Embodied Cognition and Health with Cathy Kerr (LBP 056)

catherine-kerr
catherine-kerr

Cathy Kerr is the director of the Mind-In-Body Lab at Brown University. Her research focuses on whether brain rhythms underlying body awareness and movement are actively modulated by mindfulness and movement practices such as Tai Chi and Qigong. Her hope is that understanding how these therapies work will have a positive impact on conditions like aging and chronic pain or functional disorders where these approaches have shown the clearest therapeutic benefit.

She joined me today to talk about the focus of her research broadly, but also to discuss a specific research study that is in progress which is looking at the effects of Qigong on distressed female cancer survivors.

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Conversation highlights

  • What does her research focus on? The status of body awareness as a therapeutic mechanism and looking specifically at mechanisms related to body awareness in the brain; How neurons process and relate to body focused attention, primarily in the somatosensory cortex.
  • Became interested in body awareness originally a Qigong practitioner because of having a difficult chronic illness for 20 years. Cathy noticed that with her practice the sense of touch in her hands would change.
  • Started to wonder if body experience could be part of a therapeutic mechanism. Was it a way of signaling healing? Or a very active way of creating the placebo effect?
  • Initially began researching the placebo effect with Ted Kaptchuk at Harvard
  • In 2005 departure from work on placebo and learned the neuroscience of body awareness.
  • First project to look at the effects of body awareness within a healing technique- for that technique they ended up choosing MBSR (mindfulness based stress reduction).
  • It was paradoxical because they were not a part of the mindfulness research community, and mindfulness as a body based healing technique not the majority view.
  • The study showed that after 8 weeks of MBSR training people were better at exerting pinpoint control over neurons in their somatosensory map.
  • Cathy's TED talk mindfulness begins in the body.
  • There is an interesting suta by the Buddha- the 4 foundations of mindfulness, and mindfulness of the body is the first foundation. Cathy wrote a review paper on this in 2013.
  • Cathy's teaching with medical students at Brown how to have immediate access to body sensations as an anchor for mindfulness.
  • This is an immediate way of stabilizing the mind. For many Western people their mind can be floating free and ungrounded and anchoring your mind in the body is very powerful.
  • Some people don’t even know that they can voluntarily shift their attention to their body. (story of a man who jumped away from his own hand because he was so startled when he shifted his attention to it).
  • Many people with chronic pain, and IBS don’t have that ability to bring the mind to the body. The reason is that they are already always preoccupied with these negative body experiences.
  • What’s really exciting right now is that The Davidson Lab has begun to look at the effects of mindfulness and exercise. They are bringing mindfulness off the cushion. It really helps people to understand a broader range of embodied approaches like Tai Chi, or yoga.
  • At the University of Washington Dr. Cynthia Price is working with assisted mindfulness in people with trauma. In  assisted mindfulness a bodyworker helps them to be and stay present while they work with mindful attention to body sensation.
  • Cathy's current study on the effects of Qigong on distressed female cancer survivors.
  • She chose Qigong because she wanted to see what would happen if researchers expanded the number of modalities they looked at in addition to just mindfulness.
  • There is a novel undertanding of how the mind and body relate in Qigong. The hope was that they could capture these ideas and understand them in scientific terms
  • Cancer survivors are really underserved and have a lot of psychosocial needs. About 30 to 50 % of them are actively fatigued and distressed for years following cancer remission. Is this chemo? Existential effects? They don't know but the main thing is people are not able to return to their full lives. The whole pink ribbon campaign doesn’t really capture this reality.
  • Gentle physical movement in a group can really transform people’s experiences. The question is why, and how does it work
  • Inflammatory cytokines show an up-regulated process of inflammation going on in the body. Especially in people who are highly fatigued. This process of inflammation is really important for many diseases.
  • There are now some markers in blood that we can measure- giving insight into this process of daily inflammation. They are associated with feeling sick and tired daily. If you are bathed in inflammation for years it can bode poorly for susceptibility for many issues like heart disease, vascular disease, it is associated with dementia... Getting a better understanding of inflammation is one of the main scientific tasks right now.
  • We know that if you are injected with one of these inflammatory cytokines you will get "sickness behaviors" like not wanting to get out of bed and feeling generally unwell... but we don’t know how to clear these inflammatory cytokines out.
  • There is an old Chinese folk saying- the mind (yi) leads the qi, the qi leads the blood.
  • This seems to suggest a solution to the puzzle of qi. So if you behave as a scientist you can measure the mind and its ability to focus on the body. You can measure the yi and the blood... So maybe that is a pathway of how mind intent or somatic awareness might have an effect on parameters in the blood like inflammation or the ability of the blood to flow through the body.
  • Embodied cognition: many philosophers have gone on this mind trip and have posited these ideas of brains in jars and brains in vats- that we can only look at brains. They are saying no there is a relationship between brian and body and body and world and if you miss that you miss everything.
  • Interoception research has been a very brain centered endeavor to the point where all the relevant processing is considered to takes place in areas in the brain. But in fact there is a lot of bodily signaling from the heart and other centers.
  • Neurons in the body have their own way of processing experience and an ability to send independent sources of information that are not simply sensory through-puts but are actual information processing. There are independent sources of information and embodied cognitive processing to help the body in the brain.
  • We want to measure different forms of connection between the hand and the brain. Want to see if that changes during the course of practice.
  • We hear a lot about consciousness. One of the main factors is something called a brain rhythm. The gama rhythm is of consciousness. There was a study in 2004 of Tibetan monks doing compassion practice gama rhythms go off the charts. It turns out these rhythms also extend into the muscles, and these rhythms of consciousness that extend into the muscles also relate back to the brain.
  • The beta rhythm is a stopping rhythm. It’s very operative in thinking and in moving. If you need to hold something in memory beta says no more info for a bit please. Beta becomes disregulated in parkinson’s disease. Measuring beta in Qigong. Looking at quality of information that the muscle spindle neurons send back to the cortex.
  • Curious about if that somatic awareness has effects on the ways that the muscles process information. Do some of those effects tell us anything about changes in blood flow or in inflammation?
  • The rubber hand illusion tells us that there is this very interesting multi-sensory body sensing capacity.
  • It tells us that our sense of the body is being knit together by these different streams all the time.
  • Their biggest hope with this study is that they will learn something new about how some of these body awareness practices like Tai Chi and yoga might have an impact on inflammation. It could be a novel mechanism for understanding inflammation. That’s the big home run hope.
  • Being able to have an impact on the distress of this population would be wonderful.
  • Cathy asks me is there a discussion about the intelligence of the body? How do I as a practitioner use that? \
  • I talk about the Liberated Body tribe- most of us are in a variety of manual and movement therapies. The thing that makes us all stand out is that we have a reverence for the body - we believe in its importance to life.
  • My life changes the more engaged I am with my body.
  • As a larger group the thing that makes us different in terms of the broader culture is that we talk about the body as something critical to a rich thriving life.
  • Cathy: there is so much wisdom in people who are carrying that out in a daily practice. There are so many of these practices across all cultures. There must be something universal about this, it's not just something people are making up. I’m excited about people engaging with the science.
  • Fascia research: We are all learning how the nervous system and the connective tissue scaffolding are so intertwined.
  • There is a lot of exciting sense of possibility. It’s like we discovered we have the amazon right here in the body.

Resources

Dr. Cathy Kerr's Mind-In-Body Lab at Brown University

Cathy's TED talk: Mindfulness Starts in the Body

Cathy's paper in Frontiers in Human Neuroscience Mindfulness Starts with the Body

Mindfulness Based Stress Reduction (MBSR)

Ted Kaptchuk and placebo research 

The Davidson Lab

University of Washington Dr. Cynthia Price

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The End of the Structural Model? with Eyal Lederman (LBP 054)

Dr. Eyal Lederman joined me in season one to talk about his paper on the myth of core stability. As if that topic alone wasn’t controversial enough, I heard from many listeners afterwards that the really challenging part of that talk was his rejection of the structural model- his point of view that it just plain does not give us much information about why a person is having pain or dysfunction and, more importantly, how that person will recover. To shed some light on that, today we talk about his paper titled “A process approach in manual and physical therapies: beyond the structural model.” We’re talking about why he says the structural model is outdated and needs to be replaced, what he sees it replaced with and how patients are treated at his clinic, and what the benefits are to people when we expand beyond structural explanations for things as well as structural approaches to treatment.

Dr. Lederman is the director of CPDO, which provides continuing professional development for manual and physical therapists. He is also the co-director of a masters of science in Manual and Physical Therapy in Musculoskeletal Health at University College London. He graduated from the British School of Osteopathy and completed his PhD in physiotherapy at King's College, London, where he researched the neurophysiology of manual therapy. He has a number of papers to his name and has also authored several books including Fundamentals of Manual Therapy and Neuromuscular Rehabilitation in Manual and Physical Therapy.

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Conversation highlights

  • What is a process approach?  Co-creating with the individual to support their capacity for self-healing.
  • Most of the conditions seen in the clinic are not to do with biomechanics or structural reasons, but rather represent biopsychosocial processes in the person.
  • The forces that go through the body during daily activities are tremendous the body is really tough stuff- can you change the structure and biomechanics? It’s highly unlikely- it has to withstand tremendous forces during the day that cannot be replicated in manual therapy.
  • I ask - yes but hasn't our model been wrong? We are learning based on cadavers and living tissue is different. It's more like soft matter physics rather than hard matter physics. [resources- paper on hyluranon]
  • Everything works. If you brush against somebody something will change in their body- massage will get a change. The question is what is the magnitude of change? Is it going to be an amazing change? How long is the change going to be there before homeostasis resets it to its original level. Most of the effects in manual therapy are unlikely to last the duration of the treatment and beyond that. Manual therapy should not be the sole therapy.
  • It is problematic that our clinics becomes a temple of healing- the person is then not aware that healing happens in their body. Healing depends on self-healing capacity.
  • How is the process approach informed by biopsychosocial research?
  • We are being called to work in the psychological and behavioral dimension of a person as well for true healing to occur.
  • For example imagine someone has knee surgery and it is a brilliant surgery- if they are elderly, have no social support, and have depression all the wonderful rehab is ineffective- there is nothing to maintain what happens in the clinic.
  • You have to co-create with a patient an environment in which they can improve.
  • Functioncise is using your own movement repetoire and then challenging the things you are missing.
  • There are three processes by which people can heal: repair, adaptation, and modulation of symptoms.
  • Imagine a patient with lower back pain. In an MRI scan before and after you wouldn't see anything really different, this person is still living with the underlying issues. A lot of what we seeing as healing and recovery has to do with the modulation of symptoms.
  • In chronic conditions you are looking at neuroplasticity.
  • Ask the question what the best environment is for recovery? We need to create an environment that will support each phase of recovery.
  • Most of the time we get better without any kind of help.
  • A historical mistake in physiotherapy is when they gave remedial exercise based on body building health industries. Quite often clinics look like gyms. You have to wonder why do we give activities that don’t resemble anything that people do in their lives?
  • Don’t invent anything for the patient, use their own movement and pick activities to challenge their losses
  • Imagine soothing and calming a child after a fall. Manual therapy is emulating what happens naturally. All we are doing is giving it fancy names- ultimately we are using the same behavior and professionalizing it.
  • Why do some people fail to recover?
  • When we are in pain we can’t sit in the dark alone and manage it ourselves. Having other people helps a lot.
  • Pathologizing of things blocks people from their innate self healing because we are inserting fear into the equation. There is a disparity between pain and pathology. It’s very damaging to pathologize things.
  • A lot of my clinic is helping people to re-work the narrative about what happened to them and what they are going through. The fear of movement is the nail in the coffin.

Resources

Eyal Lederman at CPDO

Dr. Lederman's paper "A process approach in manual and physical therapies: beyond the structural model"

The paper I refer to: "Mathmatical analysis of the flow of hyaluronic acid around the fascia during manual therapy motions"

Dr. John Sarno

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Interoception in Practice with Bo Forbes (LBP 053)

Bo Forbes is a clinical psychologist, yoga teacher, and Integrative Yoga Therapist. She and I had a chance to talk way back in season one, and today I'm delighted that she joins the show again. A central guiding theme of Bo’s work is with interoception, and she has put together the Interoception Tribal Council which is bringing together researchers, primarily neuroscientists, who are looking at interoception and its effect on the whole person’s health both physically and mentally. In this conversation we talk about some of the amazing research that is coming out these days, but we also talk about her own experience putting her interoceptive abilities to the test when she underwent hip surgery this year- which was her 4th hip surgery in 8 years. It’s a really beautiful story of living one’s practice. I hope you enjoy it as much as I did.

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Conversation highlights

  • The creation of the Interoception Tribal Council- who is participating and what are they working on together?
  • How has interoception become a central part of Bo's work?
  • Bo talks about the study by David Creswell which demonstrates that mindfulness leads to reduced inflammation markers in the body.
  • Remarkably, these changes were absent in people who practiced relaxation without mindfulness.
  • The Default Mode Network of the brain- thinking about the past, wishing things were different, imagining what things will be- the tendency it creates towards a negative self-referential way of being in the world. "I am not worthy" or, "I will never get what I need" messages.
  • This DMN (Default Mode Network) plays a huge role in depression. Mindfulness separates this mode from direct experience. This creates changes in the brain related to depression.
  • The Creswell study encourages specifically people to pay close attention to their bodies- even to notice the negative feelings in their bodies- so he was leading them in increasing interoceptive awareness.
  • Bo's hip surgeries- two doctor errors and one hospital error led to 4 surgeries in 8 years. There was a strong PTSD issue with this, and a compelling narrative that made her look closely at chronic pain, the DMN, and interoception.
  • The idea that someone had damaged her body and ruined it forever was pervasive in her life. The tendency to look for and predict the same pain she had felt the day before. It made her very stuck.
  • Bo's choice to not be put under general anesthesia during the surgery- how that changed her interaction with the doctors and nurses.
  • How Bo used her interoceptive practice to manage the experience of being awake through the surgery. Her intimate relationship with her breath and heart rate in order to maintain staying awake for the surgery.
  • The direct impact the lack of general anesthesia had on her rate of recovery. For whose benefit are patients put under? Is it perhaps a protocol that has become so automatic that it never gets questioned? What happens when we question its necessity?
  • Based on the Creswell study, cultivating this interoceptive ability also likely has a remarkable effect on immunity and the experience of pain. It was amazing how many times in the hospital they wanted her to take something but she didn't need it because she only had some soreness.
  • It's also clear from this experience why we don't want to be in our bodies. Our bodies can be like a vacation home that you haven't gone back to in years and it's gone into disrepair- as you approach that home that hasn't been inhabited in a long time its intimidating.
  • We get deliberate training to be out of body and to focus mostly on what is coming in through the visual cortex. Trauma also makes us not want to be in our body. It doesn't feel like a safe space to be in the body.
  • Nervous system hyper-arousal is a form of collective trauma that we all go through in our culture.
  • Being disembodied is also a form of trauma.
  • Connective tissue has this amazing linkage with interoceptive awareness. Using self-care methods like Yoga Tune Up or MELT- these are objects without emotional load that can help us to check in with our bodies.
  • Just putting our hands on our bodies and bringing attention to our bodies and where our hands meet our bodies can be so helpful.
  • In modern yoga in our culture we have a focus on proprioceptive movement. We start with action, "do this". Then if there's time we will add in an instruction to breath. Then if we really have time there might be an awareness based cue. In [Bo's tradition] they reverse that. Starting with an awareness based instruction, from that place of awareness they can breath or move where awareness is growing.

Resources

Bo's beautiful post on her surgery experience The Beauty of Broken

Bo's article on the Creswell study in Yoga Journal

The New York Times on the Creswell study

The Creswell study in Biological Psychiatry 

Farb and Segal research on the Default Mode Network and depression

Dave Vago

Catherine Kerr

Mind and Life Institute Fellow Program

Mindfulness Based Stress Reduction

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Interoception, Contemplative Practice, and Health with Norm Farb (LBP 052)

Norm Farb is a neuroscientist whose research focuses on the relationship between present moment awareness and well-being. He is in the department of psychology at the RAD Lab (Regulatory and Affective Dynamics Lab) at the University of Toronto Mississaugua. In today’s episode we are talking abouta paper of his titled Interoception, Contemplative Practice, and Health. We dive deep into what the benefits- and risks- are to honing one’s ability to connect with a sense of what is going on in our bodies, and what we appraise that input to mean based on our perceptions of who we are in the world.

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Conversation highlights

  • Norm researches how people develop habits that serve them well or cause suffering, and is focused particularly on contemplative practices.
  • Interoception is a sense of what is going on in our bodies. Bodily sensation comes from inside the skin- for example our heart beat is felt most through skin of chest. Interocpetion also includes what we do with that sensation- it is linked to our conceptual representations of what the sensations mean.
  • There is not a thing such as pure perception- nothing is unadulterated. We always try to fit our perception to our interpretation.
  • Even when signals are first hitting the brain they are already being compared to what it’s similar to.
  • Initial thoughts on interoception were naive in that people thought more interoception was good and blocking sensation was bad. Want to have access to bodily signals, but also to regulate how much impact they have over mood or decision making. It comes down to a person’s interpretive framework.
  • Most people out of touch with their bodies, but it’s too simplistic to say that if people got in more touch with their bodies they would do great. People with anxiety disorders have more awareness of their heartbeat. Interoceptive sensitivity is not a one way street into wellbeing.
  • Panic attacks are an example of interoception gone awry. It is good to have a ping of butterflies in your stomach when public speaking, but n panic attacks there is catastrophization. “What if this is actually threatening to me?”
  • Many contemporary health problems are a result of disregulated interoceptive processes.
  • When people are aimlessly binge watching shows or mindlessly putting food in their mouths- or whatever self soothing there is- they are trying to get away from some discomfort in the body.
  • Let the body be the canary in the coal mine. This isn’t to put the body above cognition- we can do incredible things with our minds- but there is a reason why intelligence doesn’t predict happiness for instance. We can get caught in a local maximum- doing the best we can do in a rational sense but that’s a limiting way of seeing the world.
  • How are you going to escape a depressive self justification unless you can open up to conflicting information?
  • Because the body is an untamed wilderness that’s a really rich place for inquiry.
  • How does interoceptive awareness get integrated? We don’t have strong neural evidence for how it is substantiated in the brain.
  • None of our perceptions are the actual thing.
  • in situations where people have the misfortune to have part of the spinal cord severed and cannot receive input from bodies still they still can have rich emotional lives.
  • Dimasio’s somatic marker hypothesis (in resources)
  • Anhedonia is an example of pleasure signals not making their way through to the representation map. People are living less rich lives when they are not tapping into their bodies- we are cognitive misers and most of us live a life based on what has happened to us.
  • A lot of the path is noticing things i do that make me or other people crazy. Without awareness that conditioning is running my behavior and conditions don’t change
  • Things might seem darker before the dawn because you are coming into contact with how you have been conditioned. You need to open the door and see how cluttered and messy the room is before you can clean it out.
  • Not all habit or behavior needs to be changed but to have deeper meaning one has to be around to witness what’s going on.
  • Presence is allowing oneself to minimize the need to change or regulate what is occurring right now.
  • At the heart of any regulatory state is a rejection of what is happening.
  • The pursuit of happiness as a goal is self-defeating. Allowing experiences to play out without having to react to them.
  • Agency- the feeling that one’s actions can effect desired outcomes in the world.
  • Any systems that fire together wire together. The more we respond with the same response it’s more likely we will respond the same way in future.
  • If you can do something to explore the quality of that stimulation you can starve the resources that would be allocated to responding to that stimulation.
  • Thinking “don’t eat ice cream” is suppressive and we know in long term it’s not successful. As soon as we take energy away from “don’t eat ice cream” it’s the strongest signal. Stick with the sensory aspect of the stimulus arc. In doing that it is literally not reacting with overt behavior- we give the signal the attention not the non-desired outcome.
  • How is interoception an intervention for chronic pain? There is evidence that paying attention to your body and not jumping into actions can turn down inflammatory markers. In the broader sense they are helpful because the suffering that comes from chronic pain is not the same thing as the sensory pain itself.
  • In chronic pain conditions there is a recurring threat message coming from the body. The secondary appraisals about the ability to live the life one wants effects quality of life to a much greater degree than the pain signal itself. Migraine sufferers completely shut down when they feel one coming on. Yet every moment of a headache is not going to be peak intensity. Not every impending migraine is going to have the same catastrophic effect.
  • How can people play with restoring interoception to a healthy state?

Resources

Norm Farb's site

The RAD Lab at the University of Toronto Mississagua

Norm Farb's publications

Paper we discussed: Interoception, contemplative practice, and health

Damasio- The Somatic Marker Hypothesis and the Possible Functions of the Prefrontal Cortex

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Connective Tissue and Inflammation with Helene Langevin

Dr. Helene Langevin received her medical degree from McGill University and did a post doctoral research fellowship in Neurochemistry in Cambridge, England. Her residency in Internal Medicine and fellowship in Endocrinology and Metabolism was at Johns Hopkins Hospital. She is a Professor in Residence of Medicine at Harvard Medical School, Brigham and Women's Hospital and is also a part-time Professor of Neurology, Orthopedics and Rehabilitation at the University of Vermont College of Medicine. She was appointed as Director of the Osher Center for Integrative Medicine at Harvard Medical School and Brigham and Women's Hospital in November 2012.

As if that weren’t enough to keep a person busy… In our worlds she is best known as the Principal Investigator of NIH-funded studies investigating the role of connective tissue in low back pain and the mechanisms of manual and movement based therapies and acupuncture.

Today she joins me to talk about her research- specifically how stretching impacts inflammation resolution in connective tissue, how connective tissue is a critical component of the immune system, how movement influences immune processes, and what this all might mean for both prevention and resolution of both chronic pain and cancer.

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Conversation highlights

  • Why her research focuses on the role of connective tissue in chronic pain, and the mechanisms of movement and manual based therapies as well as acupuncture.
  • Her first NIH grant in which they designed a robotic arm to manipulate acupuncture needles and found that the cause of the force was greatly increased when the needle was rotated. This was due to the mechanical stimulation delivered to the connective tissue.
  • How this got her interested in the effects of stretching tissue.
  • Research suggests acupuncture needles interact with different pathways in the nervous system. The connective tissue can simply be the mechanical link between needle and sensory nerves.
  • They found that there are cells within connective tissue- the fibroblasts- which change shape. They expand and remodel internally. So the needle might be having an effect on the connective tissue in addition to what happens in the nervous system.
  • When the fibroblasts change shape they secrete ATP. It's a molecule we think of in terms of energy in production in the cell. However, ATP can be used in a different way and can function as a signaling molecule outside the cell. Release of ATP from cell is necessary for the cell to change shape.
  • There is research being done at The University of Rochester by Dr. Nedergaard and Dr. Takano (in resources) on the effect ATP downstream- showing an analgesic effect on sensory nerves.
  • Dr. Langevin clarifies her 2002 paper Relationship of acupuncture points and meridians to connective tissue planes (in resources) saying, “We have to be careful here when we talk about correlation of acupuncture meridians and fascial planes." and "it’s not surprising the channels aroe found between a bone and a muscle or between two fascicles of a muscle... does that mean that fascial planes are the same as meridians? I wouldn’t say that”
  • Cancer is not just a collection of tumor cells growing out of control> They need a base and that base is the connective tissue- the stroma. The cancer takes the connective tissue hostage.
  • Dr. Patricia Keely at The University of Wisconsin has studied that cancer is likely to spread along places where the connective tissue matrix forms these railroads where the cancer can spread. (in resources)
  • Dr. Langevin's paper Stretching Impacts Inflammation Resolution in Connective Tissue (resources). She defines inflammation and what it means for both cancer and chronic pain.
  • In musculoskeletal pain it’s not always clear where the tissues are that are creating the pain. In low back pain for years the belief was that it was coming from the spine.
  • How does fascia generate pain? The soft tissues of the back can be the source of pain if they have a source of persistent inflammation in the tissues.
  • Dr. Langevin defines stretching and the protocol they used with the rats at UVM in the research study.
  • Viscoelastic changes in fascia can happen fairly quickly, but the fibroblasts are much slower and didn't start changing until about the 10 minute mark.
  • I ask Dr. Langevin to differentiate between movement and stretching.
  • Static vs. dynamic stretching is a very important differentiation.
  • In the studies of athletes and static stretching, "I’m not convinced athletes weren’t stretching too much? Stretching beyond the limits is ripping the tissue, and the idea more is better may not apply. Achieving the right and specific force of the tissue may be very important."
  • The connective tissue is really the home of the immune system.
  • In her current research she is pursing the aspect of inflammation resolution with respect to the dose of stretching. She also wants to see the role of connective tissue in back pain and the response to body based treatments- both manual and movement based.
  • She is also interested in looking at longitudinal studies- observing back pain over time. Children and adolescents that are getting back pain at an earlier and earlier age- do changes in connective tissue precede the development of back pain?

Resources

Dr. Helene Langevin on Brigham and Women's website

Osher Center for Integrative Medicine- a partnership between Harvard University and Brigham and Women's Hospital

Dr. Langevin's paper Stretching Impacts Inflammation Resolution in Connective Tissue

Dr. Nedergaard and Dr. Takano research at the University of Rochester

Dr. Langevin's paper Relationship of acupuncture points and meridians to connective tissue

Dr. Patricia Keely's research at the University of Wisconsin on how cancer spreads along "lines" in the connective tissue 

If you’re inspired to leave a review on iTunes or Stitcher I would be oh so grateful. If technology isn’t your thing however you can just tell your favorite body nerds about the show. It keeps the show rolling and connects us more as a community. Body nerds unite!

Navigating Pain with Neil Pearson (LBP 040)

In today's conversation Neil Pearson is helping us to understand what pain is.  We discuss the assumption that all pain is directly correlated to tissue damage, why your brain is messing with you by creating pain in the first place- if it’s not always telling the truth about what’s going on on the inside.

Neil also discusses how pain isn’t just biological, biomechanical, or biomedical- and how better understanding how  our  lives and bodies are integrated can help us to address it more effectively than reducing this way and trying to put it into one “box”or another.

In fact we talk about the trouble that “it’s all in my head”- one such box-  can lead to- things like deciding we need to only therapize our pain away from an emotional perspective, or that we can simply ignore it and push through it as if it being about our nervous system and not (necessarily) our tissue makes it somehow imaginary.

I also ask Neil his opinion on whether or not we can actually figure out how much pain a person is by doing a brain scan, and ask for his advice to yoga teachers and other movement and fitness educators about how they can best help their students.

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Conversation highlights

  • What is pain?
  • Pain is a complex human experience. Typically we consider it to be a symptom of injury, but pain isn’t all about tissue damage, it has a relationship to that but also to other things. We feel pain when our brain decides that something dangerous is happening.
  • We need to treat pain more like a verb than a noun.
  • Is it possible to not have tissue damage and still have lots of pain? Think of a paper cut- small tissue damage, add lemon juice, get lots of pain. We can also feel pain in the absence of signals from our body, like with phantom limb pain.
  • When the pain is really big it’s hard to imagine that there isn’t something horrific happening inside. When the pain is more intense the system is trying to get you to change behavior.
  • When there’s a situation where the body has been sending signals to the brain but the person has been ignoring, the system may ramp things up in an attempt to get your attention. There’s a point at which ignoring the pain isn’t a good idea anymore.
  • Pain as a biopsychosocial phenomenon- what does that mean?
  • Pain isn’t just biological or biomechanical or biomedical. As if pain only has to do with the physical body. We as humans lead a very integrated life. What’s happening in our body, social relationships, emotions, work, etc. will have an effect on if and how we have pain.
  • The most effective interventions are the ones that specifically address the body and the mind together.
  • A recent article (in resources) that stated that scientists can measure pain with brain scans... Are we going to use a brain scan to figure out how much in love a person is? Pain is very individual.
  • We can’t change pain like a light switch. We can have some influence- change it like a dimmer switch turning it down over time.
  • We can also change pain through knowledge. There’s lots of great work that Mosely and Butler [resources] have done- when we actually understand pain it often decreases the pain signals.
  • A number of studies show that [resources] you can change pain through breathing exercises.
  • One of the reasons why some people don’t have success they want is we on the practitioner side give up too soon because we don’t understand that the nervous system is changeable but often difficult to change.
  • If you ignore and push through the pain over and over and over again- carrying on because you are tough- you’re training the nervous system that you don’t listen very well. In that situation need to do less and to move in a way that doesn’t leave us worse afterwards.
  • “Whatever you’re practicing now is what you’re going to get good at.” Neil's yoga teacher was talking about what you’re doing with your breath, your body tension, how you’re approaching it... If you practice pushing through the pain all the time, your system gets good at creating protection.
  • Yet acute stress can be helpful for those in pain- how do we differentiate between acute and chronic stress- good stress vs. bad stress?
  • Not only do we need to feel safe and feel like we’ll be ok later, we need to keep our bodies and breath as calm as possible. If pain’s not accurate, why don’t we use some of these other alarms- our breath, body tension, etc.
  • Yoga means a lot of different things to different people- what is the approach with yoga to address pain ?
  • What are some of the things that Neil would want teachers to know about pain so it could influence their teaching?
  • If we understand it better we can provide students with better guided suggestions. Often teachers will say there should be no pain in yoga- which can be trouble for people with pain. Or people will say pain is something you will get used to, or that if you stay with it it will change. This is also well intentioned but incorrect.
  • My insight on the "fragile" language I was using when teaching.
  • We want people to find their way to yoga with a smile- to find a way with it that is peace and bliss to practice it.

Home play!

I love the two questions Neil poses for people who are in pain to ask themselves at the beginning of an activity: "Does this feel like a safe space?" and: "Do I think I'll be ok later?". What simple yet phenomenal little check ins! I believe this helps us to cultivate a healthier relationship with our nervous systems, and whether you're in pain or not at the moment, that's a winning strategy for long-term health. I just started kettlebell training- which I'm both excited and nervous about- and I will for sure be using those little check in questions. How about you?

Resources

Life is Now- Neil Pearson's website

Neil Pearson's pain management products- books, DVDs and CDs *there is a new membership site coming soon on this website to help learn about the new concepts in pain science.

Article: Brain Scans: Swimming Up a Muddy Stream to Measure Pain

The study it refers to: An fMRI-Based Neurologic Signature of Physical Pain. Tor D. Wager, Ph.D., Lauren Y. Atlas, Ph.D., Martin A. Lindquist, Ph.D., Mathieu Roy, Ph.D., Choong-Wan Woo, M.A., and Ethan Kross, Ph.D. N Engl J Med 2013; 368:1388-1397

Lormier Moseley 

David Butler

If you liked this episode, you might also like

Pain Science and How to Be a Happy Mover with Todd Hargrove

Body Maps and Interoception with Steve Haines

If you’re inspired to leave a review on iTunes or Stitcher I would be oh so grateful! If technology isn't your thing however you can just tell your favorite body nerds about the show. It keeps the show rolling and connects us more as a community. Body nerds unite!

Carolyn McMakin: The Resonance of Repair (LBP 030)

Years ago I trained with Dr. Carolyn McMakin in Frequency Specific Microcurrent and then worked in a holistic medical clinic administering it. I witnessed some pretty crazy miracles, so today I talk with Dr. McMakin about FSM, our bodies as electromagnetic systems, the history of electromagnetic medicine, and the dramatic results of Frequency Specific Microcurrent on a diverse range of things from inflammation to shingles. And as an expert in Fibromyalgia and chronic pain syndromes she also talks about the range of causes of fibromyalgia, and how we must understand what prompted an individual to develop fibromyalgia in the first place if we ever hope to resolve it.

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Show notes

Brooke: Why don't we start by describing or having you describe what Frequency Specific Microcurrent is?

Carolyn: Frequency Specific Microcurrent is microamperage current that's delivered with a machine that allows you to have a frequency on each of two channels. Those frequencies intersect in the patient's tissue and they change the way cells and tissues function.

I got a list of frequencies from an osteopath who bought a practice in 1946 that came with a machine that was made in 1922 and that machine came with a list of frequencies. I got the list and we had a microcurrent machine in the office and we were just sitting around musing one day and Dr. Douglas, who's a chiropractor that worked with this old osteopath said, "You know, I wonder if Harry's frequencies would work on that precision microcurrent." "I don't know. We could try it."

In 1995, we tried the frequencies on the machine for the first time. We made the assumption and it proved correct that the frequency on the list was to neutralize this pathology or this thing that was wrong with the tissue.

Frequencies for certain conditions were combined with frequencies for certain tissues. Then we just observed the effects. First, we found out that if you run a frequency that was not useful, it didn't hurt anything, so it was the first two or three months when we were using on each other and on my friends and on my kids.

Then we took in to the clinic and we found out all clinically what the frequencies did when you use them on patient's tissues. Probably the most dramatic was somebody had come in with rheumatoid arthritis. I had 19, 20 year old rheumatoid arthritis patient and she's now 40 and she would come in with her knee the size of a grapefruit or a cantaloupe. I'd run the frequency for reducing inflammation all over the joint and her knee would go from the size of a cantaloupe to normal in 45 minutes. We just discovered through use what was effective and how it worked.

The first year, we focused on treating myofascial trigger points and muscle pain. That was the first two papers I published and then the second year, 1998, we found out how to treat nerve pain. Nerve pain is a nerve that's inflamed, so it's inflammation, remove inflammation from the nerve. You could treat sciatica and radiculopathies.

Then '99, we found out how to treat the spinal cord. The patients would come in with full body pain and the only thing that made any sense was if their bodies all in pain, the only nerve structure that goes from your toes that carries information from your toes clear up to your neck is your spinal cord. We ran the frequency for inflammation in the spinal cord and those patients got better.

We didn't have any luck at all treating diabetic neuropathies and then I looked at what the pathology was. It doesn't have anything to do with the nerve, it has to do with the blood supply. The blood vessels are inflamed and congested and clogged up.

In '99, we started treating the blood vessels in diabetic neuropathy patients and we were able to not only correct the neuropathy and take away the pain, but it healed the wounds as well.

The advantage and the disadvantage is that the frequencies are very, very specific. They do exactly what they are alleged to do, whether that's what you think they're going to be doing or not.

Over the last 17 years, we really figured out that there's very little placebo effect at least on the part of the practitioner. You can have the best intentions in the world and if you're not treating the right thing with the right thing, things don't change. It's fascinating.

I had a patient with pelvic pain. She had painful intercourse every since the delivery of her second child, so have been unable to have intercourse for a year and a half. What I did find was that her pelvic floor muscles were in spasm, they were just rigid. I treated for the muscle. I treated to quiet the nerve, figuring maybe the muscles had been traumatized during this traumatic birth. It softened a little bit and I went to the other side and it softened a little bit. By the time I went back to the first side, it was rigid again and exquisitely painful.

During this treatment, she's talking and I'm using the frequencies to the muscles and she's talking and she said, "My uterus never had time to heal from the birth of the first child." Her first child was premature, it was very difficult, and she had her second child 9, 10, 11 months after the first one.

I thought, "Well, I have a frequency for the uterus and I have a frequency for removing the fact of trauma from the uterus. I wonder if that would do anything because treating the muscles is not working."

I shifted to the frequency to remove the fact of trauma from the uterus and her entire pelvic floor got soft. 20 minutes later, she had absolutely no pain, no spasm, no nothing.The next night she had absolutely normal and pain-free sex. One treatment and one fix and this has been almost a year.

Carolyn: It's almost not sensible that these people in 1922 somehow discovered frequencies that resonate with particular tissues and that they're correct. It's just like, "Really? Seriously?" I do things all the time that even I don't believe.

Brooke: A lot of what we talk about here at Liberated Body tends to be in the manual and movement therapy fields. A lot of the treatments that we're doing in our own practices or that people are seeking out, they're accomplished hands-on or through verbal lessons. This is really a big shift in how tissue can be affected and that it can be affected by microcurrents. Is there a model that you can use to describe how does the current effect the tissue?

Carolyn: Back in the 30s, the medical community decided that drugs and surgery was the way that medicine was going to go and the whole concept of electromagnetic therapies were shut down in 1934. It was a big part of medicine up until 1934 from about 1890, 1900s, so for almost 40 years.

We've lost the concept until Becker and Jim Oschman. The body is an electromagnetic system. We think of ourselves as a chemical entity because we know the biochemistry of how tissues put together and which are hormones look like and all the chicken wire diagrams, but your body when it functions is an electromagnetic system.

There is a natural current flow in every tissue, every cell. Cells are semiconductors because of the water molecules that line the cell. Every cell in your body is a semiconductor like a computer chip.

Your brain has chemical signals that we're aware of, but the processing of information in your brain and your nervous system happen by orders of magnitude more quickly. I want to say 10 times, but it may be more than that. It's orders of magnitude more quickly than is possible by straight chemical conductivity, so you are an electromagnetic system.

The current is physiologic. Microcurrent is millionths of an amp. It's the same kind of current that your body produces on its own. You can't feel it and when you use current that's below 500 microamps, it increases a ATP production by 500% in rat scan. That was done in 1982.

2001 and 2002, Seegers reproduced that study and she too found that current from 10 to 500 microamps increased energy production, ATP production by five times or 500%. It increased waste product removed, it increased amino acid transport, and it did it in living cells, not just rat scan, not just in culture, but it did in lymphocytes, human lymphocytes. Your body is able to use the current directly to increase energy. That's one effect, that's just the current.

The second effect has been the effect of the frequency, so just unmodulated microcurrent at 3/10ths of a hertz or 6/10ths of a hertz, that's been used since the 70s. People use probes, they'll use adhesive pads. People have used microamperage current for 40 years.

The addition of the frequencies added dimension to the treatment that has been extraordinary. It's as if the current gives your body all of the energy it needs to make the changes that the frequency is telling it to do.

The frequencies appear to resonate probably with the messenger RNA inside the cell or the cell membrane protein receptors which are then connected to the DNA and RNA in the cell.

The frequencies resonate with those structures in such ways to change their function. We're used to using a key to open up a door lock and we're used to drugs and even nutrients as operating like a key in a door lock to change cell function.

The frequencies operate like a key beeper to open the door lock electromagnetically from 20 feet away. It's a model that holds up and it accounts for all of the data that we have.

I injured my achilles in January for some year, 2011, and I treated it twice a month, three times a month with the frequencies for inflammation and chronic inflammation and after a while scarring and it just kept getting worse. I was back on a cane and my achilles was triple the size of normal. It was exquisitely tender. We went to a medical meeting, I had a booth and it was during one of the quiet times and one of our practitioners was working at the booth and I said, "Can you try treating this? I haven't gotten any place with it."

She happened to pick the frequency for torn and broken. She said, "This just feels yucky like there's little micro-tears in it." I said, "What?" She put on the frequency for torn and broken on Channel A, 124 and the frequency for the tendon on Channel B, 191. The pain started to go down and the tendon almost immediately inside of a minute.

The gloves that she was using were graphite gloves we use to conduct the current, they got warm and we sat and talked for an hour because that one frequency combination kept working. By the end of the hour, the tendon was normal size, completely not painful, no pain, normal size and never needed another treatment.

When you look up the mechanism for tendinopathy, the inflammation and hypertrophy in the tendon come from the fact that there is micro-tearing in the tendon that the tenocyte cannot repair, let's say, overnight. The tenocyte begins to express the genes for inflammation and that's why it hurts. It's not of its nature an inflammatory condition, so treating it for inflammation works for 30 minutes but it doesn't do anything.

There is a treatment in a paper that we have where fibromyalgia- people that have full body pain associated with spine trauma- these are your fibromyalgia patients that are exquisitely tender to touch. Light touch makes them sweat. It's probably the most painful of the kinds of fibromyalgia.

The one frequency that takes down that pain is 40 hertz on Channel A, reduced inflammation, 10 hertz on Channel B, the spinal cord. We have data from an immunochemist at NIH showing that all of the inflammatory cytokines go down by factors of 10 and 20 times in 90 minutes.

People that are familiar with cytokines will tell you that cytokines do not change easily. They're hard to change and they change slowly. With FSM, they reduce by factors of 10 and 20 times in 90 minutes. It is unheard of.

What's interesting is they all stop in the normal range, all of it. None of them went below the normal level. The original idea that I had was that somehow the frequencies were unwinding the cytokine peptide. That couldn't happen because they stopped in the normal range. This model where the frequencies changed cell signalling and normalize it is probably correct and we'll be able to test it eventually.

For bodyworkers, let's say every muscle in the right shoulder is tight and tender and has trigger points in it. We've all treated patients like that with our hands. We assume that the muscles were the problem that it's mechanical dysfunction in the shoulder. Most of us have also had the experience of doing that and being able to improve that tissue by 10%, 15%, 20% in an hour long bodywork session.

When you understand that the C5, C6 nerve roots innervate virtually every muscle in the shoulder and we treat inflammation in the nerve and 90% of the muscle tightness, muscle spasm and almost all of the pain disappears in 15 to 20 minutes.

With FSM, the inescapable conclusion is that you run the frequency to reduce inflammation in the nerve. Inflammation in the nerve is what's causing the increased muscle tone and muscle pain and you correct that dysfunction in the nerve and the muscles just quiet down and then treating the muscles easy.

Brooke: I trained with you many years ago and I worked at a holistic medical clinic in Napa that had a lot of pain patients. I was sort of the person who administered the frequency specific microcurrent.I saw it accomplish things that I just couldn't then and cannot now accomplish with my manual therapy practice. You mentioned fibromyalgia from cervical injury, neuropathy, things like that and just seeing people who are dealing with these debilitating pain conditions that respond to very little get better in this non-invasive, very easy way. It was really profound, so it's special stuff.

Carolyn:It continues to improve and shift. You took the course really back before I got good at teaching it and before we had discovered a lot of the things that we're using now.

There is a section on the visceral causes of myofascial trigger points in pain. I had a patient last week and among his complaints, he had sciatica and he had shoulder pain that was associated with a thing from his neck, but he had this area of exquisite tenderness from about T7, to about L2. You would touch him and he would just flinch.

Structurally, from T7 to L1 or L2 is among the most stable, hard to injure places in the body. The only thing that's there is the kidneys. I ran the frequency. I set him up, we treated the nerve with one machine and treated the neck and shoulder with another machine and the third machine up right over his mid-back and ran the frequencies for kidney stone pain.

The muscle was completely non-tender in 10 minutes. I ran it for an hour. When he came back this week, there's a little teeny hint on one side, but that mid-thoracic pain is gone, never came back.

He had kidney stones that he did not suspect. The visceral causes; How do you deal with trigger points in the rectus abdominis that are causing back pain when the triggers points were caused by inflammation in the small bowel because the patient is eating gluten and milk and they're allergic to it?

You can do anything you want to the rectus abdominis. You can treat it for hours and you'll make 5% to 10% improvement. You treat inflammation of the small intestine and it just disappears. That is probably what's changed and refined in the 14 years since you took the class. It's been a voyage of discovery that has just been extraordinary.

Brooke: Somebody who I worked with when I was doing FSMgave me a permission those years to share his story at any point. He was somebody who had a severe injury; He was almost decapitated, and had fibromyalgia from cervical injury, so you know what that means. Extreme burning pain in his hands and feet. He had been a park ranger so he was on disability for years, just miserable stuff.

We did the Frequency Specific Microcurrent and that was it. He get better. He got a home unit and he used it at home. He went back to work as a park ranger in California doing some pretty heavy duty stuff.

Carolyn:We had a police officer, same thing. He has been a motorcycle police officer, he got hit by a car, broke both his arms. He had four surgeries on his forearms. At the end of the third surgery, he woke up with full body pain.

He had been at OHS in the fibromyalgia department for four years using all sorts of meds. He came in, I treated him with that same protocol that you just described, the 40 and 10, and his pain went from a seven and a half or an eight down to a zero. He came back three days later at a four and left it to zero and he cancelled his third appointment.

He came back in a month later and said, "I don't need to be treated. I just came in to say thank you. I've spent the last month taking myself off of all of my medications and my pain level is a two and it never recurred."

Brooke: A lot of people hear about currents and they're going to be thinking about things like a TENS unit or maybe even thinking something like ultrasound. Can you describe how Frequency Specific Microcurrent differs?

Carolyn: TENS is milliamps, it's thousands of an amp and it's enough to cause muscle contraction. Basically, TENS works by putting so much sensory input from the tingling and the muscle contraction. You put in so much sensory input above the level of the pain generators that you block or compete with ascending pain signals. That's how TENS works.

What's interesting is the three studies, Ngok Cheng in 1982 and Seegers in 2001 and 2002, those three studies all show that current levels between 500 and 1000 microamps caused ATP production to level out and current levels above 1000 microamps actually decreased the ATP production. ATP increases by five times if the currents between 10 and 500 microamps.

Microcurrent works locally by increasing ATP production, it changes cell structure.

Ultrasound just makes things vibrate and heats them up. It's like, "Why would you want to heat anything up?"I know there are people that are advocates but it's never made any sense to me. Ultrasound just makes the water molecules in your body vibrate and it creates heat and that would create vasodilation and increased circulation and it's ... It's a completely different mechanism.

Brooke: Shingles is one of the things that I saw a lot of people get remarkably better from, and you have some good research on that as well.

Carolyn: We have a published case report. Not good research, but at least there's something finally in print. The patient has shingles, let's say they're in pain for week or two, then the blisters break out. At that point even or when the blisters first break out for the first two weeks or so, you run that frequency, they are out of pain in 10 to 20 minutes.

If they have blisters, the blisters dry up and are gone within 24 to 48 hours. The case that I published ... I was married to David Simons, the Trigger Point Manual textbook author. I was married to David for the last four years of his life and David had a rash on his head. His dermatologist had said was actinic keratosis. I had a booth at this event and he came to the booth and he said, "You have got to treat me. This is driving me crazy and this medicine he gave me to put on this rash isn't helping."

I treated him for actinic keratosis, his inflammation in the skin. I ran the frequencies for inflammation in the skin and it made his pain worse. If somebody has an infection and you reduce inflammation, that's going to make the infection worse, so that's what told me it was shingles instead of actinic keratosis.

He had the shingles in the ophthalmic branch of the fifth cranial nerve. It was on his scalp down over his eye, down to his ear. The full distribution of the fifth cranial nerve ophthalmic branch was involved.

I treated him at the booth for an hour, the pain was gone, it didn't come back, we went back to our room that night and he fell asleep and I treated him for two hours while he was asleep because shingles in the ophthalmic branch of five in an 85 year old man does not get better, it turns into postherpetic neuralgia virtually 100% of the time and it is what they die of or what they die with. It is horrible.

The anti-virals are incredibly expensive and they make it better after maybe a week at which point it might have gotten better on its own anyway, but this is they are out of pain in 20 minutes and it's gone in two hours. It's crazy.

Brooke: One research study was about the inflammation, reducing inflammation in mice ears. That was pretty clear too.

Carolyn: It was at the University of Sydney in the veterinary science department. There's a researcher down there who had a colony of mice and her professional career as a veterinary researcher had to do with studying the effects of anti-inflammatory drugs and processes on inflammation in this mouse model.

They paint arachidonic acid on the mouse's ears that follows a well-known, well documented inflammatory pathway and lipoxygenase mediated inflammation increases it. Then you do something to the mouse. You give it a drug or you inject it with something and you feed it something and you see what happens to the inflammation.

She painted arachidonic acid on the mouse's ears. The Health World Naturopath picked up the mouse with these graphite gloves and around 40 hertz on Channel A and 116 hertz on Channel B which is the frequency for the immune system. The swelling went down by 70%. The researcher shut down the lab, shut down the study. She had been doing this for 18 years and in 18 years she had never seen any prescription or non-prescription drug that had reduced inflammation by any more than 45%. Anything that did it by 75%, it was suspicious like there's no earthly way that that's working.

She blinded everybody in the lab. She moved the guy who is painting the arachidonic acid on the mice's ears. She moved him into one room and closed the door. She moved the people who are measuring the mice in another room and closed the door and she went in with the guy that was treating the mice, turned the machine away from him so he couldn't see it and she put in a placebo frequency.

With all of those controls, it still reduced inflammation or reduced the swelling by 62% in four minutes. It was time dependent. Half of the effect was present at two minutes, the full effect was present at four minutes.

Then she did a cyclooxygenase mediated inflammation. They paint myristyl cerate on the mouse's ears, the ears swell out and you can measure that swelling. That's a COX mediated pathway and they ran 40 and 116 and it reduced the inflammation by 30% which doesn't seem good except that that was equivalent to injectable Toradol when it was studied by the same researcher in the same animal model.

We have data that supports the use of frequencies and Frequency Specific Microcurrent in every inflammatory condition; asthma, pancreatitis, cirrhosis, liver enzymes, irritable bower, Crohn's, ulcerative colitis. Anything that is not infected; rheumatoid arthritis. Anything that is associated with inflammation; most of the dementias, most of the neurologic conditions that are associated with inflammation.

It was an extraordinary breakthrough and the only unfortunate thing was that she had 20 mice that were in this first group and the end wasn't big enough to satisfy the critics and the skeptics and so she wouldn't publish it. We have this beautiful piece of research. She is completely ethical and objective and she assures me that it is reproducible that if we found somebody with a mouse colony in the same sort of expertise, we could reproduce the findings.

The cytokine data shows that we can reduce inflammation in the nervous system. Between those two things, any inflammatory process ... Ovarian cysts, you can feel them shrink and it's you running the frequency for inflammation in the ovary and you can feel the ovary if you're trained in that kind of palpation. You can feel the ovary go from the size of a grapefruit to the size of a golf ball or loquat in 15, 20 minutes.

Brooke: Circling back a little to fibromyalgia, one of the thing about that. When I had trained with you, you differentiated different types of fibromyalgia which I think is so helpful that they don't all get lumped in to the same thing. Can you speak to that a little bit?

Carolyn:It's a neuroendocrine pain problem. Patients end up with very similar appearance and difficulties at the end of it, but how they got there ...

There's one group that's probably 30% to 40% of fibromyalgia patients get there because they have a spine injury, a neck injury, and that inflames the spinal cord and that gives them full body pain.

Then after you've been in pain for one to two months, your endocrine system just gives up the ghost and you end up with the endocrine difficulties, but there are patients that don't have that. Their mechanisms are different, so there are patients who get full body pain because they have been exposed to organic chemicals or pesticides, their liver can't handle the detoxification just because of their genetics.

The organic chemicals get in to the nervous system membranes and change the firing characteristics and create pain and the pain takes you down. This endocrine stress cycle that creates the other symptoms we associate with fibromyalgia.

There are some patients where they have fibromyalgia but what they have was poorly managed menopause. They are estrogen dominant, progesterone deficient that gives them a sleep disturbance and fatigue and then they have trigger points in the neck and their low back and that gives them the body pain.

Then the combination to the pain, the fatigue, the estrogen dominance that ends up creating this milieu that we call fibromyalgia. There are some patients who have it because they're vitamin D deficient.They have vitamin D levels of 7 or non-detectable or 12. You get their vitamin D levels up to 50 or 60 where they belong and the fibromyalgia goes away. Then they still have to transition off of all the drugs they're on to be able to have a life.

There's another group that has full body pain because of basically food sensitivities. It's serum sickness, it's not IgE food allergies where you eat a peanut and you turn bright red and you fall over. It's macrophage mediated food sensitivity.

The IgG antibodies have multiple sites for antigen to stick to. Let's say you're sensitive to gluten and you've got these IgG antibodies and if you put your hand out in front of your face, you're going to see five fingers and each one of those fingers has room to hook on to a little gluten peptide and they stick to each other.

The IgG antibodies form circulating mats when they stick to each other and make little antigen antibody complexes. The macrophages are kind of like your clean up guys. Macrophages come along and hoover those up, vacuum those up and the macrophages are not great at appetite control. They eat as much as  they can and then they explode and they release histamine everywhere.

Histamine stimulates class C pain fibers which are the slow multi-modal achy pain fibers. The pain can get quite intense. That creates the pain and you can develop these food sensitivities at the age of 20, 30, 40, any place in there once your body gets in pain. Histamine stimulates alertness in the brain which is why anti-histamines make you sleepy.

Histamine interferes with sleep. The histamine creates pain and once you're sleep deprived and in pain, it doesn't take three to four months and you'll develop fibromyalgia. The way to fix that group is to put them on an elimination diet, get them off of the most likely foods with no cheating for six to eight weeks. Body pain goes down, you treat them with microcurrent, you treat their gut, you treat the muscle pain, quiet down the gut, treat the liver, treat the adrenals.

The studies that we had out of my clinic takes about four months for fibromyalgia patients to recover. You get their pain down and the neuroendocrine system just writes itself. Their energy levels come back, they start getting tired at night instead of waking up at night. Their digestion improves. Their allergies settle down. It's pretty extraordinary.

There's another group that gets immunized so they get a flock of immunizations to go to China or Africa and they are never well after that. There's another group that will get a viral illness of some sort, some sort of retrovirus and they had immune system compromises after that.

There's six or seven different ways I think in my textbook Frequency Specific Microcurrent in pain management. In the textbook, there's a chapter on fibromyalgia and those types and how you diagnose someone, really how you treat them is included in that chapter on the textbook.

Brooke: It's so helpful, because I feel like it has been wrongly just dumped into the same basket for so long which is why so many people struggle with it and don't know how to get out of it.

Carolyn:They're told it's unfixable. It is not a Prozac deficiency, it isn't an Advil deficiency, it's not a Celexa deficiency. You have to be willing to look in the history and find out where it came from.

One patient comes to mind, she lived out in Hood River which is an agricultural area and she had brain fog and body pain and she gained 80 pounds and she had fibromyalgia. She was a mess.

The history took an hour and a half. I kept looking for what would have caused it. No auto accidents, no food sensitivities that she knew about or she was already on in an elimination diet. I said, "Well, have you ever been exposed to organic chemicals or pesticides?" "No." "When did your symptom start?" "2000." "Have you ever lived on or near a farm or near an orchard?" She said, "Well, yeah. We live in a house in the middle of an orchard."

I said, "An organic orchard?" "Oh, no, the men come in moon suits twice a month and sprayed the trees and they tell us to just stay inside for an hour or two and it will be fine." I said, "Do you have city water or well water?" "We drink water from a well that's on the property."

"When did you move in to this house?" "'99." Her symptoms started in 2000 and she never associated the two because her onset was so gradual. I said, "You have to move." We treated her for toxicity and her pain went down but it wouldn't last because she kept going home.

She went on vacation, went to stay with an aunt for a month, took the husband and kids with her. She got better. She moved back, she got sick again, they move and she recovered and she was fine after that.

It comes from some place. It does not just land on you from space. It is not just central sensitization, it is not a Celexa deficiency, it's not a serotonin deficiency most of the time, sometimes it is, but it's fixable.

I confess I got a little frustrated with the fibromyalgia community because they don't want it to be fixable. It's like they can't get their head around the concept that it comes from some place and then if you address the place that it comes from, you can fix it. That is my contention.

Brooke: Is there anything on your mind or in your practice these days?

Carolyn:  This has been the year of the relationship between the cerebellum, the spinal cord, and the neuromuscular system.  It's also been the year of the visceral connection to myofascial pain.

This lady with the pelvic floor spasms, the man with the thoracic pain where it comes from kidney stones and the pelvic floor spasm where it came from the uterus. That's been the last couple of years, but this last year, dealing with patients who have spinal cord myelopathies or spinal injuries and ...

Basically rebuilt a peripheral area like the shoulder or the hip and the leg, you've changed all the scar tissue, changed the mechanics and then the brain has to figure out how to get this region to function normally biomechanically to have all the muscles fire in the right order.

The shoulder muscles have to fire in a certain order in order for the shoulder to move properly in a coordinated fashion. We treated the shoulder, that wasn't doing anything and I was out on the exercise floor and we had the microcurrent around my neck and around my upper arm and we ran the frequency to increase secretions in the cerebellum and the shoulder coordination mechanics completely changed in 10 seconds. It was crazy. It was like, "Did that just do what I think it did?"

The PTAs are watching me go, "Yes." We exercised with that running for about five to ten minutes and so the muscle coordination was good but it was still hard for me to find the muscle. She'd say, "Okay, now move us or contract that." It was hard to locate it.

There's a frequency for the sensory cortex, so I ran the frequency being my own guinea pig, increased secretions in the sensory cortex and in a way that is very difficult to describe, all of a sudden I could find my shoulder. I could find the muscles.

We started doing this with patients who were in rehab, increased secretions in the sensory cortex, have them move it and they can find it then increased secretions in the cerebellum and the spinal cord and the nerve and you can follow that whole train from the brain down to the extremity.

When you get to more elaborate RSD kinds of neurologic dysfunction or spinal cord injuries or brain injuries, a little more complex peripheral injuries, when you can manipulate the brain to connect with the periphery, it's a total game changer. It takes eight months worth of work and compresses it to about an hour.

Home play!

Some goodies on resonance to watch and ponder:

First, from The Gentleman Physicist

Next, an artist using sound resonance to make art with water

Last, one more crazy sound/water experiment

Resources

Frequency Specific Microcurrent website

Frequency Specific Microcurrent in Pain Management textbook

video of FSM

Seegers ATP research

 Microcurrent Experimental Results (mouse ear research)

Microcurrent Treatment of Myofascial Pain in the Head, Neck, and Face

Cytokine Changes with Microcurrent Treatment of Fibromyalgia Associated with Cervical Spine Trauma

Microcurrent Therapy: A Novel Treatment Method for Chronic Low Back Myofascial Pain

Non-Pharmacologic Treatment of Shingles

Non-Pharmacologic Treatment of Neuropathic Pain Using Frequency Specific Microcurrent

Visceral and Somatic Disorders

Todd Hargrove: Pain Science and How to Be A Happy Mover (LBP 025)

Todd Hargrove of www.bettermovement.org, and author of  A Guide to Better Movement is talking about what happy movers have in common, how learning better movement is more like sculpture than painting, the feather-ruffling information that posture does not predict pain levels-and how posture still matters and why. We also dig into motor control, cortical maps, the neuromatrix model, and all kinds of wild things about how perceptual tricks affect our brain and our perception of our body which gets us asking, “What is pain really?”. Of course we also discuss what our nervous system wants from us in order to keep it from creating pain and dysfunction in the first place so that we can all be happier in our bodies.

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Show notes

Brooke: You used a great Tolstoy quote and related it to movers. The quote is , “happy families are all alike; every unhappy family is unhappy in its own way.” and you write that the same is true of happy and unhappy movers. What are some of the things that happy movers do have in common?

Todd Hargrove (all from here on unless noted are Todd): The point of the quote is that there are many more ways to do something the wrong way than the right way. If you watch novice runners running, you will see them doing a lot of idiosyncratic things- the way their foot is swinging, or their limbs are swinging- but if you watch elite athletes move, you will see much less variation in their movement.

In the book I identify 10 or 11 characteristics of good movement. Things like mobility, stability, posture, coordination, efficiency [and more]. But one of the things I can illustrate is distributing the work of movement which means many different joints in the body working together in an intelligent way. Handling the compressive stress every time you take a step- a really efficient runner would have all the joints sharing that stress. There is not one place that is taking all that work. It’s evenly distributed.

For example, if you are standing up and looking behind you- the ankles move a little bit, the hips move a little bit, you have 24 vertebrae that all rotate a little bit. All the different parts of the whole cooperate in that movement. But if some of the parts aren’t doing their job- sometimes you’ll see this as 4 or 5 vertebrae stuck and moving in a block- then other vertebrae are going to work harder. The essence of good movement is really harmonious coordination of all the parts

Brooke: You also say in your book that “Learning better movement is more like sculpture than like painting.”

The tricky part is to relax all the muscles you should relax, to get out of the way of yourself.  If you think about playing the piano, the hard thing is not hitting the key at the right time, the hard part is not hitting the key right next to it at the same time. It’s very easy for muscular activation to spread from one area to another.

So if you see novices fencing or doing a golf swing they are going to have a lot of unnecessary muscular tension. They move one area and other areas move at the same time. What characterizes really skilled movement is the ability to relax things, that’s why good movers always look easy, they don’t have a grimace on their faces, they don’t have this parasitic tension.

Brooke: You mentioned that marathon runners use 30% less energy than novice runners, and that people often train to “put a bigger engine in the car” [getting stronger, fitter, etc], when they really should just try to take their foot off the brake.” in this example would that be what you’re saying, learning how to relax this parasitic tension and take the foot off the brake? Or are there other ways to conceive of the tension too?

They are using their energy to move forward, and part of running training is getting stronger and increasing your power output. But another part should be getting out of your way- so each time you use your muscles to push yourself forward you are using all the muscles in your posterior chain. But if at the same time you are still contracting the hip flexors a bit, and you try to get the hip to go back, that will get in the way.

A skillful mover will be able to inhibit that unnecessary tension. So every time you contract a certain group of muscles to do a certain job, you are also relaxing the opposite group of muscles- it’s that coordinated teamwork.

Brooke: Posture- this can ruffle a lot of feathers in our fields, but a lot of studies are showing that differences in posture do not correlate to or predict differences in pain. (in resources)

Yes it is very surprising and it’s very counterintuitive to people like us who are working to get people  moving better and feeling better. We’ve directed a lot of attention to posture and looking at pain problems as being caused by bad posture, but there has been a lot of research looking at people’s posture and trying to correlate pain, and they don’t find those correlations there, so it’s really a wake up call to people who are putting excessive importance on static posture as something that causes pain and that we can fix to improve pain.

Brooke: Yet this doesn’t imply that posture doesn’t matter.

Yes we kind of throw out the baby with the bathwater sometimes. Posture is obviously very important for good function. Anytime you want to get something done in an efficient way, the alignment of your spine is going to be very important. If you want to do a heavy dead lift, or if you want to throw a baseball, or anything really. There is a great quote form a Russian physiologist Nikolai Bernstein  that I like, “trying to move with bad posture is like trying to write with a floppy pencil”. The orientation of the spine is the base from which our limbs move, and it matters.

It’s a pretty complicated question. I think you can predict injury [with posture]. If you do a dead lift with a rounded back you can predict that person is more likely to get injured. The world class spine biomechanist Stuart McGill says that about dead lifting. But if you look at someone’s static posture as they are standing, it is right to conclude that if you look at their posture you wouldn’t be able to predict if that person has pain.

Brooke: That brings us into motor control. Is there a nutshell version of what that means?

It’s the process by which your nervous system controls all your movements. You have all these different muscles and each muscle is broken down into different motor units and they can contract separately, and the nervous system can issue commands to contract these ones and relax those ones. You can think of it like you are a marionette with all these different joints that can move and all these different rubber bands that can move them- thousands and thousands and thousands of rubber bands- and there are strings attached to all of them. To move that marionette intelligently you would have to figure out what string to pull at what time, it’s an amazingly complex job that requires an amazing amount of information processing and intelligent decision making to get the job done.

There is a massive amount of unconscious brain power devoted to doing this. We have computers and robots that can beat chess champions, and win on Jeopardy, but we still haven’t built a robot that can do simple motor control things that  3 year old kid can do. We can’t build a robot that can walk over and load a dishwasher. Motor control is an amazing accomplishment of the brain. And we don’t really recognize how difficult it is because so much of it happens unconsciously.

Brooke: It’s amazing to think about how much of our brain is dedicated to movement. That our brain is really for us to move.

If our thoughts and emotions don’t end up in some sort of a movement- like walking to the store or reaching for a cup of coffee- then it’s all irrelevant it’s all wasted.

Brooke: You write about cortical maps, or body maps, and that the state of the map has big implications for how we feel.

The maps are part of the way we process information to get motor control done. We have discrete parts of the brain. A little part of the brain is devoted to gathering information from the body about what is going on in that part of the body, deciding what it means, and issuing commands to do something about it. So if I get touched on my hand, it activates sensory receptors and sends a message to the to the brain: “Something just happened down here, I just got touched on the hand.”, and the part of my brain with the map for my hand goes to work in figuring out what’s going on there and figuring out what to do about it.

The interesting things about these maps is that, for one thing, they are all different sizes depending on how much work needs to be done by the brain in figuring out what is going on in those body parts. So the map for my hands is huge, because my hands need to have this incredibly differentiated sense of perception. By contrast, the part of my brain that listens in on what is going on in my elbow is small, because it does not have major sensory demands.

If I’m a musician and I have to have a great awareness of where my fingers are and what they are doing, the map for my fingers and my hand will grow bigger in my brain. On the other hand if I really neglect moving in a certain way, my map will smudge, shrink, and not be as good at doing its job at sensing and moving that area precisely.

Brooke: There is a huge paradigm shift going on right now in understanding pain that takes into account these maps and motor control, but it’s also being explained quite a bit by the neuromatrix model.

The neuromatrix model is a way of explaining pain. It is simply the pattern of brain activity that gives the subjective experience of pain. Pain is an unpleasant conscious experience and it is designed to protect you against what the brain perceives as a threat to the body to motivate you to do something about it. Pain is an output of the brain- it is something the brain creates to warn you of the situation.

The reason I make that clear is that sometimes we get confused about pain and tissue damage. Tissue damage is damage in the body. It results in a sensory signal, a nociceptive signal coming from that damaged area. That’s not pain yet. The damage is just damage, and the signal is just a signal. It goes up into the brain and then the brain decides what to do about it. It’s not going to create pain unless it decides, “This is a dangerous situation, we need to create pain to protect us from that potentially dangerous situation.” It might decide, “I hear those nociceptive signals, but I don’t want to create pain right now because I don’t think that’s a good idea.” For example, if you were a soldier, and a toe got cut off, it would surely activate nociceptors in the foot and send a signal, but the brain might not create pain, because the pain might not promote your survival very well. The brain might think, “We’re not going to create pain because we need to run across this field and to get out of this emergency situation.” That’s why people often don’t feel pain in emergency situations.

On the other hand, there might be a relatively innocuous situation going on in the foot, and there is sensory information coming into the brain, and the brain for some reason interprets it as a very dangerous situation for the foot, and so can feel a lot of pain even though there is not a lot of tissue damage. That might be why tissue damage doesn’t correlate all that well with pain. It’s because the important decisions are being made in the brain by the neuromatrix.

The brain can be confused. Something happens in the body, the sensory organs report it, and it’s like a big game of telephone. The spinal cord receives that information from the body, it can suppress that signal, it can amplify that signal, it can misinterpret that signal as it goes to the brain. When you have a heart attack the problem is with the heart, but people often feel it in the left arm. It’s because the brain doesn’t really now what is going on, because it doesn’t usually receive signals from the heart.

Anytime you have referred pain there is this issue of miscommunication going on. And that’s why maybe the accuracy of the maps- their ability to accurately read what is going on in the body- is important for dealing with certain pain in the body.

Brooke: You describe it as “smudges” in body maps. That this can be a significant factor in contributing to chronic pain conditions.

It might be. People with chronic pain are found to have these smudges in their maps. You can see it on an MRI. The physical parts of their brain devoted to sensing different body parts, those delineations aren’t as clear. People in chronic pain don’t do as well on various tests of body awareness compared to people who have less pain. If you ask the person with chronic back pain to draw their back, they don’t draw the outline as well as people who have less pain. They locate the spine closer to the side that has pain. They don’t do as well on test of lumbo-pelvic control; They don’t have quote as good coordination. People in chronic pain, there is this connection between loss of body awareness and pain. That might be a two way street, we don’t know whether the pain is causing poor awareness, or the poor awareness is causing the pain. But it seems there is a dynamic relationship there.

Brooke: Some of the really interesting research you pointed out were researchers who found they can cause pain by creating sensory illusions.

The use of illusions is a way to trick your brain into perceiving something that is not there. One is the rubber hand illusion [resources] Here you put a rubber hand on a table right out in front where you can see it. You put if where your left hand would normally be, and your left hand is out of sight behind a screen. Your left hand gets tricked by the experimenter in a certain rhythm, while the rubber hand is stroked in an identical rhythm. So you are watching that rubber hand getting stroked at the same time you are feeling your actual hand getting stroked.

What this does is it fools the brain into taking ownership of that rubber hand. You get this visceral feeling that this hand belongs to you, and you’ll flinch when someone goes to hit that rubber hand.

What’s super interesting is that the hand that is out of sight, the brain disowns it. Less blood flow goes to it, it will suffer more inflammation. It’s almost like the brain is saying, “That’s not a part of our body anymore.” The takeaway here is that it’s important how the brain looks at your body.

Brooke: Hearing this it can maybe make us feel nervous, like we are at the whim of this strange dictator, and you write to think of the nervous system as an intelligent, overprotective mother.

But overprotective mothers can be kind of like dictators. One of its important priorities is keeping you alive. It doesn’t really care how you feel, it cares about keeping you alive to pass your genes along to the next generation. Sometimes overprotective mothers can be the same way. The care about you being safe, so they don’t let you go out and play. The nervous system, to protect you from yourself, it creates pain when it perceives that an activity is dangerous. It might make you stiff to keep you from going into what it perceives too much range of motion. It might make you tired to protect you against what it perceives as too much activity.

The idea is that part of the way we can improve ourselves is to convince that overprotective mother that what we’re doing is the safe thing to do. I think that’s what we’re doing when we do exercises in a safe, mindful, non-threatening way. You are sending good news to the nervous system. And it decides, ok, you can do that forward bend. It’s a lot of why bodywork works, and yoga works, is that you convince that overprotective mother to cut you some slack.

Brooke: A lot of your book is dedicated to Feldenkrais lessons.

Feldenkrais is a system for using these slow, gentle movements for more mindfulness and efficiency. Let’s say it’s not comfortable for you to reach your arm over your head. In a Feldenkrais lesson you can start doing the movement very slowly, really break it down and you repeat a small version of the movement enough times so that you are starting to chill out the nervous system and to show it that it is a safe thing to do. The hopeful result of the lesson if things go well is to gain subtle awareness about details that we might normally miss.

Brooke: On the opposite end of the spectrum, one of the ways people can reinforce negative maps is to push themselves through the pain.

You see that all the time in type A people who have a no-pain-no- gain attitude to the movement.  And to some extent that’s true- sometimes doing hard exercise can be a little bit unpleasant and you push yourself through that as a way to get your body to adapt and be more fit. But you can push yourself harder than your body can adapt as well, and you create a cycle of injury, and pain can be a habit. The more we create a certain kind of pain, we get better at creating that kind of pain.

Brooke: As a personal interest to me I found it fascinating when you talked about poor skill in motor inhibition and increased tendency to poor impulse control disorders like ADHD and even addiction. It’s an interesting bridge between movement and behavior.

The ability to inhibit unwanted movement is something we work with in Feldenkrais. You’re doing a very slow movement trying to inhibit unnecessary tension as you do the movement. Apparently, there is some correlation between inhibition like that and also inhibiting making of risky bets, or engaging in impulsive behavior.

One of the ways they can test that that is a stop task. You are looking at a computer and hitting a certain key every time something happens, but the next time something comes up on the screen and you have to inhibit yourself from continuing to hit that. The people who are better at inhibiting themselves from hitting that key are also better at inhibiting themselves from drinking too much.

I think there may even be a study [resources] that showed when people practice these stop tasks, and get better at this inhibiting themselves from unwanted motor responses they actually also decrease their tendency to engage in impulsive or compulsive behaviors. What the researchers had in mind is that our emotional skills in inhibiting unwanted behaviors and emotional responses is probably built on the same framework on which we are inhibit unwanted motor responses. So there might be a general skill there that is developed by motor control training. There have been a lot of traditions like yoga and martial arts where you are really training the mind and training your emotion by movement.

Brooke: I would love to see the world showing that bridge more and more- that training in good movement patterns will help them with these other issues.

Brooke: One other thing you point out is about play, that children in general don’t learn fundamental movement patterns through work, or through instructions.

It’s interesting to look at the way kids develop their motor skills. Within 2 years they go from a quivering blob on the floor that can’t do anything to someone that can walk across the floor and perform thee amazing feats of motor control. There’s something to be learned by how that development takes place. It doesn’t happen by a coach telling a kid exactly what to do. It happens by a kid following their own interest and doing what they want to do. They actually learn extremely fast. I think there is something we can learn from that as we try to do anything better;  Having an attitude that is playful, exploratory, and curious. If you want to get better at tennis you are going to have a coach, but it’s also important to go out there and explore things in ways that are interesting to you and to do your own thing. You can bring that to any practice.

Home play!

I read through a very abbreviated version of one of Todd's Feldenkrais lessons in his book, A Guide to Better Movement. The book has many lessons for improving your motor control and your cortical maps. This particular one that I go through in the podcast is flexion/extension patterns in quadruped.

Resources

Todd Hargrove's site, www.bettermovement.org

Todd Hargrove's book, A Guide to Better Movement

On posture not correlating with pain: Christensen, Hartvigsen "Spinal curves and health: a systematic critical review of the epidemiological literature dealing with associations between sagittal spinal curves and health."

The rubber hand illusion increases histamine reactivity in the real arm: Barnsley et al.

The Feldenkrais Method

Studies on motor control and inhibition of risky behavior or impulse control: Spierer et al, "Training-induced behavioral and brain plasticity in inhibitory control, and Verbruggen et al "Proactive motor control reduces monetary risk taking in gambling"

If you liked this episode

You might like:

Steve Haines: Body Maps and Interoception

Bo Forbes: Mindfulness Expressed in the Body

David Weinstock: Neurokinetic Therapy and Motor Control Theory

Constance Clare-Newman: Alexander Technique