Based on my recovery, the following is my explanation for chronic pain and many pain-related syndromes currently classified as idiopathic (the cause is unknown).
Logic starts here: midline anatomy & the median plane.
I used to think the human 'machine' was a poor design - but I was wrong, it was poor usage that had made life so painful. I did not use my main muscles of movement. I had no connection to my Base-Line. No core pillar of strength. No inner reference to reset back to 'baseline healthy'.
I was too young to voice my pain when it started and grew up thinking 'stiff and sore' was normal - that the pains, spasms and weird sensations were just a part of life.
Over the years traumas built up on my body, restricting my natural range of movement (see below for 'stored trauma'). I became increasingly tense and imbalanced. I never slept well. A long list of seemingly unrelated injuries and symptoms. There was always pain, and then a lot of self-doubt. Depression hit hard and enveloped my life for many years.
My rock-bottom was akin to the cruciatus curse (an acceptable reference on LW I presume?). But rather than sending me crazy, it forced me to surrender. Stuck on the floor on morning , screaming as the pain seared through every part of my body. I was unable to move, any attempt just increased the screams. I could feel myself going in to shock. I helpless and I knew it. The fear brought a sudden clarity that my body was saying "NO MORE". Something had to change.
Terrified of returning to that level of pain and knowledgeable enough to know prescription drugs would not magically fix me, I started doing Pilates - a few basic exercises at the easiest levels. Taking it gently and working with my breathing.
I began to notice what muscles were activating as I attempted to move, of how I braced myself to do anything. Of how much movement I lacked and how tense and twisted my body was.
The day my depression lifted as I stood up from a roll-down was the day I knew I could get better. It was that dramatic. Like a blanket being pulled from over my head - a shift, a freshness, a hope.
I healed by using the right muscles (bold and underlined! My willingness to use the word at all on LW is just how sure I am about this) starting from Base-Line.
Approximate time scale:
Pain ~ Life long. 4+ decades. My earliest memories.
Depression ~ 17+ years. Too scared of failure to attempt suicide. Too scared of suicide to try antidepressants. I hated myself, the world, everything. Angry, stressed, miserable - hopeless of ever feeling better. I was broken. I wanted it all to stop.
Rock-bottom until the day my depression lifted ~ 14 weeks. My fear of pain and my support network were both strong allowing full time consideration of how I was using my body.
Recovery ~ 3+ years of hard slog. Bit by bit, reliving and releasing the pain and tension I had been carrying around. A developing awareness of my body, a new sense of balance and calm. Every day better than the one before.
My earliest symptoms were of muscle pain = myalgia.
Myalgia (from Greek) myo ≃ muscle + algos ≃ pain.
Base-Line Hypothesis of Human Health and Movement (Part 3):
The 5 main muscles of movement should be under full voluntary control for optimal functioning of the body. The mind-body connection is strong.
Optimal Functioning - Strong, Balanced and Pain-free.
The body functions at optimum when it is dynamically balanced and aligned i.e. it is free of physical restrictions (see below) and the main muscles are fully utilised so an ideal posture can be achieved.
Movement is smooth and controlled, unrestricted through a full range of natural movement. The head and limbs can all be moved independently without pain or tension whilst the rest of the body remains stable.
I believe this capacity is what so many disciplines are trying to demonstrate. (to be expanded on in later posts)
We are balanced, we are aligned. A strong connection between muscles and mind.
pelvic floor, rectus abdominis, gluteus maximus, rectus femoris, trapezius
An ideal posture cannot be maintained if any of the main muscles of movement are not fully functional or range of movement is restricted.
Dynamic alignment and balance are easily lost - the body becomes imbalanced.
Imbalance, Mimic Muscles & Myalgia.
A functional posture is maintained by the activation of parts of other muscles (the 'wrong muscles') in an attempt to mimic the action of the main muscles, but stresses are distributed less efficiently - either side of ideal - adding to imbalance.
The location and distribution of these 'mimic' muscle areas varies, dependant on:
- The body's current position and action. Standing, sitting, bending, walking, climbing etc.
- External stresses. Pushing, pulling, lifting, hugging, throwing etc.
- Physical restrictions that are present. (see below)
- Habits that have formed. e.g. anticipatory postures recruiting mimic muscles rather than the main muscles.
- Skewed body map in the mind. Motor signals from the brain instructing which muscle areas to activate follow a 'pattern' but are not overlaid onto the body correctly. ('patterns' to be expanded on in later posts)
- Other. Anything not thought of yet.
I became aware of when mimic muscles would activate. The 'wrong' muscles, activated via motor pathways that need to be reprogrammed to the 'right pattern' by consciously engaging with the 'right' muscles.
Mimic muscles cannot tolerate the same burden as the main muscles of movement. The muscle tissue is quicker to fatigue and more prone to spasms and strains, resulting in myalgia.
When areas of muscle become painful, 'fresh' areas of mimic muscle are then used. More and more areas become stressed and sore as the burden shifts around, the body adjusting its posture in an attempt to avoid/minimise the pain.
If not corrected ⇒ imbalance leads to further imbalance.
Widespread myalgia occurs with an imbalanced body.
There is a tendency towards a pattern of distribution of mimic muscle areas and the associated adaptations (see below) of the body, which are what I believe are the basis of the "tender points" associated with a 'diagnosis' of fibromyalgia (see below) are.
From personal experience I say these documented tender points are the early indicators of an imbalanced body and many more tender points develop (just about everywhere eventually!) if the underlying issue of imbalance and misalignment is not rectified.
- - -
Some Thoughts on Bones and Joints.
Historically, the skeletal system has been considered the basis of the body. Bones remain, long after we have gone, but it is our main muscles that 'do the work' - that create our posture, that allow us to move.
Stressed muscles 'pull' on the bones they attach to, causing pain that is often misinterpreted and misdiagnosed as a problem with a joint.
Radiographs provide clear images of bone in living patients. It has become habitual to focus on bones and joints because we can see them on an X-ray and 'diagnose' a problem. Muscles and connective tissue are not so easily imaged and consequentially, not so considered.
Changes to the surface of a bone (roughening, remodelling, osteophyte spurs etc.) provide a visual abnormality for doctor and patient to focus on. But WHY have they occurred? Bone is a comparatively inert body tissue (bone marrow is active) and these changes take time to develop. Although they may become clinically significant, bony changes should be considered a symptom of a problem not the primary issue, and should not be used to 'explain the pain' without supporting evidence.
♢ "Traction spur" osteophytes occur where muscles attach to bone. They indicate a long-term problem where a muscle (via its connective tissue attachment) is pulling on its periosteal attachment causing the periosteum to react.
♢ Osteochondrophytes occur at the cartilage-bone junction, in response cartilage damage. This can be due to acute trauma, but more commonly is "wear and tear" (degenerative joint disease, osteoarthritis). Are osteochondrophytes also due to long-term misusage of the main muscles of movement?
An MRI after rock-bottom was comforting. A sense of relief at having evidence of physical damage and that the pain wasn't just all in my head but when I evaluated my MRI I could see the pathology was old - I'd been living it with for years. It was not an explanation for all the pain.
Studies have shown there is little correlation between pain levels and findings on imaging the spine (I exclude acute trauma and nerve impingement).
Clinical guidelines lower back pain - includes references to various studies.
MRI and X-Ray Often Worse than Useless for Back Pain - An article worth skimming through.
With "back-pain" our attention is drawn to the spinal column (vertebrae) because:
- Fear of the consequences of spinal cord damage.
- Imaging often provides something to look at.
Our vertebrae are there to protect the spinal cord. They are NOT a stack of blocks that keep us upright.
I've seen back pain attributed to the “rapid” evolution of humans - the suggestion that our ability to walk on two legs developed too fast and our body didn't adapt itself to bipedal movement.
A face-palm thought now that I understand the importance of the 'five main muscles of movement'!
Non-specific Location of Pain.
We tend to use our joints as reference when talking about pain, umbrella terms covering a section of body. "Oh, it's my knee." or "It's my shoulder."
But where is the pain? The joint itself, or the surrounding connective tissue and muscles?
Is the pain always in the same place? Or does the exact location shift around? Even if it's still your 'knee', or your 'shoulder'? Examine your pain.
Base-Line Hypothesis of Human Health and Movement (Part 4):
Physical Restrictions in The Body:
- Reduce range of movement.
- Cause stiffness.
- Apply tension.
- Add to imbalance.
- Increase misalignment.
- Affect the way we move and act.
- Generate sensory feedback → pain and weird sensations.
Many others have noted physical restrictions on the body using various terminology ('fascia' is popular). I use the covering term 'connective tissue'.
Connective tissue: The stuff that surrounds and links all the other bits of us.
Physical restrictions form in 'connective tissue' (see notes below) because of:
Trauma, Inflammation & Tissue Repair.
The effects of trauma on tissues, inflammation and the healing process are well documented (but still subject to research).
Traumatic injury causes affected tissues to get 'sticky'. Tearing of tissues/vascular damage, leakage, inflammatory factors etc.
The healing process is complex (fibroplasia, granulation, collagen deposition etc.), involving the creation and cross-linking of collagen fibres (see notes below).
Wounds 'contract'. Physical restrictions form e.g. scar tissue, surgical adhesions.
Inflammation is a topic too complicated for me to cover in detail. Here's one article as a starter.
Connective tissue gets sticky, then it gets stuck = physical restrictions.
Main injuries (whatever's bleeding or broken) are treated, but the effects of trauma can be widespread. e.g. an impact shock radiates throughout the body - micro-tears and micro-restrictions leave an 'imprint' of the 'max-stressed position', effectively storing the trauma on the body. (?component of PTSD).
The body tries to avoid pain (signals saying: watch it! protect!) by making adjustments above and below the injury - twists, kinks, tilts and compressions. This maintains a functional posture but increases the body's misalignment and imbalance.
Adaptations to Imbalance.
If the main muscles of movement are not adequately functioning the body lacks their central support. In an attempt to compensate, physical restrictions form in connective tissue, 'reinforcing' areas under stress.
Physical restrictions may not be noticed at first. Like a few loose sticky plasters all over, then maybe a few tacks up and down the body, then ropes and glue and nails ...
If imbalance is not corrected, more and more restrictions develop, forming chains of misalignments spread throughout the body. The body stiffens.
Micro-restrictions become macro and range of movement severely limited as connective tissue becomes a restrictive scaffold.
- If not released, physical restrictions = stored trauma.
Tensions, Pain and Weird Sensations.
Along with the myalgia of imbalance, tensions from the physical restrictions generate sensory feedback resulting widespread pain and weird sensations that can occur from head to fingers to toes, along affected 'patterns'.
Some of the sensations were scary at first, but I was so young when they started I didn't know any different. I got used to a lot of pain over the decades.
When an injury has healed the body should regain a full range of natural movement by releasing restricted tissues and 'resetting back to baseline healthy', if not then cumulative damage = trauma stored on the body.
I've come across various therapies that release physical restrictions - "myofascial release" appears to be the commonest term these days.
Self healing is possible. I worked though and released the physical restrictions myself. By:
- Working from my Base-Line muscles.
- Developing my sense of conscious proprioception.
- Instinctively moving to release some tension.
- Regaining a little more freedom of movement each time.
- Constantly moving.
- Letting go.
- Working towards aligning my body. Imaging a ribbon from pelvic floor to back of the head. Full extension, smooth ribbon is alignment.
Physical restrictions: I have felt 'releases' - pops, cracks, kruppals all over. I have seen them, I have heard them. Working through the pain and tension. Slowly regaining my natural range of movement, guided by my Base-Line.
The sounds and sensations of releasing restrictions might be scary at first - a noise, a twinge, a shock - but they FEEL RIGHT. Never force anything.
The mind-body wants to heal and return to a state of balance and alignment. Made possible when the central framework of the main muscles of movement is active.
Healing involves releasing the restricted tissues and regaining a full range of movement - including returning to positioning of trauma. Relive to release, working from Base-Line to alignment.
My Experience of 'Fibromyalgia'.
(New Latin) fibro ≃ of fibrous tissue + (Greek) myo ≃ muscle + algos ≃ pain
The pain and tension of an imbalanced and restricted body?
Constant pain. A whole list of things that are poorly explained. Symptoms that come and go and then come back again. Worse and worse over time.
The foot spasms, shin splints, sore knees, pulled hamstrings, pelvic pains, chronic 'bad back', abdominal pains, sore ribs, burning shoulder, stiff neck, crunching jaw, headaches ... The random shocks, spasms, sudden intense itching, stabbing, biting and gnawing sensations. The chest palpitations, abdominal 'pulsing', restless legs, eye twitches, white fingers, numbness, sudden extreme fatigue feeling and pins and needles in my arms and legs.
I had no idea how stiff and restricted my body was. No idea the physical pain was the cause of my depression and emotional issues. They had always felt like a fault with "me", that I was a failure. I doubted my pain, myself, my abilities. I shutdown, I hid. My emotional issues have been released during my physical recovery. Stored traumas - finally healed.
To those with 'fibro':
- A diagnosis of fibromyalgia may be a recognition of your suffering, but it is a label - not an explanation.
- Medications may mask some symptoms but won't cure the pain.
- Imbalance is a physical problem that affects body and mind.
- Find your Base-Line muscles.
- How is your range of movement?
- Is there tension?
- Develop your sense of conscious proprioception - Feel how to heal .
- Get to know your body. Keep notes. Look for patterns. Acknowledge your pain.
- Don't expect someone else to fix you. They won't.
- This is a do-it-yourself approach.
- Keep moving. Movement and releasing physical restrictions is why tai chi, yoga, and other exercise help.
Look for imbalance. The body misaligned, tense, restricted and in pain. A holistic approach to a macro-dysfunction.
The clinical presentation of myalgia due to imbalance is variable, influenced by:
- The sufferers biggest concerns - what they are currently most worried about. The primary complaint/s versus symptoms that get ignored, classified as not so serious or are so chronic they are barely mentioned. People can get used to a lot of pain.
- Duration of dysfunction. Symptoms will only spread and worsen over time if the body is imbalanced.
- An individual's trauma imprint - what the body has been through. ('Individual trauma imprint' to be expanded on in a later post.)
- The quality of history and clinical exam.
As a starting example: The nuchal ligament is an easy accessed piece of midline anatomy - 'our secondary guide for alignment' but an easy first check for alignment. The nuchal ligament should be easily palpated when the trapezius muscles are free to fully move. If not - the body is imbalanced. How many clinicians give the nuchal ligament much/any consideration?
Some Notes On:
Simple notes to maintain my sanity. There's much more information out there if you are willing to go down the rabbit hole of research and if anyone has thoughts to add I would love to hear.
Connective tissue - it's everywhere throughout the body.
I don't have the histology to be more specific than 'connective tissue' when I refer to the physical restrictions that form. There are many types of connective tissue, varying in composition, organisation and scale. The differentiation and delineation between 'connective tissues' isn't always clear. I include the extracellular matrix (see below) in my thoughts.
A spectrum of fibres, cells, water etc.
From solid and tough to fuzzy and goo.
Connective tissue surrounds and connects muscles and bones, suspends internal organs, runs through those organs and wraps around individual cells.
For example, connective tissue runs through and around every muscle:
- Every single muscle cell (muscle fibre) is surrounded by connective tissue called endomysium.
- Muscle fibres are grouped into bundles surrounded by connective tissue called perimysium.
- Then the whole muscle is surrounded by more connective tissue called the epimysium.
- Bones are surrounded by a membrane of dense irregular connective tissue called periosteum.
- Bone matrix is a collagen scaffold for the deposition of bone minerals.
- reticulin is the supporting meshwork in soft tissues such as the liver and bone marrow. Formed from the cross-linking of collagen III fibrils (fibrils see below) named 'reticular fibres' .
The broad classification categories for connective tissue are:
- Dense or loose - Solid or soft. Depending on the amount and type of collagen.
- Regular or irregular - whether the collagen fibres arranged in parallel or not.
Irregular connective tissue (loose and dense) is found mostly layers of the dermis (skin) and adipose (fatty) tissue - surrounding and enveloping the rest of the body.
Specialised connective tissue includes tendons, ligaments, aponeuroses, cartilage, fascia, bone, teeth, meninges, pleura, peritoneum, pericardium, dermis etc.
Connective tissue can be thought of as a body-wide web of collagen fibres.
Collagen is the most abundant protein in the body. 25-35% (figures vary between sources) of the body's protein is collagen.
a major structural protein ... protecting and supporting the softer tissues and connecting them with the skeleton. Twenty-eight different types of collagen have been identified in vertebrates. Source.
Collagen is the major insoluble fibrous protein in the extracellular matrix and in connective tissue. 80 – 90 percent of the collagen in the body consists of types I, II, and III. Source. (Out of date on the number of collagen types but a good grounding in collagen.)
Collagen consists of
collagen fibres which are 'ropes' made from covalently bonded strings of
collagen fibrils which are bundles of
collagen molecules which are triple-helices of
polypeptides (α chains) which strings of a repeating sequence of 3
amino acids 'twisted' around each other.
The 3 amino acids (the building blocks of proteins) determine the type of collagen. Most collagen in the human body is type I where the amino acids are 'glycine-proline-hydroxyproline' that form a tight triple-helix that form 'straight' fibrils that bond well to create strong collagen fibres.
Extra-Cellular Matrix (ECM).
Collagen is the most abundant fibrous protein within the interstitial ECM ... Elastin and Fibronectin source - stiffening etc.....
Not so random last words, I'm just not sure what to do with them:
Restrictions: Protein fibres. Bonding, cross-linking, like velcro?
arrangement of collagen, elastin, fibronectin ... Alignment of fibres...
Proteoglycans - Large molecules consisting of a core protein with one or more covalently attached glycosaminoglycans (GAG).
Are you balanced and aligned? Physically and mentally? Free of pain and past trauma?