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  • Facilitated Segment

    Posted by Nigel Biggs (Member # 1325) on<SCRIPT language=JavaScript1.3 type=text/javascript> document.write(timestamp(new Date(2002,0,18,15,53,0), dfrm, tfrm, 0, 0, 0, 0)); </SCRIPT> 18-01-2002 22:53<NOSCRIPT>January 18, 2002 03:53 PM</NOSCRIPT>:

    I've recently been reading about the concept of the facilitated segment in a book by Leon Chaitow,an osteopath.This idea has been around for some time in osteopathy.It states that because of abnormal afferent or sensory inputs to a particular area of the spinal cord,that area is kept in a state of increased excitationThis facilitation allows normally ineffectual or subliminal stimuli to become effective in producing efferent output from the segment,causing skeletal and visceral oggans innervated by the affected segment to be maintained in a state of overactivity.
    It struck me that this is pretty similar to what I at least understand by cental sensitisation.So have the osteopaths been ahead of the game here?I'd be interested in others' views.
    Best Wishes,
    Nigel Biggs

    <HR>Posted by Barrett (Member # 67) on<SCRIPT language=JavaScript1.3 type=text/javascript> document.write(timestamp(new Date(2002,0,18,22,20,0), dfrm, tfrm, 0, 0, 0, 0)); </SCRIPT> 19-01-2002 05:20<NOSCRIPT>January 18, 2002 10:20 PM</NOSCRIPT>:

    Nigel, Thanks for the post. I heard Irvin Korr, the physiologist who worked with the osteopaths in Kirksville Missouri in the early 50s, speak about his discovery and description of facilitation at the IFOMT meeting in Vail in ’77. I was struck by the clinical relevance of what he said and I will occasionally quote from his classic article published in ’55.
    In my personal conversation with Korr it seemed evident that he was not satisfied with the way in which those who would palpate the area of tenderness and increased sympathetic support and direct treatment to the same spot. He insisted that this was a serious misinterpretation of the concept and would never result in truly lasting care.
    Facilitation’s relation to central sensitization is interesting. Korr demonstrated that this clinical phenomenon is closely associated with our psychological state and that it maintained its presence in the absence of additional peripheral trauma. Sounds familiar to me.
    I use these facilitated segments as “doorways” into the system when trying to elicit reflexive reaction. Given the nature of the tissue here it makes sense to do so.

    <HR>Posted by chipomalley (Member # 1547) on<SCRIPT language=JavaScript1.3 type=text/javascript> document.write(timestamp(new Date(2002,0,18,22,26,0), dfrm, tfrm, 0, 0, 0, 0)); </SCRIPT> 19-01-2002 05:26<NOSCRIPT>January 18, 2002 10:26 PM</NOSCRIPT>:

    Barrett, please continue. It seems as though you have stopped short in the point you were making on the doorways... Chip

    <HR>Posted by Barrett (Member # 67) on<SCRIPT language=JavaScript1.3 type=text/javascript> document.write(timestamp(new Date(2002,0,19,9,33,0), dfrm, tfrm, 0, 0, 0, 0)); </SCRIPT> 19-01-2002 16:33<NOSCRIPT>January 19, 2002 09:33 AM</NOSCRIPT>:

    Chip, Think of the skin as the medium through which the manual caregiver must reach in order to alter the body in some way. If you see it as a door that must be breached forcefully your technique will follow suit, but if you intend to elicit a reflexive response you'll look for ways to get this door to open in response to something like a password. We know that reflexive response grows larger when the membranous tension of the cytoskeleton of the skin is high (see "Touch and Sensation" on my web site). It stands to reason that areas of increased muscle tone (a consequence of facilitation) would be the best areas to touch. Bony prominences can work well for the same reason.
    Facilitation weakens and alters the door that both protects us from insult while simutaneously offering us an entryway for touch designed to be therapeutic. To me, it's important to understand the nature of the materials in this way if you're going to deal effectively with abnormal neurodynamics.

    <HR>Posted by chipomalley (Member # 1547) on<SCRIPT language=JavaScript1.3 type=text/javascript> document.write(timestamp(new Date(2002,0,19,17,28,0), dfrm, tfrm, 0, 0, 0, 0)); </SCRIPT> 20-01-2002 00:28<NOSCRIPT>January 19, 2002 05:28 PM</NOSCRIPT>:

    What do you mean by increased muscle tone? Do you mean perhaps hypertonicity that may be called muscle spasm? i am hearing you say you are focusing on touch of these areas..overlying the muscles? I have been reading Ad Warmerdam's book in which he refers to the facilitated segment resulting in what he terms pseudoradiculopathy. This is manifested by three main findigs. These are myotimal weakness that varies by spinal joint position, a strengthening effect by sustained spinal movement into the restriction and lastly that facet mobility restriction is present as seen in weakness at the level of the spinal musculature at that level. He cites Korr in that the facilitated segment can produce intense sustained activity of the periheral nerve hence the sensitivity, hyperalgesia.

    <HR>Posted by Barrett (Member # 67) on<SCRIPT language=JavaScript1.3 type=text/javascript> document.write(timestamp(new Date(2002,0,19,20,22,0), dfrm, tfrm, 0, 0, 0, 0)); </SCRIPT> 20-01-2002 03:22<NOSCRIPT>January 19, 2002 08:22 PM</NOSCRIPT>:

    I should never have used the term "muscle tone." It's meaningless. As you say, there's a hypersensitivity in the area. Korr demonstrated a significant increase in the tendency of the muscles in the segment to contract in response to pressure upon the overlying skin. This is what Denslow, the osteopath he studied, said he could detect. Korr found him reliable. When Korr came to Atlanta to lecture he expressed serious doubt about the contribution of the facet to restricted movement preferring to blame muscles that simply wouldn't lengthen. It may be difficult to say exactly when this resistance to lengthening becomes the manifestation of unconsciously generated correction but it makes sense to me that this would occur sooner than later. The manual handling I employ seeks to amplify that correction rather than inhibit the guarding commonly thought to be the pain generator. If I find that this movement makes the patient warmer and the segment less sensitive I reason that the patient is doing something right.
    [This message has been edited by Barrett (edited January 19, 2002).]

    <HR>Posted by chipomalley (Member # 1547) on<SCRIPT language=JavaScript1.3 type=text/javascript> document.write(timestamp(new Date(2002,0,20,20,34,0), dfrm, tfrm, 0, 0, 0, 0)); </SCRIPT> 21-01-2002 03:34<NOSCRIPT>January 20, 2002 08:34 PM</NOSCRIPT>:

    I am studying your post carefully so that I can better understand your approach although we shouldn't say we have an "approach" in this topic since we haven't exactly picked a diagnosis. Rather, I think we are trying to view the explanations for the facilitated segment phenomenon. As for trying to acertain the structures responsible for pain generation, I feel that for some cases I am treating processes and not any specific structure. I think specific techniques address structure for the most part though. Please go on about the "unconciously generated correction" and the amplification thereof.. Thanks,

    <HR>Posted by Barrett (Member # 67) on<SCRIPT language=JavaScript1.3 type=text/javascript> document.write(timestamp(new Date(2002,0,20,20,44,0), dfrm, tfrm, 0, 0, 0, 0)); </SCRIPT> 21-01-2002 03:44<NOSCRIPT>January 20, 2002 08:44 PM</NOSCRIPT>:

    Chip, I agree that we need be more concerned about processes than structures. I've explained what unconsciously generated correction is about and how to go about encouraging it many, many times in essays both here and on my web site and hesitate to do so again.
    Read "Without Volition." If that doesn't explain the movement I'm talking about I don't know what more I can say.

    <HR>Posted by David Butler (Member # 1041) on<SCRIPT language=JavaScript1.3 type=text/javascript> document.write(timestamp(new Date(2002,0,21,5,56,0), dfrm, tfrm, 0, 0, 0, 0)); </SCRIPT> 21-01-2002 12:56<NOSCRIPT>January 21, 2002 05:56 AM</NOSCRIPT>:

    No doubt about the observational power of the osteopaths. Please correct me if I have missed something in the concept – I see the facilitated segment as now completely explained by central sensitisation. For example, La Motte’s work in the early 90s.
    However, I never really understood why it was referred to as the “segment” inferring a dermatomal/myotomal distribution rather than the more widespead effects we often see in central sensitisation. Cheers all

    <HR>Posted by Barrett (Member # 67) on<SCRIPT language=JavaScript1.3 type=text/javascript> document.write(timestamp(new Date(2002,0,21,8,33,0), dfrm, tfrm, 0, 0, 0, 0)); </SCRIPT> 21-01-2002 15:33<NOSCRIPT>January 21, 2002 08:33 AM</NOSCRIPT>:

    David, I agree. When we speak of the facilitated segment we are talking about research done fifty years ago. That alterations in sympathetic function are widespread remains true and central sensitization is a more accurate description of the underlying cause.
    More recently (1978) Korr wrote of "Sustained Sympathicatonia" in The Neurobiologic Mechanisms in Manipulative Therapy (Plenum Press): "Effective manipulation is that which results in the re-establishment of coherent patterns of afferent input such that local adjustive reflexes are once more appropriate and harmoniously integrated in the total, supraspinally directed patterns of activity and adaptive response. The most critical effect, clinically, is the subsidence of sympathatic hyperactivity and its pathogenic, pain-producing influences."
    I take this last sentence to mean that if your handling makes the patient warmer, you're doing the most important thing you can do. It is this that has guided me to the kind of manual technique and active movement I encourage in various ways.
    Korr goes on to say: "Improvement in the afferent input is accomplished by appropriate adjustment of articular, interosseous relationships, muscles lengths, and muscular, fascial and ligamentous tensions that enable these tissues to once more report in coherent proprioceptive patterns; and, in some process, by relieving mechanical deformation or irritation of neural structures."
    This sounds perfectly reasonable to me, and, given the date of the writing, the last part is downright prescient.
    By this time Korr seemed to have accepted the fact that facilitation was not reasonably considered "segmental" in the clinic, and neither should we. I direct my care at the nervous system, not the nerve.
    [This message has been edited by Barrett (edited January 21, 2002).]

    <HR>Posted by ian stevens (Member # 3209) on<SCRIPT language=JavaScript1.3 type=text/javascript> document.write(timestamp(new Date(2002,0,21,15,11,0), dfrm, tfrm, 0, 0, 0, 0)); </SCRIPT> 21-01-2002 22:11<NOSCRIPT>January 21, 2002 03:11 PM</NOSCRIPT>:

    nigel, i dont know if you have access to the PPA newsletter or can get hold of one but the UK physio conference had a lecture by Prof Lars Arendt Nielson from the university of Aalborg Denmark . His lecture was called Mechanisms of muscle pain and central sensitisation ....the subtitle was Muscle Pain - A window on the excitability of the Cenral nervous system ...
    Importantly the effect on muscle pain on motor activity and control was discussed. Ideas relating to the adjustment of emg profiles by biofeedback were introduced .....this has also been done by Chris Main and Paul Watson in Manchester I think.
    The 'facilitated segment' is discussed a lot in Ledermanns book and Ledermann echos many of the points raised by Barrett in relation to arousal and sympathetic facilitation ...

    <HR>Posted by Nigel Biggs (Member # 1325) on<SCRIPT language=JavaScript1.3 type=text/javascript> document.write(timestamp(new Date(2002,0,21,16,16,0), dfrm, tfrm, 0, 0, 0, 0)); </SCRIPT> 21-01-2002 23:16<NOSCRIPT>January 21, 2002 04:16 PM</NOSCRIPT>:

    Many thanks for the replies-they have certainly clarified some issues for me.As I suspected,the concept of a purely segmental facilitation seems to have been overtaken by our understanding of central sensitisation.
    Any idea where I can get hold of that newsletter Ian?Can you put me in touch with someone in the PPA?
    As ever Barrett,I'm fascinated by your approach-maybe I'll get over to attend one of your courses one day!
    Best Wishes,

    <HR>Posted by Barrett (Member # 67) on<SCRIPT language=JavaScript1.3 type=text/javascript> document.write(timestamp(new Date(2002,0,22,16,3,0), dfrm, tfrm, 0, 0, 0, 0)); </SCRIPT> 22-01-2002 23:03<NOSCRIPT>January 22, 2002 04:03 PM</NOSCRIPT>:

    Walking down the sidewalk with the dog last night I had some thoughts that may be related to this discussion. I hope so anyway. The weather here in Ohio during the past week has included a light snowfall followed by a few days of alternate freezing and warming. This has resulted in a patchwork of snow-covered ground that is quite irregular across the lawns but displays a distinct symmetry along the sidewalk. Two or three perfectly dry, clear blocks of pavement are often adjacent to another that still contains an inch of snow and ice. Precisely at the line demarcating this block from its neighbor the pavement appears again, dry as July.
    I realize that the nature of the materials of the individual square of sidewalk contributes to this though I couldn’t see any obvious pattern. It isn’t as easy as slate versus cement. It occurred to me during the course of this night time walk that the pattern of the day’s sunlight, the wind between the houses, the foot traffic and the previous care provided by each homeowner may have had something to do with this as well. And then I began to think about the pipes that led from the houses out to the street and the proximity of the sewer grates, each with their own contribution of heat. The number of influences grows the more you think about it and how they all might relate to each other can’t possibly be known in advance of the picture you eventually see.
    Isn’t the surface of the body like this? When palpation and observation reveals a variety of responses our ideas about the origin and significance of each should be tempered with the knowledge that we’re seeing the end result of a remarkably complex process and one that may or may not be relevant to the patient’s complaint. This is to say nothing of the possible transience of what is revealed. In other words, what we think we feel may not represent what we hope to change.
    Maybe stepping back and considering the “weather” within the whole body and working to change that with care that alters the total physiologic state would be a good idea. To me, this is more like what we do when we consider central sensitization rather than the “segmental” notions still often taught in the manual therapy world.
    Make sense?

    <HR>Posted by chipomalley (Member # 1547) on<SCRIPT language=JavaScript1.3 type=text/javascript> document.write(timestamp(new Date(2002,0,23,10,43,0), dfrm, tfrm, 0, 0, 0, 0)); </SCRIPT> 23-01-2002 17:43<NOSCRIPT>January 23, 2002 10:43 AM</NOSCRIPT>:

    I appreciate the chance to work this through for myself..Barrett, I am going to go to your website soon to read as you have asked. I know you have posted and explained much of your work already. Meanwhile I am thinking of a case "tennis elbow" that doesn't get better with local treatment. The extensors may be hypertonic and usually are due to articular receptor influences on gamma bias. The segmentally related spinal joint(s) would likely be C5/6 and C6/7 and the mechanoreceptor and nociceptive influences of the facet joints on the wrist extensors and the spinal muscles at the level may influence gamma and alpha neurons. There may be pain referral within the segment via polysynaptic connections with internerons in the lamina. So in this case there was no actual inflammation at the extensor tendon. This would in my mind be a causative factor to the central sensitivity state, upregulated here and often in varying degrees of reactivity. Central and peripheral changes are concurrent. If the relationship of the facilitated segment is part and parcel of CS I can accept that, it doesn't have to be cause/effect.
    What excites me is starting to define how we can best treat these conditions using the wonderful expanse of information we now have.
    Chip O'Malley

    <HR>Posted by Diane (Member # 1064) on<SCRIPT language=JavaScript1.3 type=text/javascript> document.write(timestamp(new Date(2002,0,23,17,53,0), dfrm, tfrm, 0, 0, 0, 0)); </SCRIPT> 24-01-2002 00:53<NOSCRIPT>January 23, 2002 05:53 PM</NOSCRIPT>:

    Hi Nigel, Barrett, Chip, David, Call me old-fashioned but I'm still not ready to throw away the idea of facilitated segments meaning something. (Maybe putting the idea in a box in the back of the closet, but not throwing it out. Not yet.)
    The reason is because embryologically we started out to be a worm, started to form a nervous system, then ended up on our feet with a lot more layers on the nervous system onion. The nervous system had to add new chunks of wiring and splice it in/on as we grew up and finally decided what we wanted to be (come).
    So I'm sure, based on anatomical and structural cosiderations that segmental wiring exists, although likely primitive and mostly overridden by other fancier, faster, more functional circuitry. Perhaps segmental wiring functions at some old deep level, like a background hum in the body, letting it know its origins, keeping it connected to some old life impulse. Maybe it extends all the way up into the brain and ends up as predisposition for homonculaic arrangement.
    I watched a science program last night that depicted neurons forming in a fetus and hauling themselves along glial lines (like cable cars) to their unerring destinations. From the back of the brain to the front. Wave upon wave. Layers of onion.
    The program mentioned the spontaneous connecting that happens as these neurons stretch out to their neighbours to make contact. That these contact points are spontaneous, numerically astronomical, non-hierarchical. That a newborn's brain lights up everywhere for any reason. That a preemie's brain hasn't even finished making neurons yet when it has to learn to live outside the buffer zone. (so learning disabilities happen more with preemies because of the bad timing.)

    That maturation and "learning" actually means the death of a huge percentage of this connectedness, in favor of efficiency. That by the time we become adults we have sacrificed about half of the interneuronal connectedness we were born with. Jeepers.
    Til later,

    <HR>Posted by David Butler (Member # 1041) on<SCRIPT language=JavaScript1.3 type=text/javascript> document.write(timestamp(new Date(2002,0,23,22,5,0), dfrm, tfrm, 0, 0, 0, 0)); </SCRIPT> 24-01-2002 05:05<NOSCRIPT>January 23, 2002 10:05 PM</NOSCRIPT>:

    I think the key thing here is as Chip says, that peripheral and central issues are concurrent. Its just that every human pain state has a variable contribution of processes "outside" the dorsal or medullary horn or "inside". What could be called a facilitated segment could be due to more peripheral or more central processes. This discussion will probably end up as many are now doing - how do you pick the various contributions?

    <HR>Posted by ian stevens (Member # 3209) on<SCRIPT language=JavaScript1.3 type=text/javascript> document.write(timestamp(new Date(2002,1,1,14,40,0), dfrm, tfrm, 0, 0, 0, 0)); </SCRIPT> 01-02-2002 21:40<NOSCRIPT>February 01, 2002 02:40 PM</NOSCRIPT>:

    nigel re PPA Physiotherapy Pain Association ....maybe put a request on line there is a forum there ask for someone in the area or e mail me with your address and i could photocopy some stuff out of the journal.. ian

    <HR>Posted by Medad (Member # 1588) on<SCRIPT language=JavaScript1.3 type=text/javascript> document.write(timestamp(new Date(2002,1,2,5,40,0), dfrm, tfrm, 0, 0, 0, 0)); </SCRIPT> 02-02-2002 12:40<NOSCRIPT>February 02, 2002 05:40 AM</NOSCRIPT>:

    Ian, Nigel There is a little error in the web address provided.
    The correct one is:

    Last edited by bernard; 28-12-2005, 06:18 PM.
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