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FC2O Solo 1 - Matt Wallden - Panjabi's Model
26 Plays5 years ago
To find simplicity on the other side of complexity, models are created. In this episode, we discuss the powerful Panjabi's model with imagery available at www.mattwallden.com/fc2o-podcast/fc2o-podcast-show-notes/fc2o-solo-panjabis-model-show-notes/, or at https://vimeo.com/mattwallden
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Transcript
Healing and Recovery in Muscles vs. Ligaments
00:00:00
Speaker
Now if that was a muscle that was damaged, then absolutely that would happen because muscles have a great blood supply. The problem is that passive tissues like ligaments and discs have a very poor blood supply. And so when they get traumatized, even if it's at a microscopic level, just a little bit of stress to the ligament more than it's designed to handle.
00:00:20
Speaker
then they often can't repair as quickly as you're damaging them, especially if you're a professional sports person or you've got a recurrent habit of moving in a certain way or sitting in a certain way. Back to the disc example, if you tend to sit down with a flex spine every day, and that's the way you sit, that's the way you are at work, that's the way you drive your car or sit on your sofa at home in the evenings,
00:00:44
Speaker
then the cumulative stress across maybe 15, 20, 25 years longer into that disc will mean that the same extreme strength that it has as a healthy disc will gradually decrease and decrease and decrease over the years.
FC2O Solo Podcast Introduction
00:01:02
Speaker
And then at a certain point, you may bend to pick something up, you may twist to say, strike a hockey ball in a hockey match and pop the disc ruptures.
00:01:14
Speaker
And that really is a great example of the straw that breaks the camel's back. F C 2 O From chaos to water From chaos to water Here we go From chaos to water From chaos to water
00:01:51
Speaker
Welcome to FC2O Solo. Today I'll be interviewing no one. In fact, this is the first of a series of solo podcasts that will be interspersed with my podcast with guests.
Clarification on Ultrasound and Left-Handedness
00:02:02
Speaker
So you may have noticed we had no podcast last week and that was because we had a big release with Mark Sisson interviewing me for his Primal Blueprint podcast.
00:02:11
Speaker
where we talked about two recent papers that we've published all about archetypal rest postures, primal patterns and instinctive sleep postures so that's quite a fascinating topic and you can see that I'll put that on the show notes so if you want to catch up on that then fantastic
00:02:26
Speaker
Also, I just wanted to clarify a point that I made in my podcast with Sheri Tenpenny, the second one, which was her Q&A, episode eight, where I mentioned that if a child is ultrasound in the womb, then it increases the risk of left-handedness. And I used that exact turn of phrase. And of course, you know, that could be misinterpreted, and I didn't mean it to come across. I meant to clarify a little bit, and that is that
00:02:54
Speaker
There is one line of thought that if the standard sort of dominance in human populations is to be right-handed and therefore left hemisphere dominant,
00:03:09
Speaker
and one of the lines of thought is that when a child is left-handed that there may have been some subtle damage to the left hemisphere and so they preferentially pick the right hemisphere as their dominant hemisphere and therefore become left-handed. Now obviously that's very controversial and I don't know that there's any strong evidence behind it but one of the things that it ties in with which of course relates back to the whole discussion with Sherry Tenpenny is that
Panjabi's Model of Joint Stability
00:03:39
Speaker
kids that are on the autistic spectrum have a much higher instance of left-handedness. So it was one of those kind of connections that I actually failed to make in that discussion, but that was what I was alluding to there. So join me for this episode where we're going to be discussing Panjabi's model of joint stability and all the different ramifications of that, how it can benefit us, how it can benefit clients, and how it can benefit students that are learning about human function.
The Concept of Simplicity Beyond Complexity
00:04:09
Speaker
Enjoy the show. Here we go. Hello and welcome to our first edition of FC2O Solo. So this is Solo, it is me just talking to you. And the theme for this series is simplicity on the other side of complexity.
00:04:33
Speaker
So with that in mind, what I'm going to just do is just remind listeners of the preview to the podcast where I introduce the whole idea from chaos to order. And the name, simplicity on the other side of complexity, relates to a graph
00:04:52
Speaker
which I described and if you want to see the graph then it's in the show notes on our website and we also have a video of this on our Vimeo page and the details of that can be found in the description under the podcast. So the image is essentially of a graph which is a bell-shaped curve and up the left hand side of the graph is the y-axis saying complexity
00:05:18
Speaker
And across the bottom of the graph is the x-axis saying elegance. And what it's alluding to is that whenever we start out in any new endeavor of learning or mastery of a given area, skill set, etc, then we start off pretty dumbed down, let's say. We're pretty poor at, let's say, taking up a new sport or new instrument.
00:05:39
Speaker
or you're learning a new course at school, at college, at university, or you're starting school even, where everything's pretty dumbed down when we start off, so elegance is fairly poor, the complexity is low, but as you move across and you start to go up the levels of complexity, you start to head towards a peak.
00:05:59
Speaker
and your elegance at playing the sport, playing the instrument, describing the field of knowledge that you're diving into gets more and more elegant.
The Power of Well-Conceived Models
00:06:10
Speaker
And ultimately, you move from a kind of beginner phase where it's all dumbed down, very, very basic, very simple, and you move into a kind of complexity phase as the complexity increases, of course, and you become more and more of an expert in that discipline.
00:06:27
Speaker
So ultimately you reach a peak of expertise and beyond that expertise, what you find is that the complexity starts to slowly drop down. So someone who's a master, take someone like Roger Federer, for example, as a tennis player, an expert tennis player, he's not just an expert, there's lots of experts out there, lots of coaches, lots of great players, but people that don't make it to the same pinnacle that Roger Federer does.
00:06:53
Speaker
And that's because he's gone beyond the other side of the complexity curve and he has sort of moved into what we call the mastery phase. So he's a master of tennis or it might be a master of taekwondo or of playing piano or whatever. And these guys really don't have to think about it. Think of Elton John or someone like that on the piano. He could just sit down and he can play chords and melodies and sub melodies and harmonies and all sorts of stuff because he's just a master of that discipline.
00:07:21
Speaker
and again many experts in the piano but he is an example of someone who is a master and this is the same in in fields of knowledge as well but the thing about masters is that they can make things extremely simple and they can help to explain very complex topics or to demonstrate complex skills
00:07:45
Speaker
in what seems like an effortless way and that's why I used Roger Federer as an example, he just seems to be effortless in the way he plays tennis.
00:07:55
Speaker
The quote, again, I mentioned it in the preview, but there's a great quote from a guy called Oliver Wendell Helms, Sr. And he says, for the simplicity on this side of complexity, I wouldn't give you a fig. But for the simplicity on the other side of complexity, for that, I would give you anything I have. And so what he's talking about is mastery. And of course, mastery of any given discipline
00:08:20
Speaker
takes about 10,000 hours, the research shows it takes about 10,000 hours of not just 10,000 hours of doing the skill but actually focused attention and contemplation and you know really a form of concentration which is an interesting word because it means that you're focusing when you concentrate
00:08:42
Speaker
then it's the opposite of e-centration, which is where things go outwards and you drift off, et cetera. So concentration. And so really, you know, there's many factors that contribute towards making a master. But for today, what I'm going to do is I'm going to talk to you about a model because a model is something that gives you simplicity on the other side of complexity called the Punjabi's model. Now Punjabi is an orthopedic specialist. He's a master of his craft.
00:09:12
Speaker
and he developed this model. And I found this model so useful, not only for me to understand the human body, but also to help students understand things more easily, to help patients understand things more easily. And I think you'll find it really useful too. So just to preface it a little bit, I'm going to explain that a model, and this is from a guy called John Hollins, who essentially studies modeling.
00:09:38
Speaker
And he's a complexity theorist and a chaos theorist. So he's a master of his craft. And he says, a well-conceived model can yield organised complexities that repay decades and centuries of study. And I would say that Punjabi's model is a great example of that.
00:09:58
Speaker
He goes on to say that this capacity for prediction provides a deep connection between modeling and emergence. So in other words, the emergence of new ideas, the emergence of mastery, the emergence of new skill sets, etc. The usually simple specification of a model, what is called the transition function, can yield a limitless array of consequences and predictions.
00:10:22
Speaker
And if that transition function is faithful, in other words, if the model is accurate, then we can make predictions into the indefinite future. OK, so a model is an extremely powerful tool. And to give you a sort of more real world example of that, there's a guy called Gleich who wrote a book on chaos theory. And he says that the choice is always the same. You can make your model more complex and more faithful to reality, or you can make it simpler and easier to handle.
00:10:52
Speaker
Only the most naive scientist believes that the perfect model is the one that perfectly represents reality. Such a model would have the same drawbacks as a map as large and detailed as the city it represents. A map depicting every street, every building, every tree, every pothole, every inhabitant, and every map.
00:11:11
Speaker
were such a map possible its specificity would defeat its purpose which is to generalize and to abstract. So imagine that a map that is essentially the same size as the city that you're trying to get around it's just it's just not helpful so you need to make it simpler but you know with enough detail that you're able to navigate that new territory and that's what Punjabi's model does. Now
00:11:34
Speaker
Some people find this kind of way of working challenging to their minds and quite often, interestingly enough, it's people that have reached a level of expert so that they've gone from the beginner phase on that complexity curve. They've gone in right up that complexity curve to the top and they are experts in their discipline but they've not yet mastered it.
00:11:59
Speaker
And so what that means is that they look at a simple map and they go, well, that's far too simple. That doesn't explain everything. You know, I've studied far too much to believe that that could really help. And so what Blake says is that what's actually the case is that as physicians and scientists learning all 50,000 parts of everything,
00:12:20
Speaker
we resent the possibility that there are in fact universal elements of motion, so universal truths, simple understandings that allow us to essentially get not quite the level of mastery but to get the insights of the master but in a very simple way and that's what a really good model does and Punjabi's model is a great example of that.
00:12:43
Speaker
Okay, so I'm going to describe Punjabi's model to you, and again, if you're just listening on the podcast, then you have to imagine it, and that's no bad thing.
Components of Panjabi's Model
00:12:51
Speaker
But if you want to see the model, then again, it's on the show notes on mattewaldon.com, and it's on our Vimeo page, okay? So, the model is essentially a triangle, or a triad, and at the top of that triangle, you've got neural, and what that means is the nervous system.
00:13:11
Speaker
On the bottom right hand corner, you've got active and that's the muscular system.
00:13:16
Speaker
And in the bottom left-hand corner, you've got passive, and that's things like the ligaments and the joints and the bones and the connective tissues, things in the body that essentially are part of the structure, part of the biomechanics, but they're passive. They wouldn't do anything on their own. You think of a skeleton standing in a room. It doesn't move. And the reason it doesn't move is because it has no active component to move it. And even if it did have an active component, that active component would need a nervous system to get those muscles to move. So that's Punjabi's model, and it's very simplistic.
00:13:46
Speaker
state. So why this model is important is that it not only tells us a lot about anatomy and physiology and how the body functions but it also gives us great insight into things like injuries. So if you've been injured or if you were to get injured then Punjabi's model can help you understand how to recover from that injury or if you're a practitioner of some sort that helps people with injuries well then it will help you to help the patient or the client.
00:14:13
Speaker
and it will help you to educate the patient or the client to understand their situation. So injuries is the first thing but it also really helps with performance and we're going to talk about that. It can help with health in general and of course Punjabi developed the model for musculoskeletal health but as you'll see it is important for so much more than just the musculoskeletal system.
00:14:38
Speaker
And then it will help explain things like in medicine at the moment, one of the key, a different model, which we may well do one of these FC2O solo sections on.
00:14:49
Speaker
is called the biopsychosocial model and it helps to explain a bit more about the biopsychosocial model as well so that we get a bigger context to understand our own situation and our patient situation or loved ones situations especially when they have health challenges and how to avoid those things, how to prevent them.
00:15:09
Speaker
And then also things like gut health and many, many more things beyond it. So a good model is something that can explain many, many things very simplistically so that we're able to get our heads around what would otherwise be quite a complex topic.
00:15:24
Speaker
Now, I'm going to take a few examples when I go through the model. So first of all, I'm going to tell you a bit more about the model and explain it in a little bit more detail. But then I'm going to take some injuries, which are quite common. So I'm going to look at anterior cruciate ligament injuries. That's a very common sports injury. I'm going to look at shoulder injuries, in particular, maybe shoulder impingement or rotator cuff injuries. So you may have experienced that or know someone who's had a rotator cuff injury. I'm going to talk about low back pain.
00:15:53
Speaker
And I'm also gonna give another example of ankle sprain. So if you've ever experienced a sprain ankle or low back pain or shoulder injury or knee injury like a cruciate ligament injury, well then this should give you some insights. And indeed it may not be you, it may be a friend or a colleague or a loved one or a teammate, those kinds of things. So let's dig into the detail of this very simple but very sort of profound model.
00:16:20
Speaker
So as I mentioned, at the top of the triangle, you've got what Punjabi calls the neural subsystem. The neural subsystem essentially means the nervous system. And it means really anything that both affects the muscles, but also receives information from the muscles and receives information from any other part of the body, including the passive subsystem, which we'll come on to in a moment.
00:16:46
Speaker
and things that may influence those systems such as your beliefs, your values, your emotions, your organ health, the way that you are handling stresses in life and so on and so forth. So that's the neural system in a snapshot.
00:17:05
Speaker
Then we've got the active system and the active system is the muscles, as I mentioned earlier, but the muscles can be really usefully divided into two main categories. And those two categories are the deeper muscles, which tend to be deep in the joints or deep in the spine. And those muscles are what's known as tonic muscles because they hold tone and they tend to be involved in holding posture.
00:17:28
Speaker
They have very good endurance so they can hold you up all day long. You don't generally get tired even though you may have been sat down or stood up or walking around all day. Those muscles will keep you upright all day long. Those are deep muscles and therefore sometimes they're called the inner muscles or the inner unit muscles. So that's one part of that active or muscular system.
00:17:53
Speaker
The other part is the outer muscles. And so those are the muscles that we can see. They're things like the biceps in the arm and the triceps in the arm. They're the pec muscles you can see. They're the abdominal muscles, the six pack you can see. They're the quadricep muscles in the thigh or the hamstring or the calf muscles. They are outer muscles.
00:18:11
Speaker
those muscles are involved in moving us so they move us they move our joints and they can also have quite good endurance but actually they are more fatigable so in in other words what happens is if you were to let's say climb up some stairs then those muscles are the ones that are doing the climbing if you were to go for a sprint or a run those are the muscles that are propelling you forwards
00:18:36
Speaker
and they have a higher number of fast twitch fibers in them. And the fast twitch fibers move you powerfully, move you quickly, but they fatigue early. That's why if you were to sprint now, you could only sprint at your top speed for about eight to 10 seconds. Now you can still keep going pretty fast for perhaps 20, 30, 40 seconds, but most people within eight seconds or so, they'll have dropped below their top speed.
00:19:03
Speaker
And so these are indeed not just about speed but about lifting heavy things. Now if you were to lift something really heavy, perhaps it's a weight in the gym or it could be your moving house and you're lifting a table or a sofa or piano or something.
00:19:17
Speaker
You can only do that for so long and generally for quite short periods. Um, so those are the outer muscles. So in that active component of the, of the models, neural and active so far, the active system or the muscular system has the inner muscles, which are tonic and postural and the outer muscles, which are what's called phasic because they phase on and off. If you think of when you walk or when you cycle or when you row or when you swim,
00:19:45
Speaker
you contract a muscle and then it relaxes a little bit and you contract it again and you relax again so when you're walking for example as you take a step you contract the muscles in the front of the leg to swing the leg forwards
00:19:58
Speaker
leg hits the ground and the muscles at the back then contract to pull you forwards okay or push you forwards depending on depending on what angle you're at okay so that's the active system now the passive system is really quite interesting because the passive system sounds a bit dull it sounds like it doesn't do too much but the passive system is the ligaments
00:20:17
Speaker
in particular and the joint capsules. So these are kind of connective tissues. The fascia sometimes is another name for connective tissues which you find throughout the body and it holds the organs in place and it contributes to the stability of the joints. You find it holding the muscles together. So the fascia is a very important connective tissue.
00:20:38
Speaker
But so are things like discs in the spine. So you probably heard of people getting disc injuries in their back or slipping a disc is the colloquial term for that, which isn't that accurate, but it's what a lot of people know it as. And that would be an example of damage to the passive subsystem in the back if you get a disc injury or if you get a ligament injury or a joint injury.
00:20:59
Speaker
Now the function of the passive subsystem is to be a kind of, both to provide structural integrity and to hold you together, but it also is designed to be a backup system for if the muscles don't respond quickly enough. And this is where something like an ankle sprain comes in, because the reason we sprain an ankle is because we might be walking or quite often running.
00:21:22
Speaker
And if the foot hits the ground and the ground is slightly, let's say, you know, it's cambered or there's a root or a rock or a stick or something that we didn't see or a dip in the road or a curb, these are all things that often sprain ankles.
00:21:38
Speaker
And what happens is the foot rolls over, you don't have time to react. So your nervous system, so the top component on Punjabi's model, the neural system, doesn't have the time to register that your foot has fallen down a hole or whatever it is.
The Role of Blood in Stability
00:21:55
Speaker
And so the muscles cannot be engaged to counteract that. It's just happening too quickly. And so then what happens is all of the stress goes into the passive subsystem, the ligaments around the ankle, and they stop your ankle from dislocating. Now, of course, you constrain the ligaments in that process and it can swell right up, but at least you didn't dislocate your ankle. So the ligaments are like a backup system for when the muscular system and the nervous system are unable to respond.
00:22:22
Speaker
Okay, so that's that's the passive subsystem but interesting enough within the passive subsystem you also have another Tissue which is perhaps slightly unexpected which is blood and blood is also part of the passive subsystem Now what I mean by that is that blood actually gives the body stability gives muscle stability discs stability
00:22:44
Speaker
vertebrae stability, whenever there's blood within the system, it makes the system stronger. And so passively it makes the system stronger. So blood is actually part of the passive subsystem as well.
00:22:56
Speaker
Now, if we were to look at injury, for example, you know, so we mentioned ankle sprain and I earlier mentioned things like cruciate ligaments, sprains or strains or tears. You could have shoulder impingements or rotator cuff injuries. These things all impact on Punjabi's model. So let's take, let's take a cruciate ligament injury. Okay. Now,
00:23:21
Speaker
The cruciate ligament is in the knee and it's called the cruciate because there's actually two of them and they form a cross which is a cruciate shape.
00:23:28
Speaker
So the most commonly injured of those two ligaments is the anterior cruciate. And some of you will have known people that have injured their cruciate or you might know famous sports people. Michael Owen, who is the English striker, is one of the best strikers of his generation for the football side. He famously strained his cruciate ligament at one point when he was playing a game for England and actually tore it.
00:23:55
Speaker
Now, what happened there, of course, no one knows exactly, but what would have been part of the mechanism is that the muscles wouldn't have been doing what they were supposed to do to stabilize the knee. So what you've got is you've got an injury to the passive subsystem. And the reason that occurred is because the muscles weren't supporting the knee in the way they should have done. So you say, well, why weren't they supporting the knee? Well, he may have been fatigued. I'm not sure that he was in that instance.
00:24:23
Speaker
or the muscles may have contracted inappropriately. Certainly he probably transferred his load over his knee in an unusual way. But what most likely happened with him is that he probably had a muscle firing pattern which had been putting stress into his anterior cruciate ligament for many years. And what happens when you put stress into a ligament or into a disc or into any connective tissue across a period of time
00:24:51
Speaker
is that quite frequently that ligament will lose its tensile strength. So what that means is that it gets weaker and weaker and weaker until a relatively small stress to it can rupture it or tear it. And I think that's probably what happened in Michael Owen's case and in many injuries that we see in sports or in activities of daily living or at work, etc.
00:25:14
Speaker
Now, why is that the case? Well, you know, the reason I say that that was probably the case with Michael Owen is that one other thing he was unfortunately famous for was getting repetitive hamstring strains. And so the hamstring is actually in the human body. It's the one thing, and there's a particular hamstring, three hamstrings in the human body.
00:25:33
Speaker
And one of them, which is the biceps femoris, and it's on the lateral side of the leg, the outside of the leg, it actually serves as what's called a dynamic agonist to the anterior cruciate ligament. So what that means is that it dynamically works in the same way and supports the anterior cruciate ligament.
00:25:52
Speaker
Now Michael Owen, in one season, had eight hamstring strings. So my guess is that, and he went on to have many more as well, but my guess is that his hamstrings were not doing the job that they should have done throughout his whole career. And so across all those years of playing football, with every step he took, he was getting a degree of sheer
00:26:12
Speaker
through his anterior cruciate ligament so his muscular system was not supporting his passive system and that ultimately meant that he lost connective tissue strength or tensile strength and then just a small untoward movement caused his ligament to rupture and this is often the case with many people with these kinds of injuries
00:26:36
Speaker
back injuries, shoulder injuries, ankle injuries is that it's not so much the actual impact or injury that causes the the rupture to occur or the damage to occur but it's that for many many years the muscles that support those structures haven't quite been doing their job properly.
00:26:54
Speaker
Okay, so just to move away from the Michael Owen example for a moment, if we were to look at a disc injury in the back, what we know about discs is that when you have a flatter lumbar spine, so the lumbar spine should have a curve in it, should have something called a lordosis, and that curve normally allows for optimal distribution of loads through the spine. So the spine should share the loads of every step you take,
00:27:20
Speaker
because each time you take a step, you're getting a ground impact. It's going up and into the spine. And it should share those loads nicely between the disc and the virtual body at the front and the facet joints at the back. But if you've got a spine which is being held a little bit flat,
00:27:38
Speaker
In other words, it's lost its curve, then most of the load goes into the disc at the front and less goes into the facet joints at the back.
Pain, Injury, and Recovery
00:27:44
Speaker
And so what this means is that, of course, those tissues are extremely strong and they can handle a lot of load. And one thing I was going to mention with Michael Owen and his cruciate ligament is that ligaments, which of course are part of this passive subsystem, as are the discs, they have a tensile strength greater than steel. So they're incredibly strong.
00:28:06
Speaker
But if you keep loading them repetitively in an aberrant way or a dysfunctional way, then they progressively get weaker and weaker and weaker. And you would think that, well, hang on, if something has tensile strength greater than steel, then it should be absolutely fine and there should be no problems with transferring load and it should never tear.
00:28:30
Speaker
But the issue is that across time, the ligaments themselves and the passive subsystem has typically a very poor blood supply. So what that means is that with someone like Michael Owen, if he's stressing his anterior cruciate ligament each time he takes a step when he's playing football, then he's creating a degree of trauma
00:28:54
Speaker
to that ligament, not significant enough to tear it, but enough to create some stress to it. And what you would hope would happen is that after the game that night, his body would go to sleep, he would go into repair mode and it would repair that ligament. Now, if that was a muscle that was damaged, then absolutely that would happen because muscles have a great blood supply. The problem is that passive tissues like ligaments and discs have a very poor blood supply. And so when they get traumatized,
00:29:21
Speaker
Even if it's at a microscopic level, just a little bit of stress to the ligament more than it's designed to handle, then they often can't repair as quickly as you're damaging them, especially if you're a professional sports person or you've got a recurrent habit of moving in a certain way or sitting in a certain way.
00:29:38
Speaker
Back to the disc example, if you tend to sit down with a flex spine every day and that's the way you sit, that's the way you are at work, that's the way you drive your car or sit on your sofa at home in the evenings, then the cumulative stress across maybe 15, 20, 25 years longer
00:29:58
Speaker
into that disc will mean that the same extreme strength that it has as a healthy disc will gradually decrease and decrease and decrease over the years and then at a certain point you may bend to pick something up, you may twist to say strike a hockey ball in a hockey match and pop the disc ruptures.
00:30:22
Speaker
And that really is a great example of the straw that breaks the camel's back. So it wasn't the fact that you just bent to tie your shoelace that caused the disc injury. It was the straw that broke the camel's back. It was really, it was the 20 years of sitting with poor ergonomics that caused the weakness in the disc to arise. And then you ended up bending to tie your shoelace or pick something up off the floor and pop the discos.
00:30:52
Speaker
With that in mind, when something like that happens, of course it's painful. And the pain is perceived by the neural subsystem. So we've talked about the active, we've talked about the passive. Now we're going back to the neural subsystem again. So let's say someone's just blown their desk out. Someone's had a cruciate ligament injury or indeed any injury in the body. We know we're injured because we're in pain.
00:31:19
Speaker
Pain is being registered, or indeed created, you could argue, by the nervous system. So that's the neural subsystem. Now, the interesting thing about pain is, of course, that it has a function. And I've got a book actually called The Gift of Pain, and it was written by a doctor who spent a lot of time in India actually working in leprosy colonies. And one of the features of leprosy is that you lose the ability to sense pain.
00:31:48
Speaker
and you know he saw so many injuries as a result of leprosy that he started to really recognize that pain truly is a gift and this is why in the check system we teach that pain is really a teacher so we call it the pain teach if you
00:32:04
Speaker
get an injury, then you're having a visit from the pain teacher. So really the question is, what is the pain trying to teach us? And if you have a model, like Punjabi's model, then you can look back and say, okay, well, I'm feeling pain. The physio or the doctor tells me I've injured my cruciate ligament. What is that telling me? Well, generally speaking, it's telling you that there's something has been going on that has weakened that tissue across a period of time. And this is where sometimes the medical system
00:32:33
Speaker
goes into repair mode and says, okay, we'll operate on that, we'll stitch it back together. But the problem with that is that it's not really dealing with the original cause. So the original cause in Michael Owen's case was probably what we call quad dominance, which is where the quadriceps activate more strongly than the hamstring and often the gluteal group. So the muscles on the front of the thigh activate more strongly than the muscles on the back of the thigh. And the end result of that is it creates a sheer
00:33:01
Speaker
in the cruciate ligament which with every step you take will stress that ligament. So talking about the pain, now the pain is a neural phenomenon so it's back to the top of that Punjabi's model and what that means is that the pain we know has an impact on the active subsystem because what we know is that when people are in pain the pain will inhibit
00:33:28
Speaker
that inner component of the active subsystem so what we call the inner unit or the deep muscles that stabilize the joint or you know with the disc injury they'll stabilize the spine and so there's lots of research again this is kind of the complexity side of it going back stepping back into the complexity to say that
00:33:46
Speaker
When someone has pain in their back, certain muscles will become inhibited and shut down. In other words, they don't fire at all or they don't fire when they should do. So the interesting thing there is that if someone comes in to see me in my clinic in pain in their low back, well, I can assess them and almost straight away I can find muscles that are not firing.
00:34:06
Speaker
Now, that doesn't mean that I can just instantly get those muscles to fire and the pain goes. What we actually have to do is we have to bear in mind that pain will continue to inhibit or shut down those muscles until we manage the pain effectively. And this is where sometimes a pharmaceutical approach can be beneficial because sometimes by taking a painkiller, for example, it can inhibit
00:34:32
Speaker
it can stop those pain messages and because the pain messages are stopped now we have a better chance of reactivating the inner muscles. The challenge though is that of course some injuries are extremely painful and painkiller won't sort that and of course the danger of a painkiller is that you can start to move when you shouldn't do because essentially what you're doing is you are snipping
00:34:55
Speaker
the warning light in the car it's like you know the petrol light comes on you think oh that's a pain i'll snip the cord which is the pain killer and then i won't see that light anymore but that's actually a warning sign it's telling you you need to rest this area you need to get some rehabilitation here don't do that same movement again that just injured you okay so that's what the pain messages are for and that's the gift of pain
00:35:18
Speaker
But so if the pain's inhibiting these deep inner muscles, then what that means is the body strategizes and it activates the outer muscles more. And that's a great strategy because it means you can still move, hopefully. It means that you can still get by on a day-to-day basis. But what we also know is that unless the pain is managed effectively and unless the
00:35:46
Speaker
inner muscles are rehabilitated, even after the pain is gone, those muscles don't start to fire again. Now one of the roles of those deep inner muscles, so we're now going back to the active subsystem, the muscular system, is that they control the
00:36:04
Speaker
fine movement, so they have what's called fine motor control. They're very, very sensory. So what it means is that they send really useful and intelligent information back into the neural subsystem. So when they're working, you're getting a really good readout of what's going on in the joints.
00:36:23
Speaker
But if they are shut down, now you don't get such a good sense of what's going on in the joint. You lose what's called joint position sense. So it's really important as part of the rehabilitation process, we reactivate those muscles. And there's a whole number of ways you can do that. There's very specific exercises that can do that. There's kind of clever clinical techniques that can help to reactivate those muscles. But this is where
00:36:49
Speaker
really we need to consult with someone who understands what they're doing to be able to help reactivate those muscles.
Manual Therapy and Rehabilitation
00:36:56
Speaker
Now, as I mentioned, those muscles may not reactivate effectively if pain is still present, so it can be really helpful to see someone who's good at getting you out of pain. So there's many manual therapists out there, for example, that are great at getting people out of pain and helping that process along. So you might go to see a physiotherapist, a sports massage therapist, you might see an osteopath,
00:37:19
Speaker
chiropractor there's many many different disciplines that can help to relieve pain and that's where the value of these disciplines really is is in helping reduce the pain. Now when the pain starts to subside some of the specialists in those fields can then help you to reactivate those muscles as well and that's very important.
00:37:39
Speaker
Now, if you don't reactivate those muscles, then what happens is the outer muscles, so remember the active system has the inner and the outer muscles, and the outer muscles are a little bit clumsy. They're not nearly as refined as the inner muscles. And what we know is that when the outer muscles contract, they generate a lot of power
00:37:59
Speaker
but they're not very good at controlling the position of the joint itself or the disc itself. So what it can do is it can create more shear into that joint, into that ligament, into that disc. So by not reactivating that inner unit, the inner musculature, you can end up with certainly compensating, certainly getting by, but the outer muscles are now trying to do the job of two different systems.
00:38:25
Speaker
so and they create more shear at the joints and this can then create stress ongoing stress into the passive subsystem and you can get caught in a loop where that stress creates pain in
Impact of Organ Health on Muscle Function
00:38:39
Speaker
the passive subsystem again the passive subsystem pain is directed back into the neural system the neural system says up yep this area is in pain and therefore what we're going to do is we're going to shut down that inner unit again so the inner unit gets inhibited
00:38:56
Speaker
So, obviously we need to reactivate that any unit. Now, when we do that, if we can do that successfully, what it does is it minimizes stress through the passive subsystem, through the joint, through the connective tissue, through the ligament, through the disc. And in doing that, now the disc is supported or the ligament is supported.
00:39:17
Speaker
And that means that there's no pain coming from it. That means that the neural subsystem can do its job and you get into what's called a virtuous circle. So rather than being in a vicious circle or vicious cycle, you go into a virtuous cycle and you can start to repair. And that's where good manual therapy, a good rehabilitation specialist can really help someone.
00:39:37
Speaker
However, there's much more to it than just that. As alluded to in the introduction, there's a huge amount of complexity involved with this. And one of the things that can cause issues with muscle firing is another neural input, which is input from the organs or the viscera. And so many of us, in fact, all of my patients that come to see me when I
00:40:03
Speaker
initially speak with them and explain what I do and how I help to rehabilitate and give them the tools to get themselves better. What I explain is that I need to get a series of questionnaires filled out so that I have a good understanding for how their hormonal, their limbic emotional, and their visceral systems are functioning. And so I send a questionnaire and it gives me all this feedback to say, well, there's stress on that organ, there's stress on this organ, there's stress in this emotional component of this person's life.
00:40:31
Speaker
maybe there's stress on a gland or hormonal system. And what that tells me is how well they're likely to respond to treatment or lifestyle or exercise interventions. So a great example here is that
00:40:48
Speaker
When people have digestive issues, often you'll find that they bloat. So many people have experienced this. Probably most people will have done, you've eaten something. It might be just a normal meal to you, but it's made you bloat. And some people start to suss out that, actually, you know what? It's when I eat bread, I get bloated. It's when I eat rice, I get bloated. And people who are really paying attention, they'll notice that certain foods make them bloat. Now, what's happening there?
00:41:18
Speaker
is you're getting inflammation in the digestive system as a result of what you've just eaten. And gluten is a very good example of this, but there's many examples in the human diet. And also, in fact, medical drugs can make you bloat as well, and they can create inflammation in the digestive system.
00:41:33
Speaker
And of course I'm not saying all medical drugs do that, but it's one of the most common side effects of medical drugs is to create digestive inflammation or irritation. So this irritation, what it does is it fires the nerves in the organ system or the visceral system.
00:41:51
Speaker
And those nerves, they feed back into the neural system because they are neural. So now the nervous system is sensitized. So it's kind of on red alert. And what happens when the nervous system gets sensitized is that you get more aware of things like pain.
00:42:09
Speaker
So whereas someone who has, let's say irritable bowel syndrome and a disc injury may be in pain, someone who has no irritable bowel syndrome and a disc injury may have no pain. So here's one of the things that we know about disc injury is that most people have disc injuries. It seems to be almost a normal part of life that we get wear and tear, we get injuries, we get disc bulges, this kind of thing.
00:42:34
Speaker
but a lot of people have no symptoms whatsoever. Now, why is it that they get no symptoms, whereas someone else may get terrible symptoms? Well, one very likely answer is that the person that's getting terrible symptoms has other stuff that's irritating their nervous system. So the neural component of Punjabi's model is already irritated. It only takes a small further irritation, and now they've got perhaps quite significant pain.
00:43:01
Speaker
Now that of course as we've already talked about pain can inhibit the inner or the deep muscles around the spine so now you've got a kind of double whammy you've got an injury there which is generating some sensory drives into the neural system but you've also got a visceral issue or a gut issue that's causing irritation to the nervous system as well. Now that irritation what it does
00:43:26
Speaker
is it shuts down the inner unit and that is actually what bloating is. A lot of people think that bloating is gas or it's wind and often they feel a bit relieved if they belch or if they pass wind and so there's some truth to that but the research that's been done into this shows that the bloating is only accounted for
00:43:49
Speaker
uh 18 percent that's one eight percent of the bloating is accounted for by gas so then the other 82 has to be down to something else and what it's down to is it's down to the muscles being inhibited again just like they were with pain so the
00:44:08
Speaker
irritating food or medical drug or whatever it is that you've taken into the body, actually additives are very common irritants to the digestive system as well. So if you're not eating organic foods, you're eating sort of standard food with lots of additives in it, colourings and preservatives and this kind of thing.
00:44:28
Speaker
then those can also create irritation and, indeed, glyphosate, which is the pesticides that are sprayed on cereals, so if you were to eat Kellogg's cereals, for example, or any commercial cereal, unless it's organic, it will have glyphosate in it, and glyphosate is a strong irritant to the digestive system as well.
00:44:47
Speaker
So these are all examples that probably many people are experiencing on a daily basis without realising and it's creating irritation to their digestive system which as I mentioned predisposes you not only to pain conditions but also to bloating and to inhibition of the muscles that stabilise the joints.
00:45:08
Speaker
So now, let's imagine you're a standard person in a industrialized society. You have cereal for breakfast, bread for breakfast. It's not organic. You have sandwich for lunch. You have pasta for dinner. None of it's organic. You're getting glyphosate into your system the whole time. You might also be reactive to something in the grains, something like gluten. There's other substances. Fructan is another common one.
00:45:31
Speaker
many people react to milk and to dairy, other people react to soya, other people react to rice, these are some of the most common food allergens or irritants. Any of those things, if you're reacting to them, they will be creating neural drives from the digestive system, so it's a neural part of the subsystem again.
00:45:51
Speaker
which is sensitizing the neural system and inhibiting the inner part of the active system. So now you're running around playing your sport, picking up your kids, jumping in the car, doing the gardening, doing the housework, doing the washing up, whatever it is.
00:46:10
Speaker
but you're doing it all using primarily the outer system. Now the outer system as I mentioned earlier is not only the power system you know it's the strength system and it moves you but it fatigues early. So if you're feeling tired if your muscles are feeling achy
00:46:27
Speaker
if you feel like you don't have the energy that you used to, well it could purely be that your digestive system is creating irritation that's shutting down the inner muscles and therefore you're relying on the outer muscles to try and stabilize you. So if we go back to Michael Owen, I don't know anything about his medical history other than what's been in the press, but imagine if he has something like a gluten intolerance.
00:46:51
Speaker
or some kind of irritation in his digestive system. Well, if that were the case, then he could still run around, he could still play football, because remember the outer system, which generates power and strength and speeds, he could still play. But the issue is, is that system fatigues early. And so this is why most sports injuries occur towards the end of a match or a game, because the system's starting to fatigue, and you see that the incidence of injuries goes up as the person fatigues.
Chronic Stress and Ligament Strength
00:47:18
Speaker
Now, someone who's fit, well-conditioned, and everything's working well, generally they can last the full game without an injury. But you've got someone like Michael Owen who got seven or eight hamstring strains in one season. Well, perhaps around that time his digestive system was inflamed, and who knows what might have been causing that? There's many possibilities. But it's an extremely common finding, so I mentioned the questionnaire I sent to patients.
00:47:43
Speaker
When I send that questionnaire out, I would say somewhere around 80% of people that fill that in have some kind of digestive, it might even be higher than 80%, but they have some kind of digestive irritation. So if Michael Owen was one of those people, well, he'd be running around on the pitch, he'd be performing really well, but because he's using the outer system to not only move him around, but also to try and stabilize, well, it gets fatigued even quicker. And so then he gets his hamstring strain, okay?
00:48:11
Speaker
and so then you know that happens again and again he gets scar tissue in the hamstrings the hamstrings stop doing their role across a period of time of course because the hamstrings are dynamic agonists to his anterior cruciate ligament what happens is that cruciate ligament gets more and more stressed the stress creates a weakening or a lack of tensile strength in the ligament and then suddenly in one game playing for englands
00:48:37
Speaker
the anterior cruciate ligament ruptures and if you see the footage which i have on the slideshow which you'll be able to see on Vimeo on our Vimeo channel well you can see he barely does anything he literally receives the ball on the wing he goes to turn not at high speeds and then he falls over and he crawls off the pitch and that was him rupturing his anterior cruciate ligament now if that anterior cruciate ligament was healthy and had the tensile strength greater than steel
00:49:04
Speaker
then there's no way that would have happened, but it did and so we can pretty much surmise confidently that it lost its tensile strength across a period of time. Now to give you an idea on the tensile strength of steel,
00:49:19
Speaker
Now, let me just let you know, I don't know the tensile strength of steel exactly, but what I do know is the tensile strength of ligaments. But to give you an idea, a ligament has a tensile strength of somewhere between 250 kilograms and 1280 kilograms per square centimeter, okay? Now, what does that mean? Well, it's very difficult to know what that means. It sounds strong, right? And we know it's stronger than steel. So we know steel is extremely strong.
00:49:46
Speaker
But to give you an idea, muscle also is very strong. Okay, you know that when you're running, you're transferring huge loads through your legs. So you're transferring about three times body weight through your legs. You imagine your own body weight. For me, I'm close to 100 kilograms. So it's quite a lot of weight. So when I'm running, let's make it 100 because it's easier to calculate. But
00:50:08
Speaker
hundred kilograms is passing through each leg as I run but because of the momentum of me running what you find is that actually the loads are three times that so each time I take a step I'm transferring 300 kilograms through each leg now if you've ever tried to pick up even a hundred kilograms that's an incredibly heavy load someone who is a hundred kilograms like me should be able to do that
00:50:32
Speaker
good benchmark for fitness and health and function you should be able to pick up roughly your own body weight without too much of a problem but it's extremely heavy so it's right towards the high end of the most you could lift unless you've trained up to lift heavier.
00:50:51
Speaker
So muscles are extremely strong. Now that's just running. If you were to jump, you get nine times body weight going through one leg. So that's 900 kilograms going through one leg. And the most that people can squat, even the Olympians that are, you know, doing their powerlifting in the Olympics, what you find is that the strongest people in the world can only lift about three times their own body weight. Okay. So only, of course, that's incredible.
00:51:17
Speaker
but when the average Joe is down the park playing a bit of cricket with their kids they go to bowl the cricket ball they're putting nine times body weight through one leg and they haven't done any of the conditioning that the Olympic lifters and they don't have the genetic adaptations and you know the genetic gift that some of these lifters have so just put it in perspective it's extremely high loads
00:51:41
Speaker
But those are the kinds of loads that your body can take. When I was doing my master's degree, I found that when you sprint, the gastrocnemius muscle, which is the calf muscle, takes up to 22 times body weight, and the quadriceps take 33 times
Shoulder Mobility vs. Stability
00:51:55
Speaker
body weight. So in my case, that would be 3,300 kilograms going through my thigh muscles as I'm sprinting. Crazy amounts of loads. Now, muscle has a tensile strength of 5 kilograms per centimeter squared.
00:52:12
Speaker
Back to the ligaments, ligaments have a tensile strength of 250 kilograms to 1280 kilograms per centimeter squared. So it gives you an idea. Crazy, crazy amounts of strength. So let's have a think about a different part of the body. Let's think about the shoulder. Well, when you get a shoulder injury, what often happens is that the, it's a ball and socket joint. And one of the things with the shoulder,
00:52:38
Speaker
is that you have a lot of mobility there. You can move it through a huge range of motion. So you always get mobility at the price of stability. So in other words, what you've got is you've got a passive subsystem there that's extremely flexible. The joint itself has all kinds of folds in it, the joint capsule, which means that you can have a huge amount of flexibility there, much more so than something like a knee or even a hip.
00:53:04
Speaker
And so the passive subsystem is flexible, which means that it has to depend a lot more on the neural subsystem and the active subsystem to stabilize it. So any kind of
00:53:17
Speaker
negative impact on that active or neural subsystem can have quite profound effects for the shoulder. It's also the reason that the shoulder itself is the most dislocated joint because it's the most mobile. So you know with a shoulder joint the shoulder has to have very refined control and indeed it's highly proprioceptive which means that it has a very good awareness of what position it's in at any moment in time
00:53:41
Speaker
and that's of course controlled by very refined nerves and very kind of high control muscles. So these muscles are often quite tonic and particularly the deeper fibers of these muscles are very tonic so they're the inner fibers the inner unit if you like.
00:53:58
Speaker
And so if you were to get any kind of disturbance to the information coming back from the shoulder, such as pain, or if you were to get an organ that might refer to the shoulder, so now the stomach tends not to refer to the shoulder so much, it can refer to the back of the shoulder, to the shoulder blade kind of area, but
00:54:17
Speaker
Other organs such as the liver, the pancreas, the stomach can a little bit but it's primarily the liver, the heart, the lungs, the diaphragm, they can all refer to the shoulders. Now any issues there whether it be tension in the diaphragm which often is related to holding emotions,
00:54:38
Speaker
So you know we mentioned earlier that emotions can contribute here because of course they are neural so they can have an effect on the active subsystem. Well these things can all potentially impact on the function of the shoulder. So the organs, neural drives from those, the ones we just mentioned, they can impact on the function of the shoulder. That's not to say if you have a shoulder injury that you have a
00:55:03
Speaker
a heart condition or liver condition or anything like that. But what it does mean is that if you've got something like a heart condition or liver condition, then that can actually predispose you to shoulder injuries. And it may not even be a condition. Now, this is something that we test for on the check system is we look for physiological load or stress. And you'll find more about that on my website if you want to dig into that. But what that can do is it can both cause
00:55:30
Speaker
an increased propensity to injury in any case, you know, just having high physiological load which essentially is high stress on the system and that might be through poor diet or poor lifestyle habits or poor exercise choices, that kind of thing. But also what it does is it is a precursor to what's called central sensitization
00:55:51
Speaker
And central sensitization is where the central nervous system is kind of on a red alert. It's kind of hypervigilant, if you like. And what that means is that certain muscles, and again, returning to the active component of Punjabi's model,
00:56:06
Speaker
the active component as we've described several times can be broken down to the inner unit muscles and the outer unit muscles and those inner unit muscles can be impacted by central sensitization so we know that for example the tonic motor neurons get inhibited by pain but they also seem to be impacted by this kind of
00:56:27
Speaker
cumulative effect of sensitization on the central nervous system and that can therefore you know if we're talking about the shoulder that of course will disrupt the optimal mechanical functioning of the shoulder and so you might be doing everything else right but if you've got stress on your organs then that could be enough to create a shoulder injury.
00:56:46
Speaker
So if we look at this in terms of performance of course that's going to compromise your ability to let's say accurately throw something to be able to catch something accurately those kinds of things and of course for someone who is playing sports whether that be just for fun recreation or more seriously or professionally that's going to have a potential impact
00:57:10
Speaker
it certainly could have an impact in the short term and in the longer term as you fatigue earlier, of course, because that outer unit is dominant and the inner unit is shut down, then what that means is that your performance is going to tail off. So from a performance perspective, it's not a great scenario to be caught in. For many of us, of course, one of the interesting things behind all this is that
00:57:37
Speaker
What they find is that there's research which I quoted in one of my recent papers. Let me think what it was called. It was called, Modern Disintegration of Primal Connectivity. So we're talking about the connective tissues, the passive subsystem. But what has been found is that when people have markers of cardiovascular disease, in other words, the heart's under a little bit of stress, then they are more prone to various injuries in the upper limb. Things from carpal tunnel syndrome to
00:58:07
Speaker
tennis elbow to rotator cuff injuries, even nerve impingements in the upper limb. And that could well be as a result of some kind of underlying stress on an organ, which is impacting on the musculoskeletal function.
The Biopsychosocial Model in Rehabilitation
00:58:21
Speaker
So in other words, a neural component is affecting the active subsystem and ultimately causing injury.
00:58:28
Speaker
So that is essentially creating an impact on the neural component which is, as we mentioned earlier, inhibiting these inner muscles which provide fine motor control and there goes your shoulder the next time you go to catch a ball or strike a ball or throw a ball or throw a
00:58:45
Speaker
throw a punch or serve a tennis ball, whatever it might be. Okay, so let's look at this model from a slightly different angle now. And if we were to look at it from the perspective of another key model that's being used a lot in rehabilitation at the moment and has been for a number of decades actually by various people is the biopsychosocial model. And so what this is really saying is that a lot of what we're describing with Panjabi's model
00:59:14
Speaker
is biological, is within the body. But there's also a psychological component and a sociological component. So let's look at that now.
00:59:24
Speaker
If we consider the neural subsystem is where, of course, the brain is part of the neural subsystem. And the brain is affected by not just your own experiences, but by the experiences of your society. So the way we behave is related to the society that we live in. So for example, some societies, they're more OK with not wearing shoes, for example. Some societies are OK with more nakedness and less nakedness.
00:59:53
Speaker
the kinds of foods we eat. If someone were to ask a businessman in London to eat some witchety grubs, even though apparently they taste really good, they're like a really creamy mozzarella, the idea of a witchety grub to a London-based businessman is going to be completely different because of the society that they've grown up in and therefore the impact on their psychology.
01:00:16
Speaker
therefore, you know, their behaviour. Whereas if you were to give that to an Australian Aboriginal, that would be a real treat and a delight. So that's an example of how our society influences our minds. But tied in with that is the fact that, you know, back pain is viewed in our society as a real inconvenience. In fact, probably in most societies it would be. But in some societies you have to get by, you have to keep going out to the fields or
01:00:43
Speaker
go out on the hunt or go out to work and what we find is that actually in countries where manual labour is more required as part of the kind of economic environment then you find that back pain is much less of an issue.
01:00:58
Speaker
Now, that could be somewhat to do with the conditioning of the body, which would be bio, but it could also be very much related to the requirement to continue to move. So the psycho and the social needs of that person in that society. So what we find in society is where you've got more of a desk-based population, where a lot more office workers is that back pain is often seen as something that is not only
01:01:25
Speaker
literally a pain and inconvenience but also because of the availability of information and because of the
01:01:35
Speaker
the lack of requirement to keep moving, then what you find is that many people will stop moving, they'll start to catastrophize about the pain, they'll exhibit things like fear avoidance behaviors and so on. And often this is related to information that can be tracked down on the internet, maybe from talking to friends and so on. So it's a social impact. If you imagine in the UK or in the US, you might find someone
01:01:59
Speaker
with a cute low back pain and all their friends fancy are you gonna lie down you got you know you gotta rest even the doctor may be saying you gotta rest you know don't don't load your system. Where is in the society where you've got the need to get back out into the fields or you know on the hunt be like where you gotta get over it you know you got you gotta come out we gotta get digging we won't have any dinner.
01:02:18
Speaker
um whatever it is and so there's a different social pressure and a different psychological pressure and interesting enough as i said it seems like in these more manual labor based societies and back pain isn't nearly as much of a problem so there could well be a
01:02:33
Speaker
a psychological and a social aspect to back pain. And of course, that's coming in at the neural subsystem level. So when you look at that neural component, well, it incorporates people's beliefs, their emotions, their fears, their concerns, as well as their joy and their awe and amazement with life and with events.
01:02:58
Speaker
But so it's very important when we're looking at rehabilitation or indeed injury prevention and performance that the neural subsystem is set optimally. And that's one area where certainly in manual therapies and rehabilitation we're often
01:03:15
Speaker
guilty of not providing enough of the stimulus. A good example here that I would give is that it's been known since 1996 that after you've had about a back pain, this is in an industrialized society. Most of this research was done in Australia.
01:03:33
Speaker
But after you've had a bout of low back pain, then the inner unit muscles do not switch back on effectively unless you've been rehabilitated. So in other words, muscles around the spine like the deep multifidus muscle and the transversus abdominis, these muscles don't reactivate unless they're retrained. So essentially what you do is you find compensation mechanisms.
01:03:54
Speaker
And probably, in a more natural environment, because you're forced to go out and continue to move and to put the system under stress, those muscles will switch back on automatically. But because we tend to mollycoddle ourselves, wrap ourselves up in cotton wool, and to not exercise and avoid anything that might aggravate the situation, make it worse, we have that kind of mindset, then what it means is that we don't reactivate these muscles.
01:04:22
Speaker
What this group from Australia found is that even after the pain has gone, those muscles haven't reactivated. And so we've got a situation there where the neural subsystem is still compromised. The active subsystem in a unit of the Punjabi's model is still compromised. And so essentially what we're getting by on is just the outer unit, the passive structures, so the joints, ligaments, tendons, et cetera, and the rest of the nervous system that's not still impacted.
01:04:52
Speaker
So what that means is that unless we make the choice to rehabilitate ourselves properly or to push ourselves back into working with full function, those muscles won't reactivate. And this is one of the slight issues with our focus on pain as the key driver for rehabilitation or for let's say not exercising.
01:05:14
Speaker
Because the moment the pain is gone, then we will start going back into exercise again and we won't have that deep inner system working optimally. So the notion here is that
01:05:28
Speaker
If you are in a society where those demands are forced upon you, then you're much more likely to work through it and to not have the inhibition of these inner muscles right from early on in the rehabilitation. Now, one of the things with this is that anxiety and fear and depression and all of those emotions that can come with a persistent pain issue
01:05:53
Speaker
Those emotions can actually create what's called a descending inhibition of the musculature. So in other words, you change the way you move.
01:06:03
Speaker
because of the fear and the anxiety. Now, if you just have to get over the fear, you have to get over the pain and get back into work, then that's going to create a very different complexity to the way you move and what you do with your body and how those muscles reactivate. So what this comes down to, it's kind of reflecting how different societies will affect our psychology. But at that psychological level, the neural level, then what we all have is choice. And choice is the choice whether to move or not to move.
01:06:33
Speaker
Whether to eat a certain food or not to eat that food the choice whether to see a specialist or not see a specialist there's many many different in fact everything in life is a choice but what we find is that actually we're programmed from very early in life.
01:06:47
Speaker
with very specific behaviours that relate closely to our societal values and norms. And this means that we would tend to follow the choices of the society and believe that they're our own, when in fact they're really the societal norms. So sometimes we have to break out of the box and go against it. And that's often where, you know, pioneers work and where new innovations come from is where someone does something a bit differently.
01:07:14
Speaker
then you find it works really well so then you investigate it further and you carry on down that pathway. Now choice of course is an interesting thing because choice influences everything from the top down from the nervous system the brain down into how we behave with our bodies but it's also a bottom-up process and what I mean by that is that
01:07:40
Speaker
at the very basic level, at the very level of quantum, what's called quantum superposition, the very atoms that we're made from are delineated. They are brought into the field of action by the intention behind them. And this is where the intention behind healing or not healing
01:08:04
Speaker
the intention behind achieving something or not achieving something goal setting essentially where this comes in because if we don't have a goal that's beyond the pain and beyond the disease then what that means is that we stay stuck in a rut and the choices we make often do not serve us and so the example of the multifidus and the deep muscles that don't fire is a great example of this because what's happening is if our choice is to get out of pain
The Role of Fascia and Foot Function in Movement
01:08:33
Speaker
then getting out of pain is not a bad choice. But really, we can get out of pain and still be dysfunctional because as the research shows, you will not necessarily reactivate the stabilizer muscles, the inner muscles, until such time as you have
01:08:50
Speaker
either seeing someone who knows what they're doing or you've taken on certain activities which in a natural environment you probably would have to do such as running, climbing, twisting, turning, bending, all of these movement patterns.
01:09:05
Speaker
Similarly, our choices of foods tend to go with the society that we live in. So if we live in a society that has cereal for breakfast and sandwiches for lunch and pasta for dinner, then that's the choices we tend to make. And those choices are neural subsystems. So that's your mind and the society helping you make that choice. But then it's having its impact on the biology, which is the active subsystem and your ability to stabilize your joints.
01:09:32
Speaker
So you can see that Punjabi's model also ties in very closely with the biopsychosocial model. Now there's a number of other things we could talk about. I've mentioned that we would go into ankle sprain, so let's look at that briefly. Now the ankle typically goes into what's called an inversion sprain. So you typically roll over on the foot and you strain the ligaments on the outside of the ankle. That's the most common ankle sprain you can get.
01:09:56
Speaker
And that means that, of course, you feel, first of all, you've traumatized the passive subsystem at the ankle. But that trauma to the passive subsystem, again, is perceived by the nervous system, so the neural subsystem. And it's perceived as pain.
01:10:12
Speaker
and then the pain again inhibits musculature around the ankle so you can't move it much initially but also what we know is it inhibits a muscle in the hip called the gluteus medius and sometimes the gluteus maximus as well so there's research on that and what that means is that you can't easily load bear on that leg
01:10:31
Speaker
Now that's kind of functional when you just sprain the ankle, but again, that can stay with you because one of the things that we know is that pain reprograms the motor pathways in the nervous system quicker than any other stimulus. So whilst you're in pain, if you start to walk with a limp, then you will tend to reprogram your gait motor pattern. So in other words, the motor program that's in the brain for walking and you will learn to walk with a limp. And this is very common with people that either have recurrent ankle sprains or that have had a serious ankle sprain,
01:11:00
Speaker
in their formative years, you can analyze them. And even though they have no pain left, they're still walking with a limp.
01:11:06
Speaker
You know, why is that? We're just kind of explained it, but the thing is, is that what is happening is the nervous system isn't activating the active subsystem effectively. So again, the inner muscles, so the ones that stabilize the hip on that side are not being activated as a result of an old ankle sprain. So this is something that can be picked up on in assessment sometimes, something that people may notice, but also ironically, what it does is it predisposes you to future ankle sprains.
01:11:36
Speaker
So when you've sprained your ankle once, there's a couple of reasons why you could be more predisposed. And first of all is that probably you haven't dealt with what caused it or predisposed you to it in the first instance. That could just be a fluke. Sometimes it is. But what's happened is through having a sprain of the ankle, you've traumatized the passive subsystem of the joint. And so you've lost some stability there. So in order to effectively rehabilitate that, you want to work with the neural subsystem
01:12:05
Speaker
the active subsystem so that you can optimize the support for that passive subsystem. So that's the way I would look at it from a rehabilitation perspective. In doing that of course what you do is you work on the hip musculature which we were just talking about and the abdominal musculature which also helps to stabilize the pelvis and therefore provides a stable base for the leg to operate from.
01:12:27
Speaker
Now, if you don't do that, then another reason that you can be predisposed is that those muscles in the hip won't re-fire again because you've relearned how to walk. And what it means is that as you walk along and take a step on that leg that was injured but is now recovered, your weight will shift out over that leg. And in shifting out over that leg, it makes you more prone to rolling the ankle at the bottom of the leg.
01:12:52
Speaker
And so this is what's called in medical terms, it's called a Trendelenburg pattern or sometimes a compensated Trendelenburg pattern. And that would also predispose you to injury there and recurrence of injury. So by understanding the Punjabi's model, then what you can do is you can ensure that you minimize risk of future injury and you optimize recovery of those ligaments in the ankle. So there's another example there.
01:13:17
Speaker
Now there are certain tissues in the body which are difficult to classify as either passive or active or neural because for example the fascia which is the connective tissues which you find wrapped around muscles and wrapped around joints and wrapped around organs.
01:13:33
Speaker
that actually has smooth muscle cells in it so it can tighten up if you're under stress and it can relax off when you are relaxed and in a rest and digest state. So the fascia has a kind of component to it which means it sits somewhere between the passive and the active components
01:13:51
Speaker
of Punjabi's model. But it's also very proprioceptive, so it's actually feeding information back into the neural system. Now, so there's a lot of talk about fascia at the moment because it's one of those tissues that has traditionally been disregarded. It's something that used to be just cut out when anatomists were looking for what they consider the more important parts of the body, such as the muscles and the bones and the ligaments and the nerves and so on.
01:14:16
Speaker
But its role is becoming increasingly understood as an organ of feedback and proprioception, as well as providing structural integrity. So one of the things that we know is that if people are stressed, for example, or if they have a breathing pattern disorder, which comes with anxiety, so we're heading back up towards the neural side of the triads of the model.
01:14:38
Speaker
So stress, fear, worry, anxiety, all of those things will trigger an increased breathing response. So your breathing rate goes up. What that does is it sends you into a fight-flight state and that in turn increases tone in these smooth muscle fibers, which means that your fascia tightens up. So if you know you're particularly tight, then you might do really well with some deep breathing and some stretching, and that's what's known as yoga.
01:15:06
Speaker
But it doesn't necessarily have to be yoga, it could just be stretching on the floor, doing some breathing, doing some relaxation. And that can also then help the whole system to function better. So by breathing slowly, calmly, deeply, that relaxes the nervous system, makes you more rest and digest, not so fight flights.
01:15:26
Speaker
then the fascia relaxes off, now the joints move better so there's less stress on the joints and because the joints are moving better the muscles can work through a fuller range but also the joints will be providing good information back to the nervous system to tell the nervous system what position they're in and therefore the nervous system can activate the muscles better.
01:15:46
Speaker
So one of the examples I used to give of Punjabi's model when I was involved with the Vibram five fingers and barefoot running is that if you've got a flat foot, for example, well, if you put a support under that foot, then what it does is it doesn't really give the nervous system any additional useful feedback.
01:16:04
Speaker
normally what a foot should do is that as you land load on it as you're walking the foot should roll into a movement called pronation which is where the arch flattens down a little bit and as that arch flattens so then the connective tissues the passive subsystem in the arch will get stretched and we'll send a message to the neural subsystem to say ah the foot's going into pronation let's activate the muscles that prevent pronation so they're they're supination muscles or anti-pronation muscles
Holistic Health and Performance Optimization
01:16:32
Speaker
And that will mean that we can stabilize the joint and we can continue moving forwards in what's called the sagittal plane, so straight ahead, without losing energy into the frontal plane, so that's moving sideways. So pronation is essentially a movement that kind of takes you sideways. It's not very efficient if you're trying to move forwards.
01:16:51
Speaker
I should say overpronation, by the way, just to clarify. Pronation is quite normal. Overpronation, probably less than ideal because it's overstressing these connective tissues in the foot and it's taking you into a kind of sideways movement. So when the nervous system can read that the foot's going into pronation, it tells the anti-pronation muscles to activate. Those anti-pronation muscles activate and they prevent overstretch on those connective tissues in the sole of the foot. So you don't end up with overpronation.
01:17:21
Speaker
But if you were to put an arch support in there, which has been the way that we've kind of thought about this for some time now, then what happens is, of course, the foot rolls into pronation, but those connective tissues don't get stretched because essentially they're being held in a shortened position. That doesn't provide information to the nervous system. So the nervous system doesn't know
01:17:40
Speaker
it should activate its anti-pronation muscles, so then those anti-pronation muscles don't get activated, so you get deconditioning of those muscles, and the problem just persists and worsens. So really, the body is hugely set up to function well if it's allowed to function well. And Punjabi's model gives us all kinds of insights into how that works.
01:18:04
Speaker
Now, one other thing I was gonna mention is gut health. And the reason I mentioned gut health is that gut health not only can create inhibition of the inner unit if it's poor, so if you've got irritation to the gut, then that's an organ, the gut, and it will refer back into the spine right at the levels where the abdominal wall is fed from, and then the abdominal wall gets inhibited as a result of poor gut function.
01:18:31
Speaker
but also poor gut function has been shown to be correlated with brain function. So if you're eating too much sugar or you're eating on the run the whole time or too many grains or things that you're intolerant to, then these things can all create
01:18:47
Speaker
imbalances in the gut, inflammation in the gut, and you can end up with an imbalance in the bacteria. You've probably heard a lot about the microbiome recently, and dysbiosis is another term, but that's a term for the bacterial balance being out in the digestive system. Now, when that occurs, it creates a negative impact on our ability to produce serotonin, because most of the body serotonin, I believe it's 70% of the body serotonin, is made in the gut.
01:19:15
Speaker
And serotonin is the very chemical that keeps you happy and prevents you from getting depression. So there's this very close correlation with gut issues and depression. And then we know depression. And of course, this is all kind of affecting the neural subsystem, remember. But then depression and gut issues can both impact on the inner units. And so you can end up with stability issues and inability to move effectively and efficiently.
01:19:42
Speaker
And so then that can make you less happy. It can make you more in pain or predispose you to pain and put stress onto your passive subsystem. So the ligaments and the joints and the discs and the spine and so on. And you can end up with a kind of cascade of issues there. So really, you know, what the model shows us is that unless you're thinking holistically and working holistically to maintain optimal health and function performance,
01:20:08
Speaker
then the likelihood is that the system is going to break down in some way. And so when it does break down, which of course it does for most of us at some point, whether that be through injury or through overload or repetitive strain injuries or gut infections or stress, lifestyle stress, when those things happen, then when we look at the model, it gives us a kind of map to help us get back on track
01:20:33
Speaker
to help us create a program of rehabilitation either for ourselves or for our clients, or to explain how best to work with a rehabilitation program with the client in a very simple manner. And this is an example of simplicity on the other side of complexity.
01:20:52
Speaker
If you enjoyed that first edition of FC2O Solo, please feel free to share it and drop me a line if you have any other suggestions for subjects you'd like to discuss either here on FC2O Solo or on FC2O with Matt Walden and guests. Just email me with your ideas on inquiries at mattwalden.com. So that's Matt with two T's and Walden with two L's.
01:21:12
Speaker
If you'd like to learn more about how Punjabi's model can be applied in the real world, I mention it in almost every one of my 20 plus webinars available on my website, so take a look there to dig deeper. And as a special offering to FC2O listeners, you can get 10% off any of my webinars on matwarden.com by entering the following code. FC2O 10.
01:21:32
Speaker
So that's FC2O and remember O is the alphabetical O for order, from chaos to order. Then 10 is the numerals 1 and 0. FC2O, 10. Make sure you subscribe so you're notified of the exciting topics we have coming up in future episodes. Thanks for listening to the show.