Pam Kamoku Aug. 2017
Functional Disorders Essay 1 – Summary Chapter 1 – Musculoskeletal Conditions
1. Muscular Dystrophy Def’n – a group of neuromuscular diseases described by genetic irregularities that lead to degeneration and wasting away of muscle tissue.
Origin/Cause – inherited genetics (genetic mutations) & spontaneous genetic mutations where there is no family history – Duchenne MD is most common and affects 1 our ever 3500 boys in US (1/3 are spontaneous). Becker MD occurs in 1 out of every 30,000 birhts of boys. Other forms: Myotonic MD –most common form of adult onset MD (affects both men and women) and primary symptom is myotonia: stiffness or spasm following muscular contraction (one of my clients LG has this). Myotonic MD appears in 2 different forms (type 1 & 2)and is a progressive disorder that affects many systems (can cause cataracts, gastrointestinal dysfunction & life-threatening heart problems. And there are about 5 other varieties mentions (pg. 73) Conventional treatment options – because it’s a genetic disorder, no treatment to reverse or cure MD exists. There are interventions that work to prolong the use of muscles and limbs, including massage & physical therapy. Surgery is sometimes recommended to release tight tendons or to straighten a distorted spine (yikes). Please do Somatics instead. J Exercise is recommended and there are some medications they talk about for symptoms that come with MD.
Clinical Somatic cautions – help client understand moving in their pain-free range and about effortless effort. Help them gain awareness in their body and how some days will feel different than others with their muscles tightness/spasms. Teach them about moving well to their best capacity on any give day. I’ve used somatics with my MD client and besides supporting her parasympathetic nervous system (which in turn supports all the other systems), she has learned a great deal about moving slower, moving with conscious awareness and not trying to push so hard. Less is more. She feels like some of her tight spastic muscles let go after our sessions.
2. Spasms & Cramps Def’n – an involuntary contraction of a voluntary muscle. The difference between spasms and cramps is a bit subjective: cramps are strong, painful, usually short- lived spasms. The book described a chronically tight, painful paraspinals are in spasm, while a gastrocnemius (calf) with a charley horse is a cramp.
Origin/Cause – some of the most common reasons for muscle cramps/spasms are: 1) Nutrition (ie. calcium, potassion & magnesium deficiencies as well as water, glucose and sodium intake).
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2) Ischemia – muscles or part of muscle is suddenly or gradually deprived of oxygen. Long term tight postural muscles can become self-perpetuating in this way. 3) Exercise associated muscle cramping (vigorous work out, dehydration, electrolyte imbalance and hyperthermia may be contributing factors, but interestingly enough, a neurological element is present). 4) Splinting – a reflexive reaction against injury (ie. whiplash). Conventional treatment options – Massage is used to treat long term muscle spasm, as well as heat or ice, ointments - to create blood flow. Analgesics sometimes are sometimes used for pain management. Clinical Somatic cautions – I would say that that you’d need to be careful when using pandiculation that the contracting phase doesn’t cause more spasm/cramping when contracting into. There would need to be a teaching period of reeducating the student/client on how little some of the movement needs to be and to really listen their body and the messages that it’s giving.
3. Strains Def’n – strains are injuries to the muscle fibers that consist of tearing myofibers and creating scar tissue. Origin/Cause – they can happen as result of specific trauma; however, they often come about within chronic, cumulative overuse patterns with no specific one-time injury. Conventional treatment options – early intervention in the healing greatly improves the prognosis or end result in the healing. Treatments should involve a) an accurate diagnosis; b) control inflammation; c) rehabilitate damaged tissues; & d) preventative measures to avoid further injury (including dealing with the weaker muscles, improving techniques). Anti-inflammatories often given. Clinical Somatic cautions – I’m curious if waiting a period of time for some healing of inflamed tissues may be beneficial before doing somatic work in the directly affected area; however, doing small gentle movements of somatics in the rest of the body may be a good way to not have the person compensate in other areas or become amnesic in areas unused. 4. Bone Disorders: Osteosarcoma Def’n – is a form of cancer that starts in the bone tissues (most common in adolescents and young adults). Origin/Cause – osteosarcoma is relatively rare, except in children/young adults, where they’re most susceptible during growth spurts. It begins in bone cells, unlike metastatic carcinoma, which begins elsewhere. Osteosarcoma typically grows as one major tumor at time and commonly found near the growth plates of long bones (i.e. the femur, proximal tibia and proximal humerus are common).
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Conventional treatment options – normally treated with orthopedic surgery to biopsy the growth, to remove it with clean margins & support the remaining bone (sparing the limb if possible). Chemotherapy is often a standard follow-up treatment since many patients experience a relapse. Clinical Somatic cautions – since osteosarcoma can look like growing pains or a simple tissue injury, it’s good to be cautious and refer if a young adult/child comes in with similar symptoms. IT might be beneficial to rule it out by a doctor visit and then move forward with somatics. 5. Osgood-Schlatter Disease
Def’n – (OSD for short) – is irritation and inflammation at the site of the quadriceps attachment on the tibia (AKA: tibial tuberosity apophysitis. Origin/Cause – it occurs when the quad muscles are strongly used in combination with rapid growth of the leg bones, typically during an adolescent growth spurt in young athletes. There is acute inflammation of the quads attachment and the tendon can pull away from the bone, causing lots of tiny fractures. Although OSD cases vary greatly, most subside when the tibia fully hardens/solidifies, late in adolescence. Conventional treatment options – reduce pain and limit damage to the tibia. Milder cases can be manages by warming up and ‘stretching’ the quadriceps and hamstrings before exercise and icing them afterward. Sometimes nonsteroidal anti- inflammatories are given for pain & inflammation. Severe cases have the athlete stop activity until the pain/inflammation are gone for a few weeks. Support from a brace or cast can also be used. Also rehabilitative exercises are used to strengthen the muscles and decrease risk of recurrence. Clinical Somatic cautions – to continue to teach quiet awareness in movement patterns, so the client can continue to move well even when they are limited form athletic performance. Teach good movement patterns and pandiculate what that individual needs (as far as their other patterns of life show) & if needed to that the areas of quads &hams that they wrote about ‘stretching’ you can educate the person on why pandiculation is a better option rather than stretching – especially if they want to continue with athletics. More than likely their sport activities has them going into memorized patterns that they may have SMA in. 6. Osteoporosis
Def’n – it literally means porous bones – where calcium is pulled off the bones faster than it’s replaced, leaving them thin, fragile and prone to injury.
Origin/Cause – more common in causcasions and Asians and while it’s usually diagnosed in 50s and 60s, it is usually closely related to events, habits & activities of earlier years. To look at factors such as calcium absorption, calcium loss and bone density maintenance can help determine a person’s risk (also, accessibility of other
3 Pam Kamoku Aug. 2017 vitamins & minerals, exercise habits and pH balance in blood, other diseases, medications and even emotion state). Conventional treatment options – pharmaceutical methods include hormone replacement therapy to influence estrogen or calcitonin, bisphosphonates, SERMs (selective estrogen receptor modules) – which all come with risks of their own. Exercise is practically always part of the treatment strategy (particularly weight bearing exercises to ensure the maintenance of healthy bone mass). Diet also plays an important role and specific vitamins may help improve the calcium uptake. Interesting note to “avoid substances and behaviors that pull calcium off bones like tobacco, excessive salt, animal-based proteins and excessive caffeine and alcohol”. Clinical Somatic cautions – some small movements done by client and/or with the pressure/weight of our hand, could cause small fractures because of undue pressure or problematic positioning on the table/floor. Also remember, older clients generally have more than one pathology, so they don’t only have the osteoporosis and they may be more fragile.
7. Postural Deviations
Def’n – the curves in the cervical, thoracic & lumbar areas of the spine sometimes have over developed curves, which reduces the resiliency and strength of the spine. (i.e. hyperkyphosis (humpback), hyperlordosis (swayback) and scoliosis (S, C or reverse C-curve) and rotoscoliosis (scoliosis w/ a twist) are the ones addressed here.
Origin/Cause – the causes of most postural deviations are not fully understood, so the term “idiopathic” is often applied. There are researchers who say that some factors include bone density, environmental exposures, genetic predisposition and other postural & functional compensations. Most cases are idiopathic; unknown origin; however, a small amount of structural problems in the spine are relate dot congenital or neuromuscular problems such as cerebral palsy, polio, muscular dystrophy, osteogenesis imperfect or spina bifida.
Conventional treatment options – Most postural conditions are treated (if at all) with chiropractic or osteopathic manipulation, physical therapy and exercise protocols. Sometimes bracing is used for external support and surgeries are sometimes performed with implants or internal braces, which often require another surgery because it doesn’t last. Clinical Somatic cautions – these postural deviations could be more than likely SMA or overly engaged/contracted muscles pulling on the spine to deviate it. Habitual patterns can cause each of these conditions. This would be an educational process as is all Clinical Somatics, but to be aware of if the condition is related to any of the diseases mentioned above. Also, I imagine that if someone strongly believes it’s a ‘structural’ condition (even though it’s been diagnosed as idiopathic), if the belief is
4 Pam Kamoku Aug. 2017 so strong, it may take some time to help him or her understand the neuromuscular aspect of it.
8. Joint Disorders – Adhesive Capsulitis Def’n – also know as “frozen shoulder” – where the connective tissues that surround the glenohumeral joint become first inflamed and then thickened and limited. Generally the disorder can be resolved, but for some people it leads to a lifetime of limited range of motion in that shoulder.
Origin/Cause – often involves someone in their 50s or 60s (but not limited to this age) who experiences pain in one shoulder (especially at night). Some experts believe that it begins with an adhesion between the anterior aspect of the glenohumeral capsule to the head of the humerus, while others say it involves the rotator cuff and biceps muscles and the subacromial bursae, saying the thickening in the join capsule is secondary. There is also shown to be an anomaly in the quality of collagen fibers in the area.
What is very interesting is the excessive pain signals that are noted with this condition imply some similarities to CRPS (complex regional pain syndrome), a condition that involves a “self-sustaining pain feed-back loop between the central nervous system and peripheral tissues”.
Conventional treatment options – the treatments recommended vary and depend on the stage of progressions to manage pain and to restore mobility as much at possible – ie. physical therapy and drugs for pain management. No single treatment is consistently better (according to the book) that just letting the condition run it’s course from “freezing” to “frozen” to “thawing”. They’ve even recommended surgery to loosen the joint capsule or joint manipulation under anesthesia, or a nerve block to temporarily deaden the subscapular nerve.
Clinical Somatic cautions – teaching the person to move in an appropriate range while they’re in pain. Small movements of neuromuscular retraining may heal them faster than waiting for the thawing out on their own.
9. Baker Cysts Def’n – are synovial cysts found in the popliteal fossa, usally on the medial side (aka: popliteal cysts) – behind the knee.
Origin/Cause – these cysts form when the joint capsule or a bursa at the back of the knee develops a pouch at the posterior aspect. They usually stick out forming a bump behind the knee – and the theory is they are a protective mechanism to prevent too much fluid accumulation at the knee in the context of chronic inflammation. When adults develop these cysts, it’s almost always related to other joint problems: osteoarthritis, rheumatoid arthritis, lupus, gout, or knee injuries,
5 Pam Kamoku Aug. 2017 including cruciate ligament tears or meniscus tears. While Baker cysts are generally not dangerous, if they become big enough to impair the blood flow in the vein at back of leg, there is a risk for thrombophlebitis or deep vein thrombosis.
Conventional treatment options – first treated with ice and a nonsteroidal anti- inflammatory and if this is unsuccessful, they may be aspirated (removing the liquid), followed by a cortisone shot to get rid of joint inflammation. This is often an impermanent solution & some surgeries have been performed.
Clinical Somatic cautions – because you’re dealing with a cyst that could affect blood flow at the back of the leg, its not really a muscular condition; however, there could be side affects due to the pain and how the body responds to that by compensating, so somatics would be good to keep the body from going into unhealthy/dysfunctional habitual patterns.
10. Gout Def’n – it’s a type of inflammatory arthritis that is relatively common in men between 40 & 50 years as well as women who are postmenopausal. Origin/Cause – genetics, taking certain meds (especially diuretics, aspirin, and some PD drugs), being overweight and having a high consumption of alcohol and purine (meat, organs and seafood) - rich foods (causing high uric acid). Conventional treatment options – 3 layers of treatment: 1) pain relief (w/ analgesics other than aspirin); 2) anti-inflammatory drugs, and 3) drugs that modify metabolism and uric acid management to prevent future flares. Other preventative treatments include increasing fluid intake (especially water), losing weight and limiting purine-rich foods. Clinical Somatic cautions – when joints are locally inflamed from gout, it’s best not to do hands on work at that time. Joints that have had multiple gout spells could be distorted and susceptible to irritation with pressure or movement. If client is extremely inflamed around a joint, they should consult a Dr. before applying ice (good to know) since ice could promote the crystallization of uric acid, making the condition worse.
11. Joint Disruptions Def’n – where the articulating bones of a joint are not in correct relationship (also associated with dislocations - as with full dislocation, the surfaces have no contact and the joint can’t be used. Subluxation – is where the surfaces have partial contact; where there is limited range of motion. Dysplasia - of a joint is when the bony distortion/deformation prevents normal articulation. Origin/Cause – trauma, accidents, or congenital anomaly.
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Conventional treatment options – depends on the cause and could involve surgery (as in a trauma) or manipulation or traction of the affected joints. Chronic and congenital circumstances may use splints, braces, physical therapy and exercise to strengthen the muscles surrounding the affected joint. Clinical Somatic cautions – obviously if there is a traumatic joint disruption, it doesn’t make sense to treat with somatics; however, for subacute or chronic cases, you would need to educate the client to move only in a range that feels comfortable and safe and also heed that limitation when doing the MWB and assisted pandiculations (which is pretty standard with all clients, so it’s nothing new).
12. Joint Replacement Surgery Def’n – also know as “anthroplasty” is a surgical procedure designed to repair the articulating surfaces within a synovial fluid joint (i.e. mostly done on: hip, shoulder { ball and socket joint}; & knee { hinge joint}). The hope and goal is to restore joint function and pain-free (or pain-reduced) movement - although joint range of motion may continue to be limited. There are some long-term side effects to consider. Origin/Cause – some of the causes are osteoarthritis or “wear and tear”, as well as rheumatoid arthritis, avascular necrosis or serious trauma (and sometimes related to osteoporosis). Conventional treatment options – the surgery itself “anthroplasty” – the bony surfaces replaced by artificial parts (prostheses) made out of a variety of materials (ceramic to titanium, but most today used cobalt chrome for the ball and polyethylene for the cup/socket). Average lifespan of the joint prosthesis is 10-15 years. Surgery is a major one, involving general anesthesia, 2-4 hours of surgery and a 3-5 day hospital stay.
Clinical Somatic cautions – check with client for how old their surgery is and what their doctor specifically recommends for limitations of joint range and direction of movement. Older surgeries may have more restrictions to avoid stressing the joint; whereas newer ones, have more risk during the surgery rather than after healing.
13. Lyme Disease Def’n – an infection spread through the bites of two species of ticks: deer ticks and Western black-legged ticks. These ticks are very small and sometimes make it hard to find them on the skin. There are different stages of the disease. Origin/Cause – getting bitten by two of the types of ticks mentioned above – and affects those who work/play outside in grassy or wooded areas (the ticks don’t thrive in sunny or arid environments). Lyme disease moves in stages and the signs
7 Pam Kamoku Aug. 2017 and symptoms are characteristic of each stage. This disease can affect joints and that is why it’s classified as an arthritic condition. Conventional treatment options – first an accurate diagnosis is an ongoing challenge because Lyme disease can have similar symptoms to other chronic conditions (like fibromyalgia, chronic fatigue, and multiple chemical sensitivity syndrome). One sign is seeing the signature bull’s eye rash. Antibiotics treatments are given to some patients; however, not all work the same way.
Clinical Somatic cautions – It says that the arthritic stage of Lyme disease involves irregular and severe/painful inflammation of the joints as well as lyme disease can also affect the nervous and circulatory systems which could affect the comfort levels of the clients we’re working with for somatics. However, if the person is able to learn to move well in the muscles rather that emphasis in the joints and practice diaphragmatic breathing, these tools could be helpful in managing the different stages of this disease.
14. Osteoarthritis Def’n – OA is a condition in which joints lose healthy cartilage (synovial joints and especially weight bearing joints). This condition is noted as different than other types of arthritis by being related to age or wear and tear along with biomechanical factors and causes inflammation. Origin/Cause – age related and wear and tear of age in synovial joints. Any long- lasting imbalance in the joint capsule can have a cumulative destructive impact. Once arthritis has begun it’s possible to stop it, but regeneration and repair is limited.
Conventional treatment options – the goals are generally to reduce pain and inflammation as well as limiting or reversing the damage to the joint structures and these treatments include: NSAIDs (drugs) for pain control (with side effects), and topical applications of ointments. Also physical therapy and exercise assist with helping with healthy ROM, increasing stamina, promoting weight loss and improving the muscle strength of the muscles surrounding the affected joint. Sometimes nutritional supplements are recommended too (glucosamine & chrondroitin sulfate). Arthroscopic procedures (cortico-steroid to reduce inflammation) and sometimes joint replace surgery is performed.
Clinical Somatic cautions – the somatics works can feel very good and give the joints a feeling of much better movement and fluidity, without force – keep in mind the inflammation and helping someone sense what is good movement and what is pushing too far. 15. Patellofemoral Pain Syndrome
Def’n – it is a group of conditions in which the patellar cartilage becomes aggravated as it contacts the femoral cartilage. This can be a precursor to osteoarthritis.
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Origin/Cause – overloading (caused by carrying excessive weight in joint or activities that overload) or overuse of the patellorfemoral joint and could be triggered by an injury or trauma to the knee, as well as poor alignment (from poor footwear or running on uneven surfaces can change how the forces move up the leg and into the knee).
Conventional treatment options - finding strategies to slow or stop the progression, while not becoming sedentary/non-active. You may need to replace weight bearing type activities with ones that bear less load (ie. running jumping types swapped with swimming and cycling). Physical therapy offers exercises to strengthen and then balance tension in the muscles that cross the knee and that aid with knee alignment. Other options include nonsteroidal anti-inflammatories for pain management and orthodics to assist with alignment. And some specialists recommend a knee brace or sleeve to stabilize. Last resort, if other methods don’t work, surgery is sometimes recommended and may be a form of arthroscopy.
Clinical Somatic cautions – no real precautions, other than listening to the client as far as pain awareness in movement. Generally in somatics there is not too much weight bearing in the knee joint and somatics will definitely help with alignment issues as you start to find yourself standing better towards gravity as you undo the current habitual stress reflexes that are pulling you in different directions.
16. Spondylolisthesis Def’n – a condition in which on or more vertebral disks in the lumbar spine slip anteriorly. I have this condition in L4L5. This can involve tiny or large bone fractures and also put pressure on nerve roots at the intervertebral foramina (the openings between adjacent vertebrae. Through each intervertebral foramen passes a single spinal nerve). Origin/Cause – can occur in adolescents during growth spurts combined with athletic pursuits. Athletes lifting heaving weights or who twist & hyperextend their spine, gymnasts, wrestlers, rowers, weight lifters, javelin throwers, pole-vaulters and football players have a high risk. Adults over 40, tend to have a degenerative spondylolisthesis & women outnumber men. This latter version doesn’t involve any damage to vertebrae and instead might begin with arthritis and disc thinning causing the ligaments to slacken and destabilize the lumbar joints. It’s rare, but sometimes an accident or trauma can damage this area too.
Conventional treatment options – mild pain relievers, exercise to strengthen the abdominal muscles and massage therapy to relieve back pain and tight hamstrings. (there should be a recommendation for somatics too!!!!)
Clinical Somatic cautions – the only caution which isn’t really a caution and just what we teach people is to move in a pain free range so you don’t over extend and cause the bone on bone to rub onto one another. Another thing I notice is that after doing a class or a session, when I first get up, sometimes I feel a little unstable in the
9 Pam Kamoku Aug. 2017 lumbar area – waiting momentarily and grounding myself in a stabilizing way can be a big help and then I feel great!
17. Spondylosis Def’n – this is a form of degenerative arthritis, concerning age-related changes of the vertebrae, discs, joints and ligaments of the spine. It occurs most often and most severely in the neck. Origin/Cause – as the spine ages, and as ligaments are lax or if the vertebrae are out of ideal alignment (I’m guessing from over-use, injury, activities as well as habitual stress response), shearing and compressive stresses can affect the joint. This causes back and neck pain only when the growth puts mechanical pressure on nerve roots or the spinal cord (occurring when the foramen is considerably less than it’s normal size). Sometimes there is no painful symptoms, but there is slow, painless, but irreversible stiffening of the spine (if worked on soon, this could change with somatics couldn’t it?). Sometimes people have headaches that begin at the back of the neck and if pressure is on the spinal cord, this could cause lost balance and loss of bladder/bowel control. Conventional treatment options – depends on the complications that are present. Commonly used are anti-inflammatories to begin to assist with pain. Movement, bracing and exercise can limit the progression (it sounds like gentle somatics could be an important piece as well). Also recommended are massage, acupuncture, and hydrotherapy before more intrusive methods (i.e. local injections of steroids, only for temporary relief ) and a variety of surgeries can create more space for the nerve roots of spinal cord. People: try somatics!!! It can create space too. Clinical Somatic cautions – to be careful around certain neck/spinal pandiculations or kinetic mirroring so as not to compress more. Otherwise, I imagine that somatics could be ideal especially when the condition is caught early.
18. Sprains
Def’n – tears to ligaments, (which is the fibrous connective tissue strapping tape that connects bone to bone throughout the body).
Origin/Cause – when some of the ligaments fibers are stretched or ripped in an injury/accident/over stretching. Injury to ligaments triggers an inflammatory response and the rapid response is a rapid production of new collagen fibers;
10 Pam Kamoku Aug. 2017 however, they’re laid down in a haphazard mass & if a new injury is immobilized and kept from movement, the scar tissue may become dense and contracted. Conventional treatment options – PRICE therapy (Protection, Rest, Ice, Compression & Elevation) is pretty normal (don’t use heat as it increases edema and accumulation of scar tissue and don’t immobilize as it prevents new fibers from aligning with the rest of the structure). Some sources say use PRICE protocol for only a day or two and then use the POLICE protocol – Protection, Optimal loading, Ice, Compression & Elevation. Clinical Somatic cautions – when there is acute pain, wait a day or so and really educating the person on the sensory motor ability of the ligaments closely relating to the muscles nearby to do the work of somatics. I would say that somatics would also be effective for older sprains to help with movement quality in areas with scar tissue and wake up the SMA that may have developed. This is not a caution but I found it interesting with regards to somatics: ligaments are also highly invested with sensory neurons, many of which are proprioceptors that work with nearby muscles. This can help us understand and create new approaches when dealing with ligament injuries and the accompanying muscle adaptations that are involved.
19. Temporomandibular Joint Disorder Def’n – TMJ disorder is a larger term that refers to a variety of common problems in and round the jaw: such things as a dysfunctional bite, bruxism (teeth grinding), and loose ligaments surrounding the jaw. These different issues can lead to excessive moment between the temporal bone and the mandible, damaging the internal cartilage and possible dislocation of the joint. (AKA as TMD- temporomandibular joint disorder)
Origin/Cause – because the TMJ cannot move independently and the joint still has a wide range of motion, the joint is unusually mobile which can lead to problems – tension, stress , tight muscles can all lead to this disorder – and the factors that cause it can also be the symptoms. (i.e. tight muscles can lead to pain and tissue damage, which can lead to arthritis at the jaw, which reinforces muscle tightening). Other possibilities are misalignment of the bite and congenital malformations of the bones.
Conventional treatment options – first ruling out some similar injuries like Ernest syndrome (spraing of a nearby ligament); trigeminal neuralgia, occipital neuralgia and osteomyelitis (from an infected tooth). There are nonsurgical and surgical options. Nonsurgical options include: applying heat or cold to painful areas, physical therapy, ultrasound and massage therapy for jaw muscles, anti-inflammatories and local anesthetics and special splints that reduce bone-to-bone pressure. Surgical procedures can range from an outpatient
11 Pam Kamoku Aug. 2017 procedure to arthroscopic surgery to manipulate the cartilage or a full prosthetic joint replacement. Clinical Somatic cautions – try somatics first before anything more invasive J . As long as patient gets correct diagnosis, there should be somatics treatments that will support and help decrease this condition. Fascial Disorders
20. Compartment Syndrome Def’n – is a condition where an injury (or repetitive stress) creates pressure inside a tight fascial compartment – this can lead to death or starvation of muscle and nerve cells. It occurs mostly in the lower leg, but can happen in other areas.
Origin/Cause – Can occur with an onset massive swelling usually due to a crushing injury , a closed long bone contusion or fracture or a penetrating injury that damages an artery (i.e. gunshot wound, stabbing) – Acute compartment Syndrome is usually due to some clear trauma but in odd cases it can arise from intense exercise or even from no real seen cause. Described as tight, burning pain. Chronic compartment syndrome is almost always a reaction to a repetitive athletic activity and symptoms may include pain, cramping, weakness, numbness & changes in gait.
Conventional treatment options – Fasciotomy: a surgical split of the affected fascial sheath to relieve internal pressure, as well as Hyperbaric oxygen and drugs to support kidney health. For Acute compartment syndrome, surgery must be performed within a few hours of the trauma or the patient could have loss of function, amputation, or life-threatening kidney failure. Someone with Chronic compartment syndrome may consider surgery of the fascial sheath, but since it’s not an emergency, they may want to try improving footwear, to “stretch” carefully, to warm up and cool down well during exercise, to use massage therapy which can delay the onset of other symptoms.
Clinical Somatic cautions – Acute compartment syndrome is a medical emergency and must be treated quickly so we would not be involved in something like that. As for chronic compartment syndrome, somatics may be a way to help the muscles stay loose and not so tight; however, when the client is irritated by this syndrome, it may be best to let them settle before trying any somatics.
21. Dupuytren Contracture Def’n – AKA: palmar fasciitis, is an idiopathic (don’t know why) thickening and shrinking of the palmar fascia that can limit the movement of the fingers. Ususally the ring and little fingers are affected, but the middle and index finger may bend as well. People affected cannot straighten their fingers.
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Origin/Cause – seen in middle aged white men or northern European descent, but generally speaking data reports to it’s related to physical labor that involves vibration, smoking, alcohol use and type 1 or 2 diabetes.
Conventional treatment options – corrective surgery OR if it’s treated before too much atrophy occurs, they use corticosteroid injections to limit progress. They also do injections of collagenase, to release of the cord by way of tiny punctures Clinical Somatic cautions – I don’t believe there are any contraindications for somatics; in fact, I believe that somatics and the tools/principles would be helpful for this condition. If the sensory motor system forgets to move the muscles of hand/fingers, these MWB & differentiating, could be beneficial. If someone stops moving this area, then they are going to lose that motor control, so by moving mindfully in a somatics first person way, they could continue to gain function in areas, that might otherwise be forgotten and stiff/unused.
22. Ganglion Cysts
Def’n – they’re small connective tissue pouches (filled with fluid) that are connected or grow on joint capsules or tendinous sheaths. (ie. often appear on the wrist, hand, top of the foot & can be found elsewhere too). Origin/Cause – they may maybe gradual or more sudden onset and often accompany osteoarthritis in older people (and can be seen in children and young adults).
Conventional treatment options – best is to leave them alone, as they often resolve on their own. They can also be aspirated to relieve internal pressure, but often they grow back. (don’t smash them with a bible as this could cause tissue damage). Some cysts may need surgery if they’re big enough. Clinical Somatic cautions – there isn’t any cautions other than be careful near the cysts, but since our hands on work isn’t like massage, just take normal precautions.
23. Hammer Toe Def’n – a foot malformation that affects the lateral toes. Most commonly affected is the 2nd toe. When the 2nd toe is affected, the muscles and tendons that cross the foot joints become permanently shortened, and their fascial wrappings shrink to fit, which means there is hyperextensiotn at the joints (metacarpophalangeal & interpahlangeal joints) & flexion at the PIP.
Origin/Cause – seen most often in people with second toes that are longer than the great toe, and they occur frequently along with bunions and pes cavus. They can start from footwear that causes the 2nd toe to curl over, or the use of high heels that force pressure onto the long second tow, trauma, underlying disease (ie. diabetes,
13 Pam Kamoku Aug. 2017 rheumatoid arthritis and osteoarthritis) and a genetic predisposition for this condition to develop, a seen with Charcot-Marie tooth syndrome. Conventional treatment options – changing footwear, using pads to treat corns and callus, orthotics, and using tape or splints to straighten toes maybe some of the first steps to helping hammer toe. Sometimes steroid injections are used for inflammation and to work with connective tissue thickness. If none of these work, the surgery may be suggested.
Clinical Somatic cautions – no specific contraindications.
24. Hernia
Def’n – hernia means “hole”. Muscles may herniate through fascial walls; vertebral discs may herniate; and even the brain may herniate through the cranium. Origin/Cause – weakness in the connective tissue layers that normally form strong containers. Fascia may be challenged through mechanical forces or congenital flaws and thus a hole forms and abdominal contents (usually fat or loops of small intestines encased within a peritoneal sac) can be forced thru.
Conventional treatment options –many hernias are reducible (ie. the contents can be put back where they belong without surgery - not always an option due to reoccurrence and forming a bigger hole). Often surgery is recommended to tighten up or close the hole. Sometimes a special corset or truss is worn if surgery isn’t needed immediately – this helps to prevent sudden changes in abdominal pressure, but this is only temporary Clinical Somatic cautions – Since somatics doesn’t put pressure on fascial walls with hands on work, the only precaution would be to make sure the client is taking care with necessary precautions and moving easily – not in a emergency situation.
25. Morton Neuroma Def’n – is a condition in which the connective tissue sheath that encases the common digital nerves of the toes becomes thickened. Even though neuroma is used here, it is not a nerve tumor, in stead it’s a perineurial fibrosis (a pathologic condition of the perineurium {connective tissue wrapping around bundles of nerve fibers})
Origin/Cause – nerve irritation in the ball of the foot; if the fascia is tight and restrictive, it inhibits the ability of the nerve to function well and increase the risk of entrapment or stretching of the nerve. Another cause could be tightness in the hamstrings or plantarflexors and this can pull on or compress the medial and lateral plantar nerves that eventually become the common digital nerves. This may arise from people who spend a lot of time in heels - -this puts pressure at the
14 Pam Kamoku Aug. 2017 metatarsal heads, where the nerves are compressed under the intermetatarsal ligaments. Conventional treatment options – if diagnosed early, it can be treated with changing footwear, wearing orthotics and pads for the metatarsal heads. They recommend stretching and massage therapy as part of treatment. If the pain is more severe, it might include steroid injections to reduce the size of the fibroma or injections to kill the sensory neurons if the pain is stubborn. Surgery is risky with complications but may be suggested. Clinical Somatic cautions – no real cautions and somatics could play a key role in reducing the muscle tightness that is causing the irritation in nerves.
26. Plantar Fasciitis
Def’n – a common complaint that includes pain at the plantar fascia, which stretches from the heel bone (calcaneus) to the proximal phalanges on the plantar surface of the foot. Note: “-itis” implies that this is an inflammatory condition; however, PF is more related to the degeneration of collagen (to the plantar aponeurosis) more than to chronic inflammation. (more accurately termed “fasciosis”)
Origin/Cause – can be associated with foot pronation, excessive running (especially in worn down shoes), and prolonged standing (both sedentary and athletic people experience it, & women twice as much as men). Being overweight can play a role for some as can sudden changes in activity levels. Unequal leg length, flat or pronated feet & jammed arches, as well as tight calves are also some causes or are related to PF. (note: PF may occur as a result of another conditions such as: gout, rheumatoid arthritis or diabetes and PF is often bilateral, occurring on both sides)
Conventional treatment options – important to manage tensions that cause the plantar fascia to be irritated after period of immobility (as in waking up from sleeping). Warming and massaging the foot and lower leg before getting out of bed can help the tissues feel more flexible. Orthotics and heel pads are sometimes recommended as well as night splints that hold the foot in a slightly dorsiflexed position, allowing the plantar fascia fibers to heal so they won’t be irritated. Frequently prescribed are ice, stretching and deep massage to the calf muscles and the site of the irritation. Sometimes corticosteroid injections are given; however, these damage the fat pads on the heels and may weaken collagen fibers and increase the risk of a rupture. Clinical Somatic cautions – no precautions. Somatics would be ideal for shifting patterns, differentiating and releasing tight muscles related to the condition. Somatics can shift the patterns of daily living that got them to this place. (RED LIGHT & GREEN LIGHT issues include Plantar fasciitis)
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27. Pes Planus, Pes Cavus Def’n – Pes Planus are FLAT FEET (lacking the medial arch between the calcaneus and the great toes, the lateral arch between the calcaneus and the little toe, and the transverse arch between the great toe and pinking and stretches along the ball of the foot) and Pes Cavus are CAVED FEET (also referred to as “jammed arches”, or hyperaccentuated arch that doesn’t flatten out with each step; stays high and immobile)
Origin/Cause – some reasons may be: a congenital problem in the shape of the foot bones or the strength of the foot ligaments; foot trauma and malunion fractures of the calcaneus or talus may alter the shape of the foot; also can be from an ongoing battle between deep flexors and everters, combined with poorly functioning ligaments and footwear that offers little or no support. If the foot bones lack spring and mobility, shock absorption is lost! Each time the foot hits the ground, thousands of pounds of downward pressure that should be softly distributed through the tarsal bones reverberates through the rest of the skeleton. These 2 conditions can lead to arthritis in the feet, plantar fasciitis, neuromas and knee, hip and back problems/pain, even headaches and TMJ disorders. Cool fact: each foot has 26 bones, 33 joints and more than 100 muscles, tendons & ligaments to mediate our relation to gravity when we stand. Imbalance at the forefront, midfoot, or hindfoot can lead to problems in how weight is distributed over the whole surface and how the stress of weight bearing is translated to the rest of the body.
Conventional treatment options – someone who is unaware that the alignment of their feet, may be a problem, may be told to switch to highly supportive shoes. Physical therapy may be referred to rebalance the peroneus longus and tibialis posterior muscles, as well as orthotics or braces to improve foot alignment. It’s rare that surgery is recommended. Clinical Somatic cautions – no precautions and please do somatics – Thom Hanna has some great foot lessons that have you really thinking about how amazing this work is – to differentiate the toes, feet, arches and bring that into the relationship of the legs and hips to pelvis can be amazing.
Neuromuscular Disorders: 28. Carpal Tunnel
Def’n – (aka: CTS) – it’s a set of signs and symptoms brought on by the entrapment of the median nerve between the carpal bones of the wrist and the transverse carpal ligament that holds down the flexor tendons. Where the nerves are caught, pinched or squeezed in any way that creates symptoms in the part of the hand the nerve supplies. (median and ulna nerves)
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Origin/Cause – some say the pressure directly on the nerve causes pain and others say the pressure that impedes blood flow to the nerve is the problem. Many of these symptoms are caused my over use injuries in arm and shoulder and many things can mimic or contribute to nerve pain in the hand. Conventional treatment options – often starts with a wrist splint, corticosteroid injections into the wrist are often recommended as well as acupuncture, chiropractic and low-level laser treatments as well as yoga may be suggested as another form of non-invasive options to deal with the symptoms. If none of those solve the problem, then often surgery is recommended. Clinical Somatic cautions – I don’t believe there are many cautions with somatics and in fact, as with other neuromuscular conditions, they can be over come with somatics and going right to the source of the habituated patterns that are causing this. (TRAUMA REFLEX issues include Carpal tunnel)
29. Disc Disease
Def’n - is an “umbrella term” concerning a range of problems in the vertebral discs. As noted in the book, it refers to “problems in which the nucleus pulposus and/or the annulus fibrosus of an intervertebral disc extends beyond its normal borders”. There is pain if the disc presses on the spinal cored or spinal nerve roots. If the bulge (or crack) doesn’t interfere with nerve tissues, then often there are no symptoms. Disc Disease is now sometimes referred to as “intervertebral disc degeneration” or IDD (also referred to in some cases as “herniated disc”).
Types: Herniated disc; Bulging disc; Protrusion, Extrusion, Rupture; Degenerative disc disease; Internal disc disruption; Endplate junction failure.
Origin/Cause – overuse patterns, injury (can be from major trauma like car accident or bad fall, sports injury to bending over and picking something up in daily living), and studies of disc disease in twins show that genetics can play a role. Conventional treatment options – depending on your diagnosis, the treatments options vary and sometimes they just allow time to do it’s work in healing without long-term problems. The main goal of a treatment would be to create relief from the pressure on nerve roots. This could include: bed rest and traction, or chiroprators, osteopaths could assist with correcting bony alignment to create more space for nucleus to retreat back to normal boundaries; physical therapy, posture & body mechanics education are also great for people that are recovering from disc issues. If non-invasive options aren’t working, the other options may include injection of cortisone to take care of inflammation/pain and surgery to remove the disc (L). Clinical Somatic cautions – it’s good to be a part of the health care team and get advice from doctors and other providers as far as limitations and contraindications for spinal movement. Using tools/props to support client so they don’t experience pain is helpful and teaching the proper mechanics of movement and posture can be
17 Pam Kamoku Aug. 2017 ideal for somatic education. Doing many somatic exercises and protocols could also enhance building the support in other areas so that they can build stability and awareness. (GREEN LIGHT has issues with discs often)
30. Myofascial Pain Syndrome Def’n – also referred to as MPS, is a condition where a person develops points/pain- generating spots in muscles that are intense (palpable) as knots or taut bands. Origin/Cause – sedentary people often develop these trigger points more than physically active people. Chronic overuse or poor ergonomics can play a role in MPS also. MPS can be related to issues with the synapse between the motor neuron and the motor endplate of the myofiber; this is what makes the myofascial pain syndrome mostly a neuromuscular condition. This is a sustained, involuntary contraction of an isolated group of sarcomeres. (this can often resemble another chronic pain syndrome; fibromyalgia). Conventional treatment options – priority in a treatment would be to eliminate both active and latent trigger points and could be done with: vapocoolant (topical anesthetic) spray, local injections of anesthetics, dry needling and acupuncture. Also things like trigger point massage may work and of course they prescribe muscle relaxants and lidocaine patches (topical anesthetics).
Clinical Somatic cautions – because of the many active trigger points that could cause chronic pain in many areas, I believe it would be good to still take in the person’s context as far as habitual patterns and use your sleuthing abilities to figure out which protocols may have the best affect as well as educating on posture and movement mechanics.
32. Thoracic Outlet Syndrome (TOS) Def’n – is a neurovascular entrapment where the nerves of the brachial plexus or the blood vessels running to or from the arm (or some combination of) are impinged or impaired at one or more of the 3 places: between the anterior and medial scalenes, between the clavicle and the first rib, or under the coracoid process. (photo p.135) Origin/Cause – over-use repetitive movement patterns like carrying heavy loads or people who spend a lot of time with their arms in the air (ie. electricians, plumbers, painters, etc). While postural habits and bony growth patterns can make people susceptible to TOS, it appears that often a traumatic event/injury (hyperextension injury) before the repetitive stress can be part of the cause too. Common contributing factors include: Muscle imbalance; Connective tissue bands (around the attachment of scalenes, can be long term posture habit or congenital); Cervical ribs (only 1% of population experience this, pg. 136)
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Conventional treatment options – analgesics, gentle physical therapy, and stretching are first recommended. If these don’t work, surgery is recommended to correct the bony anomaly or to remove connective tissue bands.
Clinical Somatic cautions – there are no cautions really and somatics can play a huge role in helping this musculoskeletal condition, like others, due to repetitive patterns that can change by changing motor feedback loop. (RED LIGHT and TRAUMA REFLEX issues include TOS)
Other Connective Tissue Disorders:
33. Bunions Def’n – AKA: Hallux valgus, means “laterally deviated big toe”. The first phalanx of the great toe is distorted toward the lateral aspect of the foot.
Origin/Cause – the joint capsule stretches, a bursa grows at the irritated site and callus grows over the protrusion. (A smaller version happening at the baby toe is referred to as “tailor’s bunion” or “bunionette”). High-heeled and narrow-toed shoes are both factors, but also a genetic weakness in the toe joints may be a factor to some people regardless of footwear. However, footwear seems to be the biggest factor. High-heels and narrow-toed shoes (or cowboy boots) that squeezes the toes or forces weight onto the medial aspect of the foot) can be a huge cause.
Muscle imbalances within the foot and the lower leg can influence how force is distributed throughout the joint. The shape of the head of the first metatarsal determines the stability of the joint: the rounder the head, the less stable and the more prone to stress. Conventional treatment options – remove whatever irritates and contributes to the problem like footwear and making room for the bunion and then starting to do massage and exercise (range of motion stretches, gentle traction, and friction around (not on) the affected area – though it says these interventions may not realign the toe. Elevating the heel can relieve some pain & corticosteriod injections are done for pain and inflammation and sometimes surgery is recommended. Clinical Somatic cautions – no cautions other than the usual moving in a pain free range. Education of footwear, mechanics of movement and doing MWB and differentiation could be very beneficial in the foot area as well as teaching them somatics for whole body function (GREEN LIGHT issue include bunions).
34. Bursitis Def’n – it’s inflammation of the bursae. Bursae are small closed sacs made of connective tissue. They’re lines with synovial membrane and filled with synovial fluid. When these sacs are irritated, the internal cells reproduce excess fluid, which causes pain and limits mobility. Note: the human body has about 160 bursae, but
19 Pam Kamoku Aug. 2017 new ones can be made in areas that need protection (most are small but ones that protect the knee, hip and shoulder can be quiet large). Bursae are the cushions or water balloons that ease the movement of tendons over the bony angles – they cushion elbows, knees, heels and ischial tuberosities – some are present at birth and others grow in response to wear and tear.
Origin/Cause – repetitive stress is a common trigger, that can cause the walls of the bursa to thicken and get inflamed with a massive production of fluid. Nearby muscles contract to secure/immobilize the perceived injury, which then limits the range of motion of the affected joint. Permanent damage in the bursal lining, which should be synovial membrane, can be replaced by tough fibrous tissue and the fluid inside can change and become thick and protein rich. Bursitis is common in phryscially active people and often occurs at the same time as other general inflammatory conditions. Conventional treatment options – rest, oral anti-inflammatories, hot or cold packs, aspiration of excess fluid and corticosteroid injections. Left untreated, most cases resolve by themselves; however, once it has occurred, it’s likely to happen again. Worst-case scenario, sometimes surgery is recommended.
Clinical Somatic cautions - moving the affected joint even within a healthy pain-free range could cause more strain/inflammation??? However, from the work I’ve done with a student/client, learning a new way of moving within the limitations and learning what it means to not move more than that is where the learning is.
(TRAUMA REFLEX issues include Bursitis)
35. Shin Splints
Def’n – refers to a variety of lower leg problems, although medial tibial stress syndrome is the most common one associated. Some others might be ‘periostitis and stress fractures’ in lower leg, and chronic or acute ‘compartment syndrome’ can be a related injury too.
Origin/Cause – over-use injury, lower leg muscles & fascia get irritated, or if the feet aren’t spread out and able to rebound with each step (foot has inadequate shock absorption due to flat feet or jammed arches i.e. pes planus or pes cavus), as well as worn-out shoes, hard surfaces or any combination thereof. The muscles of the lower leg (especially soleus, tibialis anterior, and tibialis posterior) absorb a disproportionate amount of the shock. Conventional treatment options – for mild shin splints, reduce activity and alternate applications of heat and cold to the affected area. Also it can help to change footwear and analyze and change inefficient movement patterns.
Clinical Somatic cautions – no cautions other than it might be ideal to have the condition checked to make sure it’s nothing more serious. Somatics could be ideal for mild conditions – pandiculating the muscles of the shins as well as full body
20 Pam Kamoku Aug. 2017 movement patterns (reflexes, stress patterns), and feet and toe differentiation/movements as well as educating on body mechanics and movement patterns.
36. Tendinopathies Def’n – it’s an umbrella term that involves injuries and damage to tendons & tenosynovial sheaths. This can include acute tears and ruptures, but are most commonly related to chronic, degeneration due to injury, repetitive use, age, nutrition and other factors. Types of tendinopathies: Tendinitis; Tendinosis; Tenosynovitis; Trigger Finger; & de Quervain tenosynovitis. Origin/Cause – the aging process makes tendons less elastic and more prone to injury – can happen to active or sedentary people. People more susceptible to these conditions include: those with rheumatoid arthritis, lupus or chronic renal failure; people that have taken quinolone-type antibiotics; and people that have used oral or injected steroids.
Conventional treatment options – combination of rest, ice, stretching and carefully gauged exercise turns out to be a great remedy for many of these injuries. Also used is ultrasound or extracorporeal shock along with exercise for great results. Eccentric contractions appear to be particularly useful to rebuild a damaged tendon. Clinical Somatic cautions – no cautions.
37. Whiplash Def’n – (aka: CAD: cervical acceleration-deceleration) – is a wide term used to describe a mixture of injuries including: sprains, strains and joint disruptions. Often addressed simultaneously with these soft tissue injuries are bone fractures, herniated discs, nerve damage and traumatic brain injuries – which are often seen along with whiplash. Origin/Cause – often from motor vehicle accidents when the head whips backward and then forward very quickly. While the majority of whip lash incidents are from automobile accidents, there are other injuries that can mimic the same scenario (i.e. sports injuries and falls). Conventional treatment options – neck collars are used for acute whiplash in order to take the stress off their ligaments and reduce muscle spasm. It says the sooner the injured structures are put back to use, the less scar tissue is likely to accumulate; therefore, collars are for short-term use (as this type of immobilization can create long-term problems) & this must be why somatics small gentle movements can be ideal for this type of injury.
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Medical intervention includes pain relievers, anti-inflammatories and muscle relaxants; however, these ingredients can change the quality of the tissues and sensory responses of the client.
Clinical Somatic cautions – if client is on drugs this can affect the sensory motor responses & I’d like to know more on how soon it’s recommended to start doing tiny movements of somatics – I believe I remember my teacher on Maui saying that a client of hers did it immediately following an accident but how to you know if it’s safe? By being super highly aware and moving in a small pain-free range of motion. In the book it talks about the trapezius including the scapula being triggered as well, so to use that information and work on connecting muscular areas that went into stretch reflex can be effective.
Chapter 4: Nervous System Conditions Chronic Degenerative Disorders
1. Alzheimer Disease Def’n – a progressive degeneration disorder of the brain; causing memory loss, personality changes and eventually death. Lesions in the brain & the hippocampus (the part of brain that processes and stores new info and knowledge) also shrinks and loses access to memories and loses the ability to process new information. Origin/Cause – plaques and tangles in the brain, and other contributing factors are: genetics, chronic inflammation, a history of head injury, exposre to environmental toxins, high cholesterol levels, low estrogen levels (in women), the presence of cardiovascular disease and diabetes, and many other variables. Factors that could lessen the risk are: regular physical activity, a healthy diet, frequent interactions with others, & lifelong learning. Conventional treatment options – no single treatment can address all symptoms and no intervention seems to prevent or reverse the disease. Meds are prescribed to deal with other conditions that frequently occur with AD (depression and anxiety). Clinical Somatic cautions – Be informed about the whole history of client. Somatics could improve the quality of life for some patients.
2. Amyotrophic Lateral Sclerosis Def’n – aka: ALS, Lou Gehrig disease in US & motor neurone disease in Great Britain, is a progressive and fatal condition that destroys motor neurons in the central and peripheral nervous systems, leading to atrophy of voluntary muscles. The cells most at risk are the large motor neurons in the lateral aspects of the spinal cord.
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Amyotrophic – refers to eh muscle satrophy; lateral refers to the parts of the spinal cord; and sclerosis refers to the hardening of the spinal cord tissue. Origin/Cause – unknown although serveral possible contributing factors might be genetic predisposition, oxidative injury, mitochondrial dysfunction, premature cell death, glial cell pathology and presence of too much glutamate. Conventional treatment options – Drug treatment deals with general fatigue, muscle spasms, and secondary infections and some drugs can limit the amount of glutamate in the CNS so the motor nerves function for a longer period of time. (resulting death usually occurs within 2-10 years; however, some patients have survived decades and it’s unclear how) Clinical Somatic cautions – late stage patients become very frail and susceptible to secondary infections, so the be careful with exposure. It seems that heat, exercise and physical therapy are helpful, meaning that somatics could play an integral role in adding comfort (both in movement and breathing).
3. Huntington Disease Def’n – a progressive degenerative disease of the CNS & eventually terminal. It’s brought on by an autosomal dominant genetic mutation (only one gene must be present for the disease to manifest) and can be passed down to children by both mothers and fathers. Origin/Cause – the result of a genetic mutation that alters the behavior or neurons in the basal ganglia and the cerebral cortex, leading to cell death and irreversible and progressive loss of brain function.
Conventional treatment options – since it’s a genetic mutation, HD is not treatable at this time. Drug therapies are more aimed at controlling the worst of the symptoms and complications. Clinical Somatic cautions – since this disease affects the basal ganglia cerebral cortex, I’m thinking that the sensory motor feedback loops will also be affected and if they are declining in the cortex (latter stages of HD), I’m unsure if Somatics will be effective at all? I’m curious to hear more about this. This is of course at the worst case scenario, so before then, I think it would be good to do somatics work to keep functioning physically, mentally and emotionally while symptoms are not as bad.
Def’n – aka: PN is usually not a disease in itself, but a symptom or a complication of other primary conditions. Peripheral nerves (either singly or in groups) are damaged through a lack of circulation, chemical imbalance, trauma or other factors.
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Origin/Cause – from injuries like: carpal tunnel syndrome, thoracic outlet syndrome, Bell Palsy, disc disease and trigeminal neuralgia- related to acute or chronic injury. Infections can also cause peripheral nerve irritation this like: Herpes simplex, herpes zoster (shingles) HIV/AIDS, Lyme Disease, hepatitis, syphilis, and Hansen disease (leprosy). And also systemic diseases like: Diabetes (type 1 or 2), renal failure, vitamin B12 deficiency, cancer and other tumors as well as some autoimmune diseases (including Lupus, Sjogren syndrome, sarcoidosis and Guillain- Barre syndrome. And finally, Toxic Exposure like chronic alcoholism, sniffing glue and some medications (including chemo) and exposure to heavy metals can affect the peripheral nerves. Conventional treatment options – depends on the underlying pathology that is causing the nerve damge: controlling the original disease can help to control associated nerve pain. Other therapies include: TENS unit (a transcutaneous electrical nerve stimulation device to control pain), biofeedback, acupuncture, relaxation techniques and massage to improve circulation in the affected extremities.
Peripheral nerves may be able to heal and regenerate if PN is interrupted before damage affects the neuronal cell bodies.
Clinical Somatic cautions – I don’t think there are any precautions and I believe this could relieve some of the symptoms and possibly relieve some pressure on nerves if habitual muscles patterns are part of the cause.
5. Dystonia
Def’n – it’s a common condition involving repetitive, involuntary, sometimes constant contractions of skeletal muscles. Sometimes in the form of tremors too as in Parkinson’s Disease. Origin/Cause – sometimes without cause and other times as a result of a genetic anomaly, or as a secondary symptom of an underlying disorder or drug reaction. Conventional treatment options – work on controlling motor function in the affected muscles. Physical therapy and gentle stretching are often recommended. Injected drug therapies are sometimes used and a device can implanted in the brain to help regulate motor functions (deep brain stimulation). It also talks about surgery (last resort) to disrupt portions of the basal ganglia or interrupt nerve transmission to the muscle or in the spinal cord. Clinical Somatic cautions – somatics could be a good choice for nervous system relaxation response.
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6. Parkinson Disease Def’n – is a movement disorder that entails progressive degeneration of nerve tissue and a reduction in neurotransmitter production in the CNS. Origin/Cause – unclear why PD begins in most cases. Sometimes environmental agents may be one cause – these risk factors may include exposure to pesticides, herbicides and fertilizers & other industrial chemicals. Sometimes it’s genetics and other times it’s linked to mitrochondrial dysfunction. Some primary symptoms: Resting tremor; Bradykinesia (hard to do voluntary movement, they can visualize but can’t make it always happen); Rigidity; Nonspecific achiness, weakness & fatigue; Poor postural reflexes. Secondary symptoms: Shuffling gait; Changes in speech and eating; Changes in handwriting; Sleep disorders; Depression; Mental degeneration.
Also the flexors muscles progressively tighten. Conventional treatment options – pharmaceuticals are used to treat symptoms and can be very complicated. Doctors try to balance the benefits of early intervention to slow the progression of this disease with the many horrible side effects that accompany long-term drug use. Due to PD being related to the lack of dopamine in the basal ganglia, the most common plan is to supplement a synthetic form of this neurotransmitter. Speech and occupational therapies are often used to maintain the health and general functioning of patients and psychotherapy /support groups for depression.
Clinical Somatic cautions – nothing different from the norm. I worked with a client with PD for years with movement therapy, primitive reflex integration and only the small amount of what I knew about somatics and it was very beneficial for him.
7. Tremor
Def’n – referring to ‘involuntary oscillating movements on a fixed plane’. This can be a disorder on it’s own or a symptom of a number of CNS problems. The key characteristic of tremors/tremor disorders are that the movements are rhythmic back-and-forth movements of antagonistic muscles groups and the movement occurs in a single plane (this is distinguishes tremors from Dystonia, which can have tremors in multiple planes. Origin/Cause – can be related to dysfunction in the links between the brainstem, the cerebellum, and the thalamus, although these are not always fully understood. Tremors affect hands, face and head more often than other areas. They are categorized by physiologic or pathologic – physiologic are exacerbated by stress, fear & other underlying issues and pathologic tremors are either idiopathic or caused by another condition.
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Conventional treatment options – medications as well as moderate alcohol consumption can help control tremor symptoms. Surgery may be used if the tremor is debilitating and not responding to meds (ie. implanting a deep brain stimulation device or creating interruptions at the thalamus) Clinical Somatic cautions – I don’t think there would be any cautions.
Infectious Disorders 8. Encephalitis Def’n – an infection of the brain, usually caused by any of a variety of viruses. It frequently happens along with inflammation of the spinal cord (myelitis) and or inflammation of the meninges (meningitis). Origin/Cause – a virus (most common in the US is herpes simplex and is responsible for about 10% of all cases, as well as herpes zoster, influenza and arboviruses like dengue fever, transmitted thru mosquitos). Conventional treatment options – antiviral medications as well as steroids to limit inflammation, sedatives to moderate convulsions and “supportive therapy” like rest, good nutrition and sufficient hydration. Speedy treatment is important to avoid the risk of permanent brain damage or death. Clinical Somatic cautions – avoid contact with this person if the infection is spreadable. Once the infection is gone, there won’t be any cautions.
9. Herpes Zoster Def’n – an infection of the nervous system caused by the varicella zoster virus (VZV). The virus targets the dendrites at the receiving ends of sensory neurons, which leads to painful, fluid-filled blisters on the nerve endings of a specific dermatome. (chicken pox and shingles could be a form) Origin/Cause – from exposure to this pathogen thru a childhood bout of chicken pox. Later in life, when circulating antibodies are low, the virus may reactivate and this time it will be shingles.
Conventional treatment options – mainly thru soothing the symptoms such as cool baths, soothing lotions for chicken pox and more aggressive painkillers might be required for shingles and PHN (postherpetic neuralgia). Clinical Somatic cautions – you don’t want to be around someone that has this infection due to it spreading to you and normally they aren’t seeking a movement therapist either. The person is probably uncomfortable with itchy sores.
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10. Meningitis
Def’n – inflammation of the meninges that surround the brain and spinal cord. Origin/Cause – usually caused by bacterial or viral infection; and fungi and amoebae can also cause it, but is rare.
Conventional treatment options – most common forms of bacterial meningitis can be prevented with infulenzae type B vaccine. Vaccines for viral types can be obtained but are recommend only for people traveling to areas where the infections are endemic. Once you have the infections, large doses of antibiotics are given to stave off any possibility of CNS damage & steroids may be prescribed to limit inflammation in the brain. Viral meningitis is treated with supportive therapy like rest, fluids, and good nutrition while the patient’s immune system fights back.
Clinical Somatic cautions – stay away during communicable stages of virus & only work with clients that have fully recovered.
11. Polio, Postpolio Syndrome Def’n – an viral infection (aka: poliomyelitis, or infantile paralysis) – this polio virus targets intestinal muscosa first and motor nerve cells in the anterior horn of the spinal cord after. (paralysis caused is motor only; sensation is still present. Some muscle fibers still function, even though motor neurons damaged). Postpolio syndrome (PPS) – a progressive muscular weakness that develops 10-40 years after the initial infection with the poliovirus. Origin/Cause – can be spread thru airborne droplets and most common thru oral- fecal contamination (ie. contaminated water and causes infection in the intestines). Conventional treatment options – heat applications, physical therapy, and massage once the initial infection has diminished. Clinical Somatic cautions – don’t do during acute infection stage.
Psychiatric Disorders 12. Addiction Def’n – dependence on a substance (ie. drugs, alcohol, smoking, gambling) - (although it can be to other things like caffeine). They talk about addiction as an arc of 3 patterns: USE, ABUSE And DEPENDENCY.
USE – if a person ingests a substance to specifically alter mood or experience – this is a substance abuse. ABUSE: the use of a substance in a way that is potentially
27 Pam Kamoku Aug. 2017 harmful to the user or to other people. DEPENDENCY: the line between use, abuse and addiction is sometimes blurry…. Dependency happens when 3 or more of the follow are true: user develops increasing tolerance; increasing amounts are used; the user cannot voluntarily limit use; user devotes significant time to using or recovering from use; user replaces other activities with substance use or user continues even when aware of the dangers. Origin/Cause – can be pathologic, family history (genetic predisposition) & depending on the chemical make up of the substance, this can cause the addiction also. Also mental illness may increase risk of substance abuse to drugs used; environmental factors; type of drug being used, age & medical reason.
Conventional treatment options – first and very important is for the addict to accept that a problem exists. Then there are treatment programs, detoxification, rehabilitation and aftercare. Some meds can suppress the craving for alcohol. Clinical Somatic cautions – a person w/ history of drug or alcohol addiction is at a higher risk for secondary problems. Not sure there are other cautions ?? – this form of care may bring about change when reflexive habits decrease.
13. Anxiety Disorders Def’n – a collection of distinct psychiatric disorders that have to do with irrational fears. They range in severity from mild to completely debilitating. Origin/Cause – some neurotransmitter disruptions (ie. serotonin, dopamine, norepinephrine, and GABA) – different causes for different anxiety disorders. Conventional treatment options – combination of medication and psychotherapy. Other areas shown to improve the quality of life for anxiety disorder patients include relaxation techniques, mediation, yoga, acupuncture & massage (& somatics). Clinical Somatic cautions – perhaps the same cautions as massage, which is if the person with anxiety issues has had physical/sexual abuse this could be a factor with reactions to touch, so creating a safe environment. Somatics could create more calm for the person as well as take their mind towards the focus of what they’re doing and not on their anxiety.
14. Attention Deficit Hyperactivity Disorder Def’n – (ADHD) – is a neurodevelopmental disorder resulting in difficulties with attention, movement, and impulse control.
Origin/Cause – it’s a neurochemically mediated disorder that has been traced to problems with dopamine production, transportation and reabsorption and w/
28 Pam Kamoku Aug. 2017 noradrenaline disruption in the front cortex, basal ganglia and cerebellum: areas in the brain that have to do with decision making and movement. Causes are still unclear, some factors that may affect this are: genetic predisposition, maternal behaviors (ie. smoking and alcohol consumption), and exposure to toxins (lead, dioxins and PCBs). Conventional treatment options – psychostimulants (drugs from classes of drugs called methylphenidates or dextroamphetamines) – these work by stimulating the brain where activity is diminished. Also family counseling &/or parental training, therapy.
Personally, I’ve seen Rhythmic Movement (working with primitive reflexes and neurodevelopmental movement) used and be very effective as well as nutritional/dietary changes be a huge asset. Clinical Somatic cautions – no precautions and currently I have a student (adult ADHD) that has written me to tell me that Somatics is the one thing that he finds calms him, where he can focus and quiet down and he said the work has an amazing effect for him that no other modality has had.
15. Autism Sprectrum Disorder Def’n – (ASD) – is a complex developmental disorder described as having problems with interpersonal interaction, communication, & learning. There may also be sensitivity to touch or temperature (sensory stimulations issues). Symptoms vary according to what type is present, but 3 major issues are present ofr most types: deficits in verbal and nonverbal communication; problems with social interaction, and repetitive behavior or movements. Origin/Cause – can be a genetic factor, environmental factor (exposure to toxins), even thru utero.
Conventional treatment options – can vary depending on individual, but might include highly structured, specialized settings that reinforce positive behaviors and work to reduce negative ones. Applied behavioral analysis & Sensory Integration therapy (sensory integration uses, play, touch, pressure, vibration, massage). Dietary changes can help too (avoiding gluten and casein {protein found in dairy products}, supplementing Vit B6 w/ magnesium also. Sometimes meds to help with seizures, anxiety and depression, but no drug addresses autism itself.
Clinical Somatic cautions – just be present with client that some sensation to touch is unpleasant, but somatics could truly by a wonderful integrative therapy.
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16. Bipolar Disorder Def’n – also called manic depression where the person has mood swings on a continuum from major depression to mania (super highs). Origin/Cause – a genetic component can be one factor; differences in brain development that occur during adolescence may trigger some symptoms and could explain why this condition is often identified in the teen years. People with bipolar disorder also show some differences in myelination in various brain regions suggesting with the findings in schizophrenia, there may be some similarities.
Conventional treatment options – a complicated mix of medications to address manic, depressive and possible psychotic symptoms. And even if a mix has found to work, the drugs have horrible size effects and some patients take other meds to deal with the side effects – it’s a vicious cycle of meds for the person . The drugs try to out the mood swings with mood-stabilizing medications built on a mineral called lithium. Lithium can be toxic in the patient as it was with my dad, who went toxic with lithium intake twice and that final toxicity put him in the hospital and soon after he died. Antidepressants are also used, but they can precipitate a manic episode if they are used alone. So if prescribed they also give an antipsychotic or mood stabilizing drug too. Clinical Somatic cautions – I would say the side effects of the drugs and the client- therapist relationship would be cautions and knowing a handful of people with this disorder, including my dad, I believe somatics would be amazing work for them to learn during a time where they are between manic and depression (not limited to this time; however, to deepen the understanding of the work when they are not at an all time low or high, may have them understand the work and use it during the highs and lows too)– to continue to help them live a full life. I’ve seen patients on meds and they are lethargic and don’t make good healthy decisions or care for themselves (depressed eating and manic binge eating) so the systems of their body start to go downhill not only from the drugs but from poor nutrition, lack of exercise, lethargy (this has been my personal experience).
17. Depression Def’n – a group of disorders that involve negative change in emotional state. A CNS disorder involving a genetic predisposition, chemical changes and a significant triggering event that results in a person losing the ability to enjoy life. Unfortunately, this condition can be a long-lasting, self-propagating, and ultimately debilitating – even life threatening disease. It seems the older the person is at onset, the harder depression seems to be to treat and the longer each episode appears to last.
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Origin/Cause – genetic predisposition with common distinguishing features of depression is a neurotransmitter imbalance especially with serotonin, norepinephrine an dopamine.
Conventional treatment options – drugs (antidepressants) to increase the accessibility of these important chemicals mentioned above. Besides drugs, other natural therapies are psychologists and psychiatrists support with talk therapy & help with coping skills. Other therapies are: Light therapy, electroconvulsive therapy, St. John’s wort, and nutrition like omega-3 fish oil, 5-hydroxytryptophan (building block for serotonin); acupuncture, massage and exercise have also helped to manage symptoms.
Clinical Somatic cautions – no contraindications or cautions and could have a positive effect on reducing the feeling of helplessness (working with red light reflex) and assisting with breathing which could cause some of the anxiety/depression onsets.
18. Eating Disorders Def’n – a variety of unhealthy eating habits that become difficult to eve impossible reverse. They disorders often come about in response to a physical or emotional stressor (ie. anorexia, bulimia and bing-eating disorder)
Origin/Cause – a dysfunctional relationship to food, might be a cause. Personality profiles include young adults with high expectations of themselves, eager-to-please, over achievers, who do well in school and may be involved in athletics that emphasize thinness (ie. could be girls into gymnastics or dancing/modeling or men who are wrestlers; although this may be cliché). It could be someone with those qualities who has been abused and is using this as a way to cope. (an issue of control that she has). These choices ultimately affect the way her body functions).
Conventional treatment options – interventions that support patient’s psychological and emotional issues, rather than focusing on weight gain/loss. The issue that lead to the behaviors are foremost what is needed to resolve. Clinical Somatic cautions – be aware of these disorders can lead to changes in body functions that could affect the gastrointestinal tract, the cardiovascular system and bone density – for a frail client, you want to be sure of your pressure you might be giving and for an overweight client, any other sensitivity issues.
19. Obsessive Compulsive and Related Disorders Def’n – a group of conditions that used to be classified as anxiety disorders, but have been designated as unique because of their predictable pattern of obsessive preoccupations and repetitive behavior. (highly developed rituals to try to quell or control those thoughts {compulsions}).
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Origin/Cause – conditions may vary, but for some, there is a strong family tendency that exists, which means it could be a genetic predisposition to a fundamental change in brain function. For others it may have been a specific event like an illness or surgery that is a trigger to a new behavioral pattern. Conventional treatment options – a combination of psychotherapy and mediation. A branch of therapy called “exposure and response prevention” is designed to help with behaviors seen with OCD-type disorders. And of course, drugs like antidepressants or antianxiety medication can be prescribed. Seems like it would be better to get to the route of the problem. Clinical Somatic cautions – no cautions.
20. Trauma- and Stressor- Related Disorders
Def’n – a collection of conditions that used to be considered subtypes of anxiety disorders. They have some different and very specific diagnostic criteria and therefore separated: Posttraumatic Stress Disorder (PTSD); Dissociative PTSD (subtype of PTSD); Acute Traumatic Stress Disorder; Adjustment Disorder; Reactive Attachment Disorder.
Origin/Cause – can be childhood stressors or an adult traumatic event stressor that causes a psychological detachment from one’s surroundings. Conventional treatment options – usually involves some combo of group, individual, and family therapy along with medication. Other natural treatments included eye movement desensitization and reprocessing, which combines psychotherapy and eye movements to influence the way the brain processes information. Medications. I have read a lot about mindfulness meditation and yoga nidra (iRest) being a very effective natural treatment plan together with counseling. Clinical Somatic cautions – no precautions other than to be sensitive to anything in a session trigger a flashback or other kind of reaction. I would think that the highly focused wording and neuromuscular work we do along with helping someone breathe better, could be a practice that creates calm and focused as well as their entire way of being feel better.
Nervous System Injuries 21. Bell Palsy Def’n – is the result of damage to or impairment of the CN VII, the facial nerve (which provides most of the motor function to facial muscles). This nerve is composed almost entirely of motor neurons and is responsible for facial expression, blinking the eyes, and providing some taste sensation. This condition is usually temporary.
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Origin/Cause – often seen in people who are pregnant and those with diabetes, those who are immune-compromised and those who had recently dealt with a cold or the flu. IT’s a type of peripheral neuritis; inflammation of a peripheral nerve.
Possible factors that may contribute to Bell Palsy: herpes simplex virus (most common); Lyme disease, Epstein_Barr virus and cytomegalovirus (also can be related to multiple sclerosis, Guillain-Barre Syndrome, sarcoidosi, or tumors on the CN VII or CN VIII.
Conventional treatment options – it depends on the cause of this condition, which means an accurate diagnosis is imperative. Most cases resolve without interference. They use steroids and antiviral meds (although research suggests that the antiviral has no particular benefit); and massage to stretch and mobilize facial muscles until the nerve repairs itself. Clinical Somatic cautions – no cautions.
22. Complex Regional Pain Syndrome Def’n – is a collection of signs and symptoms including long-lasting pain and changes to the skin, muscles, joints, nerves, and blood vessels of the affected areas. An abnormal pain and other signs related to soft tissue or other injuries, usually to a distal portion of the arm or leg – a progressive disorder that is potentially debilitating. Origin/Cause – an initial trauma (often to hand or foot, but anywhere in body can be affected), begins a pain sensation that is mediated by the sympathetic nervous system. This disorder is often associated with high-velocity trauma like a bullet or shrapnel wound, but has been seen with minor strains and sprains as a postsurgical complication, with fractures, at injection sites, following strokes, as a consequence of disc disease, and sometimes with no identified causative trauma at all. Conventional treatment options – this can be challenging – evidence suggest that the best outcomes are the ones started early, but this can be hard to distinguish this condition in early stages. Physical and occupational therapies are recommended to maintain function and prevent or delay atrophy of the affected areas & massage therapy is sometimes suggested in this context as well. Sometimes this type of therapy can be a problem for those that feel pain exacerbate when moving or exercising. Other non-invasive therapies include recreational therapy, hydrotherapy (within tolerance), biofeedback training, topical analgesics & TENS units to block some pain perception (TENS unit: a transcutaneous electrical nerve stimulation device, use to control pain). Psychotherapeutic intervention is useful, as the pain and disability can lead to depression, anxiety & sleep disorders. Intrathecal pumps can deliver painkilling meds directly tto the spinal cord and allow patients to manage their own pain. And
33 Pam Kamoku Aug. 2017 some patients undergo a full sympathectomy, where their sympathetic motor neurons are surgically severed. (that seems wrong) & thus has lead to many serious possible complications. Other meds are prescribed for antidepressants to muscle relaxants. Clinical Somatic cautions – no really any cautions other than be aware of stimulation to pain. I would think that somatics could have a positive effect much the same way biofeedback therapy would.
23. Spinal Cord Injury Def’n – (SCI) is damage to nerve tissue in the spinal canal. Traumatic SCI falls into 5 categories: 1) Concussion; 2) Contusion; 3) Compression; 4) Laceration; 5) Transection (cord is severed completely, which are rare and mortality rate is high. An injury that affects the nerve supply to the lower abdomen and legs but leaves the supply to the chest and arms intact is called paraplegia. An injury that affects the body from the neck down is tetraplegia or quadriplegia.
Origin/Cause – most times from a traumatic injury/accident Conventional treatment options – emergency surgery, and another important early intervention is to limit secondary reactions that may damage uninjured tissue, in the form of anti-inflammatories and other meds usually given right away. Some alter treatments may include actions to implant electrodes that can help with movement or transplantation of tendons for improved strength. As SCI survivors adapt to new skills, physical therapy and occupational therapy can specialize in helping with new functions. Clinical Somatic cautions – possible risks including numbness that could interfere with accurate feedback in the sensory motor loop. However, I think that somatics could also be helpful in some way like PT with new adaptations to movement, breath, etc.
24. Stroke
Def’n – also called brain attack or cerebrovascular accident (CVA), is damage to brain cells due to oxygen deprivation brought on by thrombosis (a clot forms onsite), embolism (a clot travels from elsewhere), or hemorrhage (internal bleeding). Origin/Cause – oxygen deprivation in the cranium kills brain cells, and this can be due to a clot forms onsite or a clot travels from elsewhere or internal bleeding.
Conventional treatment options – there are 3 categories for stroke: 1) prevention; 2) acute care; 3) post-acute or long-term care
Prevention – identifying those at high risk and promoting preventive measures; including exercise and diet changes, antiplatelet or anticoagulant drugs or surgery
34 Pam Kamoku Aug. 2017 on the carotid artery. Intracranial aneurysms may also be treated with surgery before they rupture. For acute ischemic stroke, a thrombolysis medication to melt existing clots, but this needs to given within the first few hours of onset to be effective. Hemorrhagic strokes are treated by working to relieve pressure in the brain as quickly as possible. For recovery once it’s clear how much function is lost, then physical and occupational therapy can be employed to help with tasks like walking, speaking, eating and self care. It’s important to teach the unaffected side of the body to do self-care and understanding neuroplasticity, this can also strengthen the side that has been weakened. Clinical Somatic cautions – not during an acute stroke obviously, but working with some post stroke in recovery could be potent work to help build function again (I’m curious about this and would like to know of people working with stroke recovery patients).
25. Traumatic Brain Injury Def’n – (TBI) is an injury to the brain, (not from congenital or degenerative conditions), that leads to altered states of consciousness, cognitive impairment, and disruption of physical, emotional, and behavioral function. Origin/Cause – motor vehicle accidents, falls and assaults (for soldiers in war zones, exposer to blasts is the leading cause). Conventional treatment options – surgery to remove pressure on the brain if necessary, followed by intensive physical, recreational, occupational and speech therapy to preserve or recover function. (prognosis is best with children since it seems their brains seem to be most capable of establishing new pathways to relearn new skills. Clinical Somatic cautions – this condition is complicated and would need a health care team to see if this would be part of the treatment plan. Some clients may be numb or noncommunicative.
26. Trigeminal Neuralgia Def’n – it’s neuro-algia (“nerve pain”) along one of more of the three branches of cranial nerve V, the trigeminal nerve. There is repeating episodes of sharp, electrical, burning or stabbing pain on one side of the face. It’s also called tic douloureux, Frenh for painful spasm or “unhappy twitch”. Origin/Cause – Happens when a blood vessel wraps around or irritates the trigeminal nerve where it emerges from the pons (part of the brainstem, located between the medulla oblongata and the thalamus) at the base of the brain. Secondary causes of the irritation to trigeminal nerve can include: accidents, injuries, tumors, bone spurs, recent infection, complications of sinus or dental surgery or MS.
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Conventional treatment options – medications like analgesics (not super effective), antiseizure drugs that inhibit nerve conduction (more successful in the short run, but many patients don’t do well with them and experience “breakthrough pain” that requires another drug. Also prescribed are muscle relaxants and tricyclic antidepressants (yikes). Other methods include laser part of the nerve, radiation, a heated probe or inject chemicals (double yikes) – these give permanent side effects like permanent numbness and some facial muscle weakness. Surgery most invasive procedure and has the most risks for complication.
Clinical Somatic cautions – no cautions; you may want to wait until after they’re having the intense symptoms to do somatics, but it seems that this could be addressed with Red light and other headaches/migraines , etc. I’ve experienced this (or at least that is what the doctor called it – it was a guess and the drug I took was super strong and weird sensations) – I then went a natural approach to my sinus pain and all symptoms went away. I imagine not all cases are that easy; however it’s worth trying somatics and other natural methods since the treatments described above leave bad risks/side effects.
Nervous System Birth Defects 27. Spina Bifida Def’n – means “cleft spine”, is a neural tube defect in which the vertebral arch fails/falls to close completely over the spinal cord. Origin/Cause – contributors are: genetic predisposition and maternal diabetes, and exposures to heat or toxins, but the greatest risk factor is folic acid deficiency. Conventional treatment options – a baby born with cystic spina bifida needs surgery to reduce the cyst and maintain as much spinal cord functions as possible. Many surgeries are done in utero before baby is born. Physical therapy and exercises to maintain function in the leg muscles as much as possible(even in tiny babies). Sometimes crutches, braces, wheelchairs and other equipment are needed.
Clinical Somatic cautions – I’m not entirely sure what and if there are precautions and if someone would come in with spina bifida?
28. Cerebral Palsy Def’n – (CP) is a collective term for many possible injuries to the brain during gestational development, birth and early infancy. There are a few types of CP that involve different parts of the brain. The brain damage, usually is to the motor areas of the brain, specifically the basal ganglia and cerebrum.
Origin/Cause – statistics say that high-risk populations say that it could affect: children of mother’s who smoke, who live in poverty, who don’t receive prenatal
36 Pam Kamoku Aug. 2017 care, and who have previously had preterm babies. Prenatal causes, birth trauma & acquired CP. Conventional treatment options – the CNS damage that occurs with CP is incurable and irreversible, and therefore, CP is managed, rather than treated, by providing skills and equipment to live as functionally and as full as possible. This can include intensive occupational, physical, and speech therapy for many years. They’ve found that computers have allowed new opportunities for communication. Massage therapy is also used to maintain muscle function and elasticity. Medications help to manage seizures and reduce muscle spasm. Clinical Somatic cautions – I’m wondering if kinetic mirroring and MWB type of work can be helpful to maintain muscle function and elasticity as well. I’m not sure that the patient would have function in the part of the brain in the motor cortex to do assisted or self pandiculations, so that may not be an option.
Other Nervous System Conditions
29. Fibromyalgia Def’n – FMS Fibromyalgia Syndrome describes a condition with multiple factors, encompassing problems with neurotransmitter and hormone imbalances sleep disorders, and ultimately chronic pain in muscles, tendons, ligaments and other soft tissues. It’s often seen with chronic fatigue syndrome, irritable bowel syndrome, migraine headaches, temporomandibular joint disorders & a few other conditions.
(interesting note: this condition can affect anyone, but prevalence increases with age, peaking for among women between 60-70 yrs old? And yet I’ve know young people to be diagnosed with this as well.) Anxiety and depression are common complications because many times it takes a very long time to diagnose and people are in a lot of pain and no one knows why and they’re sometimes dismissed. Origin/Cause – patients seems to have a HPA axis dysregulation: the axis line between the ANS and the endocrine system. This means the patient tends to secrete more stress-related hormones for longer periods of time than others. Other commons factors are sleep disorder; they never enter into the deepest level of sleep & have lower than-normal levels of human growth hormone. They also have central sensitization, neurotransmitter imbalances and tender points.
Conventional treatment options – a good diagnosis is a challenge and takes time by ruling out other diseases. For most it’s a lifelong condition and can go thru phases of remission and relapse. Patient education, lifestyle choices that include careful exercise, good diet, and good quality sleep and many people do cognitive-behavioral therapy. Meds of course are sometimes prescribed: mild antidepressents, and some antiseizure drugs.
Clinical Somatic cautions – I’d like to find out more about this since Steve was able to pretty much alleviate this Fibro with somatics work.
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30. Headaches
Def’n – a pain somewhere felt in the head – one of the most common physical problems in the range of human experience. Although sometimes they can be a symptom of another problem, quite often most headaches are self-contained, short- lived issues.
Origin/Cause – often organized into many subtypes of primary and secondary phenomena. Primary headaches can be due to hypersensitivity among specific nerve pathways, irritability of the trigeminal nerve, and dilation of cranial blood vessels with subsequent edema. A phenomenon called cortical spreading depression can be a cause and is a wave of increased brain activity that usually begins in the occipital lobes and spreads anteriorly. Primary headache types: Tension; Migraine; Cluster; Rebound. SECONDARY headaches are symptoms of underlying pathologies (ie. mild fever and flu to stroke, brain injury or tumor. Conventional treatment options – over the counter NSAIDs as well as avoiding and managing headache triggers. Clinical Somatic cautions – May want to do session after the symptoms/pain has subsided.
31. Meniere Disease
Def’n – is a group of signs and symptoms that center on inner ear dysfunction, leading to vertigo, tinnitus, and hearing loss.
Origin/Cause – exact causes are not well understood. Though specialists say that it has to do with the accumulation of excess endolymph inside the membranous labyrinth (called idiopathic endolymphatic hydrops). Possible factors include allergic reactions, head trauma, genetic predisposition, auto-immune activity or viral infection. Conventional treatment options – because it’s idiopathic (they don’t know why it happens), focus is on symptomatic control. Some patients can identify triggers that increase their risk of having an episode. Avoiding foods and habits that raise blood pressure and increase fluid retention (low salt, avoid MSG, limiting caffeine and alcohol, quitting smoking) and then meds to mange vertigo and nausea. Clinical Somatic cautions – I remember this condition is associated with the red light reflex and I’m not sure of the connection. Only caution would be to make sure client is comfortable getting on & off table and not in the middle of an episode.
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32. Seizure Disorders Def’n – any kind of problem that causes seizures. (Epilepsy would be a subtype of seizure disorder) Origin/Cause – When interconnecting neurons in the brain are stimulated in a certain way, a large burst of excess electricity may stimulate the neighboring neurons. This reaction is repeated and soon millions of neurons in the brain are giving off electrical discharge – like a CNS “lightning storm” of a seizure, and it affects the rest of the body in a variety of ways. Conventional treatment options – antiseizure medication, which acts to make neurons in the brain harder to stimulate. It’s important to treat and prevent seizures because the more someone has, they change the cardiovascular autonomic reflexes and this can be progressively more difficult for a person with seizures to maintain an appropriate heart rate and blood pressure. (SUDEP: Sudden Unexplained Death in Epilepsy) Clinical Somatic cautions – obviously, during a seizure this work would not be appropriate. I believe that some somatics may add to quality of life during times when seizures aren’t in progress.
33. Sleep Disorders Def’n – these are disorders that interfere with the ability to fall asleep, to stay asleep, or to wake up feeling refreshed. There have been more than 70 sleep disordered defined and several of these are stand-alone problems that need to be addressed specifically rather than as an add-on to another problem.
Origin/Cause – can be a medical or psychological problem, emotional stress, unhelpful environmental conditions, nutrition/meds/supplements (ie. Insomnia could be due to: hyperthyroidism, fibromyalgia, depression, kidney failure, heart problems, and chronic fatigue syndrome are possible factors). Sleep apnea is another type when oxygen levels fall sufficiently, muscles tighten slightly and air reenters the passageway with loud snort or gasps. One type of sleep apnea (Central Sleep Apnea) is a neurologic problem. Circadian rhythm disruption, Restless leg syndrome & Narcolepsy (another neurological dysfunction) can be due to a deficiency of hypocretin, a neurotransmitter that promotes wakefulness.
Conventional treatment options – insomnia can be treated with lifestyle changes that better support healthy sleep (ie. diet, exercise habits, quitting smoking, adjusting temps or sound levels in room, etc). Over the counter meds (long term not the answer) and prescriptions meds (can me addicting and should be short term use). Sleep apnea can be treated in a few ways: a mask with oxygen to continuous positive airway pressure, or surgery to keep airways open. Also sleep apnea patients shouldn’t sleep on their backs. Restless leg syndrome is believed to be associated with dopamine deficiencies in certain brain areas; these are managed with
39 Pam Kamoku Aug. 2017 dopamine agents and other drugs. Narcolepsy is treatable with some meds and increasing exercise, which has shown to reduce the number of sleep attacks. Clinical Somatic cautions – no cautions.
34. Vestibular Balance Disorders
Def’n – VBDs are a group of conditions that can cause the vestibular branch of cranial nerve VIII to dysfunction, leading to debilitating vertigo and may last anywhere from a few seconds to many hours. Origin/Cause – changes in the vestibule or other problems with vestibular branch of CN VIII can lead to vertigo (a sensation of uncontrollable spinning). These changes can be related to fluid pressure as seen in Meniere disease. Less common causes of VBDs focus on the CNS and can include: stroke, tumors, MS, aneurysm or migraine headaches. Allergies that block the Eustachian tubes can interfere with fluid in the inner ear. Drugs, including alcohol, barbiturates, antihypertensives, diuretics, and cocaine, can also cause vertigo. Types: BPPV (Benign Paroxysmal Positional Vertigo); Labyrinthitis; Acute vestibular neuronitis; Perilymph Fistula.
Conventional treatment options – depends on what the contributing factors are determined to be. PBBV is treated with appropriate head maneuvers (EPLEY maneuver) and meds not needed; Labyrinthitis and acute vestibular neuronitis are treated with drugs to control nausea and vomiting and vestibular rehabilitation exercises to help the CNS adapt to changes in sensation. Other forms of vertigo are treated according to underlying causes. Clinical Somatic cautions – don’t work with person while they’re having an episode, as this can be traumatic and ill feeling. I have found that working with clients that have this, it’s best to work with them during times where they don’t feel any symptoms because if they’ve had a recent episode, then just slightly turning the head or eyes can bring them into the spinning sensation.
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