Friday, August 08, 2014

Collection of references

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:

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.
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: 

Moving beyond the technique: From Operator to Interactor

A bit further on I added the foundational paper I wrote that it was based on:
Operator/ Interactor - Google Docs: Manual therapy and its treatment models

This wonderful blogpost at Body In Mind was included: Starting conversations - has Jason hit the silvernail on the head?  It referred to Jason's thread on SomaSimple,  Enough is Enough, about joint heads, disc heads, fascia heads, all that.
Great commentary under the BIM blogpost.

Great review in general.

Add to that, Adam Meakins blogpost, There is no skill in manual therapy..? 
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 2007Schleip 2003Threlkeld 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 2007Weppler 2010Katalinic 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 2003Aquino 2009Schomacher 2009Nyberg 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 2014Kumar 2014Artus 2010Kent 2005)"
Thank you for your well-organized reference list, Adam! 

I would like to add a list of my own, that I file under "Skin is the outside of the brain" in my google doc of dermoneuromodulation references

1.  Walsh LD, Moseley GL, Taylor JL, Gandevia SC. Proprioceptive signals contribute to the sense of body ownership. J Physiol. 2011 June 15; 589(Pt 12): 3009–3021. (FULL ACCESS)

 2. Tomás J. Ryan and Seth G. N. Grant; The origin and evolution of synapses. Nat Rev Neurosci. 2009 Oct;10(10):701-12. Epub 2009 Sep 9. (FULL ACCESS)

3. Valeria Gazzola, Michael L. Spezio, Joset A. Etzel, Fulvia Castelli, Ralph Adolphs and Christian Keysers; Primary somatosensory cortex discriminates affective significance in social touch. PNAS 2012 ; published ahead of print June 4, 2012,doi:10.1073/pnas.1113211109 (FULL ACCESS)

4. Gallace A, Torta DM, Moseley GL, Iannetti GD; The analgesic effect of crossing the arms. Pain. 2011 Jun;152(6):1418-23. Epub 2011 Mar 26.

5. Carsten Dahl Mørch, Ole K. Andersen, Alexandre S. Quevedo, Lars Arendt-Neilsen, Robert C Coghill; Exteroceptive aspects of nociception: Insights from graphesthesia and two-point discrimination. PAIN Volume 151, Issue 1 , Pages 45-52, October 2010

6. R Shechter, K Baruch, M Schwartz and A Rolls; Touch gives new life: mechanosensation modulates spinal cord adult neurogenesis. Molecular Psychiatry 16, 342-352 (March 2011) | doi:10.1038/mp.2010.116

7. Desmond J. Tobin; Biochemistry of human skin—our brain on the outside. Chem Soc Rev. 2006 Jan;35(1):52-67. Epub 2005 Oct 26. (FULL ACCESS)

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

9. Aaron L. Williams, Gregory J. Gerling, Scott A. Wellnitz, Sarah M. Bourdon, and Ellen A. Lumpkin; Skin Relaxation Predicts Neural Firing Rate Adaptation in SAI Touch Receptors. Conf Proc IEEE Eng Med Biol Soc. 2010; 2010: 6678–6681. doi:  10.1109/IEMBS.2010.5626264 (FULL ACCESS)

10. Scott A. Wellnitz, Daine R. Lesniak, Gregory J. Gerling, and Ellen A. Lumpkin; The Regularity of Sustained Firing Reveals Two Populations of Slowly Adapting Touch Receptors in Mouse Hairy Skin. J Neurophysiol. 2010 June; 103(6): 3378–3388.

11.  Lumpkin EA, Caterina MJ; Mechanisms of sensory transduction in the skin. Nature. 2007 Feb 22;445(7130):858-65.

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)

13. Björnsdotter M, Löken L, Olausson H, Vallbo A, Wessberg J.; Somatotopic organization of gentle touch processing in the posterior insular cortex. J Neurosci. 2009 Jul 22;29(29):9314-20. (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.

15.  Rotem Ben-Tov Perry, Ella Doron-Mandel, Elena Iavnilovitch, Ida Rishal, Shachar Y. Dagan, Michael Tsoory, Giovanni Coppola, Marguerite K. McDonald, Cynthia Gomes, Daniel H. Geschwind, Jeffery L. Twiss, Avraham Yaron, Mike Fainzilber; Subcellular Knockout of Importin β1 Perturbs Axonal Retrograde Signaling. Neuron Volume 75, Issue 2, 26 July 2012, Pages 294–305 (Also, see news story about this: Long-Distance Distress Signal from Periphery of Injured Nerve Cells Begins With Locally Made Protein, and Crucial Protein for Peripheral Nerve Repair Manufactured Within Axon Near Injury Site)

16. Edin BB; Quantitative analysis of static strain sensitivity in human mechanoreceptors from hairy skin.  J Neurophysiol. 1992 May;67(5):1105-13.

17. Collins D et al;  Cutaneous receptors contribute to kinesthesia at the index finger, elbow, and knee.  J Neurophysiol. 2005 Sep;94(3):1699-706 (FREE ACCESS)

human central nervous system. J Physiology 1995 487.1 243-251 (FULL TEXT PDF)

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.


Adam Meakins said...

Does this mean you are not coming the UK in Sept now Diane?


Diane Jacobs said...

Alas, probably not. Unless Chris can produce some miracle at the last second.
Your government isn't interested in PT it seems. No category for visas for people like me or outfits like his.