movement

Scar tissue - is it an issue?

Is scar tissue really an issue? Alongside myself, scars may be one of the most under appreciated and neglected structures, when it comes to assessing aspects of an individual's pain and movement limitations.   For many people, which include physicians, surgeons and often the owners of said scars, there’s an acceptance that the scar has healed and is not involved in any process of pain, strength or movement dysfunction. Dr’s and surgeons often assume that time enables optimal healing and patients simply forget about the previous trauma. Time may be a great healer but the healing is only partial - the nervous system always remembers. Writing this, reminds me of a client who had filled in all historical injury and trauma that he had experienced on my intake forms, which might have been a factor in his chronic back pain. It wasn’t until he took his top off and under questioning revealed that he had  donated his kidney to his brother some twenty years ago. It wasn't a big deal though as it was twenty years ago apparently.

This sequence of events has been summarised as homeostatic, inflammation, granulation and remodelling phases (1) which are undergoing symbiotic relationships with other structures and dependant on energetic, endocrine and other functions of the individual, which often depend on environmental stimulus. During the granulation and proliferation phase, sub-phases, which include collagen deposition, remodelling of blood vessels and tissues occur. It’s likely that during these phases the health and energetic response of the individual will dictate the capacity to regenerate and may also influence the layers of dysfunction that are present with scar tissue.

“ In childhood, wounds heal quickly and inflammation is resolved, in extreme age, or during extreme stress or starvation, wound healing is much slower and the nature of inflammation and would closure is different. “Ray Peat.

Unsaturated vegetable fats, serotonin and estrogen promote collagen synthesis and resulting fibrosis and keloid scars are associated with these states (3). Perhaps the capacity to organise energy and regenerate are instrumental in decreasing the associated dysfunctions that can be found in all scar tissue? Most Drs that I have spoken to just assume that after 12 weeks the scar has generally healed and that normally activity can be resumed. As a rule, there is no thought given to mechanical, pain sensitising or emotional constraints induced by the presence of the scar. It’s generally accepted that most scars have 80% tensile strength of the previous structure, but again might that too be a product of the quality of healing available to the individual?

“ The amount of disorganised fibrous material formed in injured tissue is variable and depends on state of the individual and tissue situation. “

In hypothyroidism, high levels of the pituitary hormone TSH (thyroid stimulating hormone) are known to stimulate fibrosis (1) Maintaining adequate thyroid hormone production promotes DNA transcription, optimal energy production, carbon dioxide production and probably decreases the proliferative effects of 'estrogenic' states that can be attributed to keloid scar formation.

The bigger the scar, the more likely the associated dysfunction? Perhaps the more disorganised tissue that exists, the increased likelihood of fuzziness between the central nervous system and output to structures associated with that scar. In scar tissue that has not been assessed or treated, it's relatively easy to induce weakness or stress to the surrounding tissues by a variety of stimulus which might include thinking and different types of pain,  touch or vectors of stretch that create neurological chaos or threat to to the individual.

Good therapy should allow for conversations between the clinician and patient that create stimulus that may (or may not) affect the output of surrounding structures associated with the scar. Poor feedback mediated by the scar might involve the following:

Emotional: Aspects of recall of the event that the individual finds upsetting.

Nociception/pain: First and second pain, visual or auditory, crude/fine touch, tickle/itch temperature, stress or recall od suffering responses to stimulus. (Involve pain feedback related to spinothalamic, spinotectal, spinohypothalamic and spinomesencephalic tracts)

Mechanical: Pressure, rebound, stretch, joint mechanoreceptors and other responses to tissue and structures. (Related to Golgi, Pacini, Ruffini and other dorsal column feedback pathways.)

Improving the optimal healing of scar tissue might involve aspects such as adequate carbohydrate, proteins, sunlight (or red light), carbon dioxide, thyroid, progesterone, vitamin A and E. Avoiding phytoestrogens and low carbohydrate diets would also be prudent.

Despite optimised nutrition and endocrine function, it’s likely that many scars leave some artefact that prevents the nervous system communicating with tissues. C - sections, episiotomies, appendectomies, laparoscopies and most surgeries, injuries or trauma leave a trace that needs to be resolved with the right therapy. Inhibition can be purposeful but restoration might need a little nudge from therapies like proprioceptive deep tendon reflex (P-DTR).

References:

  1. Kim, D., Kim, W., Joo, S. K., Bae, J. M., Kim, J. H., & Ahmed, A. (2018). Subclinical Hypothyroidism and Low-Normal Thyroid Function Are Associated With Nonalcoholic Steatohepatitis and Fibrosis. Clinical Gastroenterology and Hepatology, 16(1), 123–131.e1. http://doi.org/10.1016/j.cgh.2017.08.014

  2. https://emedicine.medscape.com/article/1298129-overview?pa=1ZDxXAnEOeNV9BUnYezdYpt49YJzASbxEvvw80YIDjlelzZDQj3XLvbI0V2MbTq%2FX8MwC0EECwzp432Skuf9qw%3D%3D

  3. http://raypeat.com/articles/articles/regeneration-degeneration.shtml

Why baby walkers are a disaster for the growing child.

Why baby walkers are a disaster for the growing child. It was the fourth client in the space of two weeks that prompted me to write this quick blog. Four teenagers all aged 14 with pain and compromised movement. Where did it all start? How does this happen? The parents enquire, looking for a definitive reason.  walker-clipart-baby_in_walker

As with all aetiologies of pain and movement dysfunction it can be hard to determine exactly what drives an individual’s problems. But when you can observe the way that a young person breathes you can, in most cases determine whether they have been placed in a baby walker, without any other form of assessment.

A rough overview would reveal that, within the first 9 months of movement and prior to the process of standing (verticalisation) there are many key stages of development that need to occur.

These include.

  • Lifting the head
  • Stabilising the back line between neck, chest and pelvis
  • Rotation via rolling
  • Quadra pedal or four point stance
  • Crawling and cross patterning of shoulder to hip.

So why is it that the baby walker is such a problem?

Consider the actions that a baby needs to achieve before it stands, let alone walks. Crawling develops hip, trunk and shoulder musculature. Due to the reciprocal relationship between the neck and the lower back, which counter rotates to the direction of the thoracic spine, optimal conditioning of reflexes, muscles, tendons and ligaments should occur. If a child is placed into a walker, the challenge is then geared towards locomotion and gait, rather than rolling and crawling. This is where the problems start and it presents several issues to consider.

  1. The ability to stabilise using the diaphragm is decreased due to in an early standing position, that is not conditioned enough from crawling. (observation can be made by the upper breathing pattern, using chest and neck muscles)
  2. The lower leg muscles are stressed to create movement and in particular the calve muscles are strengthened and may contribute to excessively to actions such as hip and knee flexion and extension (as well as many other movements. (look for those over developed calve muscles)
  3. The lack of rotation created by a lack of motion in the spine, decreases essential loading of the spinal ligaments, which will decrease recruitment of the muscles needed for optimal gait. (you can see poor movement and stability from the most basic movements)

Another insult added into the equation is the constant use of flip-flops. This previous blog breaks down why flip-flops are disastrous for athletic and day-to-day performance.

To develop optimal movement that progresses throughout childhood into adult life, rolling, crawling and walking patterns should not be supported with baby walkers or bouncers. It might be hard to believe but the walker does play a significant part to why younger clients present with pain and movement issues. There's no doubt that technology has significant benefits it many aspects of life. But when it comes to human movement, the brain already has it optimised, you just need to let it of its own thing.

Thankfully with a little work, the problems can be unravelled but don’t get me started on the use of iPads and mobile phones!!

References:

Kobesova, A., Kolar, P., Developmental kinesiology: Three levels of motor control in the assessment and treatment of the motor system, Journal of Bodywork & Movement Therapies (2013),

Kolar, P. et al. Postural Function of the Diaphragm in Persons With and Without Chronic Low Back Pain. J Orthop Sports Phys Ther 2012;42(4):352-

 

Latest Dubai Eye Interview: Longevity, pain relief, movement and well being

If you can’t rotate, just wait…for the injury.

Rotation is one of the most important motions that humans have in their repertoire of locomotion. After stabilisation of the neck, chest and pelvis is achieved at the age of 4-5 months, a baby develops the ability to rotate from supine to prone and back and then progress to four-point, quadrapedal and then verticalisation before the monumental task of gait is achieved. So if rotation is one of the first components of movement and locomotion that we establish, it would also appear to be one of the first movements that we tend to lose as we develop dysfunctional or habitual movement.

Why does this happen? Or A question that I am often posed by my clients. How did I get to be like this? I would offer the following scenarios:

  • Too much exercise- focus on sagittal plane or backwards and forwards motion.
  • Too little exercise – stuck at a desk-sofa, inability to breathe, lack of movement.

For the committed exerciser a lack of rotation or the lack of reprogramming of rotation is often key. The neck and thoracic spine were built for rotation. Squats, deadlifts, pull ups, benching, Olympic lifting and other exercises do little to improve rotation. Even if a good trainer implements some great rotational exercisers such as wood-chops, cable push or pulls with rotation, med-ball tosses and the like, the action of creating an optimal rotation pattern is hard to achieve without some form of neuro-biomechanical re-programming. In short:

MORE DOES NOT MEAN BETTER

Understanding how good rotation (and frontal plane or side to side mechanics) looks like and how to reprogram it, should be considered by those wanting to improve mechanics or to move away from sources out of pain but of course a lack of rotation is not the only cause of pain and or altered mechanics. Regional interdependence is a concept that suggests that poor movement and pain in one area may be the product of another seemingly unrelated area.

So what’s good?

As always depending on your slant opinions can vary. I tend to use mechanical analysis such as SFMA (Selective Functional Movement Analysis), combined with some other biomechanical considerations such as, DNS, gait and to change the clients patterns I use techniques such as Neuro Kinetic Therapy and Proprioceptive Deep Tendon Release or PDTR for efficient results.

Here’s a quick way to analyse rotation.

Standing

OLYMPUS DIGITAL CAMERAThe standing position observes a ground up view of rotation. In short it helps to breakdown issues related to mobility or stability. What you are looking for is approximately 45-50 degrees of rotation at the hip and pelvis and 90 degrees of rotation of the upper body. It should be compared with the other side

 

 

 

 

Seated

ComplOLYMPUS DIGITAL CAMERAeting  the test seated with the feet on the ground allows for an assessment of rotation of the upper body minus involvement of the lower body to determine interactions. In short an approximate rotation of 50 degrees either side is ideal. Unilateral differences should be compared as part of the treatment strategy.

Is it a mobility or stability issue? An old vid blog can you up to date on this concept. 

Rolling.

OLYMPUS DIGITAL CAMERAThe rolling pattern is a great leveller for the athlete and non athlete alike. The concept is to assess the ability to roll using only upper body or lower body, analysing segmental movement and in most cases many people cannot adequately roll.

In fact the compensation strategies can reveal much about how an individuals brain has elected to move with compensatory mechanisms. Correcting these can be achieved with NKT and PDTR in the space of a few minutes in some cases.

Rolling patterns represent one of the first forms of locomotion in the neonate and initial rolling patterns starts at the age of 4-5 months.

Rolling assessment allows for the identification of muscles/structures that may contribute to poor rotation in gait, day - day and sporting activities.

Comparing upper to lower body and prone to supine can determine deficits that can be rectified in both pain and optimisation of movement.

  • Upper body prone to supine left to right
  • Upper body supine to prone left to right
  • Lower body prone to supine left to right
  • Lower body supine to prone left to right

 When we lose efficient rotation in everyday activities such as walking and running, structures that may not be able to rotate efficiently may be forced into compensatory movement. For instance, the lumbar spine which has minimal degrees of rotation when compared to the thoracic spine can often be the source of pain

Integrating rotation into your exercise and injury prevention routine should be as important as your warm up itself. If you feel that you can’t rotate that well then get in contact with someone who can assess and change your rotation.

You can find out more in my breathing pattern and core workshop coming up soon called The Foundational Five about how to change core function.

 References:

  • Cook, G. et al. Selective Functional Movement Assessment. Course Manual
  • Kobesova, A., Kolar, P., Developmental kinesiology: Three levels of motor control in the assessment and treatment of the motor system, Journal of Bodywork & Movement Therapies (2013),
  • Weinstock, D. Neuro Kinetic Therapy.
  • Cook, G. Gill, L. Hoogenbam, Voight M. Using Rolling to Develop Neuromuscular Control and Coordination of the Core and Extremities of Athletes. N Am J Sports Phys Ther. May 2009; 4(2): 70–82.

 

 

 

 

 

Nutrition and Exercise dogma

Dogma creation If you haven't yet met someone who has recommended you either some form of diet or a type of exercise, you are unique, in fact a real rarity, and somewhat lucky.

The fitness and wellness industry is awash with much dogma, often created by short term ideologies, that in long term may be harmful to ones health. A friend sent me a link to a simple yet effective graph from Keith Norris's blog  on chasing performance goals and their impact on health.  This got me thinking about the fields that I work in and how much of the recommendations are riddled with dogma and lack critical thought processes.

There's often a reason for this dogma existing and for many it is due to the anecdotal gains that can be experienced in the short term. Here are just a few reasons why:

  • High carb to low carb
  • Eating grains to not eating grains
  • High meat eater to vegetarian
  • Sedentary to high intensity exercise
  • Modern SAD to Paleo
  • Regular diet to juicing

There are plenty more and the point to be made is, some positive gains can be made in the short term, change to metabolic markers, restriction in excessive calories, weight loss and a variety of other markers. From the diagram above you can observe that whenever there is a change to the input of a system, change can occur and especially when there has been little variance in the past. As change occurs and an almost linear increase in perceived health markers also occur, a Zone of Optimisation and resultant dogma often ensue.

'This really worked for me, and it will do for you, trust me!'

Is the problem for many people, those often short term gains, on the way up on your performance curve, may actually start falling sooner than you think.

For the performance exerciser, poor movement, compensation and ultimately pain will ensue.

For those to the new diet, great results could  turn into stagnation, weight gain and a host of metabolic disturbances.

Is it working for you? Well do you:

  • Have good digestion?
  • Have deep restorative sleep?
  • Balanced energy?
  • Healthy libido?
  • Balanced emotions
  • Good stress response

If you don't, you may just be coming down from that peak of physiological and biochemical gains. When might it happen, 1, 2 or even 5 years down the line perhaps?  Hysteresis or a systems memory can be changed with ease if there exists, little underlying metabolic damage and a reduction of factors that increase resistance to repair  that system. Supporting metabolic processes should be first and foremost.

Understanding that fitness is not always a healthy pursuit and paying attention to markers that increase vitality should be a goal, and be pursuant to any fitness goal.

Move, play, eat, digest and sleep well.