As a follow-up to my previous post on Multiple Sclerosis (MS) (Battling Multiple Sclerosis: Integrated Advanced Techniques), I am posting the first in a series of field reports designed to keep you up to date and ¨in the loop¨ as to how these techniques are progressing and what are the objective and subjective observations that are noted. 

It is important to, once again, thank our MS patient for their permission in documenting this journey and for their time and generousity in facilitating the exchange of valuable information and insight.

To review and refresh the specifics of the case involved in this field report, a person with MS is being treated with two (2) of the eight (8) components of the Activ8System (What is Activ8?).  In cooperation with physiotherapist Richard Paletta and the REB (Rehabilitacion Estructural Biotensegral) Clinic in Rosario, Argentina, this person is receiving various Trans-Fascial Viscolelastic Stimulation (TFVES) techniques as well as receiving elastic taping applications as part of the Activ8 Systemic Health Development protocol.  

Two weeks ago, the first elastic taping applications were applied to his back which remained attached for a full week.  During this week, he received regular TFVES treatments on the back, chest, and lower legs.  He kept to his regular maintenance routine which includes movement based activities like swimming.  Upon completing the first week, he reported that he was able to perform and extra 50 meters above and beyond his usual distance.  Although this does not confirm any direct link with the specific protocol, this does suggest that it could indeed play a significant role in performance based activity and contribute to improved homeostasis.  Given the extra muscular involvement, the following 48 hours were characterized by some significiant muscle aches which indicate that exercise progression should be well monitored and be modified (periodized) carefully. 

The tape was removed fullowing the first week to allow for the skin to breath and be exposed to the air to restore it´s natural condition.  This week begins an additional investigation into the effectiveness of the Activ8 applications on the reduction of chronic inflammation of the legs. 

Silicone Stress Transfer Mediums for TFVES

For the specific manual drainage / connective tissue health development technique on the lower legs, small silicone cylinders are used as a stress transfer medium (maximize mechanical impact and efficiency) with specific loading and rolling parameters to manaully massage the lower leg along the posterior leg beginning on and around the Achilles tendon and extending into the calf and lateral leg.  The colours of the cylinders correspond to different densities and therefore can be adapted to the specific conditions of the area begin addressed. 


The elastic taping application is a relatively common application used in many cases of lymphedema and chronic inflammation conditions.  This particular application covers only the lower leg, but can also be modified to extend into the thigh, depending on the extent of the inflammation.


The first tape (black) is called a fan tape and is applied at the lateral side of the calf just behind the proximal head of the fibula. The fans extend down towards the ankle and spread across the posterior lower leg all the way to the lower medial side.  The second tape (red) is also a fan tape and is applied in a similar fashion starting from the medial side of the calf. 

Note that at the bottom end of the application, there is a small piece of Kinesiotape that extends across the ends of the fan tape...this serves no mechanical purpose other than to ensure the ends do not get caught or pulled away during movement, swimming, or removal of socks etc. 

The TFVES techniques are then applied directly over the elastic tape and contribute to maximum movement of interstitial fluid during the treatment.  In addition, the machanical lifting of the skin allows for continued drainage throught the time it remains on the skin and therefore results in better overall fluid movement and improve peripheral blood flow. 

Activ8 Lymphatic Drainage

In the interest of study and investigation, only the left leg will receive the elastic taping application.  The left side is the most symptomatic and presents the greatest movement challenge to our patient. 

In summary, the first 2 weeks are very encouraging and are characterized by reports of observable and tangible improvements in energy, movement competence, and standing posture and endurance.  This investigation will continue for many more weeks and therefore more palpable and concrete observations will be made as time progresses. 

I hope this first field report is as interesting to you as it is to all of us involved.  The addition of strategic protocols in the battle against MS is essential and should be characterized by a responsible multi-disciplinary response that involves teamwork.  Thanks again to our generous client, Richard Paletta and REB, and to all of the readers.

Cheers!

I have just finished reading a very short (but informative) musing from Leon Chaitow regarding breathing...more specifically, how respiratory mechnics contribute to overall systemic homeostasis.  After reading some of his rants, I experienced a clarity of sorts...not exactly "revelations", rather a more clear tangible understanding of the complex relationship between the biomechanical competence and systemic competence.  Although it is a relatively intuitive understanding, it is sometimes difficult to verbalize and put into some formal context that can be understood.  Therefore, I think it will be very valuable to at least attempt to deliver some of these "moments of clarity" in an effort to further understand the multi-layered complexity of Cerebral Palsy (CP).  It should be remembered that understanding and improvement potential go hand-in-hand...the more we understand the physiological reality, as well as the overall conceptual message, the better we are in formulating strategies that are efficient and contribute in a more immediate and permanent manner.

The importance of proper respiratory mechanics is well understood and quite easy to relate to.  However, most of the understanding is based on a relatively simplistic view of  "bringing oxygen in and expelling carbon dioxide".  In addition, most of the focus with respect to breathing is placed on the lungs.  Although this is an obvious focal point, the larger picture should still be the context from which these focal point are examined.

This perspective is vital in the understanding of rehabilitative priorities in CP.  Chaitow's discussion on breathing was related to a significantly less complex situation (hyperventilation).  If the simple act of hyperventilation results in such significant changes in the brain environment, the effects in the CP individual can be assumed to be more significant simply due to the fact that the respiratory dysfunction is constant.

Cerebral Blood Flow

The image on the left is a brain scan during normal breathing and a scan during hyperventilation.  The obvious reduction in cerebral blood flow is quite significant.  Although it is obvious that hyperventilation is not a consistent condition in the CP individual, the respirstory dysfunction IS.  Therefore, cerebral blood flow is not only reduced, but it persists 24 hours a day.  In addition to the reduced blodd flow, Chaitow lists:

-Smooth muscle constriction of the intestines
-Bronchiole constriction
-Magnesium and Calcium imbalance in muscles


There are more, but the overall message is quite clear.  The discussion is therefore directed to the general root causes of this characteristic dysfunction of respiratory mechanics in CP.  This list is also quite extensive, however in an effort to maintain the flow of this post, I will summarize some of them below:

-Insufficient circumferencial volume of the thorax
-Reduced elasticity of the individual ribs and ribcage
-Extremely weak connective tissue system that is characterized by:
         -weak upper respiratory pathways
         -unstable trachea (leads to turbulent and disrupted air flow)
-Distortion of the bony alignment of fascial bones
-lack of sufficient control of the lips and tongue
-lack of division between the clavicles and upper 3 ribs
-underdevelopment and underuse of the upper lobes of the lungs

There are numerous strategies that are currently in place in an attempt to improve respiratory mechanics, however the overwhelming majority are formulated with the objective of "teaching" proper breathing mechanics...or using some repetitive training mechanisms in the hopes of reducing this challenge.  The reality is that breathing is a function that should require LESS mental focus and be something that is AUTOMATIC and not the result of training.  Increased mental and muscular effort placed on breathing is not only metabolically expensive, it negatively affects cognitive development potential and creates more difficulties to an already neurologically challenged system.

Although this post is clearly more of a rant, the main message should be relatively clear and understood:  adressing the structural and biomechanical considerations as a priority has a positive cascade effect on all of the other considerations (social, cognitive, systemic, metabolic, neurological).  Therefore, a focused and intelligent strategy to improve thoracic volume and elasticity will ultimately contribute to better brain metabolism and homeostasis.   IMPORTANT NOTE:  These are my personal views and do not necessarily reflect those of Mr. Chaitow.  I have reviewed his comments on this subject and have simply provided my own interpretation based on my professional experiences with CP.  Fortunately, Mr. Chaitow has generously provided some feedback on my interpretation and understanding of his perspective and this exchange is posted in the comments section.

You can refer to the One Giant Leap Facebook page for Chaitow's discussion as well as other interesting subjects.

Cheers.

It is rare that I mention specific authors or practitioners in my posts, simply because I am a big believer in the formulation of one's own philosophy and central belief system as opposed to blindly adhering to a single person or single philosophy.  However, in the evolution of one's own central philosophy, it should be understood that the exploration / examination / absorption of other positions and approaches are essential in the formation of a valid, intelligent, and responsible position of your own. 

The reality is that gaining access to the "elite" in any professional field is a difficult challenge.  They are often in high demand, extremely busy, or on occasion too self-absorbed to bother with inquiries from anyone who doesn't fit within their perceived status level.  Although obviously very busy and in high demand, I can conclusively say that Mr. Leon Chaitow is definitely not self-absorbed and is very generous in sharing his extensive knowledge and experiences with anyone.  It is likely that our exchange will go unnoticed to him, but my recent brief exchange with him will remain with me as a refreshing gesture and serve as an example of responsible and intellectual conduct. 

Leon Chaitow is a now semi-retired naturopath, osteopath, and acupuncturist with over 40 years of clinical experience.  He is also Editor-in Chief of the Journal of Bodywork and Movement Therapies.  He is also a prolific author who has written over 60 books on natural health and alternative medicine. 

It is indeed a pleasure to get feedback from such a well-known figure, therefore I have decided to post the (very brief) exchanges that occured over the last 2 days regarding a couple of his recent musings and which lead to the publishing of my previous post. Although some of our philosophies do not entirely align, it is obvious that his input is valuable and most certainly will shape future formulation and investigation.  Enjoy!


Chaitow Post:



 

This is the work of Graham Scarr D.O.  It is such a great piece of work that I had to include it this blog.  Although I try to stick to "original" work, this one is absolutely fabulous.  Very long, but worth every minute.  Enjoy! 

 
Biology

BIO-TENSEGRITY is a structural system that maintains stability by distributing mechanical forces through components that interact in just one of two different ways - attraction (tension) or repulsion (compression). Such simplicity is due to some basic laws of physics and because it is energetically efficient is likely to have developed throughout evolution to produce biological organisms of great complexity. Tensegrity systems eliminate the need for bulky elements and are lightweight structures with a high resiliency that depends on the integration of every part. It seems to be pervasive in biology and is described in the human body through molecules, cells, the extra-cellular matrix, vascular system and entire musculo-skeletal-fascial system.

Many examples of tensegrity in biology can be found but they often occur in obscure journals or are written in complicated scientific language; they are described here in the hope of making them more accessible. Most experimental work has been carried out on cells, which are essentially complete organisms, while generalizations from a 'whole-body' perspective have been reasoned from first principles or inferred from models and observation. Because tensegrity describes biological systems more thoroughly it is only a matter of time before it becomes the standard approach to bio-mechanics.

CONTENTS:

Structural hierarchies; Cellular cytoskeleton and morphogenesis; Cell cortex; Helix; Collagen; Fascial system; Cranal vault; Spider silk; Shoulder joint, elbow and pelvis; Respiratory system of the bird; Mammalian lung; Central nervous system; DNA nanostructures.

Biological structures appear to be very different to the simple tensegrity models that we make with sticks and bits of string, but they conform to the same simple rules of geodesic geometry, close-packing and symmetry, to build more complex structures (the basic principles and construction of a tensegrity structure are given on the geodesics and models pages). Physical models are usually built with components on the same size scale but the essence of bio-tensegrity is structural and functional interdependency between components at multiple size scales. One particular aspect that is often not appreciated in simple models is structural hierarchies and an example of one is shown here.

STRUCTURAL HIERARCHIES

Hierarchies are ubiquitous in biology and an inherent capability of tensegrity configurations. They provide a mechanism for efficient packing of components, the dissipation of potentially damaging stresses, and a functional connection at every level, from the simplest to the most complex, with the entire system acting as a unit. Each component in a hierarchy is made from smaller components, with each of these made from smaller still, often repeating in a fractal-like manner.

Tensegrity hierarchies achieve a significant reduction in mass and as tension always tries to reduce itself they automatically balance in the most energy-efficient configuration. Because every part influences every other part forces are distributed throughout the network and stress concentrations avoided.

The separation of tension and compression into separate components means that material properties can be optimized and these forces transferred down to a smaller scale with the elimination of damaging shear-stresses and bending moments. At atomic and molecular levels they automatically balance in the most energetically efficient configuration to form crystals and molecules which are, therefore, tensegrity structures in their own right. The forces of tension and compression always act in straight lines, but components arranged in hierarchies can give the appearance of curves at larger scales, and curves are common in biology (see definitions page).

The helix is a common motif in protein structure and a general model for coiled winding at multiple size scales throughout the body; its functional value has been demonstrated in a diverse group of organisms and is also described in relation to tensegrity (also see geodesics and helix pages).

The hierarchical arrangement of helixes in muscle shows this scaling up and links with the close-packing geometry of a myofibril.

At the nano level, tensegrity helixes describe the mechanical behaviour of the cellular cytoskeleton - a semi-autonomous structural system amenable to such analysis because of its size.

CELLULAR CYTOSKELETON AND MORPHOGENESIS

Ingber showed how the cytoskeleton behaves as a multi-functional tensegrity structure that influences cell shape and activates multiple intra-cellular signalling cascades. Within the cell, microtubules under compression are balanced by microfilaments of actin under tension with bundles of actin and spectrin fibres playing similar respective roles in the cell cortex. Intermediate filaments link them all together from the nucleus to the cell membrane so that any change in force at one part of the structure causes the entire cytoskeleton to alter cell shape. Tension is generated through the action of actomyosin motors and polymerization of microtubules.

Many enzymes and substrates are immobilized on the cytoskeletal lattice and mediate critical metabolic functions including glycolysis, protein synthesis and messenger RNA transcription. DNA replication and transcription are also carried out on nuclear scaffolds that are continuous with the rest of the cytoskeleton. Changes in the cytoskeleton and cell shape thus alter cellular biochemistry leading to a switch between different functional states such as growth, differentiation or apoptosis.

Experiments that allowed individual cells to assume certain shapes showed that those able to distort or spread had the highest rates of growth; rounded cells became apoptotic (died) while those intermediate in shape became quiescent and differentiated. Cells also tend to extend new motile processes (lamellipodia and filopodia) on sharp corners rather than blunt ones and this is linked with the cytoskeleton.

The cytoskeleton connects to the extracellular matrix (ECM) and other cells through adhesion molecules such as integrins and cadherins, respectively. These transmembrane proteins create a mechanical coupling that transfers tension generated within the cytoskeleton to the ECM and adjacent cells. Because a prestressed state of tension exists between them, so a change in ECM tension also causes a realignment of structures within the cytoplasm and a change in cell function; this process is known as mechanotransduction.

Integrins act as strain gauges that respond to changes in tension on both sides of the membrane and their ativation promotes the binding of proteins such as talin, vinculin, alpha-actinin, paxillin and zyxin. These physically link them to contractile actin bundles ('stress fibres') in the cytoskeleton and form part of a specialized complex called a 'focal adhesion'.

The transfer of tension from the ECM stimulates actomyosin tension generation, causing an increase in integrin binding and clustering, and the recruitment of more focal adhesion proteins that balance the ECM tension. Force transfer is also transmitted via the cytoskeleton to other focal adhesions and integrins, stress-sensitive ion channels, cadherins, caveolae, primary cilia and nuclear structures etc.

The attachment of fibronectin molecules (ECM) to the outside of certain integrins (alpha-5-beta-1) is what stimulates a reorganization of actin in the cytoskeleton and the accumulation of focal adhesions to the area. Changes in tension then feed back to cause unfolding of the fibronectin molecule and exposure of cryptic sites within it that lead to fibrillogenesis of itself and ultimately of collagen. The spacing of fibronectin nanofibrils on the outside of the membrane is proportional to the spacing of cross-linked actin bundles in the cytoskeleton and the cell is thus able to maintain tight regulatory control over collagen morphogenesis.

During embryogenesis, tension generated in the cytoskeleton is transferable to the ECM, and changes in matrix tension cause a realignment of structures within the cytoplasm and a change in cell function. Consequently changes in enzymatic activity produce local and regional variations in the compliance of the basal membrane and cells adhering to these regions then distort more than neighbouring cells. Mitogen stimulation can then lead to the development of more complex tissue patterns such as budding, branching (alveoli) and tubular structures (capillaries) or produce motile cells that are able to migrate(epithelial-mesenchymal transition).

Branching can create a pattern similar to the 'Koch snowflake' fractal and it has been suggested that the position of coronary artery lesions around the heart follows a pattern related to the Fibonacci sequence and Golden Mean, maximising perfusion of the myocardial bed.Gibson Simple geometry seems to get everywhere.



If the reciprocal transfer of mechanical forces between the cytoskeleton and extracellular matrix orchestrates cellular growth and expansion, it is likely that complex multi-cellular tissue patterns can emerge based on the same principles, and continuity of the extracellular matrix with the fascia could extend this throughout the entire body. Levin and Ingber have both proposed this as a tensegrity configuration but it is not universally accepted as yet; however, new developments in computer modelling confirm the relevance of tensegrity to the cytoskeleton  and multi-cellular systems.

CELL CORTEX


The cellular cortex (cortical cytoskeleton) lying just beneath the cell membrane can be considered as many tensegrity units within a geodesic dome and has been modelled around an icosahedron. It is essentially made from triangulated hexagons of the helical protein spectrin (tension) coupled to underlying bundles of the helical protein actin (which in this case are under compression). The network is organized into ~33,000 repeating units, each with a short central actin protofilament, linked by 6 spectrin filaments to a lipid-bound suspension complex (model). About 85% of these units appear as hexagons, with ~3% pentagons and ~8% heptagons, which suggests that the hexagonal arrangement is a biological preference (see the geodesic page).



The erythrocyte with a diameter of 8um has a composite membrane that distorts as it flows through smaller capillaries but allows the cell to recover its biconcave shape. Deformation of the membrane network may cause turbining of the actin protofilaments through the suspension mechanism thereby facilitating oxygen transfer from one side of the membrane to the other. The membrane is itself a bilayered structure of phospholipid molecules with outer heads under tension separated by hydrophobic tails under compression (see 'spheres' on the geodesics page).

THE HELIX

The helix is a common motif in protein construction and creates a general model for coiled winding in many other structures throughout the body; it has links to tensegrity through a common origin in the geodesic geometry of the platonic solids (see geodesic and helix pages). Helical molecules behave as tensegrity structures in their own right as they naturally stabilize through a balance between the forces of attraction (tension) and repulsion (compression). Globular proteins contain multiple helical domains and can themselves polymerize into larger helixes such as those in the cytoskeleton. Similar helixes can form hierarchies as they wind around each other to form coiled-coils (eg. spectrin) or assemble into mechanically rigid rods or filaments, or further combine into more complex structures with specialized functions (eg. collagens). Collagens are major structural proteins that consist of several hierachical levels of helixes within bone, tendon, ligaments and fascia.

Axial stretching or compression of a helix initiates rotation in a direction that depends on the direction of twist or chirality. Linking it to another one surrounding it with opposite chirality causes resistance as each helical layer counteracts the rotation of the other. Crossed-fibres of collagen scale up to form tubular helixes in the walls of blood vessels, the urinary system and intestinal tract and influence their mechanical properties. Elastic arteries such as the aorta have walls organized into lamellar units with collagen reinforcement and smooth muscle cells that form crossed-helixes with an orientation of 55o. It is likely that wall components under tension contain sub-structures under compression at a different hierarchical level, and vice versa.

Capillary formation results from tension-dependent interactions between endothelial cells and an extra-cellular scaffold of their own construction and these cells form a selective barrier that allows vascular contents to pass out between capillary walls. The internal cellular cytoskeleton determines cell shape and orientation through tensegrity, is affected by signalling mechanisms and variations in fluid flow, and alters the tension between cells through adherens junctions, ultimately affecting tube permeability. This compares with the wall of a helical tensegrity model that has many gaps but if the struts could be expanded into plates that just touched each other they could be made to 'seal' the internal space; just like the capillary cells.

An optimum helical angle of ~55o balances longitudinal and circumferential stresses and helical fibre arrays allow pressurized tubes to bend smoothly without kinking and resist torsional deformation. Cardiac muscle fibre orientation varies linearly between inner and outer walls, from 55o in one direction to 55o in the other, with tangential spiralling in a transverse plane. The heart is a helical coil of muscle that contracts with left and right-handed twisting motions, and a simple tensegrity pump that may have relevance to cardiac dynamics has also been described using the 'jitterbug' mechanism.

Similar helixes form hierarchical 'tubes within tubes' in fascia and permeate and surround the muscles, limbs and body walls of a huge variety of species, all considered through tensegrity (see helix page). Tubular organs that maintain constant volume throughout changes in shape have been described in the tongues of mammals and lizards, the arms and tentacles of cephalopods and the trunks of elephants. The arrangement of scales in the pangolin and snake illustrate the helix at the macro level although notice how the orientations of left and right-handed helixes on the body are different in the limbs; the pattern in the limbs may be related to the Fibonacci sequence (see geodesics page). The thoraco-lumbar and abdominal fasciae also have a spiral appearance, if only in part, and helical fascial sheaths that transfer tensional forces within and between themselves have been described in controlling movement in a way that the nervous system is incapable of. Fascial tissues are also reinforced by two helical crossed-ply sets of collagen with the 'ideal' resting fibre orientation of 55o (axial) that varies with changing muscle length.

COLLAGEN


Bones, tendons, ligaments and fascia are all arranged in hierarchies with collagen the most widespread of all structural proteins appearing at several different levels. In collagen type I repeating sequences of amino acids spontaneously form a left-handed helix of procollagen with three of these combining to form a right-handed tropocollagen molecule. Five tropocollagen molecules then coil in a staggered helical array, that lengthens longitudinally by the addition of more tropocollagen to form a microfibril, and pack radially to form a fibril; with higher arrangements forming fibres and then fascicles. (see helix page).

The collagen molecule exists in many different configurations and is a major component of the extracellular matrix (ECM) that surrounds virtually every cell. The matrix attaches to the cellular cytoskeleton through adhesion molecules in the cell membrane and forms a structural framework that extends through the fascia to every level in the body.

FASCIAL SYSTEM

Traditionally considered as mere packing tissue fascia has been show to exert considerable influence over muscle generated force transmission. It naturally develops into compartments, or 'tubes within tubes', particularly noticeable in cross-sections of the limbs. Within muscle a delicate network of endomysium surrounds individual muscle fibres and is continuous with the perimysium ensheathing groups of fibres in parallel bundles, or fasciculi. Perimysial septa are themselves inward extensions of the epimysium, which covers the muscle and is continuous with the fascia investing whole muscle groups. These fascial tissues are reinforced by two helical crossed-ply sets of collagen with the 'ideal' resting fibre orientation of 55o (axial) that varies with changing muscle length (see helix page).

The fascial system has been described as a tensegrity system which might seem rather strange initially because there dont appear to be any compression struts. The extracellular matrix/fascial system is a complex biological hierarchy which means that it is likely to be different to simple models. As tension and compression always occur together it must have structures under tension and others under compression.

Considering a sheet of tensioned fascia between two bones, or even both ends of the same bone, any two points along that tension line (x,y) will be separated by a pull from either end. The points are held apart by tension but as one of the functions of a 'strut' is to hold two points apart (nodes) the tissue between them is behaving as such to other parts lower down in a tensegrity hierarchy. Collagen and proteoglycans probably interact in a tensegrity way at the nano level. Fascia could thus be considered as a network of tensioned cables and [virtual] 'struts' but only if it is part of a larger tensegrity system that includes 'real' struts such as bones at a higher level. The basic tensegrity principles remain the same but the description starts to become a bit more complex (see definitions page).

At the macro level,bones (struts) are compressed by muscles and fascia under tension. Muscles are cables that generate axial tension on contraction, but the resulting changes in their diameter also make them variable length compression struts perpendicular to this, which probably contributes to the tension in associated fascia and force appearing at tendons. The balance of ‘agonist/antagonist’ muscle tensions has also been shown to reduce stress concentrations in long bones (bending stresses) making them compatible with the resiliency required of tensegrity struts.

Guimberteau described a 'microvacuolar' system that allows sliding between different tissues throughout the body as the basic network of tissue organization. These microvacuoles are collagen envlopes containing proteoglycans and "histological continuum without any clear separation" was observed between fascia, skin, muscles and vasculature; sounds remarkably like a tensegrity.

THE HUMAN CRANIUM

Many aspects of normal cranial development are poorly understood, with some previously held views now outdated, but a tensegrity model can explain some of these and improve understanding of normal and abnormal development. A more detailed explanation is given on the cranial vault page.

The skull is generally considered to be a solid box but is actually made up of 22 bones most of which remain distinct throughout life; several of these bones contribute to the cranial vault that covers and protects the brain. The sutural spaces between the bones are filled with fibrous tissue and are important to the mechanism that allows the cranium to grow larger and accommodate the developing brain. A tough membrane called the dura mater lines the internal surface of the bones. Until recently the general opinion was that the growing brain pushes the bones outwards but this is now known not to be the case; an increase in dural mater tension does stimulate bone growth but the mechanism is much more complex than previously thought and better explained through tensegrity.



The geodesic dome (icosahedron) is developed into a tensegrity model (T6-sphere) with the struts connecting opposite vertices. The straight struts are then replaced with curved struts and these are replaced with curved plates (not shown) to produce the model skull with bones that surround a central space. The bones of the cranial vault are tensioned by the dura mater (elastic cord in model) and configured as a tensegrity structure. The curved struts are at the top of a bone hierarchy (at least seven different levels within bone) that extends down to the molecular level (see definitions page).



Adult bones are separated by a sutural gap of about 100 microns and have curved outlines with a fractal relationship between them. Dural membrane (tension cords) attached to the peaks of bone convexities, and the alignment of collagen fibres in sutures, cause adjacent bones to be pushed apart as they form the tensegrity structure. (see definitions page).



The vault bones develop totally within membrane which they separate into an outer periosteum and inner dura mater membrane as they grow around their edges (bone fronts). Tension in the dural membrane beneath the sutures, combined with chemical signals from the osteoblasts (bone-making cells) at the bone fronts, influence the cytoskeleton of epithelial cells in the membrane beneath the suture through the process of mechanotransduction, and change cell activity that results in further bone growth. It is a cyclic mechanism that regulates bone growth and maintains sutural patency up until at least seven years of age (when the brain stops growing). Even after this age the sutures should remain patent and may contribute to the small amounts of bone mobility recognized by 'cranial' osteopaths and 'cranio-sacral' therapists.



The bones form a dome that provides protection to the brain, compression struts of a tensegrity structure that maintains sutural flexibility and accomodates brain growth, and a microstructure that transfers external forces down through a hierarchy to the nano-scale. The centre of the bone is a honeycomb like structure made from collagen and mineral reinforcement. Curved-strut plates are still compatible with tensegrity when considered in terms of hierarchies because the forces of tension and compression ultimately act in straight lines at some smaller scale.

A tensegrity configuration allows the skull to enlarge and remain one step in front of the growing brain rather than being pushed out by it. It also allows the skull to respond to the mechanical demands of external muscular and fascial structures and integrates the entire cranium. The dural membrane also reduplicates into four sheets that penetrate the cranial cavity (falx cerebri and cerebellum and two halves of the tentorium cerebelli). Abnormalities in the cranial base may alter the tension pattern in these sheets and cause the sutural/dural mechanism to behave differently, leading to premature sutural fusion in babies (craniosynostosis) and malformation in head shape (plagiocephaly).



SPIDER SILK

Spider silk can be considered as a tensegrity structure with some similarities to fascia. It is a composite material with a hierarchical structure composed mainly of the proteins Spidroin I and II. Spidroin I consists of poly-alanine chains in anti-parallel beta-sheet conformation packed into an orthorhombic crystallite unit. These crystallites are interconnected by helical oligopeptides rich in glycine that form a polypeptide chain network within an amorphous glycine-rich matrix. The overall network shape is circular segments (40-80 nm diameters) interconnecting in series to form a silk fibril with many of these arranged laterally to form the silk thread with a diameter of 4-5 microns. It is the regular spacing and orientation of these crystallite units and hierarchical structure that suggests that it is a tensegrity structure.

An analogy can be made between a spiders web and the spoked bicycle wheel where cable tension is balanced by compression within the rim and central hub. If the cables were relatively elastic the central hub could be moved around always returning to the same position of stable equilibrium. The multiple hubs in the second model could also be reduced so that they looked like single nodes between crossing cables (although under a microscope they would appear unchanged). The common spider web is made from silk woven into a configuration of radial and spiral tension cables attached to a gate post and tree. These latter form a single compression element connected through the ground like the rim of the bicycle wheel. Each of the connecting nodes between cables represents one of many ‘hubs’ that can be displaced within the elastic tension network but that always returns to the same position of stable equilibrium, one of the conditions of tensegrity. However these examples of the bicycle wheel and spiders web should probably be considered as on the limit of 'tensegrity' (see definitions page).

THE BICYCLE WHEEL AND SHOULDER JOINT

Levin was the first to describe the higher complexities of the human body in terms of tensegrity using the analogy of a bicycle wheel. Here the outer rim and central hub are considered as compression elements held in place by a network of wire spokes in reciprocal tension. This type of wheel is a self-contained entity maintained in perfect balance throughout with no bending moments or torque, no fulcrum of action, and no levers. He suggested that the scapula functions as the hub of such a wheel, in effect as a sesamoid bone, and transfers its load to the axial skeleton through muscular and fascial attachments. The sterno-clavicular joint is not really in a position to accept much compressional load and the transfer of axial compression across the gleno-humeral joint is at maximum only when loaded at 90o abduction. The joint is essentially a frictionless inclined plane which means that it must rely heavily on ligamentous and muscular tension in all other positions. The humerus as a hub model would function equally well with the arm in any position. Interestingly, different parts of the gleno-humeral capsule that transfer specific tensional stresses can only do so if the capsule is intact, even if those stresses do not apparently pass through the missing parts (this would make sense if the capsule is a tensegrity sheet at a microscopic level).

In a similar way the ulna could be likened to a hub within the distal humeral ‘rim’ of muscle attachments, where load bearing across the joint may be significantly tensional and allow compressional forces to be distributed through a tensioned network and the hand to lift loads much larger than would otherwise be the case (see the elbow page).

The pelvis is also like a wheel, with the iliac crests, anterior spines, pubis and ischia representing the outer rim and the sacrum representing the hub tied in with strong sacro-iliac, sacro-tuberous and sacro-spinous ligaments. Similarly the femoral heads may act like hubs within the ‘spokes’ of the ilio-femoral, pubo-femoral and ischio-femoral ligaments.

'Hinge' joints in the skeleton are very different to those in man-made structures. A standard door hinge has metal plates screwed to the door and fram, with one side of each plate bending around a central metal rod. The rod holds the door part of the hinge to the frame part and is compressed between them as the door swings. Most skeletal joint movements display helicoid motion around a variable fulcrum and in the knee joint it has been shown that there is no continuous compression between bones and cartilage, even when they are pushed together.  A tensegrity ‘hinge’ joint in a biological context doesn’t need a single compression element to carry the entire load and the tensegrity arm models clearly shows these features (see the elbow page for more anatomical details).



The body is made of many joints and they are all linked together through the fascial system. Theo Janssen is a Dutch artist who has linked multiple joint units so that they can walk; a comparison with the human locomotor system seems inevitable. A Janssen mechanism is a structure made of parts with specific lengths according to a precise formula so that they can move as a single entity.

The second model is a multi-joint tensegrity based on the same mechanism with each joint modelled with the six struts of a T6-sphere. Some of the struts are elongated so that they become parts of two of these joints. The rotation then produces the same relative motion and interactions although it needs a bit more head scratching to work out which parts are pushing and pulling during the movement. The long thin struts between the 'joints' are substructures in a hierarchy where the next level above is comparable to the metal plates of the original TJ mechanism. Apart from the fixings to the wooden block there are no fixed fulcrums, levers, or moments of inertia in this model. This model shows how the movement of a tensegrity joint can cause other joints to move passively at a basic level and that muscles just refine that movement further down the chain as a higher active level of control. We can separate passive and active components in models but in biology they are often inseparable. This model still has a long way to go but it is one more step.

According to Wolff’s law, tensional forces remodel the bony contours and alter the positions and orientations of their attachments, contributing to the complexity of shapes apparent in the skeleton. As part of a tensegrity structure each attachment would influence all the others, distributing forces throughout the system and avoiding points of potential weakness, in contrast to a rod or truss which is vulnerable to buckling. Such a mechanism would be an advantage in long-necked animals such as giraffes, camels and dinosaurs, where the load from the head is distributed throughout the neck, as opposed to a stress-ridden cantilever system such as the Forth Bridge.

The erect spine and bipedal weight bearing capability of humans has traditionally been viewed as a tower of bricks and compressed disc joints that transfer the body weight down through each segment until it reaches the sacrum; but a vertical spine is a relatively rarity amongst vertebrates. Most other species have little or no use for a compressive vertebral column which is frequently portrayed as a horizontal truss and cantilever support system. As the main difference in vertebrate anatomies is in the detail it seems reasonable to suppose that they have some structural properties in common. Tensegrities are omni-directional ie. they are stable irrespective of the direction of loading, and the spine, pelvis and shoulder all demonstrate this property (within physiological limits), enabling dancers to tip-toe on one leg and acrobats to balance on one hand.

RESPIRATORY SYSTEM OF THE BIRD

The respiratory system of the bird differs substantially from the mammalian lung; it is an exceptionally efficient gas exchanger that processes the large amounts of oxygen required to sustain flight. Some of the reasons for this are considered to be its geodesic design and hierarchical tensegrity arrangement that mechanically couples each part into a functionally unified structure. The volume of the bird lung is about 27% less than that of a mammal of similar body mass although the respiratory surface area is about 15% greater. The lung is attached to a rigid ribcage and its volume changes relatively little during a respiratory cycle (1.4%); instead, separate air sacs act like bellows and cause unidirectional and continuous ventilation. The air passages of the lung have a hierarchical arrangement with two-thirds of the lung volume taken up with several hundred parabronchi; their polygonal atrial openings each give rise to several funnel shape ducts (infundibulae) that terminate in numerous air capillaries, the terminal respiratory units (fig. ?). Both blood and air capillaries anastomose and interdigitate to form a tightly packaged three-dimensional network.

The parabronchi develop from epithelial cells that are compressed due to space restraint and naturally form hexagons with lumens that enlarge during development (fig. ?). This geodesic packing arrangement persists into the adult and makes the most economical utilization of space, thus maximizing the potential respiratory surface area. The constitutive parts of the parabronchus act together to function as an integrated unit that prevents the air capillaries from collapsing under compression and blood capillaries from distending with over-perfusion; mechanically, it is rather similar to the tensegrity bicycle wheel described in chapter 2.

Intertwined smooth muscle bundles and collagenous tissue surround the atrial openings into the central lumen and form a complex helical arrangement. The collagen forms an intricate system of longitudinal, transverse and oblique fibres that connect to elastic fibres in the interatrial septa and floor of each atrium, and continue as the interfundibula septa that eventually becomes the basement membrane surrounding the exchange tissues. The smooth muscle, collagen and elastic fibres surrounding the atrial openings form an internal parabronchial column that lies next to the lumen (fig. ?). The collagenous septa and exchange tissues are also continuous with the interparabronchial septa that enclose the walls of larger blood vessels and form an external parabronchial column. The exchange tissues and associated septa are thus suspended between the internal and external parabronchial columns like the spokes in a bicycle wheel.

Contraction of smooth muscles around the atrium tenses the interatrial and interfundibula septae and stretches the elastic fibres, with collagen limiting their stretchability; the elastic fibres then act as energy-storage elements and recoil when the muscles relax. The interatrial, interfundibula and interparabronchial septa thus balance the centripetal force produced by contraction of the smooth muscle. An outward centrifugal force is also produced, by surface tension generated within the air capillaries and the prevailing intramural pressure in the interparabronchial arteries, and this is balanced by the elastic and inflexible collagen fibres. The parabronchus thus exists in a dynamically tensed state, with the inward pull of the atrial smooth muscles (internal column/wheel hub) ultimately counterbalanced by the interparabronchial septa (external column/wheel rim) and surrounding parabronchi. The morphology of the parabronchus and its constitutive parts thus fits every definition of a tensegrity structure.



MAMMALIAN LUNG ALVEOLI

The matrix surrounding alveoli is considered to be a tensegrity structure. “The septa between alveoli are very thin and contain a single dense capillary network. They are supported by a fine network of fibres that are interwoven with the capillaries and anchored at both ends in axial fibres that form the network of alveolar entrance rings in the wall of alveolar ducts; and peripheral fibres that extend through interlobular septa towards the pleura. This allows the spreading of the capillaries by mechanical tension on the fibres. Because of this disposition of capillaries and fibres, alveoli in the mature lung are not structural units that can be separated: each of their walls is shared by two adjoining alveoli, both in terms of gas exchange with the capillary and with respect to mechanical support. Even the epithelial lining is shared by two adjacent alveoli as it extends through the pores of Kohn... This disposition of the fibre system makes the lung a tensegrity structure, which means that, in terms of mechanics, the integrity of lung parenchymal structure is exclusively ensured by the tension of the fibre continuum that supports alveolar walls and their capillaries. If one fibre is cut, this causes collapse of the septum followed by rearrangement of the adjacent parts, as occurs in emphysema.

THE CENTRAL NERVOUS SYSTEM

It may be that a tensegrity mechanism is responsible for morphogenesis of the central nervous system, based on some particular characteristics of developing neurites and anatomy of the cerebral cortex. Tension along axons in the white matter is considered to be the primary driving force for cortical folding and is counterbalanced by hydrostatic and growth-generated pressures.

When neurites are transiently stretched, their length increases in proportion to the applied tension, indicating simple elastic behaviour. Under sustained stretching, however, they display visco-elastic properties as the initially elevated tension passively relaxes to a lower level over a period of minutes. Active elongation occurs when tension is maintained above a threshold level and active retraction occurs when tension is fully released. Collectively these passive and active mechanical properties allow neurites to adjust their length by a negative feedback mechanism that tends to maintain a steady tension, much as a fishing line is reeled in or out to regulate tension on the line.

Early in development, neurons migrate to the cortical plate along radial glial cells, differentiate and emanate axons that reach specific target structures. Many structures have pronounced anisotropies in the orientation of axons, dendrites and glial processes; and are under tension. Consequently tissue elasticity will vary in different directions and expansion will occur preferentially in the direction with the greatest compliance, generally perpendicular to the main fibre axis.

The trajectories of long-distance processes arising or terminating in a given region of the cerebral cortex are biased towards one side as they enter and leave exclusively through the underlying white matter. During cerebral growth collective axon tension pulls strongly interconnected regions towards one another (conjoining arrows), forming outward folds (gyri) and allowing weakly connected regions to drift apart and form inward folds (sulci). Consequently cortical cell layers vary in thickness beneath gyri and sulci (similar to the effect of folding a paperback book).

DNA NANOSTRUCTURES

The self-assembly of three-dimensional tensegrity nanostructures of the simplest 3-strut tensegrity model and platonic solids is now possible using single and double strands of synthetic DNA. They confirm that the tensegrity concept can realistically be applied to the evolutionary development of biological structures.

Once again, the work of Graham Scarr D.O.  This is an amazing look into the tensegral properties of the human skull and therefore providing a greater understanding of the mechanics of the cranium.  As usual...a very insightful perspective!

 

Considering the two previous posts were relatively "heavy" in nature and content, I thought it would be appropriate to put a slightly "lighter spin"into this post.  Forced perspective is something that I have always been aware of, but it is only recently clicked on how it actually applies in everyday life...and of course, rehabilitation. 

The image to the left is one of many examples of Forced Perspective Photos.  What is forced perspective?  It's quite simply examples of how reality can sometimes easily be distorted depending on "how you are looking at it".  In photography, this distortion results in some fabulously creative images...however, in the field of rehabilitation, the results are not as pleasant.  Distorted perspective leads to inefficient strategies and therefore unproductive results.  

With forced perspective photography, we KNOW that it is all a trick...whereas in the rehabilitation community it seems like most are convinced that their perspective is the actual reality.  Using the clever image to the left, if this was your only perspective, you would be lead to believe that while two men are enjoying a pleasant day in the city, another man is dangling precariously in the air.  Which is the reality and which is the distortion?  I suppose it depends on who you ask.  In the healthcare industry, the idea of "it depends on who you ask" is an unfortunate reality...however, if there is focused effort to step back and gain some additional perspective, the inevitable product would be an improvement in the desired goal and result. 



In the spirit of keeping this a "zero-calorie" post, I will use a very simple (yet organic) example of how perspective plays a fundamental role in the implementation of successful rehabilitation protocols. 

 Nothing could be simpler than a good old orange...it's round, has a skin, and is filled with delicious pulp.  Although this is in fact true, the paradox is that the information it provides is quite complex and comprehensive.  For the sake of efficiency, I will formulate this idea in a conceptual manner...thus it will simply be a question of importing this concept to your existing reality.  Consider the skin of the orange (the bright orange outer layer) as analogous to human skin, the dull orange underlayer as the subcutaneous tissue, the watery orange pulp as the muscle, and the "stringy" portions that seperate the orange segments as the connective tissue. 

Fundamental Perspective Question #1  What provides the structural stability within this organic system?  It seems strange to ask such a complex question about a simple fruit...but the conceptual message is quite important.  Is it the pulp itself that supplies the compressional integrity of the fruit or is it the "connective tissue" within?  Further, is it a combination of both...with the pulp delivering the compressional stability and the rest supplying the tensional support?  If you ask this question in relation to the human organism, the flood of new questions would be quite powerful.

Axial

   Fundamental Perspective Question #2:  How is the internal architecture organized? In the case of our friendly orange,  your perspective would be dependant on whether you sliced it axially or transversely.  When most of us think of oranges, we perceive them in the classic "transverse" way...nice triangular pieces housed nicely within the soft skin of the orange.  But the "axial" slice is obviously part of the same orange, but it presents a very different understanding of how the orange os actually organized.  It is a hslf-circle of pulp secured to the center via a thickened extension of the outer layer.                                                                      

Transverse

These questions and analysis may seem trivial, however the conceptual message should once again be understood:  If a simple orange can demonstrate such vast architectural differences depending on perspective, imagine how important perspective becomes when analyzing the human organism. This is precisely why even professionals gets confused when presented with cross-sectional images...the anatomical perspective changes completely and leaves them confused as to "what is what". 

Continuity

 Fundamental Perspective Question #3:  Where does the skin end and the pulp begin?  This is perhaps the most important concept to integrate.  Is the orange the sum of an outer skin, an inner skin, and pulp...or is it one complete entity.  My perspective should be obvious...the orange (and therefore the human organism) is a singular entity that is characterized by the differentiation of tissue types.  Each differentiated tissue is intimately connected to the other and function in complete inison.  In addition, integrity of the whole organism is dependant on the balance and stability of the combined tensional and compressional forces within. 

In summary, I am sure you have never devoted as much analysis to a fruit...however, examples of the complexity of life are everywhere...even on the kitchen table.  It is important to realize and understand that it is impossible to import simplistic strategies into complex systems...which is the unfortunate reality in many cases with respect to current healthcare.  Ido not pretend to hold the answers to the complexity of the human body...but gaining proper perspective is most certainly one of the first steps towards responsible and effective strategies.

I will end this post with some more cool forced perspective photos...they are not only fun, they remind us to always think about what we ware looking at!  Cheers!






 

My recent look into the work of Leon Chaitow and the subsequent "dip" into respiratory mechanics resulted in an exponential growth in understanding (and appreciation) of the continuity of the human organism...more specifically, each and every action, however small, is intimately linked with the entire organism.  To be precise, it is literally impossible to "dissect" unique movements / functions / systemic actions out from the body...it is quite frankly unrealistic to remain adhered to this simplistic idea. 
There are many different examples that can be brought forward and examined, however I think it would be more productive to choose an example that will resonate with the largest number of people...in other words, something that can be understood immediately regardless of their "anatomical competence".  

In a previous post on respiratory mechanics I discussed the effects of dysfunctional breathing patterns on the brain.  This is also an example of the intimate relationship between structural distortion and systemic performance...however it relates to the brain, which remains a relatively "mystical" organ that we still do not completely understand.  This post is intended to demonstrate the pure mechanics of breathing and its relative complexity.  In addition, it becomes very clear that breathing isn't as simplistic as we like to think...or in some cases, not as simple as some people would like you to believe.  The reality is that respiration is a multi-faceted function that engages all of the architectural components (bones, tendons, ligaments, muscles, fascia) of the body as well as the metabolic / systemic components (lungs, organs, brain).  This is best understood through the fundamental examination of the 4 diaphragms of the body.

The 4 Diaphragms:

 It is well documented in Osteopathic studies that the central nervous system (CNS) has a certain "rhythmical motion" to it.  In other words, it has life and actually pulsates as a means to mobilze Cerebral Spinal Fluid (CSF).   This rhythmical movement is said to be intimately linked to cardiac rhythm and is profoundly affected by breathing patterns.  The cranial diaphragm is composed of differentiated connective tissues in the skull called the Falx Cerebrii and the Tentorum Cerebelli.


2) Cervical Diaphragm
The cervical diaphragm is composed of the tongue, the muscles of the hyoid bone, and scalene muscles.

3) Thoracic Diaphragm 
The most common and well-known diaphragm which separates the thoracic cage from the abdomen.

4) Pelvic Diaphragm
Found on the pelvic floor, it links the sacrum to the pelvis and is essentially a large "sheet" of specific muscles. 






In the above video, the 4 diaphragms work together in unison to contribute to the respiratory rythym which is fundamentally important for the proper function of the central nervous system, circulatory system, and critical metabolic / systemic functions.  This very informative video brings into focus the fundamental concept of fascial articulations as a valid consdieration as a true joint. The mechanical movement of the thoracic diaphragm mobilizes the abdominal viscera and therefore requires that the "disconnecting" lubricating physiological appearance of connective tissue is in place and healthy.

In addition, the mechanics of breathing require proper movement and passive excursion of the entire musculoskeletal system (elasticity of the ribcage, mobility of the sacrum between the iliac bones, division and segmentation of the clavicles from the first 3 ribs.  In addition, the impact of the thoracic diaphragm on the viscera stimulates and activates the pelvic diaphragm below.

The video essentially speaks for itself, therefore long paragraphs and a high "word count" isn't necessary.  However, I hope the overall message is relatively clear:  there is no possible way to disentangle the systemic from the architectural.  They are a symbiotic entity and therefore, by definition, depend on each other to ensure the homeostasis of the organism.  

I anticipate more informative posts as my look into respiratory mechanics continues and evolves...please stay tuned!

Cheers! 

This post is intended to complement my earlier post on Multiple Sclerosis (MS) and the multi-modal approach of the Activ8System to address the common symptomatic challenge of lymphedema and chronic inflammation in the lower leg.  The multi-modal approach is designed to integrate complimentary interventions in an effort to maximize the potential impact as well as allow for customized modification and adjustment to ever-changing systemic and mechanical environments.  

Lymphedema is a chronic condition that is characterized by the inability for the lymphatic system to remove fluid from the lower extremities in conditions such as MS and can also be the result of acute injury which results in a level of edema accumulating that the lymph system is unable to remove efficiently.  In chronic conditions such as MS, this symptom can be uncomfortable and even incapacitating...therefore focused intervention is not only a productive long-term objective, but it may also be a very real and critical short-term goal as well.

The specific multi-modal approach used to address lymphedema in the 

Silicone Stress Transfer Mediums

Activ8  System is the combination of therapeutic taping (Kinesiotaping) and Trans-Fascial Viscoelastic Stimulation (TFVES).  As described in the initial MS post, TFVES is an innovative technique developed by Mr. Leonid Blyum in the treatment of children with Cerebral Palsy and other disorders of movement and posture.  Using various stress-transfer mediums, the practitioner is able to access the connective tissue / fascia at all levels including the very deepest visceral / core level.  TFVES is a very comprehensive set of skills, applications, guidelines, and targets that require an extensive process of learning and development...however the overwhelming scientific and clinical evidence shows that is produces extraordinary benefit and contribution to the improvement of connective tissue strength, health, integrity, and homeostasis...therefore reducing fascial dysfunction and the reduction of abnormal pain signalling.  In addition to the enormous systemic benefit, there is also a very significant improvement in the overall health, strength, and integrity of the connective tissue system which contributes to structural integrity and therefore improves functional performance.  More importantly, and most relevant to this specific application, TFVES is a very effective tool for the manual movement of fluid.  In other words, the very specific loading properties (guidelines) and the specific viscoelastic characteristics of the stress stransfer medium enable the practitioner to access fluids at the deepest level...which are typically unaccessible using the hands alone.  This powerful tool facilitates very rapid and effective movement of the interstitial fluid through the lymphatic system and therefore replenishes the entire system by flushing stagnant fluid and stimulating return of new nutrient rich fluid. 

Kinesiotaping is a specifc technique that has been widely used since the early 1970's in the rehabilitation setting in Japan but since the 80's has risen to become relatively mainstream.  Its function / implementation serves 2 essential purposes:  1) facilitate movement performance, 2) facilitate fluid flow and systemic homeostasis.  For this particular post, it is being implemented as a facilitator of lymphatic drainage and interstitial flow.  It is applied using the lymphatic correction technique (Kase) and is channelled to another part of the system that is functioning properly...therefore application location is highly variable depending on the individual case.  In combination with the TFVES technique, fluid flow is effectively channelled away and therefore facilitating the return of nutrients back into the system as well as the proper elimination of waste and toxic by-product.  I recommend that you refer to my two previous posts that outline the diverse potential of the systemic implications of the use of Kinesiotape.  


Lymphedema of the Lower Leg:

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Completed Application

 TFVES application with Kinesiotape:


As previously mentioned, the TFVES technique has very specific guidelines and movement / loading properties that require some expanded and enhanced demonstration and training in order for it to be effective.  However, I will provide a demonstration that is to serve for illustration purposes only.  

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2

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The same guidelines should be applied along the entire length of the lower leg in separate sections (mid-calf, proximal calf) until the proximal end of the application is reached.

In summary, this particular multi-modal intervention has shown significant results in our MS patients. Not only is there a visible and tangible improvement, the patients report overall relaxation and a slight increase in function and performance. These initial reports conclude that further implementation of the multi-modal approach is indicated. Future posts will demonstrate the diversity of this intervention over a wide spectrum of acute and chronic conditions.

Cheers!

The last few months have shown a very exciting and welcomed jump in "readership" of the One Gian Leap blog...which has generated a different set of challenges and "probelms"...how do I get all of the relevant information out without putting the audience to sleep?

Therefore, the OGL Facebook page has emerged as a more broader and diverse extension of the blog that covers more topics and also links to other valuable sources of information and knowledge.  It allows for the more efficient "day-to-day" exchange of information and education while keeping the format relatively informal, quick, and digestible.  The OGL blog can be considered as the resource for more in-depth, comprehensive, and detailed explanation and formulation.
However, each source will compliment the other and therefore contribute to the more efficicent delivery of the overall OGL message.  I would encourage anyone and everyone who has read material here on the blog to visit the One Giant Leap Facebook page and "browse" all of the additional information from multiple and diverse sources.

Part of the central mandate of this blog is to deliver intelligent and well-formulated concepts, theories, and practices...and the reality is that these are found in a great many places and come from a great many people...therefore the Facebook format is the most efficient and effective way to deliver them to you and provide you with productive links to informative and productive resources.

If this blog has provided some valuable information, then the Facebook presence will certainly continue the process.  Once there, click LIKE as it provides useful information on the most popular subjects and helps to define the subjects and issues that resonate most.

Cheers and happy reading!

 This is the beginning if what is likely to be a relatively long series of posts...therefore I will make every attempt to keep it as "digestible" as possible.

The stimulus for this particular focus and direction was derived from two sources: 1)  my recent trip to Chile to work with another amazing group of CP children and their (always entertaining) parents and extended family, and 2) a very informative piece of writing I just read (see the One Giant Leap Facebook page for the article on Pain and Stress) that set in motion a train of thought that can only be integrated by writing it down.   Given that this topic is quite comprehensive, it will be more productive to consider this as a general introductory entry into more detailed discussion and explanation.  More importantly, a clear and concise explanation of the overall context will help to solidify the main message of this post.  My thoughts are still relatively "all over the page" at the moment, but my most productive posts historically come from this type of chaotic beginnings.

As part of the continuing series on systemic homeostasis, I have decided to deliver a post that has both a global application as well as a focused and specific target audience.  Although seemingly contradictory, the main message to take away from this post is that the overall implications of the contribution of interstitial fluid are universal and can be applied to any condition (acute or chronic) or pathology.

The choice of the term "conductor" was made intentionally to convey a fundamental understanding that can be imported from our intuitive notion of conductor into the general "biological" perspective:  Despite the presence of finely tuned intruments and classically trained musicians, it is the conductor that mediates the activities of the orchestra with the end objective of achieving pleasant,  seemless, and integrated sound.  Therefore without the "physiological conductor", the biological orchestra is reduced to a conglomerate of subsystems that ultimately underperform and actually contribute to the overall deterioration of the architectural integrity of the Supersystem (human organism).  More importantly, the role of homeostatic "catalyst" indicates that strategic focus in improving the flow of interstitial fluid will have a significant impact on improving the intrinsic physiological environment and health. I will refer to specific non-invasive strategies for systemic enhancement through the promotion of interstitial fluid flow in the follow-up post...but in order to fully grasp the practical aspects, there needs to be a fundamental understanding of the theoretical and conceptual ideas.

Interstitial Fluid:
Interstitial fluid is defined as the fluid found in the intercellular spaces composed of water, amino acids, sugars, fatty acids, coenzymes, hormones, neurotransmitters, salts, and cellular products. It bathes and surrounds the cells of the body, and provides a means of delivering materials to the cells, intercellular communication, and removal of metabolic waste.  In addition to these essential systemic functions, the interstitial fluid also transports nutrients to all of the tissues in the body and has a critical role in tissue maintenance.  It has also been shown that interstitial fluid flows have a role in tissue morphogenesis, tissue remodelling, inflammation, morphoregulation, and immune cell trafficking (1). 

Interstitial flows and their corresponding microenvironments

As shown in the adjacent image, interstitial fluid is exists within a matrtix (extracellular matrix, or ECM) that is composed of specialized cells (fibroblasts, etc),  fibers (collagen, elastin), and other differentiated tissues.  The cells are attached to the ECM in a 3-dimensional manner by the specialized fibers and therefore compose a highly active and reactive environment (respond to mechanical stress).

Interstitial flow through the ECM

The flow of blood (within the red vessel) and the flow of lymph (green vessel) can be considered as luminal flow.  The green arrows  represent interstitial / intervascular flows which act upon the ECM through sheer stress and therefore, depending on flow rate and velocity, contribute to the establishment of mechanical stability through mechanotransduction and systemic competence.



Importance of Interstitial Flow Rate:
With the fundamental relevance of interstitial fluid well established, the efficiency of flow velocity and rate become quite obvious.  More specifically, the reduction of interstitial flow rate results in degeneration of the tissue environment (mechanical and systemic).  Further, the flow of interstitial fluid (convection) is typically generated by the pressure gradient that exists between blood and lymph capillaries (see image, red and green tubes respectively) (2), as well as by the mechanical stimulus generated by active muscular contraction.

Relevance to Multiple Sclerosis:
The individual with Multiple Sclerosis manifests a very diverse range of symptomatic challenges which ultimately stress the ability to establish and maintain systemic homeostasis.  Regardless of the specific neurological genesis, the biomechanical manifestations are significant and demonstrate progressive deterioration over time.  They can be demonstrated in the more intuitive fashion such as gait difficulties and dysfunction, postural dysfunction, and spasticity...however, the long-term consequences are more profound.  The select muscular dysfunction ultimately leads to fibrotic conditions brought on and exacerbated by irregular muscular activation, chronic overuse syndromes, and gradual deterioration of the entire extended fascial (connective tissue) system. This can also be described as a loss of the visco-elastic properties of the fascia, connective tissue, and ECM.  This loss of viscoelasticity in the ECM will ultimately reduce interstitial fluid flow similar to the way (to use an analogy) a hair mat would block the flow of water through a drain.  The denser the hair mat, the more resistance to flow is present.  This flow reduction will ultimately results in metabolic waste build-up and inefficient delivery of nutrients to the tissues.  When this is allowed to persist, it will inevitably accumulate and tax an already sensitive system which contribute to a degenerative "spiral" (reduced systemic competence---reduced muscular performance---irregular muscle activation and force transfer---increased fibrotic environments---further reduced systemic competence---further reduced muscular performance, etc...).  The profound muscular consequences are a result of the reduced viscolelastic properties of the deep fascia and the secretion hyaluronic fluid which permits the efficient "sliding" of muscle bundles (as well as capillaries) between each other.  When this is deficient, the result is poor muscle function and force transmission through the mechanical chain as well as to adjacent synergists.

In summary, when the accurate "biophysical" reality is examined and explored, it exposes some fundamental concerns regarding the "Big Pharma" philosophy of treatment of pathology.  Indeed, when a specific "diseased state" exists a pathogenetic (disease fighting) strategy should be considered...however, the over-looked and under-appreciated reality is that there exists a profound salutogenetic (promotion of health) opportunity that shows equally (or greater) potential to contribute to a homeostatic state (credits to L. Blyum for bringing this philosophy to my attention).

Practical Strategies:
The follow-up to this post will focus on the strategic implementation of practical (non-invasive) interventions designed to contribute to the improvement of interstitial fluid flow.  As a result, there will be a "flush" of stagnant interstitial fluid and a subsequent "drag" of fresh and nutrient rich fluid.  In addition, the mechanical stimulus will contribute to the healthy remodelling of weak and dysfunctional tissues and therefore reduce any muscular imbalances that exist.

Using the pre-established analogy:  this paradigm serves to contribute to the potential and performance of the "conductor" of the orchestra.  Even with sub-standard "instruments" and musicians, the overall effect on the "music" will be far greater.   

Cheers!
---Gavin---

ABSTRACT
Tensegrity is a structural system popularly recognised for its distinct compression elements that appear to float within a tensioned network. It is an attractive proposition in living organisms because such structures maintain their energy-efficient configuration even during changes in shape. Previous research has detailed the cellular cytoskeleton in terms of tensegrity, being a semi-autonomous system amenable to such analysis because of its size. It has also been described at higher levels in the extracellular/fascial matrix and musculoskeletal system, but there are fewer syntheses of this.

At a fundamental level, the helix and tensegrity share common origins in the geometries of the platonic solids, with inherent hierarchical potential that is typical of biological structures. The helix provides an energy-efficient solution to close-packing in molecular biology, a common motif in protein construction, and a readily observable pattern at many size levels throughout the body. The helix and tensegrity are described in a variety of anatomical structures, suggesting their importance to structural biology and manual therapy.

1. INTRODUCTION
The world of biology is full of weird and wonderful shapes, some with no obvious purpose, and others that suggest some hidden meaning. Even human anatomy has its fair share of the bizarre in the shapes of bones and limbs. How and why does each one develop its characteristic form, and how does that relate to function? Is there more to shape than genetics and Wolffs’ Law?
Three thousand years ago, the Greeks believed that just five archetypal forms could describe everything in the universe, because they were pure and perfect, and part of natural law. Recent research reinstates these physical laws as a major determinant of biological complexity in the sub-cellular realms, and significant to structures at higher scales.^1-4
Tensegrity (tension-integrity) is a structural mechanism that potentially integrates anatomy from the molecular level to the entire body, and is popularly recognised for its distinct compression elements that appear to float within a tensioned network. It is a most attractive proposition in living systems, because such structures automatically assume a position of stable equilibrium, with a configuration that minimizes their stored elastic energy. Tensegrity structures allow movement, with the minimum of energy expenditure, without losing stiffness or stability.^1,5-7
This contrasts with the orthodox view that explains the musculo-skeletal system through classical Newtonian mechanics, using pillars, arches and fixed-fulcrum levers to counteract the force of gravity. In this approach, bones stack on top of one another like a pile of bricks, restrained by soft tissues that permit movement in a local piece-meal like way.⁸ Comparisons of tensegrity and biological structures show them both to have non-linear visco-elastic properties, with fluid-like movements that result from integration of all components in the system.^1,5,6,9

The molecular helix provides an energy-efficient solution to close-packing in biology and also displays tensegrity properties. It is a common motif in protein construction, and a readily observable pattern at many size levels throughout the body. It is proposed that helical tensegrity is a key mechanism in structural biology and consequently has significance for manual therapies.

2. THE HELIX
The helix is like a coiled spring, or put mathematically, “A spiral curve lying on a cone or cylinder, and cutting the generators at a constant angle” (Walker, 1991).^10,11 In biology, it can be appreciated as a regular stacking of discrete components, such as the nucleotides and bases in DNA, or the steps in a spiral staircase.
Globular proteins, often containing multiple helical domains, can themselves polymerize into helixes (fig. 1a,b).¹² Similar helixes can wind around each other to form coiled-coils (Fig. 1c),¹³ and assemble into mechanically rigid rods or filaments, or further combine into more complex structures with specialized functions (fig. 2).
In collagen type I, repeating sequences of amino acids spontaneously form a left-handed helix of procollagen, with three of these helixes combining to form a right-handed helix of tropocollagen. Five tropocollagen molecules then coil in a staggered helical array,¹⁴ which lengthens longitudinally by the addition of more tropocollagen to form a microfibril, with higher arrangements forming fibrils, fibres and fascicles.¹⁵ Collagen appears at several different hierarchical levels within bones, tendons, ligaments and fascia (fig. 2).

2.1 Structural hierarchies
Hierarchies link structures at multiple levels and are widespread in living organisms. They provide an efficient mechanism for packing in 3-D¹⁶ by using components that are made from smaller components, with each made from smaller still, often repeating in a fractal-like manner (fig. 2).^1,5,17 Hierarchies enable mechanical forces to be transferred down to a smaller scale with the dissipation of potentially damaging stresses.^18-21At atomic and molecular levels, the basic forces of attraction and repulsion automatically balance those stresses in the most energetically efficient configuration.^12,22-24

2.2 Helical tubes
The tubular nature of the helix scales up into blood vessels,²⁵ the urinary system and intestinal tract.^26,27 Carey (1920) observed left and right-handed helical patterns in the epithelium during formation of the oesophagus and trachea, respectively, in the early embryo.²⁸ In the walls of elastic arteries, such as the aorta, helical collagen reinforcement resists high loads from the pressure of blood. The middle layer organizes into lamellar units, with the orientation of collagen fibres and smooth muscle cells forming a continuous helix. Collagen is more dispersed in the outer adventitia, but still forms two helical groups of fibres.²⁵
Within the spine, the intervertebral disc contains collagen arranged in concentric lamellae, with opposing orientations in alternate helical layers of 65^o (axial).²⁹ The inner lamellae of the annulus fibrosus consist of collagen type II fibres, cross-linked to type IX on the fibre surface, within a highly hydrated proteoglycan matrix; gradually changing to collagen type I fibres in the outer lamellae.^30,31 The higher proteoglycan/water content in the inner lamellae acts as a thick-walled pressure vessel containing the nucleus pulposus, while the higher concentration of collagen type I in the outer lamellae provides tensile reinforcement during bending and torsion.^29,32

Pressurized tubes cause circumferential and longitudinal stresses in the tube wall that are typically contained by collagen under tension within a helix. Clarke and Cowey (1958) showed that an optimum fibre angle of ~55^o (axial) balances both these stresses, with a reduced angle resisting tube elongation, and a higher angle resisting circumferential and volume increases.^33,34 Such helical fibre arrays allow pressurized tubes to bend smoothly without kinking, and resist torsional deformation;³² collagen has itself been described as a tube.³⁵
Cardiac muscle fibre orientation varies linearly between inner and outer walls, from 55^o (axial) in one direction to 55^o in the opposite, with tangential spiralling in a transverse plane.³⁶ The entire heart has also been described as a helical coil of muscle with contractions that cause clockwise and anti-clockwise twisting motions.³⁷ This typically produces a left ventricular ejection fraction of 60%, for a muscular contraction of just 15%,³⁸ confirming the mechanical efficiency of a helix.

2.3 Tubes within tubes
Traditionally considered as mere packing tissue, fascia has been shown to exert considerable influence over muscle generated force transmission.^39-42 It naturally develops into compartments, or ‘tubes within tubes’, particularly noticeable in cross-sections of the limbs. Within muscle, a delicate network of endomysium surrounds individual muscle fibres and is continuous with the perimysium ensheathing groups of fibres in parallel bundles, or fasciculi. Perimysial septa are themselves inward extensions of the epimysium that covers the muscle and is continuous with the fascia investing whole muscle groups. All these sheaths (tubes) coalesce and transmit the force generated within muscle fibres through tendons and inter/extra-muscular fascial attachments.^39,42 These fascial tissues are all reinforced by two helical crossed-ply sets of collagen,³⁶ with the ‘ideal’ resting fibre orientation of 55^o (axial)³³ that varies with changing muscle length.
Tubular organs that maintain constant volume throughout changes in shape, due to crossed-helical arrangements of muscle and fascial tissue, have been described in the tongues of mammals and lizards, the arms and tentacles of cephalopods, and the trunks of elephants.⁴³ Helical winding and its functional significance have also been described in the body walls of worms;³³ squid;⁴⁴ amphibians;⁴⁵ eels;⁴⁶ fish and dolphins;⁴⁷ suggesting that a similar helical arrangement is likely to occur throughout the human. However, although the thoraco-lumbar and abdominal muscle/fasciae appear to be partial spirals, information on the fibre orientation of other fascial compartments is incomplete.
Stecco (2004) described helical fascial sheaths that transfer tensional forces within and between themselves, and control movement in a way that the nervous system is incapable of.⁴⁸ Anecdotally, palpatory phenomena with a helical component are observed within the soft tissues of the extremities.⁴⁹ A normal pattern exhibits right-handed helical motion in the limbs on the left side, and left-handed helical motion on the right, although current anatomical knowledge is unable to explain this.
The helix has long been recognized in joint motion,⁸ and its widespread appearance at multiple size-scales throughout the body suggests that it has some special significance. At a fundamental level, the helix and tensegrity are linked through a common origin in the geometries of the platonic solids.^1,4,50

SIMPLE GEOMETRY
3.1 The platonic solids, geodesic geometry and close-packing
The platonic solids are regular polyhedra distinguished by having faces that are all the same shape, and naturally form through the efficiencies of geodesic geometry (the connection of points over the shortest path) and principles of symmetry.^1,4,50 In two-dimensions, objects of similar size close-pack and form stable triangular configurations (fig. 3a). Adding another sphere to each triangle creates a tetrahedron, and the addition of more spheres allows the octahedron and cube to emerge (fig. 3b-c), because of the same packing arrangement. These platonic shapes are generally only found as fixed inorganic crystals,but there are many consequences of close-packing.
The icosahedron differs from the other platonic shapes by packing spheres around a nuclear space to form the geodesic dome (Fig. 3d).⁵⁰ It is also triangulated and has multiple symmetries which allow it to stack in a column or helix and form more complex patterns and shapes.^1,2 Some naturally occurring structures based on the icosahedron are carbon fullerenes; pollen grains and ‘spherical’ viruses.^22-24
Both the tetrahedron and icosahedron spontaneously form through the interactions of natural physical forces, and are the basis for appreciating complex shapes in human anatomy.^2,4,51 

3.2 Chirality and Equivalence
The property of chirality is intrinsic to the helix, and the platonic solids demonstrate this as they polymerize into left and right-handed helixes (fig. 4).^51-54 At a basic level, four spheres close-pack to form a tetrahedron, the shape that occupies the smallest proportion of unit space; minimum volume within maximum surface area.⁵⁰ The addition of more spheres as in the lattice packing of figures 3b & 3c, alters that proportion because of the squares within the octahedron, but a tetrahelix comes closer to the optimum, making it a more suitable model for molecular packing because of this margin of energy-efficiency (fig. 4a).^51,53,54 A tetrahelix also displays inherent hierarchy within its sub-helixes of different pitch (fig. 5).
Mapping a tetrahelix onto a plane surface, by ‘unzipping’ one of its long helical edges, displays the packing efficiency of a triangular pattern (fig. 3a). Rolling that map into a cylinder demonstrates equivalence, where each component is in the same relative position to all the others.^53,54 Equi-valence implies that components are arranged symmetrically, and the only shapes that can accommodate it have surfaces based on the platonic solids and cylinders.^22-24,55,56 Because molecules in a peptide sequence are unlikely to match the points on a geometric lattice precisely, evolution has evaded this constraint through the device of ‘quasi-equivalence’, where component proteins contort slightly but still relate to the geometric template.^1,23,24,53
Tropocollagen (fig. 2) has been described as three stretched quasi-tetrahelixes surrounding a central core.^53,54 Each glycine residue, from the three procollagen peptides, contributes a hydrogen atom that forms the corner of a regular tetrahedron, and together they form the right-handed tetrahelical core of the tropocollagen molecule. The left-handed procollagens are the sub-helixes shown in figure 5b; and this configuration also gives rise to a stack of slightly contorted icosahedra.^53,54 Most (if not all) molecular helixes are geometrically related to the tetrahelix and icosahedron,^{12,22,53,54,56} including the alpha-helix of DNA, which has been described as a [triple stranded] tetrahelix with one strand missing.⁵³

Molecules automatically assume a state of minimal-energy as they balance the attraction and repulsion of their constituent atoms. As the helix is a more efficient close-packing configuration it is understandable that it should be such a common structural shape.  At a larger scale, the bacterial cell wall contains actin homologues arranged as a structural helix determining cell shape and elongation.^57,58 Plants display similar configurations in their cell walls⁵⁹ and geometric patterns at a higher level.

3.3 Fibonacci and the Golden Mean
The number of elements within each opposing spiral is nearly always two consecutive numbers of the Fibonacci sequence, where each new term is the sum of the two preceding ones (1,1,2,3,5,8,13,21,34…). The ratio of any two consecutive numbers approximates to the Golden Mean (1.61804), and becomes closer as the sequence gets higher. The helical pattern on the side of a pineapple, arrangement of branches on a plant stem⁶¹ and position of coronary artery lesions⁶² relate to the same sequence. The Golden Mean often appears in the proportions of biological structures and platonic solids,⁶³ including the icosahedron, which is the model that takes us into the tensegrity of macro-anatomy.⁵⁰

4 TENSEGRITY
Descriptions of tensegrity in biology have appeared in the literature since the early 1980’s,^64,65 and include the cellular cytoskeleton;⁵ developing neurites⁶⁶ and cerebral cortex;⁶⁷ spider silk^6,68 and wasp arcus;⁶⁹ mammalian^70-72 and avian lung;⁷³ fascial matrix;^74-76 shoulder;⁷⁵ spine;⁵¹ pelvis⁷⁷ and cranium.⁷⁸
Fuller (1975) described a tensegrity structure as a set of struts under compression, and an arrangement of cables under isometric tension, that always balances in the most energetically efficient configuration.⁵⁰ It is geodesic by its very nature, because tension always acts in straight lines, and automatically reduces itself to a minimum. Tensegrity structures make possible an infinite variety of stable shapes through changes in the lengths of their compression members, and changes in those shapes that require very little control energy. As each component influences all the others, stresses distribute throughout the system, creating a structure that can react to external forces from any direction without collapsing.^6,7,51 An organism utilizing such a system would be able to move with the minimum of energy expenditure without losing stiffness or stability.^6,7,51 Because tension and compressional forces are separated, the material properties of components can be optimized, and in biological systems this typically occurs through hierarchies. Tensegrity hierarchies achieve a significant reduction in mass,^6,7 and provide a functional connection at every level, from the simplest to the most complex, with the entire system acting as a unit.^5,51,76

4.1 The tensegrity helix
The icosahedron is a fundamental geometric shape because it encloses a greater volume, within minimum surface area, than any regular structure apart from a sphere (fig. 6a). It is developed into a tensegrity structure by using six compression struts to traverse the inside (fig. 6b). These connect and hold opposite vertices apart with the outer edges of the icosahedron now replaced by cables under tension. The resultant pull of the cables is balanced by the struts, which remain distinct from each other and do not touch. They provide structural integrity so that the compression elements float within the tension network.^50,79

Considering the six struts in different groups of three, joined on the surface by ‘tension triangles’ (fig. 6c), shows that each strut within the group is oriented at 90^o to the others, and together they create a chiral twist. On the other side of the structure is a similar group with a twist in the opposite direction, which means that a tensegrity icosahedron already contains helical precursors of both chiralities.
When three struts are modelled on their own (Fig.7), they form a shape called a tensegrity prism.^6,7 Increasing the number of struts causes their centres to position more towards the outside of the structure, enlarging the central space and eventually forming a cylindrical ‘wall’ due to the changing orientation (fig. 7b-d). The struts are equivalent, and all form part of an infinite series of left or right-handed helixes; the model in figure 8 demonstrates their tubular nature. Each strut could be made from a smaller helix, or the whole structure become part of a strut within a larger helix ie it has hierarchical capability. Helical molecules are at the ‘lower’ end of structural hierarchies that fill the entire body, but have physical properties that continue into those higher levels. Helical tensegrity is a structural mechanism with many properties useful to organic life.

5 THE HELICAL-TENSEGRITY BODY
Helical molecules behave as tensegrity structures in their own right, as they stabilize through a balance between the forces of attraction (tension) and repulsion (compression).^79,80They readily combine into more complex structures that retain some of the same properties.^2,12

The cellular cytoskeleton is described as a multi-functional tensegrity structure that influences cell shape, and activates multiple intra-cellular signalling pathways.⁵ Helical microfilaments of actin and microtubules of tubulin are the tension and compression elements, respectively (fig. 1a,b); while spectrin fibres and actin bundles may have similar roles within the cell cortex (Figs. 1c).^81,82Tensioned intermediate filaments link everything together, from the nucleus to the cell membrane.⁸³

Tension is generated through the action of actomyosin motors and polymerization of microtubules, and any change in force at one part of the structure causes the cytoskeleton to alter overall cell shape.⁵ Many enzymes and substrates are situated on the cytoskeletal lattice, and changes in its configuration alter their activity, leading to a switch between different functional states such as growth, differentiation or apoptosis.⁵
The cytoskeleton connects to the matrix and other cells through transmembrane proteins, such as integrins and cadherins, respectively. These create a mechanical coupling that transfers tension, generated within the cytoskeleton, to the matrix and adjacent cells. A prestressed state of isometric tension thus exists between them, so that a change in matrix tension causes a realignment of structures within the cytoplasm, and a change in cell function. This reciprocal transfer of mechanical forces is likely to orchestrate cellular growth and expansion, allowing the emergence of complex multi-cellular tissue patterns, based on the same principles.^5,84,85

5.1 Helical tubes
The formation of capillaries results from tension-dependent interactions between endothelial cells and an extra-cellular scaffold of their own construction, and is described through tensegrity.⁸⁶ The growing matrix causes changes in the configuration of cytoskeletal components,⁵ and initiates chemical signalling cascades that influence further development of the capillary network.⁸⁷
The capacity for fluid flow through a tube depends, in part, on the porosity of the tube wall. The helical tensegrity ‘wall’ in figure 8 has many gaps, but if the struts were expanded into plates that just touched each other, they could be made to ‘seal’ the internal space. This compares with the selective barrier of endothelial cells that allows vascular contents to pass out between capillary walls. The internal cellular cytoskeleton determines cell shape and orientation, through tensegrity;⁵ is affected by signalling mechanisms and variations in fluid flow; and alters the tension between cells through adherens junctions,⁸⁸ ultimately affecting tube permeability.^89,90
In tensegrity terms, there is no specific need for a compressional element within the tube wall if this is provided by outward pushing radial pressure, although arterial walls are pre-stressed even when load free. It is likely that wall components under tension are linked to other structures under compression at different hierarchical levels; Fuller (1975) emphasized that tension and compression must always coexist.⁵⁰ Collagen type I fibrils are the predominant tensors, and are virtually inextensible under tension (<5%);³⁰ but the mechanical properties of more than twenty other types are poorly understood. Proteoglycans and glycosaminoglycans tend to increase in tissues under compression. Combining these and other components into tissue specific matrices contributes to huge histological variation. Confirmation that they are tensegrity configurations, however, will depend on analysis of their physical interactions.

A fundamental principle of tensegrity is that the forces of tension and compression are separated into different components, and always act in straight lines; which means that there are no shear stresses or bending moments. The model in figure 8 shows curved struts that seem contrary to this, but they can be understood in terms of hierarchies.  Curved struts only remain stable if their crystal/molecular structures are strong enough to resist the potentially damaging shear stresses that lead to buckling; or they are part of a tensegrity hierarchy that eliminates those stresses by its very nature. Curves may appear at one level within a tensegrity hierarchy, but when looked at in more detail, have structural components that handle tension and compression in straight lines.

Undoubtedly, the fibre angle within any particular tissue depends on the functional context. The model in figure 8 shows struts arranged in a self-similar array and tension cables with differing orientations. Previous descriptions of “random” collagen orientations may have misinterpreted what were actually functionally ordered tensegrity alignments,⁹¹ and the sensitivity of newer imaging techniques and their analysis may resolve this.^92,93

5.2 Helixes within helixes
Axial compression of a tensegrity helix initiates rotation in a direction dependent on the helical angle and strut orientation (chirality), with a corresponding decrease in the central diameter. Axial extension causes it to expand demonstrating a negative Poisson ratio; most man-made materials reduce their width when stretched,^9,16 but this unusual response is common in biological structures.^1,51 Surrounding a helix with another one of opposite chirality increases resistance to axial compression, as each helical layer counteracts the rotation of the other; crossed helixes have been shown to alter tubular properties.^33,34
The intervertebral disc contains collagen arranged in concentric lamellae, with opposing orientations in alternate helical layers that provide tensile reinforcement.²⁹ Whether this is a tensegrity configuration is yet to be assessed; but the widespread view that discs provide resistance to spinal compression as a prime function is probably too simplistic, and the whole spine has been looked at from a tensegrity perspective.⁵¹ Although disc failure usually occurs in tension,⁹⁴ this is usually due to abnormal loading.
The negative Poisson ratio may also have relevance to the helical dynamics of the heart and has been described with the tensegrity ‘jitterbug’ mechanism. When any two tension triangles of a tensegrity ‘icosahedron’ are pushed together or pulled apart (Fig. 6c), the entire structure contracts and expands, respectively. ^1,50,51,95

5.3 PUTTING THIS ALL TOGETHER
51,74,76 Helical ‘tubes within tubes’ mean that fascial compartments of the trunk and limbs can be considered in the same way. Objections that fascia is too flexible to contain compression struts can be overcome by considering the diameter of muscle, and its increase during contraction, as such struts. This would undoubtedly alter the tension pattern of surrounding fascia, which has itself been shown to influence the force appearing at tendons.^39,40 In a tensegrity sense, fascia is the bodies main component of tension suspended between bones under compression, with smaller compartments taking origin from larger ones. Muscle fibres can then be considered as mere motors.
Helical and tensegrity structural systems complement each other, and are based on the fundamental properties of the tetrahedron and icosahedron. A chain of tensegrity icosahedra simply contains the crossed-helical fibres of a tube. Putting all this together from a helical-tensegrity perspective necessitates a reappraisal of structural biology and manual therapeutic techniques in terms of fundamental geometry.

6 CONCLUSION
The observation of a geometric pattern doesn’t necessarily imply anything meaningful, as Johannes Kepler (1571-1630) found out with his early description of a platonic solar system. However, the simple tetrahedron, octahedron, cube and hexagon are recognised in the structures of inorganic crystals, a result of atomic close-packing and principles of symmetry. (fig. 3b,c).^1,4,50Carbon fullerenes and viruses appear as icosahedra and are related to the geodesic geometry of a sphere(fig. 3d).^1,2,23 The hexagonal packing of muscle fibrils and cells occurs because of the same physical laws.^4,5,65 There are many possible consequences of close-packing, and the tetrahelix as one of them provides a more energy-efficient solution in molecular biology (fig. 5).^53,54

Molecules assemble spontaneously and automatically balance the attraction and repulsion of their constituent atoms in a state of minimal-energy.^24,79 The helix forms because of the same ‘platonic’ rules, those of organic chemistry and the dynamic nature of biological systems. The tetrahelix and its geometry then describe the helical hierarchies of protein structures and DNA.

Concurrent with the molecular helix is the principle of tensegrity. Tension and compression (attraction and repulsion); geodesic geometry and minimal-energy; and the inherent ability to form hierarchies are characteristics of both these structures. At the cellular level, the tensegrity principle describes the mechanical behaviour of the cytoskeleton, being a semi-autonomous system amenable to such analysis because of its size.⁵ As a structural mechanism, tensegrity depends on the integration of every part, and it has been proposed that this includes the whole body from molecules, cells, extra-cellular and fascial matrix to the entire musculo-skeletal system.^1,4,5,74-76 Although it has been described at higher levels of anatomy, detailed multi-scale syntheses of its components are few. The helix, however, is a readily observable pattern at many different levels and may be inseparable from tensegrity, but there is a caveat.

If the structure of the human body is considered as a vast hierarchy of interacting sub-tensegrities, structurally and functionally, the examination of any part in isolation can be misleading, as it is inevitably incomplete.^39-41 The possibilities for enquiry become virtually endless and make it unlikely that ‘bio-tensegrity’⁵¹ could ever be proved. However, if it describes biological systems more thoroughly, it is only a matter of time before this becomes the standard approach to biomechanics.

Human anatomy and physiology have been described in terms of tensegrity, and the volume of supporting evidence is steadily increasing. The helix is a well-known structural motif in biology. The fundamental links between tensegrity, the helix and platonic solids support a comprehensive view of human anatomy that is best appreciated as a complex interaction of natural physical forces.

For those who know me well, this discussion will be a familiar one.  It had taken quite awhile to find an effective way to create a mindset that would, not only resonate and increase understanding, but also facilitate more effective learning and understanding with respect to the journey taken by CP individuals and their immediate and extended families.  I refer to the term "journey" because it most accurately describes the life-long path which is sometimes relatively smooth, sometimes filled with obstacles, and almost always evolving.  Because the "finish line" is never predictable, it is the journey that defines success...therefore it is only logical to make every attempt to instill the proper perspective and overall frame of mind that will ultimately sustain you throughout.  Although there are many different "angles" and ways to approach this topic, I have found that when there is a fundamental understanding of developmental age versus chronological age, the mindset is automatically "re-booted" into a different "mental software". 

Mental Software: DOS 2.2 to Windows 7
I use this familiar comparison in an attempt to illustrate the relative "leap" in perspective...in many ways, it can be considered a mini-paradigm shift.  Throughout human society, there has always been an underlying understanding / expectation with respect to human behaviour.  To be more precise, behaviour is almost always assessed against the "age appropriate litmus".  Behaviour is defined as either appropriate or inappropriate based on that persons age.  Without going into any complex sociological rant, this is no different within the sphere of Cerebral Palsy.  Moreover, it is equally as rampant in the professional medical mindset as it is within the general population.  In some ways, this is to be expected...we all see life through the same relative prism, therefore why wouldn't this apply to an individual with CP?  This is where the "re-install" of the mental software needs to take place.

The proper perspective is not something that is (or has ever been) elusive...in fact, it has been under our noses from the beginning.  Alarmingly enough, we have seen and read it over and over again...and never truly latched onto it.  To be more specific, we only need to refer to the definition itself to get a better understanding of the CP journey.  Cerebral Palsy can be considered as a condition that falls under the umbrella of neurodevelopmental delay (NDD).  This is a relatively large umbrella that includes West Syndrome, Miller-Diekers Syndrome, etc...therefore this perspective has implications far beyond CP as well.  By definition, neurodevelopmental delay is a condition that is characterized by the absence or delay of natural developmental milestones.  It is also defined as the persistence of primitive reactions and the absence of postural reactions.  To put this all into very straightforward terms: In the CP individual developmental age does not correspond with chronological age.

Mental Software: User Tutorial
Now that this perspective has been installed, it will require some basic orientation and familiarization.  The reality in the vast majoriy of cases is that children are "evaluated" based on their chronoligical age and the corresponding developmental achievement.  For example, a CP child of 2 years old is typically assigned strategies and tools that are intended to achieve the essential functional goal of "walking".  However the fundamental reality is that the developmental age of the pelvis, hips, knees, and feet are likely much "younger" and therefore unprepared for any load-bearing activities.  This is a simple example, of course, but it speaks to a very complex problem.  Let me illustrate an even more precise example:  Up until the age of 10-14 months, there is a tremendous amount of developmental milestones that take place...development of head control, increased strength and stability in the shoulder girdle, stability in a seated position, crawling, standing, etc...  These are all developmental stages that every human must pass through in order to achieve proper functional competence.  In a healthy child, all of these (and more) are achieved by 10-14 months.  In addition, the primitive reactions (Moro Reflex, Landau Reflex, etc...) have all disappeared by the 8-9th month and have been replaced by postural reactions such as lateral propping and counterbalancing. In the CP individual, these primitive reactions persist long after 14 months of age...and can even be seen into their teens. 

Therefore, the use of chronological age as a template for functional competence / expectation or to assess other important concerns such as bone density...is fundamentally flawed and fundamentally incorrect.  The realistic "litmus" standard should always refer to developmental age rather than chronological age.  If primtive reactions (Moro, Landau) are still present, no matter what their chronological age, the individual's developmental age corresponds to that of a child of 0-14 months.  

There is no debating the internal conflict that exists when a parent is asked to consider their 4, 5, 6 year old as an infant...however the architectural reality and developmental competence is precisely that.  If there is an implied understanding of the definition of neurodevelopmental delay...why does this understanding fail to reach beyond the words on the page?   The developmental age of the individual defines the appropriate therapeutic intervention best suited for the progress of the child.  Although this may be quite a leap in perspective, the fortunate reality is that this concept makes assessing progress much easier.  The gradual disappearance of primitive reactions and the progressive development of postural reactions signal progression through the developmental process.  What is almost ALWAYS overlooked is that functional competence is the spontaneous reaction to a maturing structure!  In a healthy individual there is no need to "train" the muscles or "train" the brain to achieve functional maturity...it is spontaneous.

Power Down:
Although it may take some time for this perspective to truly integrate, I hope that it at least stimulates some "error messages" popping up when you come to important decisions regarding rehabilitative strategy.  I wrote a few posts on Primitive and Postural Reactions which served as a follow up to a basic post on fundamentals of proper perspective that will contribute to the internalization of this important concept.  I hope it proves insightful and, more importantly, helpful.

Cheers!

I have made a somewhat delibrate decision to stay away from potential "hot topic" discussions, however the issue of hip subluxation remains the top "talking point" in the overwhelming majority of the discussions I have with parents of children with Cerebral Palsy (CP).  I have recently finished meetings with families in Argentina, and it confirmed that this trend demonstrates some significant "staying power" within the minds of most.

It is with this fact in mind that I will attempt to instill what I feel to be a fundamental understanding of the larger perspective of this greatly debated (and largely misunderstood) issue.  As always, the intention is simply to expand the panoramic and give some insight so that parents and extended families can more efficiently filter out the "noise" of information that floods their daily lives...and enable some clarity when making important decisions.

Diagnostics:  The very term "diagnosis" seems to somehow generate some relief and/or sense of progress...however, a diagnosis as such only serves to classify the particular symptomatic manifestations. The reality is that the challenge still exists.  With respect to hip subluxation, the actual "diagnosis" is unfortunately dependant on a relatively primitive device:  the x-ray.  Although the term "primitive" may be taken as somewhat controversial, it none-the-less reflects a very real and undeniable truth.  I will expand on my rationale in an effort to frame this particular philosophy with more clarity.

1)  X-Rays are 2-Dimensional
This is perhaps the most alarming reality to me...the fact that an assessment of a dynamic, 3-dimensional organism is being performed with a static, 2-dimensional image.  To be more precise, the human organism exists in 3-dimensional space and within a specific gravitational field.  Therefore, to look at it in 2-dimensional space with little or no gravitational forces placed on it seems somewhat primitive and certainly limits it's representation of the true reality.  

2) "Looking at the room through the keyhole"
I absolutely love this analogy...and for those who know me, you have heard me use it quite often.  The x-ray (in addition to the static / 2-dimensional limitations) is only representative of a very small area of the body.  This would be analogous to giving an estimate of a large conference room by looking through the keyhole of the door.  The unconscious assumption is that everything beyond the scope of the x-ray is fine...and in most cases, the pelvis (which is even INSIDE the x-ray image) is completely overlooked....and even worse, disregarded completely.  This is dangerously naive (if I may speak frankly) and further "waters down" the diagnostic reliability.

3) Bones and the diagnostic "monopoly".
The x-ray itself perpetuates the idea of the bones as the singular determinant of functional performance.  The reality is that without the soft-tissue contribution, the bones would simply clatter to the ground into a large pile of useless struts.  The human organism is a complex marvel of engineering that is charatcerized by biotensegrity.  Biotensegrity is essentially a term to describe the architecture of complex systems.  These systems are characteristed by BOTH tensional and compressional elements.  The bones are the compressional contribution to the system, while the soft tissue (muscles, tendons, connective tissue, fascia, etc...) contribute to the tensional component.  Therefore, given the obvious variables that contribute to functional performance, why have the bones been given such a diagnostic monopoly?  

Architectural Realities:
The reality with CP children (despite the diagnosis) is that they reliably demonstrate profound joint weakness.  Even in the mildest cases (Level 1 GMFCS), it is quite easy to demonstrate the significant soft-tissue / fascial weakness that exists.  The hypotonic individual demonstrates this in the most obvious way...however the spastic CP child can challenge this understanding.  The excessive muscular tension in essense "masks" the joint weakness behind an artificial shield of tight muscle.  However, in both cases there can be a reliable expectation of some level of joint weakness.  

Protocol / Procedural Flaws:
Given all of the realities mentioned above, perhaps the most glaring flaw is in the actual performance of the x-ray itself.  I am not making any direct comment on the people performing the x-rays, rather on the age-old paradigm of the "proper x-ray protocol" that has been formulated within a very narrow perspective and framework.  

The typical procedure plays out as follows...DESPITE the architectural / structural manifestations of the child, they are placed on their back, one person holds them down to the table with force from the top of the body to prevent any movement.  Then...another person actively grasps the ankles, PULLS the legs straight, TWISTS the legs into internal rotation, and holds them in place.  Although I was always aware of this protocol, it never actually "clicked" until I had an x-ray done on my 6 month old daughter.  Even in the case of a healthy child, the mere act of applying stress to forcibly move a child from their neutral position in an effort to acquire the "proper position" was (in all truth) absurd.  This was obviously uncomfortable and traumatic for such a young child, but when you compound the biomechanical distortions of a CP child into this framework...the result, at best, is highly unreliable.  

Fact #1:  The CP child demonstrates profound muscular imbalance, irregular muscle activation, and asymmetry...therefore the "straight" position is obviously one that is derived.

Fact #2: A flat examination table is completely inadequate at enabling complete relaxation for a CPchild.  The proprioceptive feedback in a CP individual is significantly distorted, therefore a flat surface generates a great deal of sensory "confusion" and can, at times, trigger an exaggerated reaction.  Even in ourselves (healthy individuals), the first few seconds of lying on a flat surface requires some adjustment...imagine the challenegs within a CP child.

Fact #3:  This is perhaps the most important concept to remember and evaluate for yourself:  If all of the joints are weak...if one end of the body is being held down...and the other end is being held down at the ankles / lower leg...the only area available to manifest movement is the hip joint.  In other words, the inevitable muscular contraction and activation (whether it is voluntary or involuntary) will "exit" through the most proximal (closest) open chain...the hip joint.  Therefore, head of the femur will actively move within the acetabulum and, depending on when the image is actually taken, you may get vastly different images.

Final Question:
Although up until this point, I may be delivering a focused "condemnation" of the entire propcedure, but this would be a relatively narrow perspective.  I do not question whether they have a role in the effective and efficient formulation of competent diagniostics...I question the relative weight x-rays are assigned.  The implications of a "Hip Subluxation" diagnosis are enormous...therefore common sense only dictates that the diagnostic process by very exacting and comprehensive.  Therefore, the final question remains:  can the x-ray effectively confirm hip subluxation with an acceptable level of reliabilty?  The answer only comes through the prism of each specifc families value system...however, the above mentioned realities should have at least been given consideration.

The True "Subluxation" Test:
The relative implications of hip alignment become more prominent when there is significant amounts of load-bearing (weight-bearing) involved...therefore when children are non-weight bearing, then alignment can even be considered as secondary.  However, a very simple "litmus test" can be implemented when this issue is brought up:

1.   Is he/she in pain?
2.  Are they weight-bearing?
3.  Is the muscular mass within the leg decreasing?
4.  Is range of motion reduced/reducing?
5.  Is functional competence reducing?

If the answer to all of these questions is "NO"...then the subjective image of the x-ray is completely secondary.  The reality is that a hip that is subluxed will manifest in reduced range of motion, depletion of the muscular mass of the entire leg, reduced functional performance, and often times manifest pain or discomfort.  These are the real signs of a hip in a deteriorating condition. 

In all fairness, the x-ray can be included as a 6th consideration within the subluxation test simply because it can provide some useful information that contributes to the overall 3-dimensional reality...but as the only source of information from which potentially drastic decisions are made, it fails due to it's primitivity.

I hope this has been somewhat helpful and insightful...and more importantly, given some clarity to an already confusing situation.  I think it merits repeating that my true intention is merely to open different levels and perspectives...not to convince or persuade...rather to provide an amplified understanding so that the chosen path is determined with more conviction and confidence as well as with an overall sense of well-being.

Cheers!

The inspiration for this brief post came quite randomly while searching for connective tissue images online.  I came across this puzzle image with the very profound "finding the beauty in disconnection"  title associated with it...then a small floodgate opened.

One of the most overlooked and under-appreciated tissues in the human organism is connective tissue. When you consider the implications of the connective tissue newtwork, this oversight goes "beyond wrong".  When you actually perform a paradoxical "step back and zoom" into fascia / connective tissue as it relates to both mechanics and systemic function...you can't help but be amazed, startled, or otherwise fascinated.  Although I can go into many different discussions on many different levels, I will focus on 2 very straight-forward, yet fundamental, functional appearances of connective tissue in the human body (as per Van der Waal).  Before I do this, I will share a very insightful image that effectively demonstrates the extent of the connective tissue "web" of influence:

I have already shared this image on the One Giant Leap Facebook page, but it most certainly is worthy of another appearance.  The image is self-explanatory and illustrates how connective tissue is more than important, rather an essential and vital contributor to mechanical and systemic competence.

Finding the Beauty in Disconnection:
The term "connective" tissue generates an obvious and intuitive thought in almost everyone's mind:  it is a specialized and differentiated tissue that connects muscle to bone, bone to bone, and organs to the lining of the internal wall.  The paradoxical reality is that the second architectural appearance of connective tissue has the functional role of disconnection!  To be precise, the intramuscular and extramuscular connective tissue is engineered to allow for proper gliding and sliding between adjacent muscles and muscle bundles (Hyaluronan).  It is also very prevalent in articular cartilage allowing for proper movement and protection against compressive forces. 

When you consider this paradoxical "duality", in addition to the mechanical and systemic contributions illustrated above, the relative "importance" of connective tissue within the living organism becomes quite astounding.  More importantly, when rehabilitative strategies are formulated, connective tissue should be considered as a primary focal point as a means to improvement and restoration of structural and systemic homeostasis.

This perspective goes hand-in-hand with interstitial fluid which will be part of a larger discussion in the very near future...and in combination, they encompass the entire spectrum of rehabilitative success.

Although brief and "reader-friendly", I hope it was educational and insightful!
Cheers!

The two previous "Guidebook" post on the blog have received quite a few reads...just over 1000 reads in about 3 weeks.  I have decided to add an "insert" here on the Facebook page as a complement to the first "Developmental VS Choronological" entry.  The essential framework of this note is identical...presenting a given perspective on the daily challenges associated with CP and how they impact the fundamental decision making process within the family unit.

 Although they may seem mutually exclusive, the reality is that symptomatic and problematic are intimately related.  Within the CP landscape, they are essentially "blurred" together and it seems that everything is defined as problematic.  It is important to make very clear distinctions between them, however...because this distinction will ultimately have a direct impact on how these challenges are received (anxiety, panic, worry) and, more importantly, how they are addressed.  In order to make this distinction, I have chosen an analogy that is likely to be the most "universal"...the famous "Check Engine" light.

As simple as it sounds, the check engine light is an indicator of more profound problems within the engine itself.  Even if the engine seems to be running smoothly, the "check engine" light may blink on to signal that some intervention is needed in the immediate future and that some form of assessment is required.  As many of you have already experienced, as soon as this light comes on, you immediately get a typical "what now?"  reaction (which may have a few expletives added to the front).  In alot of cases, myself included, the light itself becomes a nuisance...and therefore the immediate problem.  The reality is that it can be realistically considered as a "symptom" of the internal engine problem...therefore, the immediate (and instinctive) reaction is often directed at the symptomatic manifestation as opposed to the more fundamental under-lying issue.

This analogy translates quite effectively into the CP landscape.  There are multiple "check engine" lights going on and off (muscular tension, seizure activity, digestive dysfunction, joint dysfunction, immune system deficit, etc..) that instinctively grab almost 100% of the attention.  All of these challenges are indeed difficult in their own right...this is not to say that they are any less important or challenging.  The main message of this note is to understand the relationship between symptomatic and problematic.  To be precise, the alarming majority of strategies are centered purely on symptomatic resolution.  Using our analogy, this is the equivalent of "turning the check engine lights off".  Having had this discussion many times in the past, I am acutely aware that this distinction may still be somewhat elusive...therefore I will be more explicit:

1.  Symptoms are typically the most visible...Problems are essentially "hidden".  This is an important fundamental understanding to integrate.  The most immediate, obvious, and intuitive challenges are typically those that are easy to spot and identify (chaotic movement, convulsions, fever, feeding dysfunction, spastic muscles, etc.).  Although often quite difficult and challenging to manage, they stem from a general subset of systemic problems that "lie underneath the surface".

2. Symptoms have the potential for some immediate short-term relief, while Problems require a more comprehensive and long-term strategy.  Another important reality is that the symptomatic challenges have a relatively well-established list of tools for their immediate resolve.  Whether it is in the form of pharmaceuticals, manual techniques, or nutrition...the current "menu" is quite extensive.  In addition, the itemson this "symptomatic menu" have the most appeal: "immediate relief of...."   The resolution "menu" is relatively non-existent and falls short of any true appeal simply due to the idea that it is long-term and the progress is evaluated over months and years as opposed to days and weeks.

3.  Problematic issues are the most detrimental to overall health, systemic homeostasis, and general quality of life.  Although this statement could realistically be debated, when you accurately identify the problematic issues it becomes somewhat less obscure as to the true root of most challenges.  They can be outlined in this general format:

a. Profound deficiency in the connective tissue quality and integrity----- leading to joint dysfunction and irregular muscular activation
b. Reduction in the quality of interstitial fluid flow----leading to immune system dysfunction, poor tissue (skin) quality, and spastic conditions
c. Insufficient lymphatic function ---- leading to higher systemic sensitivity and susceptibility to viral / bacterial infection
d. Profound insufficiency in CSF flow --- leading to reduction in brain metabolism, poor processing potential of the brain, poor nutritional maintenance of the spinal cord, electrolyte dysfunction within the brain, convulsions

This of a basic description, of course...the list is actually alot more comprehensive and complex.  However the main message should be quite obvious. The underlying, hidden, and fundamental problems are the true source of the more obvious and external symptomatic manifestations. 

In summary, the most successful rehabilitative strategies take both  into consideration and designate selective interventions to address the entire organism.  Refering back to the original analogy, there is a fundamental understanding that should be well integrated into youe mental "hard-drive":  There is no need to WAIT until the check engine light comes on before you act".  The unfortunate reality is that most are not given this option...nor is it generally even considered.  This is a result of the Pathogenetic paradigm that currently overwhelms the thought process and therefore manifests in most treatment strategies.  The pathogenetic paradigm is also considered as the "disease fighting"  paradigm and can be equated with the idea of waiting until the engine light comes on.  This is quite common and has become almost expected as standard operating procedure:  "the x-ray shows the hip is at 20 degrees, but when/if it gets to 30 we will have to consider surgery...the spine is curved now at 33 degrees, but when it gets to 43 degress, you will need a corset...the EEG shows some irregular activity, but it isnt too bad at the moment."  Although the pathogenetic approach is an essential component of any successful strategy, it shouldnt be the singular focus.  There is also a Salutogenetic Paradigm that exists as well...which essentially is the promotion of health and maintenance of systemic homeostasis.  In other words, during periods of relative health and stability there should be some active intervention in place to address the underlying systemic deficits...or "implementing a regular maintenance program so that the engine light doesnt come on at all".  As with the car analogy, the human organism is dependant an adequate fluid flow, efficient thermoregulation, and regular structural assessment and evaluation.

Although the human organism is exponentially more complex, the general philosophy and mindset applies for both. The symptomatic challenges are addressed within the pathogenetic paradigm for immediate resolve, while the consistent implementation of salutogenetic strategies address the underlying problematic roots.  The most recent research and investigation demonstrates undeniable and significant positive results in progress when salutogenetic interventions are adopted...and therefore should become an integrated part of the rehabilitative protocol.

Cheers!

I would consider this more of an "op-ed" piece rather than a true scientific discussion. Although op-ed pieces are authors who are non-affiliated with the "editorial board", I like the idea that the genesis for this post came from a slightly critical source. 

I should point out that this criticism wasn't levelled at me personally, rather on the growing enthusiasm for fascia and fascia science.  Further, I see it not as a negative manifestation but a positive one.  As per the image at the start of this post clearly says:  question everything!  This is the only way that "normal science" evolves...current paradigms are challenged, and if the paradigm still holds, it remains the viable construct. 

I recently read a very insightful article titled "Does Fascia Matter?"  and it was somewhat of an "eye-opener".  It presented a very intelligent and sage commentary on what can realistically be called "fascia fanaticism".  Although I wouldn't go as far as to suggest that there is anything fanatical about the current surge in interest, it is a very interesting perspective.  Further, it stimulates some introspection and generates some level of self-evaluation (and evaluation of a closely-held belief).  For this reason, I feel that this is perhaps one of the most refreshing articles I have read in quite awhile.  I actually contacted the author with some brief questions, but he "graciously" informed me that his email volume is staggering and that he only had time for "the interesting 20%".   Although I fully understand the busy nature of most professionals, however when it comes to the exchange of knowledge and concept, a few sentences or words are the hallmarks of a genuine quest for knowledge.  In a previous post, I reported that renowned author Leon Chaitow even took some time to send me a few words in feedback...which he regularly does on his social media sites.  My initial reaction was slight disappointment, but that quickly faded and I chalked it up as a learning experience to integrate into my working "harddrive".  More importantly, it gave birth to the (re)evaluation of a central-belief system that I have been championing for awhile now...and the end result is refreshing.  Without going into a "critique" per se, I will simply carve out some of the legitimate talking points from the article and address them individually: 

The author of the "Does Fascia Matter" article states that fascia enthusiasts routinely denounce his article.  I personally applaud it...for the simple reason that it does precisely what every intelligent article should do:  push the boundaries of our perception and question our own philosophy.  If someone is truly serious about their craft, this article will only serve to either re-inforce or re-evaluate the pillars of ones perspective...either way, they will come out more enlightened in the end. 

1)  Fascia is biologically interesting, but is it clinical relevant?

I found this to be a very, very good question.  Indeed, it is easy to get consumed by the elegance of fascia, but it is logical to step back and examine whether it has any clinical relevance.  I think that there is no real need to expand into any great physiological explanation, rather simply to identify the fundamentals of the human organism.  The term "clinically relevant", as I perceive it, refers to whether or not it is something that is either (a) adaptive and therefore able to undergo some change, and/or (b)  something that we can actually realistically target.  The very fact that it exists in such abundance indicates it is highly relevance to the establishment of systemic and biomechanical homeostasis.  Further, it has already been established that it is packed with sensory receptors (Ruffini, Golgi Tendon Organs, Pacini, Interstitial Receptors) therefore it serves as a fundamental source of mechanical information to the brain.  Perhaps the most important reality is that fascia is a subset of a much larger consideration:  Connective Tissue.  It belongs to the connective tissue "family", therefore it has equal relevance as every other tissue in the body.  When you consider the other "members" of the connective tissue family, this point becomes relatively clear. 



The above chart provides an elegant perspective on connective tissue.  It is essentially composed of two elements (cells and a matrix) and from there it differentiates quite significantly.  The relevance to fascia is derived from the matrix branch, which is clearly identified as being composed of a base ground substance and protein fibers.  The protein fibers demonstrate the mechanical contribution, while the diverse ground substance manifestations essentially describe the relevance within the human organism.  Mineralized ground substance is manifest as bone...which responds and adapts through cellular mechanotransduction.  The gelatinous/syrupy ground substance is what is widely considered as "fascia"...and it also responds through mechanotransduction. 

Therefore the question of clinical relevance is indeed logical...however, relevance is largely subjective and can only be evaluated through specific "prisms".  I have had the luxury of working exclusively over the last 6-7 years with severely affected children with Cerebral Palsy...who can realistically be categorized as some of the most profoundly weak individuals.  The most efficient, reliable, measureable, and permanent  way to improve their condition is the focused emphasis on the extended connective tissue system! As the chart describes, the connective tissue is a large contributor to biomechanical competence therefore if manual intervention is applied with very specific loading properties and using specific stress transfer mediums, the connective tissue will respond through the process of mechanotransduction.  Perhaps more importantly, the movement of interstitial fluid through the extracellular matrix (via specialized manual applications) contributes to the improvement in lymphatic drainage, nutrient transport, and the removal of metabolic by-product.  This is seen quite clearly in these profoundly weak individuals...and is somewhat "blurred" when you are working within the "healthy" community.  Is fascia/connective tissue relevant?  WITHOUT QUESTION.  

2) Fascia is not exotic and "too tight to release"

This is perhaps the most critical error that is made by the vast majority...including the author.  He states that there are essentially two simplistic rationales that fascia "enthusiasts" cling to that explain why fascia is important:  Its everywhere and connects everything, and it gets tight.  This statement is actually largely accurate...this is indeed a widely accepted "mantra" for most.  The author is correct in suggesting that this is a primitive perspective...however he simply points out this fact without going into any further "sophisticated" enhancement.  This statement, at best, only describes 50% of the reality...and I will explain why.  Further, this explanation will in fact demonstrate that fascia/connective tissue is indeed exotic!  The common conceptual "trap" is to consider connective tissue within its "connective" physiological appearance ONLY.  Although it is intuitive, it is extremely primitive and quite mis-leading.  The exotic nature of connective tissue is that is has a paradoxical physiological function of DIS-CONNECTING as well!  Loose connective tissue (what is largely thought of when thinking of fascia) serves the role of separating specific muscle groups and bundles as well as synthesizing lubricant to allow for un-interrupted sliding between muscle groups.   This mechanism is in place to increase force transmission efficiency...without which, movement and function would be significantly disturbed.  In essence, the exotic nature lies in this paradoxical dual purpose.

The other notion that fascia is too strong to be released is not anything that I have a particular comment on.  Rather, it is the idea that fascia/connective tissue ONLY gets tight...or is only somehow "overstrong".  This is the most unproductive mindset I can think of.  In reality, "tightness" is a relative expression, NOT an absolute one.  To be specific, it is always assumed that one "sheet" is too tight and needs to be released. The overwhelming failure lies in the fact that this perceived tightness is in relation to the adjacent sheet...is it really tight, or are both of them weak with one of them being "less weak?".  Therefore, with respect to the absolute true status of the fascial band, if you disregard the potential that it may in fact be weak...you have effectively reduced your chances of success by a minimum of 50%.  It is already widely known (and researched) that a spastic muscle is approximately 4 times stronger than a healthy muscle...but the connective tissue matrix is 30-40 times weaker!  Therefore, it may in fact be true that healthy fascia need not be released...it may even be a viable extrapolation to claim that it CAN'T be released...however, this paradigm excludes the reality that connective tissue can indeed manifest weakness and that this weakness can contribute to an alteration of the biotensegral homeostasis of the human organism (both mechanically and systemically). 

In summary, the author is right in the claim that physically changing fascia by force would be "medievil"...however this falls squarely within the "tight-only" paradigm.  Weak connective tissue systems can be gradually strengthened over time with appropriate loading properties and adequate stress transfer mediums. 

3) Does it matter that fascia contains muscle cells?

The simple reality is that the human organism is the most efficiently constructed "machine" on the planet.  In essence, if it exists, it matters! It is true that, when compared to actual muscle tissue, its contractile potential is significantly less...but muscle tissue has the singular purpose of contraction!  It is a specialized tissue that does nothing else but contract and relax.  Conversely, connective tissue (fascia) has diverse and widespread physiological roles.  Therefore if you gauge connective tissue solely on contractile potential...it will obviously fall very short.  The fact that it extends throughout the entire organism from top to bottom, inside and out reflects the significant impact it has even with limited contractile potential...in other words, its effect on the organism is cummulative.  If the entire connective tissue network were to contract, it would generate significant force...which is quite regularly manifest in the "fight or flight" response where individuals are reported to perform feats of "superhuman strength".  This is the automatic recruitment of the contractile properties of conenctive tissue. 

4) What does Dr. Schleip think?

For those who are unfamiliar with Dr. Schleip, he is widely considered as one of the leading experts in fascia research.  The author makes a point to mention that he has forwarded his position to Dr. Schleip (which is a noble and respectable gesture) for his feedback.  According to the article, Schleip shares the authors reserved attitude in making any "God particle" claims with respect to fascia...additionally, that there are some people making some claims that are made from no facts, extrapolation of fact, or theory regarding fascia.  However, the mere fact that Dr. Schleip exists...and that he has been sought out for comment by the author...indicates that fascia IS important.  The reality is that there have been no real advances in physical therapy since the invention of the EMG.  The current "muscular" paradigm we currently follow is based on the idea that anything important must generate an electrical signal...if not, it isnt important.  The consideration of fascia/connective tissue as active "players" is a relative "stretch" within this paradigm.  Therefore, I can confidently say that the current environment is consistent with what Kuhn calls a "Model Crisis".  A Model Crisis is when there are accumulating anomalies that the current paradigm cannot explain.

Kuhn Cycle for Scientific Revolutions

  
This inevitably leads to a model revolution and a subsequent paradigm shift.  The typical crisis stage is characterized by a polarization of philosophy and perspective with those resisting the "revolution" and those who are attempting to drive the paradigm shift forward.  It is my personal belief that the current fascia science is stimulating and perpetuating this cycle through the most sensitive (and challenging) phase.  The ultimate result is a likely paradigm shift that reconfigures the working mindset and will therefore re-shape the manner in which "normal science" is done how research methods are approached.

Fascia matters.  Case closed.

Cheers!
 

 

This will most certainly qualify as a simple "rant".  I do not have anything particularly scientific to deliver, nor am I likely to mention anything that many haven;t likely already pondered...however, putting pen to paper (or "finger to keyboard", in this case) has always been consistently reliable in helping me to integrate and internalize certain ideas and concepts.  So perhaps this brief post is more "therapeutic" as opposed to enlightening.

Over the last 6-7 years within the CP / Neurotrauma landscape, I have had the privelege of engaging in hundreds of discussions and consultations with families from all over the world regarding the very specific and ultimately unique experience of having a child with some form of neurotrauma.  At face value, it would seem that this exposure and experience would yield some relative sense of "confidence" in being able to accurately identify and effect positive changes in the overall mindset of these families and their extended family unit.  However, the more this experience grows, the more my understanding grows as to how unimaginably complex this world is.  To be precise, it is a tangled web of fear, doubt, worry, stress, and potentially some guilt.  Within all of this mix of emotions, the concept of "where do I start" and "when will I be finished" is often contemplated...but is seldom answered.  Further, there is the additional stress of "what is the right path between start and finish"...which is often clouded and muddied by the background "noise" of competing rehabilitative philosophies and schools of thought.

In many circumstances, I have found that my efforts to "enlighten" and "educate" only served to contribute to the amount of "noise" these families were experiencing.  Although most professionals have genuine good intentions, the reality is that there is no real true concensus among neurotrauma professionals as to the best course of action...even to the extent where there are competing diagnostic definitions!  Therefore I was required to take a step back and search for a more "user-friendly" approach...which couldnt have been more intuitive.

Help to filter out the noise.  Before anyone can understand you, they must first be able to "hear" you.  Therefore, your first attempt should not be to "re-train" or "reprogram"...rather to provide some form of noise-cancelling support so that the family unit is more able to concentrate and think with more clarity and efficiency.  This involves some discussion / exxplanation / "de-briefing" on their experiences to date...how are those x-rays evaluated...what are the systemic considerations of such procedures...what is/are the general perspectives of the medical community, etc.  I equate this to the experience of trying to watch a televison show on an old black and white TV...with white noise and static buzzing on the screen, other channels popping in and out, and sometimes the signal going out completely for a time.  In this sense, my honest and transparent efforts would be the equivalent of the neighbour dropping in to play with the rabbit ears...it is likely appreciated, but often times just as distracting.  Providing some insight into the more global considerations of the specific condition will ultimately generate some overall understanding and therefore result in the establishment of an intrinsic "filter" which contributes to clarity of thought. 

This establishes a relatively reliable "starting line".  Although many wait anxiously for diagnosis, the realities of the journey are still the same...it isn't always necessary to defer your strategy until that point.  With respect to the obvious second question "where is the finish line"...the answer is generally not the most popular.  In truth, no one can responsibly provide the answer that so many people are looking for.  With all honesty and respect, this is a fundamentally wrong question to ask.  Even if someone could magically glance through a crystal ball and provide you with THE ultimate answer...would this determine whether it is "worth it or not"?  This is analogous to a young child setting a lifetime goal of achieving a gold medal in the Olympics and asking "is that possible".  Further, if that goal was never to be achieved, would all of his/her efforts have been in vain?  I recently heard a very insightful and powerful statement from a collegue: families spend so much energy trying to prove to the outside world that their child has value and that they are worth it.  This mindset ultimately contributes to the "white noise" that surrounds them...by establishing "pre-set" standards of achievement and often times unrealistic measurement tools.  The finish line should therefore be honestly and responsibly defined as "unset and undetermined".

Instill an understanding of the "Happiness Quotient".  I will outline the genesis of the Happiness Quotient (HQ) in an upcoming post, but it's beauty lies in its simplicity.  Although it can be expanded in many different ways, it is essentially a balance between a number of oppsing metrics:  Pain/Pleasure, Joy/Fear, Achievement/Failure, Relaxation/Tension, and Satisfaction/Frustration.  Within the everyday life of a child with CP or neurotrauma, there are far too many events that contribute to the negative metrics of this equation.  There is always some consistent muscular tension which may induce some pain as well...inability to effectively communicate to loved ones breeds frustration and anxiety...in many cases, positional changes generate periods of fear, etc, etc.  Therefore, the role of the family (and extended family) partly becomes a source of contribution to the positive metrics.  Establishing those activities that create some form of joy...therapeutic interventions (regardless of their overall philosophy) that generate definite periods of relaxation...and even frequent physical contact.  Hugs ARE therapy...therefore they should be considered as fundamental tools in establishing some equilibrium in the HQ.

Definitely a rant...possibly too "fluffy"...but hopefully somewhat stimulating!

Cheers!