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      Proposal for Manual Osteopathic Treatment of the Phrenic Nerve

      review-article
      1 , , 2 , 3
      ,
      Cureus
      Cureus
      myofascial, pain, phrenic nerve, diaphragm, osteopathic manipulation, osteopathy, fascia

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          Abstract

          The article reviews the anatomical path of the phrenic nerve and its anastomoses, with the most up-to-date knowledge reported in the literature. We have briefly reviewed the possible phrenic dysfunctions, with the final aim of presenting an osteopathic manual approach for the treatment of the most superficial portion of the nerve, using a gentle technique. The approach we propose is, therefore, a theory based on clinical experience and the rationale that we can extrapolate from the literature. We hope that the article will be a stimulus for further experimental investigations using the technique illustrated in the article. To the authors' knowledge, this is the first article that takes into consideration the hypothesis of an osteopathic treatment with gentle techniques for the phrenic nerve.

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          Most cited references115

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          Evidence based medicine: what it is and what it isn't

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            The Axon-Myelin Unit in Development and Degenerative Disease

            Axons are electrically excitable, cable-like neuronal processes that relay information between neurons within the nervous system and between neurons and peripheral target tissues. In the central and peripheral nervous systems, most axons over a critical diameter are enwrapped by myelin, which reduces internodal membrane capacitance and facilitates rapid conduction of electrical impulses. The spirally wrapped myelin sheath, which is an evolutionary specialisation of vertebrates, is produced by oligodendrocytes and Schwann cells; in most mammals myelination occurs during postnatal development and after axons have established connection with their targets. Myelin covers the vast majority of the axonal surface, influencing the axon's physical shape, the localisation of molecules on its membrane and the composition of the extracellular fluid (in the periaxonal space) that immerses it. Moreover, myelinating cells play a fundamental role in axonal support, at least in part by providing metabolic substrates to the underlying axon to fuel its energy requirements. The unique architecture of the myelinated axon, which is crucial to its function as a conduit over long distances, renders it particularly susceptible to injury and confers specific survival and maintenance requirements. In this review we will describe the normal morphology, ultrastructure and function of myelinated axons, and discuss how these change following disease, injury or experimental perturbation, with a particular focus on the role the myelinating cell plays in shaping and supporting the axon.
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              Anatomic connections of the diaphragm: influence of respiration on the body system

              The article explains the scientific reasons for the diaphragm muscle being an important crossroads for information involving the entire body. The diaphragm muscle extends from the trigeminal system to the pelvic floor, passing from the thoracic diaphragm to the floor of the mouth. Like many structures in the human body, the diaphragm muscle has more than one function, and has links throughout the body, and provides the network necessary for breathing. To assess and treat this muscle effectively, it is necessary to be aware of its anatomic, fascial, and neurologic complexity in the control of breathing. The patient is never a symptom localized, but a system that adapts to a corporeal dysfunction.
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                Author and article information

                Journal
                Cureus
                Cureus
                2168-8184
                Cureus
                Cureus (Palo Alto (CA) )
                2168-8184
                11 April 2024
                April 2024
                : 16
                : 4
                : e58012
                Affiliations
                [1 ] Physical Medicine and Rehabilitation, Don Carlo Gnocchi Foundation, Milan, ITA
                [2 ] Anesthesiology/Pain Medicine, H. Lee Moffitt Cancer Center and Research Institute, Tampa, USA
                [3 ] Osteopathy, Triada Zdrowia Clinic, Warsaw, POL
                Author notes
                Article
                10.7759/cureus.58012
                11007451
                38606024
                a8015e74-1106-4bd8-b5e6-c6f98decdee5
                Copyright © 2024, Bordoni et al.

                This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 11 April 2024
                Categories
                Anatomy
                Physical Medicine & Rehabilitation
                Osteopathic Medicine

                myofascial,pain,phrenic nerve,diaphragm,osteopathic manipulation,osteopathy,fascia

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