Principles of Manual Medicine
Facilitated Segment
The relationship of the thoracic spine to the sympathetic division of the autonomic nervous system is important because visceral afferent pathways usually follow the sympathetic pathways. Visceral disturbances often result in increased musculoskeletal tension in structures innervated from the corresponding spinal level through viscero-somatic reflexes.
For example, abnormal levels of afferent activity occuring at one region of the body (for example, the intestines) can maintain a pool of neurons in another region of the body (for example, muscles of the rib cage) in an elevated state of sensitivity. In this state, small additional increases in afferent activity may result in an exaggerated response at the sensitized site. Once a sensitized state is established, the spinal segment is said to be
facilitated. Facilitation may lead to alterations in muscle tone that may result in stiffness, spasm, and pain.
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