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  • #91
    Originally posted by Evanthis Raftopoulos View Post
    Here we go again, appealing to the Ecto/meso chasm tradition. Ruffini endings are embedded in mesoderm derivative (subcutaneous tissue), if you claim that you target them in a meaningful way, that makes you a mesodermalist by the ecto/meso construct.
    It does not.

    Subcutaneous tissue is not 'structural mesoderm' the way bones/joints/muscle/tendon/fascia is. It's not there to move us around. It's there to keep us warm.

    What do you mean magically stimulating? Mechanoreceptors and nociceptors are stimulated by mechanical stimuli. I haven’t claimed that I know for sure it’s a worthy goal to stimulate them, or one that we can generalize to all diagnoses/pt population. I argued that we can influence them through movement (not necessarily in a meaningful way), and that heavier pressure is processed differently in the brain for a reason.
    Self-generated mechanical stimuli. I'm pretty sure they evolved as feedback mechanisms, not as human primate social grooming targets.
    Heavier pressure in a pain situation usually leads to yet more pain.
    Why go heavier if lighter works as well if not better?

    Perhaps it’s the ruffini endings in the subcutaneous tissue being pushed against deeper layers that help create the experience of feeling the deeper layers, including bony landmarks and joints.
    Pure speculation. You wish that happened. It doesn't as far as I know.

    On a side note, Max Zusman suggested that there is some support that stronger stimuli = opioid involvement at the pathological site (more research needed). What is your speculation for how the stronger stimuli is being processed? In other words, why does it feel different in your opinion?
    I have no idea why he would say that. Show me the (speculative, probably) evidence he used for that.

    That’s not true. Every receptor has a threshold. Sensitized peripheral receptor just means that the receptor has a lower than baseline threshold. How this is processed in the brain is a different story and sensitive to other variables.
    Each receptor has a different stimulus it will respond to.
    To be fair there are a lot that are polymodal. When sensitized they will respond to thermal, mechano, or chemo stimuli.
    But don't go there. Don't stimulate them in the first place. They are nociceptive capable.
    Stick with stimulating LOW-threshold mechanoreception. It works better for stimulating descending modulation and motor illusion of a favourable kind (limbs lengthening etc.)

    We can argue that it’s good because
    - from the neuromatix perspective: the cognitive-evaluative center “cares” about them, we can even argue that in the context of tissue injury, it "cares" more about info coming from them (internal environment) than info from external environment
    - stimulating the layers that are embedded in may help improve oxygenation of their environment and/or help towards other positive changes in the context of restoring thresholds / desensitization
    Next.

    Well that's a straw man, nobody here is ignoring surface neuroanatomy.
    Gee, you could have fooled me, debating this as though it were a FIFA event or something.
    Diane
    www.dermoneuromodulation.com
    SensibleSolutionsPhysiotherapy
    HumanAntiGravitySuit blog
    Neurotonics PT Teamblog
    Canadian Physiotherapy Pain Science Division (Archived newsletters, paincasts)
    Canadian Physiotherapy Association Pain Science Division Facebook page
    @PainPhysiosCan
    WCPT PhysiotherapyPainNetwork on Facebook
    @WCPTPTPN
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    @dfjpt
    SomaSimple on Facebook
    @somasimple

    "Rene Descartes was very very smart, but as it turned out, he was wrong." ~Lorimer Moseley

    “Comment is free, but the facts are sacred.” ~Charles Prestwich Scott, nephew of founder and editor (1872-1929) of The Guardian , in a 1921 Centenary editorial

    “If you make people think they're thinking, they'll love you, but if you really make them think, they'll hate you." ~Don Marquis

    "In times of change, learners inherit the earth, while the learned find themselves beautifully equipped to deal with a world that no longer exists" ~Roland Barth

    "Doubt is not a pleasant mental state, but certainty is a ridiculous one."~Voltaire

    Comment


    • #92
      Why go heavier if lighter works as well if not better?
      Why indeed. Why do you, Diane? You've said you do albeit slowly. Why? Is it any more of a fools errand to "go heavier" with the intention of activating deeper receptors than it is to do so with the intention of "bending some deep nerve branch around some corner"? Surely the risks are equal?

      Comment


      • #93
        Originally posted by PatrickL View Post
        Why indeed. Why do you, Diane? You've said you do albeit slowly. Why? Is it any more of a fools errand to "go heavier" with the intention of activating deeper receptors than it is to do so with the intention of "bending some deep nerve branch around some corner"? Surely the risks are equal?

        No. When you give a nervous system time to adapt, and are careful to not "nocicept" anybody in the process, it has a chance to compute without being provoked to defend.
        Diane
        www.dermoneuromodulation.com
        SensibleSolutionsPhysiotherapy
        HumanAntiGravitySuit blog
        Neurotonics PT Teamblog
        Canadian Physiotherapy Pain Science Division (Archived newsletters, paincasts)
        Canadian Physiotherapy Association Pain Science Division Facebook page
        @PainPhysiosCan
        WCPT PhysiotherapyPainNetwork on Facebook
        @WCPTPTPN
        Neuroscience and Pain Science for Manual PTs Facebook page

        @dfjpt
        SomaSimple on Facebook
        @somasimple

        "Rene Descartes was very very smart, but as it turned out, he was wrong." ~Lorimer Moseley

        “Comment is free, but the facts are sacred.” ~Charles Prestwich Scott, nephew of founder and editor (1872-1929) of The Guardian , in a 1921 Centenary editorial

        “If you make people think they're thinking, they'll love you, but if you really make them think, they'll hate you." ~Don Marquis

        "In times of change, learners inherit the earth, while the learned find themselves beautifully equipped to deal with a world that no longer exists" ~Roland Barth

        "Doubt is not a pleasant mental state, but certainty is a ridiculous one."~Voltaire

        Comment


        • #94
          You tell me where else endings like that live. The info I have says they are muscle spindles (proprio) GTOs (proprio) and Ruffinis (proprio/extero).

          A quick search revealed
          Ruffini's corpuscles, although structurally similar to other tactile receptors, are not well understood. These elongated, spindle-shaped capsular specializations are located deep in the skin, as well as in ligaments and tendons.
          Diane
          The internal proprios can signal stretch, and the brain uses the information to adjust motor output. Ruffinis have a role to play in tactile direction discrimination, according to Olausson, which is something else altogether, a more cognitive role to play.
          I'm not trying to make the case that we should develop manual therapy models that focus on deeper than skin mechanoreceptors. I think someone could though (as long as they included the role of the skin) and that the model could be as defensible as DNM. I'm simply arguing that your perspective is blinkered if you've concluded that the only mechanoreceptors that contribute to the sensory/discrim component of your treatment lie in the skin. This is especially the case when you start leaning on patients with all your body weight.

          I think that is pretty straight forward. I don't know why you're not willing to acknowledge that.

          Comment


          • #95
            No. When you give a nervous system time to adapt, and are careful to not "nocicept" anybody in the process, it has a chance to compute without being provoked to defend.
            So given equal speed, the guy who tries to bend nerves around a corner is taking an equal risk to the guy who tries to activate deeper receptors.

            Comment


            • #96
              You still haven't answered the main question of why? Why do you ever have to go heavier if skin input is always sufficient?

              Comment


              • #97
                Here is a primer on exteroception.

                About Ruffini's being found in tendons, I don't know what Purves is thinking. He has always made distinctions between GTO's and Ruffini's. He even elaborated on that, years ago, saying that GTOs were similar but less well organized.
                Diane
                www.dermoneuromodulation.com
                SensibleSolutionsPhysiotherapy
                HumanAntiGravitySuit blog
                Neurotonics PT Teamblog
                Canadian Physiotherapy Pain Science Division (Archived newsletters, paincasts)
                Canadian Physiotherapy Association Pain Science Division Facebook page
                @PainPhysiosCan
                WCPT PhysiotherapyPainNetwork on Facebook
                @WCPTPTPN
                Neuroscience and Pain Science for Manual PTs Facebook page

                @dfjpt
                SomaSimple on Facebook
                @somasimple

                "Rene Descartes was very very smart, but as it turned out, he was wrong." ~Lorimer Moseley

                “Comment is free, but the facts are sacred.” ~Charles Prestwich Scott, nephew of founder and editor (1872-1929) of The Guardian , in a 1921 Centenary editorial

                “If you make people think they're thinking, they'll love you, but if you really make them think, they'll hate you." ~Don Marquis

                "In times of change, learners inherit the earth, while the learned find themselves beautifully equipped to deal with a world that no longer exists" ~Roland Barth

                "Doubt is not a pleasant mental state, but certainty is a ridiculous one."~Voltaire

                Comment


                • #98
                  Originally posted by PatrickL View Post
                  You still haven't answered the main question of why? Why do you ever have to go heavier if skin input is always sufficient?
                  Neurodynamics. Say it with me, slowly. Neu-ro-dy-na-mics.
                  Diane
                  www.dermoneuromodulation.com
                  SensibleSolutionsPhysiotherapy
                  HumanAntiGravitySuit blog
                  Neurotonics PT Teamblog
                  Canadian Physiotherapy Pain Science Division (Archived newsletters, paincasts)
                  Canadian Physiotherapy Association Pain Science Division Facebook page
                  @PainPhysiosCan
                  WCPT PhysiotherapyPainNetwork on Facebook
                  @WCPTPTPN
                  Neuroscience and Pain Science for Manual PTs Facebook page

                  @dfjpt
                  SomaSimple on Facebook
                  @somasimple

                  "Rene Descartes was very very smart, but as it turned out, he was wrong." ~Lorimer Moseley

                  “Comment is free, but the facts are sacred.” ~Charles Prestwich Scott, nephew of founder and editor (1872-1929) of The Guardian , in a 1921 Centenary editorial

                  “If you make people think they're thinking, they'll love you, but if you really make them think, they'll hate you." ~Don Marquis

                  "In times of change, learners inherit the earth, while the learned find themselves beautifully equipped to deal with a world that no longer exists" ~Roland Barth

                  "Doubt is not a pleasant mental state, but certainty is a ridiculous one."~Voltaire

                  Comment


                  • #99
                    Neurodynamics. Say it with me, slowly. Neu-ro-dy-na-mics.
                    What do you argue drives the abnormal neurodynamic? Answer: defensive motor output. What do you argue is all that is needed (from a sensory/discrim input perspective) to resolve defensive motor output? Answer: activation of ruffinis via skin stretch.

                    So why do you ever need to "go heavier"?

                    Comment


                    • You seem not to have answered this either
                      So given equal speed, the guy who tries to bend nerves around a corner is taking an equal risk to the guy who tries to activate deeper receptors.

                      Comment


                      • This looks pretty comprehensive. Chapter 2: Somatosensory Systems
                        Modality specificity, tactile stimuli vs. proprioceptive stimuli, organization, adequate stimulus, receptor types, Ruffini corpuscles (and this source also says they are in skin, joint, ligament but doesn't mention tendon). It says,
                        The Ruffini corpuscles are oriented with their long axes parallel to the surface of the skin and are most sensitive to skin stretch. Stretching the skin (Figure 2.17) stretches the collagen fibers within the Ruffini corpuscle, which compresses the axon terminals. As the collagen fibers remain stretched and the axon terminals remain compressed during the skin stretch, the Ruffini corpuscle's 1° afferent axon produces a sustained slowly adapting discharge to maintained stimuli.
                        However, later, it says,
                        Golgi tendon organs are found in the tendons of striated extrafusal muscles near the muscle-tendon junction (Figure 2.22). Golgi tendon organs resemble Ruffini corpuscles. For example, they are encapsulated and contain intertwining collagen bundles, which are continuous with the muscle tendon, and fine branches of afferent fibers that weave between the collagen bundles (Figure 2.24). They are functionally "in series" with striated muscle.

                        The Golgi tendon organ collagen fibers are continuous with the extrafusal muscle at one end and with the muscle tendon at its opposite end. Consequently, the mechanical force on the organ is maximal when the extrafusal muscles contract, shorten, and increase the tension on the tendon. When the muscles contract, the 1° afferent terminals are compressed and remain compressed as long as the muscle remains contracted. The Golgi tendon organ 1° afferent response to sustained isometric muscle contraction is slowly adapting, and the 1° afferent generates action potentials as long as the tension is maintained. The responses of the Golgi tendon organ 1° afferent axon is maximal when the contracted muscle bears a load, e.g., when lifting a heavy object.
                        I should think that the only time a person inside a nervous system would "feel" proprioception, in the context of receiving manual therapy, would be when a change happens, i.e., when the brain has decided to inhibit a motor output. Then a burst of proprioceptive input (phasic) might occur sufficient to register as an input to a person's conscious awareness. They might feel it as an expansion, or a lengthening.
                        Otherwise, I'm pretty sure (mere tonic) proprioceptive input would be largely if not wholly ignored by the brain.

                        About joint receptors, the link says,
                        Joint receptors are found within the connective tissue, capsule and ligaments of joints (Figure 2.25). The encapsulated endings resemble the Ruffini and Pacinian corpuscles and the Golgi tendon organs.
                        Here, it doesn't say they "are" Ruffinis, it says they "resemble" them.

                        The summary:
                        In this chapter, you have learned about somatosensory stimuli and the receptors of three components of the somatosensory systems. These three components provide accurate information about the location, shape, texture, and movement of tactile stimuli, (discriminative touch), the position and movement of body parts (proprioception) and the application and location of painful stimuli (nociception). Tactile and proprioceptive stimuli are the mechanical forces produced when skin contacts external objects (discriminative touch), limbs oppose the force of gravity (body position) and muscles contract and body parts move. Painful stimuli are tissue-damaging forces. The sensations produced are those of touch, pressure, flutter, and vibration/movement (discriminative touch), body position and movement (proprioception), and sharp cutting pain. The discriminative touch receptors are encapsulated 1° afferent terminals (Meissner, Pacinian and Ruffini corpuscles), hair follicle endings and Merkel complexes in skin. The proprioceptive receptors in muscle are also encapsulated and include the muscle spindle and Golgi tendon organ. The joint receptors are similar to the encapsulated endings in skin and tendon and are found in the joint capsule and ligaments. The sharp cutting nociceptors are free nerve endings.

                        Although it is convenient to subdivide somatosensory receptors and pathways for didactic, clinical and research purposes, it is important to keep in mind that most somatosensory stimuli act simultaneously and in varying degrees on all somatosensory receptors in the body part stimulated. For example, placing a heavy, cold object in an outstretched hand produces tactile, thermal, and proprioceptive sensations that allow us to appreciate the presence (touch, pressure), temperature, and weight of the object and provide proprioceptive information for finger, wrist and arm adjustments so we do not drop the object.
                        OK, boys, I concede the point that outside pressure can't stimulate deeper mechanoreception.

                        I refuse, however, to concede that using that, as some sort of defence of going after mesodermal target while ignoring all the sensitivity of skin layer (on surface) and nerve (anywhere, i.e. ECTO-dermal consideration), and building a treatment model in which ectodermal derivative is thereby invisible-ized, isn't wrong-headed, de-sensitizing for the therapist, and therefore bad in the long run for patients in particular and manual therapy in general.
                        Diane
                        www.dermoneuromodulation.com
                        SensibleSolutionsPhysiotherapy
                        HumanAntiGravitySuit blog
                        Neurotonics PT Teamblog
                        Canadian Physiotherapy Pain Science Division (Archived newsletters, paincasts)
                        Canadian Physiotherapy Association Pain Science Division Facebook page
                        @PainPhysiosCan
                        WCPT PhysiotherapyPainNetwork on Facebook
                        @WCPTPTPN
                        Neuroscience and Pain Science for Manual PTs Facebook page

                        @dfjpt
                        SomaSimple on Facebook
                        @somasimple

                        "Rene Descartes was very very smart, but as it turned out, he was wrong." ~Lorimer Moseley

                        “Comment is free, but the facts are sacred.” ~Charles Prestwich Scott, nephew of founder and editor (1872-1929) of The Guardian , in a 1921 Centenary editorial

                        “If you make people think they're thinking, they'll love you, but if you really make them think, they'll hate you." ~Don Marquis

                        "In times of change, learners inherit the earth, while the learned find themselves beautifully equipped to deal with a world that no longer exists" ~Roland Barth

                        "Doubt is not a pleasant mental state, but certainty is a ridiculous one."~Voltaire

                        Comment


                        • Link
                          This study demonstrated an abundant innervation of the fascia consisting in both free nerve endings and encapsulated receptors, in particular, Ruffini and Pacini corpuscles.
                          Disclaimer: I've only read the abstract for this link.

                          Comment


                          • It does not.

                            Subcutaneous tissue is not 'structural mesoderm' the way bones/joints/muscle/tendon/fascia is. It's not there to move us around. It's there to keep us warm.
                            Now you are trying to make a disctinction between ‘structural mesoderm’ derivatives and other mesoderm derivatives in order to fit your explanatory model (instead of modifying the explanatory model accordingly). The term mesoderm is clearly being misused in the ecto-meso construct.
                            Self-generated mechanical stimuli.
                            By ‘self-generated’ do you mean that deeper than subcutaneous mechanoreceptors/nociceptors can only be activated with active movement? If yes, then I disagree. We can stimulate mechanosensitive receptors including nociceptors with passive movement. What happens if you pinch yourself hard? Isn’t nociceptive drive most likely occurring and also most likely contributing to the experience of discomfort? How about the DNIC/counter-irritation analgesia mechanism when in pain?

                            Heavier pressure in a pain situation usually leads to yet more pain.
                            That’s not necessarily true. Stronger stimuli feels optimal to many people (in my experience) in the context of relief, and often regardless if the individual is in pain or not. For some people gentle stimulation feels suboptimal or even unhelpful.
                            Why go heavier if lighter works as well if not better?
                            Because lighter is not always effective in the context of MT/pain relief, while at the same time stronger stimuli seems to be more effective. Moreover, one could argue that the target outcome is mobilizing as many tissue layers as possible (for health and functionality of tissues) regardless of how that info is processed in the brain. I'm certainly not suggesting that stronger stimuli is always more effective or optimal either.

                            Pure speculation. You wish that happened. It doesn't as far as I know.
                            It seems plausible to me. Ruffini endings should have the capacity to respond to mechanical stimulation independent of the direction that the force is being applied, no? I've asked you many times now, what is your explanation for why strong stimuli feels different from light stimuli? If it’s not solely because of the ruffini endings, then what other receptors are responsible for the variable experience in your opinion (assuming all the other variables remain the same)?
                            I have no idea why he would say that. Show me the (speculative, probably) evidence he used for that.
                            see 30 minutes into his presentation here, the studies are referenced.


                            But don't go there. Don't stimulate them in the first place. They are nociceptive capable.
                            Do you also tell a patient not to wt bear on his injured leg because that might activate nociception? I think part of the desensitization process involves exposure to mechanical stimuli, passive or active. Whether the passive activation coincides with your treatment philosophy is a different story and up for debate.
                            Stick with stimulating LOW-threshold mechanoreception. It works better for stimulating descending modulation
                            I don’t think that we can make/ generalize this conclusion.

                            Next.
                            ???

                            Gee, you could have fooled me, debating this as though it were a FIFA event or something.
                            That’s not my intention Diane. You strongly implied that I must be ignoring surface neuroanatomy. I'm not, and I’m making a point that you misinterpreted my arguments so hopefully this doesn’t come up again in the future.
                            -Evan. The postings on this site are my own and do not represent the views or policies of my employer or APTA.
                            The reason why an intellectual community is necessary is that it offers the only hope of grasping the whole. -Robert Maynard Hutchins.

                            Comment


                            • OK, boys, I concede the point that outside pressure can't stimulate deeper mechanoreception.
                              can't or can?
                              I refuse, however, to concede that using that, as some sort of defence of going after mesodermal target while ignoring all the sensitivity of skin layer
                              As I mentioned before, I'd be happy to give much and even all the credit to the ruffini endings on the surface for the perception of stronger stimuli. I offered an explanation, the counter-force of the layers below on the ruffini endings during heavier pressure helps construct the experience of feeling deeper layers. Patrick, do you accept this explanation as a reasonable one?
                              -Evan. The postings on this site are my own and do not represent the views or policies of my employer or APTA.
                              The reason why an intellectual community is necessary is that it offers the only hope of grasping the whole. -Robert Maynard Hutchins.

                              Comment


                              • part of my reply to Diane above:

                                What happens if you pinch yourself hard? Isn’t nociceptive drive most likely occurring and also most likely contributing to the experience of discomfort? How about the DNIC/counter-irritation analgesia mechanism when in pain?
                                Perhaps the pinch example is not appropriate in the context of discussing activation of deeper mechanoreceptors. I realize that the response that follows can be due to nociceptors being activated in the superficial layers, not necessarily the deeper layers. I think a more appropriate example is passively stretching let's say your finger into extension until it starts hurting. This suggests that activation of 'deep' nociceptors is most likely occuring.
                                -Evan. The postings on this site are my own and do not represent the views or policies of my employer or APTA.
                                The reason why an intellectual community is necessary is that it offers the only hope of grasping the whole. -Robert Maynard Hutchins.

                                Comment

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