EMİLY KAPUSTIN İLE İNSAN VÜCUDUNDA DİYAFRAMLARIN İŞLEVİ VE...

EMİLY KAPUSTIN İLE İNSAN VÜCUDUNDA DİYAFRAMLARIN İŞLEVİ VE ÖNEMİ 

İnsan vücudunda diyaframların işlevi ve önemi sizler için sorduk.

25 Kasım 2022 - 13:05 - Güncelleme: 25 Kasım 2022 - 13:14

Oksijen, tüm canlıların hayati aktivitesinin eşsiz bir ürünüdür, olmamasında yaşam imkansızdır ve eksikliğinde, herhangi bir canlıda,basit bir hücreden insan organizmasına kadar tüm metabolik süreçler önemli ölçüde bozulur. Yaralanmalar dışında insan vücudunda meydana gelen rahatsızlıklar dokulardaki yetersiz gaz alışverişi ve azalmış oksijen miktarından,dolayısıyla var olan bir diyafragmanın işlevsel bozukluğa ve onun sonucunda vücutta gerçekleşen bir problem kaskadından kaynaklı olabilir.
Bu nedenle, bu konunun seçilmesine karar verildi.
 İnsan vücudu ayrı parçalar halinde değil, uyumlu bir bütün olarak işlev görür. İnsanın mükemmel bir şekilde düzenlendiğini anlamalıyız.
 Vücudun diyaframı bir baraj gibidir. Olukların bozulduğunda biriken suyun boşaltma yolunun olmaması;ya da tabanda bir boşluğun ortaya çıkması sonucunda onun yıkımına yol açacağına benzetebiliriz. Diyaframda artan gerilim iç organlarda ve onların içinden geçen damarlarda sıkışmaya neden olurken,zayıflamada ise fıtıkların oluşması görülebilir.Leonid Kononovich Rozlomy. 
Anatomik açıdan insan vücudunda birkaç diyafram ayırt edebiliriz-torakal, pelvik, subklaviyen, submandibüler ve cerebellar tentorium.Her diyafram kendine ait bir patolojiye sahip olabildiği gibi daha kompleks bir patolojinin parçası da olabilir.

PELVİK DİYAFRAM
Pelvik diyaframdaki işlev bozukluklarına bu bölgedeki yapılarda (iç organlar, kaslar, bağlar, eklemler) ağrı, sertlik, ağırlık hissi eşlik eder. Tipik semptomlar, pelvisin yumuşak dokularında ödem, gluteal kaslarda yorgunluk, kasık bağlarında gerginlik ve eklemlerde hareket kısıtlığını içerir. Pelvik patolojilerin çoğunda gluteal kaslar ve onların üzerini örten yüzeyel dokular termal görüntülemeler ile de teyit edilmiş olarak daha düşük sıcaklığa sahiptir. Deri ve derialtı dokunun sıcaklığı diğer vücut bölümlerine göre 5-7 derece daha düşüktür.
Pelvik bölgenin daha kapsamlı ve detaylı araştırmasının bugüne kadar yapılmaması çok şaşırtıcıdır.
Pelvik patolojilerde gluteal bölgedeki deri kıvrımı son derece ağrılı ve alınması çok zordur.
Kalça eklemi bölgesindeki dokular ödem;derialtı dokularda fibrozis izleri; lenfostaz; ve yağlar da dahil olarak, yetersiz oksidasyon ürünlerin birikmesi ile karakterizedir. M.gluteus maximus üst servikal omurga bölümü ile bağlantılıdır ve bu kastaki rahatsızlıklar bu bölgedeki sıkıntılara neden olabilir. (kendi gözlemim)
Büyük gluteal kaslarda kronik gerginlik refleks olarak suboksipital kasların kasılmasına de neden oluyor,bunun sonucunda da omurganın servikal bölgede hiperlordoz gelişebilir. Bu nedenle tedavi sürecinde bu faktör dikkate alınmazsa olumlu bir etki elde etmek çok zordur.
 Pelvik diyaframın patolojisindeki bir sonraki bağlantı, kuyruk sokumu, sakrum ve ilium arasındaki kaslar ve bağlardır. Pelvik taban kasların ve bağların tonusunda bir değişiklik, bu bölgede bulunan organların (mesane, rahim ve ekleri, prostat bezi, rektum) pozisyonunda bir değişikliğe  yol açabilir. 
Pelvik diyaframdaki bozuklukların en olası nedenleri şunlardır: düşme sırasında pelvik kemiklerinde gelişen bozukluklar; ağırlık kaldırırken kasların ve bağların gerilmesi; cerrahi müdahaleler (batın ameliyatları, kürtaj); yapışıklıklarla sonuçlanan genitoüriner enfeksyonlar; kabızlığın eşlik ettiği bağırsak patolojileri (özellikle alt kısmı); zorlamanın eşlik ettiği uzun süreli öksürük; hipotermi, vb. 
Pelvik diyaframın patolojileri, vasküler bozukluklara ve buna bağlı olarak bağ dokusu dahil olmak üzere dokuların beslenmesini etkileyerek fıtık ve varikosel gibi patolojik süreçlere neden olabilirler(A. Alekseev, 1999).
 

TORASİK DİYAFRAM
Torasik diyafram bölgesindeki patolojinin klinik belirtileri, yapısının ve konumunun anatomik özellikleri ile ilişkili kendi özelliklerine sahiptir. Hastalar hipokondriyumda ve belde ağırlık ve ağrı hissi…

 

 

FUNCTIONS AND IMPORTANCE OF DIAPHRAGMS IN THE HUMAN BODY

Oxygen is a unique product of the vital activity of all living beings, without which life is impossible, and with its deficiency, all metabolic processes in any living organism, from a cell to a human being as a whole, deteriorate significantly.

It is possible that all problems in the human body, except for injuries, occur due to insufficient gas exchange in the tissues, namely due to the lack of the required amount of oxygen, which leads to disturbances in one of the diaphragms of the body, and as a result, to a cascade of disorders occurring in the body.

 

Therefore, a choice was made in favor of the relevance of this topic.

“The human body functions not in separate parts, but as a harmonious whole. We must understand that man is perfectly arranged, and this is the TRUTH”. (Tkachenko B.I., 1994)

 

“The diaphragm of the body is like a dam. In one case, when the gateways are broken down, there is no way to dump the accumulated water, and in the other case, the appearance of a gap in the base leads to its subsequent destruction.

The excessive tissue tension in the diaphragm can lead to compression of the internal organs and pinching of the vessels passing through them, weakening can cause the appearance of diaphragmatic hernias”. (Leonid Kononovich Rozlomy)

 

From an anatomical point of view, a number of diaphragms can be distinguished in the human body as follows: pelvic, thoracic, subclavian, submandibular and tentorium cerebelli. Each diaphragm can have both an independent pathology and be a separate link in the pathological chain of the disease.

 

PELVIC DIAPHRAGM

Dysfunctions in the pelvic diaphragm are accompanied by sensations of heaviness, stiffness and pain in the pelvic girdle (internal organs, muscles, ligaments, joints).

 

The typical symptoms include pastosity of the soft tissues of the pelvis, congestion in the gluteal muscles, tension in the inguinal ligaments and stiffness of the joints.

 

In the most pelvic pathologies, the gluteal muscles and superficial tissues located above them have a reduced temperature, which is confirmed by thermal imaging study. The temperature of the skin and underlying tissues, as a rule, is 5-7 degrees lower than in other parts of the body.

The gluteal region deserves the most thorough research.

 

The skin fold in the buttocks area with pelvic pathology is taken with difficulty and is extremely painful. The tissues in the area of ​​the hip joint are edematous (the so-called "riding-breeches") with traces of fibrosis in the subcutaneous layer, the presence of lymphostasis and the deposition of underoxidized products, including fats.

 

‘The gluteus maximus muscle is interdependent with the topmost part of the upper cervical spine, and the pathology in this muscle affects the state of this part of the spine. With chronic tension of the gluteus maximus muscles, a group of suboccipital muscles tightens reflexively, forming hyperlordosis in the cervical spine. Therefore, it is so difficult to achieve a positive effect if this factor is not taken into account in the treatment process’. (Levit K., 1993)

 

The next link in the pathology of the pelvic diaphragm are the muscles and ligaments between the coccyx, sacrum and iliac bones. A change in the tone of muscles and ligaments in the pelvic floor can lead to a change in the position of organs located in the immediate vicinity (bladder, uterus and its appendages, prostate gland, rectum).

 

The most likely causes of disturbances in the pelvic diaphragm are: displacement of the pelvic bones during a fall; stretching of muscles and ligaments when lifting the weights; surgical interventions (abdominal surgery, abortions); infectious diseases of the genitourinary organs, ending in adhesive processes; intestinal pathology (especially its lower section), accompanied by constipation; prolonged cough with an element of straining; hypothermia, etc.

Pathology of the pelvic diaphragm can lead to vascular disorders and, accordingly, to a violation of tissue trophism, including connective tissue (A. Alekseev, 1999). As a result, hernias, varicocele, etc.

 

THORACIC DIAPHRAGM

The clinical manifestations of pathology in the region of the thoracic diaphragm have their own specifics associated with the anatomical features of its structure and location. Patients complain of a feeling of heaviness and pain in the hypochondrium and lower back, shortness of breath (more associated with inhalation), limited rotation of the body, some difficulty with bending  and arching backward and forward. The multiple sources show while examining the respiratory excursion of the chest, there is a restriction of its movement from one or both sides.

 

The inner surface of the costal margin (the place of attachment of the diaphragm) is extremely painful on palpation. As a rule, seals and strands are palpated along its course, which are adjacent directly to the costal margin, making it uneven and thickened. When the patient is lying on his back, the costal arches can protrude strongly upward, sometimes asymmetrically, if one costal edge is located below or above the other.

 

The functional state of the diaphragm may depend on the psycho-emotional factor.

“During the chronic stress in patients, I used to observe changes in the form of an excessively drawn in abdomen and tension in the muscles of the anterior abdominal wall. The painful seals, which were not recorded by x-rays or ultrasound, were often palpated, in the depths of the tissues of the abdominal cavity, in the area between the umbilicus and the xiphoid process. These changes disappeared after elimination of the effects of stress. The most effective means of relieving tension resulting from stress was to conduct a specific technique over the projection of the solar plexus”. (Shafer J., 1991)

 

During pathological processes in the liver (hepatitis, intoxication, injuries, etc.), in the esophagus (esophagitis, diverticula of the lower esophagus, diaphragmatic hernia of the esophagus) and in the stomach (gastritis, peptic ulcer), adhesions are formed between these organs and the diaphragm. On the one hand, adhesions limit the micro- and macro-movement of the internal organs themselves, and on the other hand, they involve the diaphragm in this process (J.-P. Barral, 1989). Excessive tension on the dome of the diaphragm can lead to irritation of the blood vessels passing through it. This irritation manifests itself in the form of a strong and hard pulsation, both of the aorta itself and of the vessels extending from it to the internal organs.

 

SUBCLAVIAN DIAPHRAGM

In the case of the pathology in the area of the subclavian diaphragm, the patient complains of headaches (dull, aching, with a feeling of pressure or constriction, with symptoms of heat or paresthesia), dizziness, nausea, rapid (often superficial) breathing and heartbeat.

 

The possible concomitant symptoms are: stiffness of the upper shoulder girdle; cyanosis, manifested in a decrease in the temperature of the hands; paresthesia of the hands and fingers at night and in the morning; tension in the area of the large pectoral muscles, swelling in the supraclavicular fossae; soreness and tension in the horizontal portion of the trapezius muscle; restriction in turns, tilts of the head and extension of the cervical spine.

 

In the presence of pathology, a sharp lowering of the previously raised shoulders, as well as a deep palpation of tissues in the diaphragm zone, causes some pain and irradiation of the electric current to the shoulder, the elbow and the hand.

 

SUBMANDIBULAR DIAPHRAGM

This area is limited by the edge of the lower jaw, the occipital bone, the transverse processes of the upper cervical vertebrae and the muscles of the neck. Arteries and veins pass in the depths of the submandibular diaphragm, providing inflow and outflow of blood to the brain, organs and tissues of the head.

 

The clinical manifestations in pathology are very diverse, as they capture not only the brain, but also such important organs as the eyes, ears, nose, etc. The leading symptoms are pain, dizziness, ataxia, visual and hearing disorders, smell, inadequate autonomic reactions, vegetative-vascular dystonia.

 

TENTORIUM CEREBELLI

A number of pathologies associated with disorders in the higher nervous activity may depend on the tentorium cerebelli, a change in the tension of which has a pathological effect on the adjacent tissues, meninges and, indirectly, on the human body as a whole.

 

The tentorium cerebelli can be effected by the pathology of the atlanto-occipital articulation, the blocks in the first two cervical vertebrae, compression of the sutures between the frontal bone and the bones of the nose, compression between the occipital bone and the temporal bones, disturbances in the ratio of the palate bones, etc.

 

The clinical symptoms are manifested in the form of headaches, dizziness, imbalance, etc.

 

INDICATION OF THE OBJECT OF STUDY, JUSTIFICATION FOR THE CHOICE OF MATERIAL FOR RESEARCH

Respiration is a physiological process that ensures the normal course of metabolism (metabolism and energy) of living organisms and helps to maintain homeostasis (constancy of the internal environment), receiving oxygen (O2) from the environment and removing some of the metabolic products of the body into the environment in a gaseous state ( CO2, H2O and others). Depending on the intensity of metabolism, a person releases through the lungs an average of about 5 liters of carbon dioxide (CO2) and 50 grams of water per hour. Plus, about 400 other impurities of volatile compounds, including acetone. In the process of respiration, substances, rich in chemical energy belonging to the body, are oxidized to energy-poor end products (carbon dioxide and water), using molecular oxygen for this.

 

The external respiration is understood as a gas exchange between the body and the environment, including the absorption of oxygen and the release of carbon dioxide, as well as the transport of these gases within the body through the system of respiratory tubes (tracheal-breathing insects) or in the circulatory system.

 

The cellular respiration includes the biochemical processes of transporting proteins across the cell membranes; as well as the actual oxidation in mitochondria, leading to the transformation of the chemical energy of food.

 

An adult, being at rest, makes an average of 14 respiratory movements per minute. At the same time, the respiratory rate can undergo significant fluctuations (from 10 to 18 per minute). The respiratory rate of children is 20-30 breaths per minute; of infants 30-40; of newborns 40-60.

During one breath (in a calm state), 400-500 ml of air enters the lungs. This volume of air is called the tidal volume (TO). The same amount of air enters the atmosphere from the lungs during a quiet exhalation.

 

The maximum deep breath is about 2000 ml of air. The maximum exhalation is also about 2000 ml.

After the maximum exhalation, about 1500 ml of air remains in the lungs, which is called the residual volume of the lungs. After a quiet exhalation, approximately 3000 ml remains in the lungs. This volume of air is called the functional residual capacity (FRC) of the lungs.

Owing to the FRC, a relatively constant ratio of oxygen and carbon dioxide content is maintained in the alveolar air, since the FRC is several times greater than the TO. Only 2/3 of the airway reaches the alveoli, which is called the volume of alveolar ventilation.

 

An adult (with a tidal volume of 0.5 liters and a frequency of 14 respiratory movements per minute) passes through the lungs 7 liters of air per minute. The minute volume of breathing can reach 120 liters per minute in a state of physical activity.

During the calm breathing the ratio of inhalation and exhalation in time is 1:1.3.

Without breathing, a person can usually live up to 5-7 minutes, after which loss of consciousness occurs followed by the irreversible changes in the brain and the death.

 

Breathing is one of the few abilities of the body that can be controlled consciously and unconsciously. During the frequent and shallow breathing, the excitability of the nerve centers increases, and while deep breathing, on the contrary, it decreases.

Types of breathing: deep and shallow, frequent and rare, upper, middle (thoracic) and lower (abdominal).

Special types of the respiratory movements are observed with hiccups and laughter.

 

DIAPHRAGM SELLAE

Diaphragm Sellae is a plate of the dura mater, attached to the anterior inclined processes and to the top of the back of the sella turcica, turning its fossa into a cavity in which the pituitary gland is located; it has a hole for the funnel of the pituitary gland. The diaphragm sellae separates the pituitary gland from other brain structures. The diaphragm may have sphincter disturbances that affect underlying structures.

(a picture will be inset here)

 

TENTORIUM CEREBELLI

The tentorium cerebelli (tent of the cerebellum, lat. Tentorium cerebelli) is a sheet of dura mater located between the upper edge of the pyramid of the temporal bone and the transverse sinus. It supports the occipital lobes of the cerebral hemispheres and separates them from the lobes of the cerebellum. A number of pathologies associated with disorders in higher nervous activity may depend on the tentorium cerebelli, a change in the tension of which has a pathological effect on adjacent tissues, meninges and, indirectly, on the human body as a whole.

It connects to the falx cerebri from above in the middle and it passes into the falx cerebelli from below.

 

The outer edge (large circle) is attached along to the transverse groove of the occipital bone, the posterior edge of the temporal pyramid and is attached to the posterior inclined processes of the body of the sphenoid bone, forming Gruber's ligament in this place.

The small circle is free. It bends around the subcortical structures and fuses in front with the anterior inclined processes of the body of the sphenoid bone.

A straight sinus (sinus rectus) lies in the middle of the tentorium cerebelli, at the junction with the falx cerebri.

 

SUBMANDIBULAR DIAPHRAGM

This area is limited by the edge of the lower jaw, by the occipital bone, by the transverse processes of the upper cervical vertebrae and by the muscles of the neck. The arteries and the veins pass in the depths of the submandibular diaphragm, providing inflow and outflow of the blood to the brain, organs and tissues of the head.

 

The clinical manifestations in pathology are very diverse, as they capture not only the brain, but also such important organs as the eyes, ears, nose, etc. The leading symptoms are pain, dizziness, ataxia, visual and hearing disorders, smell, inadequate autonomic reactions, vegetative dystonia.

 

 

SUBCLAVIAN DIAPHRAGM

The patient with the pathology in the area of the subclavian diaphragm, complains of headaches (dull, aching, with a feeling of pressure or constriction, with symptoms of heat or paresthesia), dizziness, nausea, rapid (often superficial) breathing and heartbeat.

 

The possible concomitant symptoms are: stiffness of the upper shoulder girdle; cyanosis, manifested in a decreasing temperature of the hands; paresthesia of the hands and fingers at night and in the morning; tension in the area of the large pectoral muscles, swelling in the supraclavicular fossae; soreness and tension in the horizontal portion of the trapezius muscle; restriction in turns and tilts of the head and in unbending of the cervical spine.

 

THORACOABDOMINAL DIAPHRAGM

This is a powerful connective tissue membrane that separates the chest cavity from the abdominal cavity. When the diaphragm is overstrained, some pain in the ribs as well as a nerve entrapment can be observed, manifested by the pain that sharply increases on inhalation and movement. This diaphragm starts the breath of the body, it determines the differentiation of pressure between the abdominal and thoracic cavities.

This diaphragm (lat. diaphragma, from other Greek. Διάφραγμα septum) is an unpaired muscle that separates the chest and abdominal cavities, which serves to expand the lungs. Conventionally, its boundary can be drawn along the lower edge of the ribs. It is formed by a system of striated muscles, which, apparently, are derivatives of the system of the rectus abdominis muscle. It is peculiar only to mammals and crocodiles. The presence of the diaphragm allows you to dramatically intensify ventilation of the lungs.

Usually the top of the right dome of the diaphragm is at the level of the fourth intercostal space, and the left one is at the level of the fifth intercostal space. When inhaling, the domes of the diaphragm descend by 2-3 cm and flatten.

The diaphragm is pierced with a series of holes that allow the structures that lie between the chest and abdomen to communicate. There are three large openings: aortic, esophageal and venous, which include a number of other small openings.

In the diaphragm, the lumbar, costal and sternal parts are distinguished. Between the lumbar and costal parts there are lumbocostal triangles, between the costal and sternum - sternocostal ones, these formations are the site of occurrence of diaphragmatic hernias.

The lumbar part of the diaphragm (pars lumbalis diaphragmatis) begins on the anterior surface of the bodies of the lumbar vertebrae.

The costal part (pars costalis diaphragmatis) begins on the inner surface of the lower six to seven ribs and ends at the anterior and lateral edges of the tendon center (centrum tendineum).

The sternal part (pars sternalis diaphragmatis) of the diaphragm is the narrowest and the weakest, it starts from the posterior surface of the xiphoid process of the sternum and ends at the anterior edge of the tendon center (centrum tendineum).

The blood supply to the diaphragm is provided by the superior and inferior diaphragmatic, muscular-diaphragmatic and pericardial diaphragmatic arteries. They are accompanied by the veins of the same name.

The diaphragm is innervated by the phrenic nerve, by the branches of the vagus nerve, by the intercostal nerves and by the sympathetic trunk.

The aperture functions are divided into static and dynamic.

There are three separate functions in its dynamic:

• respiratory. As a result of movements of the diaphragm, which, together with the pectoral muscles, cause inhalation and exhalation, the main volume of lung ventilation is carried out.

• cardio-vascular. When inhaling, the heart sac and the lowest part of the superior vena caval, lying inside of the pericardial sac, expand together.

At the same time, a decrease in the diaphragm and a simultaneous increase in intra-abdominal pressure squeeze blood from the liver into the inferior vena cava, which contributes to a constant outflow of venous blood into the right atrium.

In addition, the outflow of blood from the abdominal organs and its inflow to the heart are facilitated by fluctuations in intrapleural pressure (for example, the suction effect of the chest cavity during inspiration).

• motor-digestive. The diaphragm is of great importance for moving food through the esophagus (it is the pulp of the esophagus), and periodic movements of the diaphragm, coupled with the synchronous respiratory movements, are also important for the stomach.

The static (supporting) function is to maintain normal relationships between the organs of the chest and abdominal cavities, depending on the muscle tone of the diaphragm. Violation of this function leads to the movement of the abdominal organs into the chest.

The diaphragm is an important abdominal organ. Its simultaneous contraction with the abdominal muscles and the diaphragm helps to reduce intra-abdominal pressure. During inhaling, the diaphragm contracts, stretching with an active action towards the lower internal organs. During exhaling, the diaphragm passively relaxes and is pulled up by the tendons holding it, coming to its calm state.

The pelvic diaphragm (lat. diaphragma pelvis) occupies the back of the perineum and has the form of a triangle, the top of which faces the coccyx, and the corners are directed towards the ischial tuberosities. The final section of the rectum passes through the diaphragm of the pelvis, both in men and women.

There are several organs that penetrate this muscular septum, located between the pelvic cavity and the perineum. These organs include the urethra (urethra), the vagina, and the rectum. The pelvic diaphragm supports them and helps you exercise more control over them.

The pelvic diaphragm is actually the floor of the pelvic cavity, which contains the large and small intestines, bladder, and kidneys. It supports these organs and allows them to maintain their shape.

The surface layer of the muscles of the pelvic diaphragm is represented by an unpaired muscle - the external sphincter of the anus (Latin m. sphincter ani externus). This muscle lies under the skin surrounding the terminal rectum. It consists of several bundles, the most superficial of which terminates in the subcutaneous tissue. Starting at the top of the coccyx, the bundles cover the anus and end in the tendon center of the perineum. The deepest bundles, surrounding the lower part of the rectum, are adjacent to the muscle that lifts the anus. While contracting, all bundles of the external sphincter of the anus compress (close) the opening of the anus.

The deep muscles of the pelvic diaphragm are two muscles that form the posterior part of the bottom of the pelvic cavity. The muscle that raises the anus (Latin m.levator ani) is a steam room, it has the shape of a thin triangular plate, forms a funnel with a similar muscle of the other side, with a wide part facing upwards. While narrowing, the lower parts of both muscles cover the rectum in the form of a loop. The muscle originates on the side wall of the small pelvis in several bundles. The anterior bundles begin on the inner surface of the lower branch of the pubic bone, the lateral ones - on the tendinous arch of the muscle that lifts the anus (Latin arcus tendineum musculi levatoris ani). The tendon arch is an arcuate thickening of the pelvic fascia where it forms the obturator fascia.

The bundles of the right and left muscles, that lift the anus go down and backwards, connect with each other and cover the rectum. Some of the fibers of these muscles are woven into the prostate gland (in men), the wall of the vagina (in women), as well as into the wall of the bladder and rectum; the muscles themselves end at the top of the coccyx in the form of an anal-coccygeal ligament (lat. lig. anococcygeum). When the muscle, lifting the anus, contracts, the pelvic floor strengthens and rises, the lower (terminal) section of the rectum is pulled forward and upward and the rectum itself is being compressed. This muscle in women also compresses the entrance to the vagina and brings the back wall of the vagina closer to the front.

UROGENITAL DIAPHRAGM

The urogenital diaphragm (diafragma urogenitalis) is a muscular-fascial plate that covers the smaller, anterior part of the exit from the small pelvis. It is stretched between the pubic and ischial bones and consists of the deep and superficial muscles. The deep transverse perineal muscle forms the basis of the urogenital diaphragm. It is fixed to the pubic and ischial bones on the sides.

It consists of the muscle and tendon bundles, which form the tendon center of the perineum in the middle. The urethral sphincter is a circular muscle fiber that surrounds the membranous part of the urethra, and the vagina in women. These muscles are covered by the superior and inferior fasciae of the urogenital diaphragm. Both fasciae fuse behind the deep transverse perineal muscle. The superficial muscles of the diaphragm include 3 muscles: the superficial transverse perineal muscle, ischiocerebral, and bulbospongy.

THE ROLE OF DIAPHRAGMS

Just as the braces of a camp tent keep the center post vertical, so the 5 body diaphragms, stretched transversely, contribute to the maintenance of a general body posture which requires the maintenance of verticality for its good functioning.

Diaphragms limit narrow spaces, organically independent, but functionally connected by changing pressure.


- Tentorium cerebelli, which has special connections with the structure of the brain and is in the closest relationship with the primary respiratory movement, fully participates in its distribution.


- The intraoral diaphragm restores the balance of pressure between the oral cavity and the throat area, enabling some internal organs and functional systems (pharynx, voice formation, etc.) to work correctly. From the musculoskeletal point of view, one should not forget about the tongue, an integral part of this diaphragm, which is a link in the closing and swallowing actions.


- The superior thoracic opening closely interacts with all structures of the neck and upper chest (pleura, lungs, etc.), including also the mechanical functions of the cervico-shoulder chain.

− The pectoral diaphragmatic muscle is most associated with the respiratory functions; the organs of the abdominal cavity are strongly involved in its action, the dorsolumbar vertebral connection restores the balance of the chest and the abdominal pressures.


- In addition to influencing all the visceral structures of the small pelvis, the pelvic diaphragm is also of the great importance for maintaining the statics and dynamics of the pelvis.

In their totality, the diaphragms must be in a state of controlled asymmetry in order to guarantee the correct functioning of each organ/internal/system.

Changes in pressure can cause homeopathic changes; altered functioning of the diaphragms (not mutual integration) is the first likely cause of compression and abnormal changes in the organ functions.

The “pump effect” causes the underlying structures to experience a push, and the overlying structures to experience a tension; the pressure fluctuations (positive and negative) become the fastest endogenous means of propulsion of the liquid masses, and, consequently, a tool for facilitating the movement of molecules against the walls of capillaries, contributing directly to the homeostatic mechanism.

The continuity of the fascia contributes to an even distribution of the pressure on and within organs, since an increase in the relative volumes creates a tension that is transmitted to the smallest parts and to every smallest intercellular space, being divided.

The overall balance between containing and being a contеnt is born from the possibility of sliding and dilatation, associated with the presence of the elastic fibers in every part of the body. The hydrophilic ability, inherent in the connective tissue, makes it possible to maintain the desired degree of moisture and impregnation of the tissues, creating a subsequent liquid chain for the redistribution of the forces.

The suspensory apparatus of the blood vessels and all other vessels (including capillaries) has a series of connections carried out through a network of fascia, therefore, without a direct pressure on the lumen of the vessel, changes cannot occur in the cardiac output or bends that can limit the main actions, which guarantee homeostatic functions.

Special thanks for the guidance and help in writing this research paper to my supervisor

Emine Ezgi Erylmaz Akman,

Doctor of Fundamental and Industrial Microbiology,

Head of Laboratory, ‘Medstar’ Hospital, Antalya, Turkey

Tel. 05079247310

Email: ezgihakanakman@gmail.com

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