IT COULD BE THE TICKET FOR DIMINISHING YOUR PAIN
AND / OR HELPING SOLVE YOUR CHRONIC TRIGGER POINTS
Considering fascia's inherent capacity to act in such a wide variety of ways ----- support (TENSEGRITY), COMMUNICATION, CONTRACTILITY, ELASTICITY, HEALTH, ETC, it's important to rehab and train it appropriately. What does this mean and what does it look like? For starters it means that you need to do exercises that improve proprioception and kinesthesia (see the second link of previous paragraph). This will help you not only in the present, it will help you in the future to avoid pain, dysfunction, and DEGENERATIVE OSTEOARTHRITIC CHANGES, not to mention providing a much better chance of enjoying life into your old age, instead of repeating ignorant cliches like, "Gee doc, If I knew I would live this long, I would have taken better care of myself".
People like to talk about the Body / Mind connection; and fascia is where the rubber meets the road. There is no one-size-fits-all approach to helping every person with every situation, but there are some overarching principles --- principles that have a big upside and virtually zero downside and are not going to make you worse. In other words, controlled movement is better than being totally sedentary, and eating a diet based on WHOLE FOODS is better than eating a diet based on junk. A fairly simple concept that will never be misconstrued as rocket science. Unfortunately, many people find it difficult or even impossible to exercise because they are struggling with Myofascial Syndrome (see my RECENT ARTICLE ON JFK).
SCAR TISSUE and TRIGGER POINTS are different sides of the same coin that is Myofascial Syndrome (HERE), and I've shown you that while certainly related to each other, most cases of Trigger Points --- especially the severe and nasty ones --- will not respond very much to the TISSUE REMODELING that I do for Scar Tissue. The other day I showed you that problems in fascia are intimately tied to loss of proprioception, which is itself intimately tied to chronic pain (HERE). It stands to reason that if we know what sorts of things create said problems, it would logically follow that a person should be able to diminish their chronic pain by reversing the process. While this is certainly not always the case (it can't always be that simple), it is the case much, probably the majority, of the time. That's why today we are going to start by talking about diet.
In case you are one of those folks who didn't got the memo, diet is important. No, I take that back. It is so critical to your effort to get out of pain and regain your health and normal weight that you could be doing everything else right, and completely sabotaging your efforts by eating CRAPPY FOOD. There's no middle ground folks; the foods you eat are either driving inflammation or squelching inflammation. And while a little inflammation is important for normal healing processes (HERE), the last thing you need is SYSTEMIC INFLAMMATION --- inflammation coursing throughout your body and disrupting virtually every single physiological and metabolic function, including healing and the way you perceive pain (inflammation hyper-sensitizes the nervous system --- potentially leading to CENTRAL SENSITIZATION. When you chronically expose Scar Tissue to inflammation, said tissue can become over 1,000 times more pain-sensitive than normal tissue --- see DR. CHAN GUNN'S WORK).
The diet I recommend for most people with CHRONIC PAIN, CHRONICALLY ADHESED FASCIA, AUTOIMMUNE DISEASES, and / or CHRONIC INFLAMMATORY DEGENERATIVE DISEASES? That's easy; the PALEO DIET; and if you simply click the link you'll see what makes it so effective for dealing with out-of-control inflammation (or for that matter, subtle inflammation). You see, inflammation from diet is common, and any and all inflammation over the perfect amount needed for healing, always leads not only to Fibrosis (the medical name for Scar Tissue), but to various sorts of degeneration as well (HERE).
The cool thing about starting this post with diet is that there is a strong potential that if you'll figure out what foods --- even "good" and "healthy" foods --- you might be sensitive to, you can dramatically lessen your body's inflammation profile (which reduces inflammation, diminishes fibrosis, and improves or at least helps halt the progression of proprioceptive loss). This is the function of an ELIMINATION DIET and is so important that I made it the very first item on our DIGITAL PATIENT HANDOUT. As to the "safety" of eating this way, not only is it far better than the dumbfoundingly idiotic brand new old governmental recommendations that are trying to catapult us back into the 1970's (HERE), but it's safe enough to try on your own (HERE).
Diet effects proprioception because SUGAR AND JUNK CARBS are the single most inflammatory things most people put in their mouths on a daily basis. Inflammation always leads to fibrosis, and fibrosis not only always leads to degeneration (HERE), but also happens to be America's leading (that would be leading as in #1) cause of death as well (HERE).
For those of you who are either healthy or dealing with minor or sometimes even moderate pain, the plan is simple. Move. As the old saying goes, motion is lotion. What kind of motion? All sorts. Literally. There are great examples all over the web, so while today's post will help get you started on this endeavor, it is in no ways the definitive or final word. Probably the best suggestion I can give you here is to mix things up constantly. One of the reasons that athletes have so many musculoskeletal problems is that beyond the fact that they so often eat inflammatory diets similar to the rest of the population, they are doing the same repetitive activities over and over and over again in their training regimens (running, weightlifting, swimming, biking, etc). Extreme repetition (with the exception, of course, of SHOOTING FREETHROWS) has huge potential to produce unexpected (i.e. "rotten") fruit in the form of pain and dysfunction.
STRETCHING, STRIPPING, SHAKING, MOLDING AND REMODELING YOUR FASCIA
Although we are certainly talking about stretching here, I am not going to present a treatise on stretching as the internet is loaded with such information; much of it conflicting. It's important, however, that you understand a couple facts about stretching. First is that yes, it is possible to overdo it (HERE or HERE). Another is that for every study that says stretching a certain way is good, I can probably find you just as many showing that stretching that way is problematic. This is why you need to realize that the stretching pages for my clinic (HERE) are generic and created specifically for post-treatment use (Tissue Remodeling). One other thing I want you to understand is that if you are struggling with Scar Tissue or Myofascial Syndrome (Trigger Points), some -- not all, but some of the bullets below not only may not be effective in relieving your symptoms, they might even make you worse (HERE and HERE).
A good stretching protocol is going to address the various external layers of the fascia (HERE), as well as the fascia's inner layers --- the epimysium, perimysium, and endomysium (HERE). I have become a huge fan of Yoga stretches (see first bullet below) because they are done slowly and require progressive CORE STRENGTH, depending on how complex you want to go with them. I also tout EXTENSION THERAPY because most of us are being continually drawn into THE POSTURE OF AGE. And while I have never done it personally (there are no studios in our neck of the Ozarks) Pilates seems to be knocking it out of the park for lots of people.
When talking about the viscoelasticity of fascia, it is important to realize that you will have to stretch across numerous planes and ranges, as well as through multiple joints. This is because the most up-to-date functional anatomists have shown us that fascia has made the concept of individually functioning muscles all but completely obsolete. The viscoelasticity properties of fascia also happen to be why you need to wait to stretch until your fascia is warmed up and hydrated (i.e. don't stretch without going through some kind of warmup to get your blood pumping, and make sure you are drinking plenty of water).
In a great article by the American Posture Institute by a pair of CARRICK-TRAINED FUNCTIONAL NEUROLOGISTS (5 Reasons Why Posture Rehabilitation Improves Proprioception), the authors talk about Cortical Mapping; another brain / body connection principle. The body's map as represented in the brain cortex is called the homunculus or "little man" (HERE is a picture).
"Proprioception is processed in the sensory homunculus, the cortical map in the parietal lobe. Communication about joint position and precision of movement occurs between the sensory and motor cortical maps.... Because the brain uses the map to make decisions about how to move, it is obvious that the better and more detailed the map, the better and more precise the movement. By contrast, if the map is ambiguous or indistinct, navigation of the different movement possibilities will be uncoordinated. Accurate maps produce better motor output. Consequentially, the better we move, the better we feel. When a joint and associated muscle are not moved, the brain does not sense it as “important” and the cortical map becomes more and more indistinct at that region due to lack of movement. This is an example of the “Use It or Lose It” phenomenon of neuroplasticity. Sensory motor mismatch is a conflict in the information represented by the brain maps. Inaccuracies in the body maps of the sensory and motor cortices can be a significant contributing factor in many chronic pain conditions. Improving proprioception in these areas improves motor output, and contributes to the reduction of symptoms associated with chronic pain."
Besides what we've already discussed, what are some of the best ways to stimulate proprioception beyond moving regularly and through a complete range of motion? Just remember that proprioception training is about making sure to always mix things up and never getting into a rut, which can frequently happen with most training regimens. Another simple trick to fire off more proprioception is to do as much of this as you can barefoot, as it will dramatically increase your proprioception over wearing shoes. Also understand that anything that is restricting your ability to move through normal ranges of motion has the ability to foul up proprioception as well (yes, some of you are fooling yourselves --- HERE).
- MAKE SURE YOU AREN'T "CROSSED UP": Although many of you have never heard of either UPPER CROSSED or LOWER CROSSED syndromes, they are deal-breakers as far as solving chronic pain, chronic restriction, and chronic dysfunction are concerned. Along these same lines, if you have hardcore FORWARD HEAD POSTURE (exceedingly common in today's posture-of-age society), it will be hard to truly restore proprioception. Part of solving these issues is simply getting your body out of the posture of age, chronic illness, and chronic pain (flexion), and into EXTENSION.
- LEARN BALANCE GRASSHOPPER: There are so many ways to stimulate proprioception via balance training that it could actually be its own post. I am a huge fan of EXERCISE BALLS for a variety of things, including simply sitting on them in place of your chair (I have seen many cases of chronic low back pain solved using this one simple little trick). I often use a bosu ball (it's half an exercise ball with a hard back) to stand on or kneel on and do certain yoga poses (HERE for instance) of even as an unstable base to do dumbbell work from. TRAMPOLINES are amazing for proprioception as well, and every child should have a Hippity Hop or 'hop ball' (just don't use it as a weapon like we did as kids). There are wobble boards of almost every conceivable design, wobble chairs, balance pads, balance discs, balance boards (M Board, Bongo Board, SI Board, Goof Board, etc), slack lines (I'm getting ready to put one up), and paddle boards (HERE). Heck, even a simple 2x4 you get from your local lumber yard can be used for Functional Proprioceptive Training. For the record, this list is far from exhaustive and many of these can be done DIY via YouTube. I actually had a patient build something similar to THIS for an LD child that both bounced on a spring and spun freely on a pivot. The device was made to specifically increase proprioception, and the results were amazing!
- FUNCTIONAL TRAINING: If you are one of those people stuck in a bench press and curls sort of weightlifting routine, you need to pay attention. I could write twenty five posts on this topic alone and barely begin to scratch the surface. You need to go to YouTube and start watching videos on Functional Training. You'll usually get some of this sort of thing with CROSSFIT as well. If you don't think Functional Training is the real deal, sometime just for grins try a TURKISH GET UP or some PARKOUR. When I think of Functional Training, I can't help but think of ADAM ARCHULETA in the heyday of the Kurt Warner-led St. Louis Rams. The beautiful thing about Functional Training is the way that it stimulates the brain and nervous system. Once you realize that fascia is itself a second nervous system (see earlier link), some of this will begin to make more sense. One last thing here; I will put FOAM ROLLING here even though it probably could have been put in the previous bullet. Foam Rollers and FASCIA STIMULATING DEVICES (especially the former) both work largely by stimulating proprioception. And if you like to run, try trail running. Biking? Get off road with your mountain bike. Weightlifting? Follow the advice in this post. These are all ways to continue with the sport(s) you love, while ratcheting up the level of balance, kinesthesia, and proprioception.
A quick side note to these last two bullet points. When children are not out playing and doing the things they would typically be doing if they were not watching TV, on their computers, playing VIDEO GAMES OR WATCHING PORN, on their phone, or any number of other "plugged-in" diversions, they would probably be outside, climbing trees, making up games, and generally being active. This is why parents need to be the parent and monitor everything their young kids do as well as educate them about health and diet from an early age.
- WHOLE BODY STRENGTHENING USING COMPLEX MULTI-JOINT MOVEMENTS: I've been a fan of KETTLE BELL SWINGS for a long time, but there are other great exercises that involve the whole body, namely the deadlift and squat. Just be sure to constantly vary what you are doing as the body is always looking for that new thing --- some sort of neuromechanical stimulation it hasn't seen before, not to mention the fact that repetitive motions will sooner or later land you in hot water as far as pain and dysunction are concerned. One last thing about this bullet; as you may know if you follow my blog, I am a huge fan of RESISTANCE TRAINING (Strength Training). For the most part, machines are not going to get it done for you --- you need free weights (preferably dumbells) done like this (HERE). Even things like training with a different pace can benefit your fascia. For instance, I sometimes work out using Dr. McGruff's "Super Slow" principles (particularly if I am fighting an injury of some sort). Historically, my biggest problem has been pushing myself too far. Not surprisingly, injuries seem to happen when you spend a lot of time training in the "very heavy" or "very repetitive" zone.
- WHOLE BODY VIBRATION: I use a WBV MACHINE in my clinic's gym and typically do planks from it, along with various modified yoga poses. Whole Body Vibration is a fantastic way to strengthen your brain, while stretching, shaking, and generally loosening tight fascia. When done correctly, WBV produces a veritable proprioceptive explosion. Oh, I frequently try and do WBV exercises with my eyes closed and if possible, in a POSTURE OF EXTENSION instead of flexion. And in light of what Van Ryssegem said earlier about needing to add "cognitive tasks" to your workout; allow me to give you an example I have stickers I move around to various parts of the wall in front of me, that I will touch in sequences or touch one and then touch my nose, touch the next, and then touch my nose, etc, sometimes to the beat of the music I am listening to. There are lots of ways to add things that make you think into your workout.
- BODYWORK, INCLUDING TISSUE REMODELING: Be aware that aside from changing one's diet, this is where things must start for those with chronic pain or restriction. What do I mean? Only that if you have FIBROSIS / SCAR TISSUE or TISSUE DENSIFICATION occurring in your fascia, both stretching and strengthening are not only not going to work properly, they will OFTEN PROVE COUNTERPRODUCTIVE.
- DRY NEEDLING: I find that DRY NEEDLING works well for chronic Trigger Points much more so than it does FASCIAL ADHESIONS (even though these are related, they are two very different things). Make sure to check out our posts on the subject.
- CUPPING: Although I learned cupping back when I was certified in acupuncture by Dr. John Sunderledge over 25 years ago, it was done with glass cups and moxabustion ("Fire Cupping"). Today, cupping kits can be purchased on Amazon for 15 bucks that actually work pretty well. There are tons of YouTube DIY videos, as cupping can be a godsend for people, especially people fighting chronic Trigger Points. I am currently experimenting on myself and my chronic right-sided LEVATOR TRIGGER POINT. I sometimes draw the TP into one of the smaller cups and then needle it.
- CHIROPRACTIC ADJUSTMENTS: Just because this is last on the list does not mean it is the least. There are no medical treatments or medications that address proprioception. In fact, many of them make it worse. Once Scar Tissue has been addressed, CHIROPRACTIC ADJUSTMENTS produce a veritable firestorm of proprioceptive activity, as well as helping keep joints freely moving (which itself is proprioceptively stimulating). Actually, things like SPINAL DECOMPRESSION THERAPY or do-it-at-home INVERSION TABLES are fantastic proprioceptive restoration as well. The biggest key to chiropractic adjustments doing what they are meant to do is first making sure fascial adhesion have been addressed. Otherwise, the TETHERING EFFECTS of fascial adhesion will prevent you from holding adjustments for a reasonable amount of time.
I have talked a number of times here about WOLF'S LAW as stated by Dr. Julian Wolf --- that bones will change (remodel) over time, whether good or bad, depending on the manner they are stressed mechanically. It is critical that you also understand Davis' Law. Davis' Law, developed by Dr. Henry Gassett Davis, an orthopedic surgeon in the Civil War era, stated that.....
"Ligaments, or any soft tissue, when put under even a moderate degree of tension, if that tension is unremitting, will elongate by the addition of new material; on the contrary, when ligaments, or rather soft tissues, remain uninterruptedly in a loose or lax state, they will gradually shorten, as the effete material is removed, until they come to maintain the same relation to the bony structures with which they are united that they did before their shortening. Nature never wastes her time and material in maintaining a muscle or ligament at its original length when the distance between their points of origin and insertion is for any considerable time, without interruption, shortened."
Why is this a big deal to grasp? Listen to what the Journal of Alternative and Complementary Medicine had to say in a 2013 issue of Visceral and Somatic Disorders: Tissue Softening with Frequency-Specific Microcurrent (by the way, I have a Mens-O-Matic microcurrent machine I sometimes use on Tissue Remodeling patients).
"The fascial network is pervasive, extending to the capsules and interiors of organs, and could therefore be involved in both the origin and resolution of both somatic and visceral disorders. When the body is injured, stressed, or traumatized, fascia responds by laying down new fibers to provide support for the injured area (Davis's Law) and by 'gluing' adjacent muscles to each other. Thickening and gluing of fascial layers can persist long after an injury has healed and leave behind dense pockets or nonresilient bands that can be felt deep in the tissues. These palpable densities may correspond to the trigger points and taut bands described by Simons and Travell and/or to the inflammatory pockets described by Hans Selye. Residual local tensions and gluing in the fascial network can give rise to compensating tensions extending throughout the musculoskeletal system. Such compensations can disturb more distant structures, leading to compromised movement patterns that leave the body vulnerable to further injury."
What I really want you to grasp here is the first sentence. Yes, adhesed fascia can cause an array of movement problems and compensations that can wrack the entire body with pain and spasm. But fascia is also involved in, "both the origin and resolution of both somatic and visceral disorders." This is why very smart people such as DONALD INGBER and HELENE LANGEVIN (both are Harvard MD / Ph.D researchers) believe that problems in the fascia are the root of all sickness and disease. Look; I didn't say that, they have. Even if they are only partially correct, it still means that our EVIDENCE-BASED MODEL for treating chronically sick people or people with chronic pain, is outrageously obsolete. Why not try something new and different. What have you got to lose?