The Osteopathy Paradox

By Kuno van der Post

On the one hand osteopaths can hardly claim to treat anyone or anything, but on the other hand millions of people visit osteopaths for anything and everything, and are delighted with the results. And nowhere in osteopathic theory does it say that manipulation cures back pain. What is going on? (Opinion)

Is that an elephant in the room?

Is that an elephant in the room?

1) I’m the first to admit osteopathy can’t cure anything. Yet millions of people consult osteopaths and are extremely happy with the results.

2) There is very little proof that osteopathy can make a difference outside of back pain and a few associated issues. But when osteopaths need help with their own general health, most will ask another osteopath for an opinion before anybody else.

3) The accepted evidence for osteopathy is contradictory or inconclusive, even in everyday matters like back pain. And yet our patients swear by the benefits, and send their friends too.

And the more bizarre, confusing and complex the problem seems to be, the more some people feel let down by conventional medicine, and the more they seem drawn to alternatives such as osteopathy.

Alternative therapy makes more sense to many people, because it seems to match their own world views. In particular, osteopaths do not settle for labelling the patient and consigning them to a lifetime of incurability and drugs: we look for practical, easy, cheap and safe steps to make life better, whatever the problem. And alternatives obey the Hippocratic prime-directive far better than mainstream medicine: that is, to do no harm.

There is no shortage of research into alternative medicine, so why is there so little official acceptance for the benefits?

Do not adjust your reality, there is a fault in research…

When I learned about science, it was not observation that was supposed to validate theory: it was theory that was supposed to explain observation. It no longer seems to be that way.

Until now, the mismatch between research findings and the clinic experience has been blamed on many things, such as deluded practitioners or over-optimistic patients. But at some point we need to turn the spotlight onto research itself and see if that is where the problem lies. Is it really testing what it needs to test, in a way that will find out the truth? Or is it asking all the wrong questions, and relying on false assumptions?

The thing is, osteopaths don’t claim to take a medical diagnosis and then cure it with a prescription, and so it is a mistake to test whether or not we can. For instance, nowhere in osteopathic theory does it say that a consistentlly specified product called manipulation cures a disease called back pain. There have been many rigorous studies asking the question, but absolutely none deconstructing the question itself. If there were, they would reveal the logical holes very quickly. For one thing, back pain is not a disease: it is a symptom with countless possible causes. We keep telling people we don’t treat symptoms, don’t we?

This is why I pay no attention to research into manipulation and back pain, whether the findings are supportive or not. It is like asking if spanners fix engines. I have a box of spanners at home, and I have never seen them fix an engine. That doesn’t mean all engineering is rubbish: but this is the sort of inference many commentators seem entitled to make.

The latest study on neural mobilisation and cervical radiculopathy is really a glorified example of ‘manipulation vs. pain’. No matter that it shows the technique in a positive light, because the whole question is meaningless.

Osteopathic theory starts with a different kind of analysis of the situation, and different outcome intentions. Yes, your symptoms are important, but if the medical paradigm – symptoms: disease: diagnosis: treatment – so often leads nowhere except a worsening of health, then we really should challenge the value of this construct.

What is far more important is why the problem has occured. And the reasons are different for everybody. When the bulk of researchers in our field finally cotton on to this, then they might at last find answers that match the experience of millions of people.

If you want to test what osteopaths do, you need to research what osteopaths do

Forget manipulations and back pain for a minute, and even manipulations and colic. I am far more interested in whether osteopathic principles form a good overall strategy for raising health, and if that is a better route to lasting recovery. Over a century of real world observation suggests they do, and it is. When research begins there, I want to be involved.

It is inconvenient for research that health cannot be measured precisely. We can’t count the people who have avoided illness, or the times we have prevented worsening and complications. When our highest aim is to promote spontaneous natural recovery from within, there is no direct way to measure the difference made by our involvement. I have nothing against measuring outcomes, except that I have no idea how to measure the outcomes osteopathy is concerned with. Too bad: that is the problem researchers have to get over.

Furthermore, trials cannot encompass a patient simply ‘feeling better’ who cannot articulate why, or who gets better in an unexpected way or after a trial is finished. Exceptional recoveries are dismissed as outliers, and complex cases (the sort we are often really good at) don’t qualify for trials because of ‘confounding factors’. Individual case-studies, once the mainstay of medical learning, are now ‘anecdotes’ and not ‘evidence’. And all by some miraculous set of God-given rules, apparently.

For every critic who says osteopaths are resistant to research, there must be hundreds or thousands of people who say things like ‘I no longer need to take my antacids’, or ‘I made it to my grandchild’s wedding’, and who unequivocally credit osteopathy with making a difference.

Patient satisfaction is probably as good a way as any to find out if ‘osteopathy works’. And if something a little more objective is required, we could see how many users live to be 100, or something like that. To be any more precise, there first needs to be a thorough deconstruction of the dogma embedded in research theory.

Positive patient and practitioner experience is largely dismissed as ‘unqualified’, or ‘lacking in objectivity’. Typical justification is circular – there is no evidence this is possible: therefore the practitioner is biased, the patient is probably wrong: therefore we dismiss their testimony etc. Accepting those experiences might require the research community to do some explaining, and so the tail is wagging the dog. Clinicians are expected to alter their own narrative instead, and it isn’t on.

An inappropriate research question is one obvious flaw. On the results side, narrow outcome measures can miss an important effect when it is there. The researcher may be interested in whether a certain intervention will reduce the specified symptom within a month. But I am interested that a general strategy will, via a bespoke intervention, lead to improved overall well-being. In some way. At some point in time. And with no permanent downside. Benefit is benefit.

Take migraine. Stopping a migraine is one thing: I don’t call it much of an accomplishment. Drugs can do it cheaply and easily, while still leaving the patient in a total maze. Stopping the patient from getting migraines every week: that is something else altogether. If we do our job properly, we treat the patient, not the migraine: migraines cease to be a feature in their life, and credit goes to Mother Nature. This isn’t hypothetical: I have seen case after case go like that. Wise patients appreciate that long-term improvement may be incompatible with a quick, direct fix.

The key to all of this is in whether we treat diseases, or whether we treat patients: things we say, but what do they really mean?

We humans heal ourselves. Osteopathy assumes a fundamental acceptance of this, because we would otherwise all be dead. Even doctors promote the idea, I just seldom see clinicians betting their reputations on it. The trick is to remove the obstacles to recovery. We see all the time the staggering ability of the human body to recover once obstacles are addressed, and so that is what the smarter patients are asking for.

[This relates to the osteopatic principle that ‘the body has its own medicine chest’. This does not mean we secrete drugs from some gland: it means that our bodies are self-righting systems, always doing their utmost with the resources available. Health is the default, and symptoms are the manifestations of the body’s drive to maintain health.]

An Alternative Narrative of Health and Disease

In its broadest interpretation, osteopathy says that health is the only real solution to disease. It is a myth that you can make a disease just go away while life goes on unchanged. Once we get comfortable that the only cure comes from within, this is actually very empowering.

Even the idea of diseases – consistently identifiable syndromes with consistent causes and symptoms – may be a myth. It it were true, we ought to know by now the precise cause and cure of every disease. And the medical classification of disease conforms to no consistent rational system. It is totally haphazard in fact. If this paradigm were leading to cures, hospitals ought to be getting smaller, one might think, not bigger. The more we seek health by fighting against things called diseases, the more unhealthy and disease-prone we seem to become.

Our awareness of un-health is usually through healing processes – symptoms – which are generally the body’s healthy reactions to stress and strain. To call this disease is to misrepresent what is going on and then fire missiles at the wrong target.

A Holistic Osteopathy Paradigm

What we find is that two people with exactly the same symptoms can have completely different circumstances: the causes are not the same. And yet two people with similar lifestyles and similar patterns of stress can have completely different health problems.

Medical philosophy emphasises the weakest link in the chain, and makes that the diagnosis. Osteopathic diagnosis and treatment are more to do with the stresses upon or within the system, mechanical stress being number one. But there are many other forms of stress – emotional, nutritional, toxic, occupational, social, to name a few – and they can all create obstacles to healing. Sometimes the most osteopathic thing you can do is to drink a glass of water, or have an early night, because manipulating a tired and dehydrated body achieves absolutely nothing.

And so osteopathic scope of practice is not limited to certain types of disease (as medical specialists are), or to certain parts of the body (like physiotherapy), or to certain techniques (massage therapy). Our scope of practice is determined by the obstacles to recovery, and is as broad as our ability to address them.

Anybody who has ever felt they could sleep for a month after treatment will realise just how much stress can be held in the structure.

Most natural therapy focuses on diet, and rightly so. But complex disease also has structural and postural elements, a fact that modern diet-centred therapies have missed. The need for good mechanical adjustment was already appreciated in natural therapy before Osteopaths took it on. These ideas have very much gone out of fashion, but for mainly political reasons, not because they lack sound reasoning or clinical success.

[Note on osteopathic principles: ‘Structure governs function’, although true, was a later alteration of the much richer ‘Structural integrity, natural immunity’.]

So it is all very well eating the best nutrients possible, but if they aren’t being properly processed and distributed, they won’t solve your problems. Stress is a major disruptor to metabolism: at a fundamental level it alters the balance of circulation, and with it the internal economy of the body.

[Osteopathic principles: The ‘rule of the artery reigns supreme…’ etc. refers to the constantly changing diameter of the blood vessels. Diet is what we eat: nutrition is also about what our bodies do with nutrients. Structural adjustment addresses the processing and internal distribution of resources, by optimising regulation, and limiting unnecessary demands for energy.]

Whether or not the above ideas are currently accepted, they are what shaped Traditional Osteopathy theory and practice. One other vital point of the philosophy is that in a living system, you have to get the whole thing working, and that way all the parts are supported and can take care of themselves. Although we can learn lot from dead machines, they do not behave in this way.

[Osteopathic principles: ‘The body as a unit’ refers to treating the body as a whole, not as lots of parts.]

And hence Traditional or Classical Osteopathy is concerned first and foremost with tuning up the whole person, rather than going straight to the bit that hurts, and then understanding the natural reaction to the changes. And if you want to be safe, it makes sense to set out that way, and not go straight at inflamed tissue, hoping the diagnosis is correct.

A Traditional Osteopathic Method

Our job is not to create change, but to create the conditions for change, and then allow the intelligence of the body to determine what happens next. Osteopathic adjustment is very different from chiropractic manipulation, in a number of ways. The clicks and pops (if they happen) are the product of change not the cause, and so an audible release is not crucial to the result. Many people say osteopathy is gentler and more holistic than chiropractic, and hopefully this explains why. We are not putting bones back in place: we are looking to deal with the reasons they are out of place, and then allow them to adopt a position of better ease. We trust that the body knows what it is doing, and do not try to micromanage it. Acute symptoms are  the body’s cure in action, and so we manage the acute, while treating the underlying chronic background; the opposite of standard practice.

Summary

The difference these ideas make in technique is not something that can be explained in a hurry. Suffice to say not everybody gets their heads around it, even with one-to-one teaching. During osteopaths’ training there is a lot of academic discussion about concepts. But this is largely treated as a matter of historic interest, and it does not translate well into the environment of the modern teaching clinic. The number of teachers able to bridge the gap is very small indeed.

If Traditional Osteopathy is an antidote to anything, it is to high-tech medical healthcare that many feel they have exhausted. It is more concerned with the basic necessities of life than glamorous and heroic intervention. It addresses the bigger picture, because when we do that, the details tend to take care of themselves. It is about supporting the system to find a better equilibrium, rather than controlling everything in sight.

When influential critics (and there are some real busybodies out there) say something ‘works’ or doesn’t, we have to ask what they mean by ‘works’. Drugs don’t ‘work’ either, if what we mean is making sick people healthy by poisoning them.

Every other branch of science now recognises that complex systems behave in non-linear ways. There is no predictable mapping of cause onto effect as we would like, and so we have to find smarter ways of interacting with living things. Controlling all the bits is far too crude an approach. If healthcare is going to talk holism it is time we moved beyond the linear mechanical consciousness of the 20th century.

The pursuit of narrow outcome measures, means that helping the patient now, frequently stacks the odds against them in future, and with complete deniability for us. Most of us are blind to long-term benefit and harm because we are not trained to recognise these broader patterns.

We could say that the research community is to blame for this, by placing published trial data at the top of the totem pole, while arbitrarily downplaying or dismissing all other forms of human knowledge. But I think this feeds off a societal desire for short answers and encapsulated solutions, where complex and original ideas have to fight for survival. In fact it is researchers who have also shown us how badly modern medicine is failing, and who are now igniting the motivation to do things better. That requires better vision. Hopefully the old dinosaurs and their specious buzzwords – best practice (read: standardisation), treatment of choice (prescription) and hierarchies of knowledge etc – will soon move over for something more highly evolved.

If there appears to be any paradox in osteopathy, it is only because of asking the wrong questions; of saying one thing and doing another; of research doctrine putting square pegs into round holes. Patients say they get better, but tests in the lab say it doesn’t work. Well, this is a bit like when physicists proved mathematically that bumblebees can’t fly. Science never fails, but scientists frequently do…

PUFA in Evolutionary and Environmental Context

In life, nothing ever remains the same for very long.  One state is continually moving into another in a ceaseless flow of energy and information.  Change, in this regard, is one of the essential characteristics of life.  Seasonally, we see constant environmental shifts, such as the bright, high energy states of spring and summer, flowing into the darker, lower energy states like winter and autumn.  On a smaller scale, similar shifts are seen on a daily basis between daylight and night time.

Such environmental changes elicit adaptive responses in all organisms, which can be observed seasonally in deciduous plants, for example, who lose their leaves in a process is called abscission.  In some cases leaf loss coincides with winter — namely in temperate or polar climates.  In other parts of the world, including tropical, subtropical, and arid regions, plants lose their leaves during the dry season or other seasons, depending on variations in rainfall.  Abscission demonstrates a conservation of energy when resources for growth or proliferation become scarce.
Many flowerers display reliable rhythmicity during circadian shifts in a 24 hour period, whereby the petals open and proliferate when light is available, and close down when the “stress of darkness” returns:


Similarly, mammals in temperate climates display behaviours of conservation in times of scarcity via the survival mechanisms of hibernation and deep sleep.
Mammalian hibernation consists of torpor phases when metabolism is severely depressed and various metabolically expensive systems and tissues are downregulated in their function.  Hibernation affects the function of the innate and the adaptive immune systems. Torpor drastically reduces numbers of all types of circulating leukocytes. In addition, other changes have been noted, such as lower complement levels, diminished response to LPS, phagocytotic capacity, cytokine production, lymphocyte proliferation, and antibody production.  (This probably underpins the phenomenon of winter illness in humans and the onsets of respiratory tract infections such as common cold around seasonal shifts.)

Stress can be broadly defined as any time in which the energetic requirements of the body outweigh its ability to provide energy.  It is by way of hibernation – of shutting down of expensive apparatus – that survival in times of uncertainty (scarcity stress) is possible for many creatures.

Metabolic Switches

The salmon run is the time when salmon, which have migrated from the ocean, swim to the upper reaches of rivers where they spawn on gravel beds. After spawning, all Pacific salmon and most Atlantic salmon die, and the salmon life cycle starts over again. The annual run can be a major event for grizzly bears, bald eagles and sport fishermen. Most salmon species migrate during the northern hemisphere Autumn (September through November).
Salmon, like all fish, are considered to be cold blooded, as their body temperature varies with their environment.  The unsaturated fat DHA tends to be found in higher concentrations in deep, cold water fish like these, probably suggesting it has roles in maintaining fluidity of membranes and allowing for light capture where it is scarce (Crawford.) Concentrations of DHA are lower in warmer bodied animals – even fish found in the Amazon have more saturated fats than unsaturated.
salmon roe has the highest concentration of DHA of all sources, suggesting the presence of the lipid at the time of spawn – going in to winter – is protective for the eggs in the freezing conditions.

Fatty acid composition of plants also appears to be determined by growth temperature, and chill-resistant plants tend to have a higher composition of unsaturated fatty acids in their membranes.  (note that vegetable or seed oils kept in a refrigerator tend not to harden, wheras saturated fat such as the tropical coconut oil tend to harden at room temperature.)

The effects of the consumption of unsaturated fats on warm blooded mammals also has the effect of coupling the organism to its local environment, whereby the ingestion of food acts like information for the system.  In this regard, the environmental lipids ingested by the animal may help in slowing the metabolism to prepare for hibernation.
It is well established that unsaturated fats suppress the metabolic rate, apparently creating hypothyroidism. Lab animals fed a PUFA deficient diet, (Burr and Beber 1934), displayed markedly higher metabolic rates compared with those who consumed PUFA.
PUFA deficiency is associated with increased activity of cytochrome oxidase – a fundamental mitochondrial respiratory enzyme (Kunkel and Williams 1951).  The more unsaturated the oils are, the more specifically they seem to suppress tissue response to thyroid hormone, and transport of the hormone on the thyroid transport protein.

Again we see a coupling of natures energy flows when we take a 50,000 foot view, that metabolism should increase when substrate is available and abundant (spring/summer,) when fatty acids are more saturated, and a suppression of metabolism when substrate is scarce (fall/winter) and PUFA rises.  PUFA really do, in thise sense, appear to be a metablic switch to “survival metabolism.”  A higher metabolic rate in the face of low substrate availability (scarcity) would be disastrous for any organism as it would entail literally oxidising any resources possible – effectively metabolising oneself to death.

Lifespan Considerations

The Fountain of Youth is a spring that supposedly restores the youth of anyone who drinks or bathes in its waters. Tales of such a fountain have been recounted across the world for thousands of years, appearing in writings by Herodotus (5th century BCE), the Alexander romance (3rd century CE), and the stories of Prester John (early Crusades, 11th/12th centuries CE). Stories of similar waters were also evidently prominent among the indigenous peoples of the Caribbean during the Age of Exploration (early 16th century), who spoke of the restorative powers of the water in the mythical land of Bimini.
The legend became particularly prominent in the 16th century, and ambiguity of the concept still continues to be an obsession amongst modern day humans.  There seems to be an innate attachment youthfulness as one ages.  Perhaps it is the longing for the energy of youth that one seems to only see the value in once it is gone.
The underlying cause of aging remains one of the central mysteries of biology. Recent studies in several different systems suggest that not only may the rate of aging be modified by environmental and genetic factors, but also that the aging clock can be reversed, restoring characteristics of youthfulness to aged cells and tissues.  Whatever the case, humans seem hellbent on finding the “sountain of youth” in pill form, or something they can purchase.

The “rate of living” hypothesis is popular amongst anti aging practitioners, some of whom subscribe to the notion that you can live fast and die young, or live slow and last a lot longer.  The rate of living theory postulates that the faster an organism’s metabolism, the shorter its lifespan. The theory was originally created by Max Rubner in 1908 after his observation that larger animals outlived smaller ones, and that the larger animals had slower metabolisms.
This theory has been clearly refuted by metabolic studies that are showing the opposite can be true – that intensified mitochondrial respiration decreases cellular damage, and supports a longer life-span. For example, small dogs eat much more food in proportion to their size than big dogs do, and small dogs have a much greater life expectancy than big dogs, in some cases about twice as long (Speakman, 2003). A similar association of metabolic intensity and life-span is seen in organisms as different from one another as are bacteria and mammals.

Bats, Birds and Tortoises all have extremely long lifespans when adjusted for body mass.  Bats and birds display an incredibly high metabolic rate, whilst tortoises have some of the lowest metabolic rates.  Tortoises are simple organisms, who, literally and figuratively, lead a sheltered life, moving around slowly and seemingly not being exposed to many stressors.
Conversely, birds and bats with their incredibly high metabolic rate, have the constant need for food, entailing moving about the environment and exposing themselves to stressors such as predators, environmental toxins, as well as constant energy expenditure in doing so.  It seems to handle a barrage of stressors, one requires energy.

In all of nature, it appears that higher energy states favour complexity, and lower energy states favour simplicity of organisms, pointing to the brilliance of Lamarck’s theory of evolution.

In a clinical sense, the rate of living theory is oversimplified.  Cell turnover needs to be qualified according to the context. Trying to keep ubiquitination and apoptosis low is not a winning strategy for many cells, and the conditions for the cells that should not turnover, like cardiac and brain tissue, require a high metabolism (brain tissue metabolism can be definition never be low, and even in prolonged fasting, there are huge adaptations to maintain the high energy state of the brain.)
On the other hand, if skin cells and intestinal cells are not turning over every 1-3 days, you are in for big trouble. Even peripheral nervous system tissue is probably something that we want to be able to turnover at appropriate intervals. This applies to everything from wound healing to movement quality to gut functions (the gut is heavily innervated, and needs to modify those networks accordingly). The collagen matrix and connective tissues that give the body its structure (and function!) need to be re-built on a daily basis, lest major degradation in movement occurs. Even the liver needs to turnover all it’s cells every few months.

We can then see how clinically, an attachment to the rate of living theory (or an inability to see things from a broader, energetic perspective) may explain the reason why things like omega 3 oils are routinely prescribed for inflammatory conditions. Often, patients seem to have good (short term) results (due to immune suppression,) but might this strategy be creating down-regulation of other systems to a “hibernation state” whilst the organism is still stuck in the crossfire of modern life stress?
Having high PUFA in blood and tissue is a great way to become insulin resistant, suppress hormone production, suppress immune function, slow down cell turnover, and drastically reduce metabolic rate and nutrient needs (just to name a few effects). This is a survival advantage for the many animals who rely on such adaptations to go through hibernating periods.  The same mechanics applied (though to a lesser degree) to humans in pre-electric times to help them get through low light environments.  It could certainly be used to slow down a body that is spiralling out of control, but should these things be implemented as an anti-aging strategy, as is so often touted?  A recent course i attended gave a “basic anti aging program” for an otherwise healthy adult, that included 6-8g of fish oil a day!

With PUFA depletion, hormone production and sensitivity of all forms increases, cell turnover increases, nutrient needs increase, and adaptability to various stressors increases.
Guenter Albretch-Bueller’s cell intelligence and ‘Anarchy of the Genome’ works show that metabolism is what cells use to generate the light signals they use to communicate with each other.  This means high metabolism is the “adaptive state” whereby groups of cells relay local and global environmental information to each other, and select (and modify) the genes needed to deal with that environment.

 

The Mirena and Menstrual Woes

The MirenaMIRENA IUD istockA client recently asked if i would write a piece on the Mirena contraceptive device, and i think it is well overdue with all the clinical disasters i have seen occur as a result of its prescription over the years.

For those unaware, the Mirena is an Intra-uterine contraceptive device that secretes a synthetic progesterone surrogate known as Levonorgestrel. The two most common uses of the Mirena are for hormonal contraception, and to prevent endometrial hyperplasia (overgrowth) from unopposed estrogen in functional oestrogen dominance or hormone replacement therapy. The Mirena device is also used to “treat” secondary amenorrhea, dysfunctional uterine bleeding and endometriosis, and as palliative treatment of endometrial cancer.

The synthetic progesterone from the Mirena essentially “tricks” the body into thinking it is pregnant through constant secretion. Progesterone’s normal effects include a role in the maintenance of pregnancy, which requires the prevention of additional pregnancies during the course of an established one – herein lies the use of progesterone in birth control.

The Normally Functioning Menstrual Cycle

Menstrual Cycle

The menstrual cycle is regulated by the complex interaction of a few key hormones: luteinizing hormone, follicle-stimulating hormone, and the female sex hormones estrogen and progesterone .

The menstrual cycle begins with menstrual bleeding (menstruation), which marks the first day of the follicular phase. Bleeding occurs after estrogen and progesterone levels decrease at the end of the previous cycle.
This decrease causes the top layers of thickened lining of the uterus (endometrium) to break down and be shed. About this time, the follicle-stimulating hormone level increases slightly, stimulating the development of several follicles in the ovaries.
Each follicle contains an egg. Later, as the follicle-stimulating hormone level decreases, only one follicle continues to develop. This follicle produces estrogen .

The ovulatory phase begins with a surge in luteinizing hormone and follicle-stimulating hormone levels. Luteinizing hormone stimulates egg release (ovulation), which usually occurs 16 to 32 hours after the surge begins. The estrogen level peaks during the surge, and the progesterone level starts to increase.

During the luteal phase, luteinizing hormone and follicle-stimulating hormone levels decrease. The ruptured follicle closes after releasing the egg and forms a corpus luteum, which produces progesterone .
During most of this phase, the estrogen level is high, but progesterone should outnumber its presence by a 300-400:1 ratio in a fully fertile healthy woman.
Progesterone and estrogen cause the lining of the uterus to thicken more, to prepare for possible fertilization. If the egg is not fertilized, the corpus luteum degenerates and no longer produces progesterone, the estrogen and progesterone levels decrease, the top layers of the lining break down and are shed, and menstrual bleeding occurs (the start of a new menstrual cycle).
If the egg IS fertilized, progesterone remains high, as its anti-inflammatory and protective properties (described below) ensure optimal health of mother and child.

Hormone and Menstrual Irregularity, a leading sign of stress

Below is a simplified diagram of the hormone cascade, outlining the synthesis of hormones (pregnenolone) from LDL cholesterol, using the cofactors Free T3 and Vitamin A, through to the end products of the steroid hormones.

Inflammation CholesterolThe human hormone cascade really does show the genius of nature at work in the way it is set up. The body is geared to read and react to environmental pressures, and survive at all costs in the face of stress. We can survive without Progesterone, but not without the life saving stress hormone cortisol.

Cortisol is the “wonder drug” that allows a human being to jump onto a roof out of the way of a derailed train, and leaves them wondering how in the hell they got there. It is what allows someone to lift a car off a crushed pedestrian after an accident. But our stress responses are geared for acute stressor like these only. The problem in a modern world is that the stressors we face are both chronic and numerous.

Note that a precursor for Cortisol is Progesterone. In essence, cortisol takes precedence at the expense of the sex hormones, for there is no point putting energy into the creation of a progeny when survival is at stake! The body is geared to only produce offspring when the conditions of existence are favourable, and stress is low, to ensure optimal health for both mother and child, and best epigenetic outcomes. Many issues involving bleeding irregularity, heavy periods, endometriosis (in fact everything that the mirena is used to treat) could be seen as a direct result of stress to the system, and the consequent shunt of progesterone to cortisol, resulting in estrogen dominance.

Summary: increased cortisol = decreased progesterone = low Progesterone:Estrogen Ratio = Crazy Fucked up Menstrual Symptoms.

SO….what does the Doctor do?

PrEsCriBe MiReNa oF CoUrsE – BcOz ProGeSterOne RiTe??

Wrong.

Naming and Confusion with Progesterone-Like Substances – The Problem with Progestins

All synthetic progesterones fall under the broad category PROGESTINS. Although Progestins act by binding to the Natural Progesterone “receptor,” and impart some similar actions in terms of signalling as natural progesterone does, it should be noted that they do not produce ALL the beneficial effects of true endogenous progesterone, and often act in opposition to natural progesterone in many ways, namely by competing with it at the cell “receptor” site, and affecting its endogenous production through negative feedback.
In fact, the in vitro relative binding affinities of Levonorgestrel at human steroid hormone receptors is 323% that of natural progesterone, meaning it is a direct competitive inhibitor of natural progesterone.

Levonorgestrel in the Mirena IUD is considered a progestin because it modifies the uterus in approximately the way progesterone does (by thickening the uterine and cervical lining,) but it is also luteolytic, and lowers the ovaries’ production of endogenous progesterone. Levonorgestrel s not supportive of gestation in the way that natural progesterone is (it has been used historically as the major active ingredient in the “morning after pill”), which should point to the reasons for concern in its liberal use – it lacks the beneficial anti-inflammatory, pro-gestational, restorative properties of natural Progesterone.

Severe “side” effects of Mirena (effects):
• severe cramps or pelvic pain;
• extreme dizziness, feeling like you might pass out;
• heavy or ongoing vaginal bleeding, vaginal sores, vaginal discharge that is watery, foul-smelling, or otherwise unusual;
• severe pain in your side or lower stomach;
• pale skin, weakness, easy bruising or bleeding;
• fever, chills, or other signs of infection;
• pain during sexual intercourse;
• sudden numbness or weakness, especially on one side of the body;
• sudden or severe headache, confusion, problems with vision, sensitivity to light;
• jaundice (yellowing of the skin or eyes); or
• signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Less serious “side” effects may include:
• irregular menstrual periods, changes in bleeding patterns or flow;
• breakthrough bleeding, or heavier menstrual bleeding during the first few weeks after device insertion;
• back pain;
• headache, nervousness, mild dizziness;
• nausea, vomiting, bloating;
• breast tenderness or pain;
• weight gain, acne, changes in hair growth;
• depression, anxiety, mood changes, loss of interest in sex;
• mild itching, skin rash; or
• puffiness in your face, hands, ankles, or feet.
This is not a complete list of side effects and others may occur.

Progestins vs Progesterone

In contrast to Levonorgestrel, endogenously produced natural progesterone has a positive effect on the corpus luteum, further stimulating progesterone synthesis, and supporting gestation.
Progesterone participates in practically every physiological process in both men and women. Its tremendous increase during pregnancy serves to stabilize the organisms, both mother and child, during that crucial time. The stabilizing action of progesterone is especially visible in muscle tissue, such as the uterus, blood vessel walls, the heart, the intestines and the bladder. Less visibly, progesterone stabilizes and normalizes nervous, secretory and growth processes.
At levels reached just before delivery, progesterone produces anesthesia and contributes to tissue elasticity in the mother, allowing for easy delivery.  The rates of caesarian section deliveries in a modern world point toward estrogen dominance/progesterone deficiency.

The growing fetus requires large amounts of glucose, and progesterone makes it possible to be provided in abundance for ideal brain growth, by promoting the mother’s ability to use fat for her own energy. It is this efficient use of fat which gives women greater long-range endurance than men. When progesterone is deficient, there tends to be hypoglycemia, often combined with obesity.  Conversely when Progesterone is abundant, women tend to really “find their groove” in terms of body composition.  This is likely also an evolutionary signal to the opposite sex that the female is in good shape to have a healthy baby.

Recent studies show that progesterone prevents stress-induced coronary blood vessel spasms in aged hearts – probably explaining women’s relative freedom from heart attacks, so long as they retain functioning ovaries.  Other studies suggest that progesterone has a role in regeneration of damaged brain cells and prolonged growth of the brain. Delayed aging and longer life span have been very clearly related to extra progesterone.

Since progesterone normalizes the immune system (it causes thymus regeneration, for example) it is very effective in autoimmune diseases (which result from adverse reactions to one’s own tissues) and in those degenerative disease which have an autoimmune component.

Progesterone has been found experimentally to be the basic hormone of adaptation and of resistance to stress. The adrenal glands use it to produce their anti-stress hormones, as outlined above, and when there is enough progesterone, they don’t have to produce the potentially harmful cortisol. In a progesterone deficiency, we produce too much cortisol, and excessive cortisol causes osteoporosis, aging of the skin, damage to brain cells, and the accumulation of fat, especially on the back and abdomen.
Progesterone also relieves anxiety, improves memory, protects brain cells, and even prevents epileptic seizures. It reverses many of the signs of aging in the skin, and promotes healthy bone growth. It can relieve many types of arthritis, and helps a variety of immunological problems.

SUMMARY: Progestins =/= Progesterone, Levonorgestrel is NOT Progesterone.

Levonorgestrel imparts an Estrogenic effect, despite mimicking some of the functions of Progesterone, by competing heavily for the Progesterone Receptor, and lowering normal progesterone production – sometimes irreversibly.

Lower endogenous Progesterone is linked with early onset of diseases of aging including osteoporosis, wrinkling skin, cognitive decline, obesity, arthritis and heart disease.

Global Movement and ACL Rehabilitation

By Mark McGrath

In writing a short introduction to the below feedback, I need to be careful to contextualise the role of Convention, while at the same time, informing you of Possibilities beyond this Way of Looking.
If I Injure my Musculo-Skeletal System in a way that compromises my ability to Rehabilitate the injury without surgical intervention, then that is my Logical and Only plausible next step.
Post-Surgery, the Surgeon and other Professionals who deal with Acute rehabilitation protocols are Key to the best possible Healing and Post-Surgery Management.
However, once the Healing process is established, and the Joint is capable of being Loaded, we need to be aware of the Global Body.

The intrinsic posture of the child is undisturbed by the task

The Protocols established by Rehabilitation Professionals will be necessary, but not sufficient for Long -Term ‘Functional Ideal’ over the Years and Decades post major surgery.
This is because the compensatory mechanisms that are an inevitable outcome of any major injury, establish themselves invisibly, as we begin to move and weight-bear in our Rehabilitation.
For example, the Support phase of stepping is a closed chain contraction, that involves the information travelling from the Support Extremity to the Spine, and from the Spine to the Stepping Extremity.  If the CNS detects Insufficiency in this Closed Chain recruitment, it will by-pass the ‘Painful Line’ of Movement, creating a non-preferred Movement Compensation.

Janda Muscle Imbalance Syndromes

In an ACL Reconstruction, this will nearly always be a Frontal Plane ‘Lean Strategy’ on the affected side.  This will remain the ‘Automated Pattern’ until the Brain receives Afferent Information to the contrary.
Professionals, such as myself are interested in how you organise the ‘Central Aspects of Control.’  This is exhibited in your Standing Posture, and the array of Tests that can be done to assess the Nature of your Insufficiency.  This Ability is already an Integrated Way of Looking because the Nature of the Looking is Asking;
  • What aspects of your Functioning are Dominating your Experience, to the Detriment of evenness?
  • What aspects of your Functioning are Absent? (These 2 Observations are inter-related)
  • How do these Dominances/Insufficiencies self-organise as you perform increasingly Complex tasks such as Standing, Squat, Forward fold, Plank Push-Up, Single Leg Stance and Ultimately your Gait Mechanism.
Once this Presentation is Clear, and there is Agreement between Observation and Felt Sense, we can get to work in re-establishing ‘Functional Ideal.’
The below feedback outlines the possibility of what can happen, when we begin to ignore the messaging from the Body, Brain and CNS.  The Feedback is from a Friend and Client who is very sensitive to the changes in her body.
I am sharing the Feedback to Inform about a Post-Conventional Approach, not to diminish the Importance of Convention, Protocols and Progressive Management of Serious Injury.  My goal is to have you consider the Comprehensivity of your Rehabilitation, and to Contemplate the Ramifications through a Life-Span.

From Aposhyan; BodyMind Psychotherapy

Hi Mark
Excuse my few poor words to describe the revelation I have had over the last few weeks but I wanted to share it with you and in doing so, say thank you.
The last few weeks have brought into sharp focus the distinct difference between your approach to finding ideal movement vs current practice.
In my current stage of recovery from my knee reconstruction I had hit the proverbial wall. I was following the “expert” prescribed solution for someone in my position, essentially “get yourself a physiotherapist and join a gym”. Their advice, assessment of my function and treatment has been centred around my affected knee and its condition/appearance relative to my other knee/hamstring.  I was vulnerable enough to assume they knew more than I (could sense within) about my body. It took me two weeks to admit to myself that this approach seemed to be doing more harm than good – my right calf was tight and overworking, my QL was screaming, my left hip was starting to pinch and grab. In general I felt that in loading my right knee, quad & hamstring (to meet their requirements to regain strength) my overall function and ability to move with ease and congruency was actually deteriorating rather than improving.
I had been working with you on those concepts for three years and making significant progress, feeling the best that I have ever been. Yet being vulnerable post injury, I mistakenly thought I had to put that work on hold to listen to those “experts” who could rehabilitate my knee. In doing so I couldn’t see that the reason I wasn’t progressing was because I was getting further away from moving ideally and it was exacerbating old injuries and pain.
I am very glad that I made the decision to see you at that time. It awakened the realisation that seeking ideal is the solution, not only to rehabilitation in the short term but to ensuring I move well in future without long term compensations.
It’s only been a few short weeks since then and I know I’m back on the right path. I feel better inside and out. I have a more global approach to my rehabilitation and I’m back enjoying this ongoing journey of learning that my body (and mind) are capable of more efficient, easier and far better performance and function. Thank you.