Primary respiratory mechanism
Primary respiratory mechanism
Chronic Week 1
Chronic Week 1
Down syndrome (Trisomy 21)
Galactosemia
Tay-Sachs disease (NORD)
Mucopolysaccharide storage disease type 1 (Hurler syndrome) (NORD)
Phenylketonuria (NORD)
Phenylketonuria (NORD): Year of the Zebra
Classical homocystinuria (NORD)
Homocystinuria
Glycogen storage disease type II (NORD)
Hypertrophic cardiomyopathy
Abnormal heart sounds
Normal heart sounds
Development of the cardiovascular system
Fetal circulation
Aortic valve disease
Mitral valve disease
Pulmonary valve disease
Tricuspid valve disease
Valvular heart disease: Pathology review
Cyanotic congenital heart defects: Pathology review
Acyanotic congenital heart defects: Pathology review
Atrial septal defect
Ventricular septal defect
Patent ductus arteriosus
Coarctation of the aorta
Cardiomyopathies: Pathology review
Approach to cyanosis (newborn): Clinical sciences
Aortic dissections and aneurysms: Pathology review
Peripheral artery disease
Peripheral artery disease: Pathology review
Vasculitis
Vasculitis: Pathology review
Deep vein thrombosis and pulmonary embolism: Pathology review
Raynaud phenomenon
Fryette laws
Diagnosing cervical somatic dysfunction
Spurling test
Cervical spine counterstrain
Cervical spine facilitated positional release
Cervical spine HVLA
Cervical muscle energy treatment
Cervical spine myofascial release
Other cervical spine treatments
Diagnosing lower limb somatic dysfunction
Special tests for the lower limb
Lower limb counterstrain
Lower limb HVLA
Lower limb muscle energy treatment
Lower limb myofascial release
Other lower limb treatments
Diagnosing lumbar spine somatic dysfunction
Lumbar muscle energy treatment
Lumbar spine counterstrain
Lumbar spine facilitated positional release
Lumbar spine HVLA
Lumbar spine myofascial release
Other lumbar spine treatments
Cranial osteopathy: Cranial nerves
Primary respiratory mechanism
Diagnosing cranial somatic dysfunction
Cranial treatments
Diagnosing pelvis somatic dysfunction
Pelvis counterstrain
Pelvis muscle energy treatment
Other pelvis treatments
Diagnosing rib somatic dysfunction
Rib counterstrain
Rib HVLA
Muscle energy for rib somatic dysfunction
Other rib treatments
Diagnosing sacral somatic dysfunction
Sacrum counterstrain
Sacrum muscle energy treatment
Sacrum myofascial release
Diagnosing thoracic spine somatic dysfunction
Thoracic spine counterstrain
Thoracic spine facilitated positional release
Thoracic spine HVLA
Thoracic muscle energy treatment
Thoracic spine myofascial release
Other thoracic spine treatments
Diagnosing upper limb somatic dysfunction
Special tests for the upper limb
Upper limb counterstrain
Upper limb HVLA
Upper limb muscle energy treatment
Upper limb myofascial release
Other upper limb treatments
Angina pectoris
Stable angina
Coronary artery disease: Clinical sciences
Coronary artery disease: Pathology review
Heart failure
Heart failure: Pathology review
Congestive heart failure: Clinical sciences
Dilated cardiomyopathy
Restrictive cardiomyopathy
ACE inhibitors, ARBs and direct renin inhibitors
Adrenergic antagonists: Beta blockers
Calcium channel blockers
Thiazide and thiazide-like diuretics
Loop diuretics
Potassium sparing diuretics
cGMP mediated smooth muscle vasodilators
Lipid-lowering medications: Statins
Cardiac conduction velocity
Cardiac conduction system
ECG basics
ECG normal sinus rhythm
ECG intervals
ECG QRS transition
ECG axis
ECG rate and rhythm
ECG cardiac infarction and ischemia
ECG cardiac hypertrophy and enlargement
Notes
Osteopathic cranial manipulative medicine
Primary respiratory mechanism
“The primary respiratory mechanism (PRM) is a functional unit based on the accommodative actions of cranial articular surfaces" (Seffinger).
- "Primary" precedes thoracic respiration in importance in the maintenance of life
- "Respiratory" refers to the exchanges of gases and metabolites at the cellular level
- "Mechanism" implies an integrated machine where each part works in relation to the others
- The inherent rhythmic motion of the brain and spinal cord
- Fluctuation of cerebrospinal fluid
- Mobility of intracranial and intraspinal membranes
- Articular mobility of cranial bones
- Involuntary mobility of the sacrum between the ilia
| BODY MOTION DURING PRM PHASES | |||||
| PRM PHASE | SBS* | MIDLINE BONES | PAIRED BONES | SACRUM | THORACIC RESPIRATION PHASE |
| Flexion | Superior movement | Flexion | External rotation | Counter-nutation (extension) | Inhalation |
| Extension | Inferior movement | Extension | Internal rotation | Nutation (flexion) | Exhalation |
* SBS = Sphenobasilar synchondrosis
See the “Diagnosing cranial somatic dysfunction” learn page for more information on palpating the movements during the flexion and extension phases of the PRM.
Author: Arman Israelyan, OMS-III
Editor: Matt Lipinski, DO
Editor: Robyn Hughes, MScBMC
Key Takeaways
The primary respiratory mechanism (PRM) has two alternating phases, referred to as inhalation and exhalation phases. PRM is perceptible throughout the body, and its action is part of the normal physiology of the living human body. Five anatomic-physiologic phenomena function together as the PRM mechanism. These are: The inherent rhythmic motion of the brain and spinal cord Fluctuation of cerebrospinal fluid Mobility of intracranial and intraspinal membranes Articular mobility of cranial bones Involuntary mobility of the sacrum between the ilia