Its a new year, and this means a new project - my first blog! I chose a topic that my patients have given me a lot of good feedback for....
Any one of my patients would confirm that I like to use a lot of analogies when I treat. Education is an integral part of the process toward recovery, and, let's face it, pain is a complicated and not a very well understood process. One of my favorite analogies is that of 'The Office' to explain the interconnections in our body, and the communication that occurs between the different tissues in our body. At the risk of sounding cliche, it is true that everything in our bodies is connected. What interconnects different tissues is often a shared nerve connection, or because they are joined by a sheet of connective tissue, called fascia.
This educational process almost always starts on the initial patient visit. I like to start by showing how nerves that supply a certain section of our body can be the cause of a group of symptoms that are all related, symptoms that patients may never have thought were connected.
The conversation starts off something like this......
First of all, let's imagine a small section of a large company. This section or work unit has a group of employees and a manager. Each worker has a job that is unique to them, and it is the manager's job to monitor how each employee is doing their job, how productive the overall unit is, and to keep the boss of the company informed. As in any company, there is communication that happens along the lines of a hierarchy as depicted below: the top is the boss, the middle is the managers, and the bottom is the employees.
Now, let's picture a scenario where one of your co-workers, who we will call Bob, and Bob is having difficulty at home. His wife is cheating on him, a valid reason to be upset in my opinion, but he is talking about his problems non-stop at work. The other employees are sympathetic at first. Then Bob can't stop talking about his problems at work, this is getting distracting to the others, eventually Bob's problems are impacting his ability to do his job, his colleagues are having to take up the slack, and it doesn't take long for his co-workers to start getting annoyed. The work environment is becoming toxic, and the manager starts to notice that the level of productivity in his unit has gone down.
Now it is the manager's duty to inform the boss of what is happening in his work unit, so he/she sends an email all the way up to the top. The boss is now aware there is a problem in that sector of his company, and he is concerned. Now he is keeping a close eye on that unit, and the manager is under pressure to make things right, so he starts getting jumpy. The manager starts putting pressure on the workers to get back on track.
LET'S PUT THIS IN THE CONTEXT OF YOUR BODY
The boss = our brain
The manager = our nerves
The employees = muscles, joints, organs, connective tissues
The work unit = the injured or tender area
The following is an example of how this presents with back pain......
Your back pain = the work unit.
On examination, we see that you have very tender muscles, often called trigger points, the joints may be stiff, and you have abdominal discomfort with symptoms such as bloating, or constipation, and the connective tissues including skin and fascia can look and feel differently.
Your muscles, joints, organs, fascia = the employees
On further examination we will often find one common nerve that supplies the skin that runs fairly closely along all the symptomatic tissues we have identified, and this nerve is hypersensitive, meaning that normal touch at a point along the nerve branch is abnormally painful.
The peripheral nerve = the manager
The communication that happens via the nerves and occurs between different tissues in the body is called 'cross-talk'. Cross-talk is well known to occur between organ-to-organ, called viscero-visceral cross-talk. As an example of viscero-visceral cross-talk is frequent and painful urination in a healthy bladder when there is acute inflammation of the bowel.
Viscero-somatic cross-talk is when the lines of communication between muscles and organs. Examples of this would be back pain associated with constipation, or pelvic floor pain associated with endometriosis (a condition of the uterus).
There are different theories about the underlying mechanisms of cross-talk. Convergence or the coming together of neural pathways seems to be the common factor, but at what level in the nervous system this occurs is still unclear.
Inflammatory process = toxic work environment
In response to threat or injury, a series of chemical reactions occur that create inflammation, like a ‘toxic soup’ in the region that increases a peripheral nerve’s sensitivity that comes along with muscle spasm in our body's response to protect us.
The good news: Cross-talk can go both ways and you can change the input to the nervous system. One way is to help desensitize an irritated peripheral nerve, and this can be done through a manual technique called neuromodulation. This is a gentle, hands-on technique that shows the nerve that things are not that bad; we are essentially giving 'the manager' what it wants, and the manager responds by calming down. When the 'manager' is calm, the workers can also take a sigh of relief. Similarly, the tissues in the surrounding area can now relax. In your body, this can mean where there was a trigger point in a muscle that was found on evaluation is now significantly or fully resolved! This allows the underlying 'tissue issue' to be addressed, by identifying what is the main driver to the symptoms, be this a muscle, joint, organ, or connective tissue issue.
Everything is connected – either through a connective tissue or neurological connection. The driver to your systems can be anywhere along this two-way line of communication, and identifying the driver is key to addressing the issue. For example, when a person has back pain associated with periods of constipation, we should be addressing both conditions because we know that one influences the other.
The message a nerve transmits can be changed from 'something is wrong' to ‘hey, things are actually not that bad, and maybe even ok’.
Getting the team back on track - 'Bob' has taken the time he needs to sort out his personal problems, and has gradually resumed his usual duties, and overall productivity is on an upward trend. Similarly, the body can make a gradual return to previous activities and functions, while staying below the nerve's threshold to initiate a protective/inflammatory response.