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Let us first start by limiting this discussion to
something that a person would reasonably expect to
go to a Myotherapist for (i.e. not cancer or a
severed hand etc.).
In short, a symptom cascade is a bit like an
avalanche in snow country. Avalanches have
very specific triggers which start a snow shelf
sliding BUT the circumstances where an unstable
accumulation of snow occurs typically have happened well in
advance of that final trigger. This is
actually a very good example of how a symptom
cascade acts.
A possibly very minor misalignment triggers a
limitation in a particular tissue, requiring
compensation (think of limping after stubbing a
little toe). In many cases, this restriction
is so minor it goes without notice. As the
body compensates for the restriction, more 'bits' go
'out' in an ever increasing cause and effect cycle.
Eventually, the person bends over to pick up a piece
of paper or sneezes at the wrong angle and BANG!..
they are now in pain.
This is probably the most challenging thing for a
structural therapist to hear. Two reasons?!?!
Why do Myologists (muscle specialists) study for
years then? I hear this objection often, yet
when thought about, it comes back down to these two
EVERY time.
Reason 1. Pathology - trauma.
A muscle is vulnerable to direct injury or a lesion
creating dysfunction including systemic problems (MS
for example). Getting hit by a cricket ball,
tearing a muscle during exceptional exertion, being
injured by a gun shot; these are all traumas. Illness
directly effecting how a muscle functions, even
though the muscle itself may remain mostly functional, falls under
pathology, but includes muscular tumours etc too.
Reason 2. Compensation - protection.
If a vital tissue is challenged by malplacement or
other restriction of whatever cause, the body only
has one real goal; protect that tissue & prevent
further damage. Protection is facilitated by
the body tightening the
muscles in the area to suppress mechanical forces
placed into the distressed tissues. By far the
most common, this protection - compensation is the
leading cause of muscular pains and misalignments in
the body based upon mine, and my colleagues clinical
observations over the past twenty + years.
Here is a simple thought,.. if a muscle keeps
hurting, time and again, there has to be a reason.
If there is no history of trauma or pathology
effecting that muscle, it MUST be compensation
triggered pain. Poor posture requires muscular
compensation just as much as the cascades
illustrated below.
I will assume a little poetic license not to list
every bit of connective tissue in this example but
rather, to focus on the logical steps of
progression.
A person presents with 3 month history of
increasingly restricted right shoulder movement,
pain when lifting their arm past horizontal and a
'dropped' right shoulder following an impromptu
tennis game.
In their history, we might find a skiing accident a
couple of years previously where they were 'winded'
for a couple of hours following a solid fall onto
their right buttock and then onto their head and
shoulder before sliding to a stop. Whilst the
buttock and head impacts were more significant at
the time, their liver was also subjected to some
extreme physical forces leading to a restriction in
the way it moves during in-breath.The body will
not tolerate a restriction endangering such a vital
organ so it tightens up the muscles between the ribs
around the liver to reinforce the physical space the
liver occupies and reduce the physical requirements
placed upon it. Limitation in the way the
muscular diaphragm sucks air into the chest will
also be commenced - as the liver is situated against
the bottom of this muscular bell.
The cascade continues. Now the bottom of
the rib cage is restricted, movement is limited in
the lower chest causing the latissimus dorsi muscle
to over-do its movements of the shoulder. The
body responds to this by asking the pectoralis minor
to activate a bit more than normal, pulling up on
the top of the ribs which are limited to protect the
liver already.
Eventually, this mobility restriction of the
shoulder is challenged during an irregular tennis
game (they watched a tournament on TV and got
inspired). When trying to serve, they felt the
restriction in their shoulder for the first time.
After this match, the shoulder just never got
better! Now three months on, they are here for
their shoulder which has already had cortisone
injected for the pain and manipulations trying to
get it moving again.
Without addressing the still problematic
restriction to the liver's mobility, the shoulder
problem will remain perpetuated, despite localised
attempts which will inevitably fall back into
disability.
This is a real person and a real case referred by
a doctor after the shoulder remained unresponsive
past short term relief. Once the problem was
detected, a long lever technique was applied to
release some of the liver's restriction and an
instant improvement was noted in shoulder movement
and pain levels.
Here is the key to this thought process.
After 'playing' with the liver, we left it alone for
two weeks. The reason was that by addressing
only one major variable in this client's body, we
could reasonably expect to be able to attribute any
change to the symptoms to that one change.
They were asked to go about their normal life and
change as little else as possible. Had we done
heaps to them, and then had a change, we would still
be no closer to being able to define WHY the
shoulder was dysfunctional. Why two weeks?
It gives the body time to resolve the myriad
compensations required previously to facilitate the
liver's restriction.
In this case four visits addressing only the
liver saw a complete and lasting recovery of
function in this client's shoulder as well as much
improved breathing and general spinal and chest
flexibility.
Be it by blood, nerve, tendon, ligament or the
many other tissues in the body, there is not a
single part of the body that is not, in some
mechanical and practical way, well attached to
everything else in the body. We are not
talking metaphysics here, just good old anatomy!
The fascia that folds to become a falciform ligament
from the liver to the belly button continues to form
the central (uracus) and median ligaments of the
lower abdominal peritoneum, leading to the
sacro-genital structures that are key in the
functional positioning of the sacrum and lower back
function as well as sexual function and fertility.
At the other end, that same falciform ligament of
the liver shares tissues with the diaphragmatic
passages supported by the various structures of the
diaphragmatic crus, the position of the pylorus
and duodenum and so on.
We could keep this example going until using just
the strong, elastic and contractile visceral fascia
and peritoneum until we have joined all of the dots.
We could also do the same with blood vessels, lymph
vessels and so on too.
The teaching of anatomy in universities must, by
the nature of volumes of students, be presented
first in reductionism terms, breaking the body into
systems and component structures. What is
typically missed is the reconstruction of this
structural knowledge into something that
approximates a living person, not a cadaver.
This functional training is lacking and whilst
certain industry groups influence remains within our
teaching institutions, functional applications will
remain very much in the realm of post-graduate
workshops and controversy.
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