Yule pondering

Dec. 25th. Temperature a mere minus 5°C.
So calm, so bright. Gorgeous blue sky, white all over the ground, bright white clouds. The best thing - I can see sky from every room in my place, unlike when I lived in Vancouver, every window of my place covered up by hideous huge shaggy photon-sucking trees, and that horrible never-ending thick cloud layer beyond.

I swear I could feel the very second solstice came and went, at 11:11 AM my time, Saturday, 21st.
I felt like a weight dropped away.

Today, the day everyone else gets excited about, is completely beside the point to me, as yet another year circles the drain, takes from Dec 21 to Jan 1 to carry away everything about that year that needs carried away, as by a culturally agreed upon cosmic vacuum.

Really, it's all about the light coming back. For me.

In an other hour or so I'll have to put on some respectable clothing ( I can't wear pyjamas) and go over to my mother's house, hang out, try to be social with an aunt and a cousin. It will feel like suspending freedom for a little while, but it's OK though - she's almost 90, and the way life goes, one of these years she won't be around anymore to fuss and bustle over making a christmas party. When that happens, I'll probably have all the rest of my own christmases to myself, to luxuriate in all the light, blue sky, and white snow that I can see out the window to my heart's content.

The plan is, I'll take my laptop over so that we can all sit down and identify relatives long deceased, photos of whom were put up on facebook by another cousin. My mother has procured a password from a neighbour so that we can do this project. She doesn't use a computer herself.
She is very important to this project, as she is the last sibling standing of five originals. As the oldest member of a shrunken clan, most of whom lived and died in the US, she is the most likely to be able to remember who all these people are/were. Their names at least.

.....

This morning as I worked on an image in photoshop (a picture of quadratus lumborum, of all

My little art effort

things), I listened to Handel's Messiah on CBC.  Once upon a time, long long ago, I was in a big choir for a year, and we sang the whole thing. I didn't like it then and I don't like it now. So frilled and repetitious. Why people still stand up for the hallelujah chorus to this day just because some king stood up back in the 1700's when he heard it, puzzles me.

I became curious and looked up the words online. Really, if I were the king, I wouldn't likely have stood, because the whole thing seems a bit subversive: some baby is born who is killed and then comes back and now will take over the world. Maybe the king stood up because his butt was sore from sitting for so long listing to such repetitious music and singing. The king may well have thought, let the peasants believe any nonsense they want; as long as I run the army and collect the taxes, all the world are belong to me - I don't have to worry about some conceptualized idealized "king" who stands for perfect justice and mercy and love and end to war. Heck, I've worked hard to be where I am. So let them be happy in their little fantasy.

I will never stand up again for that song. I will never go out to hear it live. It's a travesty. The world is not much different 300 years after the fact. People are still fighting and killing each other over imaginary kings and ideas associated with them.

Really, all we need is sunshine for ourselves and kindness for each other. Not as an idea, but as an everyday action.

Loose ends: Welcome back Louis Gifford: David Butler, please, glia are NOT "immune" cells.

It's a beautiful day here in the deep south of the Canadian prairies - the sun is blazing, glinting off wet streets. Yes, wet!
It's mid November, but bits of snow that fell last month disappeared; this month's temp has hovered at zero-ish, with almost no precipitation. Last night it must have rained a little bit. 
Not bad for mid November! No seasonal affective disorder at all! Not a trace. And in only short 5 weeks, daylight will turn around and lengthen yet again.  

Lately I had been all wound up spending hours and hours a day doing new images for yet another draft of my nerve book, also the manual I use for teaching, when the big screen computer died. It's currently in the Mount Saint Apples hospital, an hour to the north, for a dead hard drive ectomy. It will be there for a few more days probably. So I'm at loose ends, kind of.

I'm going to have to get a dolly for trips to the computer hospital. I can carry that beast for short periods of time, but jeepers, the distance between the mall parkade and the Apple service store is very long, involving a short flight of stairs to boot. I had to rest frequently. This time I was offered help by a lady using a wheeled walker: She suggested I put the box on top of the walker somehow, and she would give it a ride to the Apple store. I didn't see this as a good idea, worried the box might fall off or something. Just then along came another woman, a few inches taller, a few pounds lighter, and quite a few years younger than I, who offered to carry it for me. So I let woman number 2 help me. I mean, I would have made it, maybe with one more rest, but hey, she looked capable and acted like she needed to acquire service points for some imaginary merit badge or something, so... what the hey, OK.
Still, a little fold up dolly would do the trick, then I wouldn't be so besieged by helpful strangers. Not that I don't appreciate the offers to help, but just this: You can spend your life thinking you're completely invisible, when really you are totally visible, which is a little disconcerting. And it doesn't take much social ripple for strangers to appear out of the shadows if they see something that bothers them, but isn't a threat, and think they might be able to help restore peaceful calm to the mall.
......


When I'm at such loose ends, I blog. 

......

In the last few days some exciting news from the UK: Louis Gifford has relaunched his wonderful series from a decade ago, Topical Issues in Pain. Maybe this time round, the kindling will catch fire, and his brilliance will not only revitalize, but deepen the profession.
Seriously, my profession has lots of 'splainin' to do: The first time I ever even heard of the neuromatrix model of pain was from Topical Issues in Pain book #3, where Melzack had written a very nice long foreword. Why did I have to stumble across it in Louis Gifford's book in 2003? It had already been out for years! Why had no one presented it or written about it yet in any of our professional publications here in Canada? 
Better late than never, I suppose. But I can't help but think the profession in Canada was still so mesmerized by pushing around mesoderm that it couldn't quite make the leap to considering the effects we have on way more sensitive ectoderm. It was only about a year later that Nick Matheson put a bug in my ear, and a few months later that I contacted Neil Pearson, and the Canadian Physiotherapy Pain Sciences Group  (which eventually became Pain Science Division of CPA) was launched.

.........
Today I found the latest edition of noinotes in my inbox. I love David Butler, the therapist, the teacher, the author... and I love this little professional confessional, but: 

Excerpt: 
"I thought I may have reached nirvana with the brain, but now I realise that neurones are only 10% of the brain and as the rest is immune cells, so there is long way to go."

David, David, David... 
A little bit of me dies every time you say that. It's misleading.
I realize you picked that up from Mick Thacker; I do not know why he continues to assert that, because if he closely read developmental biology, he would see how that statement is not correct.
Immune cells are from way far back in development, before, the body has even started to be built. They come from the yolk sac or something. Microglia are immune cells; hard long rigorous argumentative and painstaking lab bench gruelling research over decades has finally established this.  
There was no controversy as far as I am aware about the origin of all the other glia: glial origin seems to have been recognized quite straightforwardly, early on: no arguments arose. They come from neural tube stem cells, i.e., ectoderm; neural stem cells differentiate into either neuronal cells or non-neuronal cells. If they turn into a neuron, then they do neuron stuff. If they turn into an astrocyte, an oligodendrocyte, etc. (i.e., any other cell termed "glia"), then they can do all kinds of stuff, including (but not restricted to) immune-like stuff. 
I think, therefore, it's misleading to call glial cells immune cells as if the two categories were completely equivalent. I saw it in your latest edition of Explain Pain, too. 
Please, please stop. 

The fall of the postural structural biomechanical model

I saw this gif posted today by Eric Kruger on SomaSimple, and it made my day.

For more, read Eyal Lederman's very good paper, The fall of the postural–structural–biomechanical model in manual and physical therapies: Exemplified by lower back pain, open access.

Some people just can't seem to let go of this model, though...

"Biomusic" and Personhood

Nautilus magazine published this piece today on facebook, and I was immediately entranced by possibility:

What's the Sound of Personhood? 

A boy lies in a coma ward in a hospital in Toronto. He cannot communicate. 

"Thomas didn’t move, and hadn’t for two years. He suffered from a brain injury that left him profoundly disabled. He was incontinent, unable to eat, speak, gesture, or breathe on his own, and dependent on round-the-clock medical care. His parents realized they couldn’t give him the care he needed at home. This is how Thomas came to be in the Holland Bloorview Kids Rehabilitation Hospital in Toronto, Canada, in a hybrid unit that serves as both a permanent home and medical facility to similarly disabled children, who range in age from infancy to young adult. These “silent” children, as they are known, are not in acute life or death situations, but they cannot live without constant monitoring and medical care."

Caregivers look after him, but get no feedback from him. 

This is the fate of a large percentage of people. Babies fare somewhat better, with their big eyes, exaggerated reflexes and possibilities. People at the other end of life, not so much. Care homes for those with dementia are filled with people who once had full lives, but who are now treated as biological "objects" to be "managed." Input, throughput, output. Get them up, clean them up, sit them up, feed them, water them - leave them unattended for hours sometimes, because of doing the same for all the others, toilet them, put them back to bed, roll them over once in awhile. Add to that, the opportunities for abuse by frustrated underpaid caretakers. Language barriers. It can become a horror show.

Back to the article: A woman appears, Stefanie Blain-Moraes, an interesting cross between engineer and musician. She has volunteered for eight years at this facility. She noted the perfunctoriness that sets in after awhile, the detachment, the burnout, the treatment of these patients as objects to be dealt with. That happens naturally, to anyone, after years of never getting any real interaction or feedback.

So, she invented sound feedback - "biomusic"!!

"Biomusic sounds something like avant-garde electronic music. Generated using a Musical Instrument Digital Interface (MIDI), it has an ethereal, other-worldly quality. An underlying drumbeat represents heart rate. Skin conductivity—which varies with sweating—controls pitch. Respiration rate dictates the musical articulation and phrasing. The melody and chords are smooth and flowing through the breath, and soften towards the end of the breath. In the first minute of monitoring, the system takes a baseline reading and assigns the average to middle C. So, every instance of Biomusic begins with the same pitch and moves up or down from there. The overall key signature is determined by skin temperature, which changes gradually about 15 seconds after an emotional or physiological stimulus. States of stress, with fast and jagged breathing, sound different than states of relaxation, when the breath is slow and smooth. More subtle emotions can also be translated into distinct-sounding music."

Whoa! Suddenly, with critter brains able to indicate how they feel, caregivers have instant feedback on how their actions are affecting their charges, and can modulate - themselves! And furthermore, their own critter brains have a way to connect and affect this unconscious person's critter brain directly, without having to go through cumbersome, or non-existent anymore, strictly human brain language based social brain channels.

Brilliant. Freaking brilliant. 
.........................

My brain turned immediately to wild fantasies about how marvelous it would be as a tool for human primate social grooming, manual therapy. Imagine being able to bypass all the conceptual clutter and gaining instant feedback through "biomusic" on how a patient's nervous system is responding to your input. Think how the manual therapy recipient could use the feedback from their own critter brain/ nervous system to enhance their own relationship to it!

I love this idea. Just love it.
Can't wait until we can implement it somehow in our work. Truly interactive. No clunky "thought" objects to navigate anymore. Just hook up, get the music started, then all four brains - the two language-interactive human brains and two critter brains, the nervous systems themselves of both people, could have a nice involved kinesthetic conversation aimed at reducing pain.

Think of all the possibilities: 
1. Easy outcome tracking. You could do a baseline on that patient, in pain, before treatment, during assessment. You could record the whole interactive treatment process. Then another post treatment recording. Then compare. Wow. 
2. No more arguing over what I call "thought" objects (models of treatment). No more need to set up horribly complicated test situations or try to teach patients how to fill out complicated questionnaires and send them in. All the data flows in effortlessly, and can be pooled ongoingly. 
3. Instant feedback during treatment for the practitioner, who can easily and instinctively modulate themselves and what they're doing without having to go through all the "How does this feel?" and get a response you can't be completely sure of, because you have no idea to what extent the person understands what sort of feedback to provide, or might be trying to be nice, and not mention that you're inadvertently pulling their hair or something noceboic.. 
........................

Another interesting part of this article: a definition of "personhood" that finally makes sense to me. 

"Perhaps it shouldn’t matter that children like Thomas cannot respond or show gratitude for their care.  And yet it does. When the nurse said that the biomusic reminded her that her charge was a “person” she invoked a concept with echoes in law, philosophy, and psychology: “Personhood” is a title for those whom we recognize as being like ourselves and worthy of our concern. The act of caring is a relation, not an attitude; it is a duet, not a solo."

Did you see that? 
"The act of caring is a relation, not an attitude; it is a duet, not a solo."

Personhood is an interaction, not a thing. It's a verb, not a noun. It's buried inside the biopsychosocial exchange. "Personhood" is a word, a concept, or a thought object, that represents this relationship and the connection embedded within it, between critter brains, acknowledged by human brains. It can be either inhabited, or abandoned.

We can provide better care by inhabiting the relationship. Therapeutically.

The Skin as a Social Organ. Part 2h: Social bonding's broader context.

The paper, The skin as a social organ


Previous introductory blogpost to this series.    Preamble: Random thoughts on spas

Part 1: Dual nature of touch: as PTs, do we "get" this? Part 1a: Touch can be pleasant, rilling Part 1b: Vallbo on C-tactiles 

Part 2a: Different kinds of touch Part 2b: Proxemics Part 2c: The sad dearth of manual therapy aspects in reviews of interpersonal touch Part 2d: Learning to sit still, learning to behave, learning to not be connected to oneself Part 2e: Touch early, touch often Part 2f: Human allogrooming Part 2g: Bonding aspects of social grooming. 

Next piece:

"Positive affect and hedonic feelings may be the glue which holds individuals, as necessarily physically separate beings, together in social bonds. Grooming, indeed, may reflect a generalized form of pair-bonding usually seen in reproductive or mother–offspring dyads across numerous taxa (Dunbar 2008). As such it may rely on similar neural and physiological mechanisms as the dyadic cases. For example, in addition to its role in maternal behaviors, the neurotransmitter oxytocin is also an important mediator of grooming (Drago et al. 1986), as demonstrated by the exaggerated grooming behavior that results when it is administered into the cerebrospinal fluid of knockout mice which do not express oxytocin (Amico et al. 2004). Endorphins may also play a central role in grooming. In both talapoin monkeys (Keverne et al. 1989) and rhesus macaques (Martel et al. 1995), opioid receptor blockade results in increased solicitations for grooming. Dopamine may also be important in affiliative behavior and bonding (Depue and Morrone-Strupinsky 2005)."

Dunbar RI (2008) The social role of touch in humans and primates: behavioural function and neurobiological mechanisms. Neurosci Biobehav Rev (Full access pdf)

Drago F, Caldwell JD, Pedersen CA, Continella G, Scapagnini U, Prange AJ Jr (1986) Dopamine neurotransmission in the nucleus accumbens may be involved in oxytocin-enhanced grooming behavior of the rat. Pharmacol Biochem Behav 24:1185–1188

Amico JA, Vollmer RR, Karam JR, Lee PR, Li X, Koenig JI, McCarthy MM (2004) Centrally administered oxytocin elicits exaggerated grooming in oxytocin null mice. Pharmacol Bio- chem Behav 2004(78):333–339

Keverne EB, Martensz ND, Tuite B (1989) Beta-endorphin concentrations in cerebrospinal fluid of monkeys are influenced by grooming relationships. Psychoneuroendocrinology 14:155–161

Martel F, Nevison C, Simpson M, Keverne E (1995) Effects of opioid receptor blockade on the social behavior of rhesus monkeys living in large family groups. Dev Psychobiol 28:71–84

Depue RA, Morrone-Strupinsky JV (2005) A neurobehavioral model of affiliative bonding: implications for conceptualizing a human trait of affiliation. Behav Brain Sci 28:313–395

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I know I'm losing interest in a project when I'd rather spend my time doing jigsaw puzzles on an iPad than blogging. Seriously.

Right now, I have no dopamine for this series. I do so dislike leaving things undone after I've committed myself to doing them.  But I'm also somebody who likes to fully utilize my own critter brain, especially in the motivation department, and right now, my critter brain doesn't want to do this anymore. I think it has become bored.

I won't close the project, but I will meander away from it, turn my back on it completely, blog about other topics for awhile. I don't know for how long. The way my brain recycles, and the way life presents intersecting criss-crosses in bits and pieces read here and there, I'm sure I'll wander back.

Topics in this paper left to cover:
1. Touch as communication
2. Pathways of pleasant touch
3. C-tactile fibres
4. Where pleasant touch lands in the brain
5. Intersubjective representation
6. How it all ties in with empathy.

These are all fascinating, but I've got to go do other things for a little while. I'm waiting for a new book to come, Neurobiology of Grooming Behavior. Well, not "new" - it was published a few years ago, but relatively new, and new to me. It might serve as re-inspiration. Or not. We'll see.

The Skin as a Social Organ. Part 2g: bonding aspects of allogrooming

The paper, The skin as a social organ


Previous introductory blogpost to this series.    Preamble: Random thoughts on spas

Part 1: Dual nature of touch: as PTs, do we "get" this? Part 1a: Touch can be pleasant, rilling Part 1b: Vallbo on C-tactiles 

Part 2a: Different kinds of touch Part 2b: Proxemics Part 2c: The sad dearth of manual therapy aspects in reviews of interpersonal touch Part 2d: Learning to sit still, learning to behave, learning to not be connected to oneself Part 2e: Touch early, touch often Part 2f: Human allogrooming

[Hello! I'm back.]

I will pick up exactly where I left off:  The next paragraph of the paper:

In romantic partnerships, relationship satisfaction, previous experience of familial affection, and trust were positively correlated with self-reports of mutual grooming (Nelson and Geher 2007). The same study showed that individuals who scored higher on anxiety subscales of an attachment questionnaire also reported more frequent grooming behavior, suggesting that an anxious attachment style may be accompanied by behavior likely to lead to more secure bonds. It is also important to consider the stage of an affiliative and/or romantic relationship with respect to the role of intensive touching and grooming (Emmers and Dindia 1995). Indeed, different neural mechanisms may come into play during the initiation of an affiliative relationship and during its maintenance (Depue and Morrone-Strupinsky 2005). 

Nelson H, Geher G (2007) Mutual grooming in human dyadic relationships: an ethological perspective. Curr Psychol 26:121–140
Emmers TM, Dindia K (1995) The effect of relational stage and intimacy on touch: an extension of Guerrero and Andersen. Personal Relatsh 2:225–236
Depue RA, Morrone-Strupinsky JV (2005) A neurobehavioral model of affiliative bonding: implications for conceptualizing a human trait of affiliation. Behav Brain Sci 28:313–395

I don't know much about this; unmarried by choice, childless by choice... at least I knew what kind of life I didn't want.

A few stray thoughts about this paragraph:

1. maybe a higher proportion of people who have anxious attachment styles end up in human primate social grooming professions than in other walks of life.

2. proper treatment boundaries are very important, the thicker the better.


If I weren't a thorough person and if I hadn't made a deal with myself to make a blogpost about each and every paragraph in this paper, I would have left this one out as irrelevant to the art and science of human primate social grooming.
..........

Skin as a (therapeutic) social organ, and the nerves of my knee.

I've been WAY too busy to be able to blog on the paper, but before I return to it, decided I want to pour down a few reflections in a lull here, in a hotel room in Regina, awake from a heavy sleep after returning from Madrid where I taught this weekend. So I got in at about midnight, after leaving the nice Hotel Confortel at 7:30am, fueled by a couple or three cafe con leches, and comida.. from there to the aeropuerto, sitting for awhile to await boarding, flying to Charles de Gaulle in Paris, admiring the airport!, finding my new gate (always a couple kilometers between gates and a security check/passport check with the snaking lines, having to drag luggage.. ), boarding the cross Atlantic flight (I gotta say, the food was really good!), arriving in Toronto with customs, security check, snaking lines, take a bus, find the checkin counter, sit and wait for the next plane to Regina..

Anyway, long story short, I was upright for another Very Long Period of Time. Counting the 8 time zones with an hour lost every time, plus the three airport experiences, I'd guess it was more than 24 hours. Going to Spain was even longer. I'd already been traveling 14 hours by the time I got on a plane that would fly me to Europe out of Toronto.

So OK: Why am I telling you this? More moaning from the woman who hates traveling? Well, partly, but this time is not just a long sad moan: this time there is a point.

The point is, I had knee pain for a couple months previously, couldn't walk well, couldn't access smooth biomechanics, and now I can. Yay!

Even after all that sitting, snoozing, not moving, fast walking, pulling luggage, going up and down short steps to and from aircraft, no knee pain anymore. I'm delighted. So, that is really what I want to talk about.

In the beginning
On a previous flight in July, to teach in Minneapolis, which is a short flight, not even two hours, I sat with my left leg crossed, foot on knee, balanced an iPad on it, played games non-stop to kill time. I should have known better, but my urge to kill boredom and stress overwhelmed my good sense about taking care of nerves, and any nociceptive input that may have been coming from my knee. As I recall, that entire weekend, I felt some stiffness in my knee, but not pain. It didn't really bother me. A few days after arriving back home, though, huge pain developed along the inside of the knee, across the front. along the medial calf, and at the back, it felt like a thick short bungee cord took up space and prevented full flexion. It was worst standing up after sitting for any period of time.

It hurt a lot. There was swelling. I did exercises for sliding nerves, I used tape, I managed the pain, and managed to do everything (badly..) except be able to use stairs. I had to use those one by one, unless I wanted to feel pain... Sometimes I capitulated to it and went one step at a time. Other times I thought, no, hurt doesn't equal harm. I'm going to act as if my knee were normal, even if it hurts.

Facing the ordeal
I kind of dreaded having to go back on a plane, especially a long trip like to Spain, but some part of my

Class in Madrid Sept 14-15, organized by Zerapi

brain decided it would ask for help once I got there, and at an appropriate moment. (see class photo at the right - a wonderful class! people with hands like butter.)

When I arrived, I was in about the same condition as before I left. The class was a ten-minute walk from the hotel, but carrying computer, etc., and my knee, and stairs, and cobblestones, it took me about 15 minutes. The second day was the workshop on  lower body/leg. I had the guy who translated, whose name was Julio (see picture), perform the treatment for entrapment points for saphenous nerve, patellar plexus, and fibular nerve. That took care (immediately!) of all the biomechanical problems. After I could even use the knee for jumping. I could handle a few steps smoothly, even carrying a load. I could walk evenly, no limp. I could feel my knee lock and unlock smoothly and appropriately with each step back to the hotel. Yesterday morning I woke up with no awareness of knee pain for the first time in at least 6 weeks. I did that huge plane trip. Today I woke up with even less discomfort. It's getting even better! With normal use, and normal biomechanics, the nerves will receive normal mechanical input. The neurons will be fed by movement. The residual soreness will vanish.

The treatment
Saphenous nerve exit point:
For the saphenous nerve I laid prone and had Julio put both his arms on the back of my leg, elbows apart, so he could elongate the skin along the back of the leg away from the knee crease. Then he located the "punta dolorosa" at the medial knee. Using both hands, he gently pulled the skin around the knee into more medial rotation around the leg. The point softened and was no longer tender. I felt extreme heat as if it were coming from his hands; actually it was coming from my leg itself as the sympathetic nervous system reacted. 80% of vasodilation occurs thanks to the sympathetic nervous system, and about 20% thanks to afferent C-fibres in the vascular plexus of cutis/subcutis. He could barely hold on to the skin, as a lot of sweating arose at the same time. But he did.
Patellar plexus:
Over the patella a bunch of nerves, cutaneous ones from the femoral nerve, all anatomose and form something called a rete. It contains lots of vasculature as well. The treatment for that is in supine: the therapist gathers as much skin circumferentially as possible, and lifts it up toward the ceiling, holding it there for a long period of time. This feels really good to the brain.
Fibular nerve:
The therapist sits beside the table, with the leg off the side of the bed, foot resting on their lap. The hip is in about 45 degrees abduction, full extension: The knee is in about 45 degrees of flexion. The therapist locates the "problem child" behind the knee. It might be a nerve, a vessel, a muscle.. I don't know for sure. There is a hard spot, anyway, large, and it feels tender.  The therapist places the other hand on the skin atop foot and the lateral side of the fibula at the lower end of the leg. They pull that skin obliquely away and into more internal rotation. The lower leg itself wants to move to follow the skin to which it is attached, into more adduction, but the top of the tibia can't move because the edge of the table is a fulcrum preventing that. But the bottom end of the leg moves slightly into adduction and internal rotation. This lengthens the fibular nerve slightly where it winds around the head of fibula, and maybe pulls it out of some deep grommet hole behind the knee at a branch point. Anyway, something in behind the knee lets go of the spinal cord reflexive guarding it was doing, or rather, was being told to do by the spinal cord. Intrinsic rotary movement at the knee restores itself. The position is completely comfortable and with the added pressure from the therapist results in a wonderful yes-ciceptive response experienced in the knee part of the body schema in the brain.
Today, my body schema is absolutely delighted with the outcome we obtained.

..........

There wasn't enough time to present the lecture I have about operator vs. interactor models, unfortunately - translating everything means a class takes twice as long. I really really want to get across the point though, that implements are not necessary for treating anything in the periphery that has to do with pain. Only careful hands. The nervous system is absolutely self-corrective, as long as it's intact and has the ability to make any and all proteins, receptors etc., that it needs for its own maintenance. I saw this paper (full text) posted this morning and want to share it - Flexible Cerebral Connectivity Patterns Subserve Contextual Modulations of Pain.  Can you imagine the detriment to this sort of brain function if it has to put up with gouging tools, needles and high velocity manipulation? From a certain subset of practitioner who has decided they Must Be In Control of the Situation? And don't want to allow a nervous system have its own natural response? (To me, this is like a subset of rape culture.)

Another very short comment appeared in a wonderful blogpost by David Butler today, who apparently has been in Paris, visiting Pasteur's home: 

"I came out thinking “this man has saved far more lives than the Mona Lisa ever will, and why are scientists hardly revered these days – adulation goes to politicians, sportsmen and Kardashian types”. I am sure most people think the term “pasteurized/pasteurised” on the milk carton means the milk came from a pasture. And too many of my colleagues think they have to be doctors to get anywhere."

Yes. 
Oh yes. 
Such nonsensical and completely beside-the-point puffery. Egos walking on hind legs. I'd much rather be a SomaSimpleton.  

The Skin as a Social Organ. Part 2f: Human allogrooming

The paper, The skin as a social organ


Previous introductory blogpost to this series.    Preamble: Random thoughts on spas

Part 1: Dual nature of touch: as PTs, do we "get" this? Part 1a: Touch can be pleasant, rilling Part 1b: Vallbo on C-tactiles 

Part 2a: Different kinds of touch Part 2b: Proxemics Part 2c: The sad dearth of manual therapy aspects in reviews of interpersonal touch Part 2d: Learning to sit still, learning to behave, learning to not be connected to oneself Part 2e: Touch early, touch often

Next (at last!!) 

"A major context for social touch among primates is grooming. For most primates, grooming one another (allogrooming) is not just about hygiene. Although it does serve this function, the amount of time many primate species devote to this activity is disproportionate to what is required for keeping fur and skin clean. In fact, some species (such as gelada baboons) may spend up to 17% of their time grooming despite requiring perhaps only 1% for strictly hygienic purposes (Lehmann et al. 2007; Dunbar 2008). Instead, allogrooming has taken on a new significance as a form of bonding and reinforcing alliances (Dunbar 1996, 2008).
In contrast to the work on grooming in nonhuman primates, research on human allogrooming is rare. It is possible that grooming is a comparatively more restricted behavior in humans (for example, in intimate or parent–offspring interactions, or in ritual or professional transactions), or that its social role has been largely replaced by language (Dunbar 1996). Nelson and Geher (2007) have defined human grooming broadly as including ‘‘any behavior in which an individual removes or mimics removal of something from the skin or body.’’ In nonhuman primates, such activity involves parting the fur. Typically, allogrooming movements involve a coordinated sweeping through the fur with one hand and plucking at debris with the other (Sparks 1967; Dunbar 2008). Humans, of course, have much less abundant hair than our primate cousins, but our allogrooming practices may have adapted to our nakedness. A homologue to the ‘‘sweep’’ may manifest in the stroking gestures over the skin surface common in the ‘‘dynamic’’ category of interpersonal touch. Such dynamic touch is also pleasant for the toucher, with others’ forearm skin rated more pleasant to touch than one’s own, and forearm skin as more pleasant than glabrous (palm) skin, whether one’s own or another person’s (Guest et al. 2009)." 

Lehmann J, Korstjens AH, Dunbar RIM (2007) Group size, grooming and social cohesion in primates. Anim Behav 74:1617–1629
Dunbar RI (2008) The social role of touch in humans and primates: behavioural function and neurobiological mechanisms. Neurosci Biobehav Rev (full text with a page missing)Dunbar R (1996) Grooming, gossip, and the evolution of language. Harvard University Press, Cambridge, MA
Nelson H, Geher G (2007) Mutual grooming in human dyadic relationships: an ethological perspective. Curr Psychol 26:121–140 (full text)Sparks J (1967) Allogrooming in primates: a review. In: Morris D (ed) Primate ethology. Weidenfeld and Nicholson, London
Guest S, Essick G, Dessirier JM, Blot K, Lopetcharat K, McGlone F (2009) Sensory and affective judgments of skin during inter- and intrapersonal touch. Acta Psychol (Amst). 130:115–126

All right, now maybe we can get somewhere. 

"In contrast to the work on grooming in nonhuman primates, research on human allogrooming is rare." 

Actually, no.. I would beg to differ: millions of hectares of trees have sacrificed their lives so that avalanches of research could be printed on this. People call it by any other name than what it actually is, human allogrooming. Instead it is called massage therapy or manual therapy. Those names are pretty generic - so hold onto your hat. There are a million "kinds." Acupuncture falls under this along with its supposedly a bit more biomedically acceptable version, dry needling. High velocity manipulation [the kind that paralyzes unfortunate victims who only want their necks to feel better, or who get hornswoggled into thinking they "need" to have their necks or spines cracked at least once a month forever], falls under this. Gouging with many different kinds of tools, often made of some sort of fancy material, falls under this. 

..............

Alfred North Whitehead
I think this guy nailed it. 

From this Wikipedia page on Reification:

"Reification (also known as concretism, or the fallacy of misplaced concreteness) is a fallacy of ambiguity, when an abstraction (abstract belief or hypothetical construct) is treated as if it were a concrete, real event, or physical entity. In other words, it is the error of treating as a concrete thing something which is not concrete, but merely an idea."

Another way to look at this is objectification. Buried deep in our social psyche is the regarding people as though they were interchangeable, fungible. Lip service might be paid to individuality, but in the end, in manual therapy, patient problems are relegated to various diagnoses or body parts. The tennis elbow in cubicle 17. The knee in stall 12. The low back in cubicle 8 - give that one to Jack - Jack has a knack with delivering the crack.

Individuality is allowed to flourish when it is to the advantage of the practitioner, however. Whoever comes up with the latest technique du jour, or fool proof system, gimmicky tool for sale, snazzy video to promote it, supposedly "wins."

..................

I’ve always felt confused about what my profession is supposed to be about.

ANdy, an Irish PT and poster to SomaSimple, said this recently, and eloquently:

"We do seem to have a problem with specialization where too many senior Doctors/Consultants seem to have far to narrow knowledge coupled with highly technical but limited skillsets and lack the general oversight that care so often demands. I think that too often we, as physiochiropathics, simply ape that, a pale shadow that haunts the passageway of healthcare leeching life from those who pass too close to our undead shades."

A few years ago, I was transfixed for awhile with an inner vision that resembled ANdy's. I saw this, on ScienceBasedMedicine blog, by Mark Crislip:

“Monkeys, and other animals, groom each other often with a marked reduction in stress. Touch is good, and one doesn’t need to wrap it up in pseudoscientific nonsense for it to be beneficial.”

Inspired by this, I wrote this, in order to try to gain clarity. Operator/Interactor.

It contains a slide of various animals performing social grooming, social contact. I always include this slide when I teach.

...................

Skin has been disregarded. So I teach about skin. 

Nerves (cutaneous ones) have been disregarded. So I teach about nerves. 

The sensory nervous system has been completely disregarded. So I teach about the nervous system.

Pain has been misconstrued as being sensory input. So I teach from a Melzackian, "pain as output" point of view.

In my opinion, leaving these items and their interactions out of the picture led us down some pretty convoluted rabbit holes, leading nowhere but to mutually exclusive dead ends. I try to put individuality back into the picture. Every brain is unique, pain is always personal, be with your patient wherever they're at, try to see their life from the perspective of their neuromatrix, not your own. Not your profession's even. Not when your own profession has become just another sausage factory.

Hey, somebody has to do it, point out the obvious. 

Even though it makes people cringe, I use the term, Human Primate Social Grooming, at least once during the talk. 

........................

Anyway, back to the paper, I look forward to greater clarification. 

More to come, because it's long.

The Skin as a Social Organ. Part 2e: Touch early, touch often

The paper, The skin as a social organ

Previous introductory blogpost to this series.    Preamble: Random thoughts on spas

Part 1: Dual nature of touch: as PTs, do we "get" this? Part 1a: Touch can be pleasant, rilling Part 1b: Vallbo on C-tactiles 

Part 2a: Different kinds of touch Part 2b: Proxemics Part 2c: The sad dearth of manual therapy aspects in reviews of interpersonal touch Part 2d: Learning to sit still, learning to behave, learning to not be connected to oneself

Next paragraph of the paper:

‘‘Protracted’’ touch, ‘‘dynamic’’ touch, and tickling can also have positive concomitants and outcomes in affiliative behavior. Holding a loved one’s hand can reduce the anxiety posed by an impending threat (Coan et al. 2006). Skin-to-skin contact has been shown to have clinical benefits for premature infants (Field 2001), as well as an analgesic effect in human babies undergoing minor tissuedamaging procedures (Gray et al. 2000). Stroking an infant can not only give rise to positive emotions in the baby, but can also modulate negative ones, compared to other forms of touch (Peláez-Nogueras et al. 1997). Tickling is a playful social act and is also seen in other mammals (Panksepp and Burgdorf 2003; Blakemore et al. 1998). It often gives rise to pilomotor responses like goosebumps, the elicitation of which is associated with the insula (Warren 2002). Interestingly, individuals with Asperger’s syndrome (associated both with social impairments and tactile hypersensitivity) rated the intensity and ‘‘tickliness’’ of a piece of foam on the palm as higher when the stimulus was applied by an experimenter than when the subjects touched their own palm with it (Blakemore et al. 2005)." 

1. Coan JA, Schaefer HS, Davidson RJ (2006) Lending a hand: social regulation of the neural response to threat. Psychol Sci 17:1032–1039
2. Gray L, Watt L, Blass EM (2000) Skin-to-skin contact is analgesic in healthy newborns. Pediatrics 105(1):e14
3. Peláez-Nogueras M, Field TM, Gewirtz JL, Cigales M, Gonzalez A, Sanchez A et al (1997) The effects of systematic stroking versus tickling and poking on infant behavior. J Appl Dev Psychol 18:169–178
4. Panksepp J, Burgdorf J (2003) ‘‘Laughing’’ rats and the evolutionary antecedents of human joy? Physiol Behav 79:533–547 (Full text)
5. Warren J (2002) Goosebumps and the insula. Lancet 360:1978
6. Blakemore S-J, Bristow D, Bird G, Frith C, Ward J (2005) Somatosensory activations during the observation of touch and a case of vision-touch synaesthesia. Brain 128:1571–1583 (Full text)

I think we could file this paragraph under "Skin is the outside of the brain." 
Touch is like brain food. I think the message is obvious: get those little meaning-maker brains going early in life. The more input they get in the context of emotional safety and pleasure, the better they're going to work later on. 

People often ask me if I can do dermoneuromodulation on myself. 

The answer is yes. If I can reach whatever part of my body is "hurting" me, without much struggle, and can pull my skin organ in a direction that alleviates whatever kinking might be going on in some vascular array inside some cutaneous nerve or other, and hold it there long enough for it to get over itself, then yes, it means I can do dermoneuromodulation on myself. 

The answer is no. I can't feed my own brain the way it can be fed by the careful handling of another; I want to relax, not have to think or do anything, produce any deliberate motor output, and use all my whole brain to just feel, and breathe, perceive and create yes-ciception. 

The Skin as a Social Organ. Part 2d: Learning to sit still, learning to behave, learning to not be connected to oneself.

The paper, The skin as a social organ

Previous introductory blogpost to this series.    Preamble: Random thoughts on spas

Part 1: Dual nature of touch: as PTs, do we "get" this? Part 1a: Touch can be pleasant, rilling Part 1b: Vallbo on C-tactiles 

Part 2a: Different kinds of touch Part 2b: Proxemics Part 2c: The sad dearth of manual therapy aspects in reviews of interpersonal touch

We continue with the paper:

"Effects of touch in social interactions have been found to increase liking of a person or place, and to facilitate a footing of trust or compliance, often manifesting in increased prosocial behavior. For example, a half-second of hand-to-hand touch from a librarian fostered more favorable impressions of the library (Fisher et al. 1976), touching by a salesperson increased positive evaluations of the store (Hornik 1992), and touch can also boost the attractiveness ratings of the toucher (Burgoon et al. 1992). Recipients of such ‘‘simple’’ touches are also more likely to be more compliant or unselfish: returning money left in a public phone (Kleinke 1977), spending more money in a shop (Hornik 1992), tipping more in a restaurant (Crusco and Wetzel 1984), or giving away a cigarette (Joule and Guéguen 2007). The greater degree of compliance, or even generosity, with resources in these studies implies that such rudimentary social touches can potentially provide a platform for trust and cooperation in future exchanges." 

1. Fisher JD, Rytting M, Heslin R (1976) Hands touching hands: affective and evaluative effects of an interpersonal touch. Sociometry 39:416–421 (Preview)
2. Hornik J (1992) Tactile stimulation and consumer response. J Consum Res 19:449–458 (full text)
3. Burgoon JK, Walther JB, Baesler EJ (1992) Interpretations, evaluations, and consequences of interpersonal touch. Hum Comm Res 19:237–263
4. Kleinke CL (1977) Compliance to requests made by gazing and touching experimenters in field settings. J Exp Soc Psych 13:218–223
5. Crusco AH, Wetzel CG (1984) The Midas touch: the effects of interpersonal touch on restaurant tipping. Personal Soc Psych Bull 10:512–517
6. Joule RV, Guéguen N (2007) Touch, compliance, and awareness of tactile contact. Percept Mot Skills 104:581–588

Well, there seems to be quite a bit of interest in, and study of, how to create a good impression with interpersonal touching. Most of looks like it has to do with social manipulation, deception, priming non-conscious brain function by touching in a way that is deliberate, but that touchees don't even notice. Distracting the touchees so that they don't even notice that somebody (in on the project) touched them right in the critter brain, bypassing their human brain, or at least disarming it so that it doesn't make a "thing" out of having been touched without permission. 

Not that it isn't easy enough for the human part of the brain to be distracted away from the critter brain most of the time, anyway - maybe because of the "proxemics" we touch-deprived, northerly, cold-climate, big-personal-space, culturally-imprisoned human primates have allowed our culture to train us into from childhood, generation after generation. 
...............

Earlier today I listened to a radio program, Ontario Today, What Every Parent Should Know About School, an interview with Michael Reist. Not that I have ever had any kids, or am remotely interested in what school is like these days; however, the radio was on while I was buried in a photoshop project, and bits crept in.. 

Apparently educators find themselves feeling as overwhelmed by neuroscience as I do. Apparently a few have woke up to the fact that the institutions they are part of, proud to represent even, are dinosaurs modelled after sausage factories. Much like my own is. 

Apparently a few have done enough reading to realize that every kid is an individual who would turn into a way more successful adult (happier, more creative, smarter, confident, etc.) if they were treated as such; taught according to whatever learning style they inherently possess, had contact with nature, had contact with lots of people of different ages (the better to build mental representations of diverse "other" instead of being pancaked into a group of 25 kids all the same age, none of whom can learn to relate to any other age, therefore), were allowed to move around, weren't bullied or accused of being stupid or fat (by the teacher! right in front of the child! and the parent!).

Apparently it is dawning on a few people that just because they enjoyed sitting quietly, listening, learning, taking notes, this method of transferring knowledge just doesn't work for lots of kids, for whom school, as graded exposure to being distanced from their own critter brains, doesn't feel good. It just stresses them out. Or in any event, stresses out their little critter brains. 

Then the kid grows up into an adult whose brain has neuroplasticized around huge school-induced social stress. 

..............

I count myself lucky that I attended a prairie one-room school, nature right outside. The same room,  same teacher, from grade 1 through grade 8. Eight years in one room. Sometimes only one kid in a grade, sometimes as many as three, usually only 12 or 13 kids in the whole room. By the time I got to the grade 8 sized desks on the north side of the room, away from the grade 1 sized desks on the south side, by the big windows you could gaze out periodically to give your brain a rest, I was 8 years older, quite a bit taller, I had heard all the material 8 times, and easily passed all the exams. I'd played softball with kids much older, and much younger. Fairness had been installed - I could relate, at a kid level, anyway, to other kids of many different ages. 

Every day after lunch, the teacher (same teacher for 6 years) read to us from a book. I can't remember any of the books. It doesn't matter. It was a time when she let us move around the room a little. Our favourite thing (as girls) was to sit behind each other and take turns combing each others' hair while being read to. It felt really good.  

Otherwise, you had to sit there. If you wanted to move, you had to pretend your pencil needed to be sharpened. You had to raise your hand, ask permission to go to the back of the room and sharpen it at the sharpener, which was bolted to the back windowsill, beside the piano. Or you had to pretend you had to visit the bathroom. The girls' bathroom was on the same floor. The boys' bathroom was in the basement. Boys could move more, get some stairs in. Michael Reist would approve, because he thinks boys have a whole lot harder time with the no moving thing. He's probably right.

Anyway, I guess the point of writing about this, is, rumination about how much I was trained in school to not move freely. 

Another reflection is, is it any wonder we now have an epidemic of chronic pain? All those invisible, socially imposed chains? Not enough allowance for learning how to reduce stress in each other through simple interaction as children, like gently and slowly combing each other's hair, just for the beauty of how nice that feels? Both parties fully aware and engaged, fully attentive? The recipient fully connected interoceptively, exteroceptively, and socially, all at the same time? No deception?