"I Have a Meme..."

A PT colleague in Nova Scotia just wrote this resounding echo of Martin Luther King's famous speech on a discussion forum called SomaSimple.

It speaks to the effort people on that board (and I'm proud to count myself among them) are making to try to wake up our broader human primate social grooming community to the simple fact that nervous systems run bodies, that manual therapy researcher/clinicians spend far too much time obsessing over mesodermal minutiae and constructing science projects designed to flatter themselves and their mesodermal obsessions, Balnibarian-like. (You might remember Balnibarians from Gulliver's Travels. They specialized in inside-out and backward science:)

After requesting to leave the island, Gulliver is lowered to the continent of Balnibari and enters its metropolis, Lagado, where the crops are poorly managed, people wear ragged clothing, and the houses are in bad condition–except for the house of the governor of Lagado. He tells Gulliver that 40 years before, some Lagado residents visited Laputa and came away with a smattering of mathematics that caused them to undertake bold scientific projects and other heady enterprises. They even built an academy in which to carry out their projects. Now every town in Balnibari has an academy, and the people spend most of their time conducting experiments. For example, at the Academy of Lagado, scientists are attempting to do the following: extract sunbeams from cucumbers, turn human feces back into food, erect buildings from the roof down, plow farmland with pigs, make marbles soft enough to stuff pillows and pincushions, breed sheep whose entire bodies are bald, and have students learn mathematics by swallowing wafers on which formulas are written.
.......So absorbed in these enterprises are the inhabitants that they avoid taking part in almost all other activities.

A lot of the participants on this discussion board, SomaSimple, including me, just shake our heads and wonder what on earth we are doing in this profession that tests our sanity so, a little community of skeptics with the odd true believer thrown in to keep things rolling along (every discussion board needs dissent to keep it alive, I suppose). It's the small version of larger debates going on everywhere among those who like to think and those who want to simply believe.

Re-membering the Forgetting

PTs go to university to learn what there is to know about the human organism that can be applied to helping it improve its function. We all learn anatomy, physiology, pathology, neuroanatomy..

When we graduate, only those of us who end up having a talent and proclivity for "Neuro", a contracted concept that for us means treating patients who have profound functional deficit, profoundly damaged nervous systems from birth or through trauma ... only these graduates ever stay caught up in neurosciences. Metaphorically we all land on the same beach, then a stalwart few head inland to climb steep mountains.

The rest gratefully exhale post-graduation, allow their info base on neurosciences to drop away, erode, disappear, and turn their cognitive hard drive to learning more about biomechanics. They turn their attention to the stuff of the body, the mesoderm, under a large conceptual umbrella called "Orthopaedics", splitting off from the true functional organizer of the body, the nervous system. Metaphorically, these are all the ones who stay by the water and build piers out into it, preferring beach life, the equivalent of treating a host of issues in tissues that (mercifully) they can classify and reclassify to their hearts' content; the nervous systems of the people they treat are usually intact.

But what is gradually and steadily coming in like a tide is pain science. The pain science advance is forcing the beach boys and girls to pack up all our previous cognitive and conceptual gear and move further inland, closer to where our Neuro colleagues make their livings.

I say "our." I was a beach bum too, for a long time, although I like to imagine I'm already a bit further inland than some. It has only been in the last 10 years or so (out of a 35 year long adulthood as a PT) that I have learned to see pain sciences as a link that will (potentially) one day unite the profession, maybe all manual therapies, into a deeper level of real understanding. There are lots of other PTs on the same path, who have been on it much longer, and are much further along. Some are even working to widen the path.

Of great additional benefit to this whole scientific deepening of the profession would be a much deeper appreciation for EvoDevo, something our hands-on social grooming professions currently lack. If understanding human pain means having to grasp understanding of the human nervous system in all its complex multi-faceted glory, it will also mean understanding the place humans occupy in life itself, not just in multi-varied human culture.

C fibres and Autonomics

In this short essay, Kevin McHenry of
www.painonline.com
examines a likely culprit in the persistent pain circuit.

DermoNeuroModulation

At last, after several years of probing, searching, trying on and then rejecting one name after another for what I physically do with patients' bodies, trying to encompass the whole of the nervous system and the whole of one's interaction with it within a single name, I've settled on dermoneuromodulation.

It has these main important inclusions:
1. The "neuro" portion is the most important. It provides the concept that the nervous system is central to any treatment interaction, at any and at every level, the whole way from the attempt to include only slowadapting non-nocioceptive stretch receptors (Ruffini endings in the skin), to answering any and every question a patient may have, to providing an overview of how the nervous system works and how pain is generated, as a standard part of every encounter with every new patient.
2. The term "modulation" is what the nervous system is doing in response to an input. It modulates itself in response to any sensory input. It does this continually from its initial formation in utero until the moment it dies, at whatever age one dies.
3. The prefix "dermo" means, sensory input through the skin, kinesthetic sensory input. Other prefixes mean other things. For example "psychoneuromodulation" would lean more toward describing psychological input that could result in modulation delivered to the human organism via the (cultural, social) mind, as opposed to kinesthetic input that could result in modulation delivered to the human organism via the physically sensing brain. Not that both couldn't happen simultaneously, or don't all the time in manual treatment. (If we try to pretend they don't we're kidding ourselves.)

It has these important exclusions:
1. It is a brand new word combination that I've seen nowhere else.
2. It therefore carries no baggage.
3. It will never (as long as I am in control of this new meme I'm introducing) contain anti-scientific or pseudo-scientific ideas.
4. Most importantly, there is not a speck, not one hint of any reference to any mesodermal derivative embedded in this term anywhere. This means;
- no mention of mobilizing of any joints
- no reference to moving bones
- no suggestion of releasing fascia
- no talk of muscle lengthening
If any of these things happen during or after dermoneuromodulation, fine, but any changes in any mesodermally derived tissue will be as a result of the brain/nervous system of the patient in question deciding to modulate itself to allow such a thing to happen, not a direct result of a practitioner's applied force.

I have spent years working my way out of confusing conceptual traps by learning all I can about how the human organism with an intact nervous system actually works, how it can end up in trouble (i.e., pain), how it actually interacts with another system (e.g., mine) to its own benefit. The hits now outweigh the misses by far, because my own nervous system (including my own mind) and motor output has adapted over many years, has become the best possible human primate social grooming nervous system it can be, has learned to be slow and gentle and patient on the one hand, nitpicky and precise and persistent on the other, when treating other nervous systems.

This naming process has been a long time coming, mainly because those exact same personal traits carried over into it. It feels like a long-awaited birth has finally occurred, but (thankfully) not as exhausting as the teaching experience was.