Past, present, future
Past:
Initial discovery
1999 – I had just completed both the McKenzie diploma and chiropractic rehabilitation specialty course. I knew many musculoskeletal conditions didn’t heal due to a ‘faulty’ repair process. A goal of therapy was to ‘remodel’ collagen fibres in the correct orientation by taking the affected joint in its physiological end range. This would prevent contractures. Remodelling collagen (scar tissue) takes 6 weeks. Surprisingly, I found some of these patients responded after 1 or 2 visits. I asked Colin Davies, a senior McKenzie instructor, mentor, and a friend of mine how this could have happened? He replied that he often wondered the same and sent a paper along. Thank you, Colin.
Overuse syndromes of the upper extremity: Rational and effective treatment was written by Dr. Vert Mooney in the Journal of Musculoskeletal Medicine 1998.”With common tendon problems an additional findings was a consistent increase in proteoglycan content-up to 40 times more than normal.Besides interfering with normal collagen organization, proteoglycan molucules absorb water, this causes the swelling and distention that causes persistent pain. (Pain resulting from local muscle spasm and mechanical tissue damage, in contrast, is not persistent)
The affected tendons have high levels of proteoglycans, edema and a lack of blood elements. Eureka! Blood flow was curtailed due to increased tissue pressure. These conditions may not be a collagen problem at all. My successful treatment had a different mechanism of action. In the process of moving the joint to a physiological end range, I was actually increasing pressure in parts of the tendon. The increased pressure would cause the edema to leave the area. Tissue pressure has now decreased and blood flow and oxygenation returns. This insight changed everything. The goal of therapy was now to increase pressure at the affected area. The patient’s response during the procedure gave me the information on how to conduct the treatment. Stretching to a physiological end range had little to do with outcomes.
We learned in college that collagen and proteoglycans have a trade-off role in the musculoskeletal system. Fibrocytes produce both chemicals at different rates, more collagen in tendons and more proteoglycans in cartilage. [Anatomy/Physiology]
Development of the Discovery
2000 – I heard a medical doctor on CBC radio saying that some CFL players suffer from post concussive syndrome and may not be improving. Could this have a similar pathophysiology as tendons, a case of an impaired healing response? Eureka! Degenerative brain conditions did show edema, too much proteoglycans and a lack of blood elements. How in the world could one produce a therapeutic pressure within the brain to allow the edema to drain? Total body acceleration would do it. (Not unlike the spin cycle in a washing machine).
2001 – Perhaps other illnesses exist that have poor recovery rates. There are many of them: chronic pelvic pain prostatitis syndrome, wet macular degeneration, inflammatory bowel disease, avascular necrosis of bone, stress fractures and pulmonary edema are some examples. Could all of these conditions have a similar underlying pathology? They often do.
Around 2005 – Where do these proteoglycans come from? There are not a lot of fibrocytes in the brain. I soon learned that most cells produce proteoglycans. I am now no longer dependent on fibrocytes and connective tissue as part of my theory of treatment. Eureka! The nerves themselves produce proteoglycans. Some people produce more of these chemicals than others (genetic). How can I test their physical properties? Perhaps the other tissue derived from the ectoderm (epidermis) produce similar proteoglycans. Gathering epidermal proteoglycans may be easier to do and their properties may be similar to PG’s secreted by nerves. Hey, wait a second, fish have a slimy epidermis. Eureka! Let’s look at fish. [Gel]
2015 – Hag fish epidermis produce copious amount of proteoglycans when it is mixed with sea water. This means the edema seen interstitially in humans is also probably a gel. Proteoglycan gels can be physically thinned either through shear or resonant wave forces. Eureka! Certain vibrations did thin hagfish gel.
2015 – Perhaps marine creatures’ nerves also produce proteoglycans when stressed. I asked myself why would a marine creature want to decrease blood flow to an area? Eureka! To reduce the load on the heart.
Take a look at the two points on page 91 in Circulation in Fishes. Our neural proteoglycan response to stress may be an evolutionary vestige.
2016 – Back to Bamfield trying more vibrations. One in particular clears the gel in 15 – 30 seconds and is also effective in resonance thinning. Similar vibrations are now helping with my treatments.
2016 – Hypoxia markers (HIF) have shown hypoxia exists in many conditions. Anywhere there are nerves, I suspect. Eureka! The body does not only react to hypoxia via cell death, degeneration and pain. Through homeostasis, the body also tries to get oxygen back into the area. In some cases, in the attempt to restore oxygen, the body has ‘gone awry’ (probably genetic) resulting in hemorrhage, inflammation, autoimmune responses or even tumour formation and malignancy. [Hypoxia and inflammation are two sides of the same coin]
2017 – Let’s test the hypothesis. See in Bamfield Paper for more information.
Surprisingly, this new “cause-and-treatment” is an echo of what therapists diagnosed and how and why they treated thousands of years ago.
Hypoxia as a cause for illness is not a new idea. Ancient therapies such as Thai massage, yoga, and traditional medicines which assess chi energy all believe that a lack of ‘air’ to the affected body part is an underlying pathophysiology. They feel that somehow, the air in the lungs is blocked from entering the affected tissue and by finding and freeing these blockages with mechanical means, the patient will respond; thus, they also have a mechanism of action. It must be remembered that the heart and circulatory system were not discovered until well over a thousand years later. In freeing the blockages, ancient therapists were actually normalizing tissue pressure gradients so blood flow would be restored.
I think they were correct. Modern imaging studies and biochemical analyses now show that increased tissue pressure and hypoxia are commonly associated to more and more conditions. [Hypothesis]
Present:
Just recently he realized a more all encompassing explanation: thermodynamics.
A broad definition of thermodyamics is the relationship between all forms of energy and spacetime. In our discussion, the temperature remains constant, not the pressure/volume. Energy dynamics is, therefore, an appropriate name when dealing with warm-blooded animals.
Energy is the capacity to do work and to transfer heat. Internal energy (U) is the energy within a system. It arises from the movement of the molecules making the system as well as the energy contained within those molecules. Entropy (S) is the most likely gross arrangement of all these billions upon billions of molecules and their energy states over a given time. The more combinations that make up this average, the greater the entropy. Whether a biological process takes place or not, (Gibbs Free Energy(G)) is due to the relationship between energy and entropy: the change in free energy equals the change in internal energy plus the pressure/volume change minus the absolute temperature times the change in entropy.
∆G = ∆U+ ∆PV – T∆S
Systems exist in both the macrostate and the microstate. Pressures, volumes, and temperatures define macrostates. In contrast, the movements and interactions of individual atoms and molecules describe a microstate. Energy dynamics encompasses both. In living systems, various states exist in discrete spaces. Together, they form a ‘native’ macrostate, a conglomerate of closely related energy states in an open system (1). Examples of macrostates within the ‘native’ state would be pulmonary tidal volumes and fluid pressure within the cortex of the bone. An example in the microstate would be the internal movement of enzymes.
When a process takes place in our body, -∆G occurs. This process can be as small and fast as an electron switching orbitals (measured in femtoseconds) or as large and slow as breathing. The circulation of blood, folding of proteins, electical conduction through the nervous system, all metabolic activities, and temperature maintenance are all included.
Warm-blooded creatures absorb energy at a relatively low entropy, process it at a constant temperature and finally release it into the environment at a higher entropy (mainly heat transfer).
Pathology is a change in a particular aspect of the native macrostate (and its substrate microstates). For example, an increase in tissue pressure due to edema would result in higher U, and therefore a change in G. Phenomena such as local blood flow, cell volume, and enzyme action will now be altered. If this new state persists, degeneration takes place and tends to worsen over time. This common pathology is given names depending on where it takes place. Examples in the musculoskeletal system would be tendinosis, enthesopathy, osteonecrosis, and trigger point. Other systems can also be involved in pathologies such as post concussive syndrome, arterial stiffness, chronic prostatitis pelvic pain syndrome, and pulmonary edema.
Effective treatment is the restoration of the involved aspect of the native macrostate. In the case of increased tissue pressure, the goal of therapy would be to lower it. G would then be normalized. Manual therapy can achieve this. By applying pressure to the affected area, the edema will move away. The new therapeutic pressure changes G again, causing the fluid to egress. After the treatment, normal pressure and internal energy are restored.
The following condition demonstrates a practical example of the application of the information above.
Neuropathic pain (NP) is a chronic disabling pathology. It is difficult to treat and affects millions of Americans. Recent studies shed new light on this condition (2,3). More generally, our understanding of disease processes is changing rapidly. Meta-analyses on the research of musculoskeletal conditions have shown it to be weak. New imaging techniques and biochemical analysis coupled with deep learning are revealing pathophysiologies not realized before.
Ion channels and pumps are often altered in the area of the dorsal root ganglia of affected nerves.
Elevated pressure here increases the tension of the cell membranes, which in turn affects osmosis and enzyme action across the membrane. (4,5,6) U has increased, resulting in sensitization of the nerve.
The goal of therapy would be to restore U by lowering the pressure and thereby decreasing the cell membrane tension.
The manual therapist applies pressure to the affected part of the nerve. Paradoxically, this will raise U even further but only for a short period of time, during which he edema will thin and move away. Restoration of the nerve should result. The therapeutic pressure may be in the form of traction, compression, torque, or a combination of these.
Energy dynamics explains common pathophysiologies seen in the office. It explains proven mechanisms of action of treatment. It also explains mechanisms of assessment. By understanding these principles, massage therapy techniques will be improved and become less dependent on ‘cook book’ procedures.
There is one significant caveat: This knowledge may go beyond massage therapists’ scope of practice. For example, a chronic infection may be due to a biofilm. Principals of energy dynamics can explain and possibly treat the pathophysiology of biofilms. Most therapists are not allowed to treat infections. The same goes for coronary artery disease. Many conditions may be helped using energy dynamics. Its imperative you stay within the scope of practice.
Future:
Our hypothesis is easily disprovable scientifically. It bodes well for future research. Parameters such as blood flow, pressure, and oxygenation are quantitative properties that can now be measured.
Increased tissue pressure exists outside the musculoskeletal system as well. In these instances assessment and treatment should be conducted by medical specialists. Having a solid base of evidence now will attract research departments of various medical specialties to investigate further. For example, some cases of atrial fibrillation will be due to increased pressure and hypoxia surrounding the conducting system in the affected muscle.