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Tom Myers is well known to have disseminated knowledge of human anatomy whilst attempting to tie into his Rolfing practice the felt experience of having a human body. Myers has been touted as the Father of Fascia, quoted by a Canadian Masseur come science writer as being ‘over it'(1).
The architecture of the cell is remarkable for many reasons, the one of importance here is that when a cell is under tension from its environment as opposed to tension within its inner environment a change in genetic expression occurs. Yes! The nucleus of a cell alters the expression of its available genes from external tension placed upon the cell. If my body to some degree is a collection of cells that exist within the medium of my connective tissue. Then differences in connective tissue tensions have a genetic difference in how my cells within my body express the 23,000 (ish) genes I possess.
Allowing for markedly different function(s) to occur in adjacent areas of the body. Undoubtedly in my mind having an effect upon the mechanics of the area and the felt sense of the area and of the inner experience of the area; not to mention a different physiology of the area. A different genetic expression may give rise to a strength, or a vulnerability, altering ones health.
Is the falling rate of male fertility in modern society a result of immune system dysfunction? eg leukocytospermia. The dysfunction of white blood cells has been linked to MMP signalling proteins which also interact with c fibres of the nervous system (a route to give a pain signal). To summarise genetic expression, immune function and pain levels are all linked by science to connective tissue tension (aka fascia).
Are the rising levels of immune dysfunction (demonstrated by an over reliance upon antibiotics), the rise in autoimmunity disease rates and the rise in medically unexplained symptoms all a function of a change in the tensions placed upon our body tissues, because we just do not move as much as we did?
Fascia is one view of the body and in itself is not representative of the entire conglomerate of the human body and tells us nothing of the human (interoceptive) experience of having a body. A professional body worker (dancer yogi Qi Gong instructor included) would be well advised to have an adaptable view of the human body and not become any one tissue centric about their approach. After all as a teacher, instructor, therapist, chiropractor, osteopath or physiotherapist the outcome of a patient is not a function of how right you are!
Keep going science you have a long way from which to ‘catch up’!
(1) Ingraham P Does Fascia Matter? A Science Review of Fascia
Chiropractic Care includes the interventions and advice given to you by your Chiropractor in your treatment session. I don’t really know why but some people save up a long list of things for their Chiropractor to ‘fix’ during a session. Perhaps it is value for money or not feeling as though you need much help until there are a lot of things to get fixed. You’ll have to decide for yourself…
When something for whatever reason goes wrong in your body, your body in another area will compensate or try to help and this process of help will continue until you die unless the original problem is ‘fixed’. Leaving it a longer time frame just means more compensations and more compensations make it harder to find the start of the chain of compensations (the real problem).
Getting the best from your Chiropractor would involve the 3 day rule (if you are not fixing your symptom within 72 hours then you are incorporating it into a new normal and not fixing it. This is why most niggles clear up in a few days. getting an appointment on day 4-10 is optimal.
To get value for your money have a check up / treatment 1-4 times a year and get an appointment for a new symptom between day 4 and 10 of when it first started as long as it lasts more than 3 days. If it went away in less than 72 hours there is no need to see your Chiropractor.
The best things to do for a bad back pain episode has challenged people and medical doctors for generations. In the 1980’s bed rest and even a hospital stay was the best option in the USA. In England traction was thought to be the answer to a tight contracted back, that was to gradually stretch it out. Some people had two weeks of traction as the best medical care. Today in England the main medical approach is to provide anti inflammatories and mild over the counter pain killers, with a physiotherapy referral (within a few months). The physiotherapy approach to back pain is to provide reassurance at first. Typically an episode is bad for 3-5 days and can be felt to some degree for 4-6 weeks. People’s episodes are normally over by the time a hands on approach from the NHS is provided. The way the first back pain episode is cared for can have a knock on effect to future pain episodes. If you don’t get fixed at first it just keeps on coming back until you either get fixed or get used to having back pain episodes. 1-3% of back pains will have a sinister aspect eg a red flag such as a collapse fracture
It has been known for 15 years that anti inflammatories are enzyme inhibitors that alter the natural balance between cyclooxygenase (COX) and lipooxygenase (LOX) enzymes. Altering any natural balance creates a drive to re-balance leading to more COX enzyme increasing inflammation after 2 hours. Yes there is a decrease in inflammation in the first 30-60 minutes, then a rebound increase in inflammation begins to develop surpassing previous inflammation levels at about 2 hours after taking the NSAID (Ibuprofen). The marketing of anti inflammatories is highly suggestive having a strong impact on a lot of people.
Recommendations are now recognising that for acute low back pain the best approach is to rest for the first day, then allow yourself to move around as normally as possible, light duties and slow. Consider Chiropractic Care to help (not only this episode but also future episodes – having chiropractic care for your first episode can actually prevent the next episode form occurring).
According to advise from Harvard University medical Doctors, Chiropractic Care is a very good idea. See for yourself at http://www.health.harvard.edu/blog/heres-something-completely-different-for-low-back-pain-2017070611962
The connection between the tissues of the human body bring all body components together on the inside. This connection is known as fascia. Sensory nerves (pain fibres) are densely packed into the superficial fascial layer. This superficial layer lies between the dermis and the deeper fascia. One could paraphrase that the underside of the skin and the top side of the skin are both well innervated by nerves; with the underside being more densely packed with sensory nerves (pain receptors). Whilst the outside of the skin has a greater variety of specialised nerves.
The way the superficial fascia is innervated confirms the idea of Andrew Taylor Still (Father of traditional Osteopathy) that the fascia of the body is a ‘sensory organ’. More recently Helene Langevin wrote about ‘a body wide signalling network’. How information is relayed to the brain, about the body. Udup also showed an interaction between the endocrine system and fascia in his research on hormones and yoga. The human brain, seems to me, to be calculating the movement of your body based upon sensory information from fascial tissue. Thus the condition of the fascia in your body can aid or hinder how you move (proprioception), how you feel and what hormones are being produced.
If you have an inefficient (relative to your most efficient) body you might experience delayed onset muscle soreness (DOMS). Called ‘muscle soreness’ yet it is accepted that the soreness is in fact from fascial tissue. Soreness from within your fascia can mean abnormal loading and conflicting sensory motor signals are occuring within your nervous system affecting your proprioception. Abnormal loading of fascia can lead to pain of a variety of intensities. Making identifying what you are doing to bring on the DOMS or pain difficult to pin point. Adversely loaded fascial tissue can give rise to what is traditionally thought of as ‘nerve pain’ or nerve root pain. As well as other types of pain.
Next time you are thinking you have a stubborn old injury, nerve issue, strain or sprain, perhaps you need your fascia attended to? This is why with fascia first chiropractic fascia is included along with your other body tissues as a potential source of pain and discomfort. (Fascia information above was collected from JBMT 2015 No.19). (Picture above from ‘stroll under the skin’ by Guimberteau)
When you are a can do-er working through discomfort can be a part of your life. Pushing the envelope to grow toward your potential is commendable and I thoroughly recommend it. When you do work through a discomfort (or a pain) you can psychologically move to a new normal; no problem. Psychologically we have no boundaries. Physically we do; the most obvious being your skin less obvious being dysafferentation.
Due to the lack of knowledge that humans have about a human body we humans can sometimes create more problems than we solve when we push through it once. When we push through it more than once we can accumulate (learn bad habits) errors. As we move with error we abnormally load our body tissues. Abnormal loading of body tissues leads to degeneration. Normally loaded tissues last a lifetime. If you are broadening your horizons your body might just thank you now for regularly taking it to Fascia First Chiropractic. Your psychology can thank you later as you enjoy your body for years longer. This is of course my opinion but here’s a little of the why:
- The fascia of the human body talks to the brain telling it where and how your body is.
- The superficial fascia is densely packed with pain fibres.
- Fascia is the reason (not muscle tissue) why you get D.O.M.S. (delayed onset muscle soreness) after exercise.
- Fascia has more free nerve endings in it than your eyes; so the potential for pain is very high.
- Under abnormal loading fascia can grow in on itself creating an ‘in-growth’ of highly pain sensitive tissue. Perhaps how something seems to ‘go’ without due provocation.
- The fascia is responsible for housing nerves. The nerve sheath is innervated by the nervi nervorum and could be the cause of ‘nerve’ pain. Fascia can also mimic muscle pain….
- Increased adrenergic signalling in the fascia leads to a vasoconstriction of blood vessels slowing up nutrient delivery to your fascia. This could worsen an immune condition, a pain syndrome or a symptom that seems to be ‘stress related’.
- Autonomic tone can change fascial stiffness; When you are stressed your autonomic tone will change as will the stiffness of your fascia (body). This stiffness needs to be balanced not just worked out.
- The fascia feeds information into your insula nucleus in your limbic brain about the pH, temperature and ion content of your connective tissue. Your limbic system can alter your ability to handle stress, socially interact well, and alter your sensitivity to fear and pain.
- An immune response can also stiffen your fascia through a marker known as TGF-B1. Think of how you might stiffen up and get achy when you have a bad bout of the flu. Yes it needs balancing out afterward. An autoimmune condition is when you are stuck in a constant immune response and an allergy is an immune response to a given irritant.
Fascia First Chiropractic is more than a quick click. Fascia is behind the rate at which you are currently stiffening (ageing) over time.
Source: Tozzi P. (2015) Journal of Bodywork and Movement Therapies 19 310-326.
Stroll under the Skin A you tube video where you can see and learn more about fascia.
Two recent studies seem to have conjoined in my mind; one is from Zurich University Chiropractic department showing brain activity relative to lumbar spine pressure such as might happen in low back pain syndromes. The other is about training mice to ‘fear’ a smell across their generations controlling for nurture. Answering the long debate of nature versus nurture. Researchers showed that without nurture the cue for a fear response can still be passed on.
The first study carried out in Zurich; showed that back pain is linked to a part (nucleus) of the brain involved in social pain. What if we as humans could pass on in our genes information that affects the life experience of the next generation? You may find yourself as an individual with a back symptom from ‘nowhere’ due to an ancestral social cue. In generations passed going out of favour with the group could have had deadly consequences.
The second study was published in Nature Neuroscience (2014; 17, 89-96) demonstrating a transference of a fear response genetically; without nurture. The mice were shown to pass on a (protective) smell memory to their children and their grandchildren (F2).
If we as a species can have an ancestral cue for a social stress causing back pain passed on from family member to family member and social stress is not considered in your care plan. You could be forgiven for thinking that you have to ‘live’ with pain. Identifying potential cues from your environment ‘stressors’ to your behaviours, thoughts and/or feelings can be methodologically worked through. Whilst you figure out the cues to your stresses consider having body work to help you with accumulation. Accumulation in my opinion can make your condition worse.
I think when human body tissues are abnormally loaded the tissues do not undergo a training effect and instead are strained. Having a genetic fear response in social conditions where I reflexively squeeze my back muscles from an unidentified cue, providing pressure on my vertebrae, would be an abnormal load; like a repetitive strain scenario on the low back tissues of the body. Choose fascia first chiropractic it is more than a ‘quick click’.
The spine has about 24 vertebrae with most having three joints. One joint is a disc and the other two are joints just like your finger joints that are synovial type but called facet joints. When we imbricate our facet joints of the spine as suggested by Horrigan in a condition called facet Arthrosis, pain can be generated just the same as when one stubs their finger or a toe. We all know that stubbing produces more than one type of pain because we have probably experienced it. The spine has 6 different pain mediators. Pain killers affect 2 or sometimes 3 different types of pain mediator. Meaning that pain killers have no effect on some back pain.
Imagine stubbing your finger against a wall over and over 24/7 for about two weeks. This behaviour would cause you to have a reasonably sore finger. You can stop stubbing your finger; probably because someone can point it out to you and unlike the spine you do not have to use it to move around. You have to use your spine when you move. Thus you will have a certain amount of stubbing that continues with regard to the spinal joints.
The spinal joints are surrounded by other tissues that can be pain sensitive and also be part of mixed up motor sensory signals within your nervous system. essentially a healthy joint is moving well in it’s full range of motion with synovial fluid providing nutrients in and waste product removal. A healthy joint is only part of the movement that you perform when you move. Having joint manipulation may be only part of a strategy to get you well, once again.
If you do nothing (called natural history) back pain will likely resolve in about 6 weeks. Pain killers can help to take the edge off of your symptoms during that time and you can get through it without body manipulation. Unfortunately the route of natural history can mean that your nervous system adapts to a new normal (learns to have back pain). This new normal is like updating your operating system on your computer; it is changed from the original. Once installed a new normal could return back pain as back pain is now part of your normal when you get up in the morning (load up your operating system).
Getting bodywork for a back episode helps prevent the accumulation of injuries that can occur when left to natural history. A psychological impact of (natural history) having pain in the body for over three weeks means that you become more sensitive to pain in the same area in the future. Over time you can accumulate many odd patterns of movement in a lifetime that lead you to abnormally load your tissues and send to the brain conflicting sensory motor signals. Conflicting sensory motor signals (subluxation, dysafferentation) can be the problem behind surprising bouts of back pain. The type of episodes that are really severe for a day or two and then symptomatically resolve like there was never a symptom. These conflicting messages are an indication that your sensory system could do with some help. A bodyworker provides sensory information to your brain about your body through the medium of touch (amongst other interventions). Once the right touch ‘language’ is used then your conflicting sensory motor signals conflict no more.
Chiropractic’s famous first adjustment story is recognized each year by the Chiropractic profession when we are reminded about our roots. There is much hyperbole about the story as one can imagine that occurs when embellishment meets embellishment and enthusiastic well meaning generations alter the story slightly to fit with their momentary feelings whilst retelling the story. This process repeated many times over gives a sense of mystery. The stuff every good story is made up of. For example this year the ICA have released their version of the story as:
‘On this day, 118 years ago, Dr. Daniel David Palmer administered the first specific chiropractic adjustment on his patient, Harvey Lillard in Davenport, Iowa. Dr. D.D. Palmer delivered this historic first chiropractic adjustment with the specific intent of realigning a malpositioned vertebra on the patient, restoring its normal position, and Harvey Lillard, who had lost most of his hearing 17 years earlier, noted his hearing swiftly returned under Dr. Palmer’s care.’
I personally have had two people have vast improvements in their hearing and know of 5 other chiropractic patients that have had vast improvements even two brothers under consultant supervision within the NHS who had years of tests and investigations as to their hearing deficits. The real life examples are there but few and far between to really ‘hang one’s hat on’.
Not only was the story of DD Palmer rare but a stroke of luck as described by Life University in their reconstruction of the story told by DD Palmer himself(!) http://www.youtube.com/watch?v=kSfQQGAkb7k In this telling the story is different to the intended and ‘specific’ nature of the first adjustment by DD Palmer. Here the story is that DD Palmer was saying goodbye to Harvey Lillard and on the staircase gave him a truculent slap on the back with a large book. A few days later Harvey returned to DD unannounced and said his hearing was significantly improved. Chiropractic had a chance beginning.
DD seemed to have gotten lucky and then set to work to explain what he observed. There is not mention of how many other people he tried to slap on the back with a book who had hearing problems or of his attempt to replay the context within which the slap was given. DD immediately set to work on the spine and tried to be more specific in his net application of force to Harvey. Further ‘ adjustment’ restored the rest of Harvey’s hearing (or now that Harvey was primed his expectation was to create the same state and rapport and he’d naturally get better). This is a great story and one that has set the tone of the profession from bone setting (DD had training in) into the muti technique conglomerate of done by hand that is helping millions of people get well today.
I have a particular view based upon how our practise is set up today that the first adjustment was as much about the context, meaning, intent, environment, priming and belief as much as it was the spine to ‘align’… Ever since Chiropractors have been stuck on just the spine. By using nothing more than interaction, simple props and rapport humans can help other humans over come just about anything as long as their culture and/or they think it is possible to get well (hope).
In my mind there are a myriad of explanations for why Harvey Lillard had an improvement in his hearing. DD Palmer explored many and found that adjusting the spine had a miraculous effect. Just as alcohol could fuel the first riders in the Tour De France times change, perceptions, knowledge and culture changes. Thus today the founding principles of Chiropractic cannot be held onto. They can however be kept as a comforting story about the beginnings of the largest non drug health care profession in the world. From such chance beginnings people have a way of being healthy that does not have to involve drugs. Education, knowledge and standards are changing and those for Chiropractors have changed too.
In yester year there may have been a singular adjustment that was considered the reference point that made a difference and lead to the ideas of administering an adjustment. Contemporary Chiropractors realise that the same rules do not apply today as they did one hundred and 18 years ago. The first subject may have been ‘subluxed’ at his T4 segment or his atlas (depending upon which story version you hear!) whereas today a look into the nervous system of a person may look something like:
Symptom: upper cervical pulling sensation that leads to an almost unbearable migraine that is not totally relieved with valium, pain killers and anti-inflammatories. Imaging was unremarkable.
Chiropractor interprets: Occiput dysfunction (CN10 vagus nerve), no sacral dysfunction or lower extremity dysfunction, CN9 motor dysfunction at back of throat, cn12 tongue motor dysfunction, cn11 traps weakness and opp scm (hemisphericity?), along with external ear pinna sensitivity (cn9), shimizu reflex, larger vessels in the eye, eye press dysfunction in changing heart rate; corneal reflex is ok so just cn10 dysfunction etc. Chiropractors continue along a deductive line of thought based upon the idea that somewhere the body is telling the brain the wrong information creating a Chinese whisper (subluxation) that creates an unconscious reflex response from the brain to create the sensation of a symptom. The point is that examination today is in more detail than it was in 1895 by a long way due to the advances in science and the understanding of the brain body and body brain connection.
Some chiropractors can rest on their laurels and only follow lines of possibility that are similar to the founding principle of everything comes from the spine. Even though this line of enquiry into human health was reinforced by Henry Windsor MD in 1921 for just over a decade who demonstrated that natural causes of death correlated exactly to the controlling level of the spine 99% of the time in cats dogs and humans. There have since been advances in knowledge around causes for changes in human health that are not considered a disease process. For example: development (attachment), interaction, genetics, trans-generation habits (copying conscious and unconscious aspects of influential people), environment, activation of HPA axis (trauma), culture, religion, mechanical injury, insidious injury, infectious load, fitness, family commitments, pressure of life, relationship with yourself, diet, hours driving, hours sitting, free time, spiritual development, social group, and knowledge are all factors to take into account when considering the health of a person’s nervous system.
Stories convey meaning and enable us to feel. We can all recognise a pleasant feeling over an unpleasant feeling and thus a good story from a bad. Altrusim / helping the greater good of mankind is a great theme to help Chiropractors be reminded of why they are chiropractors and not a time to return to the (original) adjustment being king and everything is from the spine! May the chiropractic profession expand, spread the modern word and help millions more people.
Sitting for long periods doesn’t help people feel good naturally but is this really a problem or are some people moaning?! When we sit we sit on our gluteal muscle group as well as the backs of our legs (Hamstring muscles), possibly sit bones and greater trochanter (hips). Recent findings about the gluts has changed professional opinion about the gluteus maximus in humans. It was thought to be different to monkeys but now is thought to be very similar to that of monkeys with almost identical origin (where the muscles starts) and insertion (where the muscle goes to).
What I can deduce from our current anatomy is that we’d have had a functional element to the gluteus maximus other than a cushion way before even the first chair or log was sat upon. Our anatomy suggests that we have a sling system (roughly) incorporating the tensa fascia latae, gluteals and sacroilliac ligaments; meaning we have the tools within our body to squat down and be supported by a sling of tendon know as the IT Band or Tensa Fascia Latae (TFL).
The ‘natural squat position of a child and that of a monkey are very similar. When we use a chair we do not need to hang supported on our natural sling and thus do not have the muscular co-ordination required to hold the body in the seated shape (within Earth’s gravitational field). Thus the brain will be getting ‘bum(!)’ information and given enough time will not be able to coordinate sit down or stand from sitting efficiently. It is common thought that people who have had more time on the planet cannot sit to stand or stand to sit due to age; this concept I dispute. We simply do not practise or reinforce the co-ordination of movement required to sit down and stand up efficiently and thus we will over time go more and more wrong. When we go wrong we cause wear and tear, pain and tight or slack musculature.
By squatting down we are resembling how monkeys will ‘sit’ and how our anatomy can increase circulation in our hips rather than reduce circulation by sitting on our gluteus maximus. It is a medical norm to expect to see some wear and tear (coxarthrosis) and reduced circulation in a man of only 40 years of age! I think this is a medical norm because medics are looking at the smallest parts of physiology and have not yet begun to understand the machinery (anatomy) of the body.
I believe that when we become uncoordinated it will be the cause of pain in cases where there is no obvious injury 97% of the time. An insidious onset for back pain is presumed to be due to age. Medicine falls so far short in understanding the body mechanics that it would be like going to see a caterer to help you put up a marquee. There are some overlooked aspects of muscles that can lead to musculo-skeletal dysfunction which are easily explained without having to describe a primary injurious mechanism. People who have had back pain or treat people that have low back pain are often fixated on the cause. This day and age if it isn’t cause and effect then it must be a trick or something sinister! Whilst almost every western person is having to perform sit to stand and stand to sit I suspect that very few are practising how to perform this movement. To condition our body to be strong in a particular way we need to repeat the action in an intensity that is enough to create adaptation but not enough to injure. The best posture to sit in is a squat. How you get to a squat position in my opinion is through the Qi Gong wall squat technique as this enables us to integrate our body from head to toe. Other variations on a squat movement may concentrate force at particular points of the body. Ideally for health one would look to integrate their whole body in a given movement. Through integration we reduce thixotropy and improve proprioception.
The time it takes you to learn the wall squat techniques can vary from a few weeks to a few years depending upon your current ability. The point of the exercise is to coordinate your whole body within the movement and not to simply reach the lowest point. If you can only squat down a very short distance like many out there will find, then begin with a short distance and with practise within your chosen personal limits increase the distance you can squat. The only thing to improve against is your previous ability. If you are not improving then you are likely getting worse as our dynamic body and brain do not hold static ability. The art of integration of your body is much more important than copying the full movement. If it doesn’t feel right then odds are it isn’t! consult an expert who can help you to reach the goal of always being able to sit to stand and stand to sit in a whole body integrated way so that you are aware of how your body works together through your own internal representation of your body through your mind’s eye. The internal art of movement is something being slowly lost from the human race which will lead to more focus on accumulating stuff and experiencing more pain. Movement and a chiropractor like me is what your body wants …