Summary
Chapman reflex points refer to nerve gangliform contractions located deep in the skin and subcutaneous tissue, most often within the deep fascia or periosteum of the bone. These neurolymphatic points are found in specific areas of the body that correspond to visceral dysfunctions. 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 2–3 mm in diameter. Although Chapman points are typically diagnostic, they may also be manipulated for therapeutic purposes.
Sources differ on the precise Chapman points.
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
Chapman points should not be confused with myofascial trigger points (MTrP) or Jones (counterstrain) tender points.
Characteristics
- Round, smooth, discrete, and tender palpable nodules (∼ 2–3 mm in diameter)
- When compressed, they cause sharp, non-radiating pain
- Associated with visceral dysfunctions (i.e., viscerosomatic reflexes)
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Location
- Anterior Chapman points: within the deep fascia (e.g., intercostal space, sternocostal and costochondral junction)
- Posterior Chapman points: periosteum of a bone (e.g., vertebral transverse and spinous processes)
Anatomy
HEENT
| HEENT Chapman points | ||
|---|---|---|
| Chapman point | Anterior | Posterior |
| Eyes | Surgical neck of the humerus | Posterior to the mastoid process |
| Middle ear | Superior to the clavicle, lateral to the junction with 1st rib | C1 articular process |
| Sinuses | 1st rib, 2nd rib near the clavicle | C2, midway between spinous and transverse processes |
| Pharynx | Inferior aspect of sternoclavicular joint | |
| Larynx | 2–3 inches lateral to sternocostal junction of the 2nd rib | |
| Tonsils | 1st intercostal space (ICS) | Atlas, midway between spinous and transverse processes |
| Tongue | 2nd rib | N/A |
Cardiorespiratory
| Cardiorespiratory Chapman points | ||
|---|---|---|
| Chapman point | Anterior | Posterior |
| Heart | 2nd ICS, at the sternocostal junction | Intertransverse space between T2 and T3, lateral to the spinous process |
| Bronchi | Intertransverse space between T2, midway between spinous and transverse process | |
| Upper lung | 3rd ICS, at the sternocostal junction | Intertransverse space between T3 and T4, midway between spinous and transverse process |
| Lower lung | ||
| 4th ICS, at the sternocostal junction | Intertransverse space between T4 and T5, midway between spinous and transverse process | |
Gastrointestinal
| Gastrointestinal Chapman points | ||
|---|---|---|
| Chapman point | Anterior | Posterior |
| Esophagus | 2nd ICS, at the sternocostal junction | T2, midway between spinous and transverse process |
| Stomach (acidity) | 5th ICS on the left | Left intertransverse space between T5 and T6, midway between spinous and transverse process |
| Stomach (peristalsis) | 6th ICS on the left | Left intertransverse space between T6 and T7, midway between spinous and transverse process |
| Pylorus | N/A | Costotransverse junction on the right 10th rib |
| Liver | 5th – 7th ICS on the right | Right intertransverse spaces between T5 and T7, midway between spinous and transverse process |
| Gallbladder | ||
| Pancreas | 7th – 8th ICS on the right | Right intertransverse space between T7 and T8, midway between spinous and transverse process |
| Spleen | 7th ICS on the left | Left intertransverse space between T7 and T8, midway between spinous and transverse process |
| Duodenum | 8th ICS near the costochondral junction | Intertransverse space between T8 and T9, midway between spinous and transverse process |
| Jejunum | 9th ICS near the costochondral junction | Intertransverse space between T9 and T10, midway between spinous and transverse process |
| Ileum | 10th ICS near the costochondral junction | Intertransverse space between T10 and T11, midway between spinous and transverse process |
| Appendix | Tip of the 12th rib on the right | Right intertransverse space between T11 and T12, midway between the tips of the transverse processes |
| Cecum | Upper 1/5 of the right proximal femur | 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 distal femur | |
| Sigmoid colon | Upper 1/5 of the left proximal femur | |
| Descending colon | Middle 3/5 of the left lateral thigh | |
| Splenic flexure | Lower 1/5 of the left proximal femur | |
| Rectum | Proximal inner thighs on the lesser trochanter | Sacrum, level of S2, near the lower end of the sacroiliac articulation |
Genitourinary
| Genitourinary Chapman points | ||
|---|---|---|
| Chapman point | Anterior | Posterior |
| Kidneys | 1 inch lateral and 1 inch superior to the umbilicus (bilaterally) | Intertransverse space between T12 and L1, midway between spinous and transverse process |
| Bladder | Periumbilical region | L2 transverse process |
| Urethra | Anterior pubic bone | L3 transverse process |
| Ovaries | Intertransverse spaces between T9–11, midway between spinous and transverse process | |
| Testes | ||
| Broad ligament | Lateral femur (from greater trochanter to 2 inches proximal to the knee) | Between the posterior superior iliac spine (PSIS) and the transverse process of L5 |
| Prostate | ||
| Uterus | Medial border of the obturator foramen | |
| Fallopian tubes | N/A | |
| Seminal vesicles | N/A | |
| Vagina/Clitoris | N/A | PSIS and posterior aspect of the proximal inner thigh |
Endocrine
| Endocrine Chapman points | ||
|---|---|---|
| Chapman point | Anterior | Posterior |
| Thyroid | 2nd ICS, at the sternocostal junction | N/A |
| 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
Chapman reflex points are typically utilized selectively for diagnostic purposes. However, they may also be manipulated for therapeutic purposes.
- Somatic manifestations help diagnose visceral dysfunctions.
- Both the anterior and posterior points need to be present to be considered a Chapman reflex.
- Reflex points can be slightly painful to extremely tender without radiation → signifies potential visceral dysfunctions of the corresponding organ
Treatment
- Goal: decrease sympathetic tone, improve myofascial motion and lymphatic drainage
- Technique: apply deep, firm, or gentle pressure, alternating clockwise and counterclockwise motions for 1–5 minutes, until the point softens or disappears and the pain is reduced.
- Associated somatic dysfunctions may also be treated separately.
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