Thursday, October 25, 2012

Spine meets Brain - a love story

So is your love story one of harmony and balance or is it like Wuthering Heights and totally dysfunctional?

People with pain don't think about anything else but the pain so talking about brains when you first meet is not a good idea.  However while the spinal joints and their components do tear, swell and hurt the research is mounting that tells a story of the complex sensorymotor relationship between the spine and the brain and what happens to each when things don't work.  Moreover research tells the story that physically based treatments work primarily because of the effect they have on the way the brain senses or feels the spine and it's movements.

The brain moves the spine and in turn receives feedback about movement, pressure, pain and a myriad other things.  Both change in response to each other.  They improve together and decline together.  People with long term spinal pain demonstrate muscle wasting on the side of injury, poor local joint control, poor postural control, poor pain control and changes in parts of the brain concerned with emotions and thinking and autonomic changes.  The autonomic system is housed in the brainstem along with the mechanisms which are sensing and controlling the spine, balance (orientation) and posture.  They are both housed there because they talk to each other ALOT.

This is why a common presentation would be 'chronic neck/shoulder pain and stiffness, headache, head tilt, postural instability (disorientation), feeling 'out of it', trouble focusing, unable to follow a moving target without swaying, and the list can go on.  Many of these findings change with application of physically based treatments and studies are suggesting that these findings precede pain.  That's saying that in chronic cases the brain gets things wrong BEFORE a person experiences pain.

What do we mean by 'wrong'?  A person should stand upright, level and be stable but typically many chronic spine patients are crooked, unlevel and unstable.  So when treating people we look at pain control and changes in body orientation as well as another indicator of improvement.

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