Ged: ‘I’ve got this thing that you need to get to a sort of proficient skill level, then we’re all the same; all practitioners are equally effective. You don’t need to be in practice for 20 years. You know what I mean? It’s like the body needs a certain amount of skilful listening. Beyond that, it doesn’t matter, it can do it itself.’

You can download the transcript here http://bit.ly/ged-steve-2014-04-transcript

Expertise

Ged: As you get more experienced and you’re in practice longer, I think it’s fairly typical that you do get simpler. I think that just goes across the board about anything actually. Don’t you think the more expert you get tends to be..? You just know the terrain, you know the way the body moves in these sessions. It tends to morph and shift in very idiosyncratic ways. Plus, I think your touch just becomes much more knowing. It’s like: “Yeah, I’ve felt that many, many times. Oh, that’s the pulls of the liver.” Or: “That’s a membranous, this or that. That’s the cymatics. Now there’s a visceral thing going on. There’s the vertebral column,” and so on.

I think that just starts to colour in wonderfully, so you know that. You know the feeling of: what’s the body doing in terms of health? How much health is showing? Maybe that’s one of the biggest things actually. Thinking back in time, I’m not sure… I think I’ve got better at relating to health, listening to health, and actually what it is. What’s the feel of health? Even people who are not well at all, chronic this or that, really strong pathologies – sometimes I touch them and think: “What pathology?” Because I think you’ve just become very honed at the skill of listening to the vitality of the body.

Read the rest of this entry »

myodural bridge

Myodural Bridge, Enix DE et al 2014 J Can Chiropr Assoc 58: 184

Myodural Bridges

This is a great review of connections between the sub occipital muscles and the cervical dura. There are some more images in the article. Here is David Butler discussing the anatomy:

The Myodural Bridge
‘What a name! I was always intrigued by the difference between a group of patients who could quite easily elongate their upper cervical extensor muscles (“pull your chin in”) and another group where upper cervical flexion was particularly sensitive and easily evoked headache. The repeated clinical anecdote is that the second group can flex their upper cervical spines more easily in sitting or even better, in supine with their knees flexed. This may well unload the myodural bridge.
Myodural bridges are connections between the cervical dura mater and the cervical extensor muscles. These connections probably anchor the dura and stop it folding in on the cord when you look up and extend your head back (Hack et al 1995, Rutten et al. 1997). This may have been an evolutionary advantage to our ancestors as they gazed up in awe at the firmament! There is a great recent review out by Enix et al (2014), updating the anatomy of the bridges including sub occipital bridges and proposing clinical implications. Think of it next time you are having a look at a patient’s posture as they sit in front of you with their worries and concerns? or ask someone to tuck their chin in. It also remind us that everything is kind of joined up in the body; discrete anatomy is for the textbooks.‘ David Butler NOI notes July 2014

Enix DE et al (2014) The cervical myodural bridge, a review of literature and clinical implications. J Can Chiropr Assoc 58: 184

Atlantoaxial Instability

Here is a good article on why it pays to be cautious in bodywork. I am so glad I do not introduce strong forces into the neck when I work. The biodynamic paradigm makes working with the upper neck and cranial base much safer. I was taught tests for vertebrobasilar insufficiency at chiropractic college but not that much about atlantoaxial instability.

‘Either atlantoaxial instability or vertebrobasilar insufficiency causes severe dizziness and vomiting after massage therapy, with lessons for health care consumers’

http://saveyourself.ca/articles/my-barber.php

Pain Throw Amputated Leg

This is a great story of how extreme the body can be in prioritising threat.

Pain has a geography in the body. Suffering is a bigger category and existential?

This is tricky territory, hence the question mark.1

My view is that in pain there is an explicit representation that involves the body. Considering suffering as initially experienced through thoughts and emotions is a broader category that acknowledges that thoughts feel primarily psychological. Of course mental events have correlates in body physiology, they have to; there is no such thing as a pure thought or pure mind outside of body.2 However it is an achievement to be embodied. Tracking psychology, thought, or emotion in our bodies is a skill that requires practice and discipline.

It is not efficient to always track every sensation associated with a thought, in exactly the same way that it is not efficient to track every muscle we contract to pick up a glass of water. The goal of the brain is predictions and outputs that work quickly in nature. When we are suffering and in pain then retraining our brain to operate differently necessitates bringing awareness to the steps that make up our thoughts and movements. Only then can we can chose to assemble the simple building blocks of how we think and move in more optimum, non painful ways.

‘I think this is a quote from Antonio Damasio that is worth repeating: “The mind is embodied, not embrained.”
Let’s consider some of the evidence that shows how important the body is to the mind. For example, the role of emotion. We’ve talked in the past about the importance of the parts of the brain that monitor the body’s internal state. Antonio Damasio is the one that has shown that when parts of the frontal lobe that are involved with getting emotional input are damaged, a person can’t even make decisions. So we need the body’s input. That’s why separating the brain out by itself is a dangerous example of reductionism. It’s the whole person that has experiences, not the brain.’ Ginger Campbell (2009)3

Pain is a conscious experience

‘Pain is an unpleasant conscious experience that emerges from the brain when the sum of all the available information suggests that you need to protect a particular part of your body.’ Lorimer Moseley4

You cannot be in pain and not know about it. Your body can be working poorly, be inhibited, have silent tumors growing, and have metabolic disorders humming away all outside of your awareness. That is disease. Pain is something that grabs attention as the brain decides the information it is receiving is dangerous. The goal of acute pain is to change behaviour to protect.

The body has other ways of changing behaviour. Tiredness is an output that limits behaviour, it is also a conscious perception like pain. Interestingly inflammation is increasingly being understood as a protective output, in parallel to pain but led by the immune system.5 However inflammation has the difference of running outside of our awareness and is non-conscious.

A consequence of embodied awareness is that as you pay attention and learn to feel you may suffer more. What you learn to feel is your suffering. Often as people come out of dissociation what they encounter is pain. The strategy of cutting off from sensation occurred because something was too much. This is why pacing and resources and are essential when meeting the body if there has been trauma. Levine (2010)6 offers that health is the ability to hold increasingly intense sensations and not get activated.

‘Let me tell you something really, really shocking. As late as the 1970’s young infants in hospitals, having major operations, including amputations, are having them without any form of anaesthetic, let alone analgesic.’ Jonna Bourke7

In the 18th century the baby was seen as exquisitely sensitive, there was a shift in 1870’s to infants being considered not at all sensitive and this continued for another century. Small children were not perceived to experience pain in the same ways as adults, it was thought you needed to have the capacity to suffer to feel pain. Presumably babies were thought to have no self consciousness and no memory. Oh dear, a sad example of why clear understanding of pain matters.

References

1 Bourke (2014 p60-62) gives a good discussion of pain versus suffering and relates it to an historical split between mind and body:

‘Finally, astute readers will already have noticed that I am using the terms pain and suffering interchangeably. It used to be radical to question the distinction between the mind and the body. Not any more. The assumption that there is a clear distinction between the mind (characterized as disembodied, rational, computational, and male) and the body (caricatured as presocial, emotional, impetuous, and female) has been attacked from all sides. Feminists have led the assault on the representation of the mind as some kind of superior, active, unique entity, which ‘feeds’ information to a passive, universal, and inferior physiology. In more recent decades, though, anthropologists, social scientists, and cognitive scientists have enthusiastically joined in the skirmish. Historians have been relatively slow to commit themselves.

Of course, people-in-pain typically highlight one aspect of the pain-event over another (I am in physical pain because I burnt myself while making coffee; I am psychologically suffering because I have fought with my lover). The Cartesian distinction between body and spirit or soul is deeply embedded in our culture. Nevertheless, mental pain always involves physical events – neurochemical, muscular nervous, and so on – and physical pain does not exist without a mental component. My burn depresses me; my sadness weighs down my body. As physician and writer David Biro astutely argues in ‘Is There Such a Thing as Psychological Pain? And Why it Matters’ (2010), ‘psychic distress can itself be painful in a meaningful sense, that it can be phenomenologically akin to physical pain, and, therefore, should be categorized under the same rubric’. Furthermore, the Cartesian distinction made between ‘bodily pain’ and ‘psychological distress’ (often denigrated as the difference between ‘real pain’ and its ‘psychosomatic’ variety) has done a vast amount of ideological work for physicians, psychiatrists, psychologists, the pharmaceutical industry, and chronic pain patients. For researchers in the arts and humanities as well as in the sciences, however, mind/body dichotomies have been an impediment to scholarship. There are many grounds to be suspicious of them, including the vast scientific and medical scholarship that demonstrates the interconnectedness between physiological and mental processes. Bodies are actively engaged in the processes that constitute painful sensations. Mindfulness is engaged in a dialogue with physiological bodies. And culture collaborates in the creation of physiological bodies and linguistic systems. The body is mind-ful and the mind is embodied.’

2 Another very tricky bit: no pure, independent mind is the materialist view. Dualists and religions argue that mind/soul is distinct and independent from the body.

3 Campbell, G. (2009) Did My Neurons Make Me Do It? Brain Science Podcast Episode #53: Aired January 17, 2009

4 Mikkelsen S. (2014) Notes on Lorimer Moseley lecture 7 June 2014. Facebook post. https://www.facebook.com/ManuellterapeutSigurdMikkelsen?fref=ts. Accessed 17 July 2014 Manuellterapeut Sigurd Mikkelsen

5 ibid

6 Levine P. (2010) In An Unspoken Voice: How the Body Releases Trauma and Restores Goodness. Berkeley, CA: North Atlantic Books.

7 Bourke J. (2014) The Story of Pain: From Prayer to Painkillers. Oxford University Press. http://www.bbc.co.uk/programmes/b046j8z5  Interview July 2014 @10.00mins.

 

I’ve Seen A Lot Dance Moves, But Nothing Like This. I Can’t Stop Watching This!

 

Dancers always inspire around how I can move my body.

Graded Exposure Helps Pain

‘If you perform some movement without pain that normally hurts, your brain is likely to get very interested. It is ‘good news’ that reduces threat. A major goal of any program for movement health should be to send as much ‘good news’ to the nervous system as possible about the state of the body and its ability to withstand the stress of movement’

Todd Hargrove (2014) Better Movement. p143 (A stunning book and blog)

Let’s say you have 10 muscles holding your shoulder in a given position. Let’s also say, being really simple, each muscle can be on, off or halfway. That’s three options per a muscle. That is already 1000 (10x10x10) options on how to hold your shoulder still. Even this number is orders of magnitudes below the actual degrees of freedom you have available to move your shoulder.

Maybe an injury has limited the range of movement or strength in one position – there is a tear in some tissues or some wear or tear (arthritis) in the joints. It turns out these are normal signs on medical imaging, they are commonly seen in pain free individuals. Consider how many other possibilities exist to perform any given motor act. At least 1000 if my maths is any good.

Feed your brain novel and non threatening ways to move. Try lots of small, gentle, movements and build up to more complex and long sessions. Visualise the movements to enhance the maps of your body in your brain (neurotags). Be persistent, it is about learning new, non pain habits; it may take the amount of work you would have to do to write with your opposite hand.

Your body and brain will accommodate to the limitation and you will be able to live and move without pain. And, yes, you are a little bit older and little more experienced than you were before. You may not have a tennis serve that is going to win Wimbledon, that can be sad and a loss, but it does not mean pain. You will still be able to do amazing things with your body.

Famous welcome sign, Las Vegas, Nevada.

Research into the fabulous vagus nerve is a gift that keeps on giving. Activating the vagus supports people to be less depressed, enhances the immune system, including regulation of inflammation, and reduces pain. The first section is a summary from Dacher Keltner of some vagal highlights. The second section has some tips on working with the vagus from a biodynamic craniosacral therapy perspective.

How can you become a vagal superstar? How can you help your clients become vagal superstars?

Vagal superstars

The following are all features of the vagus according to Dacher Keltner (1), researcher and author of ‘Born to be Good’.

  • The vagus nerve is almost like an alternative spinal cord.
  • When you stimulate the vagus you improve people’s capacity to make decisions, this is true of the vagus nerve but not so much the spinal cord.
  • The vagus stimulates the release of oxytocin.
  • It optimises your heart rate. It evolved to support communication, social engagement and prosocial emotions such as compassion.
  • Nice touch to the back, you see a smiling face, (compassion towards) images of harm; these all cause the vagus nerve to fire. It gives specific stimulation to emotional processing centres. (Italics added)
  • ‘Vagal superstars’ demonstrate elevated base activity in vagal tone. Vagal superstars are more generous, more trusted, and kids with high vagal tone break up play ground fights.

Tips on applying the vagal brake: increasing vagal tone inhibits the sympathetics

Enhance vagal tone

  • Stimulating the new vagus (2) is the best way of switching of the sympathetics and supporting homeostasis (3), (4).
  • Be soft, slow and present.

Engage the extensors

  • Think of a monkey grabbing onto a tree trunk; all the muscles being used are flexors and are associated with sympathetics, stress and making ourselves small. The sympathetics are switched on when we contract into the fetal position.
  • We are in parasympathetic mode when we come into an upright posture with the extensors engaged. We feel safe enough to show our belly, heart and throat. We can engage with our environment, make ourselves big and move towards new things.
  • On the treatment table you can engage the extensors by getting your client to orient to the back of the body: ‘Can you feel the weight of your body on the table? Push your elbows and/or feet into the table.’

Engage the feet

  • Loss of the vagal brake results in a surge upwards as we orient; the head gets hot and tight, there is increased activity in the neck, cranium, heart, and lungs. We lose relationship to the bottom of the body and tend to disappear from our belly and our feet.
  • Grounding, being present and firing in parasympathetics nearly always involves engaging the lower half of the body and feeling the feet.
  • On the treatment table keep asking people if they can feel the size, shape and weight of their feet and their belly. Be persistent.

Facts_of_back_pain_a_man_sitting_straight_in_chair

Go slow and embody vagal states

  • Words associated with the vagal activity are trust, love, compassion, acceptance, joy. Work to find these qualities in your own body as you treat. The clients body will mirror your state.
  • Think of a perfect lazy afternoon, full of a delicious dinner, in front of a warm fire, cosy in a chair, chatting with old friends……

Know the anatomy of the vagus and its ganglia

  • The vagus can be influenced by supporting change around the jugular foramen, the superior and inferior sensory ganglia below the jugular foramen, the carotid sheath, the larynx (4), the tragus of the ear, freedom in the breath and diaphragm, and resolving inertia in and around organs (especially the heart, lungs and sub diaphragm organs) to free up vagal motor ganglia and the enteric nervous system.

The Vagus. Left: The territory innervated by the paired vagus nerves above and below the diaphragm.     Right: Vagus nerves in black, and sympathetics in white, supply the heart and organs above the diaphragm.

The Vagus. Left: The territory innervated by the paired vagus nerves above and below the diaphragm.
Right: Vagus nerves in black, and sympathetics in white, supply the heart and organs above the diaphragm.

(1)  Keltner D. (2009) Born to Be Good: The Science of a Meaningful Life. 1st Ed, W. W. Norton & Company. See also Dacher Keltner in Conversation. http://fora.tv/2009/02/05/Dacher_Keltner_in_Conversation.

(2) The ‘new vagus’ refers to the mylinated vagus controlled by the ventral vagus complex (nucleus ambiguus) that co-ordinates oxygen control inline with muscles of facial expression. Porges, S. (2011) The Polyvagal Theory: Neurophysiological Foundations of Emotions, Attachment, Communication, and Self-Regulation. New York: Norton

(3) ‘The relative sympathetic activation seen in anxiety disorders may represent dis-inhibition due to faulty inhibitory mechanisms.’ The vagus inhibits the sympathetics.   – Thayer J. and Lane R. (2000) ‘A model of neurovisceral integration in emotion regulation and dysregulation.’ Journal of Affective Disorders 61, 201–216.

(4) ‘We propose that these findings have important implications for the understanding of the two-way communication between the heart and the brain, and provide a connection among negative emotions and negative health consequences via the common mechanism of autonomic imbalance and low parasympathetic activity.’  – Thayer J. and Ruiz-Padial E. (2006) Neurovisceral integration, emotions and health: An update. International Congress Series 1287 (2006) 122–127

(4) ‘The vagus nerve innervates the larynx’ it carries ‘general sensation, including pain, touch and temperature’ from the larynx. –  Laryngeal nerve anatomy: emedicine.medscape.com accessed Feb 2014.

Image

Above is a fresh dissection showing a superior view of the cranial base with the dural lining intact, tentorium removed. The image is taken from here. You can see the olfactory and optic nerves passing through the dura. Fabulous. How shiny is the fascia lining the skull? This is very different from the dead bones you normally see.

Note how the shapes of each middle cranial fossa are quite different between the left and the right. The left greater wing seems to be anterior (towards the nose/ top of the picture). It does not look like a side bend to me – there is no bulge to the left? In Sutherland’s framework, probably a left lateral shear?

In palpating a clients head on a table, orienting to a squashed fluid balloon head, this pattern might present as the left hand towards the ceiling and the right hand towards the table. Often these are the obvious shapes and directions you feel in lateral shears, rather than feeling lateral translation of sphenoid.

Whatever we name it, and it is easy to get confused here, there is clearly experience and shaping by conditional forces. A great clinical approach is to try and work out the forces that have acted on the babies skull to generate the shapes you perceive.

For comparison here are three more real skulls, showing a variety of shapes.

 

Cranial base - three real skulls side by side

Cranial base – three real skulls side by side

cranial base labelled

 

 

dp_planes-BB

Being in 3 dimensions is part of being a member of the Universe. It seems to be one of the major aspects of it actually. Though sometimes we can feel distinctly 2 dimensional and thats not a great feeling. Anyway here’s an easy way to find your 3D. Simply come into relationship with your planes.

Most of us in the modern world are oriented to the front part of the sagittal plane. We are so front. So best to start there and notice what happens when you shift to the full sagittal experience of front and back. Yes there is a back! The sagittal plane is significant, its not just an arbitrary plane, it’s the body in stereo, a body of two halves. We are a physiological left and right organism and the sagittal plane defines that. So hang out with the plane for a just a minute and notice how your body physically responds. It loves to be reminded of it.

Now to plane no.2. The coronal plane. Named after the coronal suture at the top of the head. This one is even more significant. It’s the plane of our embryonic disk. So no small thing and a really good reminder to the body to relate back to where it formed from. Best way to get into this plane is open up to the sides of your body. Start with the felt sense of the sides of your head then follow that feeling down the flanks of the torso and outsides of the legs. Now open up to the space left and right. The lateral spaces. This is such a great feeling. It makes you instantly feel spacious. Makes you realize how lacking in lateral space we are.

And finally the transverse (or axial plane in the image). This is about the horizontal. Notice the word comes from horizon. Its a plane that is resonant with the horizon and brings all the horizontal structures of your body into communication i.e. all your transverse diaphragms which therefore brings you into relationship with the interior of the body and its volume/length.

So that’s 3 minutes to find each plane and establish your 3 dimensionality. You can see you can not only use this in daily life but also as a way to establish a state of balance awareness in BCST.

skull da sein front v2 skull da sein inferior v1 skull da sein side v1
Real skulls are so fascinating. I took these pictures of a newly acquired skull at the Da Sein Institut recently.

There is a torsion across the occiput, notice the uneven shape of the foramen magnum. You can easily make out the borders of the temporal bone and the large mastoid processes of the temporals. And square eye sockets, bizarre.

This skull has a condylar canal on both sides – first time I understood that bit of anatomy could exist. You can see the canals in the middle image, posterior to the occipital condyles.

I recently came across Jerry Hesch writing on alignment and treatment of the sacrum. He makes a convincing case for the most common sacral misalignments being torsion on one of the two oblique axis as shown below. The graphic is mine (I found his images a bit hard to follow). The model is really simple, feel for the most posterior quadrant of the sacrum and you can work out how the sacrum is torsioned using the graphic below. Hesch says the most common pattern is posterior low left sacrum.

Sacrum Hesch_edited-2

From my experience of holding lots of sacrums over the last 13 years, I would agree sacrums are often torsioned along these oblique axis. It feels a really simple way to assess the sacrum and has helped me quickly clarify my experience during treatment this week.

He includes more testing in his full assessment of the sacrum, including springing (‘springing with awareness’) the ‘four corners’ or quadrants of the sacrum in childs pose. The most posterior corner will also be the stiffest, with no anterior posterior recoil. His treatment is really simple as well, sustained anterior posterior pressure of upto 20lbs for 2 mins.

The chapter is in a new book on soft tissue work by Eric Dalton. He has commissioned chapters from most of the leading fascia researchers and practitioners around right now. I have not heard of Hesch before, but he is in very good company in Eric Dalton’s book. Here is a video of him introducing his chapter.

Reference

Jerry Hesch chapter in (2013) Dalton E. (2013) Dynamic Body: Exploring Form, Expanding Function. http://erikdalton.com/products/textbook/

He obviously is a detailed thinker, you can access more of his writing here. (I have not explored in depth.)

http://www.heschinstitute.com/hesch-method-basics.html

Chronic pain is nearly always a habit in the nervous system. Acute pain is an interpretation of nociceptive signals indicating tissue damage and inflammation. The tissues optimise the local repairs after a few months, so if the experience of pain persists then it is far more likely your central nervous system still frames the region initially damaged as unsafe in some way.

Here is a really nice graph (adapted from a NOI group training manual) giving some sense of the shift from tissue damage making up 3/4 of the pain experience in acute pain, to central processing making up 3/4 of the pain experience in chronic pain.

pain gifford graph_edited-2

New Research – you can see the changes in the brain in chronic pain

Here is a video describing how brain changes can be seen in chronic pain patients on MRI scans. Wild stuff, pain is very strange, and not what I was taught at chiropractic college.

The full original article on brain changes can be seen here

http://americannewsreport.com/nationalpainreport/scientists-say-brain-hot-wired-chronic-pain-8821714.html

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