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OMT Minute  |   January 2018
OMT for Cancer Patients After Bowel Resection
Author Notes
  • From the Touro University College of Osteopathic Medicine-CA in Vallejo. 
  • Financial Disclosures: None reported. 
  • Support: This video was produced by the Touro University College of Osteopathic Medicine-CA. 
  •  *Address correspondence to Nicole Peña, DO, 1310 Club Dr, Mare Island, Vallejo, CA 94592-1187. Email: nicole.pena@tu.edu
     
Article Information
Gastroenterology / Osteopathic Manipulative Treatment
OMT Minute   |   January 2018
OMT for Cancer Patients After Bowel Resection
The Journal of the American Osteopathic Association, January 2018, Vol. 118, e1. doi:10.7556/jaoa.2018.014
The Journal of the American Osteopathic Association, January 2018, Vol. 118, e1. doi:10.7556/jaoa.2018.014
  
OMT Minute: OMT After Bowel Resection
eVideo. In patients with colon cancer, OMT after bowel resection can reduce musculoskeletal symptoms, complications, and pain.
Patients with cancer typically have substantial somatic dysfunction that results from surgical procedures and treatment regimens, including radiation therapy and chemotherapy. Osteopathic manipulative treatment (OMT) can help reduce musculoskeletal symptoms, complications from treatment, and pain, and thus lead to earlier ambulation, shorter time to flatus, and shortened hospital stays. 
In the video, we describe the application of 2 techniques for patients with colon cancer after bowel resection: release of the 12th rib via balanced ligamentous tension (BLT) and lumbosacral decompression with BLT. These OMT techniques, which should be applied to a patient in the supine position, may be safely and effectively used to improve respiration and postoperative ileus. 
Postoperative patients may splint their breath or breathe in a shallow manner, limiting the motion of the diaphragm. However, diaphragm motion is important not only for aeration and prevention of atelectasis, but also for the movement of venous and lymphatic return from the abdomen and pelvis, including the colon. The diaphragm attaches anteriorly and laterally to the lower ribs at the costal margin and posteriorly attaches to the 12th rib as the lateral and medial lumbocostal arches or arcuate ligaments, covering the quadratus lumborum and the psoas muscles, respectively. By releasing the 12th rib via BLT, the operator can affect tension in the diaphragm via its posterior attachments and increase its overall excursion, helping to optimize intrathoracic and intraabdominal pressure gradients. 
The parasympathetic innervation for the large intestine from the transverse colon onward travels via pelvic splanchnic nerves arising from the S2 through S4 ventral rami and enters the pelvic or inferior hypogastric plexus. In patients who have undergone bowel resection, lumbosacral decompression with BLT may assist the relief of viscerosomatic reflexes and improve parasympathetic outflow, improving postoperative bowel function. 
Acknowledgment
We thank Jeffery Reedy for filming and video editing. 
Resources
Baltazar GA, Betler MP, Akella K, Khatri R, Asaro R, Chendrasekhar A. Effect of osteopathic manipulative treatment on incidence of postoperative ileus and hospital length of stay in general surgical patients [published correction appears in J Am Osteopath Assoc. 2013;113(4):271]. J Am Osteopath Assoc. 2013;113(3):204-209. [PubMed]
Carreiro JE. Pediatric Manual Medicine: An Osteopathic Approach. Elsevier Limited; 2009.
Ettlinger H. Treatment of the acutely ill hospitalized patient. Foundations for Osteopathic Medicine. 2nd ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2003:1115-1142.
Jarski RW, Loniewski EG, J, et al. The effectiveness of osteopathic manipulative treatment as complementary therapy following surgery: a prospective, match-controlled outcome study. Altern Ther Health Med. . 2000;6(5):77-81. [PubMed]
Nicholas AS, Oleski SL. Osteopathic manipulative treatment for postoperative pain. J Am Osteopath Assoc. 2002;102(9 suppl 3):S5-S8. [PubMed]
Sleszynski SL, Kelso AF. Comparison of thoracic manipulation with incentive spirometry in preventing postoperative atelectasis. J Am Osteopath Assoc. 1993;93(8):834-838, 843-845. [PubMed]
Lunniss PJ. Large intestine. In: Standring S. Gray‘s Anatomy: The Anatomical Basis of Clinical Practice. 41st ed. Elsevier; 2016:1136-1159.
  
OMT Minute: OMT After Bowel Resection
eVideo. In patients with colon cancer, OMT after bowel resection can reduce musculoskeletal symptoms, complications, and pain.