Structures in Gravity
On the right is a 2-D structure of blocks equal in size and weight that is "balanced" within the field of gravity. While the blocks do not line up perfectly, the left-ward blocks are balanced by right-ward blocks and the structure remains stable within the field of gravity. It stands by itself, relatively free of strain. To create a more stable structure, we would move blocks toward the center line. However, once we begin to move the blocks we will note that it is virtually impossible to move just one block. Should we only move one block, the structure becomes destabilized in the field of gravity. Lacking balance, it strains to stay upright. The imbalance creates a both a vulnerability and a tendency towards collapse. It becomes quite obvious that each move requires a balancing move, or the structure loses stability in the field of gravity. |
With this simplistic analogy, we might begin to understand some of the difficulty in changing a human structure in the field of gravity. Indeed, to change a part we must change the whole.
The Balance of Distortions In every human body, no matter how seemingly lopsided, there remains a structural "balance" to the whole - as much as the body will permit. Distortions are balanced, generally, by other distortions. Trying to change only one distortion will generally imbalance the structure in the field of gravity and that change will either revert or cause strain to occur. While the human body is certainly not a 2-D stack of blocks, the underlying physics work in the same fundamental way: restoring balance within the field of gravity typically requires a comprehensive effort. I say "typically" because there are indeed many, many variables at play, including whether a structural/spinal distortion is traumatic and acute, or whether it is of the old and chronic variety and the body has had it's opportunity to compensate throughout. In the case of an acute and recent distortion/subluxation of a vertebrae or rib, quick "spot work" at the site can reduce the necessity for more comprehensive work. But once a distortion has been in the body for some time, the entire structure will compensate around that distortion. In that scenario, one problem is followed by a cascade of compensations over time. To correct the initial distortion then requires a change to the whole. Because of this, in general, the level of comprehensive care required goes up accordingly with the length of time a structural issue has been in the body. Which also means, for the most part, it goes up with age. This line of reasoning and observation may seem like a vote in favor of immeidate chiropractic adjustments to all acute spinal issues, and in truth, those situations exist. But, no part of the body exists in isolation, and many if not most acutely distorted/subluxed/out of place vertebrae are chronically pre-disposed to an acute fixation and distortion beforehand. Typically, the structural tendencies are already there. And with one wrong twist the previously unknown tendency suddenly becomes acute and quite painful problem. The vast majority of structural and spinal distortions, even acute, require some measure of comprehensive care. The only question is to what extent. And that question is greatly determined by the length of time a problem has been in the body. |
|
Strain and Pain As the body attempts to balance around a vertical axis in the field of gravity, it does so by distributing and re-distributing mass around that vertical line. Again, this means that a structural distortion is most often "balanced" by another distortion or set of distortions. Commonly, we see this type of balance where a Kyphosis (excessive curvature in the thoracic spine) and a Lordosis (excessive curvature in the lumbar spine) combine. More often than not, the two excessive curvatures will develop together. One may initially precede the other, but a compensatory distortion will generally follow. |
Generally, in a Kyphotic/Lordotic pattern, weight forward of a center line (in the side/sagittal view) is balanced by weight backwards of the center line. With the Kyphotic/Lordotic pattern, the lumbar vertebrae and head stray forward of a center line, balanced in back of the line by the thoracic vertebrae and lower sacrum/coccyx.
This type of structural balance relative to a center line isn't optimal in the least, but the modicum of balance to the center line more evenly distributes both strain (and fluid pressure) throughout the structure, resulting in a diminished neural response - i.e: pain. Where greater problems and pain are often encountered are where a lower curvature is not balanced by an upper curvature. The result is often a much greater strain pattern. Strain in the field of gravity, in turn, lends itself to pain. The Sagittal Balance Model The following study from the International Journal of Spine looks squarely at this issue. "Positive Sagittal Balance and Management Strategies in Adult Spinal Deformities." This study looks at spinal curvature and structural distribution around a plumb line (vertical axis). http://ijsonline.co.in/positive-sagittal-balance-and-management-strategies-in-adult-spinal-deformities/ The author, Dr. Dhillon states, "(The) Human Spine has adapted a curved morphology to compensate for the upright posture. Normally these curves are sagittally balanced and a vertical line drawn from the center of the C7 vertebral body (the C7 plumb line) passes within a few millimeters of the posterior-superior corner of S1." The study goes on to find that surgery is most often only considered for a lack of sagittal balance in spinal curvature, typically occurring with a lack of lumbar curvature to balance upper thoracic curvature, resulting in too much body mass forward of a center line. The imbalance creates strain and not surprisingly, a level of pain sufficient for surgical intervention. It is here we can begin to make distinctions between structural distortions that cause pain and distortions that do not. Many in the field of Medicine are mystified that many obvious structural distortions in people cause no or little pain. They are equally mystified when clients who have little to no apparent structural distortion are constantly in pain. On that basis alone, various "experts" have taken to dismissing structural distortions as a cause of pain. See, for instance: https://medicalxpress.com/news/2018-06-myth-persistent-musculoskeletal-pain-obvious.html Their dismissal appears quite shortsighted. As we have seen, not all structural distortions are the same and strain/pain often has a lot to do with how well we can balance around a vertical axis rather than the number or even severity of distortions present. Thus with human structure, causality of pain is not necessarily in the distortion itself, but may rather be a body's inability to compensate to that distortion. Where the body cannot compensate to a distortion and maintain a semblance of balance in the field of gravity, the result will be a structural strain -- muscles and connective tissue working hard to maintain erectness. What follows is constant tension, fatigue and, ultimately, pain -- the type and severity of pain for which a surgical remedy is quite commonly sought. The type of pain for which people are willing to risk being cut open, hardware & screws, infection, a long recovery and a risk of surgical "failure" that compounds with age. Pressure and Pain Pain from constant strain to stay upright is not the only type of pain involved. Other types of spinal pain, or the absence of such, deserves explanation as well. That explanation however is partly about mechanics, but also quite a bit about fluid and fluid pressure. It is at the fluid level that we might begin to shed some light on acute spinal pain and whether it disappears or becomes chronic in nature. Pain and fluid pressure distortion share a fairly direct relationship. As we have explored in Theoretics 1, the nervous system of the human body is acutely sensitive to variations and distortions in fluid pressure: from a zit to a boil, from compartment syndrome to a headache, a sucking chest wound to a hematoma; the relationship between fluid pressure distortion and registered pain is close, constant, and consistent and direct. How can fluid pressure become a pain signal? Well, we need not look further than the ubiquitous mechano-receptors of the nervous system that appear in almost limitless quantities throughout every corner of the human body. Included within the group of 'mechano-receptors' are the "stretch receptors": mechano-receptors that line both muscle and fascia. And sure, the "stretch" receptors register a pull on the tissue -- like when we stretch our muscles in yoga. But activating the stretch receptors also includes stretching a fascial membrane by increasing its internal fluid volume. By analogy we may stretch and increase the surface area of a balloon by manually stretching it between two points, or we may simply add air or water to it. Either way, it stretches. Our bodies are more than 60% fluid content. That fluid is contained within a vast network of fascial (connective tissue) membranes. Omnipresent, ubiquitous, everywhere; the human body is, essentially, a system of fluid-filled fascial membranes -- membranes within membranes within membranes. All the way from the wall of a microscopic cell to our outer layer of skin and superficial fascia. The fascia, the body's connective tissue that encapsulates all parts, is itself a system of fluid-filled membranes. The fluid-filled fascia has recently been declared an "organ" unto itself: "The Interstitium" https://en.wikipedia.org/wiki/Interstitium https://www.livescience.com/62128-interstitium-organ.html Lining the endless web of fascia/Interstitium are neural stretch receptors. Dependent on location in the body, stretch receptors range in sensitivity, quantity, and the message ultimately interpreted by the brain. For example, stretch receptors in the stomach relay a feeling of satiety when stretched and activated. Meanwhile a stretch receptor at the site of a sprained ankle relay the throbbing pain of an accompanying swelling. Fluid Pressure in the Spine In the spine, once a mechanical distortion to a spinal segment is applied (a vertebrae goes out-of-place), an interruption in both fluid flow and pressure occurs within the nervous system as a direct result. That pressure distortion produces pain -- just like swelling/inflammation in other parts of the body. And while the nervous system in general is very sensitive to fluid pressure distortions anywhere, the fluid pressure distortion that follows a spinal misalignment occurs within the superhighways of neurology, ultimately crowned by the brain. The sensitivity of the mechano-receptors surrounding the spine and neural system appear in general to be remarkably high. Is this just theory? No. Check out this study from the Massachusetts General Hospital: https://medicalxpress.com/news/2018-05-neuroinflammation-spinal-cord-nerve-roots.html |
|
An anti-inflammatory, of course, reduces the fluid pressure distortion, i.e.: swelling. Hence the benefit. And following the line of logic presented here, the chronic aspect of spinal inflammation present would suggest that the structural compensatory abilities of the patients in the study had been compromised to some extent.
Sciatica itself is most often a structural issue, with neural compression as a chief cause. But the compression is only part of the problem. The result of a neural compression is a disruption in both fluid flow and pressure. Within the spine, the fluid in question is Cerebrospinal Fluid (CSF). While we have throroughly explored the importance of CSF in Theoretics 1, suffice to say, we are only beginning to understand the impact of flow restriction and stasis of CSF throughout the entire neurological system, including the brain. Below is a study on CSF flow/velocity, pressure, and hydrocephalus -- an extremely painful condition whereby CSF fails to drain properly from the cranium. http://www.adina.com/newsgH64.shtml This study found CSF pressure levels to be five times greater than normal in the cases of hydrocephalus. Headaches, migraines, loss of vision, incontinence, mental impairment...are some of the symptoms. And of course, pain. |
CSF fluid pressure and flow (velocity) calculated using MRI's, Navier-Stokes and Darcy flow equations.
|
With an "open" and spacious structure, the structural compensatory process will distribute pain, strain, and fluid pressure fairly evenly throughout the structure. The body will "absorb" the initial distortion and the acute pain levels will diminish significantly. The initial structural distortion, however, will still be there to some extent -- a movement and spacial distortion fixated into the structure. But pain levels are mitigated; the acute sharpness is dulled by an overall distribution and the body may resume a fairly normal course of function.
But even with a compensatory process and response a price must still be paid. The result of the compensatory response is that the load and strain of a singular spinal distortion will be carried by the rest of the body and the system overall. The trade-off in the compensatory process is that the overall system will slow down just a bit for every trauma it absorbs. That slow-down in the short-term and especially at a young age is imperceivable to the average person. But as trauma's and compensations stack over time, the slow-downs stacks too, eventually becoming quite real and quite felt. A compensatory process is not a perfect one. It is simply a way for the body to "deal". "Balance" as a result of a compensatory process is not optimal in any way either. But it is a measure of system balance, and that lends itself to system function. But should a system be incapable of the compensatory process and absorbing a problem, whatever fluid pressure distortion within the neural system that was created while acutely twisting one's back out will likely remain at the site of injury in some shape, form or fashion for some time to come. And when that happens, what was an acute problem becomes a chronic one. The acute pain becomes a chronic pain. But why would a structure be "closed" and incapable of compensations? The obvious answer is of course "space" within the structure/skeleton to move. i.e.: "joint space" - the space between the bones (the "interosseous" space). And this includes the space between the ribs. Joint space, as we have seen, often closes first in the shoulders. Over-time, joint space decreases with age and compression in the field of gravity, making the compensatory process a greater challenge as we get older. Thus, for instance, if someone's shoulders and neck are already jammed-up at the time they twist their lower back out, the acute issue at the lower back stands a much greater likelihood of becoming a chronic one. And that likelihood increases with age. With that we may begin to understand how a older human structure, rife with movement restrictions, may have a much much more difficult time adapting and compensating to a fresh trauma, and how a young, spacious body will more easily absorb one. It is simply a question of available joint space. We may also draw parallels to the declining success rates of spinal fusions and other spinal surgeries with age. Generally, the older a person is, the greater the likelihood a spinal surgery will "fail". The reasons are the same. If structural space is generally compromised with age, then so is the ability of the body to compensate to a change. With, for instance, a lumbar spinal fusion that suddenly jacks open a neural space with hardware and screws, localized neurological pressure in the lumbars will change as well, prompting a compensatory change throughout the rest of the structure. Indeed, one problem is being fixed, but the demand for the rest of the body to change creates other problems. With a fixated thoracic above, no such compensatory change may occur. A pressure distortion, relative to the rest of the system, will likely be created at the site of surgery (or just above), and the lumbar surgery may likely "fail" due to high levels of pain and immobility. Hence, as structural spacial limitations compound (with age and trauma), compensatory ability drops, and the likelihood of chronic pain goes up. Again, this all supports the idea that not only is comprehensive manual therapy a smart idea at any age, but that the necessity for comprehensive treatment also increases with the age of the client and the length of time a problem has been in the body. Chronic Strain and Chronic Inflammation When a human structure is out of balance in the field of gravity, it is the muscles and connective tissue that must continually strain in order to remain upright in the field of gravity. This type of chronic strain creates a chronic inflammatory response in the effected soft tissue and muscle that is under strain. In turn, the chronic inflammation creates higher levels of fluid pressure within the effected muscles and fascia. Chronic inflammation is essentially, swelling, and such distortion in fluid pressures creates, in all likelihood, a pain response in the nervous system. Again, the process by which the pain response is produced is a continual, distorted load on the neural stretch receptors within muscle and fasica: Golgi tendon organs, muscle spindles, etc. These stretch receptors are activated in the inflammation/swelling process by a direct increase in fluid pressure within the fasical membranes that they line. And just like direct over-stretching, continually loading the stretch receptors results in pain response. |
|
This type of lateral "balance" would most easily be seen in the common scoliotic "S" pattern where a lower lateral curvature is balanced by an upper curvature to the opposite side. As is the case with a balanced Kyphosis/Lordosis occurring in the sagittal plane, the lateral deviations of scoliosis balance and distribute weight around a vertical axis in a similar manner.
Scoliosis is not comfortable, to anyone, ever. But, again, a more balanced lateral curvature in a scoliosis helps to balance structural strain and fluid pressure while keeping pain levels to a tolerable level. Where lateral balance is lacking, the structure is more likely to be both in strain and in pain. Where lateral balance in curvature is present, it will lend itself to better function, less strain, and less pain. |
Three Dimensional Balance
At this point, we are starting to redefine what "balance" in the field of gravity means. Without a doubt we are attempting to change the picture some. As manual therapists, this may prompt us to see the body differently. Importantly, it may also shift our perspective and change the objectives of our manual interventions away from merely trying to create a "perfect" spine to instead look for where structural balance is lacking, and also where, specifically, the structural compensatory processes of the body have been halted or compromised. But in changing the picture we are not done complicating it. "Sagittal" and "frontal" balance are still limited concepts when considering the human body. Actual balance in the human body occurs in three dimensions around a vertical axis, with spirals and rotations within the structure being the norm rather than the exception. All planes of movement are involved. |
The Scoliotic Twist
Scoliosis itself is quite often misconceptualized as only being "lateral" structural distortion -- i.e.: a side-to-side problem. However, in all cases, there are less-obvious rotational distortions and rotational patterns in scoliosis that are always present. The same may be said of the above Kyphotic/Lordotic pattern that is so common. While our attention is drawn to the obvious lumbar and thoracic curvature, what inevitably accompanies that curvature are rotational patterns -- usually, quite similar to what is seen in scoliosis: a large group left rotation in the pelvis and lumbars being balanced by a large right rotation in the bottom of the thoracic (around T11-T12). The group rotational pattern then again switches back to a left rotation around T3-T5 - making the area between the shoulder blades a junction for a major rotational change, placing a high degree of structural demand upon the body at that point. As it turns out, the area around T4 is a "problem" area for most everyone. The 'Normal' Spine What follows is the general observation that the very same rotational patterns we seen in scoliosis, kyphosis, and lordosis, are quite commonly seen on much less extreme cases: i.e.: "normal" spines. Sure, different rotational patterns may occur and do, but the 'pelvis/lumbars to the left, lower/mid thoracic to the right, and upper thoracic back to the left' group rotational patterns is, without a doubt, the most commonly seen throughout the human form. (These three large group rotations are not, however, the only rotations likely present in a given spine. Another large counter-rotation may be present in the cervical, and even between individual vertebrae, rotational patterns are quite normal. At present, however, we will concentrate on the three large group rotations identified above, as they are easily seen in photographs.) Rotational Balance With that we may add a third category of distortional "balance": rotational balance. We may observe that strong degrees of a rotational distortion at one point in the body are generally balanced by an equally strong rotation to the other direction. In scoliosis, we normally see a pronounced right rotation. ANd it is that right rotation that is typically used as an indicator of scoliosis (above right). But that strong right is always sandwiched between 2 lefts. It is arguable that the strong and obvious large right thoracic rotation is "balancing" the cumulative sum of the two adjoining, but less obvious, left rotations -- above at the shoulders, and below at the pelvis. In the non-scolitic, "normal" spine the same rotational patterns will often apply, but at far less severity. Typically as well, the right rotation of the lower thoracic will not dominate in relation to the leftward rotations. Normally, the two lefts will balance the the whole of the picture, or even dominate it. There are however, strong, built-in tendencies for the one large right twist in between to slip into an extreme. Why? One reason is that the movement potential (the range, space and ability of the spine to move) of the vertebrae changes significantly from the lumbar spine to the thoracic, making it likely that a strong rotation will occur at the lower thoracic/upper lumbar. Attached ribs in the thoracic restrict movement and add to whatever spacial limitations are present. Generally, of the three vertebral groups, it is the cervical that moves the easiest, followed by the lumbar, and in a not-so-close third, the densely-crowded thoracic. |
|
Treatment
A Cautious Approach The ancient Hippocratic Oath in Medicine essentially boils down to "first, do no harm." In manual therapy we quickly run up against a wide-spread belief that manual therapy is fairly innocuous/incapable of harm. That belief is, of course, just plain silly. Harm via manual therapy is fairly easy to do and as well, a common occurrence. However, pinning causation to a manual therapy is often difficult if not impossible, provided no action is overtly outside of the basic standards of practice. In other words, harm via manual therapy is really hard to prove, and as well, quite difficult to understand the process by which a harm could occur in the first place. Manual therapy flies significantly under the radar in terms of the power to change the human body - both for better or worse. |
But just because harm via manual therapy is difficult to legally prove doesn't mean it doesn't occur. It does. And the deeper you poke around in the human body, the more risk you take.
Of course, there is the tremendous upside, and we are barely scratching the potential of all of this, but I would be a poor educator to not impress upon you, dear reader, the specter of danger, and the need for caution. Yes you can effect structure, even when you don't intend to. If we find manual therapy to be powerful in a good way, we must also allow that it may also be powerful in a bad way. |
Body & Pattern reading remains one of the more difficult and important aspects of assessment. Here we will start with nothing but a posterior photo. At right (fig. 1) we have a stock photo of what to many looks like a fairly normal spine. If we look a bit closer however, we can note some lateral curvature. This is a scoliosis in a young man. Tracing the spinal route (fig 2), we can note a balance of curvatures: at the pelvis, lower thoracic and upper thoracic. Drawing a vertical line down the back and through the sacrum, (fig. 3), we can note how body mass, especially in the upper thoracic, favors the right side. At the shoulders (fig. 4), we can see how the left shoulder appears pinched and compressed relative to the right. Along with the lateral curves we can also see some visible group rotations (fig. 5), left at the pelvis and lumbar followed by a right at lower thoracic and another left at the shoulders. Note the bulge in the lumbars on the left side, the more prominent right scapula, and the prominence of the left trapezius area. Other rotations and counter-rotations may exist, but these main three are easily visible. Where the rotations transition are marked in (fig. 6). These are the centers of the twists and where the twist goes from left to right and then back to left. These are likely areas for problems, strain, and pain. Neurological compression here will also extend into all systems of the body. |
We can also see how the right rotation at the lower thoracic helps to cause the right shoulder to dip. Below the shoulder there is a loss of support. The space below is pinched. Because of this, a structural collapse is present, relative to the left side. (fig. 7)
With a loss of support here, strain will be transferred to some of the "usual suspects" in manual therapy - the effected muscle groups: trapezius, rhomboids, and the levator scapulae. (red highlight) (fig. 8) This area is a popular place for strain, pain, and all sorts of manual therapy and stretching exercises. Not surprisingly, most current therapeutic methods are simply focused directly on the area of strain -- the result of a loss of structural support. In other words, most therapies are typically treating the effect, not the cause. |
In our example, we have a combination of distortions that should clue us in as to where we might want to exercise caution. The lower and mid-thoracic shows a strong right rotation combined with a right shift of the spine (and body mass) in the upper thoracic. Thus there is a concentration of body mass in the thoracic that is rightward and posterior of a vertical center line.
If we were to take a cross-section at the thoracic level, and look from the top-down, we would see something like this: |
Work in the Hole, Not on the Hump
Where the body is most pushing back at us (the "hump") is here at the lower right scaplula area. It is advisable to use caution here. Manually de-constructing the soft tissue will allow the skeletal system and upper thoracic to slide into the softened tissue, and further into the right rotation and shift. As the spine slides further into distortion, the neurology running through it's bony confines is ultimately compressed to a greater degree. How critical is that? Let me count the ways... The goal is to create a more balanced structure, not a pile of mush. This "hump" in the structure will likely be where pain in different severities is often felt. A client may even ask for or expect direct attention to that area. Digging in here however, won't help the cause. In satisfying the client who insists on directing both location and pressure (go deeper!), the area may be numb in the immediate aftermath; the symptoms relieved to some degree. Later however, with gravity given a chance to do its thing and push the distortion further into pattern, the symptoms will return -- and often in greater severity.
This can set up a vicious cycle whereby a client returns again and again for spot work that helps in the immediate aftermath, but over time causes a structural tendency to worsen, which then in turn worsens the symptoms for which the spot work is continually sought. |
|
Looking at lateral scoliotic curvature, we may begin to draw in the lateral curves present. Where such curves are visible, focused soft tissue work is better suited to the concave side of the curvatures. Avoid focused, deep, or sustained work on the convex side.
Even with a full-body routine, it is still quite useful to have an idea of what to focus on and what to give less attention to. And when a client requests fix-it work on a problem, or to go "deeper"; there are very good places to fulfill that request, and very poor places as well. Don't trust your clients to necessarily know the difference. |
|
Reconciling Tensegrity The theory of Tensegrity has been discussed at length. The word is a combination of "tension" + "integrity" coined by Buckminster Fuller, famed theorist, and architect. Originally applied to architecture, Tensegrity theory was soon applied to the human body as well. Within that realm, Tensegrity is a balance of tensions within the soft and connective tissue (muscle and fascia) to give the structure (the skeleton) support and space. At a joint, applied Tensegrity can be described as the balance between agonist and antagonist muscles (muscles that act in opposite directions, such as biceps and triceps on the arm). Tensegrity in the body is based on the mechanical understanding of tissue lengths that span a joint from insertion to attachment, and when those tissues shorten, the joint shortens (or flexes) with it. Chronically shortened tissue at a joint will tend to chronically restrict Range of Movement ("ROM") at that joint. And because chronically shortened tissue always accompanies structural distortions (such as scoliosis), it is also often and commonly regarded as the primary causative factor in the structural distortion of the human body. For example, "over-tightness" in the hamstrings (below) would restrict the ability to bend forward and may be causally linked to a loss of lordotic curvature in the spine. But are tight hamstrings the only thing restricting the ROM? Are they necessarily the driving force for structural distortion present in the lumbars, hips and sacrum? Or could it be the other way around? Are spinal distortions to blame for shortened muscles and fascia? |
|
Along with a loss in ROM are come some other serious implications in joint space. In the Discussion section of the study, the authors address the effect upon the intervertebral disc space, stating:
"The disc architecture changes depending on the convex or concave side of the curve, but nevertheless, high intervertebral disc hydrostatic pressures occur due to asymmetrical weight loading. Both disc and endplate physiology hence becomes abnormal. The definitive effect of intervertebral pressure change rate on the curve progression and degeneration is unknown but nevertheless these alterations hasten the degenerative processes in the IVDs. Losing its pliability, a negative feed-back loop occurs in the spine as disc degeneration further reduces the flexibility of the spine, and the increased spinal stiffness leads to further degeneration. The implications of disc degeneration in scoliosis include earlier development of back pain, poorer quality-of-life, self-image, self-care, physical disabilities and mood problems." (emphasis added) In other words, the structural distortions have the effect of accelerating the breakdown of the body...something that has a strong correlation with this thing we call "aging". Of course and as well, the "scoliotic" pattern and disc deterioration is just a common "extreme" of what is seen all the time. As well, Kyphotic and Lordotic patterns of structural distortion will also see asymmetrical weight loading of a disc. Imbalanced and asymmetrical joint loading is more the norm rather than the exception. The degree of which will tend to directly accelerate the degeneration of the joint and the joint space available. Hence the more structural distortion present, the greater the likelihood that ROM, among other things, in the spine will suffer as a result of a loss of joint/disc space. See also: "High pressures and Asymmetrical Stresses in the Scoliotic Disc in the Absence of Muscle Loading." https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1820774/ |
|
Contrary to common misperceptions, what ultimately stops a stretch, like a forward, touch-your-toes-type of stretch, isn't the muscles or fascia and their associated lengths. What ultimately stops a stretch is the pull on the nervous system. The less neural restriction, the greater the ROM. But the more twisted things are in the spine, the less ROM will be available throughout the appendicular.
How does this happen? If we look at the very common pattern of scoliosis and it's fairly typical big left group rotation at the pelvis and lumbars followed by the counter right at the T12 area, followed by another big left in the shoulders, we can easily understand how the entire nervous system is twisting with it, and as it does so, just like twisting a towel, the whole system shortens throughout the body including down through the arms and legs. |
|
|
Injuries and Yoga
With this understanding, we may shed some light on how people get injured in yoga and why people with spinal distortions tend to be more prone to it. On occasion, yoga practitioners are pushing past the extension limitations of their neural system, and when the sensitive neural system is over-stretched and traumatized, the result can be a very painful neural inflammation along with acute muscle spasm. A failure to listen to the body and the common mindset of "no pain, no gain" can have very serious repercussions. And with twists and spinal distortions present in a structure, the danger is significantly heightened. With a deep stretch, the increase in tension through the nervous system also goes both ways -- a long stretch on the sciatics (in the legs) also tensions the neural system upwards into the spine, up into the thoracic, all the way to the cranium. And if there are spinal distortions/twists and shifts present that are already compressing the neural system, over-tensioning a spinal nerve that is already compressed and impinged will only serve to seriously aggravate the problem. Those with spinal distortions and fixations will be mechanically limited to doing less. Peer and social expectation however will demand more than the system can tolerate. Be gentle. Listen. |
|