Mesodermal movement

[Barrett Dorko]

He’s been unable to sleep in a bed for about six weeks and has found that the position of his head and neck in the recliner is critical to his low back and leg pain.

Twice each week during the past month I’ve driven to his home to see if I could help. The relief was profound after each visit and I was encouraged, but his life didn’t often include the rest we knew he needed and, even then, the pain would return.

Often those of us who emphasis neurogenic reality are accused of forgetting how profound the effect of mesodermal movement might be. But we know that such a thing might prey upon the ectoderm either immediately or slowly over time. My friend’s MRI now reveals a massive extrusion of a disc and a compromise of the nerve that has never resulted in weakness – just exquisite pain six weeks ago.

When did the disc material move? There’s no way to tell. We only know when the brain decided to output pain.

There’s one more thing: If this weren’t a primary problem of neural tension, the movement I catalyzed would never have helped.

And it certainly did.

[Barrett Dorko]

Can anyone identify the reasoning here?

[Barrett Dorko]

Okay.

I said to myself, "If this guy had a long term bit of neural tension that one day the brain decided was threatening enough to warrant an output of pain, he would still respond to various positions rapidly and I could help by doing something that enhanced his instinctive movement in that direction."

"It wouldn't last though."

[PatrickL]

Originally Posted by Barrett Dorko

but his life didn’t often include the rest we knew he needed and, even then, the pain would return.

sounds like you anticipate his relief won't last because he will return to mesodermal movement? That or he will get hung up on the MRI result and move even less.

I like the reasoning that the relieving effect of the instinctive movement points away from the disc as the driver of his symptoms

[MaxG]

Originally Posted by PatrickL

I like the reasoning that the relieving effect of the instinctive movement points away from the disc as the driver of his symptoms

Is that the case?
Maybe I am missing the point, but he could certainly have pain-free episodes, even if the driver of the symptoms was the disc, via a top-down inhibition of the afferent noviveptive nerves in the dorsal horn, no?

[Barrett Dorko]

Patrick says:

sounds like you anticipate his relief won't last because he will return to mesodermal movement?

I hadn't said it specifically, but I don't know what the future holds - ever. But, he will have the disc material removed soon and I'm pretty sure that this will help quite a bit. He wants me to see him post-op because he understands what I can add to his understanding and sense of correction. All good things.

What I find frustrating (again) is the surgeon's dismissal of any idea I might have. As it happens, the patient is also a surgeon and he immediately assumed that the disc migration was concurrent with the onset of pain. I asked him how he could know that.

He had no answer.

[CDano]

Do you think the surgery will help him because it will help him, or he BELIEVES it will help him?

[Diane]

In one corner: His certainty, belief in surgery, and belief in physical causation, and 400 years of Cartesian bottom-up reasoning about pain as an input, his hope (expectation, source of placebo) hinging on surgical intervention being a "cure".

In the other corner: Barrett Dorko, manual therapist, with a different set of foreign-sounding ideas but hands that soothe.

Sounds to me like in the end the patient will win. But maybe not the patient's nervous system. There are some mountains you just can't climb.

[Barrett Dorko]

Do you think the surgery will help him because it will help him, or he BELIEVES it will help him?

Both, of course. Isn't this what all the research indicates?

The effect of therapy is cumulative, but it's impossible to assign value to each factor because the patient does that.

[Diane]

Originally Posted by Barrett Dorko

Both, of course. Isn't this what all the research indicates?

Well, actually some research has pointed out that surgery is an elaborate placebo, in the case of knee arthroscopy at least.

[Barrett Dorko]

Diane,

I'm sure you already know this but I wanted to write it out in order to help me understand it better.

This patient has placed great store in the picture taken by the MRI and certainly the surgery will change that. Thus, his brain will output far less pain simply because there will now be less threat. What he can't see, the nutrition to the nerve, we might reasonable conclude will also be helped. After all, an intermittant amplification of his ideomotion helped him quite a bit. I'll take credit for that.

I always return to what Wall said;

A placebo isn't what you give to the patient - it is their response to something; it is what they give you.

I probably shouldn't write that as a quote, but I'm pretty sure this was his conclusion.

Am I right about that?

[Diane]

What he said was, "Placebo is not something you give to a patient, it's something you elicit from them."

I always show people the pictures I have in the treatment room of what the inside of a nerve looks like, how it feeds itself. It helps their brains concoct a new placebo, moves them gently away from thoughts of mesoderm.
(In the surgeon's case, it might help him to know that it was an orthopaedic surgeon who detailed the information, Lundborg, in the 80's.)

But as long as he's projecting his own placeboic capacity out onto an MRI, I'm sure you are correct, only changing the MRI is likely to change his pain state long term.

[zimney3pt]

We do have evidence that patients can have an extrusion and no pain see here although it appears less common then a buldge or protrusions with no pain.

There is also evidence that the disc will change ("heal") over time see here.

Based on those two pieces of info could he be relieved of the pain and nociception, if he continued conservatively and let the body try and heal the disc material over time, probably (especially since not having any significant hard core neurological loss signs of muscle weakness, sensory loss or reflexes). But it might take 2-3 months possibly 6 for the body to go through the healing process to reduce the nociception. The pain could obviously last shorter or longer because it is reliant on threat and not nociception.

So could the person be relieved of the pain because the surgery, probably because taking away nociceptive input (which I don't think we can deny surgery would do) can often be helpful to assist in pain reduction. It deals with the left side of the matrix. Surgery would take away sensory input, help with cognitive and emotional areas considering his current belief system. So a good chance the neuromatrix processing might have a decreased output of pain perception.

(If you have a sliver in your finger and it hurts, it helps to take the sliver out. Interesting though that if you can't find the sliver your body seems to eventually push it out often on it's own, just takes a little longer but the end result is the same.)

Sure there is placebo involved in surgery I don't think we can ever tease out how much as it would never be linear always an emergent property. Isn't placebo a lot of the cognitive and emotional inputs into the neuromatrix?

I agree that getting the surgery or not is a question of cost, risk and benefit that only the patient can decide after given all the accurate information, as you stated Barrett that value is only assigned by the patient.

[CDano]

What a great collage of answers, pretty much what is was thinking as well, but confirmation always helps.

What percentage of people over say 40 are thought to have some sort of disk prolapse? I recall it was surprisingly high.

[Barrett Dorko]

Yes Kory, you're right on it. Interestingly, this surgeon places a great deal of trust and confidence in my care. Many of his colleagues concluded I was an idiot long ago. This includes the man who will likely operate.

Isn't Kory's Calculus involved here? Where was that first mentioned?

[zimney3pt]

I think you termed it The algebraic analogy of Zimney initially, then shortened it (as you always do, to simplify things) to Kory's Calculus.

[Karen L]

All of this is quite similar to the Blog Lorimer Moseley recently did about his shoulder. He could not reconcile the damage shown in his radiology films and his onset of pain. He is a survivor of the second most toxic snake venom in the world and he just started training for a new charity activity (a long distance bike race). I think there is better correlation between the change of context and physical activity and the neurotags Lorimer stores than apparent degeneration of the shoulder joint and the new physical activity.

These cases are terrifically interesting and your client is walking a razors edge. I have a two time surgery client who is trying to dig herself out from under narcotic pain meds, financial stress, family stress and other health issues without multidisciplinary support.

Thank you Barrett for the case study, I will subscribe to this post and continue to follow it.

Karen