Full histories are important
I started working weekly with a new client in her mid 50s a few weeks ago. My intake sessions are long; we dug pretty deep into her history. She came to me because she saw one of my IG posts of scars. This client has a large scar on her knee, which she thought might be related to her persistent back pain. As I asked about scars I felt the need to reiterate — “but do you have any OTHER scars?” This is when she pointed out the small scar on her left temple, as if it were unimportant. I hadn’t even gotten to asking about birth trauma yet when she told me this scar was from the use of obstetrical forceps. I knew immediately that it wasn’t something we could ignore. Why?
Face Scars can create dysfunctional movement patterns
Your face has a huge amount of proprioceptive afference. This is a technical way of saying it has a massive amount of sensory reception. It sends a ton of information to your motor control center about position, tension, temperature and A LOT of other things. The Trigeminal nerve innervates the face. This nerve is divided into three portions (named V1, V2, and V3) that correspond to different parts of the face. Disturbances in any of these areas can cause dysfunction in other structures that are mediated by that same nerve.
For example, a facial scar on the forehead might create dysfunction in the supratentorial dura mater membrane (supplied by small meningeal branches of the trigeminal nerve). What is dura mater? It’s the connective tissue that protects the brain. Issues with the dura mater can cause all kinds of problems, from migraines to low back pain. But that’s not the only reason a scar like this one from obstetrical forceps might have a huge impact.
Birth Trauma is a big deal
Trauma to cranial sutures can have a HUGE impact on neuromotor habits. Your brain’s safety is pretty much the highest priority for your unconscious neuro-motor system. If it were the highest priority consciously people wouldn’t play hockey or football. Additionally, trauma to cranial sutures in infancy means that the whole neuro-developmental process adapts to the stress of this malpositioned safety wall that is your skull. A 2004 publication by Gayle Giboney Page states that “significant and long-lasting physiological consequences may follow painful insults in the very young, including changes in the central nervous system and changes in responsiveness of the neuroendocrine and immune systems to stress at maturity.” 1 The cerebellum, where the motor control center lies, is of course, part of the central nervous system. I have seen plenty of very significant dysfunctional motor control issues stemming from birth traumas. I will have more to say on this in future posts.
Foreceps are a pretty brutal tool for birthing
My interest in birth trauma is not purely professional. I had a lot of birth trauma myself, which still affects my cervical movements. It’s a long story and best kept for another post.
When I heard this client mention forceps my ears pricked up. My own complicated birth trauma includes forcep use also. Foreceps are a pretty brutal tool for assisting in birthing. Infants are often bruised and sometimes left with worse injuries. I tested her reflexive stability and the neuromotor responses for her intrinsic core. There was absolutely no question that this small scar (AND the fairly largish lump directly on the other side of her skull where the other side of the forceps would have been) did affect her stability and ability to move. The scar was inhibiting much of her posterior chain.
Assessment is my focus
I spend a lot of time taking histories for a reason. Whereas some therapists might hope to treat as many clients as possible, I focus on depth.
Often my clients come to me after years of conventional treatments that didn’t get them results. They might have seen physiotherapists, chiropractors, trauma therapists, massage therapists, doctors, osteopaths and osteopathic surgeons, each with their own bias. Conventional assessments have not dug deep enough. There’s a mystery. I am keen to document all the evidence possible in order to solve it.
Of course a history on it’s own is not enough. I ask a lot of questions. But it’s also important to gather many other kinds of information. I assess global movement patterns (like a toe touch or overhead reach). Further more, I examine specific ones movement patterns related to the complaint; like the movement of the hyoid on swallowing in the case of jaw pain. Additionally I carry out careful palpation and assessment of the tone of different structures. The energy signatures of different tissues provides invaluable information. I check joint movement both passively and actively. And importantly, I use Neurokinetic Therapy to test my hypotheses. Assessment dominates theses sessions.
Correct corrections often don’t take long
Treatment and assigning homework comprise a much smaller portion of the time I spend with clients. With this client the assessment wasn’t just the most important thing, it definitely took up most of our time together. Once we had found what needed to be worked on, the work itself didn’t take long. However, it still had enormous effects. I did some simple and gentle cranial adjustments that took maybe 10 minutes.
This client’s long standing back pain disappeared after just 10 minutes of cranial adjustment. Furthermore, her movement reflected this change. Lumbar extension was smooth, with no hinge points. What’s more, her pain remained reduced by 80% when she returned to my office two weeks later. In the second session we worked on the effect of those same birth injuries on hip centration and made big progress there too. This is exciting work and I can’t wait for week three.