Friday, January 29, 2010

Exactly backwards

I had a chance last weekend to travel to Saskatoon and visit the PT school there for a few days, talk with a few of the profs, plan a tentative future. My (not very) lofty goal is to somehow gain permission to dissect, photograph and map out, in broad visual terms, the extensive forest of rami that project out to skin from the numerous cutaneous nerves that run along parallel to and beneath skin - even if I have to suck it up and do a Master's. My friend Angela, who characterizes herself as an obstacle remover, has been extraordinarily kind and generous with her time and hospitality toward me. She and I have completed a research project together, yet to be written up.

Everyone was kind, lent me their ear, but the impression I have come away with is that there is an invisible wall I could sense, that I may never be able to unlock, between what my profession has turned itself into, and what I think it could be.

Take, for example, the nervous system.

I had an opportunity to sit in on a two-hour neuroanatomy lecture, with permission; it occurred to me that these first-year students are getting more information handed to them in one day than I ever did in a year. In the space of two hours, the lecturer covered the embryological origin of the brainstem, its organization, an intro to each of the nuclei within it, all the spinal cord tracts that move rostrally through it and descend through it, the medulla, the cranial nerves and what each does and how each can be affected by traumatic head bangs, the branchial arches and neural crest, and which muscles were formed from which arch, and which cranial nerve was associated with each arch. It's a lot for first-year students, probably.

My question is, Why should they care? How hard would it have been to put an overall frame around that headfacethroatbrain zone, as neurological core sensor, effector, consciousness producer, and (according to some, like Jaak Panksepp, emotion initiator), plus metabolic engine for the entire organism, breathing and swallowing, able to operate bi-directionally?

The prof was kind enough to meet with me for an hour or so following. My impression was that the only real teaching he does regarding the peripheral nervous system is that it is segmented, each spinal nerve innervates all the stuff coming from a particular segment, and that the main important thing about its role in the body is that there are muscle spindles and sympathetics. Other than C fibers and A deltas, the sensory aspect was irrelevant to him, it seemed.

While all that is true, there is so much more to it than that!

But I was reminded yet again, about how physiotherapy, in order to gain permission to evolve as a profession, pretty much focused its awareness of neural matters entirely around motor output, and has been stuck there ever since, child as it is of the greater touch-phobic society into which it is embedded. We are licensed to touch people, but we are not permitted, it would seem, to examine, comprehend, conceptualize or even be taught anything about how our touching might be an interactive source of brain food for the recipient brain. Too .... sexy or something, maybe. Thar be monsters, or something. This potential pitfall could easily be bridged by a single class in transference/counter-transference, a standard issue that must be dealt with up front by the psychoanalytic community. Why let it remain in the subconscious of my whole profession? Why not deal with it up front? A preemptive strike? Forewarned is forearmed.

The profession has structured itself entirely around motor output, and a gaping void exists where understanding of how the brain and PNS reads and responds to kinesthetic input should be. To be fair, it was probably easier in the beginning to follow Cartesian divisions - you bunch of therapists go deal with the mind, and us, we'll stick with the body. Neuroscience has put this idea into total eclipse: there is no separation whatsoever.

Yet, emphasis on the INput side of the nervous system, and learning to understand it, is precisely, according to me, where becoming not just a good therapist, but a great therapist, lies. These are totally uncharted waters for our profession. We could be great therapists if we hadn't got our conceptual trajectory exactly backwards. We have been looking in through the wrong end of the telescope, all along. But we no longer have any excuse for continuing to do that. Not if we look at what neuroscience can tell us about ourselves in a body, and about ourselves treating other embodied people. Other humanantigravitysuits. (We DO have that word "therapist" in our name, not just the word "physical"...)

I'm doing my very best, but may never succeed in making a big enough noise about it to be able to make any difference in the status quo whatsoever. I have to realize this yet not allow it to defeat me.

Oh yeah, he's also an OMPT. Forgot to mention that.

Sunday, January 24, 2010

Origin of the brain

Nice video explaining the principles of exaptation.

Tuesday, January 12, 2010

Taking stock

A convergence of sorts has occurred in the new year: today a friend sent me a link to this excellent essay, written by Frank Wildman, on the sad, rather shabby, rather scientifically disjointed state of PT. He was thinking of U.S. PT, I think, and he had his Feldenkrais goggles firmly duct taped to his head while writing, but I'll forgive him for that, because he makes many many good points. I like the way he compares the state of PT to the state of general science before Darwin came along with the unifying theory of evolution. This essay still seems topical, even though it is 22 years old: Learning: The Missing Link in Physical Therapy.

Lately, a New York Times article by Gina Kolata, Treat Me, But No Tricks Please, provided the reading public with a glimpse into the hall of distorting mirrors that is current, American at least, PT. This story has raised comment on a few PT forums/blogs:
1. NY Times: Physical Therapy Useless?
2. Yes, Gina you can tell if your physical therapist is "voodoo less"

There isn't a whole lot to come back with, though.. Frank is still right, I'm afraid.

This short video, "Myofascia," was constructed by a PT student, determined to be a PT who embraces rationality. It's very succinct and immediately was shared by several Facebookers. Facebook really is a networking site, because through it I met a fellow who wanted to counter the video and share that he is helping to organize an entire conference about fascia. He seems like a very nice guy. We struck up a conversation, shared who we are and what we're about. I won't divulge anything about him, as that would be improper, but I'll put here what I told him about me:

"Your enthusiasm for the topic (fascia) is palpable! [/manual_therapy_joke].

Congratulations on helping organize a conference! That's no small task!

I'm a manual therapist too, born and raised in Canada, of physiotherapy descent. ...

Anyway, I moved (grew up in Sask), now have colder weather but WAY more sun, which at my age I need. My interests include deconstruction of faulty treatment concepts, passion for the neuroanatomy, physiological function, understanding, and care and feeding of the human nervous system, and writing. I helped start the Pain Science Division of the CPA. Currently I am on the exec. and run the coast to coast online directory for PSD members/PTs who want to be in it, and for patients who want to find a pain therapist. In my private PT life I have taken what I know about manual therapy, and what I know about neuroscience, and have called the result, "dermoneuromodulation." It's basically skin stretching but with an entirely neurological treatment construct, no mesodermal derivatives involved whatsoever. I've done a pilot research project on this, along with Angela Busch at U. of S, not yet written up. I've done an initial cutaneous nerve dissection (at UBC), took lots of pictures, wrote it up but have failed to have it accepted so far. I'll be talking about dnm, and about Neuromatrix model of pain, at a congress for manual therapists in Brazil in May. Then (hopefully, don't know yet) in St John's at CPA Congress. My life goal is to help develop vast crowds of rationally thinking, compassionate PTs/manual therapists who care deeply about pain and choose to help their patients overcome it in ways and with treatment constructs that are scientifically bullet-proof. Down with woo, IOW. To help that happen my next ambition is to get ensconced in an anatomy lab somewhere and map out the entire cutaneous nervous system so that therapists of the 21st century can realize and visualize and develop treatment constructs around what they are actually touching, and what's actually responding, in the person/body they are handling. I call this an 'interactor' model rather than an 'operator' model. Many therapists learn to do this, but implicitly rather than explicitly. I want self-aware consciousness AND scientific impeccability AND simultaneous, seamless treatment construct. Not too much to ask, is it?..

I run a page here, Neuroscience and Pain Science for Manual Physical Therapists, if you'd like to check it out some time. I also help admin a skeptical PT site/discussion forum called SomaSimple. You are welcome to come, join, discuss there too! We welcome everyone who wants to learn to think more clearly about what we do or who might have light to shed.


Thursday, January 07, 2010

Grooming behaviour

Insights into primate social grooming. Yeah. That could be why I was attracted to becoming a manual therapist/HUMAN primate social groomer. I don't like fighting. I'd rather preemptively groom instead. Gives me some sort of illusion of control over a boundary between me and others in my troop who are much bigger/stronger. It makes sense in certain ways, especially if it works. Why it's not considered "smart".. I do not know. I'd call it social intelligence which has been underestimated.

Primates’ Social Intelligence Overestimated: Primates Groom Others If Afraid They'd Lose in a Fight With Them

Wednesday, January 06, 2010

Getting the shot

Yesterday I got the H1N1 vaccination, previously discussed here. I hadn't had any shots since traveling about 25 years ago, and wasn't really looking forward to the poke, but as it turned out, that part was fine..

I will digress for a moment: health care/medical insurance in this province is completely free. Just get a health care card by showing proof of residence, and voilá, you're in the system. I had to get a health card in order to get a vaccination. I needed to get one anyway, but due to an application which had to be downloaded, printed, filled out and sent in, a broken printer, procrastination about getting a new one hooked up due to a case of acute (but not terminal) technophobia, which came at a time of psychological fray... this process was all delayed for awhile. Suffice it to say that my BC coverage lapsed, and I was actually, officially, uninsured for a few weeks. I won't go into how that felt.. let me just say I was glad when that little Sask card arrived in the mail, early December.

There were a series of vaccination clinics downtown, where I live, but for one reason or another, mostly my own disorganization, I missed them all. On Dec 22 there was one scheduled according to the internet, but when I got to it, it wasn't at the mall a few blocks away - it had been moved to the Public Health office, out of prairie winter walking range, where the Weyburn Mental Hospital used to stand before it was completely razed. (I've always thought it odd to call leveling a building down to the ground "razing" it, but that's a different topic for another day.)

Yesterday the clinic was open for H1N1 vaccination, and my mother agreed to drive me over. It was cold and snowing. The clinic is a few miles away. There are no buses in Weyburn. There are taxis, but because I'm not working for a living right now, I've learned how to be cheap.

It was typical Weyburn, a waiting room full of people, smiling and quietly chatting, a couple bored and antsy young children, only one nurse, I was told, in absolutely no hurry apparently, therefore a long wait. There was a long-ish form with a blank for me to write in my new health card number to complete, only three people ahead of me, but it seemed that each shot took a good 15 minutes. I fumed quietly to myself, thinking of how much of my life was getting sucked away sitting there, how in Vancouver this whole process would have been way more streamlined and way more people would have been processed much more quickly and the receptionist would automatically have filled out the health number to lessen the chance of error. I thought of my mother sitting outside in the cold, in a warm car, but still.. Finally I went out and told her it was going to be at least another 45 minutes. To my surprise, she wasn't fussed at all. I was the one fussed.

When it came my turn, I was given a nod by the receptionist who was wearing a cool, hightech headset thingie, through which she communicated to people not in the room. I walked down a long long hallway as directed, turned right to walk down another hallway, and entered a large room, empty of people except the nurse. What a laid-back place, I fumed silently to myself. The nurse collected my form and asked if I had ever had any reactions to any shots. I told her that the only reaction I'd ever had was a swollen, hot, red upper arm that had lasted a week, from a typhoid shot long ago.

Eventually I got my jab, and realized that the hold-up was that the nurse loved to chitchat with her patients after. I expect that what she was really doing was keeping people talking so she could scan them for reactions or something. There was certainly a great deal more focused attention than I remember from 25 years ago..

The shot itself was swift and relatively painless. Today I have a sore arm, but only at skin level - I can move my arm anyway I like. I feel fine. No Guillain-Barré, so ordinary genes must have made my peripheral nervous system. I have done my part for herd immunity.

Friday, January 01, 2010


Dawkins and Dennett, great conversation. About 50 minutes. How improbable our existence. Where and how we fit. Humanity as the nervous system of the planet. Gratitude for a chance to be here, even for a little while. Unedited.