The Pain Revolution

Helene Langevin, M.D – Director of the National Center for Complementart and Intergrative Health (NCCIH)

THORACOLUMBAR FASCIA AND LBP (lower back pain)

During an experiment performed at Harvard University titled, “The shear plane motion of connective tissue layers within the thoracolumbar fascia”. Helen Langevin was able to demonstrate, that there is no correlation between lower back pain and herniation, but that there is close to a 100% correlation between immobile, stuck thoracolumbar fascia and LBP.

This was demonstrated with the use of a table that could cycle the test subjects through flexion and extension of the body while they were lying prone, on a motorized mechanical table. The subjects thoracolumbar fascia was simultaneously imaged during this process, using ultra sound.

What this demonstrated was that whenever a subject experienced LBP there was a lack of movement of the thoracolumbar fascia. When the subjects reported no pain, the ultra sound showed that the layers of thoracolumbar fascia where sliding freely. So, back pain cannot be addressed with any sort of muscle training. This is a Fascial problem.

“When all you’ve got is a hammer, everything begins to look like a nail”

It’s very difﬁcult to assess the mechanical condition in vivo of collagen material. Whereas an EMG will tell you exactly what the muscles have done.

So you have an entire generation that was sidetracked by the easiness in which you can measure electro-muscular activity, and they simply forget that it is only part of the equation.

MUSCLE SORENESS

It is now known, that when you experience sore muscles. What you are actually experiencing is sore fascia. The pain receptors in fascia, outnumber those in the muscle by a ratio of 10 to 1. It is actually the epimysium of the fascia you are feeling. That sausage like casing around the red contractile protein ﬁlaments, Actin and Myosin.

What are we stretching?

let’s ﬁrst of all deﬁne what connective tissue is, and what it’s role in the body is, and why it’s so important that we stretch that connective tissue. Muscles – we start from muscles.

When we stretch we think we are stretching our muscles. Muscles are surrounded by an envelop of connective tissue, not only around the muscle but also inside the muscle. Every single little muscle ﬁber has a little mini envelop of connective tissue around it. So the whole muscle is invested in this multidimensional tube of connective tissue. But the connective tissue doesn’t stop there. It goes between each muscle so it transmits the force from one muscle to the muscle next to it.

We used to think that the force that the muscle exerts pulls on the tendon, and that the tendon pulls on the bone. That’s actually not the case. There’s some really elegant recent research that’s shown that a large component of the force that a muscle exerts goes laterally to the connective tissue around it, and then to the muscles next door.

It’s distributed throughout the limb very interestingly. And then the connective tissue just doesn’t stop at the musculoskeletal system, which is what I have just described. That’s the musculoskeletal type component. It also surrounds every single other part of the body including veins, arteries, nerves, lymphatic vessels.

The connective tissue matrix is a scaffold

Then it goes inside of organs. Your heart, your liver, your lungs, your kidneys. Every single organ of your body has what we call a matrix of connective tissue. It’s the scaffold. It’s what makes the shape of whatever body part your looking at. It’s a common denominator through the entire body. It’s really mind blowing because it’s absolutely everywhere.

Prof Lorimer Moseley – clinical scientist investigating pain in humans

It’s all about the brain getting credible evidence that something is dangerous, and needs protecting.

2. Pain relies on context and cues.

3. Pain is all about protection. 
Pain is not about measuring the state of tissues of your body. Never!
Pain is always about getting you to protect those tissues. Pain is about protecting something that needs protecting.
Anything that suggests you need protecting, takes pain up.
Anything that suggests you don’t, takes pain down. 

If you hurt your back and you get and MRI on your back, you have reduced your chance of recovering, by getting the MRI. Isn’t that an amazing discovery. Does anyone feel like saying, why wasn’t I told?
Pain doesn’t measure the state of your tissues.

4. Pain and tissue state are poorly related. 
You can have brutal pain without having a brutal injury. Your twisted ankle stops hurting way before it is back to normal physically.
Your ankle will usually be pain free 2 weeks after you strained it, although it will take 6 weeks for the tissue to be back to normal.
Your pain is gone when you no longer need to protect it. The pain is making you protect it. The pain is not telling you anything about the state of the tissue of your ankle.

You can have severe pain before an injury, before the injury happens. That’s what stops you from getting the injury. The pain is not telling you anything about the state of the tissues. The pain is telling you to stop.

Once the injury gets really bad there’s a very counter intuitive relationship with pain. A catastrophic injury is nearly always not painful, because there is no point. If you rip your arm during a battle. There is no point to making your shoulder hurt because you need to survive.

So the brain is producing pain.

“Degenerative” changes to the spine are inevitable as we age. Here are some common types…

This is the percentage of people at different ages who have these conditions, yet who have no back pain. Pain’s not measuring damage. Pain is trying to protect you. Once we ﬁnd out why. we can start to address it. The difﬁculty is ﬁnding out why.

5. We are amazing adaptable, bioplastic, learners. 
Bioplasticity means everything as well as the nervous system (which is neuroplasticity).

We adapt very quickly and we learn very quickly. The longer you have pain the more your nervous system and your immune system learn to make pain. You learn pain. You don’t have any control over it. It is an adaptation of your nervous system.

It hurts in the tissues, but the problem is in the nervous system. Once you understand this, you can retrain the system.

The buffer is here so that you get pain before you damage any tissues.
If you have had pain for a long time. The single biggest impact on your biology, and therefore on your entire life, is the increase in the size of the buffer.

The buffer increases because your nervous system and your immune system has learnt how to be very efﬁcient at producing pain. So you get pain when you’re not anywhere near being in danger, and it’s real pain, because pain is always real no matter what is causing it.

So the challenge is to ﬁgure out why your brain is protecting, and how you can reduce the size of your buffer. Your system is over protective.

6. Movement is king. 
Movement is critical for retraining this system. And here are some facts.

• Movement gradually suppresses the pain system.
• Movement helps you learn things.
• Movement protects you against other problems.
• Movement is the best way to recover.
• Even imagining movement is helpful.

Unless you understand pain. It will make no sense to do things despite pain. It will make no sense that you are safe, even though it hurts. It will make no sense how you will need to slowly progress. We want it to make sense.

7. Understanding pain and retraining your pain system works.
It’s not a quick ﬁx. you have to retrain a system. We know that with the right resources and the right coaches around you. We know that you can return to life and you can recover,

This is typical data which shows what happens when we treat with a tissue based or drug based approach. Nothing is fast. Three months later there is not much visible change.12 months later there is, if you stick at it.

Science cannot offer people with persistent pain an immediate ﬁx. Except for one in a thousand people. Where it is a ﬂuke. For the other 999 we need to take a journey. The evidence is just so overwhelming and compelling.

• Rethink pain.
• Get a plan to re-engage.
• Get a good coach.
• Start your journey now.
• Recover.

Careful lifting weakens your back 

Always lifting loads with a straight back and bent knees will actually weaken your dorsal fascia and predispose us to future back injury in the event that you forget to use a straight back and bent knees.

Vary the challenge and directional stressors to your back and knees with light loads to build a buffer against injury, to both your knees and back. This will strengthen the dorsal fascia and collateral ligaments. Save the straight back and bent knees technique for heavy loads.

Elastic recoil decreases with age

But it can be trained. Tendons need a high intensity load to grow. More than a 50% max load is necessary. Skipping twice a week is a good dosage for tendon growth. Every day to is too much.

Choose muscle training for its anti-aging qualities

If you can choose only one form of training, neurological, muscular or fascial, choose muscle training for its antiaging qualities. Also, muscle mass maters. All things considered and independent of nutrition. The individual with the greater muscle mass will be more protected from developing insulin resistance due to the greater capacity for disposing of excess glucose. Glucose can only go two places. The liver, ﬁnite, and the muscles, elastic.

Be passionate, activate dopamine, switch on your brains for quick results not necessitating 20 thousand repetitions.

Removing Pain from the Human body by Adaptively Reconfiguring the Connective Tissue Support System…

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