Are things getting hot on twitter?

[PatrickL]

thanks mason. i'm glad someone can see that point.

Diane says

Manual therapy models must adapt, teach about pain, teach top-down, not just bottom-up, and interactively, not only operatively

For sure. Is this process contingent upon a conceptual meso/ecto underpinning? Is it necessarily harder to achieve these ends if the endo/meso conceptual divide is not utilized?

Diane, do you only consider the ecto/meso divide a useful heuristic to drive change, given the current state of the profession (i.e. to point out the faults in old ways and to provide a path for change that can't be confused with the old ways)? Or do you actually think that the CNS is hard wired to attend to afferent input from fellow ectodermal derivatives?

[bernard]

Neurons are using the disproportionate amount of fuel, not all of the ectoderm derivatives.
Again, this is talking about the nervous tissue not epidermis. I don't see how these arguments support the use of the ecto/meso distinction.

Since it is now a quite well assumed thing that therapy is a communication affair, it seems plausible to say that skin is more communicating than some other parts of our body.
It contains 70% of neural terminations and it is the outer and first barrier with our environment. The first called may be the first to transmit a message (via nerves).

[Evanthis Raftopoulos]

I see that neither Patrick nor Evanthis have bothered to read the McGlone paper yet. They might want to.

Thank you for the reference, I’m on it. Is there something specific in the paper that points towards the arguments presented here or helps us problem solve as to which receptors are activated during the application of light to strong stimuli? Perhaps I missed it, but I think that so far you have not provided with a clear answer for that (even speculative), and you seem to disagree with me that the activity of the superficial mechanoreceptors is possibly the dominant peripheral influence that helps construct the experience of strong stimuli.

Or not, if they want to remain staunchly mesodermalist in their thinking and treatment approaches.

None of us is ignoring the nervous system/ neurophysiology, so I think that you are being unreasonable for calling us 'mesodermalists' on the basis of our disagreements here. Thanks for the discussion though.

[bernard]

BTW, I think the distinction between meso/ecto remains useless.

[PatrickL]

But the nerves sure can, and do, and keratinocytes, which are epidermal cells, express the exact same receptors, respond to substance P, CGRP, etc.

wasnt there a paper that said that tenocytes produce substance P? I'll have to dig it up.

here it is

http://www.plosone.org/article/info%...l.pone.0027209

It has been hypothesised that substance P (SP) may be produced by primary fibroblastic tendon cells (tenocytes), and that this production, together with the widespread distribution of the neurokinin-1 receptor (NK-1 R) in tendon tissue, could play an important role in the development of tendinopathy, a condition of chronic tendon pain and thickening. The aim of this study was to examine the possibility of endogenous SP production and the expression of NK-1 R by human tenocytes. Because tendinopathy is related to overload, and because the predominant tissue pathology (tendinosis) underlying early tendinopathy is characterized by tenocyte hypercellularity, the production of SP in response to loading/strain and the effects of exogenously administered SP on tenocyte proliferation were also studied. A cell culture model of primary human tendon cells was used. The vast majority of tendon cells were immunopositive for the tenocyte/fibroblast markers tenomodulin and vimentin, and immunocytochemical counterstaining revealed that positive immunoreactions for SP and NK-1 R were seen in a majority of these cells. Gene expression analyses showed that mechanical loading (strain) of tendon cell cultures using the FlexCell© technique significantly increased the mRNA levels of SP, whereas the expression of NK-1 R mRNA decreased in loaded as compared to unloaded tendon cells. Reduced NK-1 R protein was also observed, using Western blot, after exogenously administered SP at a concentration of 10−7 M. SP exposure furthermore resulted in increased cell metabolism, increased cell viability, and increased cell proliferation, all of which were found to be specifically mediated via the NK-1 R; this in turn involving a common mitogenic cell signalling pathway, namely phosphorylation of ERK1/2. This study indicates that SP, produced by tenocytes in response to mechanical loading, may regulate proliferation through an autocrine loop involving the NK-1 R.

this seems to raise more doubt over the value of a conceptual division of ecto/meso with regards to which derivative tissues can "signal". I feel obliged to add my disclaimer that this is not a reason to base entire treatment models on the targeted stretching, massaging, poking etc of muscles, fascia, joint capsules or discs etc derivatives.

[Diane]

Some excellent points were made here, and my meso-ecto line of thinking will strive to accommodate some of them, because correct points will add to the line of reasoning, not destroy it.

I do think that the brain pays more attention to ecto derived tissue than it does to meso derived tissue. This includes its own lovely self-referential self.

A casual glance at the somatosensory cortex will tell you it pays a lot more attention to the face and tongue than to anywhere else on the body (palmar surfaces the exception). (There is always going to be exceptions.)

Teeth actually are sensitive, filled with thermoreceptivity, mechanoreceptivity.. most animals use their mouths to explore texture, surface, build cognitions about the world - humans are no exception. Babies of all species bite to find meaning.

Teeth become very sensitive as they lose their enamel. [This comes with age. I look forward to development of some sort of spray-on enamel replacement one of these days from dentists, not just fancier and more expensive kinds of toothpaste.]

Teeth have never turned up on any homuncular diagram, but I suspect it isn't because they aren't represented/representable there - only because probably no one has ever thought to check to see if when tapped their representation doesn't light up in the brain. That could be a cool project for some dental PhD student some day.

Face bones are exquisitely sensitive, which one learns if one ever has had a fall in a bathtub or something and given oneself a so-called black eye. The zygoma becomes cracked. The eye itself is fine but the surrounding tissues turn black. The tissues return to normal colour but stay tender for a few years after.

Most of the righting reflexes have to do with keeping the head, especially the face, from being struck, and most of the ducking reflexes, the same. Ken might be able to corroborate that somehow, from the sports world. Simultaneously faces, noses actually, evolved to be the first contact most swimming animals have with their environment; this got laid in pretty solid during evolutionary time. We still have this sensitivity, which I can only guess might be another ectodermal remnant from our fishy ancestors.

Other ectodermally/epidermally derived structures, such as fingernails, fur, hair, feathers, etc, are there to be like amplifiers. True, they aren't intrinsically sensitive, but the mechanoreceptor wound around the root of that hair or feather certainly is, and as the structure is bent by the breeze, the organism at the other end of the mechanoreceptor will feel it minutely. Animals of all furry or feathery species fluff themselves to find meaning. Then they groom or preen to build social relationship. And to get rid of nits, of course. Everything has a practical angle when you look closely.
These days girls go off to have their fingernails/claws decorated. They find some kind of meaning in that, I guess.
............
To conclude, the most useful thing about the meso-ecto distinction, to me, is, that, like a flare going up and hovering briefly, it can quickly highlight and sort those who can and will be willing and eager to think from a nervous system perspective (the less wrong one according to me), from those who are really left hanging as they realize that mesoderm (sorry, body structure and tissues derived from mesoderm) doesn't really have any actual agency in a human organism, but who can't let go of all the ideas they were wrongly taught or those that wrongly grew in their heads about pushing on bones , joints, muscles, fascia etc. to fix a little thing called "pain", operator style, who don't want to bother learning nerves, the only things in soft squishy parts of the body (beneath and aside from skin, obviously) that can actually "feel" you treating; whose idea of having crossed the chasm is that there are some neurons plugged into the layers of structure they hold so dear because of having been trained/having learned to think about, picture anatomically, treat operatively, from the outside in. They don't understand that ecto in meso is mostly there to swap trophic factors with it, and (in the case of muscle) to tell it what it needs to do now. And now. And now.

Some can make the leap to nerves. Some can make the leap to manual therapy, the therapy part of it, at least, being about focusing on all that is ecto and carefully stepping away from all that is meso in their reasoning (mesoning? Measoning?). Very few apparently. Which is why mentioning such distinction riles them up and thereby identifies them.

Some who don't/never learned to make the distinction at all start to confuse all glial cells with immune cells to the point they even start to call glial cells immune cells, which I can't help but call out, for I find that misleading. And yes, recently it was determined that microglia were true immune cells. All the other ones still come from ectoderm. Which makes them neural - nonneuronal but still neural.

It's a distinction I use mostly for my own purposes, and mostly around here. Mostly because I try (and fail, a lot of the time) to be correct using language, and thinking (and I fail, a lot, but I keep trying. There isn't anything better to do with my time until I go back to being mere stardust again, same as everything else around me..).

The human organism is a moving target - the study thereof, treatment thereof and interchange therewith. So I'm keeping the distinction alive - sorry boys - it's just too darn useful in helping me sort the wheat from the chaff.

And no, I'm not cemented, or "certain", unless certain that it's less wrong to do so than not to do so, then yes, certain about that one little thing.

Over and out.

[PatrickL]

Some can make the leap to nerves. Some can make the leap to manual therapy, the therapy part of it, at least, being about focusing on all that is ecto and carefully stepping away from all that is meso in their reasoning (mesoning? Measoning?). Very few apparently. Which is why mentioning such distinction riles them up and thereby identifies them.

This is quite a loaded statement. In one foul swoop you've equated questioning of the meso/ecto division with being "riled up". And that the riled up state is the result of PTs (read me and Evan, and possibly Bernard) not being able to "step away from meso reasoning" or not being able to focus on "all that is ecto". You then link the ability to "focus only on all that is ecto" with being able to "make the leap to nerves", and then you link the "ability to make the leap to nerves" with the ability to "be a manual therapist".

It's choc full of non sequiturs, and demonstrates to me that you are unable to interpret questioning of the meso/ecto division without assuming the worst of the questioner ( ie questioner must be suffering from an inability to unlearn that which they have been previously taught). It's pretty frustrating, since I think I've clearly demonstrated an understanding of your arguments AND I treat in a manner consistent with them. Please let me repeat that... I treat in a manner consistent with your ideas... Thank you for sharing then with me.

Despite that, I still maintain that a PT can, as Diane wrote:

Adapt, teach about pain, teach top-down, not just bottom-up, and interactively, not only operatively

Without using a meso/ecto conceptual division as a basis.

Some who don't/never learned to make the distinction at all start to confuse all glial cells with immune cells to the point they even start to call glial cells immune cells, which I can't help but call out, for I find that misleading. And yes, recently it was determined that microglia were true immune cells. All the other ones still come from ectoderm. Which makes them neural - nonneuronal but still neural.

Well no, it doesn't make them neural unless you equate ectodermal origin with being "neural".

To conclude, the most useful thing about the meso-ecto distinction, to me, is, that, like a flare going up and hovering briefly, it can quickly highlight and sort those who can and will be willing and eager to think from a nervous system perspective (the less wrong one according to me), from those who are really left hanging as they realize that mesoderm (sorry, body structure and tissues derived from mesoderm) doesn't really have any actual agency in a human organism, but who can't let go of all the ideas they were wrongly taught or those that wrongly grew in their heads about pushing on bones , joints, muscles, fascia etc.

Um, no. I am proof that you're off base with all these conclusions. I have been and am willing and will continue to be willing to think from a nervous system perspective. So when I question meso/ecto, I'm a false positive for your flare identifier system. Further, those who lap up the ecto/meso division, because they've bowed to your (unintentionally disseminated) intellectual authority without having thought things through thouroughly, are what I would call a false negative for your flare identifier.

to fix a little thing called "pain", operator style, who don't want to bother learning nerves, the only things in soft squishy parts of the body (beneath and aside from skin, obviously) that can actually "feel" you treating; whose idea of having crossed the chasm is that there are some neurons plugged into the layers of structure they hold so dear because of having been trained/having learned to think about, picture anatomically, treat operatively, from the outside in. They don't understand that ecto in meso is mostly there to swap trophic factors with it, and (in the case of muscle) to tell it what it needs to do now. And now. And now.

Again, you're not able to participate in this debate without assuming that questioners are irrevocably attached to erroneous thinking that they "hold dear", and desires to treat operatively.

Do you think you could suspend your default reaction to assume that I'm not just another joint head trying to cling to what I was taught in yesteryear? Do you think it's possible that I was never particularly attached to what I was previously taught? Do you think I only began asking questions when I discovered ss?

Perhaps you should get it over with and just come out and state that anyone who disagrees with any part of the model you've developed must be misunderstood .

The human organism is a moving target - the study thereof, treatment thereof and interchange therewith. So I'm keeping the distinction alive - sorry boys - it's just too darn useful in helping me sort the wheat from the chaff.

I don't think it accurately sorts anything out, all it does is reinforces your biased perspective on all this stuff.

[Diane]

Well no, it doesn't make them neural unless you equate ectodermal origin with being "neural".

Well, yes, it does. In neuroscience textbooks and in embryology textbooks. Anything that is generated from neural tube is neural, including glia. So there.

I confess; I read textbooks. Maybe that is why I sound so annoyingly declarative most of the time, don't convey the appropriate manual therapist humble "we just don't know why this works" attitude, while ignoring huge branches of basic science to do with the human organism.
BS to that. I try to d-m well find out.
If you don't like the gleanings, tough darts.

when I question meso/ecto, I'm a false positive for your flare identifier system. Further, those who lap up the ecto/meso division, because they've bowed to your (unintentionally disseminated) intellectual authority without having thought things through thouroughly, are what I would call a false negative for your flare identifier.

Thanks nice, you just keep thinking that.
You help make the place lively, I'll give you that. And you are good at making threads be ten pages and a thousand posts long.

Perhaps you should get it over with and just come out and state that anyone who disagrees with any part of the model you've developed must be misunderstood .

Perhaps I should.

[Diane]

One thing I need to clarify: I made it sound like fish invented noses. They didn't - land animals did. Fish didn't invent head ends. either. Worms did. Fish took the bilateral plan with a head end that sensed chemogradients in an environment, probably through taste, and noses came along once air became the main way to sniff out chemogradients, on land, by land animals. Who derived from fish ancestors. Who we can still blame for inventing the vertebrate nervous system - those lousy spinal cord issues we can suffer from, from time to time, which (among other things) forced the evolution of a lot more hard drive out in front to manage/inhibit its otherwise often totally unhelpful reflexive behaviour.

Just wanted to correct myself there.. don't want to mislead people.
Even though some fish certainly do look very nosy.

[Ken Jakalski]

Hi Diane!

Even though some fish certainly do look very nosy.

Like this?

[Diane]

Hi Diane!



Like this?

Yup!
And like this...

[Evanthis Raftopoulos]

Diane, couple of my central points in this thread that I feel have been ignored by you for whatever reason:

1. during the manual therapy process of applying light to strong force (let's say for example towards “deep tissue” massage in a lateral stretch +perpendicular pressure fashion), which receptors in your opinion are activated and most likely help construct the perception of stronger stimuli? For example, ruffinini endings in the subcutaneous tissue? deeper mechanoreceptors? My speculation is that the subcutaneous mechanosensitive receptors play a dominant role in the processing and experience of stronger stimuli partially due to the counter-force of the layers below, which do not seem to be as richly innervated by these receptors as the subcutaneous tissue(mesoderm derivative btw). When I mentioned this in previous posts you clearly disagreed, yet you have not provided with any reasonable alternative. How many times do I have to ask?

2. if we agree that the patient should have for the most part the locus of control of manual therapy force parameters (assuming all parameters are equally safe and appropriate in the context of quality care, and that the therapist is comfortable delivering them), then we should stop arguing which force parameter is optimal for outcomes like temporary pain relief (eg, lateral stretch vs. perpendicular force), whether we like it or not it’s not up to us, it’s up to the patient.

[Diane]

I do not know why you seem to care so much what I think.
You don't seem to care for it, yet you ask me repeatedly to reply to things I've discussed and answered in numerous threads.
I'm sorry if you don't get it.

[PatrickL]

Well, yes, it does. In neuroscience textbooks and in embryology textbooks. Anything that is generated from neural tube is neural, including glia. So there.

i see. sorry, i stand corrected. "neural" meaning derived from neural tube.

what is the implication of mislabeling glial cells as immune cells? ( i think you debated mick thacker on that point on ss somewhere.

here are mick's comments

I think that just taking a embryological perspective without considering phenotypic switching and de-differentiation in mature and responsive cells is a little short sighted and feeds the nature rather than nurture argument which is in my opinion limiting. Both immune cells and neurons constantly change their phenotype to respond to their environment and have a vast response profile inherent to them. Importantly following injury the response characteristics in terms of secondary messengers systems is almost identical in both immune cells and neurons which leads to the release of a similar profile of mediators.

I'm all for correct taxonomy for the sake of correct taxonomy. Reading too much into embryological origins and their influence on the mature cells/tissues seems, well, misguided to me.

Diane has stated that she is ectocentric - I think this is telling - as with all centricites it makes one look at topics from a single perspective - embryology is one important component to understanding the function of nociception and the potential generation of pain, but is just one of many equally important perspectives. Thanks for allowing me to comment.

I think this second paragraph neatly summarizes my disagreement with diane's perspective. All her reasoning is filtered through an ecto/meso prism. At best the ecto/meso distinction is a useful heuristic to wake up thoughtless or otherwise misguided PTs. At worst, it's a devisive distinction that creates opposing camps, leads to pointless ego defending and hampers progress for the profession.

I do think that the brain pays more attention to ecto derived tissue than it does to meso derived tissue.

I'm convinced that there is nothing in the world that could persuade you to think otherwise. I think that under varying contexts, the brain will be susceptible to having it's attention "grabbed" by afferent flow from any tissue. And I think under varying contexts, the brain will attend to afferent flow from any tissue. I do think that there exist afferent pathways that are probably more hardwired for saliency relative to others (i.e. input from skin grabs the brain's attention). I don't think that as a rule, the brain pays more attention to ecto derived tissue than meso. It doesn't make sense that it would'. And even if it did, its an untestable hypothesis that shouldnt form the basis for all the clinical reasoning of a PT.

I'm not going to bother attempting to convince anyone here of this anymore.

[Diane]

I'm not going to bother attempting to convince anyone here of this anymore.

Thank you.