I’ve been in quite jubilant mode for the last few days – we’ve
got our first really major article published in a “Journal of Bodywork and
Movement Therapies” (JBMT) – “The
presence of physiological stress-shielding in the degenerative cycle of
musculoskeletal disorders”.
This is THE place to be published for anyone who addresses
complex musculoskeletal challenges; and JBMT has the reputation of being at the
cutting edge of new developments in hands-on therapies, strategies and
concepts. To a great extent “Journal of Bodywork and
Movement Therapies” is also a main tribune for a rapidly growing Fascia
community that transcends borders between bodyworkers, biomechanical researchers,
medical and fitness specialist etc.
So, congratulations to Mark Driscoll – the most serious:-)
and intellectually disciplined person in the entire ABR Team– he did the most of the heavy lifting for seeing
this work through and I hope that our collaborative effort will result in a lot
more of worthy publications in the future. Congratulations to all the members
of ABR Teams worldwide with this inaugural step to a developing ABR recognition
– after all ABR Trainers are the people closest to you, they are the ones who actually
hand you, the parents, the tools of
overcoming the ‘vicious’ degenerative cycle caused by physiological stress shielding that our
article describes so convincingly and eloquently ( well, I couldn’t help some
blatant self-promotion :-)
And of course, I am very happy to share this major breakthrough with entire ABR
community and with all the families who honored
us with trust and commitment even at the times when we had a lot less of ‘official’
credibility to back ABR up.
You see, there are ‘articles’ and ‘Articles’ – I’d dare to
say that this one belongs to the latter category.
First, because “The presence of physiological
stress-shielding in the degenerative cycle of musculoskeletal disorders” is a
large (6 pages) conceptual article.
Having conceptual article published by a leading academic journal is quite a ‘big deal’ because usually the articles that are easiest to publish are the ones that address a very particular smaller subject or document a study result. The more statistics and measurements are in – the less friction there is in a publishing process.
Sure such narrow specific articles are important as well, but
they are usually compliant with the existent status quo and do not have cross-platform
effect leaving aside the ‘big’ questions.
Conceptual articles that potentially have a far reaching are exposed to a lot greater scrutiny and have
to present well above average value of ideas and quality of the logical
argument in order to make it to publication.
Second: This article is a really hard-earned one.
We faced some extra serious scrutiny.
If you’d look at the submission and publication date you’ll
see that there is more than 1 year between them. Why? – Exactly because of this
elevated level of scrutiny reserved for conceptual articles.
Allow me to give you a peek at the way the academic journals
work.
All of the distinguished journals in any scientific field are
peer-reviewed. A journal has a panel of experts who are recognized authorities
in a particular field as reviewers of the articles submitted to publications.
An expert remains anonymous to the authors and the name of the authors is
unknown to an expert. The logic is
obvious – the authors should not be able to find some ‘sneaky’ way of influencing
the reviewer and, on the other hand, the reviewer shall judge a submitted paper
purely on scientific merits regardless of whether he likes or dislikes the
authors personally, whether the authors have pre-established authority – none of this shall influence an
expert, he should be concerned with pure scientific value and nothing else.
This system ensures the objectivity and allows the academic
journals to maintain credibility staying away from being manipulated.
We submitted our first draft of “The presence of
physiological stress-shielding in the degenerative cycle of musculoskeletal
disorders” in April 2009. Obviously a lot of time went into the preparation,
checking the references and solidifying the concepts. I must admit that our
hopes for quick acceptance were quite high – especially after having smaller
papers on stress shielding effect accepted at the Fascia Congress and Cerebral
Palsy Congresses.
We got the review back in a few weeks – and it was it was a shock! It looked like our
article was handed to the fiercest and the most knowledgeable reviewer in the
entire fascia community – the first 3 pages were all RED from endless
questioning about the used references, interrogation into the statements that
we made and so on.
It was so “red” that I had an instant flashback from school years memory – when I was 12-13 I used to sit at the same desk with a friend who was one really smart chap but happen to be dyslexic. Those days no one recognized such a diagnosis and his spelling and punctuation was evaluated by a Russian language teacher by regular standards. My friend always ended up being below ‘F’ –there was no grade for him! This amazing guy was able to make 3-4 spelling mistakes in a 6 letter word and when we had our test papers returned – his was red absolutely everywhere.
I must confess that at the end I ended up pre-checking his spelling for him before he passed a per to the teacher trying to keep a percentage of errors just at the ‘C’ level to avoid detection … and it worked quite alright for well over a year until eventually we were found out and we had to sit at the separate desks in Russian language classes…
Ok, I digress..
I must say that it took us a few days to digest that shocking
review before getting back to the improvement of the article.
My reasoning was simple: on the one hand, having such a tough
reviewer reduced our publication chances, but on the other, – if we were able
to make it through we’d have a really solid confidence in what we have wrote.
There couldn’t be more than a handful of experts in the world
of a caliber that our mystery reviewer was. He has shown not only the immense depth
of knowledge and mind-boggling encyclopedic familiarity with most obscure
publications on fascia properties but also a willingness to go through the
details of our article, even though it was quite a workload for him as well. I
guess, a good number of experts take their reviewing duties much more lightly
and don’t go into every little detail. Ours – did! I was annoyed and somewhat
frustrated when that happened but in hindsight I am very grateful to a
distinguished scientist who did a fantastic job of pushing us towards our own
improvement.
To cut the story short – it took us a few months to get an
improved article for a next round of reviewing – now being much more cautiously
optimistic about publication chances… And rightfully so! – 2nd
review was harsh as well – but at least we had progress. When the first review
stopped at the 3rd page – this time the reviewer managed to get to
the end of the article.
Fast forward few more months – and with a 3rd
version – we made it even though this time we had no positive expectations at
all. To our surprise the draft of the article came back with only some minor
corrections – which meant that we were
on the way to publication!
However, one thing is ‘being on the way’ and another
one is to see it finally published. That’s where we are now and I hope that
seeing a bit of a history behind this publication will help you to realize why I
am truly happy about seeing it in print.
You are going to find a text of “The presence of
physiological stress-shielding in the degenerative cycle of musculoskeletal
disorders” at this link in my blog: http://blyum.typepad.com/on_abr_and_beyond/the-presence-of-physiological-stressshielding-in-the-degenerative-cycle-of-musculoskeletal-disorders.html
(PLEASE CHECK THE UPPER RIGHT-HAND CORNER OF THE BLOG FOR THE
LIST OF PAGES)
This the original publication link:
http://dx.doi.org/10.1016/j.jbmt.2010.05.002
I do invite you to read it from end to end – although I must
admit that it is relatively dense and heavy for a casual read :-)
So I think it makes sense to reiterate the major ideas “The
presence of physiological stress-shielding in the degenerative cycle of
musculoskeletal disorders” and conclusions that it leads to in respect to the
everyday life and principal decision-making for families of children with Cerebral
Palsy:
1. Every
parent of a child with Cerebral Palsy has to realize the presence of degenerative ‘Vicious ‘Cycle’ within musculoskeletal
that affects a CP child’s development and leads to deterioration of posture and
movement that is documented by GMFCS ‘curves’. (see blog post: )
Unfortunately, for a child
with Cerebral Palsy ANY spontaneous biomechanical interactions with environment
(movements, positions etc.) feed the degenerative cycle via the stress shielding
effect, i.e. the preferential loading of excessively strong myofascial
elements. As a result the strong ones keep getting stronger, whilst the weak
ones keep getting weaker – aggravating the imbalance even further – hence “Vicious
Cycle”.
2. The
article explains in a nutshell THE ONLY
STRATEGY THAT CAN ENSURE THE LONG-TERM
PROGRESS for any child with cerebral palsy – CONTRIBUTE TO THE ‘VIRTUOUS CYCLE’, i.e. the techniques/ training /
exercises that reduce the stress-shielding imbalance within mechanical
homeostasis; AVOID FEEDING DEGENERATIVE
‘VICIOUS CYCLE’ via increasing the stress-shielding imbalance
Effectively the article lays a groundwork for the ‘Do’s’ and ‘Don’t’s’
that are fundamental for ANY child with Cerebral Palsy at any stage of their
life (especially during the growth period) and make the essentials of ABR.
3. The “Do’s”:
·
One needs to target the weak links within musculoskeletal
system in order to move away from degenerative ‘Vicious Cycle’ and to
contribute towards ‘Virtuous Cycle’ ;
·
One needs to address the weak links within musculoskeletal
system according to their ‘importance rank’.
·
One needs to use techniques that are specifically
designed to bypass the stress shielding effects within musculoskeletal system –
that’s the ONLY way that provides
legitimate expectation of a true long-term progress for a child with Cerebral
Palsy
4. The Don’t’s:
·
‘Nothing forceful’ – Forceful applications aim at the
stronger elements of the musculoskeletal system and only emphasize the stress
shielding effect instead of reducing it
·
‘Nothing stupid’ – if you do not know whether you are
addressing the excessively weak or excessively strong elements of musculoskeletal
through a particular technique/ training / exercise – find it out before doing
anything. It’s simple – doing wrong things cost your child with Cerebral Palsy more than not doing anything
·
Stay away from biomechanical ‘vandals’ (techniques/
training / exercises) that do not have a very clear idea and specific
strategies of addressing the weak elements and potentiating the ‘Virtuous Cycle’
5. “Step
aside, Mr. Brain”…
Importantly – the
article emphasizes the separation of neurological challenges (non-progressive
brain injury) from biomechanical ones (stress shielding within musculoskeletal
system) – laying out the argument that the KEY FACTORS that determine deterioration
of posture and movement of a child with Cerebral Palsy ARE BIOMECHANICAL.
That leads to two main conclusions:
a) Major improvements are realistic even despite the
presence of a brain injury – provided that there is a proper set of tools
and impacts that deals with stress-shielding effect within the musculoskeletal
system.
b) When designing a long-term program for motor development enhancement
for a child with Cerebral Palsy – the ‘horse’ is biomechanical; the
neurological deficiency has the role of ‘the cart’
c) Stay away from ‘signal merchants’ who base their training
/ exercises on the primitivistic notion ideas of sending “good signals” to the
brain whilst being clueless about the detrimental effects that such training /
exercises have on musculoskeletal system.
Any ‘brain-based’ training system is most likely feeding the ‘Vicious
Cycle’ via ‘wrong’ impacts on the musculoskeletal system even though the only
talk is about ‘good signals’. Talk is cheap –
as a responsible parent you need to evaluate tangible facts…
––-
Well, it turned out as a relatively long post – I hope that despite
the summerish lighter mood you’ll still find it interesting enough to read this
heavy reading stuff.
Thanks a lot for your ongoing attention and support.
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