Crossing the Chasm - Meso to Ecto

[Barrett Dorko]

John,

I work in the same place these days. It sucks.

It took a long time for the geologic community to figure out how the formations they observed were, well, formed. But in the eighteenth century they finally discovered a repair mechanism that could balance the process of erosion; a way in which the earth might be rebuilding itself so that it might last.

Paraphrased from Midgley

The quote above brought to mind the natural processes of self correction and neuroplasticity that have been discussed on this site for several years now. Both of these are decidedly ectodermal.

Regulars here seem to understand something fundamental about human function others have yet to see or speak about publicly. Still, time after time, I’ve had students come up to me in class and say (often in hushed tones), “I’ve been handling my patients like this for a long time but never had an explanation for its effect.”

The question remains: Why didn’t they ask their colleagues about what they were seeing?

[Walt Fritz]

John,

Whether one is ecto- or meso-based, options do exist to so as to not be trapped in the "treat to document" quagmire. While I am considering "ecto" explanations more these days, my practice has always been one of avoiding the situations that you described.

[Diane]

The question remains: Why didn’t they ask their colleagues about what they were seeing?

They must have been afraid of what the answer might have been. I.e., maybe they were afraid of the latest new-age or otherwise shallow, goofy "explanation", borrowed from the latest neighbourhood "free" journal delivered door to door and paid by vitamin, chiropractic, and various "healer" advertisers.

[smith]

They didn't want to appear stupid, and. lets face it, the nerves are mysterious. If I didn't have so many nerve problems myself, It would tough to believe .

[Barrett Dorko]

No doubt there’s something mysterious about humans in pain for no obvious reason. Many therapists have sought to solve this problem by understanding the anatomy hidden beneath the skin but, as Butler pointed out long ago, we aren’t treating the anatomy – we’re treating the physiology.

My recent conversation with Stan Paris revealed that he was now writing a book that he feels will be “definitive” regarding the anatomy of the lumbar spine.

Such a focus can only result in the mesodermal perspective we see the profession clinging to like grim death, but, as Midgley says, it is the contour of the visible surface we should attend to and this contour is at root fractal. This means that the underlying processes are chaotic in the sense that modern science has defined it. We can’t expect to disturb it with our touch and get a response specifically predicted by an anatomical part without a purely predictable pattern of reaction; in other words, a life of its own. See Collecting Butterflies and Stepchild for some writing I did about this nearly 15 years ago.

Maybe it is this recognition of chaos within the body that has deepened and widened the chasm.

It has also made what we see far more mysterious.

[Diane]

I guess we can presume all sorts of things re: why it's so hard to persuade people to move across the chasm from meso to ecto... I think it mostly boils down to some sort of failure to visualize, failure that is heavily exploited by traditional memeplexes about joint "function" and "dysfunction."

I have a gameplan; here it is. It's the one I used to cross my own chasm, so I know it works - at least it did for me. And it did actually involve learning a bit of anatomy - the bit that was skipped over in my own PT training.

Plan

1. Make the chasm "smaller"
Make the gameplan easy. Start with something you already know. Start with a joint. Pick your favorite joint. Got one in mind? (Better if it's a large simple joint for starters.)

2. Visualize that joint.
Visualize it as clearly as you can. (Do not pick up or handle a bone model or you will remain doomed to mesodermalism forever.) Forget fascia. Do use your brain. Look at a picture in an anatomy book if you really need to, but stay away from focusing on the bony part of the joint - look at what it's embedded into, briefly. As soon as you can tear yourself away from being mesmerized by how convoluted all the ligaments are, do so. Move quickly to step three.

3. Make your perspective be a cross section through the entire body part of the "joint" you have selected. It doesn't matter which way is up. If you are adopting a centralized perspective, it won't matter which way the joint is oriented or which way it can bend or how. Ideally you will see a sort of circular kaleidoscopic image, with bone in the center, meat around it, and skin around that.

4. Carefully introduce the nerves which flow past that joint, into your new image/imagination. This is where an anatomy book will really help. Netter's will be fine. You might have to switch to an ordinary viewpoint on an anatomy book page to "see" the nerves, but as soon as you can, try to place them in the inner vision of the "joint" surrounded by meat, surrounded by skin, with cross-sectons of nerves added in. (Place vascular structures in as well, if you wish, but take your time contemplating the regional nerves.

5. Learn the nerves themselves. Congratulations - you are across the chasm. You are now on planet ectoderm. From here, it's ... well, I'd like to say the rest is a piece of cake. I'd be lying if I said that. It is still hard work, but at least you're finally on the right "tissue," and can see the vastness of the vista much more clearly.

6. Learn how nerves "work."
Welcome to the world of topsy turvey, fun house mirrors, fractal effect. You can easily sponge up what there is to know, it's just that there is a great deal to know, and time ticks on. Tick-tock. Nervous system including brain and spinal cord and 72 km/45 m of neural structure in the body, - total equals only 2 % of the entire body. This measly two percent uses up 20% of all available oxygen energy. Right away you gotta know there's something going on in that - it's a busy system. What does it need? Oxygen. When does it need it? All the time you are alive. What happens if it doesn't have enough? It starts to "hurt" somewhere. Pain is an output which evolved to warn you of a threat. What threat? Probably some perception the brain has that its system isn't getting enough oxygen somewhere. What should we do? Well, maybe we should try to help that system alleviate this perception. How? Through careful hands-on along with explaining to the "I" module nested within that system what's likely going on, what you are going to try to do to help, asking that "I" module to help by providing feedback to you, then doing your best to do what you said you were going to do. Turning the "process" into a three-object juggle. Setting up the treatment scenario so that the patient is watching his/her own nervous system watching yours. Which focuses their waking attention toward the process of treatment, which is the only way the he/she/you/it combination can arrive successfully to the desirable outcome of treatment. That system must "learn" its way out of perceived problems using its own neuroplasticity. It's the only "tool" that truly exists - all the rest are imaginary.

Pain pathways: spinothalamic pathways, spinocortico pathways, cortico-spino pathways. Up-regulation, downregulation. Decsending inhibition. Learn about brain maps. The term homunculus is archaic. Learn about brain parts which add flavor to the perception of touch.

Stay away - deliberately- from (voluntary) motor outflow - spend way more time learning sensory input. Forget the motor outflow to muscle tissue, for now at least, ... why? because it reinforces mesoderm as somehow being more important than ectoderm. Yeah yeah - there's outflow to muscle, but so what. Learn how what you are doing - manually - at even a skin level, is being received and interpreted by the brain you are "touching." Learn how the same receptors found on skin cells are common throughout the entire nervous system. If you want, learn how skin and brain are made out of the same embryonic layer. One continuous system from skin cell to construct of self. Expensive system to maintain, which is why it is so disproportionately smaller by volume, but it runs everything, and it feels everything. It's a learning machine, which evolved to sense threat and keep its organism safe. When you treat, it senses you, tries to interact with you. Let it - this is how it learns. With any luck, and with a decent pair of hands on you, you will help it learn how to not hurt.

So learn about nerves first. There are two kinds. Cutaneous and the deeper kind. We already "know" about the deeper kind, from school, and their names. Why? Because our brains were being subtly and not so subtly mesodermalized - made to believe that mesoderm and what ever made IT work, was all we needed to learn. The chasm, in my opinion, stems from a cognitive hemineglect of the input side of the picture, the sensory system.

Cutaneous nerves, you will find, are WAY more numerous and although have been explored by anatomists, and given anatomical names, only just now are they being "studied" in terms of their multiple functions and behaviours and capacities, and the way the brain receives or senses their input. Sensing. This fits right in with manual therapy. This fits right in with what we do - we touch people. We can definitely learn the underpinnings of touch, how to handle a nervous system through skin, get it to do what we'd like it to do, by understanding how the interconnected, indivisibly-operating neuromatrix reads us. How IT reads US. We do this anyway. But we can do it this other way, by learning the names and basic layout of the sensing network in the body. Once we've learned something, we can work with it.

If you love anatomy, learn neural anatomy. Learn all about the inside of a nerve, how it feeds itself, what kinds of receptors it has, what annoys it and what calms it, how you can be more a part of its solution and stay away from inadvertently creating more problem for it by knowing not much about it. Learn to see yourself moving nerves, embedded in body parts, not just the body parts. If you have had enough of anatomy, move to physiology. This is what's up right now - it seems like every day some new receptor is being discovered. The entire field of neurotransmitters is being transformed. The proteins around synapses have been shown to have evolved before the nerves themselves did. It's crazy. It's exciting. We should be looking at how we can be part of this instead of ignoring it at our peril and our profession's peril.

We shouldn't rule out that which we haven't considered. Historically we've ruled out the sensory cutaneous nervous system. Chances are pretty high, that once you have considered the sensory system, the sensing system, you'll be able to rule out, instead, quite a lot of unnecessary "mesodermalism" which you have already considered, and which you've probably discovered leads you exactly no where in terms of understanding. Instead you'll be on a new level, and the neuromatrix model, and so on, will start to make more sense. As a manual therapist you will realize that everything you thought you knew about anatomy and how to push it can all fit precisely on one small part of that diagram, under sensory-discriminative input. I realize that that little realization might rock your world briefly, and I am so sorry about that. But I promise you that the discombobulation is usually only temporary, and that understanding how you might have influence on this enormous continent of function called the nervous system will be well worth it.

The nice part about this is that you do not necessarily have to change what you do, just how you think about what you do. See Jason's posts above about that.

[Erica]

Diane,
:thumbs_up:thumbs_up I found myself pulling out my anatomy book-not the Netter one but the one with the cadaver pics. I would love to do a cadaver course again!

Your suggestions are good-I find myself not changing so much what I do, but how I look at my treatment and explain it to a patient. It is the explanation that I need to refine.

It requires a thoughtful and introspective approach but one that is worth it when I see the results I get with some of these chronic pain patients I see. Even with some of my post ops who are a doing well but have a little ache here and there-I am using more ecto based treatment with them as well.

Erica

[aplikator]

Crossing the Chasm -

Hi everyone.

I have been wandering around the SomaSimple forum for quite a while now. Picking up links, reading relevant threads and some most interresting discussions.

It has been one inspiring jorney so far,- and I am looking foreword to be a part of the forum in the time to come.

Jason and Diane; thank you so far, i really enjoy reading your posts!

:lightbulb Jan K.

[Diane]

Hi aplikator, perhaps you would like to start a thread on the welcome forum, introduce yourself and your work? Let us welcome you properly? Welcome anyway. :angel:

[Mary C]

Thanks, Diane for this post

Carefully introduce the nerves which flow past that joint

You've just given me a new idea for a workshop: draw nerves on the skin instead of bony landmarks. (They'll have to learn them anyway to find the nerves--he he.)

Mary

[Diane]

draw nerves on the skin instead of bony landmarks

Good idea.
Once upon a time, when I had more energy, I thought about how cool it would be to get one of those skin tight stretchy dance costumes and paint the cutaneous nerves on it, everywhere, in their correct anatomical locations. Then have someone model it. Never got around to it, but I still like the idea, and would like to see it happen some day, but maybe not by me in this lifetime.

[Mary C]

Diane, I'm going to add your "grommet holes."

Mary

[gerry]

The other side allready has some of these

http://www.egeneralmedical.com/bonessocks.html

There is a need for ectodermal outer wear!

[Mary C]

:clap2::clap2::clap2:

[Line M]

We're (at least I am) trained in a biomechanical - mesodermal way in terms of seeing, visualising, reasoning while the ectodermal approach is all about feeling and experiencing. I realised as long as I keep visualising and reasoning I can't feel.

Line