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.I hope that helps, looking forwards for your replies and questions…