This Website and information is presented in a scientific manner. The intent of this site is to resolve many of the theoretical 'holes' present in the current understanding of the body and it's structure. The focus is spinal mechanics, distortion, and the compression of neurology. Practical information and methodology follow.
Hypothesis:
The force of gravity upon the human structure over time results in a cumulative comprehensive interosseous (between bone) compression of the nervous system. This process of structural distortion may also be caused and/or accelerated by physical trauma to the human body. Interosseous compression of the nervous system distorts both local and systemic hydrostatic (fluid) pressures within the nervous system. These compressions and the resulting pressure distortions within the nervous system are reflected throughout the whole of the body. Compression and the resulting fluid pressure distortions impair both local and systemic neurological function.
Abstract:
Degrees of interosseous compression of the nervous system results in degrees of lost function to the innervated tissue, including organs. Interosseous compression occurs by way of trauma as well as naturally over time in the field of gravity. There is a critical relationship between the available interosseous space for the neural system and the fluid pressure that is within it. Fluid pressure distortions in the governing neural system have a wide range of impact, structurally as well as functionally, and directly impacts not just fluid movement, but fluid exchange. Fluid pressure distortions within the nervous system require significant compensatory action by the human body that may include the further distortion of the human body in order to balance internal fluid pressures. As spacial and pressure distortions and compensations stack over time, function and movement is lost, having a wide, overall impact on health and function.
Theoretical Layout:
Theory is organized according to First Principles Thinking: a Physics mode of inquiry that relentlessly pursues the foundations of a problem; as well as ‘Occam’s Razor’ and the Law of Parsimony, which generally states:
“Among competing hypotheses, the one with the fewest assumptions should be selected.”
To develop and organize the theoretical aspects of this presentation, I will be starting each section with fundamental truths as applied to the structure and makeup of the human body. Probable conclusions and applicable practicalities will then be derived from these fundamentals:
Fundamental structural principles of the human body relating to a fluid and mechanical understanding:
A. The human body is comprised of approximately 60%-70% water/fluid. It is within fascial membranes that this fluid exists. These membranes are pressurized.
B. The body will attempt to balance and equalize internal pressure relative to itself as well as relative to external pressure.
C. The neural system is a fluid, pressurized system.
D. Compression of neural space compromises the function of the innervated organs/tissue.
E. When a vertebral segment rotates in space and gravity, and relative to the vertebrae below, a tendency is created for the adjoining vertebrae directly above to counter-rotate to the vertebral segment below. The available space for compensation will dictate whether a counter-rotation occurs and to what degree.
F. When a vertebrae rotates in space, and the vertebrae above counter-rotates, the joint space in-between shortens. Rotation is always coupled with side-bending, thus the joint space shortens in an asymmetrical manner. Through the vertebral joint space runs the nervous system. Exiting the joint space on either side are the peripheral nerve roots. Asymmetrical compression of these nerves imbalances neural function side to side.
G. Ribs 6-7 are physically the largest ribs in the body. Above and below ribs 6-7, the ribs become consecutively smaller in a physical sense.
H. The 'movement' ability/potential of a vertebrae changes dependent on its location within the body and the movement restrictions that are placed upon it.
The force of gravity upon the human structure over time results in a cumulative comprehensive interosseous (between bone) compression of the nervous system. This process of structural distortion may also be caused and/or accelerated by physical trauma to the human body. Interosseous compression of the nervous system distorts both local and systemic hydrostatic (fluid) pressures within the nervous system. These compressions and the resulting pressure distortions within the nervous system are reflected throughout the whole of the body. Compression and the resulting fluid pressure distortions impair both local and systemic neurological function.
Abstract:
Degrees of interosseous compression of the nervous system results in degrees of lost function to the innervated tissue, including organs. Interosseous compression occurs by way of trauma as well as naturally over time in the field of gravity. There is a critical relationship between the available interosseous space for the neural system and the fluid pressure that is within it. Fluid pressure distortions in the governing neural system have a wide range of impact, structurally as well as functionally, and directly impacts not just fluid movement, but fluid exchange. Fluid pressure distortions within the nervous system require significant compensatory action by the human body that may include the further distortion of the human body in order to balance internal fluid pressures. As spacial and pressure distortions and compensations stack over time, function and movement is lost, having a wide, overall impact on health and function.
Theoretical Layout:
Theory is organized according to First Principles Thinking: a Physics mode of inquiry that relentlessly pursues the foundations of a problem; as well as ‘Occam’s Razor’ and the Law of Parsimony, which generally states:
“Among competing hypotheses, the one with the fewest assumptions should be selected.”
To develop and organize the theoretical aspects of this presentation, I will be starting each section with fundamental truths as applied to the structure and makeup of the human body. Probable conclusions and applicable practicalities will then be derived from these fundamentals:
Fundamental structural principles of the human body relating to a fluid and mechanical understanding:
A. The human body is comprised of approximately 60%-70% water/fluid. It is within fascial membranes that this fluid exists. These membranes are pressurized.
B. The body will attempt to balance and equalize internal pressure relative to itself as well as relative to external pressure.
C. The neural system is a fluid, pressurized system.
D. Compression of neural space compromises the function of the innervated organs/tissue.
E. When a vertebral segment rotates in space and gravity, and relative to the vertebrae below, a tendency is created for the adjoining vertebrae directly above to counter-rotate to the vertebral segment below. The available space for compensation will dictate whether a counter-rotation occurs and to what degree.
F. When a vertebrae rotates in space, and the vertebrae above counter-rotates, the joint space in-between shortens. Rotation is always coupled with side-bending, thus the joint space shortens in an asymmetrical manner. Through the vertebral joint space runs the nervous system. Exiting the joint space on either side are the peripheral nerve roots. Asymmetrical compression of these nerves imbalances neural function side to side.
G. Ribs 6-7 are physically the largest ribs in the body. Above and below ribs 6-7, the ribs become consecutively smaller in a physical sense.
H. The 'movement' ability/potential of a vertebrae changes dependent on its location within the body and the movement restrictions that are placed upon it.
A. The human body is comprised of approximately 60%-70% water/fluid. It is within fascial membranes that this fluid exists. These membranes are pressurized.
"The human body is an expression of its context."
- Emily Conrad, founder of Continuum Movement.
Among several fundamental aspects of our environment that shape who we are, what we look like, and how our bodies function, is pressure. That list also includes the fundamental aspects of gravity and temperature as well. It is beyond question that the human organism exists and has evolved within a specific range of temperature and pressure, and within the force of gravity.
Ida Rolf, the founder of ‘Rolfing’/Rolf Structural Integration; a therapeutic bodywork modality focusing on the freedom and balance of the body’s fascia, an omnipresent web of connective tissue in the body that provides, among other things, structural support, was revolutionary in her time in considering gravity as a factor in both therapeutic assessment and treatment.
A rather ubiquitous and controlling presence of our context and hence our physical makeup, gravity yet still often flies well under the radar. Pressure -- atmospheric pressure, is also a fundamental aspect of our context as well, and easily just as ignored as gravity. There is of course a complex relationship between gravity and atmospheric pressure, as well as hydrostatic pressure - i.e.: fluid pressure in the field of gravity.
Within the human body, there is a fluid pressure to everything. All fluid in the body is under pressure. This includes, among others, blood (blood pressure), lymph, fascial ground substances, and cerebrospinal fluid. The nervous system itself is a fluid system; a system of fluid-filled, pressurized tubes/hoses. The fluid makeup of our nervous system is surprising to many -- we as a society have primarily thought of the nervous system in terms of electrical conductivity only. We typically analogize the human body to robots and mechanics, and the nervous system with electrical systems or computers. But this historical and societal analogy presents an incomplete picture of the human body with lasting implications towards how we approach and see the human body, and how it shapes our overall inquiry.
Deane Juhan, author of Job’s Body, a comprehensive study of anatomy and function, states:
"In addition to supporting individual cells, tissues, and other organs, this connective (tissue) organ (fascia) serves an over-all structural purpose as well - it is woven together with the bones to create the movable frame which supports our posture and from which everything else is suspended. We normally think of the ligaments lacing around the joints, and perhaps the tendons which tie the muscles to the bones, as being the chief support that connective tissue offers the skeleton. But the situation is really much more complex than that; not only joint capsules and tendons, but literally all of connective tissues -- together with the fluids they contain – – aid the weight-bearing capabilities of the skeleton.
To see how this works, we can view the body as a large bag filled with water. If the surface and interior of this bag were perfectly uniform, like a filled balloon, then this bag would rest on the ground in the shape of a slightly flattened sphere. However, if we circle this sphere with cords and tighten them up, an interesting thing happens: The sphere is transformed into a cylinder, and can be made to stand erect. And if we continue adding chords, we can make the cylinder taller, thinner, and modify it into any number of shapes – – all without adding a single rigid member to the interior. Given a tough enough bag (and remember that connective tissue is VERY tough), we can keep lacing and squeezing until we have created enough hydrostatic pressure to make the cylinder quite rigid.
This is exactly the same kind of water pressure that holds a flower stem up straight, exactly the same kind of forces that erect a penis when it's corpus caver-nosum is distended with blood. At this point, our cylinder does not really need an internal skeleton in order to remain upright; in fact, a skeleton could even be suspended inside the cylinder from the top, without its toes touching the bottom, supported solely by the tension of the pressurized walls of the bag.
This of course is what the various shape-giving cords and bands of connective tissue do to our own bags of liquid, trussing them up into cylindrical shapes and squeezing them tightly enough to give them rigidity. When all the bands and cords are properly adjusted, and, the hydrostatic pressure is balanced, this tensional force goes a long way towards keeping us erect, and can give us that wonderfully light "skyhooked" sensation, as though our frames were suspended from the tops of our heads -- as, to a degree, they literally are."
Job's Body, 3rd Edition, Hydrostatic Pressure (Juhan, Deane; pg. 81)
Lift
The “skyhooked” sensation referred to by Deane is also commonly known as “lift”. Fluid pressure, and more specifically, a "balance of fluid pressure" within the body gives rise to this phenomena -- a feeling of lightness or 'bounciness' in the field of gravity. Lift is what separates the runner who looks like he is gliding from the runner who looks like he is trudging through a swamp. Lift is what allows someone to jump high. And the physical feelings associated with "lightness" in the body are often associated with emotional feelings of happiness and well being.
Lift works with Newton’s 3rd Law: For every action, there is an equal and opposite reaction. In the human body, the force of the foot hitting the ground produces a reactive force back up and through the body. Whether or not this reactive force is dispersed as it comes back up through the body is a primary factor in whether or not the body has lift. Where the human structure is distorted and an internal balance of pressure is distorted, and ground force reaction coming through the body will be dispersed, and the ground force reaction will not be utilized into lift. On the other hand, where fluid pressure in the human body is balanced, and the structure is both spacious and aligned, ground-force reaction will be utilized by the body. The result being a feeling of physical lightness and ease of movement.
In practice and observation, lift in the body is obvious most often with athletes and dancers: young, well-muscled, and physically aligned. Where lift is typically lacking is in bodies that show structural distortion or collapse - easily seen in the elderly but also commonly seen across all age brackets. Along with an overall lack of "bounce-in-the-step" is a change in tissue quality. In the young and healthy, body tissue (muscle, skin, fascia, etc), presents as full, hydrated and "plump". In the old, there is an apparent systemic loss of hydrostatic (fluid) pressure. Loose and saggy muscle and skin tissue is the norm. But why?
While many reasons may exist, here our principle inquiry focuses on compression of the nervous system and it's systemic effects, including the loss of fluid pressure. In the elderly, we are genearlly looking at a lifetime of compression in the field of gravity and a physicality which has suffered an overall, systemic compression (collapse and compression happening everywhere). A loss of lift, fluid pressure (and loose and saggy) always tend to accompany old age. However, the very same loss of fluid pressure, sag and limpness may also occur at any age with trauma and early structural distorion. A severe compression of a nerve will show the same correlating effects in body tissue at any age. This is most easily seen in quadriplegics and paraplegics where compression of the nervous system is severe, utter and complete. The effects not only include a loss of muscle tissue, but a complete loss of hydrostatic pressure in the affected, innervated tissue.
Reasoning by Analogy (Part 1)
Therapeutic structural bodywork has long been preoccupied with mechanical aspects of fascia and how fascial length impacts the human structure. Fascia has been dubbed "the ‘organ’ of structure", and while the profession has often been fixated on the makeup, length and tensile strength of this “organ”, it hasn’t generally considered the fluid pressure within the system of fascial membranes.
The most basic Rolf analogy, drilled into the heads of students and clients alike, is generally one where the human body is compared to a house, following the basic logic that in the field of gravity, if the foundation of the house is faulty, the structure above it will have a tendency towards distortion and collapse. Additionally, the faultier the foundation is, the faster the collapse in the field of gravity.
While the analogy certainly has it's merits, a critical difference between the human body and a house or other constructed structure is that a house does not have a separate set of internal pressures to what is external. A house is not in a constant homeostatic process in which a vast number of separate internal systems seek a pressure balance with each other as well as with external atmospheric pressure.
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The structural theoretical model most common in therapeutic structural bodywork is called “Tensegrity”, and it is an almost purely mechanical model that, when applied to the human body, assesses and compares the relative lengths and tonus of muscle and fascia and their relationship to the structure of the human body.
Tensegrity, applied to the human body, largely ignores any aspects of fluid pressure. It focuses instead on fascial length and tonus from insertion to attachments but gives little regard to the fluid or fluid pressure within its membranes. With fluid being more than 60% of our makeup, and support within the body largely provided by fluid pressure held within a framework of fascial membranes, the structural model of Tensegrity appears incomplete at best, and our attempts to solely develop and complicate a tensegrity-based understanding of the body has us understandably ‘failing to see the forest while we are lost in the trees’. In science, life, or otherwise, 'the approach often dictates the results'. And here we’ve been, essentially reasoning by analogy for decades and more, and the results reflect as such. Data reflecting the benefits and successes of massage and bodywork in general unfortunately shows no more than a marked inconsistency. Therapeutic massage and bodywork in general, remains a fairly marginalized profession with rather scattered theoretics and almost no consistency in teaching. Educational standards are extremely low and the availability of higher-level students is often lacking. Theoretically, massage and bodywork exists in the realms of “quasi-science” and has yet to be in any way vetted by scientific process. However, and rather importantly, it should be noted that inconsistent or short-term results are a fair deal better and far more encouraging than no results, or only negative results. Bodywork, despite it’s flaws, has hung around for thousands of years and has still managed to find it’s niche in medicine -- either as benign treatment or something to try before more dangerous alternatives such as surgery or opiates. |
Tensegrity Models
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With structural manual therapy, such as Rolf work, consistency and permanency of results is also squarely at issue while education remains underwhelming and fractured. The field struggles. Yet many of the fascial techniques common to structural bodywork have been widely incorporated into the physical therapy world. Meanwhile, “myofascial release” remains a buzzword within the massage community as a whole, including its clientele. Potential, it seems, is not the problem. Consistency in results, theoretics, and education is.
Although I disagree with many of the conclusions here, I sympathize with many of the critiques: www.painscience.com/articles/does-massage-work.php
Although I disagree with many of the conclusions here, I sympathize with many of the critiques: www.painscience.com/articles/does-massage-work.php
B. The body will attempt to balance and equalize internal pressure relative to itself as well as relative to external pressures.
Within the body, all separate parts that make up the whole, including organs, have their own individual pressures, balanced relative to the complex system around them. Internal pressure balance is a function of homeostasis, as is internal systemic pressure balance with external pressure. Anyone who has ever taken an airplane ride or dove scuba has experienced how the body attempts to balance internal pressures with external.
External pressure, or ‘atmospheric’ pressure, varies widely around the earth and with altitude. And while external pressures may vary widely on land, under the water or in the darkness of space, pressure varies even more drastically. Biologically, pressure variations have a great deal of influence on the types and shapes of organisms that can exist within specific ranges of pressure. Underwater, heightened pressure is a major factor in the structure of the organisms that inhabit the seas. Our structures were not intended for the same pressures. Nor can we exist in the absence of pressure - ie: space, where pressure is almost negligible. We are instead expressions of our context, and our context is an atmospheric pressure within a certain tolerable range. And within that range, our bodies are generally capable of pressure equalization, internal to external atmospheric.
But I say "generally" here as our body's ability to equalize and balance isn't always a perfect one and our body's ability to cope and compensate to atmospheric pressure variations changes with age and spinal distortion.
In order to equalize internal pressures with atmospheric pressures, the body requires "space" to move and change. Specifically - joint space. If a joint has no space (ie: compressed), it's ability to move will be compromised, along with it's ability to compensate to other changes occurring within the body, including pressure changes.
We might pose the question: how does a grandmother know a storm is coming in? Why do her joints hurt so much when the weather changes? A change in weather is typically accompanied by a change in atmospheric pressure as well. This requires an internal to external equalization process within the human body. Where joint space is plentiful, equalization is an easy process. But in the elderly, generally, joint space over time and gravity has been compressed pretty much everywhere. Thus, joint movement pretty much everywhere may also be impaired. Hence, the ability to change with atmospheric pressure variations will likely suffer.
While the elderly often show extremes in compression and joint immobility, ultimately the same process of compression and distortion is happening through all age groups at differing severity; from negligible in effect to very serious. The young are not immune. A younger person who has suffered a trauma or an early onset spinal condition such as ‘kyphosis’ or ‘scoliosis’ may also reflect a profound lack of joint space and an inability to adequately compensate to pressure changes, both internal and external.
Within the body, all separate parts that make up the whole, including organs, have their own individual pressures, balanced relative to the complex system around them. Internal pressure balance is a function of homeostasis, as is internal systemic pressure balance with external pressure. Anyone who has ever taken an airplane ride or dove scuba has experienced how the body attempts to balance internal pressures with external.
External pressure, or ‘atmospheric’ pressure, varies widely around the earth and with altitude. And while external pressures may vary widely on land, under the water or in the darkness of space, pressure varies even more drastically. Biologically, pressure variations have a great deal of influence on the types and shapes of organisms that can exist within specific ranges of pressure. Underwater, heightened pressure is a major factor in the structure of the organisms that inhabit the seas. Our structures were not intended for the same pressures. Nor can we exist in the absence of pressure - ie: space, where pressure is almost negligible. We are instead expressions of our context, and our context is an atmospheric pressure within a certain tolerable range. And within that range, our bodies are generally capable of pressure equalization, internal to external atmospheric.
But I say "generally" here as our body's ability to equalize and balance isn't always a perfect one and our body's ability to cope and compensate to atmospheric pressure variations changes with age and spinal distortion.
In order to equalize internal pressures with atmospheric pressures, the body requires "space" to move and change. Specifically - joint space. If a joint has no space (ie: compressed), it's ability to move will be compromised, along with it's ability to compensate to other changes occurring within the body, including pressure changes.
We might pose the question: how does a grandmother know a storm is coming in? Why do her joints hurt so much when the weather changes? A change in weather is typically accompanied by a change in atmospheric pressure as well. This requires an internal to external equalization process within the human body. Where joint space is plentiful, equalization is an easy process. But in the elderly, generally, joint space over time and gravity has been compressed pretty much everywhere. Thus, joint movement pretty much everywhere may also be impaired. Hence, the ability to change with atmospheric pressure variations will likely suffer.
While the elderly often show extremes in compression and joint immobility, ultimately the same process of compression and distortion is happening through all age groups at differing severity; from negligible in effect to very serious. The young are not immune. A younger person who has suffered a trauma or an early onset spinal condition such as ‘kyphosis’ or ‘scoliosis’ may also reflect a profound lack of joint space and an inability to adequately compensate to pressure changes, both internal and external.
C. The neural system is a fluid, pressurized system.
Job's Body, (Juhan, Deane; 3rd Edition, pg. 158):
"A nerve is not a wire; it is more accurate to think of it as a tiny gland, with the axon serving as the duct. From the tip of this duct, secretions are released in small quantities and circulate to contact the target tissue - the next nerve in line. So neural activity has really as much to do with the laws of hydraulics as it does with the laws of electricity. The action potential is the movement of fluids. It is only 'like' an electrical signal in certain respects.
In this regard, the delicate cell bodies, dendrites, and axons are like the many other fluid-filled tubes within the body. The quality of their function is susceptible to changes in pressure, distortion, and viscosity. ...You can park a truck on top of an electrical wire and it will continue to work nicely. It will work, in fact, until it is completely severed. In contrast there are many intermediate stages of malfunction in a nerve short of this final breakage --or lesion--most of them having to do with the relative effectiveness of the delivery and circulation of nutritional fluids and the adequate flushing of toxins and wastes. These intermediate malfunctions do not normally stop the system; they just make it less efficient. They confuse sensations, cloud thoughts, disturb the precision of our muscular efforts, make us numb in some spots, unaccountably sensitive in others, eliminate responses, and force compensations....No matter, then, how metaphorically useful electrical terminology may be in describing the nervous system, we must always remember that we have to do with fluids and membranes, not wires, switches, or chips. We will not be able to completely avoid the metaphors, but let us not allow them to obscure the realities, or seduce us into believing that by applying a well-worn analogy we have "explained" anything. Comparisons of the nervous system to a telegraph wire, or a telephone switchboard, or even to a large main-frame computer, are gross oversimplifications, capable of severely distorting our view of the complexity and of the organic, developmental plasticity that is inherent in sensation, thought and behavior."
(bold emphasis added)
Job's Body, (Juhan, Deane; 3rd Edition, pg. 158):
"A nerve is not a wire; it is more accurate to think of it as a tiny gland, with the axon serving as the duct. From the tip of this duct, secretions are released in small quantities and circulate to contact the target tissue - the next nerve in line. So neural activity has really as much to do with the laws of hydraulics as it does with the laws of electricity. The action potential is the movement of fluids. It is only 'like' an electrical signal in certain respects.
In this regard, the delicate cell bodies, dendrites, and axons are like the many other fluid-filled tubes within the body. The quality of their function is susceptible to changes in pressure, distortion, and viscosity. ...You can park a truck on top of an electrical wire and it will continue to work nicely. It will work, in fact, until it is completely severed. In contrast there are many intermediate stages of malfunction in a nerve short of this final breakage --or lesion--most of them having to do with the relative effectiveness of the delivery and circulation of nutritional fluids and the adequate flushing of toxins and wastes. These intermediate malfunctions do not normally stop the system; they just make it less efficient. They confuse sensations, cloud thoughts, disturb the precision of our muscular efforts, make us numb in some spots, unaccountably sensitive in others, eliminate responses, and force compensations....No matter, then, how metaphorically useful electrical terminology may be in describing the nervous system, we must always remember that we have to do with fluids and membranes, not wires, switches, or chips. We will not be able to completely avoid the metaphors, but let us not allow them to obscure the realities, or seduce us into believing that by applying a well-worn analogy we have "explained" anything. Comparisons of the nervous system to a telegraph wire, or a telephone switchboard, or even to a large main-frame computer, are gross oversimplifications, capable of severely distorting our view of the complexity and of the organic, developmental plasticity that is inherent in sensation, thought and behavior."
(bold emphasis added)
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Deane states about nerves and innervation: "The quality of their function is susceptible to changes in pressure, distortion, and viscosity," and identifies the process driving these changes essentially as one of compression of the nervous system. While compression of a nerve by soft tissue is a possibility, what Deane is chiefly alluding to and what we are primarily concerned with is in-between bone (interosseous) compression.
All nerve routes at some point run between a bone space - always initially at the spine itself (the central nervous system (“CNS”) and exiting nerve roots that create the peripheral nervous system (PNS). In the thoracics, the exiting nerves run between the ribs. Clavicle/Rib 1 compression is a commonality in thoracic outlet syndrome. In the periphery, a nerve can be compressed between the tibia/fibula in the lower leg and the radius/ulna in the arm. “Sciatica” is a nerve compression of the sciatic nerve/sacral plexus and often involves a distortion of the sacrum and compression of the sacral plexus within the pelvis. |
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While nerves can be compressed by soft tissue, it is the interosseous compression that creates the most serious of problems to where surgery becomes a viable option. In-between bone compression, a product of structural distortion, results in a physical loss and change of space for the nerves running through those spaces. And as space changes, fluid movement and relative pressure change within the nervous system, just as they would in your plumbing.
Viscosity "Viscosity" as mentioned by Deane Juhan above, is defined as "the state of being thick, sticky, and semi-fluid in consistency". We often think of viscosity as applied to motor oil and the internal combustion engine - also a pressurized system. But in a fluid system in the body, such as the nervous system, the makeup of the fluid involved is much much more complex than motor oil. Cerebral spinal fluid is packed with proteins, peptides, neurotransmitters, etc. Hence the question: if the nervous system works upon a fluid, chemical reaction, how does viscosity affect those reactions, the strength of those reactions, and their speed? In general, a more viscous fluid system is normally associated with with a relative stagnancy in movement - like a muddy river with no flow. Lack of movement, stagnancy and viscosity, all relate to fluid "concentration" and makeup. Here, with a mind-bogglingly complex fluid makeup at hand, and a system full of compressions, movement and pressure fluctuations, we then ask the question, "how does compression of the neural system affect fluid concentrations within that system? And how does fluid concentration affect neural function? I explored this question in the two concept paintings here. The first painting looks at neural activity as a chemical reaction, the second looks at in-between bone compression, and how that may change the concentrations, viscosity, and flow of the fluids within. Sensitivity to Pressure Change
From the slightest breath of wind to mild changes in the weather, our nervous system is incredibly aware of pressure both internal and external. "Touch" and it’s fabled power is partly an extension of a much broader and deeper subject -- the nervous system's sensitivity to pressure. And while we may banter about on the importance of touch, without understanding touch within its proper framework in the realm of pressure, I'm not sure we get very far. When pressure gets extreme - for example ‘compartment syndrome’ or severe swelling, it is a hospital emergency. A zit or a boil can become excruciating, and both are examples of very minor pressure distortions just in the epidermis. A puncture wound is the sudden loss of pressure. And in the spine, unrelenting nerve pressure and compression drive millions every year to surgical options. One could argue that the relationship between pressure and pain is more than casual, but at a more fundamental level, there is absolutely no question that we are extremely sensitive to pressure and pressure change. Arguably, there is nothing we are more sensitive to. |
Concept painting: chemical reactions of the neural system
Concept painting: interosseous compression, fluid motion and concentration
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The nervous system is of course the governing system of the body. At the same time it is responsible for registering pressure changes both within its more central aspects as well as throughout the whole. The pressure changes are a result of changes in physical structure. To seek balance, the governing neural system will likely change physicality as well. However the compressions therein and the hard boundaries of the system are bony and ligamentous in nature, which leads to the question: to what ends will the nervous system require of the body and skeletal structure in order to balance pressure within it’s own system?
Chiropractors are fond of saying, “the body will follow the nervous system”, and in many respects, it is certainly true. And here in regards to pressure change and what the nervous system will have the body do in order to balance pressure changes within the system, empirical observation would arguably validate this idea: The nervous system, in order to balance pressure change within its own system, will twist and skew the body to whatever structure and shape is necessary to allow such pressure balance to occur, to the extent that it has the available space to do so.
Chiropractors are fond of saying, “the body will follow the nervous system”, and in many respects, it is certainly true. And here in regards to pressure change and what the nervous system will have the body do in order to balance pressure changes within the system, empirical observation would arguably validate this idea: The nervous system, in order to balance pressure change within its own system, will twist and skew the body to whatever structure and shape is necessary to allow such pressure balance to occur, to the extent that it has the available space to do so.
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The Compensatory Process
From observation, we have seen that a structural distortion in the body will tend to create compensations elsewhere. For example, if the pelvis is tilted forward with an accompanying "lordosis" (exaggerated lumbar curvature), a compensatory curve will often develop above in the thoracics. This is often called “kyphosis” or “kyphotic curvature”. Scoliosis and compensations of a rotational nature are also readily seen on the average body. A rotation in the lower aspects of the spine and pelvis will demand a compensatory rotation further up the chain. This is easily observable. The question is: what is driving this compensatory process we see in the human body? Arguably, two of the most preeminent fundamental factors in our context and makeup - gravity and pressure. In gravity, when one segment shifts forward of a vertical axis, a segment elsewhere will likely shift in the other direction in order to create balance around a vertical line. But gravity alone fails to explain how a traumatic distortion higher in the spinal chain may cause a structural compensation elsewhere, including in the lumbar area and pelvis. |
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Which brings our current list of suspects to:
1. Pressure equalization
2. Gravity
But what of Tensegrity? The theory of “Tensegrity” explains that a shortening anywhere within the fascial system will cause a shortening effect throughout. For example, from a tensegrity perspective, it is believed that shortened flexor and adductor muscle groups at front of the hip will cause the pelvis to tilt forward, and as it does so the lumbar muscle groups and fascia will shorten in response. This is a widely held belief among many modalities including physical therapy as well as therapeutic structural bodywork.
1. Pressure equalization
2. Gravity
But what of Tensegrity? The theory of “Tensegrity” explains that a shortening anywhere within the fascial system will cause a shortening effect throughout. For example, from a tensegrity perspective, it is believed that shortened flexor and adductor muscle groups at front of the hip will cause the pelvis to tilt forward, and as it does so the lumbar muscle groups and fascia will shorten in response. This is a widely held belief among many modalities including physical therapy as well as therapeutic structural bodywork.
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And where we certainly see shortened muscle groups accompany an anterior pelvic tilt and kyphotic pattern, the question remains, are the shortened muscle groups driving the process or simply just along for the ride? From a practical perspective, having spent many years as a Rolf Structural Integration practitioner and having lengthened my fair share of shortened hip flexors, I found that doing so had often a minimal and short-lived effect on the anterior tilt of the pelvis. Perhaps my work could have been better, however, I kept hitting on a few glaring facts: 1. Muscles (and associated fascia) are stupid. They contract, then relax, then contract, then relax, contract, relax, contract, relax… They are the foot soldiers of the body. The idea that shortened local muscle tissue is driving a what is obviously a complex compensatory process in the body just doesn’t compute. We may however, allow that shortened muscles and fascia are still a big part of the human body and rather likely, a good part of problem when we are addressing a distorted structure. But simply lengthening shortened muscles does nothing to influence the control of the muscle, and without influencing control, our muscular interventions are short-lived. Historically in bodywork, the issue of permanence when solely addressing the structure of the body through a tensegrity approach has always been an issue. 2. Muscles are reactive in nature. They do what they are told, and it is the nervous system that tells them what to do. In the absence of neurological input, such as in paralysis, muscles do nothing. Muscles are of course reactive to input through the “somatic nervous system” or “voluntary” nervous system where muscles are controlled through a person’s voluntary input. But what of non-voluntary nervous system input that controls the normal resting length or tonus of a muscle? Where is the control, and can we affect it? Through a Tensegrity approach we have attempted to directly change the normal resting length of muscles and associated fascia by manually lengthening them. But “normal” resting length and tonus is an “autonomic” function of the nervous system is set by the nervous system, not by the muscle tissue itself. And when voluntary muscular input is absent, the muscle and fascia will return to a resting length and tonus dictated solely by the nervous system. Absent this neural information, such as in paralysis, the muscle loses all internal pressure, tonus, and quickly will atrophy. The question thus becomes: If muscle and fascial length and tonus is integral to the balance of the structure of the body, how then do we influence the normal resting length and tonus outside of directly lengthening the reactive tissue? To answer this question, it may help to look at a common situation that heightens the body’s autonomic input to muscle and fascia, i.e.: throwing one’s back “out”. In this situation we are generally referring to an occurrence where a person has twisted in such a way that a nerve in the lumbar or sacral area has become seriously compressed (the mechanics of which are described in Sections E and F). The body’s immediate reaction to the compression is to cause the surrounding musculature and fascia to “spasm” or severely increase in tonus in order to establish a musculature “holding pattern”. The spasms and holding patterns are created by the body so that no further compression to the affected nerve will occur. The holding pattern, however, while helping to prevent further harm, also tends to prevent the twist from subsiding, the normal resting lengths of associated muscles and fascia from resetting, and the body from returning to normal. If we look at the process at play, it appears quite convincingly that compression of a nerve causes local associated soft tissue (muscle and fascia) to increase in tonus and shorten in order the prevent further damage and compression on the nerve. We then must ask the question, if this process is happening in extreme cases, should not the process also be happening in less extreme cases of compression? If chronically, there is compression on a nerve, should we not expect a chronic muscular and holding pattern to accompany the compression? The answers to the latter questions more than likely being yes, we then may surmise that if compressions are happening comprehensively through the whole of the body, then muscular holding patterns are also happening throughout the whole of the body at differing degrees, respective to the degrees of compression at associated neural pathways. To create long-term change and affect muscular holding patterns as well as the ‘normal’ resting length and tonus of a muscle, a roundabout approach is required. Rather than directly attempting to lengthen the reactive soft tissue, a more rational approach would be to reduce the compression on the nerve by opening the joint space, thereby decreasing the neural input to the soft tissue causing it to hold and shorten. |
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Length As a Derivative of Space
In working with many acute cases through the years, I would find that lengthening acutely held tissue could possibly help the client temporarily, but within a short time, the tonus and spasms demanded by the nervous system would re-appear. Many of the times I tackled a severe spasm from a Tensegrity/Rolf approach the client would have no benefit, or symptoms would worsen - indeed, the holding pattern was there for a good reason, and by releasing that holding pattern, often painful neural compression would increase for the client. Major fail.
Ida Rolf was fond of saying “the body needs length”. But to create that length by manually lengthening the soft tissue is often an elusive endeavor; an endless search for the correct tissue to lengthen. But at this point of analysis we may find that it is certainly more probable than not that just manually lengthening soft tissue with an elbow or knuckle in order to create overall length in the body (and spine) is a simplistic notion and understanding of cause and effect. Treating an effect gets us very little.
Cause: Interosseous compression of neural space
Effect: Length and tonus distortion in muscle and fascia
In working with many acute cases through the years, I would find that lengthening acutely held tissue could possibly help the client temporarily, but within a short time, the tonus and spasms demanded by the nervous system would re-appear. Many of the times I tackled a severe spasm from a Tensegrity/Rolf approach the client would have no benefit, or symptoms would worsen - indeed, the holding pattern was there for a good reason, and by releasing that holding pattern, often painful neural compression would increase for the client. Major fail.
Ida Rolf was fond of saying “the body needs length”. But to create that length by manually lengthening the soft tissue is often an elusive endeavor; an endless search for the correct tissue to lengthen. But at this point of analysis we may find that it is certainly more probable than not that just manually lengthening soft tissue with an elbow or knuckle in order to create overall length in the body (and spine) is a simplistic notion and understanding of cause and effect. Treating an effect gets us very little.
Cause: Interosseous compression of neural space
Effect: Length and tonus distortion in muscle and fascia
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While there may be other processes in the human body that affect the length and tonus of the soft tissue, there is little doubt that the compression of nerve space has a direct correlation. In practice, I’ve solved far more acute holding patterns by gently de-compressing a particularly twisted joint space than I ever have or could by lengthening the reactive tissue around it. And when the joint space is decompressed, the neural system allows the associated muscle and fascia to relax without direct intervention. Thus, in order to create the length we seek, we may do so indirectly by increasing joint space. Thus, length in the soft tissue may be a derivative of neural space.
Conversely, it doesn’t work well the other way around. It is quite difficult to simply impossible to increase a joint space, especially intervertebral (between the vertebrae) joint space, by simply lengthening the soft tissue around it. Why? Again, soft tissue holding is neural reaction. And the shortening of the soft tissue may be in part due to the compression at the same joint. The hold is the effect. But even if holding patterns in muscle and fascia were a cause rather than an effect, we run into purely physical limitations in practical application. In spinal work, we are typically confronted with distortions which are relative and specific vertebrae to vertebrae (for example, a distortion between L4 and L5). Our muscles and fascia typically span multiple vertebrae. Superficial fascia, our first layer of fascia, wraps the entire body. How then may we be specific to a distortion that is specific to a particular vertebrae? |
In this picture (above), my client presents with acute back spasms and severe movement limitations following an awkward twist. Two sessions (2 weeks) of gentle unwinding of vertebral joint space and movement is restored as well as balance in the structure, including the spasmed musculature (below).
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Most commonly, bodyworkers in general are not very particular. Even in structural therapeutic bodywork, practitioners often “shotgun” their spinal work. "Shotgunning" is a gross and non-specific 'release' to the posterior fascia. There is an absence of particularity. A Tensegrity approach with particularity to vertebrae would require specific attention to individual paravertebral muscle - multifidus, rotatores, spinales, etc… Again that very few practitioners of bodywork ever attempt this degree of particularity. Along with particularity comes a very high degree of difficulty. |
“Shotgunning” is a non-specific lengthening of muscle and fascia, in this context by slowly engaging one’s knuckles or elbow down the length of the entire spine.
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From a purely practical perspective, even distinguishing these tiny muscles on an average spine is extremely difficult. Second comes the question, which paravertebral muscles are to be lengthened in order to correct typical distortions? And here we may be hard pressed to figure out which tiny, indistinguishable muscles may be ‘causing’ a particular vertebrae to rotate, side-bend, and shift, all at the same time.
A paravertebral muscle and fascial Tensegrity model of the spine.
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Paravertebral Muscles spanning multiple vertebrae.
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Paravertebral Muscles in greater detail spanning individual vertebrae.
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The shift or “translation” of a vertebrae, which often occurs in extremes with degenerative spondylolisthesis, is a particularly difficult and common spinal distortion, and one for which there is no possible muscle or set of muscles to lengthen in order to address the distortion. Shift/translation, is a distortion of a vertebrae that occurs mostly on the horizontal or transverse plane.
Shift or translation of a vertebrae with associated nerve compression. (See also Section F)
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An X-Ray showing the same
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Understandably, the practical results of a purely Tensegrity approach to spinal distortions have been poor and inconsistent. While there are other issues to consider and muscle and fascia remains reactive rather than controlling, with a Tensegrity approach focused on lengthening shortened muscles and associated fascia, there is simply no practical way to address spinal distortion that occurs vertebrae to vertebrae -- for example, how L4 relates to L5. And, as we shall discuss in detail in Section F, in order to understand and address the larger spinal patterns in the human body, we must be able to understand and address the smallest of the patterns that occur -- and those patterns and those distortions exist relative vertebrae to vertebrae.
System Adaptation/Compensation
A key component to Ida Rolf's structural theories was the principle of "system adaptation". This is the idea that in order to change a part of the body, you must change the whole of the body, as no part of the body exists in isolation. The compensatory process we are investigating is essentially the same idea -- where one part of the body changes in physical structure, the rest of the body must change and compensate.
Either way, what we are talking about is an intervention into the body which changes the physical structure of the body and requires a compensatory process throughout the rest of the system. A trauma is an intervention into the body that, when it changes the bony structure of the body, requires compensations throughout the whole. When we bodyworkers attempt to remedy that trauma, we cannot solely address the site of that trauma. The effects of the trauma are held throughout the whole and in order to fully address the trauma and its effects, the whole of the body, and the compensations therein, must be addressed as well.
Rolf Structural Integration, despite its flaws, got some things very right, and one of those was system adaptation. This principle of comprehensive adaptation and treatment helps to explain why “spot work” in manual therapy as well as chiropractic adjustments typically only result in a process of diminishing returns.
Chiropractic
The chiropractic principle that, "the body will follow the nervous system" appears to have some validity. The principle may be found to be in accord with what we are arguing here: changes in local fluid pressures within the nervous system will require balancing change elsewhere throughout the system. And within this process the human structure will twist and skew itself in order to accommodate that change.
The chiropractic interpretation of their own principle however has its flaws, none so apparent as in its methodology -- the quick ‘crack’ and the focus solely on the vertebrae that appear “subluxed” or out of place. There are limitations here. Criticisms aside, Chiropractic theory has played a critically important role in the development of this work. I'd also note that Chiropractic seems most effective on acute rather than chronic structural issues. Once a distortion has rippled throughout the whole and settles into a chronic issue, Chiropractic has its difficulties, as does every manual modality.
In chiropractic, often a practitioner will not address the whole of the spine, rather only areas deemed 'out' of alignment. This approach may work well with acute distortions. But in the chronic realm, the idea that the “body will follow the nervous system” appears slightly misinterpreted to mean that only a minimal amount of work in “correcting” the most apparent of distortions will suffice. It is thought that in correcting the “subluxations”, the rest of the body will follow the nervous system back into balance and function.
There are of course vast differences with treatment protocols within the profession. However, the quite prevalent quick-crack strategy is at odds with the principles of system adaptation and really, with what we have all witnessed -- a complex compensatory system quite obviously present in the human form.
In regards to fluid pressure and a balance sought within the body; where a distortion in structure and fluid pressure is balanced by another distortion or set of distortions, a measure of balance in systemic fluid pressure will achieved. Where structure and fluid pressure in one part of the body is balanced by another, to change either requires change to both.
With this in mind, in a system that has achieved a measure of fluid pressure balance, regardless of how distorted the overall structure is, when a chiropractor pushes only one or two vertebrae (in "subluxation") into "place" - he may very well be pushing the vertebrae back into what was very much the former proper place, but, he is also likely now pushing that piece out of pressure balance with the rest of the system, and the vertebrae (and pain) will revert to their former positions.
Chiropractic is also arguably limited in its effectiveness by a common methodology that appeals to our own desires for instant gratification. Rapid treatment protocols, high-volume clientele, great profit margins, and social conditioning, comprehensive treatment remains a distant thing for much of the profession.
However, within the profession, many progressive Chiropractic practitioners are combining soft tissue work (massage) with adjustments, and getting better results and higher client satisfaction. The result of the combination is a far higher degree of comprehensive care.
Comprehensive Care
While we can criticize chiropractic for it’s lack of comprehensiveness, achieving said comprehensiveness remains a lofty goal for anyone. There are approximately 139 articulating synovial joints in the spine. How does one apply a comprehensive approach/ "system adaptation" to spinal work? How do we affect the whole - and in what time period must we do so?
With Rolfing, Ida Rolf took system adaptation to be process where the "whole" body was addressed in a ten series of sessions, generally over ten weeks. In between sessions, the body was to adapt and compensate to the work already done, setting it up for the sessions to come. She thus addressed both the concept of holism and a consideration of the time involved to do so.
While Rolf Structural Integration took great steps towards overall comprehensive care, there remained a good deal more to go, especially when it came to spinal work. The Rolf ten-series itself is heavily weighted towards the lower body and the pelvis. Ida Rolf believed that balance in the spine first and foremost had to do with balance in the pelvis. When it came to working directly with the ribcage and spine, things got very non-specific. Ida called the interosseous level there "a can of worms". She worked there personally but declined to teach that work in basic classes. She regarded the Rolf ten-series as the “pathway to intuition”, meanwhile in the Rolf world the deep thorax remained a place to venture only for the "intuitive."... It was pretty clear where she was going and what she wanted to get to.
While a system or “recipe” was in place to address the overall fascial structure in Rolf work, no such system existed to address the intricate spine or thorax with any reasonable particularity. And in regards to particularity with vertebrae, the non-specific shotgun approach was and remains the Rolf-norm with the spinal fascia. Additionally, in terms of comprehensive, whole-body care, standard Rolf work, or for that matter, any bodywork from a standard Tensegrity approach generally fails to address the anterior of the spine in any meaningful fashion. And especially, the anterior thoracic spine -- i.e. under the ribcage. In terms of comprehensiveness, this is a large omission.
We may at this point be wondering what happens when we take the same crucial principle of system adaptation and we re-apply it more specifically to spinal work. And with a great deal more particularity. Vertebrae to vertebrae.
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Vertebrae to Vertebrae Change
Under close observation, you will note that each vertebrae in the spine is doing something different from the one above and the one below. There is arguably a change at every spinal level. Ultimately, it follows that if every level of the spine changes, our work must then be particular and specific to each and every level, each vertebrae, each rib. While this sounds difficult, time-consuming, and complex, we hopefully will acknowledge that the human body itself is rather difficult and complex, and our past methods and understandings haven’t quite held up to just how difficult and complex we know the body to be.
D. Compression of neural space compromises the function of the innervated organs/tissue.
This is well-settled in modern medicine, but generally only as it applies to the muscular system, where it is more easily quantifiable.
The Merck manual states:
“Nerve root disorders result in segmental radicular deficits (eg, pain or paresthesias in a dermatomal distribution, weakness of muscles innervated by the root.”
And...
“Nerve root disorders (radiculopathies) are precipitated by acute or chronic pressure on a root in or adjacent to the spinal column.”
http://www.merckmanuals.com/professional/neurologic-disorders/peripheral-nervous-system-and-motor-unit-disorders/nerve-root-disorders
How widespread is such a problem? Well, in practice, neurosurgeons and spinal orthopaedic surgeons are most often occupied with clearing away bone and other tissue in order to create space or reduce compression upon the exiting nerve tissue. And with procedures such as fusions, they are using hardware to permanently open a space for an exiting nerve.
Here is a fairly common explanation of spinal surgeons and their focus:
“Orthopedic surgeons...who specialize in spine surgery are skilled in taking care of disc herniations, disc degenerations, spinal stenosis, fractures of the spine, slippage of the spine (spondylolisthesis), scoliosis, bone tumors of the spine, etc. Neurosurgeons additionally perform procedures inside the dura mater, which is the protective lining around the spinal cord. Examples of conditions such as these include spinal cord tumors, Chiari malformation, spinal cord arteriovenous malformation, tethered spinal cord, spina bifida, nerve root tumors, and other less well-known conditions.”
(http://www.njspinaldisorders.com/orthopedic-versus-neurosurgeon-spine-surgery-whats-difference/)
Each one of the conditions listed creates a compression of some sort on the neurology running through the space. Spinal surgery is, in a sense, decompressing that neurology by removing bone, opening spaces, fusing open spaces, removing debris...all in order to take pressure off-of nervous system tissue. But while pain may often be the motivating factor, it is function that ultimately is the issue when it comes to "health". And it is irrefutable that degrees of function are lost with degrees of compression of neural pathways.
However, and importantly, in medicine today, it is primarily the muscular system by which this relationship between compression and loss of function is understood. However, muscles of aren’t the only things that require innervation and it is far more likely than not that the same relationship between compression of innervation and loss of function acts in the same manner with all other systems of the body as it does with the muscular system. This necessarily includes organ function, as well as function to every system of the body including:
Respiratory
Reproductive
Endocrine
Muscular
Fascial
Digestive
Renal
Skeletal
Lymphatic
Integumentary/Exocrine
Circulatory
Neural
We may find that the question is not “is neural compression a bad thing?” but, “just how bad a thing is it?”
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The Flow of Cerebrospinal Fluid (CSF)
Again, it is far more accurate to think of the nervous system as a fluid system of tubes and hoses, not wires. Within those tubes and hoses flows Cerebrospinal Fluid ("CSF"). Our early understandings of this complex fluid were overly simplistic -- it was initially believed that the function of CSF was to provide a cushioning barrier to the cranium, and protect the brain from injury. Although a function of the fluid, it was only later in the 20th century that researchers began finding that CSF was also instrumental in waste removal from the brain as well as a pathway for nutrients to the brain. Later still, it began to be clear that CSF was also instrumental in the transmission of neural signals.
CSF flow into the cranium.
Here, it may serve us well to repeat Deane Juhan from above, "neural activity has really as much to do with the laws of hydraulics as it does with the laws of electricity. The action potential is the movement of fluids. It is only 'like' an electrical signal in certain respects." Job's Body, (Juhan, Deane; 3rd Edition, pg. 158).
An excellent study on CSF and it's functions:
Multiplicity of cerebrospinal fluid functions: New challenges in health and disease
https://doi.org/10.1186/1743-8454-5-10
(Brown University)
This highly in-depth study finds that: "CSF integrates a multiplicity of functions for the CNS. From fetal life through adulthood, and extending into terminal stages, CP-CSF actively engages in building, maintaining and repairing the brain. Efficient CSF homeostatic mechanisms are vital to neuronal networks. CSF dys-homeostasis in aging and illness, however, can compromise motor functions and cognition...."
Here I will summarize the study where it specifically addresses flow of CSF:
CSF Flow
"CSF flow pathways need elucidation for both healthy and diseased brain....There is increasing appreciation that reduced CSF flow adversely affects brain metabolism and fluid balance...Evidence continues to accumulate, however, for the importance of CSF flow on cerebral metabolism...Because the CP-CSF supplies micronutrients and peptides to neuronal networks, and removes many catabolites, impeded CSF flow disturbs metabolism in early life as well as in late stages...Flow effects on fetal germinal matrixInterference with CSF flow through the ventricles and aqueduct in fetal life profoundly retards brain development...Because CP (choroid plexus) function is fundamental for CNS development, it is pertinent to assess how perturbed CSF flow and composition harm the growing brain...."
Decreasing CSF flow in aging
"CNS/CSF flow disruption in adult chronic hydrocephalus also devastates cerebral functions. Throughout aging, the ability of CP epithelium to manufacture CSF undergoes continual decline...As CSF formation rate dwindles by 50% or more in senescence and disease the sink action of slower-flowing CSF is attenuated. The concentration of potentially-toxic peptides and organic metabolites in CSF and brain consequently builds up due to sluggish flow. Less favorable concentration gradients for catabolites diffusing from ISF to ventricular CSF, results in reduced clearance of harmful substances from brain."
Refinement of non-invasive flow measurements
"Recent advances have been made in the technology and algorithms for quantifying CSF flow non-invasively. Using phase-contrast MRI to calculate CSF and CBF curves over the cardiac cycle, Stoquart-Elsankari et al. extracted data for several CSF parameters: mean and peak flows, latencies and stroke volume. They found that CSF stroke volume was reduced in the elderly, both at the aqueductal and cervical levels."
(Section 4, summarized, quotations and references removed, emphasis added).
Multiplicity of cerebrospinal fluid functions: New challenges in health and disease
https://doi.org/10.1186/1743-8454-5-10
(Brown University)
This highly in-depth study finds that: "CSF integrates a multiplicity of functions for the CNS. From fetal life through adulthood, and extending into terminal stages, CP-CSF actively engages in building, maintaining and repairing the brain. Efficient CSF homeostatic mechanisms are vital to neuronal networks. CSF dys-homeostasis in aging and illness, however, can compromise motor functions and cognition...."
Here I will summarize the study where it specifically addresses flow of CSF:
CSF Flow
"CSF flow pathways need elucidation for both healthy and diseased brain....There is increasing appreciation that reduced CSF flow adversely affects brain metabolism and fluid balance...Evidence continues to accumulate, however, for the importance of CSF flow on cerebral metabolism...Because the CP-CSF supplies micronutrients and peptides to neuronal networks, and removes many catabolites, impeded CSF flow disturbs metabolism in early life as well as in late stages...Flow effects on fetal germinal matrixInterference with CSF flow through the ventricles and aqueduct in fetal life profoundly retards brain development...Because CP (choroid plexus) function is fundamental for CNS development, it is pertinent to assess how perturbed CSF flow and composition harm the growing brain...."
Decreasing CSF flow in aging
"CNS/CSF flow disruption in adult chronic hydrocephalus also devastates cerebral functions. Throughout aging, the ability of CP epithelium to manufacture CSF undergoes continual decline...As CSF formation rate dwindles by 50% or more in senescence and disease the sink action of slower-flowing CSF is attenuated. The concentration of potentially-toxic peptides and organic metabolites in CSF and brain consequently builds up due to sluggish flow. Less favorable concentration gradients for catabolites diffusing from ISF to ventricular CSF, results in reduced clearance of harmful substances from brain."
Refinement of non-invasive flow measurements
"Recent advances have been made in the technology and algorithms for quantifying CSF flow non-invasively. Using phase-contrast MRI to calculate CSF and CBF curves over the cardiac cycle, Stoquart-Elsankari et al. extracted data for several CSF parameters: mean and peak flows, latencies and stroke volume. They found that CSF stroke volume was reduced in the elderly, both at the aqueductal and cervical levels."
(Section 4, summarized, quotations and references removed, emphasis added).
I would note that this study primarily addresses flow of CSF to the brain, and its actions there. CSF, however, flows through the entirety of the nervous system. And if it is critical to the health of the brain, it is likely just as critical to other organs as well, and more than likely, every system of the body.
From here we may find ourselves wondering just how CSF flow gets disrupted and the mechanisms behind it. Of course, we are arguing here that distortions within the vertebral column and ribcage close and compress the neural space, thus effecting both CSF flow and pressure. There are of course deep and valid analogies here into to the world of hydrodynamics...and plumbing.
Princeton University, Canada, has published a study of interest:
"Scoliosis linked to disruptions in spinal fluid flow"
www.princeton.edu/news/2016/06/10/scoliosis-linked-disruptions-spinal-fluid-flow
The study postulates that scoliosis may itself be caused by disruptions in CSF flow; in this case, CSF flow was disrupted in adolescent fish by impairing the motile cilia -- "which stick out from cells and make synchronous whip-like motions to push fluid through narrow passages such as the spinal column."
The study hypothesizes that a particular gene linked to cilia in the spinal canal could alter the flow of CSF, and that when the gene was switched off, and cilia action ceased, scoliotic distortion would occur. In order for the gene to be "switched off" however, it required that the fish be moved from a cooler tank to a significantly warmer tank during an early stage of development. The researchers further found that "the development of spinal curves in these adolescent fish could be blocked by switching the fish back to the cooler tank...provid(ing) proof-of-principle that the development of severe idiopathic scoliosis spinal curvatures can be managed without invasive surgical manipulation”.
Importantly, as the researchers changed the temperature of the water, they were also altering another significant factor -- pressure, and in particular, relative fluid pressure within the fish themselves.
How is pressure related to temperature?
http://littleshop.physics.colostate.edu/activities/atmos2/TempPressureRelated.pdf
Temperature and pressure are directly proportional to each other. This means that as the temperature
increases, the pressure also increases. The adolescent fish in this study were switched to abnormally hot (86 degrees Fahrenheit) tanks, from cooler tanks, causing rapid changes to internal fluid pressures, at a very early stage of development. The study did not address the role of changing internal fluid pressures in the CNS of the fish.
Importantly as well, the study did not address whether impaired cilia motility effected the relative CSF fluid pressure within the CNS of the fish and how a drop in fluid pressure with the CNS could have resulted in skeletal structural ramifications. What is the relationship between fluid flow and pressure? Well, it's complicated, but generally, when flow drops, so does pressure.
See the "Bernoulli Equation":
http://kb.eng-software.com/display/ESKB/Relationship+Between+Pressure+Drop+and+Flow+Rate+in+a+Pipeline
In either case, both actions - the switch to the warmer tank, and the impairment of cilia, would have created internal fluid pressure change and ultimately distortion within the central nervous system of the fish, at a time when it was immature and least able to compensate to severe internal changes. In other words, the researchers both changed the internal fluid pressures of the fish whilst handicapping their nervous system's capabilities to deal with it.
From here we may find ourselves wondering just how CSF flow gets disrupted and the mechanisms behind it. Of course, we are arguing here that distortions within the vertebral column and ribcage close and compress the neural space, thus effecting both CSF flow and pressure. There are of course deep and valid analogies here into to the world of hydrodynamics...and plumbing.
Princeton University, Canada, has published a study of interest:
"Scoliosis linked to disruptions in spinal fluid flow"
www.princeton.edu/news/2016/06/10/scoliosis-linked-disruptions-spinal-fluid-flow
The study postulates that scoliosis may itself be caused by disruptions in CSF flow; in this case, CSF flow was disrupted in adolescent fish by impairing the motile cilia -- "which stick out from cells and make synchronous whip-like motions to push fluid through narrow passages such as the spinal column."
The study hypothesizes that a particular gene linked to cilia in the spinal canal could alter the flow of CSF, and that when the gene was switched off, and cilia action ceased, scoliotic distortion would occur. In order for the gene to be "switched off" however, it required that the fish be moved from a cooler tank to a significantly warmer tank during an early stage of development. The researchers further found that "the development of spinal curves in these adolescent fish could be blocked by switching the fish back to the cooler tank...provid(ing) proof-of-principle that the development of severe idiopathic scoliosis spinal curvatures can be managed without invasive surgical manipulation”.
Importantly, as the researchers changed the temperature of the water, they were also altering another significant factor -- pressure, and in particular, relative fluid pressure within the fish themselves.
How is pressure related to temperature?
http://littleshop.physics.colostate.edu/activities/atmos2/TempPressureRelated.pdf
Temperature and pressure are directly proportional to each other. This means that as the temperature
increases, the pressure also increases. The adolescent fish in this study were switched to abnormally hot (86 degrees Fahrenheit) tanks, from cooler tanks, causing rapid changes to internal fluid pressures, at a very early stage of development. The study did not address the role of changing internal fluid pressures in the CNS of the fish.
Importantly as well, the study did not address whether impaired cilia motility effected the relative CSF fluid pressure within the CNS of the fish and how a drop in fluid pressure with the CNS could have resulted in skeletal structural ramifications. What is the relationship between fluid flow and pressure? Well, it's complicated, but generally, when flow drops, so does pressure.
See the "Bernoulli Equation":
http://kb.eng-software.com/display/ESKB/Relationship+Between+Pressure+Drop+and+Flow+Rate+in+a+Pipeline
In either case, both actions - the switch to the warmer tank, and the impairment of cilia, would have created internal fluid pressure change and ultimately distortion within the central nervous system of the fish, at a time when it was immature and least able to compensate to severe internal changes. In other words, the researchers both changed the internal fluid pressures of the fish whilst handicapping their nervous system's capabilities to deal with it.
Scoliotic Fish, Princeton University, Canada
The study then went on to note that "scoliosis is prevalent in humans with conditions such as tumors that obstruct cerebrospinal fluid flow."
In consideration of that, we would also note that a tumor is essentially a growth which compresses a neural pathway, causing disruption to both CSF flow and the internal pressure of CSF.
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In the next section we will begin to discuss how skeletal structural distortion creates the same type of effect; compressing neural pathways and altering both the flow and fluid pressures of CSF.
E. When a vertebral segment rotates in space and gravity, and relative to the vertebrae below, a tendency is created for the adjoining vertebrae directly above to counter-rotate to the vertebral segment below.
Rotational mechanical distortion.
Here we are looking specifically at the process of rotational spinal distortion relative vertebrae to vertebrae. Rather than looking at large patterns of spinal structural distortion, such as a kyphosis or scoliosis, we seek instead to get a better picture at what is happening at the smallest of spinal patterns -- vertebrae to vertebrae. In understanding rotational patterning at this level, we shall have a better understanding of the larger rotational patterns within the body.
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In order to stay upright in the field of gravity, the biped spine both allows for and compensates to distortion within it’s structure. The human body, as compared to other mammals in nature, is exceedingly adept at compensating to distortion within its structure. The vertical axis of the biped spine and our relative instability allows for considerably more compensation in the field of gravity as compared to the quadruped spine, with its more horizontal axis and four legs of support. A quadruped spine, once in the process of collapsing in the field of gravity, has very few compensatory options. Our spine, oriented to a vertical axis, is quite different and may compensate to distortions in a variety of ways. The compensations allow us to remain functional. Absent the ability to compensate, an organism will suffer the effects of distortion in the field of gravity much more quickly. There is thus certainly an “up-side” to our relative instability.
With spinal distortion, empirical observation teaches us that neck and shoulder issues quite often closely follow low-back issues. Intuitively, we know that a distorted segment within a whole system will have a ripple effect through the entire system and require a systemic compensation. But what has been very unclear is the mechanical process behind it. While there have been several theories, including Tensegrity, the inconsistency of results over many, many years speaks not to technique but rather to fundamental understanding.
For now, only rotational distortion and compensation will be addressed. While there are other distortions in the spine that require compensatory action, none are so clear as the process of rotational distortion, which becomes the twist and the spiral, so common in nature and in the field of gravity, and so routinely seen in the human body. Further in this text the ramifications of the twist on fluid pressure and neurologic compression will be discussed -- essentially, how a twist compresses neurology far more than other common mechanical distortions such as flexion or extension, and how the twist creates a likelihood for other mechanical distortions to take place. For now, however, it is the basic mechanics we must focus on.
Mechanical Balance
In order for the human body to stay upright in the field of gravity, a rotated spinal segment has a tendency to be balanced elsewhere in the chain by a counter-rotation to the other direction. This method of compensatory patterning allows the spine to compensate to a rotation distortion, balance system pressure, and remain functional and upright.
a) Here we start with the basic distortion, a right rotation of the vertebrae.
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b) By virtue of the relative positions with respect to gravity and extensive tendinous and musculo-skeletal connections, whatever is on top of the rotated vertebrae, is also going to rotate with it, at least to a degree. Thus, if, for example, L5 rotates to the right, L4 will also be rotating with it.
c) However, in order to stay upright in the field of gravity, L4 will display a tendency to move its way back left and to the perceived center of balance. Hence, while L4 will rotate along with a rotated L5, it will rotate right to less of a degree than L4.
In space, both vertebrae appear to rotate to the right. L4 however, relative to L5, and by virtue of rotating right to less of a degree than L5, L4 is actually counter-rotating to the left, and is in left rotation, relative to L5.
d) The pattern of back and forth/"worming"/rotation/counter-rotation will have a tendency to continue its way up the spine in a compensatory process.
As the process continues through the chain: L3 will begin with a tendency to counter-rotate to L4. The movement tendency, over a period of time, is likely to become a physical distortion.
This process continues up the spine until the distortion and it’s effects are mitigated. The process, however, generally involves the whole in some form or fashion. If a physical distortion isn't seen, there is a great liklihood that the compensatory twist forces are still acting their way up the spine, and the tendencies towards distortion are there. This pattern and system strain may be imperceivable to the human eye, especially upwards or elsewhere in the chain, but it’s likely there. One distortion -- a whole chain of effect.
L5 rotates right, L4 counter-rotates to the left, L3 then rotates rightwards on L4.
I Don't See It
Where the chain of affect becomes imperceivable in terms of structural distortion, what will remain are tendencies in movement distortion. In other words, a structural distortion will ripple through the whole, initially, as imbalanced tendencies in movement. The imbalanced movement patterns will often become physical distortions perceivable to the eye, especially in proximity to the initial distorted segment. But also often, far up the spinal chain from the initial place of distortion, we may not be able to perceive a physical distortion and compensation. However the tendencies to twist and the movement imbalances are still present, perceivable or not, and they may predict the physical distortion that may ultimately follow.
Rotational degrees and swings vary considerably. How far a vertebrae may rotate is often heavily dependent on the relative mobility of vertebrae (movement potential). Vertebral abilities to both swing wildly into distortion or compensate to distortions elsewhere in the chain vary greatly depending on how easily a particular vertebrae may move and compensate to distortions happening elsewhere in the body. Movement potential is, in other words, "how much space is there for the vertebrae to compensate and what attachments (ribs, tendons...) may also be restricting that movement?"
At L4/L5, L5 is locked more tightly into thick tendinous connective tissues and the borders of L5’s transverse processes are contained within the pelvis itself. L4, on the other hand, is a level up and much more free of the pelvis. There is thus a rapid change in the movement potential of the vertebrae, and where L5, because of its relative immobility, may have difficulty in compensating to an issue in the pelvis, L4, with its heightened mobility, may take up the slack.
With a heightened change in movement potential between the two vertebrae, it would be expected that the joint at L4/L5 would be at risk. Mechanically, and discussed fully at length below, the twist closes the joint space in between. Not surprisingly, a rather high percentage of spinal surgeries occur at L4/L5. (Movement potential is discussed at length in Section H).
At L4/L5, we thus may see a much greater twist occurring with higher degrees of rotation and compensation, due to L4’s relative mobility and ability to compensate. Rather than simply twisting less right in response to an L5 rotation, L4, because of an ease of movement relative to L5, may likely to counter-rotate all the way to the left. For example:
At L4/L5, L5 is locked more tightly into thick tendinous connective tissues and the borders of L5’s transverse processes are contained within the pelvis itself. L4, on the other hand, is a level up and much more free of the pelvis. There is thus a rapid change in the movement potential of the vertebrae, and where L5, because of its relative immobility, may have difficulty in compensating to an issue in the pelvis, L4, with its heightened mobility, may take up the slack.
With a heightened change in movement potential between the two vertebrae, it would be expected that the joint at L4/L5 would be at risk. Mechanically, and discussed fully at length below, the twist closes the joint space in between. Not surprisingly, a rather high percentage of spinal surgeries occur at L4/L5. (Movement potential is discussed at length in Section H).
At L4/L5, we thus may see a much greater twist occurring with higher degrees of rotation and compensation, due to L4’s relative mobility and ability to compensate. Rather than simply twisting less right in response to an L5 rotation, L4, because of an ease of movement relative to L5, may likely to counter-rotate all the way to the left. For example:
The counter-rotation of L4 is the compensation to the original distortion of L5 rotating to the right. The degree by which a segment can compensate is largely controlled by it's relative movement potential.
Movement potential in a vertebrae is, again, heavily dependent on what is attached to the vertebrae (ligaments and ribs) as well as on the space available for the vertebrae to move. Thus, a collapsed disc that greatly compromises the joint space will also greatly restrict the movement potential of the adjoining vertebrae. As well, a rib that becomes fixated will, to some degree, transfer that fixation to the attached vertebrae, thus compromising the movement potential of that vertebrae. And the mere fact that ribs are attached to the thoracic vertebrae are significant factors when considering movement potential and where great changes in movement potential may be predicted to occur. This will be covered at length further on.
For now however, we will focus on the idea that the degree by which a vertebrae may counter-rotate to a rotation below will be highly controlled by its respective movement potential. In that consideration, available space to move becomes an increasingly important factor as we age, given that, over time and the constant force of gravity, it is space -- joint space, that we lose comprehensively throughout the body. As that process occurs, the relative movement potential of vertebrae and the vertebral column changes, resulting in changes to our compensatory ability. In other words, it gets harder. Over time and loss of space, our ability to compensate to changes within the axial skeleton is substantially reduced.
Thus, a trauma that causes a structural distortion, later in life, will have a much harder time being absorbed by the body.
In the same way, an intervention, such as a fusion surgery, will also show a greater failure rate with age. And while the intervention is designed to change the structure for the better, the outcome of that surgery is still heavily dependent on the rest of the body successfully adapting to that change.
This leads to some other questions and probabilities:
1) Does the same compensatory process happen downwards as well as upwards?
The answer is: it is much more likely than not. If we twist C1 and everything below must compensate as well. However, when a distortion originates from below, the addition of gravity tends to heighten the levels of compensatory process as it works upwards in the chain. In observation, the compensatory process is far more easily perceived going up rather than down.
Movement potential in a vertebrae is, again, heavily dependent on what is attached to the vertebrae (ligaments and ribs) as well as on the space available for the vertebrae to move. Thus, a collapsed disc that greatly compromises the joint space will also greatly restrict the movement potential of the adjoining vertebrae. As well, a rib that becomes fixated will, to some degree, transfer that fixation to the attached vertebrae, thus compromising the movement potential of that vertebrae. And the mere fact that ribs are attached to the thoracic vertebrae are significant factors when considering movement potential and where great changes in movement potential may be predicted to occur. This will be covered at length further on.
For now however, we will focus on the idea that the degree by which a vertebrae may counter-rotate to a rotation below will be highly controlled by its respective movement potential. In that consideration, available space to move becomes an increasingly important factor as we age, given that, over time and the constant force of gravity, it is space -- joint space, that we lose comprehensively throughout the body. As that process occurs, the relative movement potential of vertebrae and the vertebral column changes, resulting in changes to our compensatory ability. In other words, it gets harder. Over time and loss of space, our ability to compensate to changes within the axial skeleton is substantially reduced.
Thus, a trauma that causes a structural distortion, later in life, will have a much harder time being absorbed by the body.
In the same way, an intervention, such as a fusion surgery, will also show a greater failure rate with age. And while the intervention is designed to change the structure for the better, the outcome of that surgery is still heavily dependent on the rest of the body successfully adapting to that change.
This leads to some other questions and probabilities:
1) Does the same compensatory process happen downwards as well as upwards?
The answer is: it is much more likely than not. If we twist C1 and everything below must compensate as well. However, when a distortion originates from below, the addition of gravity tends to heighten the levels of compensatory process as it works upwards in the chain. In observation, the compensatory process is far more easily perceived going up rather than down.
2. Extrapolate the pattern:
This action of rotation followed by counter-rotation, traveling up and down the spine would result in a L,R,L,R,L,R... pattern or tendency within the larger, multi-vertebrae patterns at play. A "primary" tendency or pattern, it is a relative “worming” or back-and-forth that exists independently of larger rotational patterns.
With scoliosis, our most simplistic understanding of the scoliosis model portrays the pattern as a lateral distortion. However, the real hallmark of the scoliotic pattern is the twist and spiral. What we are normally able to see are the big group rotations around a center axis; i.e.: the lumbars go left, the lower thoracics right, the upper thoracics left, the lower cervicals go right, and so on. The lateral aspects of distortion accompany the twist, as do extremes in flexion and extension. This is “the “S” pattern in a nutshell. But within that larger twist, the individual relationships tend to do the same.
The spiral, the helix, the twist, is a rather routine structure within nature. Larger patterns of twists are readily observable in the human form. This observable twisting that occurs and the abundance of spiral, helix and twist patterns in nature begs the question, “if the overall relationship of the human form twists in the field of gravity, why would the individual relationships (vertebrae to vertebrae) be any different”?
And why bring up scoliosis?... The reason being that scoliosis is simply an extreme version, that mostly begins early in life, of what generally happens to all of us in the field of gravity. Distortion, compression, twist. What is called a “scoliotic” pattern on a young person, is often just called “old age” on the elderly. And what is and isn’t “scoliosis” is generally often just a matter of degree, or opinion. Still, what we’re all looking at are relative degrees of spinal distortion. The patterning, however is similar. Commonalities abound. The distortions share a similar basis.
With images of scoliosis, we have an eerily similar pattern, in different degrees of severity.
This action of rotation followed by counter-rotation, traveling up and down the spine would result in a L,R,L,R,L,R... pattern or tendency within the larger, multi-vertebrae patterns at play. A "primary" tendency or pattern, it is a relative “worming” or back-and-forth that exists independently of larger rotational patterns.
With scoliosis, our most simplistic understanding of the scoliosis model portrays the pattern as a lateral distortion. However, the real hallmark of the scoliotic pattern is the twist and spiral. What we are normally able to see are the big group rotations around a center axis; i.e.: the lumbars go left, the lower thoracics right, the upper thoracics left, the lower cervicals go right, and so on. The lateral aspects of distortion accompany the twist, as do extremes in flexion and extension. This is “the “S” pattern in a nutshell. But within that larger twist, the individual relationships tend to do the same.
The spiral, the helix, the twist, is a rather routine structure within nature. Larger patterns of twists are readily observable in the human form. This observable twisting that occurs and the abundance of spiral, helix and twist patterns in nature begs the question, “if the overall relationship of the human form twists in the field of gravity, why would the individual relationships (vertebrae to vertebrae) be any different”?
And why bring up scoliosis?... The reason being that scoliosis is simply an extreme version, that mostly begins early in life, of what generally happens to all of us in the field of gravity. Distortion, compression, twist. What is called a “scoliotic” pattern on a young person, is often just called “old age” on the elderly. And what is and isn’t “scoliosis” is generally often just a matter of degree, or opinion. Still, what we’re all looking at are relative degrees of spinal distortion. The patterning, however is similar. Commonalities abound. The distortions share a similar basis.
With images of scoliosis, we have an eerily similar pattern, in different degrees of severity.
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We thus see a rather convincing commonality in the larger scoliotic pattern -- the similarity of the twist. It is fundamentally the same. We may then ask the question, if the twist/spiral patterns for the larger observable distortions are essentially the same or share a commonality, may we also expect that the twist/spiral patterns that may occur relative to each vertebrae would also share some commonality? In other words, is it plausible that a common primary pattern exists, innate to the human form?
Arguably, yes. Given that our fundamental structure and makeup is consistent and common across the board, there is a high probability that some elements of spinal patterning are consistent and common throughout the species. In my own practice and observation, the smallest rotational pattern observable -- the vertebrae to vertebrae rotational pattern, has, as yet, only appeared as:
I will note that from the outset, the idea that a consistent, innate primary spinal pattern applies globally to the human organism creates a rather profound notion of cognitive dissonance. This idea clashes with our own learned sense of uniqueness and individuality. Yet, given the consistency of the larger, extreme rotational patterns that affect the human form, should we expect anything different to be happening at the individual levels of patterning?
Predisposition?
Innate to our common structure, makeup and anatomy is a base-level of asymmetry to everything. While symmetry is often praised and culturally accepted as a standard of beauty, the human body is anything but. Most notably in the organ system, with organs of differing shapes and sizes, functions, and, importantly, relative pressures.
Predisposition?
Innate to our common structure, makeup and anatomy is a base-level of asymmetry to everything. While symmetry is often praised and culturally accepted as a standard of beauty, the human body is anything but. Most notably in the organ system, with organs of differing shapes and sizes, functions, and, importantly, relative pressures.
Frank Netter Painting showing the asymmetric organ system
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Conceptual painting showing a balance of the whole with differing parts
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In Section B we discussed relative organ pressure and the balancing function of homeostasis. In briefly studying the picture above left, we may better understand the complexity of the system, and the rather extreme challenge the body faces in attempting to create a system pressure balance with a variety of separate internal organ pressures within a fully asymmetrical organ structure. In design, the sum of differing parts manages to achieve a measure of systemic balance (my conceptual painting above right). Left to Right, front to back. But the system is not perfect, and there are areas of concern.
We might, for example, examine the T12 area of the body and note that the large, dense liver fills the right and even spills over into the left, while the immediately adjoining organ on the left, the stomach, is hollow and changes in both size and pressure continually, while the liver remains relatively stable throughout its cycles. These differences in relative pressure create a likelihood that a structural ‘hinging’ may occur in the T12 area.
These types of innate asymmetry in organ structure and fluid pressure create innate tendencies towards specific patterns of structural distortion. Theoretically, as we have discussed, one twist in the spine will create a chain of compensation throughout the whole. Thus, an innate twist in the structure, or set of twists, will create an innate tendency towards a specific pattern throughout the entire body. This is not to say the pattern could not appear another way. It is certainly within the realm of possibility. But our common fundamental makeup will likely bias us towards common patterns of distortion. And this would include patterning at the smallest unit of vertebral relationship - vertebrae to vertebrae.
How can we use this information?
With scoliosis we are typically looking at large patterns of distortion and groups of twists as they occur relative to a center-line through the body. We may see the overall, larger rotational pattern through a center axis to look something like this:
We might, for example, examine the T12 area of the body and note that the large, dense liver fills the right and even spills over into the left, while the immediately adjoining organ on the left, the stomach, is hollow and changes in both size and pressure continually, while the liver remains relatively stable throughout its cycles. These differences in relative pressure create a likelihood that a structural ‘hinging’ may occur in the T12 area.
These types of innate asymmetry in organ structure and fluid pressure create innate tendencies towards specific patterns of structural distortion. Theoretically, as we have discussed, one twist in the spine will create a chain of compensation throughout the whole. Thus, an innate twist in the structure, or set of twists, will create an innate tendency towards a specific pattern throughout the entire body. This is not to say the pattern could not appear another way. It is certainly within the realm of possibility. But our common fundamental makeup will likely bias us towards common patterns of distortion. And this would include patterning at the smallest unit of vertebral relationship - vertebrae to vertebrae.
How can we use this information?
With scoliosis we are typically looking at large patterns of distortion and groups of twists as they occur relative to a center-line through the body. We may see the overall, larger rotational pattern through a center axis to look something like this:
But when we plug our smaller pattern within a pattern into the larger group pattern above….
….we begin to get an idea of where we should work in order to change the larger pattern; where to focus and which vertebrae share a higher degree of responsibility for larger rotational patterns. Just as importantly, we also start to get an idea of where not to work.
3) Can a vertebrae rotate in out of pattern with a primary L,R,L,R,L...pattern?
There are several possibilities to consider. While there is innate tendencies for a compensatory L,R,L,R,L,R.. pattern to occur and be maintained, we must be cognizant that spatial restrictions as well as other factors may both prevent the compensatory pattern from occurring and that it is well within possibilities that a vertebral segment may find itself "out of pattern" with the primary L,R,L,R...pattern and tendency.
In pattern...
With sufficient space available, there is a mechanical tendency to stay "in pattern".
If for example we have a right rotated L5 followed by a left counter-rotated L4:
There are several possibilities to consider. While there is innate tendencies for a compensatory L,R,L,R,L,R.. pattern to occur and be maintained, we must be cognizant that spatial restrictions as well as other factors may both prevent the compensatory pattern from occurring and that it is well within possibilities that a vertebral segment may find itself "out of pattern" with the primary L,R,L,R...pattern and tendency.
In pattern...
With sufficient space available, there is a mechanical tendency to stay "in pattern".
If for example we have a right rotated L5 followed by a left counter-rotated L4:
L5 is in Right Rotation.
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L4 counter-rotates to the Left.
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And then we add a subsequent traumatic twist on L4 forcing it towards the right:
Given adequate space, this type of action upon L4 would more than likely pull L5 with it and push L5 further into it’s own right rotation. While the degree of counter-rotation in L4 would conceivably be altered and lessened rightwards, it would be difficult for L4 to exceed the degree of right rotation present in L5. L5 would simply just rotate further into distortion -- to the right, along with L4.
L5 sliding further into rightwards distortion would be facilitated by L5’s already present tendency towards right rotation. Vertebrae in distortion tend to stay there or only slide further into their pattern. With L5 already in right rotation, and L4 relatively left, the tendency for L5 in the field of gravity is to continue going right, further into distortion.
The mechanical tendency for the vertebrae to also "sidebend" along with rotation, also strengthens the tendency and the likelihood that the vertebrae will stay in pattern.
Mechanically, rotation and the side-bending of a vertebrae are coupled. Commonly, this is known as part of “Fryette’s Laws” (https://en.wikipedia.org/wiki/Fryette%27s_laws), although an examination of the articulating surfaces make the mechanical correlation seem rather obvious and obligatory.
L5 sliding further into rightwards distortion would be facilitated by L5’s already present tendency towards right rotation. Vertebrae in distortion tend to stay there or only slide further into their pattern. With L5 already in right rotation, and L4 relatively left, the tendency for L5 in the field of gravity is to continue going right, further into distortion.
The mechanical tendency for the vertebrae to also "sidebend" along with rotation, also strengthens the tendency and the likelihood that the vertebrae will stay in pattern.
Mechanically, rotation and the side-bending of a vertebrae are coupled. Commonly, this is known as part of “Fryette’s Laws” (https://en.wikipedia.org/wiki/Fryette%27s_laws), although an examination of the articulating surfaces make the mechanical correlation seem rather obvious and obligatory.
"Fryette's Laws" state that the rotation and side-bending actions of a vertebrae are coupled. The joint positions in the vertebrae dictate and strengthen this expected motion. Combined, the two motions act to ensure a vertebrae typically only slides further into its distortion.
Because rotation and sidebending are mechanically coupled, once the process begins in the field of gravity, the tendency to continue to rotate and side-bend in the same direction is created by virtue of the influence of gravity on the side-bend: the constant downward force will either hold the side-bend, or exacerbate it. The rotation will follow suit. Hence, once a vertebrae begins a distorted pathway away from the midline and equipoise with gravity, the constant force of gravity will help ensure that it stays on it’s path.
Out of pattern.
Still, given all of these tendencies at play, we must consider the possibility that spatial restrictions in vertebrae could upset this compensatory process and a vertebrae could rotate "out of pattern".
In our example above, if we alter the facts to have L5 fixated in a right rotation and unable to further rotate to the right, a subsequent trauma or twist could plausibly force L4 into a rightward rotation of a greater degree than what is present in L5. Such an instance would set up a very challenging problem in compensations throughout the whole of the spinal column and would result in much more severe pressure distortions in fluid pressure within the neurological system and especially at that vertebrae and it's accompanying articulations.
We will address the issue of "out of pattern" again, and quite in depth in the sections on Methodology, in which we will specifically look for vertebrae that appear to be out of pattern with the body's normal patterning tendencies.
Out of pattern.
Still, given all of these tendencies at play, we must consider the possibility that spatial restrictions in vertebrae could upset this compensatory process and a vertebrae could rotate "out of pattern".
In our example above, if we alter the facts to have L5 fixated in a right rotation and unable to further rotate to the right, a subsequent trauma or twist could plausibly force L4 into a rightward rotation of a greater degree than what is present in L5. Such an instance would set up a very challenging problem in compensations throughout the whole of the spinal column and would result in much more severe pressure distortions in fluid pressure within the neurological system and especially at that vertebrae and it's accompanying articulations.
We will address the issue of "out of pattern" again, and quite in depth in the sections on Methodology, in which we will specifically look for vertebrae that appear to be out of pattern with the body's normal patterning tendencies.
F. When a vertebrae rotates in space, and the vertebrae above counter-rotates, the joint space in between shortens. Rotation is always coupled with side-bending, thus the joint space shortens in an asymmetrical manner. Through the vertebral joint space runs the nervous system. Exiting the joint space on either side are the peripheral nerves. Asymmetrical compression of these nerves imbalances neural function side to side.
This may be best described pictorially:
To our graphic above we will now add a side-bend along with a rotation. Again, rotation and sidebending are mechanically coupled. The coupling of a rotational distortion with a lateral/side-bent distortion create a tendency for asymmetrical compression of the exiting nerve roots.
As discussed in Section D above, compression of the neural system compromises and impairs the function of the innervated tissues. In taking this understanding a bit further - we are also suggesting that spinal mechanics dictate that rotational distortion will also compromise neural function in an asymmetrical and imbalanced way; i.e.: side-to-side - at the exiting nerve roots.
An analogy by example:
If we compress the innervation to a seagull’s left wing by 50%, but not the right wing, what will the seagull’s flight pattern tend to be?
Answer: Circular.
If instead, the innervation to the left wing was only compressed by 5%, or even 1%, would the tendency change?
Answer: Not really
Asymmetrical compression equates to imbalances in side to side movement patterns. In other words, function. But when we are talking about imbalances due to asymmetrical compression, the extent of the issues does not end with muscles. The list also necessarily includes organs, lymph, adrenals,... every system in the body.
Reasoning by Analogy (Part 2)
Why Traction Doesn't Work
It is oft said, “within the problem is the solution” and it is true here. Without properly understanding the problem, the solution will never be found. The inherent obvious asymmetry of the spinal column provides it’s own clear basis for invalidating a 3,000 + year old train of thought and shedding some light on just how ineffective we continue to be.
Nerve compression in the manual therapy world - such as with Physical Therapy, Chiropractic and as well with manual therapies such as Rolf Structural Integration, often follow the same general approach in treatment: symmetrically traction/pull/stretch the spinal column, and/or lengthen the paraspinal tissue to achieve a similar result. This approach of attempting to directly and symmetrically add length to the human structure has, generally, failed for more than a few thousand years, and continues to do so. While miracle recoveries adorn marketing, relief and change is typically short-lived.
Here is a simplistic marketing graphic associated with spinal decompression: a method of traction that purports to create inter-vertebral space. The graphic below makes it seem simple enough.
Marketing graphic for spinal decompression
Neural compression has certainly stated its case as a rather serious issue. However, if neural compression is such an issue then why doesn’t decompression work? Or work better? What's the problem? Let's take a look at decompression therapies throughout the years:
Decompression in early Greece
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An early portable traction brace
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The Hippocratic traction bench
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And today....
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Part of the problem, it seems is that while we may have fancy names like the "DRX9000", catchy marketing schemes and a robust self-care traction industry, the truth is, we are more or less doing the same thing we've been doing for thousands of years and getting the same underwhelming results. ("Insanity" is of course often described as doing the same thing over and over while expecting different results.)
In manual structural therapy, the basic "shotgun" approach to creating length in the spinal column shares a similarly symmetrical approach as traction. However, rather than pulling/tractioning the spine in a symmetrical manner, the adjoining muscles and spinal fascia are manually lengthened in symmetrical fashion. The results are also typically short-lived. Similar massage and myofascial techniques also achieve similarly short-lived results. We may note however that the typical massage therapist, in an hour session, spends approximately 50 minutes working on the backside of a client and about 10 minutes on the front. This imbalanced approach has become the norm in massage. Glossy marketing tends to feed this unbalanced and ridiculous approach. This is the culture of corporatized massage. But while structural therapeutic bodywork may lack particularity with a shotgun approach, it yet remains a far more balanced approach to the human body than the typical massage, with a structural practitioner spending equal if not more time on the anterior and lateral aspects of the body.
'Shotgunning' spinal fascia
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The client bends forward as the practitioner works symmetrically down the spine
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So, why has all this lengthening and decompressing failed to achieve the desired effect? The answer is quite simply, in legal-speak, 'res ipsa loquitur': the thing speaks for itself. An asymmetrical structure will not be changed through symmetrical methods. The appropriate explanation however, takes place at the functional level.
Neurologic Compression Ratio
Again, in the common mechanical patterns of distortion and nerve root compression (rotation coupled with side-bending), one side of the joint and exiting neural space will be compressed at a greater ratio than the other side, even though the joint as a whole is compressed. Thus there is a difference in the ratios of neural compression side-to-side, and with that a corresponding imbalance in function, again side-to-side. When we attempt to symmetrically lengthen or stretch both sides of the joint, even if we create some overall space, the ratios of compression, side to side, remain exactly the same, as does the imbalanced movement pattern. Whatever space that has been created, will soon be lost. Hence the temporary nature of these interventions.
Neurologic Compression Ratio
Again, in the common mechanical patterns of distortion and nerve root compression (rotation coupled with side-bending), one side of the joint and exiting neural space will be compressed at a greater ratio than the other side, even though the joint as a whole is compressed. Thus there is a difference in the ratios of neural compression side-to-side, and with that a corresponding imbalance in function, again side-to-side. When we attempt to symmetrically lengthen or stretch both sides of the joint, even if we create some overall space, the ratios of compression, side to side, remain exactly the same, as does the imbalanced movement pattern. Whatever space that has been created, will soon be lost. Hence the temporary nature of these interventions.
A symmetrical pull or lengthening will not change the asymmetrical ratios of compression. The distorted movement pattern remains.
A Key to a Larger Problem?
Our rotational distortion model thus far has focused on asymmetrical mechanical compression on the exiting nerve roots of the Peripheral Nervous System (PNS). We’ll now turn our attentions to more important compression considerations -- neural compression within the Central Nervous System (CNS), i.e.: the spine itself.
Vertebral Shift/Translation
A shift or translation of a vertebrae is a distortion of a vertebrae relative to another vertebrae which occurs in the axial/transverse plane of movement (horizontal). Shift or translation of a vertebrae tends to occur concurrent to or after rotational distortion occurs. Below, an illustration of lateral vertebral shifts.
Lateral vertebral shifts. The bottom vertebrae is shifting left relative to right shift above
As the top and bottom vertebrae shift relative to each other, the spinal canal functionally narrows and begins to compress the Central Nervous System. A systemic pressure and fluid movement distortion results within the CNS.
As vertebrae shift, the CNS running within is compressed
To understand this from another perspective, here is a top down view of two vertebrae shifting relative to each other:
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As the upper vertebrae shifts, we can start to see how the vertebral foramen, or spinal canal, begins to physically narrow. The 3rd vertebrae above then counter-shifts to the second vertebrae. As it does so, a functional narrowing or "stenosis" occurs within the spinal canal.
Shifts followed by compensatory balancing shifts create a functional stenosis (narrowing) of the spinal canal
“Stenosis” is defined as an abnormal narrowing of a body passage or opening. “Spinal Stenosis” is defined as “a narrowing of the spinal canal.”
http://www.webmd.com/back-pain/guide/spinal-stenosis
http://www.mayoclinic.org/diseases-conditions/spinal-stenosis/basics/definition/con-20036105
Shift Patterns
Shift patterns in the body often appear quite varied. Just as with rotational distortions, vertebral shift distortions will likely require compensatory distortions that will ripple throughout the whole. But while complex, there are innate tendencies in our structure that may clue us in on which shifts are priority, and where shifts are quite likely to happen, and in what direction.
In general, extreme shift distortions have a greater tendency to occur anterior to posterior (front to back), rather than side to side (lateral shifts). The reason may well rest with the physicality at play.
From observation, we can see that the spine deviates from a center-line when viewed from the sagittal plane -- the side. From the side, the spine crosses back and forth over the center line to achieve a structural balance. This asymmetrical deviation from a center line, fundamental to our structure, also creates a greater tendency for anterior to posterior distortion of its segments in the field of gravity.
Viewed from the side (sagittal plane) the human body in structure and design is asymmetric to a center axis.
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Viewed from the front (coronal plane), the human body has symmetry to either side of a vertical axis
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From the front/coronal view, our spine, at least in structural design, maintains a center, and from this perspective, the human skeleton has apparent symmetry to a center axis. We may thus propose that vertebral shifts have a greater tendency to occur anterior to posterior than laterally. Still, in practice, shift distortions of a more lateral nature are also very common. And given the complexity of the spine, vertebral distortions may be a combination of lateral and anterior-to-posterior shifts along with rotations and counter-rotations, all occurring at the same joint. However, because the body is more likely to follow its own tendencies, where those innate tendencies occur are of particular interest and consequence. Since the body is more likely to go deeper into it’s own natural tendencies over time, this should be of important consideration in where we work and in what sequence. Tendency connects deeply into severity, and while lateral shifts may be common, in practice it is the anterior to posterior shifts that are often the most severe, simply because the tendencies for an anterior to posterior distortion in a particular direction pre-exist, and once distorted, serve to continually accelerate the distortion process.
In viewing the skeleton from the side, we can see natural tendencies for the lumbars to continue forward of a center line and the thoracics to naturally fall behind. The cervicals also tend to move forward of the line, along with the head. In addressing spinal shifts, it may be strategically required to focus on these more severe, extreme shifts. This is discussed at length in the Practical sections. In practice and observation, it is quite common for L5 or L4 to be front shifted. T1,T5, T9 will often show extreme back shifts. C6 often shows a profound front shift. In sessions, I am often prioritizing these areas. However, prioritizing does not mean that I only focus my interventions on those areas -- that would create a very poor result. Rather instead, it means formulating a whole-body strategy for addressing those particularly problematic shifts.
G. Rib 6 is physically the largest rib in the body. Above and below rib 6, the ribs become consecutively smaller.
Innate Tendency
We have so far mentioned a number of innate tendencies towards structural distortion in the human body. The importance of these commonalities cannot be understated. As it stands, in medicine and even as a society, our focus is often on the dissimilar - what is different and ‘unique’ about each and every human body and each and every problem. Here however, the focus is squarely on what is fundamentally common. And quite truly, until we understand what is fundamentally common, we will never have a true basis for what is distinct. Our line of inquiry thus focuses on innate structural weak points, common to the human form.
In the human body, there is a tendency over time or trauma for the smaller ribs, generally above Rib 6, to get lodged and fixated into the larger ribs below. The cumulative force of gravity combined with pure physicality dictate this tendency. As space decreases and rib movement becomes restricted, respiration also becomes restricted, and the neurology which runs between the rib space becomes compressed.
Innate Tendency
We have so far mentioned a number of innate tendencies towards structural distortion in the human body. The importance of these commonalities cannot be understated. As it stands, in medicine and even as a society, our focus is often on the dissimilar - what is different and ‘unique’ about each and every human body and each and every problem. Here however, the focus is squarely on what is fundamentally common. And quite truly, until we understand what is fundamentally common, we will never have a true basis for what is distinct. Our line of inquiry thus focuses on innate structural weak points, common to the human form.
In the human body, there is a tendency over time or trauma for the smaller ribs, generally above Rib 6, to get lodged and fixated into the larger ribs below. The cumulative force of gravity combined with pure physicality dictate this tendency. As space decreases and rib movement becomes restricted, respiration also becomes restricted, and the neurology which runs between the rib space becomes compressed.
The anterior rib cage.
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Desiccated intercostal nerves as they exit the spine.
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Artists rendition of thoracic neurology.
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To note, the space between ribs and the size of ribs themselves as typically illustrated reflect most often a symmetrical, well-balanced body with little to no distortion. These illustrations often have very little to do with what is normally occurring in the average body with typical distortion. Skeletons are also confusing. The average skeleton or model lacks any typical human distortion. Actual skeletal bones (by which models are created) are also substantially desiccated and do not reflect their true mass or size. The heavy ligament beds, tendons, and intercostal fascial membranes that accompany a living body cannot be represented with a skeleton, nor do they show well with an x-ray. Both skeletons and x-rays remain somewhat of a confusing and misleading gauge in our perception of available neural space. This likely creates a societal bias in our understanding of the body. |
X-Ray's show mainly the core of bone. Heavy fascial membranes and ligament beds are not seen.
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Ribs 5-6 and Compression of the Cardiovascular System
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In practice, the average body will display multiple points of immobility and fixation in the thoracic region. Smaller ribs above may fixate at multiple points into the ribs below. While fixations are common in the posterior of the body, they are often seen in the anterior aspects of the body. As ribs fixate and movement is restricted, fluid pressures are distorted and structural support is lost. The thoracic compresses and begins collapsing.
A collapsed anterior chest is the hallmark of old age. It is also rather prevalent in the young as well, these days attributed to too much computer and smart-phone usage, as well as heavy backpacks. At a young age we may call the structural collapse a kyphosis, and absent a known trauma, is generally thought of as “idiopathic” (unknown cause) and possibly of genetic origin. We may also simply attribute the issue to "poor" posture or laziness, without a proper understanding of the physicality at play. |
The image of a "Russian Doll" may come to mind when looking above Rib 6.
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In the elderly, kyphotic patterns and collapsed thoracics may often be credited to Osteoporosis.
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Our common understanding of the kyphotic spinal distortion is typically in degrees of severity:
“While most cases of kyphosis are mild and only require routine monitoring, serious cases can be debilitating. High degrees of kyphosis can cause severe pain and discomfort, breathing and digestion difficulties, cardiovascular irregularities, neurological compromise and, in the more severe cases, significantly shortened life spans. These types of high-end curves typically do not respond well to conservative treatment and almost always warrant spinal fusion surgery, which can successfully restore the body's natural degree of curvature.”
https://en.wikipedia.org/wiki/Kyphosis
In looking at severe cases of spinal distortion and noting the rather severe functional effects, we must ask the question, if extreme cases of distortion are possibly life-threatening, just how far-reaching are the impacts of “less” extreme cases? Should there not be a systemic cost in less-severe cases in the same way as more severe cases? What if the same process is generally happening to everyone, but in differing degrees?
Generally, causation remains idiopathic (unknown), with hosts of possible contributing factors like genetics, trauma, and loss of bone density. These are all credible contributors to the issue. There are less-credible possible contributors to the issue as well, especially in psychological and Freudian realms. Our inquiry, however, stays physically fundamental, and is centered upon what innate aspects of our structure may pre-dispose us to issues in the problematic thoracic region. Hence, our focus remains on the physicality.
In the purely physical world, should a Rib 5 descend and fixate into a Rib 6 we will immediately have a movement distortion at both ribs. This lack of movement will generally require compensatory movement somewhere else - i.e.: another set of ribs must take up the slack. If however the compensation cannot occur for one reason or another, or can only partially occur, then the overall movement of entire thorax will be impaired to a degree. Any degree of impairment will likely have a direct respiratory effect; restricting the amount of oxygen the body can take in on a normal, unforced breath.
A movement issue at Rib 5 will also have a direct and immediate impact upon the movement and health of the relationship with its adjoining neighbor, Rib 4. Importantly as well, any rib distortion and fixation will also affect the vertebrae it is directly attached to, as well as the vertebrae(s) physically behind the rib that is distorting. This is simply a matter of change in physical space.
A side view of Rib 5 lodging and fixating into Rib 6.
Movement of Ribs 5, 6, and 4 are directly affected. Rib 6 now pushes back on Rib 5.
Force is transferred to the attached vertebrae.
The back pressure creates a tendency for CNS compression.
Physical space is compressed behind the distorted ribs.
The thoracic structure as a whole collapses upon itself.
The hallmark of the aging process, the unhealthy, the unattractive, is the ‘hunch’. But the hunch isn’t an issue with the backside, it’s generally a collapse of the anterior aspect of the thoracic. And while a distorted pelvis may create a lack in foundational support for the thorax, and we may create a modicum of result by focusing our efforts there, when T8 or T9 back-shifts, which, in practice is a high likelihood, the entire thoracic loses structural support - both in terms of alignment and in terms of fluid pressure. A loss of support here directly impacts the cardiovascular system and has serious repercussions throughout the whole. One such repercussion would likely be systemic fluid pressure; a loss of structural support to the cardiovascular and a compression of local neurology will likely impair and distort system fluid pressure throughout the whole of the body.
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Along with loss of support comes loss of movement. Shifted vertebrae greatly restrict movement at both the immediate bottom and top vertebral relationships and impact overall movement throughout the chain as a whole. Loss of physical movement and range of motion is occurring directly over the cardiovascular system, accompanied by neural compression.
But while much of the collapse is likely happening at the T8/T9 level, where the pattern becomes locked is generally above Rib 6. It is here that Rib 5 lodges into Rib 6 and thereafter, Ribs 4-1 generally follow suit. With gravity, the tendency is only for further collapse.
But while much of the collapse is likely happening at the T8/T9 level, where the pattern becomes locked is generally above Rib 6. It is here that Rib 5 lodges into Rib 6 and thereafter, Ribs 4-1 generally follow suit. With gravity, the tendency is only for further collapse.
H. The 'movement' potential of a vertebrae changes dependent on its location in the body.
As we continue to explore innate tendencies towards distortion, the movement abilities of vertebrae come greatly into play. With a heightened degree of mobility, a vertebrae also has a heightened vulnerability to trauma, as well as a heightened ability to both adapt and compensate to issues elsewhere in the spine. Vertebrae with less movement potential may tend to be more "damage-resistant" yet are restricted in how they may compensate to other issues in the spine, and their relative lack of space and movement creates a natural tendency for entrapment - i.e.: getting stuck.
In general, the cervicals have the greatest movement potential, followed by the lumbars, and lastly, the thoracic. In the cervicals, C7 and C1 have heavier ligament beds and generally, less movement potential than the rest of the cervicals. Movement potential changes drastically between the end of the upper thoracics (T1) and the beginning of the cervicals (C7). Pattern distortion that cannot be compensated to at the thoracic level must be compensated to at the cervical level. The heavy ligament bed and Rib 1 articulation at T1/C7 demands that compensations will be greater beginning at C7/C6 and then with an even greater freedom of movement and compensation at C6/C5.
Data confirms what the change in vertebral movement potential suggests.
In terms of clinical data on issues of compression, “The most common segments where discs herniate (in the cervicals) are in the middle of the neck, at C5/C6 or C6/C7 levels.”
http://www.spinemd.com/patient-resources/frequently-asked-questions#What%20causes%20neck%20pain?
“Cervical disc herniations occur in the neck, most often between the fifth & sixth (C5/6) and the sixth and seventh (C6/7) cervical vertebral bodies.”
https://en.wikipedia.org/wiki/Spinal_disc_herniation
As we continue to explore innate tendencies towards distortion, the movement abilities of vertebrae come greatly into play. With a heightened degree of mobility, a vertebrae also has a heightened vulnerability to trauma, as well as a heightened ability to both adapt and compensate to issues elsewhere in the spine. Vertebrae with less movement potential may tend to be more "damage-resistant" yet are restricted in how they may compensate to other issues in the spine, and their relative lack of space and movement creates a natural tendency for entrapment - i.e.: getting stuck.
In general, the cervicals have the greatest movement potential, followed by the lumbars, and lastly, the thoracic. In the cervicals, C7 and C1 have heavier ligament beds and generally, less movement potential than the rest of the cervicals. Movement potential changes drastically between the end of the upper thoracics (T1) and the beginning of the cervicals (C7). Pattern distortion that cannot be compensated to at the thoracic level must be compensated to at the cervical level. The heavy ligament bed and Rib 1 articulation at T1/C7 demands that compensations will be greater beginning at C7/C6 and then with an even greater freedom of movement and compensation at C6/C5.
Data confirms what the change in vertebral movement potential suggests.
In terms of clinical data on issues of compression, “The most common segments where discs herniate (in the cervicals) are in the middle of the neck, at C5/C6 or C6/C7 levels.”
http://www.spinemd.com/patient-resources/frequently-asked-questions#What%20causes%20neck%20pain?
“Cervical disc herniations occur in the neck, most often between the fifth & sixth (C5/6) and the sixth and seventh (C6/7) cervical vertebral bodies.”
https://en.wikipedia.org/wiki/Spinal_disc_herniation
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In the pelvis and lumbar region, the sacrum is held within an extremely heavy ligament bed and has limited movement. Movement potential changes dramatically with L5 and the beginning of the lumbars. A second dramatic change occurs between L5 and L4. L5, while having much greater movement potential than the sacrum, is yet confined within the iliac crests and within a fairly heavy ligament bed. L4, however, is generally free of the iliac crest and the density of the ligament bed is decreased relative to L5. The result is an increasing ability to compensate, rotate, and distort in the vertebrae above the sacrum. Add to this the position of the lumbars with respect to gravity and the tendency for L5/L4 to shift anteriorly in the body...
The most common site for disc herniation in the human body is S1/L5 followed closely by L5/L4. http://www.aafp.org/afp/1999/0201/p575.html http://www.spineuniverse.com/conditions/herniated-disc/herniated-discs-definition-progression-diagnosis We may then ask “What is L5 and L4 trying to compensate to that the sacrum cannot?” The answer, in practice, is often below the sacrum, at the coccyx. The diminutive tailbone, often thought of as “fused” and incapable of movement. But move it can, and distort it will, especially at an early age and given the right amount of trauma . And across the planet, there is only one true biped, and that particular species is the only animal on the planet that significantly and repeatedly traumatizes the very end of it’s spine in learning how to walk. If a twist in the spine has repercussions throughout, then a twist to even the smallest of segments has an impact through the whole. No part exists in isolation. |
Acute disc herniation at L4/L5. Debilitating, my client lost feeling in his foot and needed a cane to walk. Bodywork interventions were initially successful, but then fell to inconsistent. Surgery to clean out lingering disc debris was necessary. Post surgery, the pain was improved but the movement issues and loss of feeling remained.
As my accuracy and understanding improved, my client did as well. Multiple sessions later, the cane is no longer necessary and the client has regained a significant degree of feeling back into the foot.
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T12
Ida Rolf, founder of Rolf Structural Integration, famously said that given the choice, she’d hang a rib 12 on a sign above her office. The T12 zone and the more general area of the upper lumbar and lower thoracic was dubbed by Ida ‘the dorsal hinge’ and she suspected that all movement in the human body originated at this location. In her practice, she taught her students to “clean off” rib 12 and that if they we going to ‘park it’ anywhere (i.e.: focus their interventions), they should do so at rib 12, the quadratus lumborum and the top of the iliac crest. There are good reasons why Ida was logical in her focus here.
From a movement potential perspective, the end of the lumbars and the beginning of the thoracic signal another important change in the movement potential of the vertebrae. The change here is not as severe as L5/S1 and T1/C7. At those junctions we go from almost no movement to a great freedom of movement. The transition at T12 is much more gradual, with movement potential steadily declining beginning with L1, then decreasing again with T12 and T11 and their “floating ribs” and lack of anterior articulation, then becoming more restricted through T10-T8 with their “false” ribs and shared anterior articulations, and finally to the ‘true ribs’ (T7-T1) and their individual articulations with the sternum.
Ida Rolf, founder of Rolf Structural Integration, famously said that given the choice, she’d hang a rib 12 on a sign above her office. The T12 zone and the more general area of the upper lumbar and lower thoracic was dubbed by Ida ‘the dorsal hinge’ and she suspected that all movement in the human body originated at this location. In her practice, she taught her students to “clean off” rib 12 and that if they we going to ‘park it’ anywhere (i.e.: focus their interventions), they should do so at rib 12, the quadratus lumborum and the top of the iliac crest. There are good reasons why Ida was logical in her focus here.
From a movement potential perspective, the end of the lumbars and the beginning of the thoracic signal another important change in the movement potential of the vertebrae. The change here is not as severe as L5/S1 and T1/C7. At those junctions we go from almost no movement to a great freedom of movement. The transition at T12 is much more gradual, with movement potential steadily declining beginning with L1, then decreasing again with T12 and T11 and their “floating ribs” and lack of anterior articulation, then becoming more restricted through T10-T8 with their “false” ribs and shared anterior articulations, and finally to the ‘true ribs’ (T7-T1) and their individual articulations with the sternum.
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Although the change in movement potential is more gradual here, distortions working their way up from the pelvis and lumbars will likely see a high degree of compensation at the T12 area. Where the mid-thoracics often lack space to compensate to other patterns, the T12 area does not. The heavier, more immobile mid and upper thoracic will also tend to hinge and twist at its narrower, more mobile base -- where it can.
This is also an area of notable difference in relative organ pressures that adds to the likelihood of distorted movement patterns - with a dense, large, liver on the right with relatively stable pressure, and a wildly fluctuating stomach on the left. Higher degrees of compensation, rotation and shift, are typically accompanied by higher degrees of neural compression. T12 and its surrounding area is predisposed to both. Muscular pain and strain will also accompany the compressions. However, most importantly, this area in particular is often the location of more difficult organ issues - liver, pancreas, spleen, stomach/upper GI. Compressed neurology here will likely contribute to a host of issues. |
Creases are often seen at T12 and into the lumbars. "Success" in bodywork is best gauged by the long term. The pictures above are several years and many sessions of unwinding apart. Pain issues have diminished, activity has increased.
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A twist here also affects the diaphragm. The diaphragm is a thin sheet of muscle separating the thoracic cavity, containing the cardiovascular system (heart and lungs), from the abdominal cavity. In function, as the diaphragm contracts, it forces air into the thoracic cavity (and lungs). A loss of neurlogical input would impair the respiratory function of the diaphragm. Further, any loss of innervation may also affect the normal tonus and health of the diaphragm, causing distortions in pressure and support in both the thoracic and abdominal cavities that it adjoins and separates.
Innate Structural Tendencies Towards Distortion
We have thus far identified a number of structural weaknesses in the human form that will enable us to focus and guide our practical efforts. The degree in which we can influence and change these areas may play a large role in the degree in which we can influence and change the structure as a whole.
The following is a non-exclusive list of specific joints and areas in the spine and ribcage that display a high degree of innate tendencies towards mechanical and physical distortion. This mechanical distortion is accompanied by a higher degree of neural compression and fluid pressure distortion with accompanying loss of function.
1. C7-C5
The end of the thoracics into the cervicals signals a significant change in movement potential of the vertebrae. Where the thoracic lacks space to compensate, the beginning of the cervicals takes up the slack. C6, C5 often find themselves shifted forward. The Brachial Plexus is primarily affected.
2. S1-L4
Movement potential changes drastically between the heavy ligament bed of the pelvis and L5/L4. Heavy rotations and distortions tend to be seen here. The Sacral Plexus is primarily affected.
3. L1-T11
The heavy and often immobile thoracics tend to twist and distort at their base, where the movement potential of the vertebrae changes. Twists in the lower lumbars will demand compensations as well at the T12 area, as the less mobile thoracics force compensations to occur elsewhere. The “solar” or Celiac Plexus is located here. Heavy innervation to digestive organs.
4. Ribs 1-5
Above Rib 6, the ribs become consecutively smaller, and with trauma, distortion, and the force of gravity over time, the smaller ribs above tend to tuck and lodge into the larger ribs below, creating distorted pressures on the vertebrae attached and behind. The overall effect is neural and spatial compression at the primarily cardiovascular area of the body.
5. L5
Apart from movement potential characteristics, L5, due to its position with respect to gravity and anterior position with respect to a vertical axis through the sagittal plane, shows a tendency to shift forward in the spine, as seen in spondylolisthesis. L4 may also exhibit the same characteristics.
6. T1/Rib 1
Rib 1 not only displays a tendency to slip and lodge into the larger Rib 2, but also tends to get trapped behind the clavicle. Compressive force and distorted pressure is transferred through the rib to the vertebrae (T1 and adjoining C7) and also to the vertebrae that are physically behind Rib 1: T3/T4.
7. Ribs 2 & 3
These Ribs also share double tendencies towards distortion. Both Ribs display a tendency to fixate into the larger ribs below, however, the tendency is exacerbated by the shoulder girdle - acromion, scapula, and clavicle. The weight and spacial restrictions of the shoulder girdle heighten the tendencies for Ribs 2 & 3 to fixate laterally - i.e.: in the armpit, under the shoulder as well as under the scapula.This area may be one of if not the first place in the human structure to fixate and become impaired in movement. This is also one of the most difficult places to palpate and treat due to issues in accessibility. In other words, it is likely the very last place to ever get touched.