High-Yield OMM & Chapman Point Pocket Compendium

1

Autonomic & Viscerosomatic Master Chart

Preganglionic Cell Bodies: Lateral Horn (T1–L2)

Organ / Region	Sympathetic Level	Parasympathetic	Ganglion / Path	High-Yield Clinical Pearls & Memory Hooks
Head & Neck (HEENT)	T1 – T4	CN III, VII, IX, X	Superior Cervical Ganglion	Pupil dilation, thick saliva. Horner's syndrome (ptosis, miosis, anhidrosis) from T1 apex lesion.
Heart	T1 – T5	Vagus (CN X)	Cervical & Upper Thoracic Chain	Right sympathetics: SA node (SVT). Left sympathetics: AV node (arrhythmias/VT). Left tissue texture changes in MI.
Lungs & Bronchi	T2 – T7	Vagus (CN X)	Pulmonary Plexus	Sympathetics dilate bronchia (beta-2). Parasympathetics constrict & hypersecrete. Rib raising thins secretions.
Upper GI (Stomach, Liver, Gallbladder, Spleen, Duodenum part 1)	T5 – T9	Vagus (CN X)	Celiac Ganglion (Greater Splanchnic)	Foregut embryology. Peptic ulcers and cholecystitis reflect to T5–T9 right/left paraspinal tissues.
Mid GI (Duodenum 2–4, Jejunum, Ileum, Ascending & 2/3 Transverse Colon)	T10 – T11	Vagus (CN X)	Superior Mesenteric (SMA) (Lesser Splanchnic)	Midgut embryology. Includes appendix (T10–T11 right periumbilical to RLQ). SBO and enteritis.
Lower GI (Distal 1/3 Transverse, Descending, Sigmoid, Rectum)	T12 – L2	Pelvic Splanchnic (S2–S4)	Inferior Mesenteric (IMA) (Least / Lumbar Splanchnic)	Hindgut division. Key Cutoff: Cannon-Böhm point. Distal 1/3 switches from Vagus to S2–S4!
Kidneys & Upper Ureter	T10 – T11	Vagus (CN X)	Aorticorenal / Superior Mesenteric	Flank pain and nephrolithiasis radiating toward groin. Vasoconstriction reduces GFR.
Lower Ureter & Bladder	T12 – L2	Pelvic Splanchnic (S2–S4)	Inferior Mesenteric / Hypogastric	Parasympathetics contract detrusor (urination). Sympathetics contract internal sphincter (continence).
Ovaries & Testes	T10 – T11	Vagus (CN X)	Intermesenteric Plexus	Embryologically descent from abdomen! Follow gonadal vessels (T10–T11, NOT pelvis).
Uterus, Cervix, Prostate	T12 – L2	Pelvic Splanchnic (S2–S4)	Hypogastric / Pelvic Plexus	Pelvic visceral structures receive S2–S4 parasympathetics (Erection: S2–S4 "Point"; Ejaculation: T12–L2 "Shoot").
Adrenal Glands	T8 – T10	None	Direct preganglionic innervation	Adrenal medulla cells act as modified postganglionic sympathetic neurons (release epinephrine).

2

Complete Chapman's Reflex Points Master Grid

Viscerosomatic gangliform contractions in deep fascia. Anterior = Diagnostic; Posterior = Treatment.

Organ / Pathology	Anterior Chapman Point	Posterior Chapman Point	Board Examination Trap & Memory Hook
HEENTEye (Retina/Conjunctiva)	Lateral humerus surgical neck / anatomical neck	Suboccipital space between C1 & C2	High yield for conjunctivitis. Lateral arm humerus paired with C1-C2 suboccipital region.
HEENTMiddle Ear (Otitis Media)	Superior clavicle, ~1/3 lateral to sternum	Posterior arch of C1 / suboccipital	Child with ear pain / AOM tugging at clavicle point.
HEENTSinuses (Maxillary/Frontal)	1st Intercostal Space (ICS) below clavicle	C2 spinous process / TP of C2	Sinusitis question: tenderness at 1st ICS medial margin.
HEENTPharynx / Tonsils / Larynx	1st rib near cartilage / 2nd rib superior border	C2 midway between SP and TP	Strep pharyngitis or croup stem pointing to 1st/2nd rib junctions.
HEENTThyroid	2nd Intercostal Space (ICS) near sternal border	T2 midway between SP and TP	Shares 2nd ICS with heart, bronchus, and esophagus!
CARDHeart & Myocardium	2nd Intercostal Space (ICS) next to sternum	T2 – T3 intertransverse space	#1 Most Tested. Angina/MI: tender nodule at left 2nd ICS.
PULMBronchus & Mainstem	2nd Intercostal Space (ICS) parasternally	T2 intertransverse space	Bronchitis, asthma flareup. Same level as heart/thyroid/esophagus.
PULMUpper Lung (Upper Lobe)	3rd Intercostal Space (ICS) parasternally	T3 – T4 intertransverse space	Upper lobe pneumonia (TB, Klebsiella in alcoholic).
PULMLower Lung (Lower Lobe)	4th Intercostal Space (ICS) parasternally	T4 – T5 intertransverse space	CAP consolidation in lower lobe, aspiration pneumonia.
GIStomach (Acidity / GERD)	5th ICS on the Left (from sternum to nipple line)	T5 – T6 intertransverse space on Left	Left 5th ICS = Acidity. Left 6th ICS = Motility/Peristalsis.
GILiver & Gallbladder	6th ICS on the Right (sternum to nipple line)	T6 – T7 intertransverse space on Right	Right 6th ICS tenderness in acute cholecystitis with Murphy sign.
GISpleen	7th ICS on the Left	T7 – T8 intertransverse space on Left	Left 7th ICS: Mononucleosis, splenic enlargement, hematoma.
GIPancreas	7th ICS on the Right	T7 – T8 intertransverse space on Right	Right 7th ICS: Acute pancreatitis, elevated lipase/amylase.
GISmall Intestine	8th, 9th, 10th Intercostal Spaces parasternally	T8, T9, T10 intertransverse spaces	Celiac disease, malabsorption, Crohn ileitis.
GIAppendix	Tip of the 12th Right Rib	Transverse process of T11 – T12 on Right	#1 Highest COMLEX Yield! Anterior = TIP of 12th rib (NOT McBurney point!). Posterior = TP of T11.
GIColon (Iliotibial Band Mirror)	Anterior Iliotibial (IT) Band pattern	Triangle from L2 to L4 across iliac crest	Feather pattern on IT band: Right IT band = Ascending colon. Left IT band = Descending colon.
GUKidneys	1 inch superior & 1 inch lateral to Umbilicus	Between T12 and L1 transverse processes	Pyelonephritis / acute renal stone. Classic "1 up, 1 out" from umbilicus.
GUBladder	Periumbilical ring / Superior pubic margin	L2 transverse process / Upper sacrum	UTI, cystitis with suprapubic and periumbilical tender ring.
GUUrethra	Pubic tubercles inner margin	L3 transverse process	Urethritis (Chlamydia/Gonorrhea) dysuria with pubic tubercle point.
GUOvary / Salpinx / Testes	Superior margin of pubic ramus / tubercle	T10 – T11 intertransverse space	PID, ovarian torsion, testicular torsion. Posterior matches autonomic level (T10).
GUUterus	Inferior pubic ramus / Obturator foramen edge	L5 transverse process & PSIS	Dysmenorrhea, endometriosis, fibroids. Inferior pubic ramus tenderness.
GUProstate	Posterior margin of Iliotibial (IT) Band	Between PSIS and L5 spinous process	High Yield! BPH or prostatitis: tenderness along posterior edge of IT band down the lateral thigh.
GUVagina / Broad Ligament	Posterior IT band from greater trochanter down	Sacral sulcus / PSIS	Female equivalent to prostate location along posterior IT band.
GURectum	Lesser trochanter of femur	Sacrum near iliosacral joint	Proctitis, hemorrhoids. Lesser trochanter anterior point.

3

Sacral Diagnosis & Innominate Decision Tree

Interactive 3D Solver

Step 1: Motion Axis Side

Seated Flexion Test

Positive seated flexion test defines the dysfunctional side. In sacral torsions, the oblique axis is on the OPPOSITE side of the positive seated flexion! (Positive right seated flexion = LEFT oblique axis).

Step 2: Direction of Torsion

Spring / Sphinx Test

Good Spring / Improves with Sphinx: Forward Torsion (L on L, R on R) or Bilateral Flexion.
No Spring / Worsens with Sphinx: Backward Torsion (L on R, R on L) or Bilateral Extension.

Step 3: L5 Rules

L5 – Sacrum Mechanics

1. L5 rotates OPPOSITE to the direction of sacral rotation.
2. L5 sidebends SAME SIDE as the sacral oblique axis.
(e.g., in a R on L torsion: Axis is L → L5 sidebends L; Sacrum rotated R → L5 rotated L).

Diagnosis	Seated Flexion	Spring / Sphinx	Deep Sulcus	Posterior/Inferior ILA	L5 Findings	Muscle Energy Patient Position
L on L Torsion (Forward)	Positive Right	Good spring / Improves	Deep Left	Posterior/Inferior Right	L5 rotated R, sidebent L	Sims (Face Down) on Left side (axis down)
R on R Torsion (Forward)	Positive Left	Good spring / Improves	Deep Right	Posterior/Inferior Left	L5 rotated L, sidebent R	Sims (Face Down) on Right side (axis down)
L on R Torsion (Backward)	Positive Left	Poor spring / Worsens	Shallow Left (Posterior)	Anterior/Superior Right	L5 rotated R, sidebent R	Face UP (Lateral recumbent) on Right side (axis down)
R on L Torsion (Backward)	Positive Right	Poor spring / Worsens	Shallow Right (Posterior)	Anterior/Superior Left	L5 rotated L, sidebent L	Face UP (Lateral recumbent) on Left side (axis down)
Unilateral Sacral Flexion	Positive on same side	Good spring / Improves	Deep on same side	Posterior/Inferior same side	No significant L5 rot	Prone, pressure on ILA during inhalation
Unilateral Sacral Extension	Positive on same side	Poor spring / Worsens	Shallow on same side	Anterior/Superior same side	No significant L5 rot	Prone, pressure on sacral base during exhalation

4

Cranial Strain Patterns & SBS Mechanics

Primary Respiratory Mechanism (PRM): 10–14 cycles/min

Index Finger

Greater Wing of Sphenoid

Monitors sphenoid rotation and vertical / lateral strain angles.

Middle Finger

Temporal Zygomatic Process

Sits anterior to ear; tracks temporal bone external rotation.

Ring Finger

Mastoid Process

Posterior to ear; monitors temporal rocking and petrous apex.

Little (Pinky) Finger

Squamous Occiput

Rests on occipital base to sense flexion/extension and torsion.

Cranial Strain Pattern	Axes of Motion	Direction of SBS Motion	Vault Hold Sensation	Clinical Pearls & Etiologies
SBS Flexion / Extension	2 Transverse axes	Opposite directions (Base rises in flexion)	Flexion: Fingers widen & move inferolaterally. Ext: Narrow.	Physiologic. Sacral base counter-nutates (moves posterior) during cranial flexion.
Torsion	1 AP axis	Opposite directions around AP axis	Named for HIGH greater wing of sphenoid (Index finger rises).	Physiologic. Caused by blow to anterior or posterior quadrant of head.
Sidebending / Rotation	1 AP + 2 Vertical axes	SB: Opposite directions on vertical; Rot: Same on AP	Named for side of widening / fullness (fingers spread apart).	Physiologic. Lateral blow precisely at SBS level.
Vertical Strain (Superior / Inferior)	2 Transverse axes	SAME direction (Both rotate anteriorly or posteriorly)	Superior: Sphenoid base rises (index moves down). Inferior: Sphenoid base drops.	Non-physiologic. Superior: blow to vertex or jaw up. Inferior: blow to occiput.
Lateral Strain	2 Vertical axes	SAME direction (Shearing motion creates "parallelogram")	Named for direction basisphenoid moves (Pinkies & Index shift together).	Non-physiologic. Lateral trauma to forehead / occiput. Classic parallelogram head shape.
SBS Compression	No specific axis	Sphenoid and Occiput locked together	Markedly decreased / absent CRI amplitude (feels like a "bowling ball").	Non-physiologic. Severe circumferential birth trauma or concussion. Severe depression/lethargy.

5

Rib Mechanics & Muscle Energy Activating Muscles

Golden Rule: Bottom-Up in Inhalation ("B-I"); Top-Down in Exhalation ("T-E")

Ribs 1 – 5

Pump-Handle Motion

Motion predominantly in the sagittal plane around a coronal/transverse axis. Increases anteroposterior (AP) diameter of the chest cage during inhalation.

Ribs 6 – 10

Bucket-Handle Motion

Motion predominantly in the coronal plane around an AP axis. Increases transverse (lateral) diameter of the rib cage during inhalation.

Ribs 11 – 12

Caliper Motion

Floating ribs move around a vertical axis. Move posteriorly, laterally, and inferiorly during inhalation; return anteromedially in exhalation.

Rib Level	Activating Muscle for Muscle Energy	Patient Physical Isometric Action	Exhalation Key Rib (Top Rib / "T-E") Setup
Rib 1	Anterior & Middle Scalenes	Patient lifts head straight forward against doctor's hand on forehead.	Doctor stands at head of table, contracts scalene to elevate stuck rib 1.
Rib 2	Posterior Scalene	Patient turns head 30° away, lifts head toward ceiling against resistance.	Head rotated 30° away to recruit posterior scalene onto tuberosity of rib 2.
Ribs 3, 4, 5	Pectoralis Minor	Patient pushes elbow toward opposite ASIS / contralateral hip against resistance.	Doctor stabilizes coracoid and posterior rib angle while patient contracts pec minor.
Ribs 6, 7, 8, 9	Serratus Anterior	Patient pushes bent elbow anteriorly / forward against physician's hand.	Protraction of scapula pulls serratus anterior attachments on ribs 6–9.
Ribs 10, 11	Latissimus Dorsi	Patient adducts arm (pushes elbow straight down toward side/iliac crest).	Latissimus dorsi fibers tug on lower ribs to overcome exhalation barrier.
Rib 12	Quadratus Lumborum	Patient hikes ipsilateral hip toward shoulder against leg traction/resistance.	Quadratus lumborum contraction releases floating rib 12 restrictions.

6

Counterstrain Rapid Treatment Setups

Passive Positioning · Hold 90 sec (120s ribs) · Passive return to neutral

Tenderpoint Location	Exact Treatment Position	Anatomical Landmark	High-Yield Exceptions & Traps
AC1 (Anterior Cervical 1)	Rotate Away (RA)	Posterior edge of ascending ramus of mandible	Exception! Pure Rotation Away (no flexion or sidebending required).
AC2 – AC6	F SARA (Flex, Sidebend Away, Rotate Away)	Anterior tubercles of transverse processes	Standard rule for anterior cervicals: Flex, Sidebend Away, Rotate Away.
AC7	F STRA (Flex, Sidebend Toward, Rotate Away)	Clavicular attachment of sternocleidomastoid (SCM)	Exception! Clavicular head = Sidebend TOWARD (STRA).
AC8	F SARA	Sternal head of SCM near sternoclavicular notch	Returns to standard F SARA.
PC1 (Inion)	F STRA (Marked Flexion)	Inferior nuchal line just below inion	Exception! Inion PC1 treated with FLEXION, not extension!
PC3	F SARA	Inferior tip of C2 spinous process	Major Exception! Posterior cervical treated with FLEXION (F SARA).
PC4 – PC8	E SARA (Extend, Sidebend Away, Rotate Away)	Inferior or lateral aspect of corresponding spinous process	Standard posterior rule: Extension, Sidebend Away, Rotate Away.
AL1 (Anterior Lumbar 1)	F STRA (Marked Flexion, Ankles toward)	Medial to ASIS	Exception! AL1 is F STRA. (AL2–AL4 are F SARA).
AL2 – AL4	F SARA (Hip & Knee Flexion 90°, Ankles away)	AIIS (AL2), lateral AIIS (AL3), inferior AIIS (AL4)	Physician stands on side of tenderpoint; hips/knees flexed, rotated away.
AL5	F SARA	Anterior superior aspect of pubic ramus	Marked hip flexion (>120°), knees sidebent away.
Iliopsoas	F ST ER (Bilateral hip flexion, External Rotation)	2/3 distance from ASIS to umbilicus (deep in iliac fossa)	"Frog-leg" position: Markedly flex hips, knees bent, ankles crossed, externally rotated.
Piriformis	F ABD ER (Flexion ~135°, Abduction, External Rotation)	Midpoint between ILA and greater trochanter	Prone, knee bent 90°, leg abducted off edge of table with gentle traction/ER.