Stretching

 

I’ve brought my kids to their soccer games many times. I had to get up early on Saturday morning because they had to do one hour of stretching and warm-ups obligatorily. I never understood the meaning and justification of that stolen sleep hour.

It’s assumed that a muscle has an ideal length from which it generates a more efficient action and is better protected against injury. If you don’t stretch the muscles before doing exercise, it seems you won’t get enough speed. It’s assumed that the muscle is shortened, contractured, hyper-viscous and that we need to wake it up, stretch it to its optimum length where it theoretically is more efficient and robust. Stretching, they say, softens the reflex response of stretching, a muscular base tone maintained by the neural activity responsible for responding to the stretching of the muscle fibers (responsible for the classic patellar reflex). The stretching would soften that reflex activity allowing more muscle length during the exercise.

Biomechanics is very complex and it’s beyond me when I try to understand what physically happens in a muscle when it’s at rest or moves. There are many factors that influence the muscle work. Until recently, biomechanics explained everything, but it seems there was a factor that was ignored: the sensation of stretching. The stretch limit is set by not only the biomechanical properties, but also the sensation of “I can tolerate it up to this point”.

Maybe the stretching allows greater muscle length. The induced biomechanical changes may have an influence, but perhaps the most crucial is that the perceptual tolerance threshold of the individual has changed, has adapted. Really we don’t stretch the muscle, but the tolerance to stretching. At least it’s a factor to consider. The same happens with joint stiffness. In addition to the physical resistance to movement, to action, there is the perception of stiffness.

The perceptive factor is fundamental in the action.

Biomechanics should always include a person who internalizes the motion, a brain that sets limits based on evaluations.

There is no agreement in the goodness and necessity of stretching. It seems that the warming-up, the gradual contact with the scenarios, the biomechanical, neuronal and psychological adaptation to future actions is beneficial.

I’m still wondering what was the point of that damn stretching hour on Saturday morning … In our time, we didn’t stretch.

We were always prepared to play soccer with any object that, more or less, rolled when kicking it during the school breaks.

http://ptjournal.apta.org/content/90/3/438.long

Muscle consistency

Contracture, overload, spasm, hypertension, hardness, knots, myofascial points, increased consistency …

– My neck hurts

The physical therapist feels the area in which pain is perceived and concludes:

– Your neck is stiff.

If there is a confusing issue in the field of pain it’s the aching muscle. The so-called “muscle-skeletal pain” is a damn jumble, a conceptual disaster.

The muscle is a tissue of varying consistency to palpation and the joints also show a varying opposition to pasive movement. By feeling and moving, the physical therapists draw conclusions about the muscular condition, their responsibility in the genesis of pain.

Muscular consistency is influenced by many variables. A muscle of increased consistency can be too tight, or not. If it’s tightened, it can be due to neuronal stimuli or specific conditions of the muscle fibers.

Contracture is not synonymous with contraction. Increased consistency is not synonymous with contraction. A muscle that is painful with palpation doesn’t have to be contracted. Pain is not something that makes the painful muscle contract. It is a false cliché.

The static muscle aquires more consistency and higher viscosity, but moving it actively or pasively is enough for its consistency to decrease. It’s a strange property of the so-called non-Newtonian fluids, the thixotropy. A “hard” muscle becomes “soft” simply because it’s thixotropic. The same happens with ketchup, paints, honey …

Muscles can be unnecessarily contracted (as lights could be unnecessarily turned on when there is no one in the room) and express their discomfort or vulnerability through pain. Relaxing them is enough for consistency and pain to yield.

There may be bad postural, psychological, programming conditions, overexertion… There may be myofascial trigger points that fatten the vicious circle of pain (always with the collaboration of a vigilant and catastrophic brain). There may also be a brain that defends an area from individual’s purposes.

After the pain and increased consistency of muscles from one area, there are many variables: muscular, neuromuscular, cerebral … There are contractures, contractions, viscoelasticity, protections, alerts, bait points …

The physical therapist palpates, moves, questions, values ​​… informs, back to palpating, moves, shows, convinces…

The universe of static and kinetic muscle is complex. It’s not my universe. I’m a neurologist. The physical therapists have a great job to do: to clarify that universe for themselves and for citizens.

– It hurts …

– Let’s see, calmly… This is very complex.

PD Elefante, a worthy reader of the blog, recommended me this post:

http://bretcontreras.com/2011/03/a-revolution-in-the-understanding-of-pain-and-treatment-of-chronic-pain/

Don’t miss it!

End of the cycle

“And then straightaway
he put on his hat, brandished his sword,
sand with a sidelong glance, stole off.”
My professional cycle has been closed. Today is my last day. I am retiring.
I’ll continue writing on the blog and participating in the proposed initiatives to spread knowledge about neurons and body perception.
I leave the corporate world (Osakidetza) after several years of preaching in the desert of my hospital with the most absolute disdain of what I could contribute with my proposals.
The brain, neurons, have something of a taboo for professionals and, to a lesser extent, for the sufferers.
The disdain to what is ignored is striking and unbearable. Few let the auto-complacent calmness of the politically correct doctrines and agreed protocols get disturbed. Migraine, it’s argued, is a genetic brain disease. Period. They only hope to identify the responsible genes to provide the specific antidote for each individual, upon presentation of the genomical card. Everything that isn’t a molecular contribution is pure quackery. A waste of time.
Knowledge about neural processes should have imposed a radical change in concepts and proposals for neurologists. There are no signs of that happening. Basic issues such as perception, emotion, cognition, mobility, placebo, empathy, mirror neurons, efferent copy, reward system, decision making, error detection, nociception, information processing, Bayesian logic… are exotic matter for those who feel comfortably installed (with the timely support of Farmaindustria) in the universe of new drugs.
The texts are still contaminated by a symptomatic lexicon. They keep talking about pain receptors, pain signals, pathways of pain, pain centers. They still maintain that the brain does not hurt if you puncture it and, as the only painful intracranial structures are in the meninges and their large vessels, that’s where you have to find the source of pain, in the “trigemino-vascular axis.” The reality is that the painful brain area was never actually punctured, for the simple reason that it is hidden deep in the “sylvian valley”, in the lobe of the insula. If you puncture it when the guy is awake, he confirms it hurts. The brain does hurt … if the sensitive points are found.
Pain is about anti-inflammatories, triptans, antidepressants and anticonvulsants, electromagnetic stimulations, electrodes, botulinum toxins, detachments of tight muscles … and information, a lot of information. We must make the citizen and the professional be aware of it. Workshops, conferences, campaigns, international days for pain … but no word is said about the risk of information.
“I swear to God, I’m astonished by this grandeur…”
Last week I was invited to a High School to speak about neurons and pain. Everything was new for the students. Their minds were as open for Neuroscience as for homeopathy or acupuncture. Their brains were already colonized by the alarmist culture of the “pain because of everything” and the “cure for everything”. I tried to warn them about indoctrination, acculturation, imitation of what is offered as sacred without further argument than the identity of belonging. Science against market and culture. Freedom from the critic, explorer, rigorous knowledge.
The brain is very interesting and sells audience in the media but we must move the media away from our bodies. It’s a mental thing, not a body thing. Health is not a game. No speeches. Solutions, solutions …
“And then straightaway
he put on his hat, brandished his sword,
sand with a sidelong glance, stole off.”

Pain, depression and helplessness

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Helplessness is produced when something that affects one isn’t comprehensible, predictable or controllable.

Unjustified chronic or recurrent discouragement or pain meet those conditions.

There is no adequate interpretative framework. The “when”, “how much”, “where” and “why” are not predictable, and the sufferer has no resources to control it.

The sufferer is not only helpless, but judged and convicted in a certain way because it’s considered that he has reached this situation by himself (genes and bad self-management). It’s also expected that the unprotected, given that he can’t overcome it, carries the situation with dignity and doesn’t disturb other’s good vibes.

The aching-discouraged person doesn’t understand what is happening. They are telling her she has nothing. There is no reason for wail and reluctance. It’s an impossible situation to overcome. Being well and feeling awful. That’s why the sufferer prefers doctors to find something, to give her disease labels. Labels that don’t contribute anything. They rather strengthen the helplessness. They contain the condition of the stigma, the unsolvable. They refer to past mistakes or mysterious ailments. The label relieves when it’s received, but mortgages in medium and long term. It precipitates the condition of disability (if successful in achieving it).

Pain and despair emerge in an unpredictable, chaotic way. The sufferer uses the breaks to get a fleeting breath of life before the suspicious eyes of the fellows that don’t understand how one can have the nerve to live with pain and apathetically. The brain participates in this condemnation and waits to the end of that break to apply the punishment for the ad lib of disease.

Sufferers are showered with remedies and tips, balms and encouragement, generally useless. The fellows are upset by the resistance to improvement and shrug with a clear conscience of having done everything in their power and with the suspicion that the sufferer is not “doing his part”.

The professionals are optimistic about themselves. They proclaim new remedies, spectacular advances. They show pictures of the brain, making the deficits and excesses blush.

The sufferer is confident, especially if she is a beginner in the condition. She tries everything with decreasing hope and money. Her suffering advances in direct proportion to what the promises of a solution are said to advance.

The body becomes the jailer of the sufferer. This person has become incompetent and dangerous, someone who should not be granted opportunities, as nothing good is expected seeing the status of the muscle-skeletal system, the serotonin, memory, energy and fellows.

Pain and discouragement are the hired assassins of a catastrophic brain who prefers to see the individual in a cage. The helplessness lets the cage doors be open. No guards are needed. The sufferer has resigned to flee. He only wants to be left in peace in his retreat, brooding his helpless condition in which nothing is understood, predicted or resolved.

It’s hard to push the helpless, make them see that they should react, try to understand, predict and control.

– It’s not a disease. It’s your brain. It has built an idea of a helpless, vulnerable, incompetent body. The brain is a virtual organ, like the immune system. They often see danger and failure where there isn’t. Don’t collaborate with them when they are wrong.

Defend youself.

Pay attention…

 

It’s assumed that the sufferer goes to the doctor’s office with many questions to ask, eager for quality responses.

The patient exposes his symptoms, condition, disability, the way in which pain is marking his anguish.

It seems that the presentation is over and it’s time for the professional to give explanations.

– Tell me, doctor …

– Let’s see…

One has to be paying attention to capture the lack of attention. The sufferer may still be entangled in his story looking for more and more details.

– You’re not listening to me …

– Yes doctor. How wouldn’t I listen to you…!

– Well, what was I saying?

The patient has retained some sounds and repeats them, but has not grasped the concept that one wants to expose. He wasn’t paying attention to what he had to.

Without attention, the brain catches a few unconnected words over which later it reconstructs a story from its expectations and beliefs.

– I’ve been to a neurologist. He told me that…

If one hasn’t paid attention, what is said to have been said, in fact, corresponds with what one says to oneself about what another one is supposed to be saying. We are slaves of our narrative. In it, we put the characters with their dialogues…

– I told him, he told me…

It’s advisable to make a minimum of checks.

– Let’s see. What basic idea have you caught?

In many cases you’ll get the surprise that none has been recorded or, even worse, you have managed to record right the opposite of what one was trying to explain.

– The brain … hurts because I want it to hurt … it’s psychological … I get obsessed … I’ll just forget that it hurts…

The commitment of active listening is required. The attention should be focused on what the professional is attempting to communicate, free of preconceptions, pre-meditated interpretations.

– Pay attention. Switch yourself off and listen. If you disagree or don’t grasp the content, let me know. Ask.

The office is, sometimes, a classroom. Sufferer and professional take turns in the roles of teacher and student.

– Listen to me, pay attention. I’ll explain my pain to you.

– Now you listen to me. I’ll explain the biology of pain …

I vaguely remember an extraordinary book about muscle diseases. As time went by I’m only left with the thought I started the prologue with:

“Listen carefully to the patient. He’s trying desperately to tell you what’ss happening …”

Absolutely agree, but it should be complemented with another similar thought for the sufferer:

“Listen carefully to the professional. He’s trying to patiently explain the reason of what’s happening …”

Well, let’s suppose this is true, at least in some cases. Don’t miss them.