Merry Christmas everybody!
My thanks and deepest gratitude for keeping up with my writing, which has been sporadic at best this year – I hope I’ll do better in 2011 (no tongue in cheek :-).
My extra apologies for disappearing off the scene for the last few weeks. I want to assure you that my intention/ commitment to keep this blog alive and vibrant is as strong as ever.
But even the strongest of commitments to write regularly had no chance of withstanding the avalanche of new discoveries and realizations that fell on me over the last 3-4 weeks....quite literally...
The flow of ideas has been so intense that until now I am having trouble understanding / figuring out – what is happening ? -Have I stumbled upon an unexpected goldmine or am I going to be swept away by the avalanche of the ever-growing diversity of options?
In short, the new realizations are going to lead to the new pool of strategies, techniques and tools that are as large if not larger in variety then entire ABR arsenal developed until today.
Why?
Because instead of one single Cinderella turning princess– fascia – that ABR has been committed to for the last 10 years, there are 2 more Cinderella stories that suddenly started to unfold really rapidly.
The analogy of the way that fascia recognition flourished over the last 5-10 years to a Cinderella story doesn’t belong to me. Robert Schleip is the one who came with it not so long ago, but I do find the parallel quite appropriate.
After centuries of staying relegated to the lowly ranks of the “wrapping” that serviced some other “really important” active organs and tissues – suddenly there came a realization that fascia is much more than just a ‘shrink wrap’ around the organs but has all these wonderful properties and influences that apparently have the potential for explaining and hopefully solving centuries old stubborn problems.
Isn’t it a Cinderella story? – From lowly servant to a princess and everyone’s darling.
Well, it appears that are more Cinderellas on the way!
In short, there are two more underappreciated processes:
1) “Diffusion” – filtering of the interstitial fluid through the fascial net
2) “Cushioning and lubrication” – the role of hydrogels within connective tissue
I put both in inverted commas because I believe that those ‘textbook’ attributions are overly simplistic and do not do even a fraction of justice to fundamental role that these processes play in the norm and pathology.
Both are related to the flow and filtering of interstitial fluid and its derivatives, on the one hand, and to the role of the ‘hydrogels’ in the composition of the body tissues and organs, on the other hand. I’ll open the brackets in a short while – so far I just wanted to give a bird’s eye view of the matters that I am going to talk about.
Actually it all started rather unremarkably – there were not any ‘forewarnings’ of a forthcoming avalanche.
To begin with I was routinely flipping through the literature extracts on joints performance prepared for me by Dr. I. Semenov (I guess his team should be called ABR Siberia :-)) and suddenly a well-known fact struck me from an unusual perspective…
Well, the fact itself is well-known:
Hyaline cartilage doesn’t have any direct blood supply or nerves connections having the layout of its collagen fibers so dense that nothing can really penetrate through it. The entire life-sustaining process for the cartilage works through the suction and filtering: under the loads the interstitial fluid is being squeezed out of the cartilage and into the joint space, where it mixes with the synovial fluid and being “cleaned” off the metabolites produced within the cartilage itself. After the withdrawal of the local mechanical load off the cartilage the ‘fresh’ liquid is being sucked back into it and whatever small space that is transitory between the cartilage and the bone.
Everyone in the ‘movement therapies’ domain knows about this fact. It’s textbook. However, similar to the most of the textbook facts it doesn’t really bring that much of an attention due to being ‘too basic’. Frankly, I was guilty of the same overlook until just recently when it really struck me.
All of a sudden it was, like… wait a minute… Isn’t it amazing? No blood vessels, no direct neuro-influence … and yet – the system functions perfectly alright through millions of cycles being based purely on the mechanism of filtration and irrigation under intermittent mechanical loads!?
Just try to visualize it – your knee performs at least 2-3 million steps every year, i.e. 2-3 million of loading and unloading cycles at the cartilage…– and all of that functions smoothly without any local blood supply and without any central control!
Isn’t it an example of super-efficiency?!
And frankly, nothing lights up my screen more than an example of energy super-efficiency of a certain biological process, especially an underappreciated one.
When it comes to a human body structure and function analysis – I am a bottom dweller and a bottom feeder. You can even call me a scavenger – I look for the background basics that are left out by all those carnivores who rush to the higher levels of the food chain.
I look for the structures that are the cheapest and try to find out whether there is some overlooked and undiscovered substance left over for me to feed on…
Why? – it’s simple. I deeply believe that Mother Nature is a bargain hunter. I believe that Mother Nature is greener than the Green Peace and Al Gore put together, and that whenever there is a way to do something on the cheap and using the easily reproducible, replaceable elements that can function in semi-automatic mode – that’s the option that a biological system is going to choose in favor of complex and expensive ones.
No disrespect for the blood circulation via the designated vessels and no disrespect for the nerves as the designated bioelectrical avenues , but:
- They are expensive – both to produce and to maintain.
- They are fragile and specific.
- They appeared much later in the course of evolution as the specialized superstructures.
That’s why when I was reading the textbook facts about the functioning of the cartilage with my new ‘pair of mental glasses’ – being on the lookout for examples of super-efficiency – it really struck me.
I think there are really elegant parallels with the way that fascia recognition in the scientific community started its ascent from the lowly rank of the ‘wrapping’ and to the elevated status of the cornerstone of the body architectonics.
It’s very much a similar set of alternatives: muscles are the expensive way of having a weight-bearing support framework , whilst fascia is cheap. By the same token – blood and nervous supply are expensive, whilst direct filtering is cheap.
Muscles are high maintenance structures, fascia is low-maintenance. Muscles are complex and once damaged require massive repair works, fascia is a lot simpler and responds to direct mechanical stimulation.
I hope you can see the similarity of the discourse…
But let’s stack the ‘amazement’ factor up and get back to the cartilage…
Where does that “dry land” and “zero regulation” process happen? – In the area that has the greatest risk of damage and injury because comparing to any other musculoskeletal elements it experiences the greatest mechanical loads!
If you think about it a bit deeper – isn’t it somewhat paradoxical? What appears to be the area of the greatest danger and risk seems to be paradoxically abandoned by specialized supply and monitoring systems of the body… Isn’t it odd?
From an engineering standpoint – if you were constructing a bridge where would you put more focus and monitoring devices– to the area of greatest loads or to the area of minimal loads? – No need to reply – the answer is obvious…
Shall we believe that Mother Nature is being particularly stupid or is it just being ‘lucky’ in this specific instance whilst it shows amazing wisdom of adaptations elsewhere in the body?!
Well, I can’t. I am humble enough to have a simple approach: in case we suspect Mother Nature of being irrational or inefficient – we need to think twice and revisit our own assumptions.
So, we need to dig a bit further.
The entire modern mainstream paradigm of interpreting whatever right or wrong happens in the human organism is extremely ‘vessel circulation centered’ (blood, lymph etc. – everything that has identifiable vessels) as well as ‘nerve-centered’ (i.e. put in context of descending ‘commands’ delivered via the signals).
From this perspective the ‘life of a hyaline cartilage’ is an odd one out – no nerves, no vessels. It’s the strange exception that is mainly used to prove the rule of looking for vessels and nerves elsewhere in studying both norm and failure.
So my logic is quite simple – all it takes is just a little bit of lateral thinking and systems approach. Why don’t we move our vantage point a bit and apply a different lens…
Why don’t we look at the interstitial hydrogel filtering via the cartilage as a precedent that is ubiquitous rather than an exception?
Why can’t we assume that the same filtration mechanism of the interstitial fluid and its derivatives plays the foundational role for the background performance for all of the other elements of musculoskeletal system –since they all stem from the same origin?
Why don’t we approach the situation not from “instead of” perspective but from “as well as” one?
Why the presence of the nerves and vessels in the bones, muscles, and so on shall be the reason to forgo the analysis of the role that the hierarchy of the interstitial flow and filtering plays in their existence and performance?
Yes, sure blood circulation is important and nervous regulation is essential for high level performance of, say, muscles. However, that’s just one way of interpreting the hierarchy of body’s functional systems. There are plenty of examples in physiology of the co-existent hierarchies each one being optimized and depending on its own key factors.
Why don’t we put the nerves and vessels aside for a little while and instead have a look at the other elements and areas of musculoskeletal system purely from the angle of interstitial flow in connection with mechanical loads and build a different hierarchy.
When we see that even the areas of the greatest concentrated mechanical loads such as the joint and cartilage are able to sustain their life cycle based on the filtration of the interstitial fluid and derivatives – Why shall we restrict this mechanism to the cartilage only?
Let me visualize it with a simple scribble:
Again, all it takes is a simple reversal of a the interpretation lens when looking at the fact that cartilage doesn’t have direct blood supply and nervous regulation.
Instead of casting it as an odd one out in the musculoskeletal system that is otherwise circulation and nerve supply dependent, we can put it differently:
Even if a cartilage, this densest structure in the entire musculoskeletal system, the structure that is exposed to the greatest mechanical loads, is capable of functioning just fine without the direct blood and nerve supply using an interstitial mechanical ‘pump’ alone, isn’t it logical to assume that a similar base mechanism has to exist for the less loaded and less critical elements of musculoskeletal system?
However, an attentive reader might come up with a tricky question: ‘Well, but maybe the cartilage is treated as an exception because the fluid that circulates there between itself and the joint space is a very special biochemical substance that is unique to this particular element of the body only? ’
Great question – but the answer only reinforces that analytical lens inversion I have just briefly outlined. The substance responsible for the super-efficient performance and sustainability of the cartilage is called hyaluronan. It is a derivative of a hyaluronic acid and it is as universal as it gets. It is present in the interstitial fluid everywhere throughout the body, it’s a substance that is universal at all the rungs of the evolutionary ladder and it is a key hydraulic component of the connective tissue.
So in fact, as we start digging deeper into the fine mechanism of the way that filtering works and what microstructures facilitate it – we are going to see more and more evidence for another emerging Cinderella story…
However, I’ll cut myself short right here.
Obviously, I am not finished with the description of the “New Cinderellas” – I haven’t even touched the 2nd one announced in the beginning of this piece – but this post is getting quite long already, so considering the dense packing of information and the relaxed Christmas mood I am not going to overload you right now – however, I am going to extend the explanations in the near weeks.
We still have one more New Cinderella to talk about; we need to cover the way that the new understandings link with the ‘classic’ ABR and , of course, we need to address the practical side.
What does that all mean in practical reality?
Well, in short – a new approach to the old problems plus, of course, the new tools and techniques for the old problems.
As I already said, today when analyzing musculoskeletal impairments everyone is so pre-occupied with the familiar targets – looking for problems with nervous signals and/or blood circulation that the fundamental, base factors of the interstitial flow are completely out of the equation. No one even looks at them with any specific practical perspective in mind.
Examples? – You don’t need to go far – whenever you visit an orthopedic specialist – does he ever look at the circumference of your child’s legs? Does he ever try to record relative distribution of interstitial hydrogel between different layers from the bones to the skin? Does he look for specific topography beyond the familiar borders of the muscles described in textbooks? Does he recommend anything to promote the improvement of the interstitial flow in those obviously depleted legs?
Why? – Because these are believed to be the non-specific and thus unimportant factors.
If your child’s legs were getting blue due to the cut blood circulation – that would have been investigated and the perfusion analyzed – you’d be directed to a relevant specialist.
Neurologist looks at ‘reflexes’ but not at the material tangible legs that carry those abnormal ‘reflexes’… You’ll find heaps of literature discussing the spasticity issue from the neurological perspective but you are not going to find much more than the accidental mentioning of the way the interstitial flow is affected between all the key elements of musculoskeletal system – from the inside of a bone to the surface of a multiarticular muscle to a skin via superficial fascia.
How are we going to do such an analysis? – That’s a separate question.
First, as I said, it is important to realize that we are facing another Cinderella –the process that is completely underappreciated and therefore has never really been studied diligently enough with any practical application in mind. That’s a crucial initial step.
Second, if we talk about ABR as such, and how ABR families can benefit from this insight? – I can’t exactly say: “No worries, I have everything figured out…”, however I have accumulated enough observations and palpation tests over the years that become a lot more valuable in the light of the new insights. Most importantly, this accumulated expertise and tests are good enough to evaluate the validity of the new methods that are going to be introduced. Sure, a lot more fact checking and thinking will be necessary – but at least there is enough substance to begin with.
Over the last 3-4 weeks I’ve been busy with a lot of re-inspection of the past experiences, re-evaluating through from additional new perspectives the developmental transformations that your kids go in different scenarios, and, obviously, I did a lot of experimentation with the new tools and materials as the Force Transfer Mediums.
The response is exciting – I am really pumped up and enthusiastic…
I can assure you that the arsenal of ABR techniques is going to expand really significantly – that’s the reason why I started this post by mentioning that I was overwhelmed because it’s one thing to be able to ‘test drive’ a new technique and it’s a completely different thing to make it into a consistently teachable mainstay.
However, that’s the road well-travelled in ABR… So not without the bumps and bruises – but we’ll make it through :-)
Let me mention just a few of the tools and techniques that are in the making and that I hope to deliver “hot off the press” within 2011:
- Intense Ball Rolling techniques
- Much increased variety of the rolling tools – both the balls and other materials
- Much increased variety of the Force Transfer Mediums – going beyond the good old ABR ‘foam’ and introducing several classes of different force transfer materials
- Increased focus on the periosteum; hydraulics of the bones and the syndesmotic joints (like sacroiliac joints or cranial sutures)
- New class of head and face applications
- New avenues for targeting the extremities – arms and legs
Respectively all these changes will require certain modifications in the individual tactics and strategies marrying the mainstay ABR strategies with the new additions…
Well, I have a lot of head scratching to do... :-) … and at the same time we’ll be asking for much clearer feedback from you guys considering your home performance. With more options to choose from – creating a personal menu might become quite tricky if it’s a one way communication line.
So it is going to be an exciting 2011 with lots of new opportunities…
However, I want to forewarn you that ‘every rose has its thorn’ – well, in our case, it’s 2 classes of thorns:
- A) Experience shows that as the new ABR techniques are being rolled out, the feedback and response inevitably lead to modifications and upgrades making it evolve quickly within the matter of months – usually it takes about a year for a raw new ABR technique to get stabilized and the teachings to become more or less settled into the procedure that is performed in a similar way by different ABR centers.
So I am asking for your understanding and the benefit of the doubt. Your kids will be benefiting from the new techniques right “off the bat” but clearly, it’ll take about a year to explore the full potential of a given new technique.
- B) Obviously, new techniques and tools are going to bring a new set of challenges for ABR Teams worldwide. We’ll do our best to keep our training up-to-date but with things changing fast and the teaching protocols not being stabilized – it’s a stressful time. So I would very much ask for your understanding and positive approach. ABR Trainers are amazing people who have their hearts in the right place and who really give their best for your kids.
I am not the easiest person to work with and often times I tend to rush the new things out when they are still half-baked and those are the ABR Trainers who have to deal with the double pressure. They do it with class and dignity, never really complaining too much :-)
However, I am asking for your forthcoming attitude and seeing your ABR training sessions as collaborative efforts where both sides have a shared goodwill working towards maximizing your skill output and helping your kids to progress as fast as possible.
Well, obviously this post is just a beginning of the series where I am going to dig deeper in the expanded New ABR developments.
As for now – Merry Christmas to all the ABR families and kids.
It’s an honor working with you… and thanks for finding time to read my ramblings in the midst of festive celebrations ….
No New Year wishes so far – I hope that will keep me accountable for posting at least one more time in 2010.
As always – your comments are most welcome, they help me to shape the thoughts and hopefully to be of greater help to you….
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