There were many impressive discoveries and insights presented in yesterday's 7th Interdisciplinary Low Back and Pelvic pain Congress. I'm starting with the 4th presentation because it was just so visually stunning. Reminded me of the Disneyland ride where your train car takes you down into the body and you experience yourself as a nano-chip traveling through the various systems...except this is the real thing, video using a very small endoscope.
The surgeon member of the team who made this film, Dr. Gumberteau made the presentation. There's another clip that's much more clear than my rendition below at the above link. Click on the English flag and it comes up. Mine, unfortunately, till I improve my understanding of how to edit/stream video to the web is kinda the equivalent of a xerox of a xerox of a xerox, a bit 'lossy' as they say in the graphics bus.
I just had to buy this video to be able to revisit it regularly. I'm rather proud of myself that I figured out how to edit out this short clip to share, (tho it's lost a lot of clarity in the doing) hope they don't mind. I consider it a teaser, with a link in case you want to buy it yourself and see the whole thing. It contains cool graphics of a muscle's actin myosin overlap action with the fascial web surrounding it, beautifully drawn.
The moist fractal fascial web is so clearly changing second by second in this video, gliding, self lubricating, making new fractals as loads change, wow are we constantly creative and we're not even aware that it's happening within us!
Soft tissue will never appear the same to me again, in my imagination, under my sculpting hands and hound dog thumbs, after seeing this film.
I could hardly sleep, I kept seeing this very clip repeating on my internal screen with the phrase "fascial fractal tensegrity in flux." runnin round my brain as sound track, try sayin that 10 times fast, I dare ya. Then try getting it out of your head so you can sleep once it's on a repeat loop. That presentation speaks for itself.
I missed the first presentation by Dr. Mense, for stupid reasons. I kept looking for the Hyatt Regency and the hotel I thought it was said Century Plaza. I was sure that was the Hyatt Regency, so I drove back and forth in Century City several times before asking the valet where it was. Yep I was right in the first place it's the Century Plaza Hyatt Regency, oyvay. I guess more names is better, eh? Hope someone else does a recap for us. They killed a bunch of ratties for that one.
I'm glad I didn't miss Robert Shliep's presentation. I'd read some of his studies on fascia from his great web site, knew he'd started as a Rolfer and I had a couple of questions brewing for him, if a chance arose. His presentation was more on nocioceptors in the fascia and it's role as an information feedback instrument. I kinda had hoped he'd talk about the discovery of smooth muscle cells in the thoraco-lumbar fascia a bit more, but there are papers on that on the website, so I guess he'd already presented that material. One great metaphor he used while showing us the close up slides of the nocioceptors in there to explain why we might possibly need so much feedback info from outlying tissues, was dear to my heart. He said if you're sailing a vessel, would you put your wind change/velocity indicators on the luff of the sail, tip of the boom or would you want them on the mast. Ta Da. Got it!!
Poor guy, I kept cornering him with questions when he was rushing to the lu. He was quite gracious about it tho and generous with his insights in sharing his answers to me, once he'd come back out. I didn't want to take time from the many other folks with questions pertaining to his current lecture, cause there were more questions than he had time to answer and my questions were off topic a little. I'll talk about those in more detail some other time.
His Conclusions, as printed in the $60 book of presenter's papers:
"Fascial tissues serve important load-bearing functions. Severe tensional loading can induce temporary viscoelastic deformation and even microtearing. The innervation of fascia indicates a potential nocioceptive function (with cool slides). Microtearing and/or inflammation of fascia can be a direct source of musculoskeletal pain. In addition, fascia may be an indirect source of physical problems such as back pain due to sensitization of fascial nerve endings associated with inflammatory processes in other tissues within the same segment."
"Fascial force transmission is an important player in human biomechanics.
"...muscles, via their epimysia, also transmit a significant portion of their force to laterally positioned tissues such as to adjacrent synergistic muscles ans also-more surprisingly-to antagonistic muscles (Huijing 2009)...."
Fascial tissues are prone to deformation.
"...Load bearing tests reveal the existence of a gradual transition zone between reversible viscoelastic deformation and complete tissue tearing. Various degrees of microtearing of collagenous fibers and their interconnections have been documented to occur within this transition zone (Butler, et al 1978)"
The fascial network serves as a sensory organ
"Fascia is densely innervated by myelinated sensory nerve endings which are assumed to serve a proprioceptive function. These include Pacini (and paciniform) corpuscles, Golgi tendon organs and Ruffini endings (Stecco et al.2010). In addition they are innervated by free endings. When including periosteal, endomysial and perimysial tissues as part of a bodywide interconnected network, this fascial net can be seen as our largest sensory organ. It is definitely the richest sensory organ for the socalled sixth sense, the sense of proproiception (Schleip 2009)."
Fascia can be a source of nocioception.
"...a recent experimental study revealed that the epimysial fascia of the affected musculature plays a major role in the generation of DOMS related pain symptoms. (Gibson etal. 2009)"
The human lumbar fascia as potential generator of low back pain.
"Panjabi's new explanatory model of low back pain injuries suggests that a single trauma or cumulative microtrauma casues subfailure injuries of paraspinal connective tissues and their embedded mechanoreceptors, thereby leading to corrupted mechanoreceptor feedback and resulting in further connective tissue alterations and neural adaptations(Panjabi 2006). Our group subsequently proposed and extension of that model which includes the posterior layer of the lumbar fascia as a potential focus of such microtrauma and resulting muscle control dysfunction. Factors raised in support of that explanation include the long distance of this layer from the axis of spinal flexion as well as lesser stiffness compared with spinal ligaments (Sclleip et al 2007)"
I do wish ultrasound imagery was not so fuzzy, but the images of gliding planes of connective tissue in this next presentation were stellar anyway. Helene Langevin and her team in Vermont used ultrasound to monitor movement in the 3" area of the paraspinalis muscles lateral to lumbar L2-3 interspinous ligament. They then used a vibrator and watched the tissue move. Folks with pain had thicker tissue than those without, more disorganization, fatty infiltration, fibrosis and adhesions visibly impairing the normal gliding movement of the relative planes. The gliding of the layers in different directions was what was so remarkable in those moving pics. They chose that level because the fascia planes are the most parallel to the skin. Go a little lower and the fat pad confuses the issue.
Subjects with LBP had, on average, 25% greater perimuscular connective tissue thickness and ultrasound echogenicity in the lumbar region than did subjects without LBP.
"Langevin reports that the posterior layer of the lumbar fascia tends to be thicker in chronic low back pain patients. In addition, it expresses less shear motion during passive trunk flexion (Langevin et al 2009)."
Dr Shah, a clinician participating in a NIH study assessing the effectiveness of dry needling on trigger points also showed amazing ultrasound pics of the trigger points clearly visible in the tissues. So they demonstrated that ultrasound is feasible for imaging MTrPs and that they exhibit different echogenicity compared to surrounding muscle. The ultrasound revealed differences in microcirculation in and around the active MTrPs, compared to latent ones and normal tissue, as well.
What dya know, we weren't just making up those ischemic lima beans, kidney beans, lentils and quarters we were pretty sure we were palpating in a headache producing upper traps, after all, and Janet Travell didn't conjure them out of thin air either!! Ain't it great when science supports what we've been experiencing in the field?! There they were in living color, lookin a little like knots in a tree. Leon encouraged Dr. Shah and his team at NIH to include manual therapy interventions in the next study to compare effectiveness with dry needling.
Be great if they took his request to heart and ischemic compression shows up as equally effective for most of them, at least the ones we can reach, cause I'm sure most folks would prefer to be rubbed intelligently than poked a bunch of times with a needle, while having the tissue pinched. Didn't look fun.
(Leon, Langevin, Gumberteau)
Leon gave a recap of the various styles of soft tissue manipulation and what their intended goals are. It was really interesting to me because he described a couple of European methods I hadn't known originated there. Since I tend to weave methods together to get results for my clients, it was good for me to hear this description of the specific methods and their specific attributes.
I was please to find that someone besides John Barnes is utilizing and teaching myofascial release, though it was not clear if the method is similar to the non woo woo aspect of what Barnes teaches. Trouble with Barnes' stuff, IMO, is he conflates his work with Upledger's, asking folks to feel for a still point and teaches myofascial unwinding as a form of emotional release so that whole rooms full of true believers manifest ideomotor phenoms just because there's an expectation of significance to that. The question that pops into my mind regarding these two extremely popular teachers is which of these Icarian gurus will make it too close to the sun first?
If Barnes'd stick to the aspect of myofascial release that has a sound basis in science, this field, his students and their clients would all be a lot better off. Why waste time with that woo woo stuff you've pulled out of yur hat when you've got an effective method, proven to be so, right at your fingertips, rather under your gentle palms? Just sayin.
After seeing how many layers of fascia there are and how randomly it expresses it's fractal webbing, I was surprised to find myself thinking there's more of a place for that work in my practice than I'd been willing to let myself do. I just find that slow timing and light touch of that work challenge my limited ability to be patient. I hate holding an 8-15# head in space for forever, but considering this, I'm gonna have to reconnect with this work I think.
"Myofascial Induction is a simultaneous evaluation and treatment process using tri-dimensional movements of sustained pressures, applied to myofascial structures in order to release restrictions. The term Induction is preferred to 'release' because clinicians do not passively stretch the system, but only apply an initial tension or compression force and follow the facilitating movement. The aim of the process is the recovery of motion amplitude, force and coordination (Pilat 2009)
Leon listed and described:
Connective Tissue Manipulation CTM Bindegewebsmassage (skin rolling)
Fascial Manipulation FM Stecco workshop Sunday YUM
Muscle Energy Technique MET
Myofascial Release MFR
Scar tissue release
Strain Counterstrain SCS
Trigger Point deactivatin methods.
He also sited studies in support of these methods. Maybe he wants to represent his own presentation, so I'm gonna stop here. This is getting long.
There were also presentations in the afternoon, "Parallel Sessions" but these am ones were most really juicy part for me. I do get a bit weary with too many hours of mind only information goin in.
We learned from an Aussie, David MacDonald, PT, that training on unstable surfaces doesn't enhance training effect at all. He's no longer including it in his rehab pardigms. That's not news in the S & C community, but good to have the in the trenches knowledge validated once again, and especially for the rehab community to catch up in understanding that.
I wonder if Paul Chek still espoused it in his presentation on Wed. He was the maven of physio-ball exercises for quite a while, produced lots of videos and acolytes willing to sport a very erect C.H.E.K. proudly dangling from behind their names, even though I don't think he succeeded in conjuring it into an actual acronym. Lordie Lordie.
He used to stand on the ball and squat at the beginning of the ball exercise videos, for what purpose someone would want to risk the potential injury of a fall from said squat no one but Paul could comprehend. Maybe he was secretly using these videos as audition tapes, sending them to Barnum and Baily with a suggestion that he'd like to replace the ball walking dogs in their new circus acts.
We also learned from Duncan Critchley et al that strength training makes you stronger than Pilates. Strength training exercises that don't directly target the abs still make em stronger than Pilates exercises that do. So much for Joe Pilates description that his exercises make muscles stronger deep to the bone yet long and lithe, retaining their flexibility. Dancers bought that description in droves, but any biomechanics grad knows that the reason Pilates folks have long and lean looks is that Pilates is not a good choice for hypertrophy. It doesn't strengthen effectively.
Pilates is a nice alternative for yoga, improving ROM, oil and lubing the joints, a nice option for an active recovery day, but strengthening, unless a person's seriously de-trained, ummm, not so much. Some of us American couch potatoes are seriously de-trained, so in those cases it's certainly going to create improvement in strength. If all you do for exercise is walk and ride bike, for example, it will improve the strength of the back, rhomboid/mid. trap area, because for sure you've been leaving upper body out of your training plan.
There were more, but that's the highlights I have time to offer.
Get to it Girl, Great stuff!!
ReplyDelete