Muscles are not decision-makers: Motor Control is top-down

Last week a client came in for an Initial Assessment. She’s a personal trainer and so wasn’t surprised when during posture analysis I noted the right hip was higher than the left, and the right ribcage tipped down from ribs 10-12. You can see this in the photo to the left.

These postural issues were one of the reasons she’d come in, along with lower back pain. This posture dysfunction usually means the internal abdominal oblique on the side with the high hip (the right side in this case) is stuck in a shorted position. And it was very stiff. If this was the end of the assessment we would have used a Tune Up Fitness Coregeous ball to self-massage the right internal oblique. And IF there were any results, they wouldn’t have lasted. Why not?

Full History is a crucial part of the assessment

The Initial Assessment has many parts. Further testing and a full history revealed another possibility. Scar tissue around a rib she’d broken in high school was adhering the ribs together. Why were the muscles on the right side so tight? The motor control center in the brain (the cerebellum) was USING them to try to break-up this scar tissue on the left. This scar tissue was keeping these ribs from moving and so impairing optimal breathing. Remember, the muscles aren’t making these decisions.

Posture doesn’t tell us everything we need to know

One more example from last week’s sessions.  A client came in with a left shoulder persistently rolled forward (protracted). The front of the shoulder, in the pectoralis minor area, was very tender. But testing showed that the issue was not the shoulder. The back muscles in this client’s upper back were stuck short, extending it. It was a short section of muscle that was stuck so the upper back wasn’t visibly extended. And the tender pectoralis minor was following orders from the motor control center, trying to correct his arched upper back with shoulder protraction (which wasn’t working). We released the upper back and the shoulder moved back into a much more functional centrated position. Posture exercises to retract the shoulder would NEVER have worked.

Posture Assessments and Core stability Testing in the Kitchener Waterloo Area

Releasing muscles that are painful rarely works as a long term therapeutic strategy. Releasing muscles according to postural analysis works more often. However, when the logical solutions fail, don’t keep foam-rolling the same spot. Do more analysis; take more history; test movement patterns and stability. Or, come get an assessment with me and I’ll do all that for you plus more. You can book online or contact me at tara@tarakachroo.ca for an appointment in the Kitchener-Waterloo and Cambridge areas.

Road Rash Scars: Scar Rehab for Invisible Scars

Scars are sometimes invisible.  Look at the picture. Can you see the road rash scar? No, obviously, there’s nothing there. But that’s the point. The scar is there, but there is nothing to see on the surface.

This client had a spectacular fall off his long board in his late teens. It left angry road rash in many places on his body, including the right side of his ribcage. How long does it take a road rash scar to heal? In this case it looked healed just a few months later. His skin looks perfect now and there are no visible marks of this accident a decade later. However, he said he could still feel it. The scar still needs rehab. There’s a pull there, a restriction, and that restriction is contributing to his back pain and his breathing issues.

Road Rash Scars are Burn Scars.

The scars from road rash work in the same way as those caused by burns. They are contracture scars–which means that the skin around the burn area contracts into it, causing mobility problems and pain. Just like burn scars, road rash scars come in degrees. A third degree road rash scar will expose the muscle and sometimes bone beneath scraped away skin and fat. Burn contracture scars, including road rash, can often have a very high impact on motor control because they can damage the nerves more easily than scars created by cuts in the skin. Their impact can be incredibly diffuse. Last year I wrote a blog about Burn Scars where you can read more. Because this scar is on this client’s rib cage it restricts the bucket handle movement of the rib cage as it expands outwards during the inhale. This is causing breathing issues. But the area of the scar was actually much larger than what had originally been visible on his skin a decade ago.

Contracture Scars are diffuse

On this particular client the 3 inch area of the actual road rash was just the epicenter of a contracture. This scar reached all the way to his opposite hip through his abdomen’s mid line. As an assessment specialist I used Neurokinetic Therapy to establish how his motor control was being effected by his scar. I found it had created a micro diastis recti, or separation of the two sides of his rectus abdominus, and was causing a down regulation of his right internal oblique.  This motor control problem was leading to back pain, stiff hips, and a bad slumped posture. He was unable to laterally flex his rib cage more than a millimetre before the treatment.  Within a few days of the first treatment his mobility was remarkably improved and his back pain decreased.

Scar Rehab of Burn Scars is slow

The fascial release I performed on this area took about 40 minutes — I made only 3 passes from the epicenter to the mid line of his abdomen over this 40 minutes, which tells you how slow I had to go. The direction of the release was guided by NeuroKinetic Therapy testing, which showed how the scar was impacting his motor control of his core muscles as well as which direction I should release in to get the most improvement in muscle activation. While the pressure I exerted was very strong and deep, it was also so slow and comfortable that the client fell asleep during the treatment. It was relaxing for him and afterwards his body wanted to sleep. Since sleep is when bodies do most of their repair work I take it as a great sign if my treatments induce sleepiness. 

If you are in the Kitchener Waterloo area and have burn scars or road rash scars that you would like to have assessed for scar rehab, please contact me tmkachroo@gmail.com or book an appointment.

Mind Control and Brain Training

I believe in mind control.  I have a deep faith that the power of attention can achieve what was deemed impossible.

When my son was 4 months old my husband and  I were lucky enough to to witness his realization of something truly amazing. He sat propped up in front of us, moving his fingers in front of his face with a look of utter  astonishment.  The look was easy to read “I can control these with my mind.” We felt we were witness to the beginning of him consciously inhabiting his body; it’s a journey that he, like all of us, can continue all of our lives.  The sensitivity to the sensations that originate within our bodies is called interoception.  This sensitivity can be honed, and when it is, it can result in dramatic changes in motor control and the experience of pain.

Brain Training for Interoception

Neuroscience has been offering more and more evidence for my faith in the power of mindful attention in the past decade — brain training in interoception really works. In 2016 a team of Brazilian researchers showed that it was possible for severely paralyzed patients to regain sensation and movement in their legs through brain training exercises.  These patients practiced for more than 2000 hours using Virtual Reality.  Their persistence paid off more than was imaginable at the beginning of the study. Most had returned sensation to parts of their body previously inaccessible, but even more remarkable was that most also had some motor control return as well.*

For my son, learning to control the movements of his body was sometimes pleasurable, and other times agonizing.  For weeks before he learned to crawl he would wake in the middle of the night rocking on his knees.  He cried with frustration at his inability to access the cross body movement patterns necessary to propel him forward, but despite frustration, he persistently willed it.

And yes, we all have memories of how challenging the process of learning new movement patterns can be. I remember the frustration of repeatedly stalling when I first learned to drive standard transmission, and hours of getting the steps wrong when learning to  swing dance.  But the magical moment of mind control that my son experienced at 4 months was not pride at having learned a new pattern, but the pure astonished joy of inhabiting his body. He was not moving in a new way – his fingers had wiggled like that for months. He was feeling more deeply his connection to his body — developing interoception. On the foundation of this experience skills can be built and rebuilt, motor control regained and regained, and pain overcome.

Brain Training for Pain Relief

For the most truly astonishing results relentless persistence and dedication are required — in his book The Brain’s Way of Healing” Norman Doidge chronicals the recovery of patients in chronic pain using specific brain training visualizations to rewire their brains and overcome decades of suffering.* These experiments used simplified pictures of the brain itself as the basis for the visualizations. And the brain training exercises were done for hours and hours a day, for many weeks at a time before results start to appear. But significant and joyful changes can be made in much less time.

In my regular morning yoga class at Movati I have students who have been attending regularly for almost four years.  In that time I have occasionally lead them through an exercise called psychic alternate nostril breathing.  As in nadi-shodana, in this exercise you alternately breath in through one nostril and out through the other, always changing on the exhale.  However I have my students practice it without using their hands, instead using visualization to aid them. I tell them, “this is a focusing exercise; it does not matter how successful you are at directing the flow of air, only that your focus and intention are precise.” But, repeated attention and intention result in shortening the synaptic gap, and slowly, with this brain training, students learn to control the dilation of their nostrils individually.  Recently, I had a student approach me after class with a look of happy surprise on her face — “I  can do it.”  I have seen this joy repeated again and again as my students are immersed in the vibrancy of being in their bodies in new and unfamiliar ways.

Encouraging movement from the outside can often help to more quickly restore the depth of internal sensation.  I often use self massage with grippy pliable rubber balls, or inflated balls to help encourage my tissues to feel more deeply, and thus also move more efficiently or through a greater range. If time is taken to stop, pay attention and really feel after they are used, these self massage techniques become an aid in brain training for interoception – reconnecting or strengthening our ability to feel and move our bodies — and to feel the utter astonishment of mind control.

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Radford, Tim. “‘Brain training’ technique restores feeling and movement to paraplegic patients.” The Guardian. August 11, 2016. Accessed October 01, 2017. https://www.theguardian.com/science/2016/aug/11/brain-training-technique-restores-feeling-and-movement-to-paraplegics-virtual-reality.

Howard, Jacqueline. “Paraplegics moving again years after injuries  .” CNN. August 11, 2016. Accessed October 01, 2017. http://www.cnn.com/2016/08/11/health/paralysis-brain-machine-interface/index.html.
Doidge, Norman. The brains way of healing: remarkable discoveries and recoveries from the frontiers of neuroplasticity. Strawberry Hills, N.S.W.: ReadHowYouWant, 2017. 17-18