be treated more quickly. If all points are too sensitive or painful, Myofascial Release performed around the CR should be employed to drain the lymphatics feeding the reaction. Afterward, direct treatment of the CR is better tolerated. Generally, using smaller amounts of force over the CR will resolve the point more quickly than greater forces as it should allow better relaxation of the tissues. ³

Clarification

The pelvis-thyroid-adrenal system is a concept developed by Dr. Beryl Arbuckle. Treatment of the pelvis alters secretion of estrogen, progesterone, and testosterone by sex organs. These hormones interact with immunocytes, the adrenal gland, and the thyroid gland (increase TSH, thymocyte proliferation, enhance reproductive function, and myelin production). Immunocyte proliferation and can also have a sympathomimetic effect.

Chapman’s Reflexes

To accompany Section II Chapter 19: Chapman’s Reflexes (CR), some of the most important anterior and posterior CRs are listed in alphabetical order along with a description of their locations. Following each list of anterior and posterior CRs is a diagram picturing the described location.

Anterior Chapman’s Reflex Points

Abdomen: Upper edge of the body and ramus of the pubic bone near the pubic symphysis

Adrenals: 2 – 2.5” above and 1” lateral on either side of the umbilicus

Appendix: Upper edge of the 12th rib near the tip on the right

Arm Circulation: Muscular attachments of the pectoralis minor to the 3rd, 4th and 5th ribs

Arm Neuritis: Between the 3rd and 4th ribs (3rd intercostal space) near the sternum

Bladder: Around the umbilicus, as well as on the pubic symphysis close to the median line

Broad ligament: From the greater trochanter to within 2” of the knee joint on the outer aspect of the femur

Bronchus: Between the 2nd and 3rd ribs (2nd intercostal space) close to the sternum

Cerebellum: Tip of the coracoid process

Clitoris: Upper, inner aspect of the posterior thigh 3-5” long and 1.5-2” wide

Colon (spastic constipation or colitis): An area 1-2” wide, extending from the greater trochanter to within an inch of the patella on the anterior-lateral aspect of the femur; On the Right side = upper 1/ 5th indicates cecum, next 3/ 5th reflects the ascending colon, last 1/ 5th reflects the first 2/ 5th of transverse colon; On theLeft side = first 1/ 5th just above the knee corresponds to the last 3/ 5th of transverse colon, the middle 3/ 5th reflects the descending colon, and the last 1/ 5th is the sigmoid; the extreme upper end of the trochanter on the left side = the recto-sigmoid junction

Conjunctiva: Anterior aspect of the humerus, middle aspect of the surgical neck inferiorly

Esophagus: Between the 2nd and 3rd ribs (2nd intercostal space) close to the sternum

Inguinal lymph nodes: Lowest 2/ 5th of the sartorius muscle and its attachment to the tibia, and just above the medial femoral condyle

Gallbladder: Between the 6th and 7th ribs (6th intercostal space) from the mid-clavicular line to the sternum on the right

Intestinal peristalsis (constipation): Between the ASIS and the greater trochanter

Kidney: 1” above and 1” lateral on either side of the umbilicus

Larynx: Upper surface of 2nd rib, 2-3” lateral from the sternum

Liver: Between the 5th and 6th ribs (5th intercostal space) and the 6th and 7th ribs (6th intercostal space) from the mid-clavicular line to the sternum on the right

Lung, lower: Between the 4th and 5th ribs (4th intercostal space) close to the sternum

Lung, upper: Between the 3rd and 4th ribs (3rd intercostal space) close to the sternum

Middle ear (otitis media): Upper edge of the clavicle, just lateral where it crosses the 1st rib

Myocardium: Between the 2nd and 3rd ribs (2nd intercostal space) close to the sternum

Neck: Inner aspect of the upper end of the humerus from the surgical neck inferiorly

Neurasthenia: All muscular attachments of pectoralis major on the humerus, clavicle, sternum and cartilage of the ribs, especially rib 4 in front of the mid-axillary line

Nose: Costochondral junction of 1st rib

Ovaries: Upper, medial border of the pubic bone

Pancreas: Between the 7th and 8th ribs (7th intercostal space) on the right close to the costochondral junction

Pharynx: Front of the 1st rib ¾-1” medial to where the clavicle crosses the 1st rib

Prostate: Laterally on either side of the pubic symphysis; also, from the greater trochanter inferiorly to within 2” of the knee joint on the outer aspect of the femur

Pyloric stenosis: Along the sternal body from the angle of Louis to the xiphoid process

Rectum: Around the lesser trochanter

Retina, conjunctiva: Anterior aspect of the humerus, from middle aspect of the surgical neck downward

Sinuses: 3 ½” from the sternum, on the upper edge of 2nd rib and in the 1st intercostal space

Small intestine: Intercostal spaces between the 8th and 9th, 9th and 10th, and 10th and 11th ribs near the cartilaginous attachments bilaterally

Spleen: Between the 7th and 8th ribs (7th intercostal space) on the left close to the costochondral junction

Stomach, decreased peristalsis: Between the 6th and 7th ribs (6th intercostal space) from the mid-clavicular line to the sternum on the left

Stomach, hyperacidity: Between the 5th and 6th ribs (5th intercostal space) from the mid-clavicular line to the sternum on the left

Testes: Upper, medial border of the pubic bone

Thyroid: Between the 2nd and 3rd ribs (2nd intercostal space) close to the sternum

Tongue: Anterior aspect of the 2nd rib cartilage ¾” lateral to the sternum

Tonsils: Between the 1st and 2nd ribs (1st intercostal space) close to the sternum

Urethra: Medial edge of the pubic ramus near the upper edge of the pubic symphysis

Uterus: Upper edge of the junction of the pubic ramus with the ischium

References

Chapter 19

1-Chila, Anthony G. (2011). Foundation of Osteopathic Medicine, 3rd Edition. Philadelphia, PA: Wolters Kluwer, Lippincott Williams and Wilkins. Pgs. 853-855

2-Chila, Anthony G. (2011). Foundation of Osteopathic Medicine, 3rd Edition. Philadelphia, PA: Wolters Kluwer, Lippincott Williams and Wilkins. Pg. 861

3-Chila, Anthony G. (2011). Foundation of Osteopathic Medicine, 3rd Edition. Philadelphia, PA: Wolters Kluwer, Lippincott Williams and Wilkins. Pg. 862

Chila, Anthony G. (2011). Foundation of Osteopathic Medicine, 3rd Edition. Philadelphia, PA: Wolters Kluwer, Lippincott Williams and Wilkins

DEFINING CRs

The palpable tissue texture phenomenon known as a Chapman’s reflex has a rich history, appreciating the historical evolution of its definition and integration by different practitioners, and provides a better understanding of how today we locate, interpret, and clinically use this somatic finding. The current definition used by the osteopathic profession defines CRs as “a system of reflex points that present as predictable anterior and posterior fascial tissue texture abnormalities (plaque-like changes or stringiness of the involved tissues) assumed to be reflections of visceral dysfunction or pathology” (ECOP, 2006). This definition encompasses the lymphatic, neuroendocrine, and autonomic response to injury, illness, and disease as palpable and predictable viscerosomatic tissue reflexes found on the anterior and posterior body surface. Historically, definitions of the CR point reflect its structural feel linked to an evolving speculation as to the underlying dysfunction causing it.

Several mechanisms for the CR points have been proposed by those who value their use empirically. These include lymphatic abnormalities, fibrositis deposits, inflamed lymph vessels passing over ribs and bones, inflamed nerve endings, and inflamed sympathetic nerve filaments around terminal arterioles (Ketchum, 1943). Thus, it can be seen that lymphatic, neuroendocrine, and autonomic interactions were considered to be a part of CRs from early on.

HISTORICAL BACKGROUND

Early osteopathic medicine emphasized the role of the nervous system and body fluids in health and disease. Somatic dysfunctions of the musculoskeletal system were considered to be anatomical abnormalities obstructing these physiological processes, and through these structure and function considerations, osteopathic manipulation was employed to assist the body’s recovery from injuries, illnesses, and disease (Deason, 1940; Hulett, 1922; Still, 1899, 1902, 1910). This was the prevailing philosophy when Frank Chapman (1871 to 1931) enrolled at the American School of Osteopathy in Kirksville, Missouri. After graduating in 1899, he returned to Galesburg, Illinois, where he practiced until his death (Samblanet, 1944). In 1901, Chapman had a patient with severe adenitis whose response to osteopathic treatment directed to the spine was slow. He noticed that the groin glands and those on the medial side of the thighs were indurated and painful, and he decided to gently manipulate these glands and nothing else. When the patient returned, his improvement was such that he confined the treatment solely to the manipulation of these indurated areas. This observation led Chapman to a more detailed study of the lymphatic system and its role in health and disease (Lippincott, 1946). Building on his osteopathic knowledge, which at that time lacked a detailed discourse on the lymphatic system, Chapman came across Mechanical Vibratory Stimulation published by Maurice F. Pilgrim, M.D., in 1901. This seminal text emphasized the capacity for mechanical stimulation of reflex centers to influence body fluids and lymphatic drainage, thereby affecting a variety of physiological functions such as respiration, digestion, secretion, excretion, and muscular metabolism (Pilgrim, 1903; Lippincott, 1946). Though Pilgrim’s method of treatment differed from Chapman’s, it was likely to have provided him with the inspiration that eventually led to the conception of lymphatic or CRs.

Encouraged by positive clinical outcomes, Chapman diligently began making observations and case records. He mapped the congested lymphatic areas that he found in consistent locations close to the body surface and, believing that they bore a physiological relation to the lymphatic and nervous system, referred to them as neurolymphatic points. By the late 1920s, Chapman located over 200 centers on the body surface and established their association with the visceral and endocrine glands (Lippincott, 1946). He published his observations and the first chart in his 1929 text Lymphatic reflexes: a specific method of osteopathic diagnosis and treatment (Chapman, 1929).

Charles Owens, D.O., was Chapman’s brother-in-law and classmate at the American School of Osteopathy. He had little involvement in the development of the CR system until close to Chapman’s death. Owens asked Chapman’s clinical opinion on an encumbering dizziness that was troubling him. He was intrigued by the manner in which Chapman diagnosed and relieved the ailment. Owens encouraged Chapman to chart the specific reflex lesion areas for the wider use by the osteopathic profession, a task completed shortly before Chapman’s death (Samblanet, 1944). The concept of the CRs was introduced to the osteopathic community in an article penned by Owens (1930):

“In this connection, I am glad to draw attention to the conclusions of an osteopathic physician, Dr. Frank Chapman of Galesburg, IL. As a result of years of research and study, Dr. Chapman advances the idea that in addition to the well-known spinal and sympathetic nervous system, with its controlling nerve centers, there lies within this same system an independent group of gangliform centers which control the activities of the lymphatic system in its relation to the viscera of the body, the knowledge of which enables the practitioner to determine with the utmost precision and accuracy the exact state of the various organs of the body.... That this information will be received with profound interest by that portion of the profession who have given much attention to the spleen and lymph flow in their practices, goes without saying… That the ability to be able to tell his patient, for example, by the condition of one of these lymphatic centers, that he has a markedly disturbed condition of the hydrochloric secretions of the stomach; or, that the muscular action of the stomach is retarded by the state of another of these same centers, or, that he has a highly acid condition of the blood, due to a stenosis of the pyloric orifice holding the contents of the stomach against normal ejection until, by the continued accumulation of hydrochloric acid, the pylorus is compelled to open and permit some of the stomach content to pass, and do all this by these centers in place of having to resort to test meals, x-rays, etc., is hard to believe.”

After Chapman’s death, Owens continued developing the system and organized several postgraduate teaching seminars. Owens recognized CRs as viscerosomatic tissue reflexes and believed them to be a result of a lymph stasis in the viscus, which he hypothesized was the cause of the organ dysfunction. He proposed the causative factor to be pelvic girdle somatic dysfunctions interfering with the blood and nerve supply to the gonads, triggering a cascade of endocrine responses. Owens named this cascade the pelvic-thyroid (with adrenals) syndrome (Owens, 1937, 1943)— later renamed the pelvic-thyroid-adrenal, or PTA syndrome (Arbuckle, 1947). The thyroid was central to this syndrome and its involvement was considered to result in a widespread metabolic disturbance causing incomplete oxidation in cells, body fluids to move slowly, and lymphatic engorgement leading to retention of toxins. The area of least resistance in the body would develop a local lymph stasis through nerve impulses and

chemical reactions of the lymphoid tissue (Owens believed acetylcholine to be involved), and would result in a positive corresponding CR point on the body surface (Owens, 1940). As a treatment approach, addressing CRs was proposed to deal directly with the disturbed body metabolism through the autonomic nervous system, the lymphatic system and the endocrine glands, and the treatment would help normalize endocrine secretions, augment flow of body fluids, and release inhibited trophic (nutritional) centers.

Paul E. Kimberly, D.O., F.A.A.O., first organized CRs into a course for the profession, but it was never offered. In the late 1970s, Kimberly integrated CRs into osteopathic physical examination teachings during his tenure at the Kirksville College of Osteopathic Medicine. Based on the apparent correlation with the tissue texture changes occurring at the anatomic sites where the cutaneous vascular-lymphatic bundle exited together with the anterior and lateral cutaneous nerves (Figs. 52G. 1 and 52G. 2), and like Chapman and Owens, he used the term neurolymphatic points to describe them but presented them to his students as viscerosomatic reflexes related to the facilitated segment concept work of faculty colleagues, Korr and Denslow.

Subsequently, other osteopathic educators tended to describe the reflexes as more highly correlated with the sympathetic nervous system rather than the lymphatic system, indicating that this treatment influences visceral function by acting on some part of a reflex arc (Patriquin, 1992). In the previous edition of the Foundations text, Patriquin expresses some discomfort with his earlier attempt at defining these points as being sympathetically mediated findings in and of themselves (Patriquin, 2003). Other authors have classified CRs as part of the palpatory findings in a viscerosomatic reflex level involvement, pointing to the consistency in both the location of the CRs and of the sympathetic innervation of the dysfunctional organ (Kuchera and Kuchera, 1994). In the opinion of one of the authors (MLK), defining a tissue texture abnormality as a CR without the evidence of other concomitant visceral or viscerosomatic findings may be less reliable.

LOCATING AND PALPATING CRs

CRs are manifested by gangliform contractions, which are believed to be congestions within fascia due to lymph stasis secondary to visceral dysfunction (Capobianco, 2004). The types of visceral dysfunction believed to cause positive CRs are inflammation, spasm, or distention of the viscera (Wilson, 2006). The reflexes are located deep to the skin and subcutaneous areolar tissue, most often lying on the deep fascia or periosteum (Patriquin, 1997, 2003). It is mostly found in specific locations with a size varying from a “BB” pellet to a pea, or from a pinhead to an almond, and have certain recognizable palpatory characteristics (Capobianco, 2004; Patriquin, 2003; Samblanet, 1944). Owens described them as follows (Owens, 1943):

Gangliform
Edematous
Ridge-like or ropy
Fibrospongy
Shotty

The technique best used for palpation might depend on the location of the CR points (e.g., see Table 52G. 2). For instance, in cases where the points are located on the transverse processes of vertebrae, there might be contracted muscles overlying the Chapman’s point. Remember that its location in many cases is in the deep fascia or periosteum, and it may be necessary to first relax the overlying muscle to effectively treat the CR point (Hinckley-Chapman and Owens, 1932; Owens, 1943). The patient usually feels tenderness ranging from slightly painful to almost unbearably painful. There may however be a few patients who show no tenderness response to even firm digital pressure, although the CR point is palpable (Owens, 1943). It is unknown if this is related to the visceral dysfunction being in early or chronic stages, if the patient’s pain threshold is very high, or if it is just a coincidental finding with no bearing at all. Historically, it has been proposed that the intensity of pain denotes the relative amount of involvement of the related organ, and the complete lack of pain denotes a process of long duration and very marked involvement (Brown, 1949). It has also been suggested that the absence of tenderness in the point might indicate abnormal hypofunction of the associated organ (Mitchell, 1974). For a CR point to be positive, both the anterior and the posterior CR should be present (Lippincott, 1946). It is generally recommended to initially use the anterior CR for diagnostic purposes as their consistency in location and the fact that they are more widespread than the posterior CR points. This eliminates the confusion as to which organ is involved (Brown, 1949). Once a positive anterior CR has been established, its diagnosis is confirmed through the presence of a posterior CR (Lippincott, 1946).

DIAGNOSTIC UTILITY

Many osteopathic physicians use CRs as part of a screening or comprehensive osteopathic physical examination, contributing to the differential diagnosis and implying dysfunction of an organ system rather than as a therapeutic intervention (Patriquin, 2003). This said, because many modalities can be used to directly treat these points, it is important to perform a complete or focused diagnostic screen prior to any use of physical therapy or preparatory OMT (such as soft-tissue massage) that might temporarily reduce their sensitivity or tissue texture characteristics. One of the authors (KW) has formulated two principles when it comes to using CRs as a diagnostic tool: (1) a nontender CR, by itself, indicates nothing. Never make a diagnosis based solely on a nontender CR, and (2) Never ignore or trivialize a tender CR unless you have a good explanation for the findings. (This is especially true of a persistently tender reflex.)

From a diagnostic perspective and particularly in the hospital, they are more likely to be used selectively, as in the 30- or 45-seconds CR screening examinations (Figs. 52G. 3 and 52G. 4), which is a time-effective screen that focuses on selected organ systems and in conjunction with other findings in the history and physical examination of the patient.

INTEGRATING CRS IN THE CLINICAL SETTING

Incorporation of CRs does not constitute a stand-alone approach. Its diagnostic and therapeutic usefulness depends on its integration with a more comprehensive osteopathic management strategy. The lymphatic system should be addressed by removing obstructions to lymph return and techniques to augment lymph flow. Somatic dysfunctions of the thorax and the pelvis should be treated to reduce autonomic interference caused by segmental facilitation. Respiratory efficiency should be restored by addressing rib cage mechanics and muscles of respiration. The patient’s overall energy expenditure should be reduced by improving overall biomechanical and postural function. Addressing these factors together with CRs is a useful tool in improving musculoskeletal and systemic function as well as reducing the patient’s overall allostatic load.

In the original teachings of CRs, the following points were emphasized when using this system for diagnosis and treatment (Owens, 1943):

Know the exact anatomical location of each CR and its clinical significance
Do not overtreat the CR: 15 to 30 or 30 to 60 seconds is enough time for each center
Sequence your treatment
Address biomechanical dysfunctions of the pelvic girdle first
- Treat the CR comprising the pelvic-thyroid-adrenal syndrome (PTA syndrome)
- Treat the CR corresponding with organs of elimination to reduce load placed on the body from the overall osteopathic treatment of the case at hand
- Treat the specifically involved CR
Do not forget assessment and treatment of the lymphatic system, especially involved regions of impaired lymphatic drainage
Articulatory treatment to the axial spine and ribs to reduce normalize sympathetic activity
After reestablishing the “endocrine” balance through CR, other somatic dysfunctions can be treated

It is important to keep in mind that this recommendation was made in the 1930s and 1940s, and even though the general principles might still be applicable today, the evolution of osteopathic treatment models has allowed for its reinterpretation. Excessive manipulative intervention is recognized as a potential body stressor: procedures employed prior to the use of CR treatment should be administered judiciously, specifically and with restraint (Mitchell, 1974). The algorithm in Figure 52G. 5 serves to illustrate how CRs could be integrated in a clinical setting.

SPECIFIC TREATMENT USING CRs

There are several possible approaches commonly employed to treat patients using the CRs (Table 52G. 4):

The original recommendation by Chapman was to start with the anterior points and then proceed to the posterior ones. He stated that treating the anterior points first would greatly aid in the treatment of the posterior points. Chapman’s original protocol warned against excessive pressure and he wrote that gentler means rather than forceful pressure would result in quicker relaxation (Chapman, 1928)
If the points are too sensitive to be palpated and treated, myofascial release of the tissue around the gangliform area can help drainage be more comfortably established, which in turn can make it possible to treat the point directly (Lippincott, 1946)
If the anterior points were too sensitive to treat, OMT to the soft tissues posteriorly often decreases or even totally dissipates the related anterior points; the residual change then only needing minimal treatment. For this reason, however, use of preparatory soft-tissue methods that temporally negate the presence of the anterior points for diagnosis should be avoided (Kuchera, 1994)

PATTERNS OF CRs IN CLINICAL CONDITIONS

After having completed the osteopathic evaluation of the patient, the physician will typically sequence their osteopathic manipulative treatment based on the pattern of dysfunctions present in the patient. Interaction between dysfunctions and how they might influence each other through various biomechanical, postural, neurological (autonomic and somatosensory), and circulatory mechanisms is also of major importance. Understanding these interactions typically helps the physician establish the priority and sequence of the treatment. Similarly, when evaluating and treating pain patterns from MTrP, it is important to understand that active trigger points can be maintained by distant satellite MTrP.

The Reflex

A great deal is known about how the basic structural unit of the nervous system, the neuron, interacts with other cells through synaptic structures and the release of neurotransmitters and neuromodulators. The billions of neurons and glial cells that make up the nervous system are organized into functional groups, often with widely differing structural and functional characteristics. Many of the neurons are involved in networks that respond to stimuli impinging on or even originating in the body, which results in commands to muscles and glands that produce activity or secretions. These networks, the reflexes, have been more fully analyzed in recent years. What were previously considered to be almost autonomous units of function are actually complex and interactive aspects of an organizational whole. The reflex has been found to be anything but a static unit of input/ output relationships, but rather it is an active and ever-changing mosaic. The characteristics of reflex function are modulated by messages from other areas of the nervous system and by activity of the endocrine and immune systems. In fact, reflexes must not be viewed as separate entities but as parts of various programs that control motor and secretory actions. Thus, an individual reflex may serve differing functions depending on which control program is operating. However, for purposes of analysis, reflexes have usually been isolated for study, a practice that has erroneously led many students to view reflexes as simple and unchanging entities.

REFlEX INTERACTIONS

We might expect to find that afferent input from somatic structures has some influence on visceral organs and that input from visceral structures has some effect on somatic organs. Somatovisceral and viscerosomatic reflexes have been known for many years but, until recently, have received little attention from the research and medical community. However, these types of reflex interactions are very important for the practice and understanding of osteopathic palpatory diagnosis and treatment and for the integration of body function.

A familiar example of a viscerosomatic reflex is pain and muscle tightness in the left shoulder with onset of a myocardial infarction (MI). The nociceptive input from the compromised myocardium (a visceral structure) is exciting not only the pathways that are interpreted as shoulder pain (a somatic structure) but is also causing the motoneurons supplying the shoulder muscles to become active. In a classic study, Eble (10) showed several such reflexes by stimulating visceral structures and recording somatic muscle activity. He demonstrated that stimulation of various visceral structures produced somatic muscle activity.

Conversely, activity in a somatic structure can alter visceral function. In a number of studies over the last several years, Sato (11) clearly demonstrated the effect of somatic stimulation on various visceral functions, ranging from heart rate to adrenal output. These studies have also shown that some of these reflex interactions occur directly in the spinal cord. With others, the afferent activity from the somatic stimulation travels up the spinal cord to the brainstem, resulting in a cascade of activity from the brainstem back down to the spinal autonomic motoneurons.

In both viscerosomatic and somatovisceral reflex networks, activity resulting from the stimulation of a structure can have either an excitatory or an inhibitory influence on the motoneurons involved. For example, stimulation of the belly skin usually results in inhibition of gut activity (a somatovisceral reflex) but increases heart rate.

In daily life, the body’s somatic system is active. The skeletal muscles are the machines that carry out activities. The visceral organs are the means by which the energy demands and maintenance of the muscles are met and by which waste is disposed of. Without a continuous and highly integrated communication between these two systems, the body could not continue to achieve a balance among:

Its energy needs and supply

The amount of blood necessary to carry nutrients and waste and fulfill the demands of the muscles and bones

Supply and demand in general

The neural connections represented by these reflex systems are one of the primary ways this integration is carried out.

For the osteopathic physician, the viscerosomatic and somatovisceral reflexes are of extreme importance. When using palpatory diagnosis to detect subtle problems in function, whether it be tissue texture changes, motion characteristics, or temperature variations of the body, the physician is sensing clues from the musculoskeletal system, skin, muscles, and fascias. These clues reflect not only aspects of these tissues but also functional characteristics of the underlying visceral organs and tissues through the viscerosomatic reflex networks. When the physician uses manipulative treatment to correct somatic dysfunctions, underlying visceral function is affected through the somatovisceral reflex networks. Thus, for both palpation and treatment, an understanding of reflex function is necessary.

NEURAL BASIS FOR REFlEX INTERACTIONS

Evidence is accumulating about the neural basis of viscerosomatic and somatovisceral interactions. When a stimulus is applied, afferent input from either visceral or somatic structures flows into the spinal cord along the dorsal roots and enters the upper areas of the spinal gray matter. The spinal gray matter is commonly divided into ten layers, first documented on cytoarchitectural evidence by Rexed (12) (Fig. 9.4). Large-diameter, cutaneous afferent input that signals nonnociceptive stimuli enters the spinal gray of the dorsal horn and terminates primarily in layers III and IV. Nociceptive afferents from both somatic and visceral structures enter the cord and send branches rostrally and caudally in Lissauer’s tract that runs along the apex of the dorsal horn. Branches of this nociceptive input then terminate in layers I, II, V, VII, and X. Layers I and V display an especially tremendous overlap of the input from somatic and visceral nociceptors (13).

It now appears that in most areas of the spinal cord, practically every interneuron that receives input from a visceral nociceptor also receives input from a somatic source. It also appears that almost 80% of interneurons that receive input from somatic structures also receive visceral input. Presently, there is no evidence for any ascending pathway that transmits only visceral sensory signals from the spinal cord to the brain. This raises the question of how an individual can distinguish visceral from somatic pain or sensation at all. In many cases, visceral pain is felt as a diffuse and poorly localized sensation and is referred to somatic structures. The overlap of somatic and visceral input explains the referral of visceral pain to somatic structures, which is designated as referred pain.

Impulses arriving from visceral structures and converging onto interneurons also receiving somatic afferents activate ascending pathways to the brain that result in the perception of pain in the somatic structure. In addition, more somatic than visceral input occurs because the viscera are much more sparsely innervated with sensory receptors. This suggests that visceral input has much more diffuse functional effects than the corresponding somatic afferents do. For example, it appears that many of the somatic C fibers terminate primarily in focal areas of layer II of the cord. Visceral C fibers extend for several segments and give off collaterals at regular intervals. Only about 10% of the inflow into the thoracolumbar spinal cord comes from visceral structures (14). This sparse innervation but wide distribution of visceral afferents may be the basis for the diffuse nature of most visceral pain. The evidence indicates that the widespread effects of visceral input are due more to functional (spread of activity through networks) than anatomic (many collateral branches) divergence (15).

The overlap of input onto common interneurons within the gray matter of the spinal cord is also the basis for the activation of somatic muscle activity seen with visceral disturbances. The excitatory drive provided onto common interneurons by visceral input activates not only sympathetic outflow back to visceral structures but also motoneurons (both alpha and gamma) that innervate skeletal musculature. The result is a tonic activation of skeletal muscles in the referral area of visceral input. This is the viscerosomatic reflex manifestation, or splinting, that is seen, for example, in appendicitis.

These relationships also underlie the reverse phenomenon, that of the somatovisceral reflex, in which somatic input alters sympathetic and parasympathetic outflow. The data on the convergence of somatic and visceral input are beginning to explain the interrelations between visceral and somatic structures, especially when nociceptive input is activated.

There are descending influences on the activity of both somatic and visceral reflex pathways. In many of the reflex loops driven by both visceral and somatic input, there is a strong effect of descending pathways on the long-lasting excitability of the reflex outflow. These descending influences can maintain the excitability of the reflex for extended periods. They may account for some of the long-term increases in sensitivity, muscle contractions, and hyperexcitable sympathetic output seen especially with visceral disturbances. Likewise, the long-lasting descending influences can be inhibitory, resulting in lowered somatic or autonomic outflow. For example, the effects of rib-raising techniques (a somatic stimulation) on sympathetic outflow seem to be primarily inhibitory through the descending brain influences, resulting in decreased vasoconstriction and better fluid flow in the thoracic area.

Although much of our information on the activation of sympathetic afferents by skeletal input has come from nociceptive input, there is evidence that sympathetic output can also be strongly driven independent of nociception by muscle proprioceptors. For example, Kaufman (17) has shown large effects on sympathetic outflow driven by alteration of proprioceptive input from muscles. Pickar and his colleagues have also found evidence for somatosymapthetic reflex interactions from the low back (18). Thus, the evidence for activation and control of sympathetic activity by somatic input strongly suggests a basis for musculoskeletal activity in the regulation of body function through somatovisceral reflexes. Likewise, recent research by Jou and Foreman (19) has shown that cardiac efferents can have dramatic influences on muscle activity, supporting the role of viscerosomatic reflex connections as underlying the effectiveness of palpatory diagnosis in visceral disease states.

However, the direct interactions through the spinal cord of visceral and somatic inputs are not the only important means of interactions. Goehler and her colleagues have delineated a strong vagal to brain input that is primary in signaling pathogenic disturbances in the gut (20– 22). The vagus is a very potent signaler for the very short latency first immune response to impending infections. The total response to vagal signals involves autonomic, somatic, and psychological responses that prepare the body to fight the infection. Called the bottom-up response, it prepares the whole system for defense. Interestingly, the same response can occur from the “top down” being triggered by psychological stress (21). The complexity of visceral, somatic, and psychological interactions is truly remarkable and only beginning to be understood.

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