Dr. Rex

[NateM]

Hi Diane,

I noticed from your website that you have taken classes from the URSA group. I hope you don't mind me asking about this on here.

I took a class w/ Dr. Rex this past May in Connecticut. I'm looking for your insight as to whether or not I should pursue further classes with them. Would you recommend it?

[Diane]

I'd recommend his courses (of which I have taken many) ahead of any others, as long as:
a) you are not trying to get certified with a bunch of letters
b) you don't really care about scholarship. He is maddeningly vague about his sources, does not ordinarily provide any list of references.

He does stick to the nervous system most of the time, the general overall function of it that is. However, he never has taught the connection that is now obvious to me - that cutaneous nerves are the primary structures affected in handling of skin and related tissues. He taught everything from a bone 'n joint perspective as I recall; even when he was teaching on-the-surface techniques he was mostly concerned about sutures or muscles or bones or fascia. He did not teach the individual nerves, which I think would have saved him a lot of time and me a lot of money. (He might be nowdays though - I don't know, I haven't been down there in years. He might have decided to improve on Barral and on yours truly.)

I gained a huge vista into the human body from him - embryology. I definitely recommend his classes for that. I've never heard anyone else even know much about that let alone teach it to PTs. I think he's right - that it's crucial we learn embryology to gain a respect for the body parts and layers and where they come from.

The other thing is that you won't get taught any absolutely crazy anti-scientific treatment constructs from him, such as fascia communicating at 20,000 times the speed of light (Barnes), or energy cysts (Upleger). You'll get the straight goods, but from the usual mesodermalist perspective, which if it drives you crazy enough, you'll want to translate eventually.

[Mary C]

Now for those of us who are not familiar with Dr Rex or his field of practice, could you please provide a link?

[Diane]

could you please provide a link?
Certainly. URSA Foundation (http://www.bearonline.com/Ursa%20Foundation.htm).

[NateM]

I gained a huge vista into the human body from him - embryology. I definitely recommend his classes for that.

That's great...he's planning on teaching the Embryology course next May at the UConn Health Center (where I took this past class).

The class I just took was on manual therapy for the sympathetic and parasympathetic NS. Great class, and really taught me that I'm woefully inadequate in my nervous system knowledge. I was the only person there that had never taken a class with him before, and perhaps not my best entry point into his material. But that is the class that has made me more interested in working at this whole CNS connection. I was amazed at how "simple" the techniques were that he taught us.

He taught everything from a bone 'n joint perspective as I recall; even when he was teaching on-the-surface techniques he was mostly concerned about sutures or muscles or bones or fascia.

I'm not sure if he has changed perspectives with regards to the cutaneous nerves or not. Most of the "basic" classes are changing over to Lino Cedros out of California. Dr. Rex mentioned that he's nearing retirement from teaching the classes. He did say that if you want a successful manual therapy practice, "treat ribs and pelvis". He said that not enough manual therapists treat either area well, especially the ribs. In fact, he stated that the rib cage class would change a person's perspective on treating patients.


I'd recommend his courses (of which I have taken many) ahead of any others, as long as:
a) you are not trying to get certified with a bunch of letters
b) you don't really care about scholarship. He is maddeningly vague about his sources, does not ordinarily provide any list of references.


My course manual from his class doesn't have any references, now that you mentioned it.

[Diane]

Lino likes to dig up old chiropractic texts, and alas, pass along the concepts that were developed by such individuals. These ideas do not cut to any good chase, instead they are a series of conceptual rabbitholes. I'm not saying that you won't learn anything, but I'm saying learn to vigorously sift through whatever you learn. Keep the physical handling bits that feel right and discard all crazy constructs.

If you are learning about the sympathetic and parasympathetic nervous systems, just bear in mind that everything about skin is sympathetic. The only place you find parasympathetic innervation on a human (where you can touch it, anyway) is a bit in the skin of the lips. So don't take too seriously any idea that you can affect the parasympathetic anyway but reflexively. Primary contact of skin will elicit sympathetic response only. Which is why it's a great idea to make your initial touch as kind as is humanly possible, until the patient's brain can downregulate itself.

[NateM]

Lino likes to dig up old chiropractic texts, and alas, pass along the concepts that were developed by such individuals.


Bear mentioned that Lino read a ton of books, but never mentioned what they were.


I'm not saying that you won't learn anything, but I'm saying learn to vigorously sift through whatever you learn. Keep the physical handling bits that feel right and discard all crazy constructs.


That's why I'll be deferring to this board to help with those decisions as I'm learning.


Primary contact of skin will elicit sympathetic response only. Which is why it's a great idea to make your initial touch as kind as is humanly possible, until the patient's brain can downregulate itself.


The techniques are very gentle that he went over. In fact, it's the subtle aspects of touch that I work at. I keep reminding myself "Easy and slow". Developing this touch is a slow process for me, but I don't want to rush it.

So don't take too seriously any idea that you can affect the parasympathetic anyway but reflexively.

Where would breathing techniques fit into parasymp. regulation?

[Diane]

Where would breathing techniques fit into parasymp. regulation?

I don't know where they'd fit into parasympathetic regulation. Maybe nowhere. Maybe that's just a story that is treated as if it were true.
The respiratory center is a function of one of the medullary nuclei. (Or so I read in Encyclopedia of the Human Brain. I don't remember which one.)

I suspect that deliberately deep breathing, i.e., taking over a function which usually is performed nonconsciously, brings cortex down to nuclei, strengthens projection pathways from cortex to cord. If deep breathing can be done deliberately I suspect a lot of other cortico-nuclei pathways get a boost at the same time. This helps the system downregulate itself (pain-wise anyway. Ask any woman who's had a baby.) So, I think deep breathing may not have anything to do with "parasympathetic" after all, at least not in any sort of direct way. Of course if someone can manage their pain better with deep breathing, and pain isn't tightening up the whole organism, everything will likely work better. Including childbirth.

[NateM]

I'm recalling without my notes in front of me, but I believe Bear make a comment that the techniques he taught us were to either up-regulate or down-regulate the SNS. By down-regulation of the SNS, you enable the PNS to "express" itself better. Most of this was done through manipulation of the cervical, abdominal and pelvic ganglia.

[Diane]

Bear make a comment that the techniques he taught us were to either up-regulate or down-regulate the SNS. By down-regulation of the SNS, you enable the PNS to "express" itself better. Most of this was done through manipulation of the cervical, abdominal and pelvic ganglia.

That's nice. Nowadays though, I would ask him,

1. how does he know for sure that's what's happening? Or is he just passing on some ancient manual therapy conceptual nugget? I.e., can he show definitively that that is precisely what's happening?

2. how does he get his hand through the skin and body wall to get specifically on those particular ganglia?

3. how can he possibly eliminate somaesthetic cortical influences on down through thalamic, limbic, insular, midbrain, pons and medullary processing (which present many confounding variables) to just consider a direct influence on the PNS ganglia through some sort of handling done peripherally?


I consider his construct a peripheralist one, mired in historicity, which does not do justice to the vast reams of info now available. I got a bit tired after awhile, didn't feel I was learning anything new. He never taught the anatomy/physiology of nerves themselves, which had become a new obsession for me after attending Butler's classes.

The last class I went down for was ostensibly about the brain, but it wasn't about the "brain" so much as it was just another class on how to stick your fingers in someone's mouth and imagine you could feel the palatine bone moving. At that point I announced (out loud) that in my opinion it was impossible to feel something like that (picture shocked hush from the faithful assembled here), and gave up going down there. Much as I once enjoyed learning from him, I felt I'd learned all I could from him. I feel I narrowly escaped drinking the ultimate manual therapy peripheralist koolaid.

None of this personal disillusionment is to say that I don't think he's a good teacher. He is, one of the best, ... but he has not, in my opinion, really kept pace with what is now available with regard to the nervous system nor has he updated his teaching of manual therapy to really include it.

Ironically, he is responsible for me having finally decided to become a computer owner/operator. He can consider me well- and truly weaned.

[NateM]

...it was just another class on how to stick your fingers in someone's mouth and imagine you could feel the palatine bone moving.


Funny you mention this...overheard a couple talking about this same technique during one of the breaks. Apparently this is a bugger of a bone! :rolleyes:

2. how does he get his hand through the skin and body wall to get specifically on those particular ganglia?

We were taught it was a quarter-sized nodule at each repsective location (e.g. the celiac ganglia is supposedly 1-1.5 inches inferior of the xyphoid).

I feel I narrowly escaped drinking the ultimate manual therapy peripheralist koolaid.


If I were better read on the material, perhaps I could have asked more questions. Combined with the fact that I was the only newbie to URSA classes, I just smiled and nodded. I was constantly hearing how I NEEDED to go to the thoracic class in Sacramento this Sept.: it would "change my life". So I guess I was offered a cup, but I kindly put it back on the table.:)

[Diane]

We were taught it was a quarter-sized nodule at each repsective location (e.g. the celiac ganglia is supposedly 1-1.5 inches inferior of the xyphoid).
Ah yes - the vest button reflex points. Bear in mind (a little phrase I picked up from Bear) ... bear in mind that you are not touching ganglia there - you are touching nothing of the nervous system but anterior cutaneous nerves and sensory transducers. Now, maybe you can help the system downregulate by finding those spots and carressing them carefuly, I'm not going to say one can't, but I'm not going to any longer entertain any koolaid idea that anything I'm doing on the front of the belly through the skin (body wall, omentum, all the viscera that might be in the way) is going to directly access abdominal ganglia. Maybe reflexively.... maybe.... but it's a long stretch, and the input/info is going to take a mighty circuitous and tangled route through all the brain parts/body maps before it will ever reach the ganglia. It's a very chiro idea, actually, that one can affect the nervous system, change segmental output inwardly toward ganglia and viscera by handling the outer surface of the body.. it's in the same league as other perceptual fantasies based on conceptual hallucinations, until proven otherwise.

I'm not saying it's a wrong thing to do - putting the hand on the belly is soothing, etc., but I don't think the treatment construct (specific input to elicit specific and segmental reflexive output) is worth much.

[NateM]

Your reply, Diane, reminds me of some of the other posts I've been reading on here regarding the ability to palpate specific vertebral motion and the "magical" fingers that some possess.

I wonder how many students, when being "taught" these and other manual techniques, either give up because of frustration or feel like losers when they are unable to "feel" the correct bone/movement that the instructor insists is there. Or maybe they just agree that they can feel it and lie. I don't know which is worse.

I confess I've given the "Oh, yeah...now I feel it" statement before. I always thought my palpation skills were just poor. Maybe I just wasn't fooling myself like the instructor.

[Diane]

Your reply, Diane, reminds me of some of the other posts I've been reading on here regarding the ability to palpate specific vertebral motion and the "magical" fingers that some possess.

I wonder how many students, when being "taught" these and other manual techniques, either give up because of frustration or feel like losers when they are unable to "feel" the correct bone/movement that the instructor insists is there. Or maybe they just agree that they can feel it and lie. I don't know which is worse.

I confess I've given the "Oh, yeah...now I feel it" statement before. I always thought my palpation skills were just poor. Maybe I just wasn't fooling myself like the instructor.

Entertaining a perceptual fantasy is one thing, but permanently cementing it to a conceptual hallucination is quite another, and does us all a disservice in the long run. Teaching the two together as if they were one and the same has left many a well-intentioned human primate social groomer permanently mind-bent, or at least numbed. This is the Dangerous Koolaid Factor, (DKF) best avoided entirely by instructors. But if instructors don't care about it, then the least we can do here is warn and advise potential drinkers of koolaid that their minds can be affected not just by what they've learned, but by how it's been presented.

I'd say that of any of the educators out there, Barrett has given this the most thought, and has largely succeeded in deconstructing the two elements from each other. And now his whole course is about how to do this yourself. Some, like Bear, really really try to keep the two things separate in the first place (but don't always succeed). Others like Upleger and Barnes couldn't care less, in fact they try to weld the two all the way into each other.

I don't know about what's up in this regard in the ortho side of the PT planet, but it seems to me that motion palpation combined with conceptual hallucinations that put joints as the sole source of pain, well, maybe muscles and tendons sometimes, are alive and doing well, rampaging like a forest fire. I hope I'm wrong. To this class of educator (at least in my own experience, which was long ago, in th eighties/early 90s), the "nervous system" consists merely of wires that go to the cord or brain, that signal if you push the bone the right way, get the right motion, and then pain is somehow relieved. I could be wrong about this too, now - hope I am.