Five Questions

[stregapez]

Yes there are. But most of them just get to the cord and are handled there. The ones that get signals all the way to the cortex, rapidly, are the large myelinated ones from skin.

The thin unmyelinated/myelinated ones that are all through all types of tissues report all the time, and yes, if the structure gets broken/torn, pain will occur, but secondary to the inflammatory process set up to stop movement and heal the area, not so much from the actual initial primary tissue rippage, especially if skin is still intact.

I don't know what else to say, except, get reading.

Hi again Diane,

Where can I find something "believable" that tells me that? So far as I can see by skimming and reading a little, that specific info is not in either of the Wall books (which arrived here yesterday from amazon.com)
nor in my physiology book.

Btw, when you say large myelinated ones are you talking about A-beta or A-delta?

When I think of what might produce that immediate, sickening ankle-twist pain I tend to think perisoteum (ok, i will consider skin ligaments too!) Periosteum has the highest innervation os mesodermal tissue doesn' it? What kind of fibers innervate it? By the way, in all honestly I don't know if I get that in "a fraction of a second" or a second and 1/2, but less than 15 seconds for sure, i think .

(Luke did you mean to say peritoneum or periosteum?, by the way)

Thanks for your patience.

Off topic (sort of) ~ How much education in the nervous system and pain does the average PT student get in PT School? ~ I'm partly just curious, partly wondering how comparatively tedious i may or may not be to have a discourse with

Dana

[Barrett Dorko]

The word in science is "provisional," as in "all knowledge is provisional," meaning that virtually nothing is known completely and this is why theory and experimentation are always ongoing.

When I speak to my classes about Wall's work I begin by quoting Ramachandran's opinion of what Wall says. This highly regarded neurologist (to say the least) makes it clear that it doesn't matter what Wall says - we have to accept it as reasonable and verified with good evidence.

For some reason, many therapists think that everyone's opinion is of equal weight. This is not the kind of mistake a scientist would make.

[Diane]

when you say large myelinated ones are you talking about A-beta or A-delta?

A-deltas are thin but myelinated. There is a thread here (on the marvelous nerve or fabulous skin or something like that, down the board a ways.) The info is here somewhere, is what I'm saying. Keep looking, you're getting warm.

[nari]

Dana

Modern PT schools in Australia, anyway, cover a great deal of neurophysiology. What they are still failing to do, but have improved out of sight over the last 10 years, is to link this knowledge with what the patient presents with. There is still mechanical thinking if a patient comes in with a sore knee or neck. As Diane says, it is the wrong end of the telescope.
Wall would not be pleased.

Most of us here have slowly increased their understanding of physiology through courses, reading and forums like this one.

Nari

[Luke Rickards]

Oops. Periostium.

[stregapez]

Hmn, that is interesting that you can make needle contact with periosteum without too much discomfort, though wondering if it's the same if a ligament or tendon was pulled away abruptly from.

Dana

[Baecker]

hi, something interesting supporting the skin versus muscle pains.

3rd degree burns

Third-degree burns are typically considered those that involve the destruction of the entire thickness of the skin, penetrating the epidermis and dermis as well as the structures located within these layers, including the blood vessels, hair follicles, sweat glands, and sebaceous glands. Since pain receptors are also destroyed by third-degree burns, this type of injury is often initially less painful than a first- or second-degree burn, and may simply seem numb to the burn victim. If pain is experienced by the patient, it is generally due to nearby areas that may have only received second-degree burns. The appearance of third-degree burns is usually leathery, but the color may vary from white or tan to brown, black, or red.

Burns are classified by depth of skin damage and by percentage of skin damaged. First-degree burns injure only the epidermis (top layer), with redness, pain, and minimal edema. In a second-degree burn, damage extends into the dermis (inner layer), with redness and blisters. Third-degree burns destroy the entire thickness of the skin. There is no pain, because the skin's pain receptors are destroyed.

after more searching on the internet i found something interesting as well. i thought i might share this with you cause i found it pretty amazing.

"As for those who reject Our Signs, We will roast them in a Fire. Every time their skins are burned off, We will replace them with new skins so that they can taste the punishment. Allah is Almighty, All-Wise." (Quran 4:56)

[Randy Dixon]

And I think it's true that skin (ectoderm) hurts way more than mesoderm. It makes sense that the outer wrapping of the body would have the fullest sensor array evolution could poossibly come up with, as it is our organismic intersection with the environment, both the outer and the inner environment. Was that your point Randy?-Diane

That was pretty much my point Diane, and it got fleshed out more in this thread. The reason I brought it up on this thread specifically though was because you had brought up the different responses of the nervous system, especially the ANS, to different tissues. So I thought

A) Does the ANS then react differently to injury to the different tissues? Does injury to the skin have the same effect as injury to the muscles or bones?

B) Can we find out anything useful from different relative sensitivities of the ecotdermic/mesodermic layers. Sort of how Galvanic Skin Response might possibly be used as an indicator of the ANS state or to measure a pain state.

[Diane]

Those are juicy questions!
Here is my little stab at answering them; some is a hunch, the rest is reasoning..

A) Does the ANS then react differently to injury to the different tissues?

No. (Hunch)

Does injury to the skin have the same effect as injury to the muscles or bones?

I guess it depends on what you mean by "effect." Injury to skin lights up the cortex a lot more, and conscious awareness more, because that's where the brain keeps its storehouse of "maps" to do with the body.. its "virtual bodies." Injury to mesoderm eventually hurts, and hurts a lot, because of secondary sensitization (I think I'm using that term correctly) of the sensory nerves by all the juice that gets poured out and leaked out onto them thanks to the inflammatory soup. The brain gets notified after the fact, by this sensitization, and limits movement because of it, not because of the "injury".. well, ok, a broken leg might be a bit more limiting right from the get-go.. but the brain will try to keep the body going if it can, anyway it can, at least for a while, to get out of danger. (Evolutionary reasoning.)

B) Can we find out anything useful from different relative sensitivities of the ecotdermic/mesodermic layers. Sort of how Galvanic Skin Response might possibly be used as an indicator of the ANS state or to measure a pain state.

I think you answered your own question, no? The skin responds/reacts to/reflects the inner environment to both the brain and to the outer environment, like a two way window. It responds, reacts to, reflects the outer environment also, by sensation, moving toward or away. It is the periscope of the submarine brain, and it's all around it, on all sides. It is an active communicator too.

[BB]

I knew this would happen! I'd have to spend full nights trying to catch up on all these great discussions (tomorrow's read will be the autonomic thread). Don't feel sorry for me. I'm behind becuase the beaches of Hawaii aren't conducive to computers.

Regarding question number 5:

Why always the hips? Is the autonomic state always reflected in the hips regardless of the area of origin of pain?

Is the reason that this an easy place to observe the tell tale markings of ANS adaptation?

In the posts that immediately followed question #5:
Diane,
Your post regarding this seems to spead to specific lower extremity abnormal neurodynamics whereas...
Barrett,
Yours seems to allude to a more general application.

Another great discussion.
Cory

[nari]

Cory

I think there are different means to the same end; viz, focus on an abnormal neurodynamic.

Nari

[Barrett Dorko]

Cory,

The hip position while supine is useful for a number of reasons:

1) The angulation and relation of the feet, one from the other, accurately depicts what the patient chooses when they first lie down. This is easily seen by everybody and the therapist has an opportunity at that moment to talk about this choice and its consequences both in terms of pain and breathing pattern.

2) Gentle passive movement from here reveals further what this patient chooses, what they're willing to do and what they're capable of doing. Simple Contact employed at this moment often begins to reveal the ideomotion necessary to correct the position.

3) The wide-spread effect of hip position becomes onvious to the patient in most sufficiently sensitized systems. Thousands of times I have seen it affect upper quarter pain immediately.

This thing with the hips both reflects and perpetuates the autonomic state (typically, not 100% of the time) and the sensation throughout the body. This makes it both a little confusing and extremely useful. If you're thoughful and follow its changing with ideomotion and Feldenkrais exercise you'll find it important for every patient with an abnormal neurodynamic.

[Bas Asselbergs]

I second that notion: by manual invitation.

[Bas Asselbergs]

OK - I am such a dork- this was in response to Barrett's 4th question on the first page of this thread - I just hit answer to Diane's "Manually" response.....Please continue....:-(

[Barrett Dorko]

Bas,

Been there. Your choice of "dork" to describe your mistake reminds me of a funny story my son tells of his adventures in Iraq:

While Alex was in a field talking to a farmer about the bombs planted along the road (the farmer hadn't seen anything, of course) he noticed a colonel's vehicle pull up behind his convoy. He sensed that this couldn't be good, and he was right. The colonel was unhappy with the way the formation had been deployed.

He said to Alex's rear gunner, "Who's your lieutenant?"

"Lieutenant Dorko, sir."

"Yea. But what's his name?"

Well, Alex's platoon thought it was pretty funny anyway.