WHAT THE SCIENTIFIC COMMUNITY IS INCREASINGLY SAYING ABOUT ROUTINE BLOOD WORK AND PHYSICAL EXAMINATIONSRead Now
ROUTINE BLOOD WORK AND ANNUAL PHYSICAL EXAMINATIONS
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?
PRESIDENT JOHN F. KENNEDY'S
CHRONIC BACK PAIN
On the other hand, despite the fact that he is deeply beloved and considered by public opinion to be one of America's greatest presidents, many have forgotten that his legacy also includes the failed Bay of Pigs Invasion which subsequently led to him being verbally and politically bludgeoned by Nikita Khrushchev at the Vienna Summit --- an event that arguably led to both the Berlin Wall and the Cuban Missile Crisis --- not to mention moving US military "advisors" into Vietnam. JFK was also responsible for starting our failed war on poverty in earnest (even though LBJ usually gets the credit), along with avoiding the Civil Rights issue like a hot potato solely for political reasons until it literally backed him into a corner, fell into his lap, and forced his hand. That being said, Kennedy was undoubtedly a war hero.
Shortly prior to the famous PT-109 incident of WWII, Kennedy became a commander for a Motor Patrol Torpedo Boat in a squadron of PT boats in the South Pacific (he served in the Solomons and Russell Islands -- Tulagi, Kolombangara, New Georgia, Rendova, etc). In going up against the resupply barges and the hit-and-run tactics of the warships of "The Tokyo Express," PT-109 encountered the Japanese destroyer, Amagiri. JFK's PT-109 was sitting at idle on a pitch black night waiting for an opportunity to attack the enemy, when the Amagiri appeared from nowhere and cut Kennedy's vessel in half, killing two of his crew, and severely injuring two more. Clinging to the wreckage for 12 hours before coming to the realization it was sinking, Commander Kennedy understood that to survive he and his men would have to abandoned the sinking debris and make a break for shore. Heroically, JFK towed a severely burned crew member to shore by swimming (between 4-5 hours) while clenching the strap of the man's life jacket in his teeth.
Because the island was deserted -- only about 100 yards across -- with no water, Kennedy swam 3 miles to another island to find water and see what could be done about the possibility of rescue. Kennedy and his men survived for six days on coconuts and coconut water before being found by natives that had been dispatched by an Australian naval observer living on top of a dormant volcano on KOLOMBANGARA ISLAND --- and island holding 10,000 Japanese troops (the observer had seen the explosion and sent the natives out to look for survivors). Kennedy scratched out a message on a coconut that was taken back to lieutenant Arthur Evans (the observer), who then sent natives back to pick him up in a canoe, bring him back to Kolombangara, where he could help coordinate a rescue for his crew.
Not only is this story amazing, it's made all the more amazing because of the terrible back pain Kennedy suffered with his whole life (his politically powerful father had to pull several strings to get "Jack" OK'd for military duty by burying his failed military physicals due to "a bad back"). In similar fashion to the article on ELVIS PRESLEY'S HEAD INJURY that led to (or at least heavily contributed to) his rapid and premature downfall; just days ago, the Journal of Neurosurgery: Spine ran a story by a pair of well known physicians called John F. Kennedy’s Back: Chronic Pain, Failed Surgeries, and the Story of its Effects on his Life and Death.
Because I dealt with a decade of chronic pain myself before finding someone to help me solve it (HERE), and because five days a week I deal with people who struggle with debilitating chronic pain (HERE), and because I watched the incredible strength and toughness of my FATHER-IN-LAW who managed to lead a "normal" life despite spending a year in an iron lung with polio and suffering through terrible post-polio syndrome as he got older, I have at least a tiny (tiny) degree of understanding of what JFK went through. CHRONIC PAIN changes people --- it destroys mind, body, and soul. I find it astounding that Kennedy was able to accomplish what he did despite living with the kind of pain and health problems that he did.
There have been slews of articles written about JFK's back pain, as well as the fact that for years his personal physician was DR. JANET TRAVELL, who, along with Dr. David Simmons, wrote the "bible" on MYOFASCIAL TRIGGER POINTS (Myofascial Pain and Dysfunction: Trigger Point Manual). She and Simmons not only mapped out the areas where Trigger Points tend to occur most frequently, but their crazy pain-referral patterns as well. These authors say of Dr. Travell.
"In 1955, Kennedy was introduced to Dr. Janet Travell, a Cornell University pharmacologist and internal medicine specialist known for her work using trigger-point injections of local anesthetics to treat myofascial pain. Senator Kennedy was treated with ethyl chloride spray [Spray and Stretch] and procaine trigger-point injections. This hospitalization marked the first of hundreds, if not thousands, of procaine trigger-point injections.... [and] marks the end of his major back surgeries and a shift in focus toward muscular and environmental factors contributing to his back pain."
On May 29th of this year, JFK would have been 100 years old. Something that the general public was unaware of (at least initially) is that despite his public persona of health and vitality, Kennedy (in similar fashion to Teddy Roosevelt) was a very sickly child, having nearly died from Scarlet Fever at age two. His childhood troubles didn't end there, however. According to several sources supplied by these authors, "he would be treated for a host of illnesses prior to his graduation from preparatory school." The most interesting health-related fact in this entire story, however, had to do not simply with the fact that he had back pain, but with the cause of his back pain.
"Dr. Marius Smith-Petersen concluded: 'I don’t think this is a disc since the pain complained of does not even remotely resemble a disc.' Dr. Smith-Petersen requested that JFK also consult with Dr. James White, a naval neurosurgeon who agreed that Kennedy’s current pain was inconsistent with sciatica. The Mayo team stated that 'a diagnosis of a protruded disk was not definite … at this time you are not in need of surgery.'"
In other words, Kennedy was debilitated with back pain that was probably not DISC-RELATED, but not having better solutions (or at least not having been introduced to better solutions by a HIGHLY ANTI-CHIROPRACTIC MEDICAL PROFESSION), he decided to undergo SPINAL SURGERY in 1944 --- over a year before the war's end. This leads me to a couple of conclusions that I have discussed on this site many times. Debilitating low back pain has several causes that have nothing whatsoever to do with spinal discs (HERE). It also leads to the conclusions that Dr. Travell came to in her studies, and what eventually led Kennedy to her --- albeit unfortunately after his failed back surgeries --- that the TWO SIDES OF THE MYOFASCIAL SYNDROME --- Scar Tissue / Fascial Adhesions and Trigger Points can produce debilitating / crippling pain (LH of Indy, I am thinking of you right now) that leaves the vast majority of the medical community starring at you with a deer-in-the-headlights look because these sorts of problems do not show up on MRI (HERE).
Shortly after the war's end, JFK leveraged his name and war hero status to be elected first as a Representative and then a Senator. During this time he was diagnosed with Addison's Disease --- a near total loss of adrenal hormones that is a step beyond ADRENAL FATIGUE and HARDCORE SYMPATHETIC DOMINANCE, although it carries some of the same general symptoms. Wikipedia says the chief signs of Addison's Disease include, "fatigue; lightheadedness upon standing or difficulty standing, muscle weakness, fever, weight loss, anxiety, nausea, vomiting, diarrhea, headache, sweating, changes in mood or personality, and joint and muscle pains." Think for a moment about this. JFK not only dealt with horrendous back pain, but the nightmare of Adrenal Insufficiency as well (yes, Addison's is another of the numerous AUTOIMMUNE DISEASES).
This is where things started to go off the rails. After his second surgery, Kennedy had several near-death experiences due to staph infections and an inability of his wound to heal. A friend said of Kennedy's wound, "the area where they cut into his back never healed. It was oozing blood and pus all the time. It must have been painful beyond belief…. It was an open wound that seemed to be infected all the time. And now and then a piece of bone would come out. His pain was excruciating." Despite Travell's help with strengthening and rehabilitating his spine, which "led to significant improvement in JFK’s low-back health and overall functioning during this time," Kennedy ended up requiring one more surgery (his fourth spinal surgery) to "fix" staph-induced abscesses (not to mention a ton of ANTIBIOTICS that would have further degraded his GUT HEALTH along with his overall health and IMMUNE SYSTEM FUNCTION).
"Although his back was in comparatively decent shape, the 1960 campaign took its toll, prompting Kennedy to seek the services of Dr. Max Jacobson, a German immigrant practicing in New York. Over the ensuing summer JFK’s physical condition was at its worst point in years. Not for a long time had he been in such agony. This prompted a return to frequent use of crutches, procaine injections, his corset brace, and an increase in the illicit injections from Jacobson. The poor state of his back and its effect on JFK’s overall well-being may have had a considerable and negative impact on the President’s performance at the crucial Vienna Summit with Soviet Premier Nikita Khrushchev in June 1961. In fact, on the 1st day of the tense summit the president received at least three of the methamphetamine-containing shots. Reeling from the nerve-wracking summit, his aching back, and the likely side effects of Jacobson’s methamphetamine shots, the very gloomy Kennedy admitted immediately after it ended that the summit did not go well—reflecting that Khrushchev just beat the hell out of me."
One of the White House physicians, Rear Admiral George C. Burkley, took it upon himself to have Kennedy evaluated by yet another expert --- this time, renowned orthopedist and physiatrist HANS KRAUS. President Kennedy was, "placed on an exercise and rehabilitation program built around the White House pool and gym. The program consisted of a combination of thrice-weekly weight-lifting sessions and near-daily swims, along with massage and heat therapy — and paid immediate dividends. Within months, the improvement was dramatic." Interestingly enough, there are many, including these authors, who suggest that Kennedy's continued reliance on a rigid back brace is what held him upright so that Lee Harvey Oswald could get off subsequent kill shots after a first shot that was, according to these authors, "potentially survivable".
The conclusions that the authors came to were that at least at first, there was nothing radiographically to show that JFK had a serious back problem, nor anything in his examinations that led experts to believe his problem was related to a disc herniation. Because these authors also believe that Kennedy's problems started out as (and I quote) "MECHANICAL LOW BACK PAIN," it's nothing less than shameful that CHIROPRACTIC CARE was never tried (there is no historic record of such, nor have I seen anything about Dr. Kraus doing any spinal manipulations).
No matter what your political bent or opinion of him as a leader, Kennedy's ability to continually move forward in the face of incredible pain and dysfunction is nothing short of miraculous. To read the entire paper by T. Glenn Pait, MD, and Justin T. Dowdy, MD, simply go HERE.
RESTRICTED, FIBROTIC, OR ADHESED FASCIA?
FOUR REASONS WHY
THIS MIGHT BE YOU
Because our current insurance-based healthcare system is all about diagnosing things that can be seen or tested for, issues in the tissues --- particularly in the fascia --- can make suffering people think they are loosing their minds. For instance, I have a patient who earlier this year ran into a small herd of cattle on the roadway that had gotten out of their fence in the middle of the night. She has struggled with her WHIPLASH-TYPE INJURY, even though testing, orthopedic and neurological evaluations, and ADVANCED IMAGING techniques have all been "normal". In other words, other than pain and some relatively minor restrictions in mobility, she has no visible / tangible (testable) basis for her pain.
Today I want to touch on the main ways that fascia winds up causing problems, including pain. They are mechanical reasons, chemical reasons, and electrical reasons.
- MECHANICAL: There are any number of mechanical / physical ways that people can wind up with stretched, torn, or injured fascia (HERE). While most people tend to associate this bullet point with traumatic injury, as often as not (probably more so) it comes from repetitive injuries (chronic overuse) or POSTURAL CONSIDERATIONS. Other reasons include impacts (getting hit BY SOMEONE or something), or overstretching tissues such what one might see in many SPORTS INJURIES or WHIPLASH INJURIES. And while mechanical causes of fibrotic, adhesed, or restricted fascia are super ultra-common, they might not actually be the biggest reason.
- CHEMICAL: There is a chemical process that occurs in our body that is specifically designed to allow us to heal injured or insulted tissues -- it's called inflammation. While these chemical mediators that we collectively refer to as INFLAMMATION are vital and necessary to any and all healing processes, too many of these chemicals can create problems --- particularly if they are in the blood stream all the time. In other words, if they are present on a "SYSTEMIC" basis. A big part of this has to do with the fact that inflammation always leads to fibrosis (HERE). Another big thing I have shown you previously is that according to renowned neurologist and medical professor CHAN GUNN, this inflammation can also hypersensitize scar tissue, helping make it over a thousand times more pain-sensitive than normal tissues. Not surprisingly, inflammation is the root of most of the pain and chronic illness people deal with on a day-to-day basis. And because we are talking about the chemical aspect of tissue adhesion here, remember that we have not even began to discuss the fact that in many ways fascia acts as an endocrine organ as well (HERE).
- ELECTRICAL: Because fascia acts as another nervous system (HERE), it transmits messages of all sorts. Foul its PROPRIOCEPTIVE ABILITIES and as you'll see if you click the link, you'll also disrupt the motor side of the nervous system. Not only can this whole scenario tilt your nervous system away from proprioception and toward nocicpetion (pain and spasm), it helps create aberrant motor and sensory loops that both CHIROPRACTORS and OSTEOPATHS have been talking about since the late 1800's and early 1900's. Ultimately this can lead to a wide array of problems including CENTRAL SENSITIZATION.
- IMMUNE / ENDOCRINE: Because inflammation is an immune system function, I could actually put AUTOIMMUNE FASCIA PROBLEMS here. And this does not even begin to touch on the fact that fascia is actually a NEURO-ENDOCRINE ORGAN. Once you begin fouling these two systems, things start to get much worse.
My next post is going to show people how to deal with (and hopefully restore) adhesed fascia and loss of proprioception (HERE it is). Meanwhile, if you are struggling with chronic pain or chronic illness, make sure to read these two posts (HERE and HERE). And if fascia really resonates with you --- makes sense --- be sure to at least bookmark my "FASCIA SUPER-POST" with about 175 articles on the subject, as well as a ton of peer-review!
WHY CAN'T WE REPRODUCE BIOMEDICAL RESEARCH?
"Unfortunately, in the past few years, many studies have reported that the majority of results within biomedical research cannot be replicated." From one of Harvard University's blog posts (Reproduce or Bust: Bringing Reproducibility Back to Center Stage) by Steph Guerra
"It can be proven that most claimed research findings are false." Dr John Ionnidis from the study mentioned directly below
What is the one thing that makes "science" scientific? Although you will find about a million slightly different definitions, the one thing --- the maxim if you will --- the property that makes science scientific is reproduciblity. Reproduciblity is essentially the same thing as (or at the very least, intimately related to) falsifiability --- the various methods of testing a hypothesis to learn whether or not it is true or false; accurate or inaccurate. The whole point of the science laboratory is to remove variables so that experiments can be duplicated over and over again to make sure that they are accurate and that further science is built on sound principles. When scientific experiments cannot be reproduced either by other teams of scientists or by the scientists that did the experiment in the first place, it's not science.
The famous medical doctor, JOHN IONNIDIS, said it best via the title of the study he published in PLoS One a dozen years ago next month --- Why Most Published Research Findings Are False. I've shown you why this is on many levels, one of the most recent being just a few weeks ago (HERE). Today we are going to tackle yet another aspect of EVIDENCE-BASED MEDICINE that proves exactly what Ionnidis stated well over a decade ago; that for any number of reasons, biomedical science cannot be trusted to be true or accurate.
This problem irreprocudibility is so pervasive in the scientific community that Wikipedia actually has an entry for it called "Replication Crisis" that says, "Scientists have found that the results of many scientific studies are difficult or impossible to replicate on subsequent investigation, either by independent researchers or by the original researchers themselves. The crisis has long-standing roots. Since the reproducibility of experiments is an essential part of the scientific method, the inability to replicate the studies of others has potentially grave consequences for many fields of science in which significant theories are grounded on unreproduceable experimental work." In other words, what you are going to learn today is that the VERY FOUNDATIONS OF MODERN PHARMACEUTICAL-BASED MEDICINE are based largely on misinformation. Whether this misinformation is deliberate (outright lies and fraud) or accidental, is something you'll have to decide for yourself.
For the record, this problem is not confined to medical research. The same thing is happening in other fields as well. For instance, the website of the Federal Reserve contains a study called Is Economics Research Replicable? Sixty Published Papers from Thirteen Journals Say 'Usually Not'. After looking at an awful lot of research, the authors concluded that, "Because we are able to replicate less than half of the papers in our sample even with help from the authors, we assert that economics research is usually not replicable." We see the same thing in the field of chemistry. Listen to what Dalmeet Singh Chawla said in the March 2017 issue of Chemistry World (Taking on Chemistry's Reproducibility Problem).
"A survey of over 1,500 scientists conducted by Nature last year revealed that 70% of researchers think that science faces a reproducibility crisis. Over half, however, still have faith in published literature in their field – with chemists being amongst the most confident despite reporting the most difficulty replicating other researchers’ or their own work."
Why is this such a big deal? For the very reason I mentioned to you earlier --- that modern medicine is based on the field of chemistry. And while I can see where some experiments might be tougher to duplicate because they involve living organisms and there are inherent differences in living organisms one to another, chemistry is just that; working with non-living chemicals. Nothing should be easier than reproducing experiments with non-living chemicals. Not only is this not the case, but the icing on the cake is the fact that even though scientists are often getting it wrong, the quote above shows that they think they are getting it right. Allow me to show you some of the sources revealing just how wrong we've been getting it for the past half century.
- 1960's: A few months ago, NPR reporter, Richard Harris, released his book Rigor Mortis: How Sloppy Science Creates Worthless Cures, Crushes Hope, and Wastes Billions. In it he says, "The issue of reproducibility in biomedical science has been simmering for many years. As far back as the 1960s, scientists raised the alarm about well-known pitfalls—for instance, warning that human cells widely used in laboratory studies were often not at all what they purported to be. At issue is not simply that scientists are wasting their time and our tax dollars; misleading results in laboratory research are actually slowing progress in the search for treatments and cures. This work is at the very heart of the advances in medicine. if preclinical discoveries are deeply flawed, scientists can spend years (not to mention untold millions of dollars) lost in dead ends." Stick with me to see just how "flawed" the science really is.
- 2005: This is the year that the barrage against irreproduciblity in science started in earnest. Besides the study by Ionnidis mentioned earlier, he authored another one that year; this one for the Journal of the American Medical Association (Contradicted and Initially Stronger Effects in Highly Cited Clinical Research) dealt with the number of times studies contradict other studies. After looking at 45 highly cited studies and then looking at research trying to duplicate their results, Ionnidis concluded that, "A third of the most-cited clinical research seems to have replication problems, and this seems to be as large, if not larger, than the vast majority of other, less-cited clinical research." As you will see, however, either the problem of irreproducibility is growing exponentially, or Dr. Ionnidis dramatically underestimated the severity of the problem 12 years ago.
- 2008: That January's issue of Nature Genetics "evaluated the replication of data analyses in 18 articles on microarray-based gene expression profiling published in Nature Genetics in 2005–2006. One table or figure from each article was independently evaluated by two teams of analysts. We reproduced two analyses in principle and six partially or with some discrepancies; ten could not be reproduced. Repeatability of published microarray studies is apparently limited." In other words, in this study the independent scientists were not even trying to reproduce the entire experiment, just a single table --- and could not get it done in over half the cases.
- 2011: A group of researchers from Bayer (yes, the same company famous for their ASPIRIN) published a study that can be found in the September 2011 issue of Nature Reviews: Drug Discovery (Believe It or Not: How Much Can We Rely on Published Data on Potential Drug Targets?) that looked at "published data from 67 in-house projects." (forty had to do with cancer research) They concluded that at the very most, they were able to duplicate results that were "completely in line" with the original research a quarter or less of the time. Furthermore, "In almost two-thirds of the projects, there were inconsistencies between published data and in-house data that either considerably prolonged the duration of the target validation process or, in most cases, resulted in termination of the projects because the evidence that was generated for the therapeutic hypothesis was insufficient to justify further investments into these projects. Talking to scientists, both in academia and in industry, there seems to be a general impression that many results that are published are hard to reproduce. However, there is an imbalance between this apparently widespread impression and its public recognition, and the surprisingly few scientific publications dealing with this topic."
- 2012: In March of 2012, a team led by Glenn Begley, former head of cancer research at pharmaceutical giant Amgen, revealed just how bad things really were in the field of cancer research. Published by Nature, the study (essentially this was a decade-long whistleblower sort of thing) Drug Development: Raise Standards for Preclinical Cancer Research concluded after trying to reproduce 47 of the industry's "landmark" cancer studies that, "clinical trials in oncology have the highest failure rate compared with other therapeutic areas. Unquestionably, a significant contributor to failure in oncology trials is the quality of published preclinical data." How bad was it? "Scientific findings were confirmed in only 6 (11%) cases. Even knowing the limitations of preclinical research, this was a shocking result." How do we know that BIG PHARMA is talking out of both sides of their collective mouths when dealing with this issue? All of the companies forced Amegen to sign non-disclosure agreements. In other words, they knew in advance that their published research would not stand up to rigorous scrutiny.
- 2013: The December 2013 issue of Nature published a study (Modelling the Effects of Subjective and Objective Decision Making in Scientific Peer Review) on a phenomenon known as "herding". "Given the increasing concern surrounding the reproducibility of much published research, it is critical to understand whether peer review is intrinsically susceptible to failure. Here we show that even when scientists are motivated to promote the truth, their behaviour may be influenced, and even dominated, by information gleaned from their peers’ behaviour. This phenomenon, known as herding, subjects the scientific community to an inherent risk of converging on an incorrect answer and raises the possibility that, under certain conditions, science may not be self-correcting." This is not really news, nor is the propensity to only publish data that makes one's products (in this case drugs) appear more safe and wonderful than they really are. One of the best examples of herding (probably caused by fear of being blackballed by the research community) has to do with vaccines. Both FLU VACCINES as well as the relationship between VACCINES & AUTISM provide many examples. If you want to understand this concept a bit better, take five minutes to learn who DR HUGH FUDENBERG was.
- 2015 PART I: Two years ago next month, the journal Science published a study on the field of psychology called Estimating the Reproducibility of Psychological Science. After looking at and trying to reproduce "100 experiments reported in papers published in 2008" using teams of scientists from around the globe, the authors had to conclude that, "A large portion of replications produced weaker evidence for the original findings despite using materials provided by the original authors. Ninety-seven percent of original studies had statistically significant results. Thirty-six percent of replications had statistically significant results." In case you didn't grasp the sheer magnitude of the scientific deceit going on here, re-read that last sentence.
- 2015 PART II: April's issue of The Journal of Cell Biology carried a paper called Reproducibility and Cell Biology, which showed this continued pattern. "Growing concerns about the reproducibility of published research threaten to undermine the scientific enterprise and erode public trust. Research reproducibility is crucial to the scientific enterprise, not only because it underpins the accuracy and integrity of our published literature, but also because basic research increasingly contributes to the development of innovative clinical therapies. Recent accounts describe frustrating experiences of pharmaceutical companies attempting to build upon research studies, notably in cancer biology. These companies encountered surprisingly low reproducibility (less than 25%) of published work."
- 2015 PART III: The October 2015 issue of the Journal of Controversies in Biomedical Research ran a study (How Medical Practice Has Gone Wrong: Causes of the Lack-of-Reproducibility Crisis in Medical Research) by Henry Bauer, a professor of chemistry and science at Virginia Polytechnic Institute, that hit the nail squarely on the head. Listen to Dr. Bauer's shocking conclusions. "Finding solutions to problems requires identifying their causes. Without that, only symptoms are likely to be addressed, leaving the root causes to generate further problems. The lack-of-reproducibility crisis in biomedical research is one of the indications that modern medicine in the most advanced countries has gone wrong in recent decades, as described and documented in many books and articles. Modern medical practice has gone wrong by over-emphasizing drug-based treatment for chronic, constitutional conditions. The failure to distinguish between infectious and innate conditions was exacerbated by misinterpretation of quantitative measures, inappropriate statistical analysis, and inadequate regulation. The drug industry has become too influential as a result of these mis-steps and is a source of many conflicts of interest that are barriers to improving matters." Let me summarize (after I find Dr. B and give him a hearty fist-bump). Most chronic diseases (INFLAMMATORY and AUTOIMMUNE), while having some degree of GENETIC CULPABILITY, are diseases of lifestyle that will never really respond to what our medical community is trying to do with their drugs-for-everything approach. While there are many, the best example I can think of off the top of my head is DIABETES (HERE is the blistering expose showing how grossly ineffective this class of drugs really is).
- 2016 PART I: In May of 2016, the journal Nature did a survey of nearly 1,600 scientists called 1,500 Scientists Lift the Lid on Reproducibility, which concluded (cherry-picked for time and space as are most studies I talk about), "More than 70% of researchers have tried and failed to reproduce another scientist's experiments, and more than half have failed to reproduce their own experiments. Data on how much of the scientific literature is reproducible are rare and generally bleak. 73% said that they think that at least half of the papers in their field can be trusted. Several respondents who had published a failed replication said that editors and reviewers demanded that they play down comparisons with the original study. The survey asked scientists what led to problems in reproducibility. More than 60% of respondents said that each of two factors — pressure to publish and selective reporting — always or often contributed." In other words, publish or find a new job, along with the whole "Invisible & Abandoned" thing I mentioned earlier. For those of you who are not aware, this would be a good time to mention that I am the current world record holder in consecutively-made free throws (HERE) --- 43,548.
- 2016 PART II: Drs. Kornfield (professor of psychiatry and special lecturer at Columbia University's College of Physicians and Surgeons) and Titus (former director at the US Office of Research Integrity) published a scientific paper a year ago next month in Nature called Stop Ignoring Misconduct. Their premise? That the journals and institutions that actually are addressing the issue of reproducibility are not owning up to reality. They are trying to blame this phenomenon on anything but fraud. These authors take a different approach saying, "Irreproducibility is the product of two factors: faulty research practices and fraud. Yet, in our view, current initiatives to improve science dismiss the second factor. To dismiss the role of research misconduct is mistaken and unfortunate. At best, ignoring deliberate misconduct in efforts to reduce irreproducibility is a wasted opportunity, like tilling a field without clearing it of rocks. At worst, it permits destructive behaviour to persist and flourish. Only 10–12 individuals are found guilty by the US Office of Research Integrity each year. That number, which the NIH used to dismiss the role of research misconduct, is misleadingly low, as numerous studies show. For instance, a review of 2,047 life-science papers retracted from 1973 to 2012 found that around 43% were attributed to fraud or suspected fraud. A compilation of anonymous surveys suggests that 2% of scientists and trainees admit that they have fabricated, falsified or modified data. And a 1996 study of more than 1,000 postdocs found that more than one-quarter would select or omit data to improve their chances of receiving grant funding."
- 2017: I can see where experiments with animals or people could be harder to duplicate because of the variances in living systems. However, replicating experiments in chemistry should be relatively simpler. In March of this year, Chemistry World published an article called Taking on Chemistry's Reproducibility Problem by saying that, "Not a week passes without reproducibility in science – or the lack of it – hitting the headlines. Although much of the criticism is directed at the biomedical sciences or psychology, many of the same problems also pervade the chemical sciences." The author went on to show that the problem of replicating studies in chemistry is essentially as big a deal as it is in the biological sciences.
- ONGOING STUDY: The website Psych FileDrawer keeps a running tally of experiments from the field of psychology. Although the ongoing study is called Top-20 List of Studies Users Would Like to See Replicated, it contains more like 35 or 40 studies. I counted 35 successes and 66 failures --- a success rate of about 1 in 3 --- not very good odds, but as good or better than most of what we have looked at so far.
IT'S MONEY THAT MATTERS
"Academic medical research functions as a gargantuan cottage industry, where the government gives money to individual investigators and programs--$30 billion annually in the US alone—and then nobody checks in on the manufacturing process until the final product is delivered. The final product isn’t a widget that can be inspected, but rather a claim by investigators that they ran experiments or combed through data and made whatever observations are described in their paper. The quality inspectors, whose job it is to decide whether the claims are interesting and believable, are peers of the investigators, which means that they can be friends, strangers, competitors, or enemies."
Dr. Sarah Weil from her Feb 2014 article Why Biomedical Research Has A Reproducibility Problem shows how this whole thing is related to the "Invisible & Abandoned" research problem I have talked about over and over on my site. "Unfortunately, scientists are typically evaluated based on the number of papers they have published and the quality of the journals in which they have published, but not on whether their findings can be reproduced. The “publish or perish” culture drives researchers to dig for significant results they can publish, and in the process may create subtle biases to report results in a manner that inflates the importance of a study and, by proxy, its authors. Whole sets of experiments that do not fit squarely with a hypothesis may be omitted from the published work to make the findings seem more convincing." Why is this such a huge issue for the American taxpayer? Maybe because of the 32 billion being spent by our government, the huge majority is paying for research that cannot be replicated. The June 2015 issue of PLoS One (The Economics of Reproducibility in Preclinical Research) showed just how bad things really are.
"Low reproducibility rates within life science research undermine cumulative knowledge production and contribute to both delays and costs of therapeutic drug development. An analysis of past studies indicates that the cumulative (total) prevalence of irreproducible preclinical research exceeds 50%, resulting in approximately US$28,000,000,000 (US$28B)/year spent on preclinical research that is not reproducible—in the United States alone."
Holy cash-cow batman! That's a lot of dough! As you might of guessed from what you've seen thus far, nowhere is this research a bigger money-maker, not to mention a bigger producer of unduplicatable studies, than is the field of CANCER RESEARCH. Think about this when you hear 'BROTHER JOE' or anyone else for that matter calling for yet another cancer-curing "MOONSHOT". The problem is, despite all the rhetoric about stopping this problem --- or for that matter, even slowing it down, it continues picking up steam and crushing everything in its path; sort of like a cartoon snowball rolling downhill.
IS ANYTHING BEING DONE ABOUT IT AND IS
THE PROBLEM GETTING BETTER?
Just two short weeks ago, PLoS One published a study whose title asked a question, Can Cancer Researchers Accurately Judge Whether Preclinical Reports Will Reproduce? Although the short answer is no, let me show you what they actually said. "Whether scientists can accurately assess which experiments will reproduce original findings is important to determining the pace at which science self-corrects. Science is supposed to be self-correcting. However, the efficiency with which science self-corrects depends in part on how well scientists can anticipate whether particular findings will hold up over time." After looking at how well scientists predicted the ability of six mouse studies in the field of cancer would hold up over time, the authors of this study concluded that...
"Experts generally overestimated the likelihood that replication studies would reproduce the effects observed in original studies. Experts... did not consistently perform better than trainees, and topic-specific expertise did not improve forecast skill. Our findings suggest that experts tend to overestimate the reproducibility of original studies and/or they underappreciate the difficulty of independently repeating laboratory experiments from original protocols."
If we can't replicate studies in mice, what makes us think that we are getting it right in people? In many cases, we're not. Despite what you are led to believe by industry, this field is not advancing like we are being told it is. Just a few days ago, Wired ran a story called Biology's Roiling Debate Over Publishing Research Early. The author, one Megan Molteni, concluded that, "Posting scientific papers online before peer review—in so-called preprint archives—isn’t a new idea. Preprints could solve these issues by decoupling distribution of results from their certification via peer review. But publishers and some scientists worry preprints will only further dilute the research literature and endanger fields already struggling with reproducibility failures.... One of the concerns with preprints is that scientists will sacrifice accuracy for speed—that in the rush to be first on the scientific record, they’ll wind up filling the internet with crap. Traditional peer review is supposed to catch mistakes and make sure a paper’s scientific reasoning is sound, and uploading a virgin paper means people will see work that could be wrong." We've seen just how wrong much of what we today call science really is.
This is why I believe that when it comes to your health, you need to be about he business of taking matters into your own hands. There are some simple rules to live by if you want to get healthy and stay that way. The MORE OF THESE POINTS you understand, the better the chances of regaining your health and living a life without pain and dysfunction. For instance, when "science" tells us that WHOLE FOODS and organic foods are no better than their processed, genetically altered, and chemically saturated counterparts, we should all start to realize just how bought and paid for science really is.
FASCIA, PROPRIOCEPTION, AND CHRONIC PAIN
"This study demonstrated an abundant innervation of the fascia consisting in both free nerve endings and encapsulated receptors, in particular, Ruffini and Pacini corpuscles. The hypothesis that the fascia plays an important role in proprioception, especially dynamic proprioception, is therefore advanced. In fact, the fascia is a membrane that extends throughout the whole body and numerous muscular expansions maintain it in a basal tension. During a muscular contraction these expansions could also transmit the effect of the stretch to a specific area of the fascia, stimulating the proprioceptors in that area." From a 2007 study from the journal Morphologie (Anatomy of the Deep Fascia of the Upper Limb)
"It is now recognized that fascial network is one of our richest sensory organs. The surface area of this network is endowed with millions of endomysial sacs and other membranous pockets with a total surface area that by far surpasses that of the skin or any other body tissues. A myriad of tiny unmyelinated 'free' nerve endings are found almost everywhere in fascial tissues, but particularly in periosteum, in endomysial and perimysial layers, and in visceral connective tissues. If we include these smaller fascial nerve endings in our calculation, then the amount of fascial receptors may possibly be equal or even superior to that of the retina, so far considered as the richest sensory human organ. However, for the sensorial relationship with our own body - whether it consists of pure proprioception, nociception or the more visceral interoception – fascia provides definitely our most important perceptual organ." Dr. Robert Schleip from Fascia as an Organ of Communication
"There really is a sixth sense: it’s called proprioception. It is the sense of position and movement. It is produced by nerves in our connective tissues (ligaments, bone, fascia) and our 300-or-so muscles. Without proprioception, you couldn’t stand up (standing up is actually shockingly complicated). You couldn’t so much as scratch your nose, because you wouldn’t be able to find it." Paul Ingraham from his article, Proprioception, The True Sixth Sense. I included Ingraham's article only because he was a previous editor of Gorski & Novella's SCIENCE-BASED MEDICINE and has written a large article decrying fascia as being an important target of manual therapies.
First off, don't confuse these two terms with nociception; something completely different. Nociception (certain kinds of nerve endings are called nociceptors) is associated with things like pain, constricted blood vessels (vasoconstriction), MUSCLE SPASM (this and the previous can cause hypoxia or lack of TISSUE OXYGENATION) as well as various deficits in the autonomic nervous system (can anyone say SYMPATHETIC DOMINANCE?). Functional neurologist DR. DAVID SEAMAN puts it this way.....
"Nociception and pain are two completely different animals. However, a devastating consequence of both pain and nociceptive stimulation of the hypothalamus, is the release of cortisol by the adrenal glands. Over time, elevated levels of cortisol will promote glucose intolerance, inhibit collagen formation, increase protein breakdown, inhibit secretory IgA output, and inhibit white blood cell function."
In other words, nociceptive stimulation coupled with proprioceptive loss means that you are far more likely to end up with ADRENAL FATIGUE, BLOOD SUGAR ISSUES, PROBLEMS HEALING (the body enters a catabolic state of breaking itself down as opposed to anabolic state of building itself up), various sorts of IMMUNE SYSTEM PROBLEMS, HORMONAL ISSUES (true for men as well --- HERE), not to mention CHRONIC PAIN. Mechanoreceptors are the numerous and various nerve endings (mostly "encapsulated" --- Ruffinis, Pacinis, Golgis, etc) that are greatly responsible for proprioception. What is proprioception?
When mechanoreceptors are stretched, compressed, or sense almost any sort of movement or vibration, they fire off input into your nervous system to give a person what is called "kinesthetic awareness" (kinesthesia). In other words, along with mechanoreception; inner ear function and visual input allow for balance and an awareness of where your whole body, as well as the various parts of your body, are in space. Of the three, it is widely believed that mechanoreception is the most important. Together, this kinesthetic integration of the musculoskeletal and nervous systems is known as proprioception.
When joints and tissues are being moved through normal ranges of motion on a regular basis (EXERCISE, PERIODIC ADJUSTMENTS, STRETCHING, YOGA, etc, etc, etc), mechanoreceptors of all kinds are being fired. This is important on many levels. Although I cannot find the study he was referring to, I attended a WHIPLASH seminar in Little Rock 25 years ago where the instructor (the brilliant Dan Murphy) said that for every proprioceptive impulse not fired off due to loss of or abnormal mechanoreception (usually due to loss of or inhibited ranges of motion), thirty responses are inhibited on the motor side. It's likely what caused the father of FUNCTIONAL NEUROLOGY, Ted Carrick, to say (I am loosely quoting here), "chiropractors don't move bones off nerves, they put pressure on mechanoreceptors". This helps explain some of the CRAZY MIRACLES that occur in my clinic from time to time (the link deals with an individual getting his hearing back as the result of a single adjustment after 42 years of deafness --- I did not realize he was deaf).
A majorly important thing to remember is that in the same way nociception can inhibit mechanoreception, the opposite is true as well --- mechanoreception has the potential to inhibit nociception. In other words, when joints are moving through normal ranges of motion and being moved on a regular basis (trust me when I say that people are often fooled -- HERE --- I was totally fooled by a 26 year old female yesterday), it has a pain-inhibiting / spasm-inhibiting effect, that tends to push the body away from SYMPATHETIC DOMINANCE and towards the parasympathetic side of the nervous system, meaning the body has a better ability to both relax and digest. It's also why having joints --- particularly joints of the spine --- that do not move through normal ranges of motion, even in the absence of pain, is never a good thing.
FASCIA, MECHANORECEPTION AND PAIN
Adhesed fascia leads to a phenomenon known as DENSIFICATION. Due to the adhesive nature of this problem, it tends to perpetuate subluxation, or at the very least, an inability to reduce subluxation (SUBLUXATION is defined as a loss of normal alignment or motion of joints --- usually vertebrae). This is why there are so many people CANNOT HOLD AN ADJUSTMENT. They often do amazingly well with Chiropractic Adjustments for a little while, but no matter what they do, they cannot seem to hold adjustment more than a few days, or in some cases, just a few hours.
How long have we known that fascia is loaded with mechanoreceptive abilities? For starters, in 1974 the Bulletin of Tokyo Medical and Dental University published a study called Mechanoreceptors in Fascia, Periosteum and Periodontal Ligament (PERIOSTEUM is the membranous fascia that covers bones). But there are many others. Thus, after realizing the intimate relationship between pain and abnormal proprioception, it should make you stop and think yet again about fascia as a potential generator of chronic pain. Let's briefly look at some more early research.
A 1992 study on the THORACOLUMBAR FASCIA (Sensory Innervation of Human Thoracolumbar Fascia from Acta Orthopaedica Scandinavica) takes us back even further, when the authors state, "Recent studies have proclaimed a significant role for the thoracolumbar fascia in the biomechanics of the lumbar spine. To our knowledge, there are only two histologic studies on the human thoracolumbar fascia (Stilwell, 1957, Hirsch 1963). Methylene-blue positive elements were found by Stilwell in the thoracolumbar fascia, such as numerous free nerve endings and large pacinian corpuscles. Hirsch spoke of 'complex unencapsulated endings.'" The thing is folks, this study was 25 years ago, and dealt with a study that is now sixty years old. Thankfully, however, there are many such studies on fascia and it's proprioceptive abilities now.
For instance, listen to what our own government said of fascia in this cherry-picked quote from a 2014 issue of one of the journals published by the Veterans Administration ---- the Journal of Rehabilitation, Research, and Development (Fascia—Current Knowledge and Future Directions in Physiatry: Narrative Review). For the record, physiatrists are medical doctors who, although they do use drugs to treat patients, sometimes treat in similar fashion to chiros or the old fashioned DO's. "Fascia can be considered part of the connective tissues that permeate the human body. In medical education, trainees are taught about various organ systems, including the cardiovascular, respiratory, gastrointestinal, musculoskeletal, and neurological systems. Fascia is part of all of these systems...." So, why isn't mainstream getting this message? One of the biggest reasons has to do with imaging. It takes VERY SPECIAL IMAGING TECHNIQUES to actually see fascia (MRI will not image fascia). But honestly, the lack of understanding starts long before that. The authors go on to explain why most physicians (and yes, even chiros) don't have much of a grasp of the importance of fascia when coming out of professional school.
"With embalmed cadaveric specimens, the majority of fascial tissues are either ignored or difficult to discern during a dissection. However, if unembalmed cadavers are dissected using 'fascia-sparing' techniques, much more may be garnered regarding the structure and function of the musculoskeletal system. These 'fascia-sparing' dissections demonstrate functional connections and emphasize the continuity of fascia throughout the human body. Fascia is more evident in living bodies. When defining fascial tissue via anatomical dissections, it may be difficult to define it only structurally, especially if fascial tissue has a dynamic and widespread role. For example, functions such as force transmission and sliding are not easily demonstrated in static specimens."
I had intense cadaver-based anatomy / physiology courses both at Kansas State University and at Logan College of Chiropractic, and in neither case do I recall fascia being as much as mentioned let alone its astounding properties being studied or discussed. The cool thing though, is that this is changing. There are now "Functional Anatomists" that are doing special dissection seminars. I believe that Tom Meyer's of ANATOMY TRAINS is doing this as is GIL HEADLY, JAAP VAN DER WAL,
JOHN SHARKEY, along with any number of others. Thanks to new research and new dissection methods, things are starting to change and this information is slowly filtering down to practicing physicians.
Some of this new research includes studies on the relationship between fascia and proprioception not just in an anatomical sense, but in a functional sense as well. For instance, a handful of studies from the March 2014 issue of the Journal of Motor Behavior (including The Medium of Haptic Perception: A Tensegrity Hypothesis, The Stresses and Strains of Tensegrity & Proprioception, Tensegrity, and Motor Control) each deal with proprioception as related to TENSEGRITY, which is the molecular and microscopic shape / structure that fascia uses to be both firm (strong) and springy (elastic). In other words, tensegrity allows fascia to resist not only mechanical loads that pull on it, but the axial loads that compress it as well.
WHAT HAPPENS WHEN FASCIA'S PROPRIOCEPTIVE ABILITY IS FOULED UP?
"Latest research shows that the fascia is highly innervated. Especially the thoracolumbar fascia exhibits a high density of mechanoreceptors. They are responsible for proprioceptive information, i.e. implicit information about joint position and movement. In chronic pain patients, proprioception is impaired and studies indicate that connective tissue structures in painful body parts exhibit pathological changes. Fascia should therefore be considered a cause of pain and proprioceptive deficits and treatment should be applied accordingly."
We'll get to treating proprioceptive deficits of fascia in part II of this shindig, but for now, lets take a look at a couple of real life applications of this phenomenon that are not related to DEGENERATIVE OSTEOARTHRITIS. What happens when you have a WEAK CORE, lose THORACOLUMBAR INTEGRITY, or find yourself locked into LOWER CROSSED SYNDROME? Take a look at the conclusions of this amazing study that was done by three medical doctors and published almost two decades ago in a 1999 issue of the journal Spine (The Effect of Lumbar Fatigue on the Ability to Sense a Change in Lumbar Position: A Controlled Study). After comparing the backs of those with back pain to the backs of those without, the researchers determined that.....
"Protection against spinal injury requires proper anticipation of events, appropriate sensation of body position, and reasonable muscular responses. Lumbar fatigue is known to delay lumbar muscle responses to sudden loads. Patients with chronic low back trouble had significantly poorer ability than control subjects on the average to sense a change in lumbar position, which was noticed before and after the fatiguing procedure. This feature was found in patients and control subjects, but patients with low back trouble had poorer ability to sense a change in lumbar position than control subjects even when they were not fatigued."
Why does this matter? Only because one's ability to sense joint position is one of the many functions of proprioception. When proprioception goes bye-bye, sooner or later (probably sooner) you will end up with pain. It really is that simple. But it's also far more complex. Remember a few paragraphs ago when FUNCTIONAL NEUROLOGIST David Seaman was discussing proprioceptive dysfunction as related to Adrenal Fatigue (FIBROMYALGIA --- or HERE)? CHRONIC FATIGUE SYNDROME is intimately related to both Fibro and Adrenal Fatigue. Now listen to what the May 2013 issue of Frontiers in Physiology had to say about this in a study titled Neuromuscular Strain as a Contributor to Cognitive and Other Symptoms in Chronic Fatigue Syndrome.
"Individuals with chronic fatigue syndrome (CFS) have heightened sensitivity and increased symptoms following various physiologic challenges, such as orthostatic stress [changing position], physical exercise, and cognitive challenges. Similar heightened sensitivity to the same stressors in fibromyalgia has led investigators to propose that these findings reflect a state of central sensitivity. Work by Brieg, Sunderland, and others has emphasized the ability of the nervous system to undergo accommodative changes in length in response to the range of limb and trunk movements carried out during daily activity. If that ability to elongate is impaired-due to movement restrictions in muscles, fascia, and other soft tissues adjacent to nerves, or due to swelling or adhesions within the nerve itself, the result is an increase in mechanical tension within the nerve. This adverse neural tension, also termed neurodynamic dysfunction, is thought to contribute to pain and other symptoms through a variety of mechanisms. These include mechanical sensitization and altered nociceptive signaling, altered proprioception, adverse patterns of muscle recruitment and force of muscle contraction, reduced intra-neural blood flow, and release of inflammatory neuropeptides."
They use a lot of big words, but here's the thing folks. Although he used different descriptive language than we are used to today, DR AT STILL --- the founder of osteopathic medicine --- was talking about this exact same thing back in the 1800's (HERE) as was the developer of chiropractic, DR BJ PALMER. It also happens to be why you have extremely educated people today (for instance, DR INGBER and DR LANGEVIN of Harvard) who believe that problems in the fascia are a root cause of all sickness, pain, and disease. That was not a misprint folks. That would be all as in all. Which is why you shouldn't be shocked to learn that fascia is intimately related to cancer --- HERE and HERE.
If you are looking for more detail on this subject (including information on the various types of mechanoreceptors found in fascia as well as what they do), I would suggest you try Dr. Robert Schleip's Fascial Mechanoreceptors and Their Potential Role in Deep Tissue Manipulation (HERE). Oh, and make sure to take a look at Part II of this post -- WHAT IT TAKES TO SOLVE PROPRIOCEPTIVE DYSFUNCTION IN FASCIA. And for those of you who can't seem to get enough information about this amazing tissue, I have organized all 160+ of my posts on fascia into one post (HERE).
TRYING TO MAKE A JALOPY LOOK LIKE A LAMBORGHINI
"There are perhaps 30,000 biomedical journals in the world, and they have grown steadily by 7% a year since the seventeenth century. Yet only about 15% of medical interventions are supported by, solid scientific evidence, David Eddy, professor, of health policy and management at Duke University, North Carolina, told a conference in Manchester last week. This is partly because only 1% of the articles in medical journals are scientifically sound. And partly because many treatments have never been assessed at all. For 21 problems tackled so far, the evidence has been judged — by the experts — to be between poor and none for 17, and usually the best available evidence was something less than a randomized controlled trial. Often the evidence that was available contradicted current practice."
It was one of those proverbial "shots heard round the world" in the field of healthcare --- the moment when we all knew beyond the shadow of a doubt that the emperor really was naked. But 1991 was a lifetime ago for many of you reading this, and things have surely changed in the last two and a half decades? After all, it's 2017. Medicine is more scientific now. We have the internet, and lasers, and robotic surgery, and vaccines for everything and then some, and the FDA. Science is surely enough to save us from ourselves; isn't it?
Unfortunately, a brand new study from the very same journal --- BMJ (How Good is the Evidence to Support Primary Care Practice?) showed us that the emperor is just about as naked today as he was 26 years ago. After looking at over 10,000 medical recommendations and industry guidelines that encompassed almost every imaginable category of healthcare, we leaned that the more things change, the more they stay the same. Despite the authors telling us that, "Evidence-based practice has been an important paradigm shift in modern healthcare education and practice," the so-called 'evidence' reveals that even though we may have thought we were buying a Testarossa or Countach, all too often, we are still riding in the turkey wagon.
"Previous studies have used observation of physician decisions to determine the extent to which physician decisions are based on high-quality evidence. In this study, we take a novel approach that evaluates the strength of evidence for a broad range of conditions in primary care and also assesses the extent to which that evidence is based on patient-oriented outcomes. Few medical references rate the strength of evidence of all key clinical recommendations. One is Clinical Evidence, which reported that 11% of the treatments reported in randomized trials were beneficial and another 24% were likely to be beneficial."
The July 2 issue of MedPage Today (Mediocre Evidence Behind Many Primary Care Decisions --- Only 18% of Clinical Recommendations Based on High-Quality, Patient-Oriented Evidence) by Alexandria Wilson Pecci did a better job of summarizing the situation.
"Researchers, led by Mark Ebell, epidemiology professor at University of Georgia's College of Public Health, analyzed 721 topics from an online medical reference for generalists and found that only 18% of the clinical recommendations were based on high-quality, patient-oriented evidence."
Twenty six years and we made it from 15% to 18%. A 3% improvement in medical "evidence" since my third year of chiropractic school. Are you kidding me? The emperor might not be completely naked, but he's not wearing much more than a string mini-Speedo made of tissue paper. For those that would doubt the veracity of this study, don't. I've shown you many times that the very things you thought you knew were true of the practice of medicine (get your annual physical, get your annual flu shot, get your regular colonoscopy, drugs are safe and effective and you need lots of them) are all too often, anything but (HERE). Furthermore, the research that makes it into the public eye is being shown to have been tinkered with in ways that are nearly unfathomable to the average citizen (HERE). This means that EVIDENCE-BASED MEDICINE is frequently little more than a feel-good oxymoron created to make doctors feel better about what they are doing clinically, and patients feel better about having it done to them.
What do I suggest people do who are chronically ill and / or dealing with CHRONIC PAIN? In many cases, probably even most cases, people need to be taking their health into their own hands and addressing unbridled inflammation at its source (HERE). Why? No one is going to work for your cause like you are. To see a generic template; a starting point as far as figuring out what you may need to do to begin taking your health back, HERE is something to look at --- something to at least get you thinking about creating your own "Exit Strategy". An Exit Strategy is one of the best ways I know to get off the turkey wagon and start turning your body into a fine-tuned Lamborghini.
Dr. Schierling completed four years of Kansas State University's five-year Nutrition / Exercise Physiology Program before deciding on a career in Chiropractic. He graduated from Logan Chiropractic College in 1991, and has run a busy clinic in Mountain View, Missouri ever since. He and his wife Amy have four children (three daughters and a son).
Brain Based Therapy
Can You Help
Cardio Or Strength
Cold Laser Therapy
Death By Medicine
Degenerative Joint Disease
D's Of Chronic Pain
Evidence Based Medicine
Gluten Cross Reactivity
Ice Or Heat
Jacks Fork River
Leaky Gut Syndrome
Number One Health Problem
Platelet Rich Therapy
Post Surgical Scarring
Re Invent Yourself
Rib And Chest Pain
Scar Tissue Removal
Sleeping Pills Kill
Stay Or Go
Stretching Post Treatment
Tensegrity And Fascia
The Big Four
Thoracic Outlet Syndrome
Whole Body Vibration