What is a Holistic view? - An MSK Therapy perspective.
There are multiple areas of medicine which have attempted to simplify how the human body works by dividing the body into individual parts or systems, a "reductionist" approach. However, research over the years has continued to show that the human body is far more complicated than just the individual parts. Historically, anatomy and physiology teaching has taken a reductionist view and in many respects still does to this day. The “father” of Medicine Hippocrate’s always advocated a “Holistic” approach, which looks at the person as a whole. The “whole” or overall health consists of multiple-interrelated areas such as Physical, Mental, Emotional, Social, Environmental and Spiritual aspects. A key element of “holism” is that “the sum of all the parts equals more than the individual parts”. For example, a car engine or entire car is far more than just the individual mechanical parts that form it.
The importance of a Holistic view
Relatively recent research has shown that the immune (lymphatic) system is connected directly to the brain and not a completely separate system. Such findings make it possible to look at new areas of research, which previously would never have been considered relevant. Other relatively recent areas of research have shown the importance of other living organisms within the body, particularly in the gut. The human microbiome consists of organisms within our gut, including fungi, bacteria, archaea and protists. Research is showing that the quantities of these various living organisms can have a dramatic effect on our health and wellbeing. Research is finding links between the microbiome, Parkinson's, Alzheimer's, motor neurone disease, cancers and other diseases. As with most ecosystems, types of food source and availability have a dramatic effect on numbers within any given population. Similarly, our diet appears to affect population levels within the human microbiome ecosystem. Such changes within the microbiome can affect health positively or negatively. Muscles have also been found to operate very differently to how anatomy and physiology textbooks have described them. Hence a considerable number of medical books now require updating courtesy of these relatively recent findings. Diseases and medical conditions tend to create physiological changes in tissues, which in turn affects the function of the musculoskeletal system.
Taking a holistic view of the body is equally important when dealing with sports injuries, treating musculoskeletal conditions, post-injury rehabilitation and even injury prevention. The musculoskeletal system is a sealed (enclosed) system, and one area can have a direct impact on the next. Hence, taking a holistic view is critical when dealing with such a system. The human body is made up of a combination of "structural" and "functional" elements. For purposes of simplicity "structure" will refer to the bones, joint complexes (including ligaments). The functional aspect will refer to how things then work or move and "structure" can affect "function" and vice versa. Furthermore, fascia can be both "structural" and "functional" in nature.
Theories such as the "Kinetic Chain theory" have attempted to take a more holistic view of the body. Kinetic Chain theory proposed that various segments of the body have a direct impact on other neighbouring ones. The approach divides the body into sections which consist of joints such as; ankles, knees, hips, lumbar spine, thoracic spine and cervical spine. These sections form a "kinetic chain" when one moves. If all parts of the chain are operating correctly or normally, then one tends to experience no pain, discomfort or restricted mobility. If tissues, joints or other structures are not functioning correctly, this can affect how a specific segment moves. Logically, if one section is not working correctly, it would soon lead to other areas in the kinetic chain also encountering problems. However, the body is extremely good at adapting to avoid pain, and so it may take a while to notice subtle changes to the kinetic chain. Although the kinetic chain concept is useful, it has limitations and does not take into account the fact that absolutely everything within the human body is connected. Furthermore, there are a vast number of other factors that can influence the physical properties of tissues and thus, how we move.
So what is Tensegrity?
The American architect, Buckminster Fuller first coined the term Tensegrity, though was never able to conceptualise it. The American Contemporary Sculptor, Kenneth Snelson imagined and created the first Tensegrity model. A tensegrity model is a structure that maintains its shape due to tensile forces and may look to defy gravity. Such structures consist of compressive struts (which never touch each other) and tensional wires. The forces between these struts and wires maintain the shape of the structure. Such models are three-dimensional, and therefore, the application of an external force to the structure has a three-dimensional effect.
The relevance of Biotensegrity
The concept of biotensegrity appears attributed to the Orthopaedic Surgeon, Dr Stephen Levin MD. Through Dr Levin's work, he soon realised that much like Snelson's tensegrity models, the human body was very similar, though biological. One can view the human body from a "tensegrity" or rather "biotensegrity" point of view. In essence, the body is made up of many bones (compressive struts), and structures which act as tensile wires with varying degrees of elasticity (ligaments, tendons, muscles and fascia). A tensegrity model made from compressive wooden rods and elasticated tensile wires helps explain biotensegrity in simplified terms. If one then applies an external force to a tensegrity model, then the entire shape of the model "adapts" or changes according to the applied force, up until a breaking point. The level of force applied to individual joint structures will affect the function of said joint(s) or how it moves. Too much force may restrict a particular movement or cause pain, and too little force can make a joint structure unstable, or prone to injury. As previously mentioned, "structure" can affect "function" and vice versa. Chronic pain can manifest from a continuous irritation of structures within the body and the normal healing process.
Generally, the human body starts life as a relatively symmetrical three-dimensional structure, assuming everything has developed correctly. Provided the tensile forces between the structural compressive components and tensional wires remains equal we maintain that balanced appearance. It is essential to understand that everything within the human body has grown from within via mitosis (cell division), meaning that nothing has developed separately or externally and added later. How the human body formed has essential connotations. The symmetrical nature of the human body can also change due to a wide range of factors including injury, disease, adaptions, habitual behaviours, stress (see articles) etc.
Biotensegrity - absolutely everything is connected
There have been various attempts to create what are called “tensegrity“ models to demonstrate the relationships between tissues and structures within the body. As the body developed and grew into being, everything remained connected via fascia. Anatomy books frequently refer to “layers” when discussing the human body (skin, muscles, fascia, etc.). There are various types of identifiable structural and functional fascia including, inter-structural, spinal, structural and visceral. Furthermore, fascia permeates the entire body. Fascia has many properties, including the ability to transmit forces and is thought to have sensory and communicative capacities too. Fascia itself is a form of connective tissue, which is predominately made up of collagen fibres and looks a bit like “spider silk” or “cotton wool” under magnification. In a teaching context, the concept of layers is easy to understand and makes anatomy easier to learn. However, viewing the body in terms of layers is an oversimplification and ignores the fact that absolutely everything is connected. If everything is connected, then this has connotations for biomechanics globally. One can easily see the biotensegrity nature of the human body from a simple cut. The tissues pull apart on either side of the cut and taper at each end, which demonstrates tensile forces within. Throughout the healing processes, the tissues are gradually pulled back together, resulting in a scar (see article on healing and scar tissue).
Biotensegrity in pregnancy example
A particularly good example of Biotensegrity at work is during pregnancy, due to a change in the centre of gravity. During pregnancy, the hormone relaxin is released, which results in a loosening of ligaments and joint structures throughout the body, and so there are a vast number of force changes. The changes that a woman's body goes through during pregnancy are gradual and occur over the entire course of the pregnancy. However, there is an almost instantaneous change in forces post-birth and a change in the centre of gravity. The changes which occur throughout pregnancy affect both "structure" and "function". Structure and function are inextricably linked, as the skeletal frame (structure and ligaments) have a direct impact on joint function (how they move). Equally, changes in joint function can result in changes to applied forces resulting in structural changes. Differences in tensile and compressive forces throughout pregnancy can often lead to aches and pains, as the body adapts to changes in the centre of gravity and weight. Lower back pain (see back pain article - Lower Back Pain treatment, causes, help - An MSK Therapy perspective), pelvic and hip pain are quite common symptoms during pregnancy, and this is all reasonably understandable when one considers the changes in the centre of gravity and the effect on biotensegrity. Sometimes, people continue to experience aches and pains after giving birth due to adaptions affecting joint structure and function. It is also fairly common to experience neck pain (see article - Neck Pain treatment, causes, help - An MSK Therapy perspective) or shoulder pain during or after giving birth too. During pregnancy, such pain can relate to adaptions to changes in the centre of gravity and then post-birth more related to normal activities such as feeding and holding the baby for prolonged periods. Often muscles and tissues are not used to the additional demands placed on them, and so aching, or pain can be a common occurrence. The release of the hormone relaxin and its effects stop after the pregnancy has concluded, meaning that ligaments start tightening up again. Ligamentous tension around joint structures plays a vital role in the stability of joints and functional movement. Such joints may move slightly during the pregnancy due to the ligament laxity and then become held in the shifted position once the ligaments tighten up again. Hence, it is quite common to see pre and post-pregnancy consumers in a clinical setting.
As the baby develops the additional weight at the front/anterior of the mother anteriorly tilts the pelvis forward/downwards, which also creates more room for the baby to grow. This pelvic tilting creates many other compressive and tensile force changes throughout the body, as does the space-occupying baby. Typically the more evident and apparent shape changes include:-
- the lumbar back curvature (lordosis) increases
- the posterior portion of the legs becomes longer/tighter (hamstrings, calfs)
- the anterior upper legs become shorter/tighter (quads)
- the thoracic back curvature (kyphosis) increases and shoulders tend to sit further backwards/posteriorly
- Head carriage may then also sit further forward/anteriorly.
Pregnancy has noticeable effects on the three-dimensional and symmetrical nature of the human body. Equally, if one carries a heavy bag on one shoulder, there is a tendency to see changes to symmetry. The body is forced to adapt to the shift in the centre of gravity caused by the bag and the most apparent changes affect the hips and shoulders. If the bag strap is over the right shoulder, then a large number of muscles will be contracting to hold the weight. Equally, as the burden is on the upper right-hand side, muscles in the lower back on the left will contract to counter the load. Hence, it is relatively easy to notice changes in symmetry from the side-to-side or front to back. Usually, the right shoulder will be superior (higher) than the left and the left hip or side of the pelvis will also be superior (higher or hiked). Our brain likes to see a horizontal horizon and so tries to keep the eyes level and will adapt the body accordingly to achieve this. The body is extremely good at adapting and learning (see adaption article), which in many cases can lead to the adoption of dysfunctional movement patterns. However, everything is connected, and the apparent adaptions can easily mask all of the more subtle changes, which may take some time to become apparent.
The impact of shape change more than skin deep
The general symmetrical nature of the human body was discussed earlier, along with the three-dimensional nature of it. Unlike the obvious changes in the tensegrity model shape when an external force is applied, the human body is not hollow and contains lots of other structures. That said changes in symmetry can easily be noticeable in the human body, as per the pregnancy example or changes can be far more subtle. Logically, changes to tensile and compressive forces can affect the shape of structures within the body too and not just the exterior appearance. If one looks at the human body from a Biotensegrity perspective, then compressive and tensile forces can affect almost anything within the body. Tensile changes due to adaptions and or traumas could have a functional impact on organs, nerves, venous blood supply, arterial blood supply, lymphatics, hormones and virtually anything within the body. Arteries, veins, and lymphatics are similar to “rubber pipes”, and sandwiched between “layers” of muscle and fascia. Excessive tensile forces can undoubtedly impact the normal function of such vessels by in effect “squashing the pipe(s)” and altering the flow. The same can be said for nerves, though these are more like “electrical wires” and these too can be impacted by excessive forces. Many orthopaedic tests and neurological tests are designed to apply compressive or tensional forces to specific tissues or structures to aid with diagnosis.
Historical trauma, healing, adaptions, biotensegrity
As discussed biotensegrity relates to forces affecting the human body as a whole, be they internal or external. Our bodies are constantly subjected to multiple forces daily, including gravity. How are bodies cope with such forces depends on a wide variety of interrelated variables. Examples may include:-
- Force Application - type, level, duration, direction, speed
- Tissue Type - muscle, ligament, tendon, bone, fascia
- Tissue Condition - hydration, diet, previous injury (trauma), healing, medical conditions, activity levels (conditioning), adaptions
- Habitual behaviours (postural loading)
- Stress (physical and emotional)
Although identical twins may be genetically the same (nature), there will be differences concerning elements of their life experiences (nurture). Life experiences could include historical traumas, stress, healing and resulting adaptions. Hence, such differences make each of us unique, and both “nature” and “nurture” aspects of life will undoubtedly have an impact on tensile forces affecting the body. Such uniqueness helps explain why researchers have never actually been able to find a so-called “Correct Posture” or “Gold Standard”. There are far too many variables involved to find a “fit-all” solution, meaning that what is right for one person may be wrong for another. However, this has never stopped a whole industry from developing around the mantra of “good posture”. Even stress and mood has a physiological impact on posture and can affect how we carry ourselves, sit and move. There is a lot to be said for the phrase “variety is the spice of life” concerning posture. Movement and activity have consistently been shown to be highly beneficial for the prevention and management of a multitude of conditions and not just musculoskeletal.
It is all too common to see tissue adaptions as a result of unresolved childhood injuries in a clinical setting. In some cases, treating such dysfunctional tissues can result in both a physical release of forces and even an emotional one. Hence, it is particularly important to establish what previous injuries or traumas have occurred. Unresolved past traumas can lead to problems later in life, due to the changes in biotensegrity and internal tensile forces. The longer there has been unresolved trauma within the body, the more time there will have been for the body to adapt and create multiple tissue dysfunctions elsewhere. It can sometimes take years before a subsequent problem becomes apparent. Typically, our bodies will try to avoid pain, which frequently occurs with dysfunctional or injured tissues. Pain is one of many types of “stressor”, which can keep initiating the human “fight, flight or freeze response”. Our bodies will frequently adapt and change the way they move, to avoid pain. Such adaption(s), prevents the pain but creates dysfunctional movement patterns, which become learnt or “normal”. Such movement patterns typically remain after the injury has healed and continue to result in biotensegrity change and can be a factor in chronic pain.
Quite often, a consumer/patient may purely wish to resolve the pain associated with an injury or condition. It may be possible to reduce pain in just one or two treatment sessions. However, purely just removing the pain does not necessarily resolve the underlying issue, or any other historical and unresolved tissue dysfunction. Also, removing the pain does not address the adaptive and learnt dysfunctional movement patterns or the impact of these on other tissues and structures. Hence, practitioner’s tend to recommend a course of treatments for a specific ailment and not just a single treatment, along with aftercare advice to address the dysfunctional movement patterns. Aftercare advice is at least as important as the actual treatment.
Biotensegrity and relevance in a self-treatment context
The vast majority of self-treatment aids that exist are often loosely based on specific musculoskeletal therapy techniques. Just because a self-treatment technique seems to be popular, does not mean that the inventor/seller of the method has any understanding of the original musculoskeletal therapy technique. Also, there are times when it is safe to apply a type of therapy and times when it is not. Some methods could be “globally” contraindicated, meaning that it is not safe to treat a particular individual at all, due to a specific condition(s). In other cases, it may be “locally” contraindicated, meaning that it is unsafe to apply a technique to a particular area of the consumer/patient. It is easily possible to make specific conditions far worse by using the incorrect method in the wrong context. Also, many musculoskeletal therapy-related techniques work better and are more pleasant to receive as a consumer/patient if the body is relaxed. In a normal treatment context, a consumer/patient will be on a treatment couch/plinth and areas can be propped accordingly during the treatment. Consumer positioning allows tissues to be treated in a relaxed state or to enable the release of muscles spasms with minimal discomfort. Biotensegrity is highly relevant when self-treating as one usually has to change or hold a given position to access tissues and apply a technique. Holding positions and trying to utilise tools in a self-context can make it extremely difficult to treat tissues effectively. However, that is not to say that self-treatment is pointless and it can be reasonably good, though sometimes one should see a professional. Please see the related articles on self-treatment with a Foam Roller or Self-Trigger-Point-Therapy for further details.
Sometimes we need a little outside professional help
There are many treatment modalities within the field of physical medicine or musculoskeletal medicine. Some of the better know ones might be, Acupuncture, Chiropractic, Physiotherapy, Osteopathy, Remedial Massage, Sports Massage, Sports Medicine, Sports Therapy etc. Each professional will have slightly different training, personal interests, knowledge and philosophy. Hence, two professionals from the same educational institute may work quite differently. The author originally qualified as a McTimoney Chiropractor and Sports and Remedial Massage therapist, he has also taught at advanced diploma (myotherapy) level in Australia. Experience has taught him that some techniques are better for dealing with “structural” aspects of the human body, and others are better at addressing “function”. The author takes a “holistic view” of assessment and treatment and has learnt a wide variety of techniques for creating change in the body. Some of the advanced techniques work exceptionally well with “structure” and, to some extent “function”. While other soft tissue therapy techniques tend to work exceptionally well with “function” and, to a lesser extent “structure”. Hence, combining methods works exceptionally well with the “structural” and “functional” aspects of treatment. Aftercare advice then works well with relearning what is “normal” and creating further functional change once the “structural” work is complete. Aftercare advice also helps build consumer/patient confidence to challenge tissues and not be fearful of specific movements. It is possible to create a great deal of change throughout the entire body and in a relatively short time with a combination of such techniques.
Self-awareness and frequency of any necessary maintenance treatment
The Myotherapist author has found that the vast majority of people lack a developed level of body self-awareness when it comes to an understanding of what is "normal" and "abnormal". For example, a consumer/patient may not have been able to rotate their neck for months or years. However, the consumer/patient will have adapted by turning their entire body to look over their shoulder when driving. Usually, the author does not see such people until they are in severe pain. Furthermore, the consumer/patient may have made an appointment about something very different and have no idea that their neck rotation is severely restricted. The issues with the neck could have then lead to another problem that the consumer/patient has noticed. Such a process would have been gradual and again illustrates the relevance of Biotensegrity and body adaption. Such a situation could equally apply to hip joints or other joint structures in highly active or inactive individuals. Such a lack of mobility has become "normal" to the individual, and they have adapted habits and behaviours to enable them to complete activities of daily life (ADL's).
Athletes, tend to be a little different as their ability to compete has a considerable amount to do with being attuned to one's body "self-awareness". Professional athletes tend to know when something is not right early on and usually deal things before they start to affect training and compromise performance. A significant part of aftercare is helping consumers understand how "normal" feels. Such a process is not instant, and consumers need providing tools to help develop self-awareness. The frequency of any maintenance treatment can ultimately vary from one person to the next, due to a vast number of variables involved including; previous injury history, activity levels, types of activities, habitual behaviours, diet, hydration, medications, medical conditions, self-maintenance activities, level of self-awareness etc. We all do things in life that have consequences regarding adaptions and biotensegrity. That said, the benefits of doing many activities far outweigh the effects. Some activities may involve an element of risk, though they have numerous benefits. Benefits could relate to fitness, personal enjoyment, stress relief, a sense of purpose, social interactions etc. Such benefits certainly outweigh the need to get some occasional maintenance treatment.
The article was written by Terry Davis MChiro, BSc (Hons), Adv. Dip. Rem. Massag., Cert. WHS.
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About the Author
As of December 31st 2020, the author chose to leave the Chiropractic profession and pursue studies within the Physiotherapy field. He no longer works as a Chiropractor and works as a Myotherapist in Morningside, Brisbane. The author possesses an unusual background for somebody who trained as a Chiropractor (McTimoney). His education, training, and practical experience span over two decades and relate to both health's physical and mental aspects. He has also needed to push his own body and mind to the limits of physical and psychological endurance as part of his time serving in Britain's elite military forces. His education includes a bachelor of science degree in Business Management, with a specialisation in psychology and mental health in the workplace, an Integrated Masters in Chiropractic, MChiro and a multitude of soft-tissue therapy qualifications (see the about section for more details). His soft tissue qualifications range from certificate level right through to a BTEC Level 5 Advanced Diploma in Clinical Sports and Remedial Massage Therapy. Terry also has extensive experience in security, work, health and safety and holds relevant certifications. He has also taught as a senior course coach at Advanced Diploma level (Myotherapy / Musculoskeletal Therapy) in Australia, both theoretical and practical aspects including advanced Myofascial Release Techniques and has certification in training and assessment. Terry will have taught many of the first students to train as Myotherapists in Brisbane. Terry's combination of knowledge through education, training, elite military service, and personal injury history has paid dividends for the consumers he sees and has treated over the last 15 years. He has extensive experience treating chronic pain and work and sports-related musculoskeletal injuries. Terry is still very active and enjoys distance running, kayaking, mountain biking and endurance-type activities.