Injections of fascia fitness
April 13, 2010
My previous post did not draw much of replies – I guess it
was expected from our truly stoic crowd – always putting the benefit of a child
ahead of one’s own… :-(
I tried to make a case that caring about your own well-being is
not “selfish” but essential since you have to consider yourself and your
special one – being one team, an entity where the weaker member depends on the
stronger… I guess this argument is too rational but I still hope that you at
least take these ideas into consideration and would think of your own fascia
next time you find yourself in an uncomfortable positioning when caring for
your child.
So we are moving on to the fascia lessons that are directly
applicable to your special children.
The session in Montreal started and the first course took
place Fri-Sun. I covered a lot of details I the techniques delivery, everything
was filmed – so the first steps towards proper ABR Video Library are on the
way.
Observing 3 teenage kids in the last few days during Montreal session and hearing their unanimous complains about the back pain that lasts most of the day whilst being initiated during the wheelchair-based school hours I couldn’t help but to bring you back to the diagram that I used in the previous post:
What do we see on the diagram?
Stage 1 – very short = initial muscular reaction – the ‘switch
on’ phase.
Stage 2 – switch to the superficial fascia engagement (‘superficial’,
i.e. longitudinal layers that belong to the “myofascial/muscular coat”) – as
the one that is metabolic energy-expense-free.
Stage 3– extra effort of the muscles – ‘rescue’ effort that
comes in play once the fascia support has switched off or became insufficient. Expensive
and detrimental in the long-run being an ‘overuse’ of muscles that are ‘designed’
for dynamic performance in the static mode.
Stage 4 – not on the picture – failure of muscles. The
overdrive is no longer sufficient – the person either collapses in exhaustion
or starts moving involuntary in order to escape the position that became
unbearable.
Let’s point out just some of the challenges that occur:
·
If the muscles stay in a static effort state for
prolong time – the drainage through it deteriorates. Deteriorating drainage
leads to numerous negative effects:
o Compression
that leads deficit of ‘circulation-based feeding’ of the muscle fibers
o Poor
removal of metabolites
o Increased electrolytic
concentration and hence greater likelihood of spasms – the adjacent fibers that
were electrically separated at low concentrations become electrically ‘linked’
at higher concentrations and hence likely to fire at once (instead of working
in on-off modes)
·
As the fascia strands are being stretched longitudinal
they experience their own ‘troubles’
o Micro-tearing
of fibers that needs time to heal
o The more
stretched the strands become the more their viscoelastic creep of their ‘gummy
bear’ material accelerates. In other words, when the elongation is small the creep
is relatively slow, but the further the stretch goes the easier the material ‘gives’.
o The stretch
of superficial layers of fascia causes the “squeeze of a wet sponge” effect
that leads to their relative dehydration and hence excessive likelihood of
further injury.
o The
capillary-like interstitial links with underlying layers are compromised
leading to further dehydration
Important thing to note about all these negatives is their
tendency for exponential accumulation.
Let’s consider a hypothetical example, of a person who say, sits
for 30 min in a row and really ‘feeling it’ for the last 5 min.
Those last 5 min are Stage 3. It is important to realize that
the wear and tear of first 20 min is negligible and would take, say, 5 min for
fascia ’gummy bear’ length to recover to original length and state of hydration
and for the intra-muscular drainage to be restored. Last 5 min of Stage 2 –
they presented challenges that were already much stronger – and it might take 15
min to recuperate from those last 5 min in a Stage 2. But, once a person enters
into Stage 3 – that’s where things really start to escalate. So the last 1 min
in a 30 min sitting – causes much more of lasting damage than all previous 29
min combined. And every next minute of sitting that is sustained via Stage 3
muscular effort adds disproportionally large tissue strain that might take days
for full recovery – if such a recovery is given!
I hope that you can see how this is different from the
athletic and military training mindset that we are all conditioned to follow
even without thinking about it.
What is the belief system that most of us have? – No pain, no
gain… Only driving oneself to the brink and limit brings progress. Translated
to our example that means that we somehow think that if a person can only sit
for 15 min comfortably today, then if a person makes an effort of forcing
oneself to last for 20 min and sustains that effort for some time – the reward
will follow: 20 min will be set as a new base and so the training should
continue towards a new base of, say, 25 min.
This
familiar ‘train hard’ mindset – is complete and dangerous rubbish – it’s not
only inefficient, it is detrimental for static activities and for quadriplegic
persons especially.
It works only for selected cases: healthy tissues put into dynamic
activities by athletically pre-disposed breed of people. Overtraining
definitely does not work for static situations even for healthy people and it
never works for people with compromised myofascial qualities (persons with
Cerebral palsy and TBI especially).
In this post I only focus on static
‘activities’ but I want to emphasize once again – any repetitive forceful
training, such as forcefully induced artificial: crawling, creeping, walking,
bouncing, biking etc. – does a lot more damage than good.
You’ve heard this from me before
but following the Fascia congress and advanced course I am armed like a GI with
weaponry that is necessary to blast those detrimental practices – especially
when they are applied to quadriplegic kids.
What conclusions do we need to make?
·
Teenagers with CP who speak about their back pains following
prolonged sitting – are effectively the spokespeople for the rest of
quadriplegic kids – the ones who can’t tell you about it verbally. Obviously,
the prolonged static positions have at least the same negative effects on them
as well (most likely even greater ones since these kids are weaker).
·
Even a healthy person experiences these challenges
related to Stage 3 muscular overuse and the end of Stage 2 fascia overstretch.
The research by Dr. M. Solomonow from University of Colorado
emphasizes that manufacturing workers, i.e. people who are exposed to a fixed
set of postures required by their workload, face fundamental problem – the
extend of micro-damages that occur during a typical 8-hour shift is too great to
be offset by a single night’s rest. Their fascia doesn’t recover fully – the
result is the accumulation of those micro-damages over a period of time into
major detrimental effects.
Clearly, these challenges are even more pronounced for
kids with cerebral palsy. Consider just some of the aggravating factors:
o A child
with cerebral palsy is extremely limited in the variety of positional adjustments.
Where we can do mini-shifts of sitting platform or of weight-distribution – they can’t
o A child
with cerebral palsy has much very little of compressional strength – support of
the superficial ‘myofascial coat’ by incompressible internal volumes. Hence the
relative exposure of superficial longitudinal layers of fascia and muscles to
stress in static positions is much greater.
What practical steps should you consider?
·
Frequent periods of rest
Do
not wait for Stage 3 to kick in – give rest earlier.
Let
me illustrate this principle.
If
your child complains of discomfort – verbally or non-verbally (via becoming
restless or starting to wiggle and arch etc.) – after say, 20 min, you should know
that by that time he is in Stage 4 – escape.
That
means that his Stage 3 has ended by that time – not to mention Stage 2. What
you should aim for ideally? – Give rest whilst he is at the end of Stage 2. In
practical terms that implies that rest or major change of position should be
made somewhere around 10 min mark. I want to really emphasize it – rest should
be given not when pronounced signs of discomfort are clearly visible – but it
should be calculated backwards to the time when a child was still in Stage 2.
·
Yes, I know all of you prefer to see your child in a
sitting position, since it is easier to maintain eye contact and in general it looks
more ‘able-bodied’ – but you really need to consider giving them more time
lying horizontally and supported.
·
Classic orthopedic wheelchairs and seats that
emphasize the idea of ‘forcing a child into straightness’ are most often counterproductive.
Provide as much support as possible. Try to follow the neutral position of your
child – the one of maximal muscular relaxation – no matter how slouched it
looks like.
·
I also realize that especially for the kids who go to
schools – frequent positional change is often not an option. However, there are
still certain things that you can do:
o Ask the
school to give them rest times. Not always but at least sometimes that should
be possible
o Once your child is back home – take them out of the chair and give them good rest.
Teach them the Super-Soft Ball Rolling Technique. They could have been reluctant to use the counterintuitive and more complex 'classic' 3 Q technique -- but ball rolling is much easier.
Injections
of fascia fitness.
As I said just now – I realize that positional
management might be quite problematic – considering transferring a child back
and forth; engaging the help of the school etc.
That’s why I have a suggestion to you – Injections of Fascia Fitness.
This is where the Super-Soft Ball Rolling Technique
comes to rescue. Key advantage of Super-Soft Ball Rolling is versatility.
·
The mini-sessions of could be as short as 100-200
strokes. Considering that an average stroke is just 1-2 seconds long – we are
talking about the scope of 3-10 min at a time.
·
Ball Rolling doesn’t take a lot of setup requirements –
you do not need to allocate special place in the house for it and can do it
practically everywhere. Just put the child on some mat on the floor, take a
ball and do it for a few minutes.
Super-Soft Ball Rolling Technique could even be delivered
without taking your child from the wheelchair. As long as a child can bend
forwards – you get the access to the back. Of course, there are some special
technical nuances that make it possible to deliver a quality application even
in that odd position. I already started filming the ways of doing it and by the
end of this month we’ll have quite a library that will help you to figure out
how to do it.
If we put things in perspective, I strongly advise you to
start upgrading your mindset – typically most of you tend to allocate a
specific slot of time in the day for your ABR program. That’s great but the
idea of fascia fitness injections goes further.
You need to consider the injections of fascia fitness
throughout the day – via Super-Soft Ball Rolling Technique – do it in the
morning before your child goes to school (5-10 min – it needn’t be long); do it
once he gets back from school; do it 3-4-5 times a day.
If you’d manage to establish this type of routine you’d be
able to help in ‘keeping the fascia armed and ready’ by improving the hydration
and drainage; and delivering the non-forceful mechanical stimuli to keep it ‘in
tone’ and thus ready for Stage 2 action.