Since I haven't been inspired to blog in over a month, I feel like I should take advantage of the teeny spark of dopamine that seized me today.
I've had my mind on other things lately - joined a local writer's group (we've met three times since I joined), started running (yeah I know - shock), tried (and failed) to procure a visa for teaching DNM workshops in the UK (not my bad - the Brit gov. for having such a Byzantine website that none of us on either side of the pond know what the eff is up or how to pick the right kind to apply for).
Plus I've been making many nice pictures of the neurovascular system in all zones of the body. Here is one:
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I want people to learn how interconnected nerves (green) are with the vascular system. It travels everywhere in the body, joined together, as the neurovascular bundle. This is the physiological tubing upon which everything else depends, for life. Without it, gangrene would set in.
The nervous system, including 72 kilometers of nerve, brain, spinal cord (oldest part of the CNS), is only 2% of the whole body. Two percent. Tiny in mass, but mighty in that it manages everything. Every little thing. Uses 20-25% of all available fuel to do so. Day&night, 24/7. Which means, it needs blood flow, needs it now, must have it or it will think it's dying. Nerves must have constant access to fresh blood and constant drainage of used blood, or they'll complain. Bitterly.
According to Sapolsky, the cardiovascular system is only 5% of the body, but is so finely divided and distributed that no body cell is more than five cell-widths away from a capillary. The fuel lines to and drainage lines away from nerves are delicate and subject to kinking. Nerves do not have lymphatics, according to most sources. So, "sewage" backup can occur. Not good for neurons - they hate that.
Vessels need nerve supply. If they don't have nerve supply they deteriorate, because neurons supply the tissue of vessel walls with necessary trophic factors. Plus, the vessels wouldn't be able to constrict or widen without neurons to ask the smooth muscle cells in the vessel walls to act.
So, they are completely co-dependent systems, traveling everywhere together and depending on each other.
When you do manual therapy, please keep in mind that all this tubing is in there, and monitor your pressure carefully. Maybe try working smarter by taking advantage of reflexive behaviour of the NS instead. It's not about you, it's about it.
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On Facebook recently this was posted: Therapist as operator or interactor? Moving beyond the technique, my one and only (probably forever) citation in pubmed.
It was added to with this radio interview:
In it, he lists several references to papers that combined, support everything Jason had to say about how we can leave tissue-based reasoning in the waste basket.
"I learnt you can't break down scar tissue, adhesions, 'release' a muscle or fascia (Chaudhry 2008,Chaudhry 2007, Schleip 2003, Threlkeld 1992)"I learnt that by stretching a muscle in a certain fashion, in a certain way, for a certain amount of time doesnt effect it's structure (Solomonow 2007, Weppler 2010, Katalinic 2011)"I learnt that you don't need to mobilise or manipulate a joint in a specific direction, based on a pattern of pain or specific assessment of movement and joint feel (Chiradejnant 2003, Aquino 2009, Schomacher 2009, Nyberg 2013)"I learnt that palpation of muscles, joints, trigger points are all unreliable and leads therapists to misdiagnose often and direct treatment down wrong and ineffective pathways. (I have done a blog on this topic recently with all the supporting evidence here.)
"I learnt that when all the methods and techniques of manual therapy are examined through the process of systematic reviews and meta analysis most of the research is poor and even the good research shows that it doesn't do much (Menke 2014, Kumar 2014, Artus 2010, Kent 2005)"
Thank you for your well-organized reference list, Adam!
8. Paul L. Bigliardi, Desmond J. Tobin, Claire Gaveriaux-Ruff, Mei Bigliardi-Qi; Opioids and the skin – where do we stand? Experimental Dermatology Volume 18, Issue 5, pages 424–430, May 2009
12. Boulais N, Misery L.; The epidermis: a sensory tissue. European Journal of Dermatology. Volume 18, Number 2, 119-27, march-april 2008, Review article (FULL ACCESS)
14. Hansson T, Nyman T, Björkman A, Lundberg P, Nylander L, Rosén B, Lundborg G.; Sights of touching activates the somatosensory cortex in humans. Scand J Plast Reconstr Surg Hand Surg. 2009;43(5):267-9.
Seriously, there are still way too many people who discount the effect that distorting skin (and the nerves that plug into it from beneath) will have on the central nervous system, as it frantically tries to make sense of novel exteroceptive kinesthetic input, to deal with any possible threat, and in the process might dismantle some positive feedback loops that are counterproductive.
For more about positive feedback loops, see another great blogger, Erik Meira, on the topic: Getting rid of something positive.
Getting rid of conceptual clutter (another kind of positive feedback loop) is an issue in human primate social grooming in general. OK, make that, in the whole culture.
I saw this great little piece this morning on Bigfoot, science, and approaching truth through the null hypothesis: Why we can't rule out Bigfoot.
You can't ever prove Bigfoot does not exist, but you can come very very very very close, close enough to jump that tiny gap and take a principled stand against nonsense.
In our varied and multiple human primate social grooming professions, we could do the same, as Adam Meakins has done.
Then we could rule the nervous system of the person we are treating, in.
That's all we have to do.
