Chapman reflex points

Summary

Chapman reflex points refer to nerve gangliform contractions located deep to the skin and subcutaneous tissue, most often within the deep fascia or periosteum of the bone. These neurolymphatic points are found at specific areas of the body that correspond to visceral dysfunctions (also termed viscerosomatic reflexes). Pain at any of these points represents potential internal dysfunction or pathology of a specific organ. They can be felt as small, discrete, and smooth palpable nodules, approximately 2 mm in diameter. Although Chapman points are typically diagnostic, they may also be manipulated for therapeutic purposes.

Description

  • First described by Dr. Frank Chapman in the 1920s as “gangliform contracted lymphoid tissue nodules”
  • Arise due to lymphatic congestion or blockage from nerve sheaths at free nerve endings
  • Primarily correspond to the sympathetic fibers of the autonomic nervous system running along dermatomal patterns
  • Round, smooth, discrete and tender palpable nodules (∼ 2 mm in diameter)
  • Associated with visceral dysfunctions
  • Should not be confused with myofascial trigger points (MTrP) or Jones (counterstrain) tender points
  • Located in either the deep fascia or periosteum of bone
  • Corresponding anterior and posterior points
    • Anterior points used diagnostically
    • Posterior points used therapeutically

Anatomy

HEENT
Chapman point Anterior Posterior
Eyes Surgical neck of the humerus Squamous portion of occipital bone below the superior nuchal line
Middle ear Superior to clavicles C1 articular process
Sinuses 1st rib C2 midway between spinous and transverse process
Pharynx Inferior aspect of sternoclavicular joint
Larynx 2–3 inches lateral to sternocostal junction on 2nd rib
Tonsils 1st intercostal space (ICS) Atlas midway between spinous and transverse process
Tongue 2nd rib -
Cardiorespiratory
Chapman point Anterior Posterior
Heart 2nd ICS proximal to sternum Intertransverse space between T2 and T3 lateral to the spinous process
Bronchi T2 midway between spinous and transverse process
Upper lung 3rd ICS Intertransverse space between T3 and T4 midway between spinous and transverse process
(Upper extremities) -
Lower lung 4th ICS Intertransverse space between T4 and T5 midway between spinous and transverse process
Gastrointestinal
Chapman point Anterior Posterior
Esophagus 2nd ICS proximal to sternum T2 midway between spinous and transverse process
Stomach (acidity) 5th ICS on left Left intertransverse space between T5 and T6 midway between spinous and transverse process
Stomach (peristalsis) 6th ICS on left Left intertransverse space between T6 and T7 midway between spinous and transverse process
Pylorus - Costotransverse junction on the right 10th rib
Liver 5th and 6th ICS on right Right intertransverse spaces between T5 and T7 midway between spinous and transverse process
Gallbladder 6th ICS on right
Pancreas 7th ICS on right Right intertransverse space between T7 and T8 midway between spinous and transverse process
Spleen 7th ICS on left Transverse process of T7 on left
Duodenum 8th ICS near costochondral junction Intertransverse space between T8 and T9 midway between spinous and transverse process
Jejunum 9th ICS near costochondral junction Intertransverse space between T9 and T10 midway between spinous and transverse process
Ileum Below 10th rib near costochondral junction Intertransverse space between T10 and T11 midway between spinous and transverse process
Appendix Tip of the 12th rib Right intertransverse space between T11 and T12 midway between the tips of the transverse processes
Cecum Upper 1/5 of the right lateral thigh Triangular area between the transverse process of L2, iliac crest, and transverse process of L4
Ascending colon Middle 3/5 of the right lateral thigh
Hepatic flexure Lower 1/5 of the right lateral thigh
Sigmoid colon Upper 1/5 of the left lateral thigh
Descending colon Middle 3/5 of the left lateral thigh
Splenic flexure Lower 1/5 of the left lateral thigh
Rectum Proximal inner thighs on the lesser trochanter Sacrum, level of S2, near the lower end of the sacroiliac articulation
Genitourinary
Chapman point Anterior Posterior
Kidneys 1 inch lateral and 1 inch superior to the umbilicus Intertransverse space between T12 and L1 midway between spinous and transverse process
Bladder Periumbilical region L2 transverse process
Urethra Superior aspect of the pubic symphysis L3 transverse process
Ovaries Inferior to the pubic tubercle T10 transverse process
Testes
Broad ligament - Between the posterior superior iliac spine and the transverse process of L5
Prostate Lateral aspect of the thigh among the distribution of the colon
Uterus Medial edge of the obturator foramen
Fallopian tubes -
Seminal vesicles -
Vagina/Clitoris Posterior aspect of the proximal inner thigh
Endocrine
Chapman point Anterior Posterior
Thyroid 2nd ICS proximal to sternum -
Adrenals 1 inch lateral and 2 inches superior to the umbilicus Intertransverse space between T11 and T12 midway between spinous and transverse process

Approach

General considerations

  • Typically utilized selectively for diagnostic purposes
  • Somatic manifestations clue into visceral dysfunctions → Conduct further evaluation of corresponding Chapman points.
  • Findings
    • Reflex points can be slightly painful to extremely tender without radiation → supports potential visceral dysfunctions of corresponding organ
    • Nontender reflex points by themselves are inconsequential.

Treatment

  • Pelvic diaphragm release
  • Apply gentle pressure in concentric circular motions for 20–60 seconds (or until the point softens and pain is reduced).
  • Associated somatic dysfunctions may also be treated separately.
  • Seffinger M. Foundations of Osteopathic Medicine. LWW; 2018.
  • Nicholas A. Atlas of Osteopathic Techniques. LWW; 2011.
last updated 09/09/2019
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