If you found this through some of my old blogs, find me now at www.modalitieswellness.com
Thanks,
Sheila
Friday, November 18, 2011
We learn as we grow...
Strange, I began this blog a long time ago and was erratic at best. Then I got a web site with a blog and have been blogging there, I even moved some of my old posts from here to there for reference. The strange thing is I have never moved anything from there to here! And never said where I went.
CHRISTMAS AROMATHERAPY
This is my shortest post ever – just a heads up really –
I am offering some specially priced packages of my aromatherapy products for Christmas – come see what’s on offer….
Saturday, December 5, 2009
Observing surgery
Earlier this week I had the unique opportunity of observing some veterinary surgery. I am sure many of you are trying to figure out what use this would serve for a Massage Therapist. After all, what does a dog being spayed have to do with massage therapy? Well, quite a bit.
Though I am hoping to observe some more orthopaedic surgeries (i.e knee repairs) being able to observe any surgery was an interesting exercise. When it comes down to it the structure of mammals (the hairy, live young bearing, nursing creatures of the planet) is very much similar. The skeleton is made up of almost exactly the same bones that interact in very much similar ways through the action of very similar muscles. Four-legged mammals to have some differences in how the limbs interact with the torso and the proportions of the bones and muscles are different, but there is more the same than different.
In a general sense seeing the basic process of how you cut into a living being was educational. An opportunity to see all the layers of fascia and tissue that I have learned were there and what they actually look like. Seeing tissue not in a drawing or a film of preserved tissue, but “in vivo” - “in life” - is quite different.
My first surprise though came in seeing how limp the animals were when they are brought, already anaesthetized to the table. For everyone who has seen a truly ASLEEP baby when all the limbs splay out and you are are sure that even swinging by the ankles would not disturb them are less limp than this. Everything is simply floppy. The next surprise was how quickly admission into the body is gained, and how little blood there actually is. The third, and perhaps largest surprise, came once the outer tissue had been cut through and I realized how truly separate the outer layers of skin, fascia and muscle were from all the organs lying underneath. Everything could simply be lifted up so the vet could see around the abdomen, and there was no blood in there. Well, there was blood, but it was all tidily where it belonged, in the blood vessels and the tissue.
All I saw that day were spays, the removal of the ovaries and uterus of young female dogs. The surgeries were quick and even with the poking, pulling, tying, cutting, and a bit of tearing too, there was very little blood and the incisions were virtually invisible. Within about a half hour the dogs were rousing and most did not seem particularly troubled. Though a bit drowsy, only one whimpered a bit, but then she managed to get close to one of the other dogs and she was calm again. None seemed to be in great pain or distress. Having experienced a few surgeries of my own I must say I was not so sanguine after. Apparently our pets are more stoic than ourselves.
From this experience I am taking away an new wonder with the body and the its structure. The amazing way in which all its parts work together with so little muss and fuss. The wonderous way that modern medicine can insert itself (literally) into that system and come away having solved some issue, or prevented some other issue, without having greatly impacted the system as a whole. Thank-you to the veterinarian and vet assistants who made me welcome and were happy to share the whys, wherefore, and how comes of what they did. I hope I will have the chance to come back.
Though I am hoping to observe some more orthopaedic surgeries (i.e knee repairs) being able to observe any surgery was an interesting exercise. When it comes down to it the structure of mammals (the hairy, live young bearing, nursing creatures of the planet) is very much similar. The skeleton is made up of almost exactly the same bones that interact in very much similar ways through the action of very similar muscles. Four-legged mammals to have some differences in how the limbs interact with the torso and the proportions of the bones and muscles are different, but there is more the same than different.
In a general sense seeing the basic process of how you cut into a living being was educational. An opportunity to see all the layers of fascia and tissue that I have learned were there and what they actually look like. Seeing tissue not in a drawing or a film of preserved tissue, but “in vivo” - “in life” - is quite different.
My first surprise though came in seeing how limp the animals were when they are brought, already anaesthetized to the table. For everyone who has seen a truly ASLEEP baby when all the limbs splay out and you are are sure that even swinging by the ankles would not disturb them are less limp than this. Everything is simply floppy. The next surprise was how quickly admission into the body is gained, and how little blood there actually is. The third, and perhaps largest surprise, came once the outer tissue had been cut through and I realized how truly separate the outer layers of skin, fascia and muscle were from all the organs lying underneath. Everything could simply be lifted up so the vet could see around the abdomen, and there was no blood in there. Well, there was blood, but it was all tidily where it belonged, in the blood vessels and the tissue.
All I saw that day were spays, the removal of the ovaries and uterus of young female dogs. The surgeries were quick and even with the poking, pulling, tying, cutting, and a bit of tearing too, there was very little blood and the incisions were virtually invisible. Within about a half hour the dogs were rousing and most did not seem particularly troubled. Though a bit drowsy, only one whimpered a bit, but then she managed to get close to one of the other dogs and she was calm again. None seemed to be in great pain or distress. Having experienced a few surgeries of my own I must say I was not so sanguine after. Apparently our pets are more stoic than ourselves.
From this experience I am taking away an new wonder with the body and the its structure. The amazing way in which all its parts work together with so little muss and fuss. The wonderous way that modern medicine can insert itself (literally) into that system and come away having solved some issue, or prevented some other issue, without having greatly impacted the system as a whole. Thank-you to the veterinarian and vet assistants who made me welcome and were happy to share the whys, wherefore, and how comes of what they did. I hope I will have the chance to come back.
Tuesday, December 1, 2009
Vitamin D
Recently there have been reports that Vitamin D will help protect you from H1N1. Vitamin D, long associated with bone health, has also been shown to be an immunomodulator – which is a big word used to say that Vitamin D has a role in regulating how your immune system functions. Through this function it can assist your body in fighting off infection and disease, which, of course, includes H1N1. This process can also help your body shorten the length and severity of the flu should you be infected.
Vitamin D can both enhance and inhibit the immune system. Think of it as providing maintenance and guidance to the immune system. This functions is leading to research in Vitamin D's role in prevention and treatment for not only infectious diseases, like colds and flus, but also autoimmune diseases (i.e. Multiple sclerosis and rheumatoid arthritis) and cancers. The recent recommendations for higher daily intake of Vitamin D in pregnant women is linked to a study of MS onset
Taking Vitamin D supplements will help your immune system stay strong, especially in the gloomy months of the west coast winter when our sun exposure driven vitamin D production is inhibited. At our latitude, from November to February, at a minimum, we are not exposed to sufficient UVB levels to create enough Vitamin D. Winter supplementation of Vitamin D is now strongly suggested.
It must be kept in mind that vitamin D is a fat soluble vitamin. A fat soluble vitamin is one which requires lipids (fat) to be absorbed into the body, and which can, then, be stored in fat within the body. This means that though a bit of supplementation is helpful, too much can create toxicity. Vitamin D toxicity can cause calcification of the kidney, as well as heart, lungs and blood vessels.
There is a reassessment of recommended intake for Vitamin D being undertaken but for now Health Canada holds firm with the tradition 200 IU's per day (or 5 micrograms) for those 0-50. That amount doubles to 400 IU for 50-70 year old and go up again to 600 IU for those past 70 years, to help maintain healthy bones. The recommendations however also suggest a 400 IU supplement for breast fed babies under one year. The maximum safe levels are much higher at 2000 IU per day for all over 1 year.
Fish is your most reliable dietary source of Vitamin D especially the fatty fish like salmon, tuna and mackerel – think of the same fish that supply you with Omega 3's and you are on the right track. Beef liver, eggs and cheese also naturally provide vitamin D. In Canada all of our milk, some cereal products and orange juices are supplemented with Vitamins D to a level such that two large glasses of milk should provide adequate Vitamin D for a child or adult.
If you decide to supplement Vitamin D look for a D3 supplement as they have been shown to have a stronger and longer impact on blood levels of Vitamin D than D2. Stay aware of the recommended intakes and be sensible. You drink a litre of milk a day? Extra Vitamin D is probably not necessary for you. You are a vegan or a lactose intolerant vegetarian – you may want to look at Vitamin D supplements. Of course if you are a snowbird and headed to Arizona any day now, you should get enough UVB to keep you in Vitamin D!
Some things to keep in mind generally about vitamins and supplementation generally. Always look for reputable names when you are looking at supplements. This is not the time to look only at price. Keep an eye out for quality. Ask a pharmacist or your doctor. Talk someone at a health food or vitamin store, they are are often well informed. Fat soluble vitamins (A, D, E, and K) do carry the risk of toxicity if you take high doses over time. Water soluble vitamins are harder to overdose on as they are easily excreted in urine, but you can overdose, and even if you do not and your body safely processes that mega-dose you decided to try you will simply end up with very costly pee!
As with anything you put in your body, a bit of knowledge, thought and common sense go a long way to keeping you healthy and happy – and moderation is always a good path.
Vitamin D can both enhance and inhibit the immune system. Think of it as providing maintenance and guidance to the immune system. This functions is leading to research in Vitamin D's role in prevention and treatment for not only infectious diseases, like colds and flus, but also autoimmune diseases (i.e. Multiple sclerosis and rheumatoid arthritis) and cancers. The recent recommendations for higher daily intake of Vitamin D in pregnant women is linked to a study of MS onset
Taking Vitamin D supplements will help your immune system stay strong, especially in the gloomy months of the west coast winter when our sun exposure driven vitamin D production is inhibited. At our latitude, from November to February, at a minimum, we are not exposed to sufficient UVB levels to create enough Vitamin D. Winter supplementation of Vitamin D is now strongly suggested.
It must be kept in mind that vitamin D is a fat soluble vitamin. A fat soluble vitamin is one which requires lipids (fat) to be absorbed into the body, and which can, then, be stored in fat within the body. This means that though a bit of supplementation is helpful, too much can create toxicity. Vitamin D toxicity can cause calcification of the kidney, as well as heart, lungs and blood vessels.
There is a reassessment of recommended intake for Vitamin D being undertaken but for now Health Canada holds firm with the tradition 200 IU's per day (or 5 micrograms) for those 0-50. That amount doubles to 400 IU for 50-70 year old and go up again to 600 IU for those past 70 years, to help maintain healthy bones. The recommendations however also suggest a 400 IU supplement for breast fed babies under one year. The maximum safe levels are much higher at 2000 IU per day for all over 1 year.
Fish is your most reliable dietary source of Vitamin D especially the fatty fish like salmon, tuna and mackerel – think of the same fish that supply you with Omega 3's and you are on the right track. Beef liver, eggs and cheese also naturally provide vitamin D. In Canada all of our milk, some cereal products and orange juices are supplemented with Vitamins D to a level such that two large glasses of milk should provide adequate Vitamin D for a child or adult.
If you decide to supplement Vitamin D look for a D3 supplement as they have been shown to have a stronger and longer impact on blood levels of Vitamin D than D2. Stay aware of the recommended intakes and be sensible. You drink a litre of milk a day? Extra Vitamin D is probably not necessary for you. You are a vegan or a lactose intolerant vegetarian – you may want to look at Vitamin D supplements. Of course if you are a snowbird and headed to Arizona any day now, you should get enough UVB to keep you in Vitamin D!
Some things to keep in mind generally about vitamins and supplementation generally. Always look for reputable names when you are looking at supplements. This is not the time to look only at price. Keep an eye out for quality. Ask a pharmacist or your doctor. Talk someone at a health food or vitamin store, they are are often well informed. Fat soluble vitamins (A, D, E, and K) do carry the risk of toxicity if you take high doses over time. Water soluble vitamins are harder to overdose on as they are easily excreted in urine, but you can overdose, and even if you do not and your body safely processes that mega-dose you decided to try you will simply end up with very costly pee!
As with anything you put in your body, a bit of knowledge, thought and common sense go a long way to keeping you healthy and happy – and moderation is always a good path.
Sunday, November 15, 2009
A Viagra Parfait?!?!?!?!
I heard the most ridiculous thing on the radio a few minutes ago – and I have four kids so I hear a lot of ridiculous things. Some chefs have whipped up a passion fruit dessert laced with Viagra. They wanted to “reinterpret” the medication into a new kind of aphrodisiac apparently.
Immediately I am trying to figure out how this could work. After all, Viagra is a prescription medication so how can it be sold in food? Is this a BYOBP (bring your own blue pill) deal? Do you have to bring your prescription and show some ID to be served? Do you have to promise that you won't share a spoon full? I mean come on, if this if supposed to be an aphrodisiac isn't it almost imperative to share?
Are there chefs out there running renegade from the pharmaceutical boards of the world? Is there about to be an outbreak of tented napkins in finer restaurants everywhere? Is someone going to have heart failure from sampling there neighbours dessert? In a word – NO.
Having heard this ridiculous little tidbit I did what any reasonably tech savvy woman with an interest in wellness would do – I “googled”. I discovered that the dessert in question was prepared for the Gastronomy 2009 fair in Bogota Columbia. How...anti-climatic. Due to the fact that Viagra does require a prescription this little treat will not be publicly available – though I am going to keep “googling” to see how long it takes them to post a recipe.
Ultimately, what I am realizing from this bit of absurdity is my own underlying assumption about prescription medication. The baseline belief that people will do dumb things with medicine. That someone somewhere would be willing to distribute a restricted substance in a gag dessert wasn't an impossibility for me. I was outraged and could see all kinds of legal issues but I did not immediately assume that this wasn't something that would happen. What a frightening realization. That we as a culture have become so accepting of the idea that people will abuse prescriptions that I didn't first question that part of the equation. How sad.
All over the world we have issues with people abusing prescription drugs ranging from narcotic painkillers through to our children's drugs. Perhaps the pain medication is the most obvious candidate for abuse either by the person to whom it has been given or by someone around them. But psychoactive drugs are also a major issue, from tranquilizers to the Ritalin, a drug most commonly given to children to decrease hyperactivity but abused by others for the speed-like affects it can give those not dealing with AD(H)D.
There are stats and research galore about the problem of prescription drug abuse. The links below will lead you to explore some interesting and informative articles. LINKS: Hamilton, ON statistics - check out the table on page two for a quick summary, a slide show of commonly abused presscription drugs, a local Victoria researcher comments about our attitudes towards pharmacauticals. Of course for those into less empirical research just pick up a copy of People, US, or some other weekly gossip magazine and you can read which celebrity is checking into rehab for vicodin abuse or whatever the current drug of choice might be – for the first, or the fourth time.
I am not a fan of drug taking for every problem, modern pharmaceuticals are an amazing tool in the wellness arsenal. Pharmacology provides us with tools to battle acute illness, to control symptoms, to ward of illness, to manage and slow the progression of long term illness. What a wonderful tool. How tragic that we choose to abuse and overuse this tool. We need to view pharmaceuticals with respect and as the potent tool they are in our quest to live long, healthy live.
Immediately I am trying to figure out how this could work. After all, Viagra is a prescription medication so how can it be sold in food? Is this a BYOBP (bring your own blue pill) deal? Do you have to bring your prescription and show some ID to be served? Do you have to promise that you won't share a spoon full? I mean come on, if this if supposed to be an aphrodisiac isn't it almost imperative to share?
Are there chefs out there running renegade from the pharmaceutical boards of the world? Is there about to be an outbreak of tented napkins in finer restaurants everywhere? Is someone going to have heart failure from sampling there neighbours dessert? In a word – NO.
Having heard this ridiculous little tidbit I did what any reasonably tech savvy woman with an interest in wellness would do – I “googled”. I discovered that the dessert in question was prepared for the Gastronomy 2009 fair in Bogota Columbia. How...anti-climatic. Due to the fact that Viagra does require a prescription this little treat will not be publicly available – though I am going to keep “googling” to see how long it takes them to post a recipe.
Ultimately, what I am realizing from this bit of absurdity is my own underlying assumption about prescription medication. The baseline belief that people will do dumb things with medicine. That someone somewhere would be willing to distribute a restricted substance in a gag dessert wasn't an impossibility for me. I was outraged and could see all kinds of legal issues but I did not immediately assume that this wasn't something that would happen. What a frightening realization. That we as a culture have become so accepting of the idea that people will abuse prescriptions that I didn't first question that part of the equation. How sad.
All over the world we have issues with people abusing prescription drugs ranging from narcotic painkillers through to our children's drugs. Perhaps the pain medication is the most obvious candidate for abuse either by the person to whom it has been given or by someone around them. But psychoactive drugs are also a major issue, from tranquilizers to the Ritalin, a drug most commonly given to children to decrease hyperactivity but abused by others for the speed-like affects it can give those not dealing with AD(H)D.
There are stats and research galore about the problem of prescription drug abuse. The links below will lead you to explore some interesting and informative articles. LINKS: Hamilton, ON statistics - check out the table on page two for a quick summary, a slide show of commonly abused presscription drugs, a local Victoria researcher comments about our attitudes towards pharmacauticals. Of course for those into less empirical research just pick up a copy of People, US, or some other weekly gossip magazine and you can read which celebrity is checking into rehab for vicodin abuse or whatever the current drug of choice might be – for the first, or the fourth time.
I am not a fan of drug taking for every problem, modern pharmaceuticals are an amazing tool in the wellness arsenal. Pharmacology provides us with tools to battle acute illness, to control symptoms, to ward of illness, to manage and slow the progression of long term illness. What a wonderful tool. How tragic that we choose to abuse and overuse this tool. We need to view pharmaceuticals with respect and as the potent tool they are in our quest to live long, healthy live.
Tuesday, November 10, 2009
Fascia – The Undiscovered Tissue
This last week the 2nd International Fascia Congress went ahead in Amsterdam. For four days the leading researchers presented their most recent findings to a mixed group of scientists and clinicians. After the congress there were a series of workshops, many of them very practical in nature. I am very excited to learn that the 2012 the fascial congress will be hosted by my professional organization, the British Columbia Massage Therapy Association of BC in Vancouver. To heighten my delight the 2012 congress will focus on the clinical application of current fascial research. I will be at that one, doing a little happy dance.
I expect many of you are trying to figure out what this fascia stuff is and why I am all giddy about it. Well, to steal the explanation my first fascial instructor gave me – fascia is the bag we walk around in. Imagine all the different bits in your body that you know about as being what is in the bag and that fascia is the bag. Recent research has shown that these are contractile bags – something that wasn't known when I first started studying fascia. A type of cell called a myofibroblast is responsible for this type of constriction - more on this later.
Fascia surrounds all nerve fibres, nerves, muscle fibres and muscles, organs, bones, joints and underlies our skin. Fascia acts to protect and separate structures, help maintain posture, and allow structures to glide upon one another. Problems in the fascia therefore create all sorts of problems in the body and often create mobile pain, pain that migrates far from its source and or moves around in the body without apparent cause.
The term fascia encompasses most of the connective tissue in the body and is the most pervasive substances in our bodies. Yet many people have never heard of it and our scientific exploration has just begun to bring fascia into the light. The western reductionist approach to our bodies and the treatment of them has allowed fascia to languish unexplored. Fascia coexists in form and function with all of our bodies systems and our piece-by-piece, system-by-system approach to treating our bodies meant that there has been virtually no exploration of this fascinating tissue. Basically, no one owned fascia because everyone owed fascia.
They owed fascia for the protection, lubrication and separation of the system in which they specialized. Fascia is the ultimate in multi-taskers. It can be thick, dense and organized, lending support to and separation between structures. It can be gossamer thin and allow structures to glide over one and other smoothly. It can be almost free of blood vessels and nerves or richly supplied with blood and sensory functions. Fascia can be so many things that initially anatomists did not realize it was all the same thing. So we have many names for the structures that are composed of fascia and a dearth of understanding of how all these different structures with their different compositions and functions can be discussed together.
On the bright side, there is a huge amount of research being done to increase our understanding of fascial tissue and its myriad impacts on the body. Some of the interesting directions that are being explored include the contractile nature of fascia, how tension is transmitted into the lumber fascia and how healthy fascia can move the way it does in the body without tearing.
Current research by Dr. Robert Schleip of the University of Ulm in Germany is exploring variability of myofibroblast density in fascia. Myofibroblasts are a contractile cell that are found in fascia and at wound sites. At wound sites the myofibroblast aid in wound closure, which speeds healing. However, in scar tissue these myofibroblasts sometimes stay around and continue to create contraction where it is not needed or wanted. What does this mean to fascia? If these cells are too active would they create undue restriction in the tissues they surround? Would this create tension and perhaps pain the the surrounded tissue?
Priscilla Barker and her associates have shown that contraction of various trunk muscles, including the transversus abdominis, create tension in the lumbar fascia, which then contributes to stability in the lumbar spine. Which explains why you are told to contract your tummy when you lift heavy objects.
One of the most visually arresting explorations of fascia comes to use from Dr. Jean Claude Guimberteau. Dr. Guimberteau has collected images, via laproscopic camera, of live fascial tissue and recorded the movement that occurs in the fascia and the neurovascular (nerves and blood vessels) tissue when a tendon is pulled on. The result is a video called "Strolling Under the Skin" and a book of the same title.
As a manual therapist I am excited by this research and what it tells us about one of the most frustrating things manual therapists experience. I have a client come in, I do all the indicated treatment and they leave feeling great – only to have the same pain and discomfort return almost immediately. Often, though not always, this type of pattern indicates fascial distortion or restriction. The good news is all this research that tells us about the function, structure and responses of fascia helps us to more easily recognize and successfully treat fascial issues and leave our clients with long term improvement in the performance and comfort of their bodies.
So there is a quick overview of the world of fascia and the reason I get so excited about this coming congress in Vancouver. What a wonderful opportunity to engage with and learn from the leading lights of fascial research. What a wonderful opportunity for the growth of understanding and good clinical application of that research by bringing together those who are exploring the science and those who are applying that science for your benefit.
Stay tuned for more on you and your body. Please let me know if there are wellness topics you are interested in or confused by.
I expect many of you are trying to figure out what this fascia stuff is and why I am all giddy about it. Well, to steal the explanation my first fascial instructor gave me – fascia is the bag we walk around in. Imagine all the different bits in your body that you know about as being what is in the bag and that fascia is the bag. Recent research has shown that these are contractile bags – something that wasn't known when I first started studying fascia. A type of cell called a myofibroblast is responsible for this type of constriction - more on this later.
Fascia surrounds all nerve fibres, nerves, muscle fibres and muscles, organs, bones, joints and underlies our skin. Fascia acts to protect and separate structures, help maintain posture, and allow structures to glide upon one another. Problems in the fascia therefore create all sorts of problems in the body and often create mobile pain, pain that migrates far from its source and or moves around in the body without apparent cause.
The term fascia encompasses most of the connective tissue in the body and is the most pervasive substances in our bodies. Yet many people have never heard of it and our scientific exploration has just begun to bring fascia into the light. The western reductionist approach to our bodies and the treatment of them has allowed fascia to languish unexplored. Fascia coexists in form and function with all of our bodies systems and our piece-by-piece, system-by-system approach to treating our bodies meant that there has been virtually no exploration of this fascinating tissue. Basically, no one owned fascia because everyone owed fascia.
They owed fascia for the protection, lubrication and separation of the system in which they specialized. Fascia is the ultimate in multi-taskers. It can be thick, dense and organized, lending support to and separation between structures. It can be gossamer thin and allow structures to glide over one and other smoothly. It can be almost free of blood vessels and nerves or richly supplied with blood and sensory functions. Fascia can be so many things that initially anatomists did not realize it was all the same thing. So we have many names for the structures that are composed of fascia and a dearth of understanding of how all these different structures with their different compositions and functions can be discussed together.
On the bright side, there is a huge amount of research being done to increase our understanding of fascial tissue and its myriad impacts on the body. Some of the interesting directions that are being explored include the contractile nature of fascia, how tension is transmitted into the lumber fascia and how healthy fascia can move the way it does in the body without tearing.
Current research by Dr. Robert Schleip of the University of Ulm in Germany is exploring variability of myofibroblast density in fascia. Myofibroblasts are a contractile cell that are found in fascia and at wound sites. At wound sites the myofibroblast aid in wound closure, which speeds healing. However, in scar tissue these myofibroblasts sometimes stay around and continue to create contraction where it is not needed or wanted. What does this mean to fascia? If these cells are too active would they create undue restriction in the tissues they surround? Would this create tension and perhaps pain the the surrounded tissue?
Priscilla Barker and her associates have shown that contraction of various trunk muscles, including the transversus abdominis, create tension in the lumbar fascia, which then contributes to stability in the lumbar spine. Which explains why you are told to contract your tummy when you lift heavy objects.
One of the most visually arresting explorations of fascia comes to use from Dr. Jean Claude Guimberteau. Dr. Guimberteau has collected images, via laproscopic camera, of live fascial tissue and recorded the movement that occurs in the fascia and the neurovascular (nerves and blood vessels) tissue when a tendon is pulled on. The result is a video called "Strolling Under the Skin" and a book of the same title.
As a manual therapist I am excited by this research and what it tells us about one of the most frustrating things manual therapists experience. I have a client come in, I do all the indicated treatment and they leave feeling great – only to have the same pain and discomfort return almost immediately. Often, though not always, this type of pattern indicates fascial distortion or restriction. The good news is all this research that tells us about the function, structure and responses of fascia helps us to more easily recognize and successfully treat fascial issues and leave our clients with long term improvement in the performance and comfort of their bodies.
So there is a quick overview of the world of fascia and the reason I get so excited about this coming congress in Vancouver. What a wonderful opportunity to engage with and learn from the leading lights of fascial research. What a wonderful opportunity for the growth of understanding and good clinical application of that research by bringing together those who are exploring the science and those who are applying that science for your benefit.
Stay tuned for more on you and your body. Please let me know if there are wellness topics you are interested in or confused by.
Friday, October 30, 2009
H1N1
H1N1 – the pandemic!...?
I am continually shocked at the general response of the public to the H1N1 virus. The World Health Organization is calling it a pandemic so everyone is in a flap. What no one really seems to know is why they are in a flap. A person can give you the five things they are doing to help prevent the flu – i.e. Hand-washing, anti-bacterial hand sanitizer, eschewing hand shaking, etc – and they are desperate to get the flu shot – but if you asked them what the difference was between H1N1 and the “seasonal flu” they would be hard pressed to tell you. Am I the only person who finds this a bit ridiculous? It is like being afraid of the bogeyman when you were five– you don't know what he was but you knew he would get you if the nightlight wasn't left on! The thing is we are not five anymore and surely we should be able to distinguish the difference between the real and the imagined. So why are we not doing our “due diligence” and discovering what the difference is and what it is we are actually afraid of.
The two key features that seem to be causing the most concern is that it is a pandemic and that the patients are not primarily among the elderly or ill. First, pandemic status. The H1N1 virus is a pandemic because it is found in a large number of countries – that is the World Health Organization's actual criteria – how many countries' have reported cases. Pandemic status does not necessarily reflect how severe nor how contagious the disease actually is. The WHO is classing the H1N1 flu as being of “moderate” severity which means that the majority of cases will resolve without medical intervention within a week. Yearly in British Columbia we see 400-800 deaths from the seasonal flu – mainly among the elderly – since April of 2009 we have only seen 12 deaths in BC from H1N1. In all but one case there have been underlying health issues.
Second, the unusual patient profile arises from the fact that a very similar strain of flu swept through the population in 1957 and has left those born before 1957 with a high degree of immunity to the H1N1. This type of radical change in the flu virus is a cyclical occurrence.
The issue of greater immunity is one that seems to be creating a great deal of consternation for a number of people. One, this means that the elderly, usually the highest risk population, are relatively safe. Two, it has created the differing profiles for the two flu shots we are seeing this year. As the elderly have protection from the H1N1 but not the other flu strains expected this year, they get first “shot” at the seasonal flu vaccine. The earlier vaccination for the elderly will also allow their generally slower immune response plenty of time to build up its defences from that seasonal flu. As the younger public are generally more healthy and less likely to get the flu period they are being given access to the H1N1 shot first, as that flu is expected to make significant impacts earlier in the year, and will have an opportunity to get the seasonal shot later on. The two shots are best done separately and the height of seasonal flu impact is not expected until later on so it is safer to delay that vaccination than the H1N1. The seasonal flu is also one that most of us have relatively high resistance to as it is very like last years seasonal flu, and the year before that, and the year before that, etc.
Some myth-busting – the reason everyone is getting the H1N1 diagnoses right now is that is what is out there. The seasonal flu isn't around yet so if you have the flu, you have H1N1. Why aren't they testing? Because it costs a lot to test every sniffle. You are better off staying home, assuming you have H1N1 than running around at the most contagious stage wait to hear results from a test to say you have it. The WHO actually recommends that areas with high incidence of the virus (which includes BC) stop testing in favour of concentrating resources on prevention and care for the very ill. Yes, children have died from H1N1 and that is tragic. There is also evidence that there have been underlying conditions that increased risk for those children. This is consistent with the information provided to the public by various health authorities and though extraordinarily sad is not a cause for huge concern unless your child has one of those underlying conditions. If you think you have and have had the H1N1 virus DO NOT GET THE H1N1 SHOT! You body is already producing the antibodies the vaccine is designed to provoke so leave that shot for someone else!
What everyone should be keeping in mind is that unless you have a cough and a high fever you do not have the flu. Aches and pains, headache and fatigue are other common symptoms. In the under five crowd fever may be reduced but the incidence of vomiting and diarrhoea is increased. Though a runny nose and sore throat may occur they are more common with colds and throat infections than flu. Unless you fall into one of the high risk categories – underlying health concerns, first nations ethnicity, second or third trimester of pregnancy or under five you have a very low risk of developing a severe case of H1N1. If you think you have H1N1 and fall into one of the high risk categories talk to your doctor about anti-viral medication for yourself and anyone in your household who may be at risk. Once you have the virus the vaccine is not useful! Do follow basic hygienic precautions, do get the H1N1 shot if you are in one of the at risk categories, do stay home if you think you are sick (save the rest of us!) and stay rested and well generally – but do not panic, no one is helped by that!
I have included a few links below to some sites I looked at and believe would be useful reading for those wishing to know more.
Health Canada's H1N1 information site
BC Ministry of Health Bulletin for October 27th, 2009
Sunday, December 23, 2007
I recently attended some continuing education courses for my professional standing. Generally my continuing education is very hands-on, but this one was different. I sat for two day watching the replay of a fascia congress that occurred earlier in the fall in Boston. The replay allowed about one hundred and thirty massage therapists in BC to see where the cutting edge research of fascia is taking place and I was delighted to see how intrinsic fascia is coming to be considered to healthy function of the body. This article will not be a recap of the recap, as, even I must admit, the replay was not endlessly riveting, nor am I going to tell you the most technically detailed data or the specific clinical information I managed to extract, instead I am going to talk about the basics of fascia.
I may have lost a few of you back the first time I mentioned “fascia”. It is a term that did come up in some of my previous articles and which is dear to my heart and my practice, but, you ask, what is it? Fascia is a connective tissue in the body and it comes in a variety of forms that provide several functions within the body and it is one of the most common tissues found in your body. Made up of collagen and elastin arranged in a honeycomb like matrix fascia acts to separate, to contain and to protect your body and its various parts. The two basic categories of fascia are superficial and deep (or investing).
The largest single piece of fascia in the body is the superficial fascia. This layer runs under your skin from the top of your head to the bottom of your feet. The thickness and toughness varies with its location and from person to person. Deep or investing fascia surrounds our individual muscles, bones, and nerves. This encapsulation also occurs within muscles and nerves with each muscle and nerve fiber having its own fascial sheath. There are also several sheets of thick fascia in various parts of the body. These types of fascia act differently from each other and in this article I am going to focus on the superficial fascia.
Generally speaking superficial fascia is not terrible tough or thick, though as our subcutaneous fat stores are contained within this layer some of us have thicker superficial fascia than others, and that thickness can vary for an individual over time. This layer of fascia is designed to keep out skin separated from the muscle and bone underneath, to allow our skin to slide over these deeper tissues when we move. This type of fascia is actually quite delicate. You can easily tear it by pushing with your fingertip, but it is also very powerful. If you have ever grabbed a hold of a cat’s skin, or a Char-pei’s you know that their skin moves on their underlying tissue – and so does yours. Another place you may have seen fascia is the last time you pulled the skin off a raw chicken breast (apologies to the vegetarians). As you pull back the skin of the chicken you have likely seen the shiny clear material that lifts up with it, that is the superficial fascia.
Most people can pick up their skin in several places on the body; try it on your forearm. How much or how little can you pick up? The quantity is partially reflective of your heredity. Everyone has unique levels of collagen vs. elastin in their connective tissue, and this affects how pliable your skin, ligaments, tendons, and fascia are. More elastin means stretchier tissues. The other factor that could be impacting your ability to lift the skin up is whether or not your fascia has extended little collagen bonds into your tissue. Why would it do that? Immobility and any inflammation encourage the fascia to send little fibrous strands into the surrounding tissue. So if you have injured you arm or tend to overuse your arms (i.e. spend a lot of time typing or mousing on the computer, massaging people or playing racquet sports) you are more prone to the development of adhesions. These adhesions may be limiting, completely or partially, your ability to lift your fascia or they may be making it uncomfortable (a stretching or burning is the common description for the sensations that occur with picking up shortened fascia).
Other than an interesting party trick or a way for a mother cat to pick up her kittens without injuring them what does this superficial fascia do? Well, as I said it keeps the skin separate from the underlying tissue. This is important in allowing the body to move freely and with ease. In everyday movement your various muscles contract and relax in a myriad of directions and when the skin becomes stuck to that underlying tissue it creates lines of stress in the skin and can lead to discomfort with movement as the skin is stretched, or overstretched in too many directions at once. Once it becomes stuck the fascia tends to constrict at the point of restriction and that can limit movement and exacerbate the discomfort with movement that I already mentioned. The other problem that can develop is that there are many blood vessels and nerves that travel just under the skin and when the superficial fascia becomes restricted these structures are compressed and their function can consequently be impaired.
Over long periods fascial restriction can become distortion and the pull on the fascia can lead to postural distortions. Conversely, postural distortion can be a causal factor in creating fascial restriction. Fascia provides a certain amount of stabilization within the body and by constricting or allowing stretching of itself superficial fascia is often called into action to stabilize the inherent instability we create within our bodies with postural distortion.
There are the basics of the superficial fascia. In my next article I will look at the investing, or deep, fascia. In that article we will look at the importance of fascia in allowing our muscles to work efficiently and freely.
I may have lost a few of you back the first time I mentioned “fascia”. It is a term that did come up in some of my previous articles and which is dear to my heart and my practice, but, you ask, what is it? Fascia is a connective tissue in the body and it comes in a variety of forms that provide several functions within the body and it is one of the most common tissues found in your body. Made up of collagen and elastin arranged in a honeycomb like matrix fascia acts to separate, to contain and to protect your body and its various parts. The two basic categories of fascia are superficial and deep (or investing).
The largest single piece of fascia in the body is the superficial fascia. This layer runs under your skin from the top of your head to the bottom of your feet. The thickness and toughness varies with its location and from person to person. Deep or investing fascia surrounds our individual muscles, bones, and nerves. This encapsulation also occurs within muscles and nerves with each muscle and nerve fiber having its own fascial sheath. There are also several sheets of thick fascia in various parts of the body. These types of fascia act differently from each other and in this article I am going to focus on the superficial fascia.
Generally speaking superficial fascia is not terrible tough or thick, though as our subcutaneous fat stores are contained within this layer some of us have thicker superficial fascia than others, and that thickness can vary for an individual over time. This layer of fascia is designed to keep out skin separated from the muscle and bone underneath, to allow our skin to slide over these deeper tissues when we move. This type of fascia is actually quite delicate. You can easily tear it by pushing with your fingertip, but it is also very powerful. If you have ever grabbed a hold of a cat’s skin, or a Char-pei’s you know that their skin moves on their underlying tissue – and so does yours. Another place you may have seen fascia is the last time you pulled the skin off a raw chicken breast (apologies to the vegetarians). As you pull back the skin of the chicken you have likely seen the shiny clear material that lifts up with it, that is the superficial fascia.
Most people can pick up their skin in several places on the body; try it on your forearm. How much or how little can you pick up? The quantity is partially reflective of your heredity. Everyone has unique levels of collagen vs. elastin in their connective tissue, and this affects how pliable your skin, ligaments, tendons, and fascia are. More elastin means stretchier tissues. The other factor that could be impacting your ability to lift the skin up is whether or not your fascia has extended little collagen bonds into your tissue. Why would it do that? Immobility and any inflammation encourage the fascia to send little fibrous strands into the surrounding tissue. So if you have injured you arm or tend to overuse your arms (i.e. spend a lot of time typing or mousing on the computer, massaging people or playing racquet sports) you are more prone to the development of adhesions. These adhesions may be limiting, completely or partially, your ability to lift your fascia or they may be making it uncomfortable (a stretching or burning is the common description for the sensations that occur with picking up shortened fascia).
Other than an interesting party trick or a way for a mother cat to pick up her kittens without injuring them what does this superficial fascia do? Well, as I said it keeps the skin separate from the underlying tissue. This is important in allowing the body to move freely and with ease. In everyday movement your various muscles contract and relax in a myriad of directions and when the skin becomes stuck to that underlying tissue it creates lines of stress in the skin and can lead to discomfort with movement as the skin is stretched, or overstretched in too many directions at once. Once it becomes stuck the fascia tends to constrict at the point of restriction and that can limit movement and exacerbate the discomfort with movement that I already mentioned. The other problem that can develop is that there are many blood vessels and nerves that travel just under the skin and when the superficial fascia becomes restricted these structures are compressed and their function can consequently be impaired.
Over long periods fascial restriction can become distortion and the pull on the fascia can lead to postural distortions. Conversely, postural distortion can be a causal factor in creating fascial restriction. Fascia provides a certain amount of stabilization within the body and by constricting or allowing stretching of itself superficial fascia is often called into action to stabilize the inherent instability we create within our bodies with postural distortion.
There are the basics of the superficial fascia. In my next article I will look at the investing, or deep, fascia. In that article we will look at the importance of fascia in allowing our muscles to work efficiently and freely.
Wednesday, November 7, 2007
As we enter the early fall it begins, the repeated ads and signage posted at pharmacies about flu shots and flu shot clinics. Many of you have probably heard the controversy too. The controversy about vaccines generally and the flu shot specifically.
I could run through all the lists of who should and who should not get the flu shot, of why to or why not. I could tell you how they design flu shots and dispel myths about certain risks, but that would be reiterating. All that information is nicely and clearly laid out on Health Canada’s website just follow this link: It's Your Health - Influenza (the "flu"). Or I could tell you about those who argue against the flu shot, but again, they have very good material already out there, just follow this link: Vaccination Risk Awareness Network. Following the above links will give you two contrasting view about the flu shot, both quite rational and well presented. I am not going to restate all of those facts here.
What am I going to offer you? I am going to look at some of the options you could pursue if you don’t want to get the flu shot. I want to be clear - I do not feel that the flu shot in intrinsically evil or bad. I simply believe that there are risks associated and that there are other options to improve your resistance to the flu.
But what are your options? You do not want the flu, so what can you do? In fact, there are lots of thing you can do to minimize your likelihood of getting the flu this winter. The easiest is to keep clean. Wash your hands often and thoroughly. Be sure to get between your fingers, under your nails and along the edges of your hands. This simple habit has been repeatedly shown to reduce the incidence of flu. Hand washing is one of the most important things we can stress with our children to reduce the spread of influenza. Children tend to touch everything, including their eyes, noses and faces, which make them excellent vectors, transmitters, of pathogens. If you have small beings in your life I highly recommend increased hand washing for you and them.
The other obvious thing you can do for yourself is a bit more complicated – stay healthy. Eating well, drinking lots of water, exercising and getting enough quality rest are things we all mean to do all the time, but during the flu season these steps can hugely reduce risk of flu by ensuring you have a healthy immune system (the exercise, the food and the sleep) and nice moist mucus membranes (the water).
Why would you want moist mucus membranes you ask? Mucus membranes (i.e. the lining of you nose) are one of the first lines of defense your immune system has. When your mucus membrane is moist they act as physical barriers to pathogens, and all those nose hairs help too. The hair acts as a physical filter that traps viruses and bacteria. The moist membranes act kind of like those brown sticky fly strips. The pathogen gets past the hair and then gets trapped where the cellular immune function can go to work on destroying them. This is one of the reasons air travel can often lead to illness. Not only is the air re-circulated, it is also dry and dries out the mucus membranes. Keeping well hydrated can help maintain moisture in your mucus membranes. Some doctors also suggest a saline or baking soda solution be used to flush the sinuses to help maintain moisture levels, especially during plane travel. The nasal decongestant sprays do not serve this function as they are actually designed to dry the membranes out to reduce the stuffiness that occurs when your body is fighting a pathogen.
As to improving your diet, exercise and sleep I am not going to tell you it is easy. If it were easy none of us would be overweight, out-of-shape or tired all the time. I am just trying to reinforce the importance of trying to incorporate these factors into you flu-season routine. And incorporation is the key. For lots of people they just can not imagine taking an hour three days a week to exercise, or giving up dining out/taking in. So don’t do either. Just walk somewhere you might rather drive or that moldy oldie – take the stairs not the elevator. As for food, if you are eating in a restaurant try to choose the salad with your burger, and maybe make it a chicken burger. These are not novel suggestions, but they are sound. Give yourself credit to, don’t decry if you ate out four of seven nights, as usual, be happy if you chose the salad three times, the chicken twice and a wrap some other time. It all counts and it all helps!
Assuming you are doing your best with these, what can you do to add a bit of insurance? There are a variety of other options, most of them take you into the realm of complementary medicine and like the lifestyle advice above involve ways to keep yourself healthy, improve your immune system, and maybe make incorporating some of the lifestyle steps a bit easier.
Vitamin supplements, especially A, B-complex, C and E are useful for improving your immune system. There is a homeopathic remedy, oscillococcinum, which can be taken preventatively. A visit to a naturopathic doctor can often provide you with the best options with regard to these options as they are well versed in vitamin supplementation and homeopathy. Some naturopaths are also certified to practice acupuncture, which flows into the next set of options.
This is my option of choice. I first tried it because I knew from a friend who was a registered practitioner of Traditional Chinese Medicine that acupuncture and herbal remedies could help the immune system. I have stuck with it because it has worked. In the early fall I get an acupuncture treatment that is designed to support and increase my immune function. My TCM Practitioner usually gives me herbs to drink as a tea to reinforce the acupuncture. I am very closely exposed to a large number of people through my work so I know that this option is good protection.
You could also add Massage Therapy and or reflexology to your life. Both of these disciplines have been shown to help immune system function. These options also offer opportunities to just stop, and get some rest. My reflexologist regularly puts me to sleep and from both on and off the table I know that massage can put recipients to sleep, or ensure a better sleep that night.
So give some thought to your alternatives and do some research. You may decide that the shot is for you, or you might not. I just encourage you to make an informed choice and understand that there are other active measures you can take to decrease you risk of the flu.
I could run through all the lists of who should and who should not get the flu shot, of why to or why not. I could tell you how they design flu shots and dispel myths about certain risks, but that would be reiterating. All that information is nicely and clearly laid out on Health Canada’s website just follow this link: It's Your Health - Influenza (the "flu"). Or I could tell you about those who argue against the flu shot, but again, they have very good material already out there, just follow this link: Vaccination Risk Awareness Network. Following the above links will give you two contrasting view about the flu shot, both quite rational and well presented. I am not going to restate all of those facts here.
What am I going to offer you? I am going to look at some of the options you could pursue if you don’t want to get the flu shot. I want to be clear - I do not feel that the flu shot in intrinsically evil or bad. I simply believe that there are risks associated and that there are other options to improve your resistance to the flu.
But what are your options? You do not want the flu, so what can you do? In fact, there are lots of thing you can do to minimize your likelihood of getting the flu this winter. The easiest is to keep clean. Wash your hands often and thoroughly. Be sure to get between your fingers, under your nails and along the edges of your hands. This simple habit has been repeatedly shown to reduce the incidence of flu. Hand washing is one of the most important things we can stress with our children to reduce the spread of influenza. Children tend to touch everything, including their eyes, noses and faces, which make them excellent vectors, transmitters, of pathogens. If you have small beings in your life I highly recommend increased hand washing for you and them.
The other obvious thing you can do for yourself is a bit more complicated – stay healthy. Eating well, drinking lots of water, exercising and getting enough quality rest are things we all mean to do all the time, but during the flu season these steps can hugely reduce risk of flu by ensuring you have a healthy immune system (the exercise, the food and the sleep) and nice moist mucus membranes (the water).
Why would you want moist mucus membranes you ask? Mucus membranes (i.e. the lining of you nose) are one of the first lines of defense your immune system has. When your mucus membrane is moist they act as physical barriers to pathogens, and all those nose hairs help too. The hair acts as a physical filter that traps viruses and bacteria. The moist membranes act kind of like those brown sticky fly strips. The pathogen gets past the hair and then gets trapped where the cellular immune function can go to work on destroying them. This is one of the reasons air travel can often lead to illness. Not only is the air re-circulated, it is also dry and dries out the mucus membranes. Keeping well hydrated can help maintain moisture in your mucus membranes. Some doctors also suggest a saline or baking soda solution be used to flush the sinuses to help maintain moisture levels, especially during plane travel. The nasal decongestant sprays do not serve this function as they are actually designed to dry the membranes out to reduce the stuffiness that occurs when your body is fighting a pathogen.
As to improving your diet, exercise and sleep I am not going to tell you it is easy. If it were easy none of us would be overweight, out-of-shape or tired all the time. I am just trying to reinforce the importance of trying to incorporate these factors into you flu-season routine. And incorporation is the key. For lots of people they just can not imagine taking an hour three days a week to exercise, or giving up dining out/taking in. So don’t do either. Just walk somewhere you might rather drive or that moldy oldie – take the stairs not the elevator. As for food, if you are eating in a restaurant try to choose the salad with your burger, and maybe make it a chicken burger. These are not novel suggestions, but they are sound. Give yourself credit to, don’t decry if you ate out four of seven nights, as usual, be happy if you chose the salad three times, the chicken twice and a wrap some other time. It all counts and it all helps!
Assuming you are doing your best with these, what can you do to add a bit of insurance? There are a variety of other options, most of them take you into the realm of complementary medicine and like the lifestyle advice above involve ways to keep yourself healthy, improve your immune system, and maybe make incorporating some of the lifestyle steps a bit easier.
Vitamin supplements, especially A, B-complex, C and E are useful for improving your immune system. There is a homeopathic remedy, oscillococcinum, which can be taken preventatively. A visit to a naturopathic doctor can often provide you with the best options with regard to these options as they are well versed in vitamin supplementation and homeopathy. Some naturopaths are also certified to practice acupuncture, which flows into the next set of options.
This is my option of choice. I first tried it because I knew from a friend who was a registered practitioner of Traditional Chinese Medicine that acupuncture and herbal remedies could help the immune system. I have stuck with it because it has worked. In the early fall I get an acupuncture treatment that is designed to support and increase my immune function. My TCM Practitioner usually gives me herbs to drink as a tea to reinforce the acupuncture. I am very closely exposed to a large number of people through my work so I know that this option is good protection.
You could also add Massage Therapy and or reflexology to your life. Both of these disciplines have been shown to help immune system function. These options also offer opportunities to just stop, and get some rest. My reflexologist regularly puts me to sleep and from both on and off the table I know that massage can put recipients to sleep, or ensure a better sleep that night.
So give some thought to your alternatives and do some research. You may decide that the shot is for you, or you might not. I just encourage you to make an informed choice and understand that there are other active measures you can take to decrease you risk of the flu.
Monday, October 29, 2007
If you are lucky it is virtually invisible, if not it can be pretty darn ugly, and that is just on the surface. When you start delving down you find more of it, and at this point invisibility isn’t such a blessing, and the impact of it can be more profound than you would think. What is this? It’s scar tissue. That’s right, the thick, not too sensitive, sometimes pink or red result of all injury to our bodies. This stuff is pervasive and occurs throughout our bodies, often in places we would not imagine.
So the first thing to do is define what scar tissue is, and, perhaps more importantly, why it is. Scar tissue is the fibrous, collagen rich, elastin poor granulose tissue that your body uses to repair soft tissue (muscle, tendon, ligament, and fascia) injury within your body. Almost anytime inflammation occurs in the body so does scar tissue. With more profound injury and in cases where there is tissue loss the scar tissue can be quite extensive, which of course makes its impact that much more significant. The why of scar tissue is that your body is trying to piece back together tissue that has been ruptured or to reinforce tissue that it believes is not strong enough. Basically this is the duct tape of your body, and just like duct tape it is darn handy and is an essential part of your bodies self-repairing system.
Now that is all very positive, so why was I maligning it in my last article, and why have I been dropping portentous hints in this one? Well, have you ever used too much duct tape? It makes a bit of a mess, can prevent something that should move from doing so and, if it is laid down incorrectly it can stick other things to it and that leads to even more problems. This is exactly the problem with scar tissue. Too often it is laid down randomly in the body and you end up with a scar that is larger than it needs to be, that is sticky, disorganized and dysfunctional. The other complication with both duct tape and scar tissue is if you lay down this stiff, not very stretchy material in the middle of some mobile, active material it becomes a stress point, a place where you actually have more chance of the original fabric becoming damaged. And if it happens to sticks together two stretchy things that want to stretch in different direction you are guaranteed to lose some of the original movement and to do constant, minor damage. To have little, tiny tears in the fabric happen every time you move. Now in a t-shirt that will ultimately mean the duct tape pulls off, or you get a hole or a tear in the nearby fabric, not great for the t-shirt. Now imagine that process within your body. Two muscles stuck together by scarring, every time you move small tears in the muscle fibre, a bit of inflammation, a bit more scar tissue, a bit less freedom of movement, a bit more tearing….eventually you get a rupture, here the duct tape analogy falters, for the scar tissue will not be what ruptures, it is too strong and too well enmeshed in your muscle, you will always end up with another muscular rupture adjacent to the scarring. The process then begins again. This is one of the reasons someone will have a recurrent injury. Sprained and strained ankles being an ideal example, with ankle injury you often see a mild to moderate strain or sprain followed by a series or minor irritation that the person bandages and works/plays through, and then another serious incident, and this time, even if the incident is only of the same intensity the injury will be greater, because the area is compromised. That is the great downside of scar tissue, it compromises our tissue.
Now, on the bright side this is a process that can be modified. Through proper rehabilitation treatment and exercises scar tissue development can be made more functional and less compromising. Both machine based (i.e. ultrasound) and manually applied (i.e. frictioning) techniques can help ensure that your scar tissue is laid down in a tidy manner that improves its functionality and surrounding tissue can be prevented from sticking or be released if it becomes adhered. These applications minimize the subsequent issues that I discussed in the previous paragraphs and can greatly reduce the chance of re-injury.
Cosmetically this also reduces the visibility of the scar. There are two aspects to this. One, the scar is smaller and there is less likelihood of the scar becoming keloid (a keloid scar is one that overgrows the perimeter of the original injury, is raised and discoloured). Two, the adhering of adjacent tissue that often occurs with untreated scars, especially ones of significant size or severity, creates lines of pull in the skin. If you have every seen puckering, or indentations around or over a scar that is the result I am describing. These lines can become very entrenched and distort your skin. The other, less cosmetic issue can be discomfort. It is this second development is the one that can lead to that pulling, overstretched feeling that you may have experienced if you have scars of any significance.
My next posting will touch on a seasonally relevant issue, the flu shot. Good, bad, ugly? What is your best course of action?
So the first thing to do is define what scar tissue is, and, perhaps more importantly, why it is. Scar tissue is the fibrous, collagen rich, elastin poor granulose tissue that your body uses to repair soft tissue (muscle, tendon, ligament, and fascia) injury within your body. Almost anytime inflammation occurs in the body so does scar tissue. With more profound injury and in cases where there is tissue loss the scar tissue can be quite extensive, which of course makes its impact that much more significant. The why of scar tissue is that your body is trying to piece back together tissue that has been ruptured or to reinforce tissue that it believes is not strong enough. Basically this is the duct tape of your body, and just like duct tape it is darn handy and is an essential part of your bodies self-repairing system.
Now that is all very positive, so why was I maligning it in my last article, and why have I been dropping portentous hints in this one? Well, have you ever used too much duct tape? It makes a bit of a mess, can prevent something that should move from doing so and, if it is laid down incorrectly it can stick other things to it and that leads to even more problems. This is exactly the problem with scar tissue. Too often it is laid down randomly in the body and you end up with a scar that is larger than it needs to be, that is sticky, disorganized and dysfunctional. The other complication with both duct tape and scar tissue is if you lay down this stiff, not very stretchy material in the middle of some mobile, active material it becomes a stress point, a place where you actually have more chance of the original fabric becoming damaged. And if it happens to sticks together two stretchy things that want to stretch in different direction you are guaranteed to lose some of the original movement and to do constant, minor damage. To have little, tiny tears in the fabric happen every time you move. Now in a t-shirt that will ultimately mean the duct tape pulls off, or you get a hole or a tear in the nearby fabric, not great for the t-shirt. Now imagine that process within your body. Two muscles stuck together by scarring, every time you move small tears in the muscle fibre, a bit of inflammation, a bit more scar tissue, a bit less freedom of movement, a bit more tearing….eventually you get a rupture, here the duct tape analogy falters, for the scar tissue will not be what ruptures, it is too strong and too well enmeshed in your muscle, you will always end up with another muscular rupture adjacent to the scarring. The process then begins again. This is one of the reasons someone will have a recurrent injury. Sprained and strained ankles being an ideal example, with ankle injury you often see a mild to moderate strain or sprain followed by a series or minor irritation that the person bandages and works/plays through, and then another serious incident, and this time, even if the incident is only of the same intensity the injury will be greater, because the area is compromised. That is the great downside of scar tissue, it compromises our tissue.
Now, on the bright side this is a process that can be modified. Through proper rehabilitation treatment and exercises scar tissue development can be made more functional and less compromising. Both machine based (i.e. ultrasound) and manually applied (i.e. frictioning) techniques can help ensure that your scar tissue is laid down in a tidy manner that improves its functionality and surrounding tissue can be prevented from sticking or be released if it becomes adhered. These applications minimize the subsequent issues that I discussed in the previous paragraphs and can greatly reduce the chance of re-injury.
Cosmetically this also reduces the visibility of the scar. There are two aspects to this. One, the scar is smaller and there is less likelihood of the scar becoming keloid (a keloid scar is one that overgrows the perimeter of the original injury, is raised and discoloured). Two, the adhering of adjacent tissue that often occurs with untreated scars, especially ones of significant size or severity, creates lines of pull in the skin. If you have every seen puckering, or indentations around or over a scar that is the result I am describing. These lines can become very entrenched and distort your skin. The other, less cosmetic issue can be discomfort. It is this second development is the one that can lead to that pulling, overstretched feeling that you may have experienced if you have scars of any significance.
My next posting will touch on a seasonally relevant issue, the flu shot. Good, bad, ugly? What is your best course of action?
Monday, October 22, 2007
Healing, whose job is it anyway?
In my last posting I finished with the idea that no medical profession can heal the body, only provide and promote an environment within the body for it to heal itself. That may seem like a rash statement, but let’s take an example and see if you agree.
Option #1: You break a bone and choose to go untreated. The bone would grow back together – your body would heal itself. Sounds good, and once upon a time that is exactly what would have occurred, the body would have been left to do its best with no real intervention. In some cases the body would have completely failed and the person would have died (either from blood infection or from a bit of fat from the bone marrow getting into the blood stream and causing a stroke or heart attack (medical-ese = fat embolism). Alternately the person survives the injury but with ongoing pain and permanently reduced function. The most common causes of chronic pain and dysfunction in for the survivor would be non-alignment of the bone, which would mean the bone would no longer be doing its job properly; and/or trauma to the surrounding soft tissue (fascia, muscle, tendon, or ligament), which may not heal well or functionally. In almost all cases there will be some remaining dysfunction with this option, which is why it is great that we now have Option #2.
Option #2: You break a bone and go to an emergency room where they x-ray you to determine if the bone is broken. If necessary the beak is aligned, and often a cast is put on to prevent shifting. With extreme fractures there may be surgical repair using plates, screws, or rods to provide internal fixation to severe fractures. You are also given pain-killers and anti-inflammatory medications to ease any suffering from the trauma and the healing process (NB: inflammation is a part of the healing process). We might be encouraged to eat calcium and protein rich foods to provide out bodies with the building blocks of the tissue that needs repair and replacement. In six weeks or so you have the cast removed and you generally have a nice straight bone. Then you embark on a course of rehabilitation treatment. This can encompass a wide variety of treatments - physiotherapy and/or massage therapy being most likely - with therapeutic exercises prescribed by any or all of the medical professionals you are dealing with. At the end of your treatment you should have full movement, no residual pain and your strength should be at pre-accident levels or closely approaching them.
So Option #2 is optimal. So some will ask, “What do you mean the body heals itself? Obviously medical professionals play a large role, how is that not healing?” But I contend that the body is doing the healing, medical professionals are assisting the body to do its best, most functional, least painful job of healing, and trying to prevent negative side effects.
Having pointed out the importance of your body in healing I will turn to why intervention is a good thing. In the above scenario you often have individuals who want to shortcut the process. They take their cast off early; they try to use the injured part too soon, or too vigorously. They do not undertake rehabilitation; of fail to participate in there rehabilitation by doing the stretching and strengthening that is recommended. In this shortcut version of option #2 the complications of the injury may be minor and the person may manage fairly well. They may just accept that they are slightly impaired, their reasoning being “Well, I broke my ____, shouldn’t I be impaired/in pain”. The answer to that is a resounding NO! In most cases quality follow up care and rehabilitation can have a person suffer no negative after effects. Rehabilitative care will ensure the restoration of balanced muscle function and maximize the functionality of any scar tissue that is the main soft tissue complication arising from a fracture (ah, scar tissue, the unsung villain, and hero, of the body….but that is for another time). Being active in your rehabilitation is essential. During the early stages of healing getting lots of rest and not over-exerting are the main requirements and they take little effort on your part. In the rehabilitation stages the demands begin to increase. In some cases this is great as the injured person is eager to begin activity – though in those cases the trick is to avoid over-doing. In most cases though, because the pain is gone, and the cast is gone, the person allows themselves to not do anything more, to believe that all is well as it stands and to not do more. This is a sad thing as no matter how much any professional works on a person it is the active participation of that person that allows the full progression to wellness to occur.
As I referenced earlier, scar tissue will be my next topic. How you may ask is this an important topic, well, watch for my next posting and I will tell you about the vital role scar tissue can play in wellness, and un-wellness.
Option #1: You break a bone and choose to go untreated. The bone would grow back together – your body would heal itself. Sounds good, and once upon a time that is exactly what would have occurred, the body would have been left to do its best with no real intervention. In some cases the body would have completely failed and the person would have died (either from blood infection or from a bit of fat from the bone marrow getting into the blood stream and causing a stroke or heart attack (medical-ese = fat embolism). Alternately the person survives the injury but with ongoing pain and permanently reduced function. The most common causes of chronic pain and dysfunction in for the survivor would be non-alignment of the bone, which would mean the bone would no longer be doing its job properly; and/or trauma to the surrounding soft tissue (fascia, muscle, tendon, or ligament), which may not heal well or functionally. In almost all cases there will be some remaining dysfunction with this option, which is why it is great that we now have Option #2.
Option #2: You break a bone and go to an emergency room where they x-ray you to determine if the bone is broken. If necessary the beak is aligned, and often a cast is put on to prevent shifting. With extreme fractures there may be surgical repair using plates, screws, or rods to provide internal fixation to severe fractures. You are also given pain-killers and anti-inflammatory medications to ease any suffering from the trauma and the healing process (NB: inflammation is a part of the healing process). We might be encouraged to eat calcium and protein rich foods to provide out bodies with the building blocks of the tissue that needs repair and replacement. In six weeks or so you have the cast removed and you generally have a nice straight bone. Then you embark on a course of rehabilitation treatment. This can encompass a wide variety of treatments - physiotherapy and/or massage therapy being most likely - with therapeutic exercises prescribed by any or all of the medical professionals you are dealing with. At the end of your treatment you should have full movement, no residual pain and your strength should be at pre-accident levels or closely approaching them.
So Option #2 is optimal. So some will ask, “What do you mean the body heals itself? Obviously medical professionals play a large role, how is that not healing?” But I contend that the body is doing the healing, medical professionals are assisting the body to do its best, most functional, least painful job of healing, and trying to prevent negative side effects.
Having pointed out the importance of your body in healing I will turn to why intervention is a good thing. In the above scenario you often have individuals who want to shortcut the process. They take their cast off early; they try to use the injured part too soon, or too vigorously. They do not undertake rehabilitation; of fail to participate in there rehabilitation by doing the stretching and strengthening that is recommended. In this shortcut version of option #2 the complications of the injury may be minor and the person may manage fairly well. They may just accept that they are slightly impaired, their reasoning being “Well, I broke my ____, shouldn’t I be impaired/in pain”. The answer to that is a resounding NO! In most cases quality follow up care and rehabilitation can have a person suffer no negative after effects. Rehabilitative care will ensure the restoration of balanced muscle function and maximize the functionality of any scar tissue that is the main soft tissue complication arising from a fracture (ah, scar tissue, the unsung villain, and hero, of the body….but that is for another time). Being active in your rehabilitation is essential. During the early stages of healing getting lots of rest and not over-exerting are the main requirements and they take little effort on your part. In the rehabilitation stages the demands begin to increase. In some cases this is great as the injured person is eager to begin activity – though in those cases the trick is to avoid over-doing. In most cases though, because the pain is gone, and the cast is gone, the person allows themselves to not do anything more, to believe that all is well as it stands and to not do more. This is a sad thing as no matter how much any professional works on a person it is the active participation of that person that allows the full progression to wellness to occur.
As I referenced earlier, scar tissue will be my next topic. How you may ask is this an important topic, well, watch for my next posting and I will tell you about the vital role scar tissue can play in wellness, and un-wellness.
Thursday, October 18, 2007
Medicalese - Translating Medical Language
There is a grade one strain in the biceps femoris at its origin. That’s clear, concise medical-ese for “you have a very minor boo-boo where your bum meets your thigh.” It might not be a good idea to go run a marathon for a couple of days but otherwise you’re fine. Was anyone worried there for a moment? The first sentence of this paragraph is at the heart of an issue most people face every time they visit any sort of medical professional. What the heck are they saying?
I run into this problem both at work and at home. My brain goes to that medical place and suddenly the roll shutters come down over my audience’s eyes and I am talking to no one. I have a husband who gets the willies when we watch “Grey’s Anatomy” or “House” because of the surgery scenes and all those body parts. Imagine how much he loves when I start talking about the three different ways your large intestines move food through themselves – while being possessed by a Latin dictionary.
In our defense medical professionals are put through several years of not just being encouraged, but required, to speak this way. During this time we are surrounded by lots of other people who also speak our language and are on the same amazing voyage of discovery that we are taking. It is like French immersion for anatomy geeks! After several years of this deep immersion we are turned loose into the world to learn to talk in real English again.
Sometimes the transition isn’t pretty, and sometimes we forget that there is a transition to be made. Some of us do not even try. Imagine us as foreign travelers trying to remember the bit of the local language that we learned back in high school. I try to include both technical terms and lay terms in my explanations, I will even drag out my book of drawings so I can point and show my clients what I am talking about. My clients seem to be happy with this style of communication and hopefully it is a style you encounter often. If it is not the style you encounter, try not to be afraid and ask questions, and keep asking them until you actually get an answer you understand.
In my opinion clear communication would help improve relations between medical professionals and the public that relies on them. In a perfect world all practitioners would a least try to make this shift and in doing so alleviate a great deal of frustration in patients and their families that is in no way helpful in promoting well-being.
As this is not a perfect world even persistence will not always get you the answers you need. If this is a situation you are experiencing or you at some point encounter, I suggest taking a notepad when you go to your next appointment and take notes. You might even get a friend or family member to accompany you and take notes for you. This companion serves two purposes, allowing you to listen to the practitioner and perhaps coming up with questions you do not think to ask. You may also want to take a list of questions or concerns with you so you do not forget them during the rush of the appointment. Make sure to ask for spellings from your professional, otherwise you may just be inviting more frustration. After all that stuff in you lungs that makes you cough is phlegm, not flem. You can then review the notes and, if you need to, go to a site that list medical terms with their translations, like this glossary of medical terms.
This is not a solution to the problem of poor communication that exists within the medical world. The frustration of patients who have obscure words thrown at them in stressful situations by individuals who are supposed to be assisting them is a frustrating one. What I offer is a coping mechanism, a way to educate yourself so that you are not left in the dark about your own condition. You may think this is unfair and the professionals should learn better communications skills. You are right and wrong in that. We professionals should have better communication skills. However, it is fair to expect you to take responsibility for your own body. Ultimately you are responsible to make the choices that determine your course of care. Expecting you to make an effort to understand what we are trying to communicate (even if we are doing it badly) is not unreasonable.
Patient responsibility feeds into another topic. I have many people coming into my office desperate for me to “fix” them. I am always very flattered that they have such faith in me, but I also dread those words because I know that I can only help them to heal themselves. This is the topic I am looking at next: the action of the body in healing itself, and how the medical profession can facilitate and improve that process.
I run into this problem both at work and at home. My brain goes to that medical place and suddenly the roll shutters come down over my audience’s eyes and I am talking to no one. I have a husband who gets the willies when we watch “Grey’s Anatomy” or “House” because of the surgery scenes and all those body parts. Imagine how much he loves when I start talking about the three different ways your large intestines move food through themselves – while being possessed by a Latin dictionary.
In our defense medical professionals are put through several years of not just being encouraged, but required, to speak this way. During this time we are surrounded by lots of other people who also speak our language and are on the same amazing voyage of discovery that we are taking. It is like French immersion for anatomy geeks! After several years of this deep immersion we are turned loose into the world to learn to talk in real English again.
Sometimes the transition isn’t pretty, and sometimes we forget that there is a transition to be made. Some of us do not even try. Imagine us as foreign travelers trying to remember the bit of the local language that we learned back in high school. I try to include both technical terms and lay terms in my explanations, I will even drag out my book of drawings so I can point and show my clients what I am talking about. My clients seem to be happy with this style of communication and hopefully it is a style you encounter often. If it is not the style you encounter, try not to be afraid and ask questions, and keep asking them until you actually get an answer you understand.
In my opinion clear communication would help improve relations between medical professionals and the public that relies on them. In a perfect world all practitioners would a least try to make this shift and in doing so alleviate a great deal of frustration in patients and their families that is in no way helpful in promoting well-being.
As this is not a perfect world even persistence will not always get you the answers you need. If this is a situation you are experiencing or you at some point encounter, I suggest taking a notepad when you go to your next appointment and take notes. You might even get a friend or family member to accompany you and take notes for you. This companion serves two purposes, allowing you to listen to the practitioner and perhaps coming up with questions you do not think to ask. You may also want to take a list of questions or concerns with you so you do not forget them during the rush of the appointment. Make sure to ask for spellings from your professional, otherwise you may just be inviting more frustration. After all that stuff in you lungs that makes you cough is phlegm, not flem. You can then review the notes and, if you need to, go to a site that list medical terms with their translations, like this glossary of medical terms.
This is not a solution to the problem of poor communication that exists within the medical world. The frustration of patients who have obscure words thrown at them in stressful situations by individuals who are supposed to be assisting them is a frustrating one. What I offer is a coping mechanism, a way to educate yourself so that you are not left in the dark about your own condition. You may think this is unfair and the professionals should learn better communications skills. You are right and wrong in that. We professionals should have better communication skills. However, it is fair to expect you to take responsibility for your own body. Ultimately you are responsible to make the choices that determine your course of care. Expecting you to make an effort to understand what we are trying to communicate (even if we are doing it badly) is not unreasonable.
Patient responsibility feeds into another topic. I have many people coming into my office desperate for me to “fix” them. I am always very flattered that they have such faith in me, but I also dread those words because I know that I can only help them to heal themselves. This is the topic I am looking at next: the action of the body in healing itself, and how the medical profession can facilitate and improve that process.
Tuesday, October 16, 2007
Introduction
Have you ever been told at the chiropractor that “your L5 is subluxed” and been terrified? Or been sent for some sort of treatment that had you scared witless? You leave the office of your professional “caregiver” feeling fearful and worried? Often, we discover that the whole thing was very minor and nothing to be concerned about. Do you then feel relieved? Or do you feel angry that no one bothered to take the five minutes to explain what was happening to YOUR body? On occasion the worry is legitimate, something significant has gone awry in our bodies and we need to worry about what might be coming. Even when this is the case though wouldn’t it be nice to receive an explanation you understand?
We walk around in our bodies all day and sleep in them all night and yet most of us have little or no idea how hard our bodies are working for us or what all the little messages they send to our conscious mind mean. I am constantly amazed by this, and even more startled that so many people are so happy with not knowing. If you are one of those people, you should probably stop reading now as my purpose here is to educate and inform. I am a firm believer that if we know more about our own bodies we will take better care of them and be able to make better decisions about what we need to worry about.
I am not going to advocate running marathons or mega-dosing on vitamins for everyone. For some that may be the right course at some point or always, but I do not do either of those things so why would I tell someone else to? I believe in making educated decisions to balance improved function with enjoyment. My goal is to create a life that meets my body’s needs and maintains its well being without needing to sacrifice all the pleasures of that life. A practice that I find as dysfunctional and endless indulgence without thought to the consequences, even in the face of bodily rebellion.
Too often the lack of information people receive from medical professionals and the lack of general education about human function leave patients frustrated and confused. Too often they quest around among their friends and acquaintances for someone who has been where they are in hopes of learning about what is happening to them. I am the first to say that the support of friends is a wonderful thing, but rarely do two people have identical experiences of any event, let alone one involving their unique body. The result is the passing on of information that may not be correct, especially with the rapidly evolving state of our medical science. It also means information that has been heavily filtered by the lenses of memory and misapprehension gets passed onward. After all, there may not have been give any real explanations given to the first person and be interpreting their experience based on incomplete or erroneous assumptions.
That leads us neatly into what I intend to make this series about. I want to provide some illumination of the shadowy world of our bodies and the medical professions that are designed to care for them. I want to do this in a way that eases anxiety and allows individuals to go, or not go, to their medical professionals with intelligent questions and enough knowledge to understand the answers those questions bring. I will al so try to provide some resources for people to learn more on their own and to find answers to questions they may not want to ask out loud.
Let me introduce myself so you can decide whether you think it is worthwhile to keep reading. I am a Registered Massage Therapist in the province of British Columbia. I have had training that is similar in duration and scope to the training for a physiotherapist, a chiropractor or a nurse - or a third year medical student. British Columbia has one of the highest standards of training for massage therapist in the world. My massage training created in me an acute appreciation and curiosity about the human body. My practice as a RMT has led to the revelation that though science is constantly revising and expanding their knowledge of the human body and its capabilities, the general public knows very little about the bodies that support and propel them through the universe. I suppose I shouldn’t be surprised. Not so long ago, I was one of those people who didn’t know my patella from my kneecap (by the way…they are the same thing!!).
I hope that I have engaged your interest and you will be looking for the next installment of the series. I will be looking at the issue of patellas vs. kneecaps – or medical language and the layperson.
We walk around in our bodies all day and sleep in them all night and yet most of us have little or no idea how hard our bodies are working for us or what all the little messages they send to our conscious mind mean. I am constantly amazed by this, and even more startled that so many people are so happy with not knowing. If you are one of those people, you should probably stop reading now as my purpose here is to educate and inform. I am a firm believer that if we know more about our own bodies we will take better care of them and be able to make better decisions about what we need to worry about.
I am not going to advocate running marathons or mega-dosing on vitamins for everyone. For some that may be the right course at some point or always, but I do not do either of those things so why would I tell someone else to? I believe in making educated decisions to balance improved function with enjoyment. My goal is to create a life that meets my body’s needs and maintains its well being without needing to sacrifice all the pleasures of that life. A practice that I find as dysfunctional and endless indulgence without thought to the consequences, even in the face of bodily rebellion.
Too often the lack of information people receive from medical professionals and the lack of general education about human function leave patients frustrated and confused. Too often they quest around among their friends and acquaintances for someone who has been where they are in hopes of learning about what is happening to them. I am the first to say that the support of friends is a wonderful thing, but rarely do two people have identical experiences of any event, let alone one involving their unique body. The result is the passing on of information that may not be correct, especially with the rapidly evolving state of our medical science. It also means information that has been heavily filtered by the lenses of memory and misapprehension gets passed onward. After all, there may not have been give any real explanations given to the first person and be interpreting their experience based on incomplete or erroneous assumptions.
That leads us neatly into what I intend to make this series about. I want to provide some illumination of the shadowy world of our bodies and the medical professions that are designed to care for them. I want to do this in a way that eases anxiety and allows individuals to go, or not go, to their medical professionals with intelligent questions and enough knowledge to understand the answers those questions bring. I will al so try to provide some resources for people to learn more on their own and to find answers to questions they may not want to ask out loud.
Let me introduce myself so you can decide whether you think it is worthwhile to keep reading. I am a Registered Massage Therapist in the province of British Columbia. I have had training that is similar in duration and scope to the training for a physiotherapist, a chiropractor or a nurse - or a third year medical student. British Columbia has one of the highest standards of training for massage therapist in the world. My massage training created in me an acute appreciation and curiosity about the human body. My practice as a RMT has led to the revelation that though science is constantly revising and expanding their knowledge of the human body and its capabilities, the general public knows very little about the bodies that support and propel them through the universe. I suppose I shouldn’t be surprised. Not so long ago, I was one of those people who didn’t know my patella from my kneecap (by the way…they are the same thing!!).
I hope that I have engaged your interest and you will be looking for the next installment of the series. I will be looking at the issue of patellas vs. kneecaps – or medical language and the layperson.
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