Viscerosomatic & Somatovisceral Reflexes

Sympathetic + parasympathetic innervation by organ — Chapman's points.

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◆Viscerosomatic reflex

•Visceral pathology → somatic dysfunction at the corresponding spinal level (sympathetic origin)
•Manifests as paraspinal tissue texture changes, tenderness, restricted motion
•Persistence after acute illness can become chronic somatic dysfunction (facilitation)

•Somatic dysfunction → visceral symptoms or dysfunction (through shared neural pathways)
•Basis for using OMT to influence visceral function (e.g., rib raising for sympathetic balance)

•Head & neck: T1–T4
•Heart: T1–T5 (left for inotropy/rate, right for SA node)
•Lungs/bronchi: T2–T7
•Upper extremity: T2–T7
•Esophagus, stomach, liver, gallbladder, spleen, pancreas, duodenum: T5–T9 (proximal GI tract)
•Small intestine, appendix, R colon (proximal): T9–T11 (mid-GI)
•L colon, kidneys, ureters, ovaries, testes: T10–L2 (lower GI/GU)
•Bladder & lower extremity: T10–L2 (testes/ovaries T10; uterus, cervix T10–L2)
•Erection: parasympathetic; ejaculation: sympathetic ('Point and Shoot')

•Head, neck, heart, lungs, GI (down to transverse colon): vagus (CN X)
•Descending colon, sigmoid, rectum, bladder, reproductive organs (lower): S2–S4 (pelvic splanchnic)
•Vagal stimulation: ↓HR, ↑ bronchoconstriction, ↑GI motility

•Acute MI: left T1–T4 paraspinal tissue changes (often associated with referred chest, jaw, arm pain)
•Pneumonia: T2–T7 paraspinal changes on affected side
•Cholecystitis: right T5–T9; also right shoulder pain (phrenic nerve)
•Appendicitis: T10–T12 (right); McBurney point tenderness
•Renal colic: T10–L2 (back and flank pain referred)
•Pelvic pathology: T10–L2 or S2–S4 (depending on organ)

Organ	Sympathetic level	Clinical correlate
Head/Neck	T1–T4	Sinus, TMJ, headache
Heart	T1–T5 (R: SA node; L: rate/contractility)	MI viscerosomatic at left T1–T4
Lungs	T2–T7	Asthma, pneumonia, COPD
UE	T2–T7	Raynaud, CRPS, brachial plexopathy
Upper GI (stomach, liver, gallbladder, spleen, pancreas)	T5–T9	Cholecystitis = right T5–T9 + R shoulder
Mid GI (SI, appendix, R colon)	T9–T11	Appendicitis = T10–T12 right
Lower GI (L colon to rectum)	T10–L2 (pre) / S2–S4 (para)	Constipation, IBS
Kidneys / ureters	T10–L2	Renal colic referred to flank/groin
Pelvic organs / LE	T10–L2 (sym) / S2–S4 (para)	Dysmenorrhea, BPH, ED

◆Point (parasympathetic erection, S2–S4) and Shoot (sympathetic ejaculation, T10–L2)
◆Asthma exacerbation: rib raising at T2–T7 reduces sympathetic outflow → bronchodilation
◆Vagus (CN X): heart, lungs, GI down to mid-transverse colon
◆S2–S4 ('S2,3,4 keep poop and pee off the floor'): pelvic parasympathetics

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