INFOBULLETIN
Second year, edition no.10
June 2015
ADVANCE
Posturology stands for knowledge of the human posture, body (control) systems that interfere and, based on feedback, integral implementation.
Special issue neurosciences
Introduction:
For my training podopostural therapist (formerly podo-orthesiste) a reasonable knowledge of neurology was demanded, alongside podology and basic medical lessons.
After attending the course PAIN at the ITON (formerly POSTAC) in Amsterdam (mid-eighties) my interest in neurosciences was born. Till this very day. Moreover knowledge about neurophysiology in general and brains in particular has seen a tremendous development the last two decades.
In 1989 I published my doubts in the Dutch Journal of Integrative Medicine, regarding the hypothesis of René Jacques Bourdiol, founder of the above therapy, in which he stated that 'his' proprioceptive therapy insoles act directly on the intrafusal γ-fibers of the intrinsic foot muscles.
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Dr. Rene Jacques Bourdiol, President du G.E.M.M.E.R. († 2004)
In my opinion the thin elements on the insoles influence the mechano-receptors of the foot sole: exteroceptive thus! In fact, there is (segmental) facilitation. Direct inhibition is not taking place, only reciprocal. This view is increasingly shared. I like to express however my special appreciation for the complete works of Dr.René J.Bourdiol! († 2004). See further literature.
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Segmental relationships
Both regular and alternative segmental relationships are known. Think for instance of angina in ulnar and shoulder pain left. In alternative medicine segmental relationships are often used: connective tissue massage, acupressure, acupuncture. Already around 1900, Head and MacKenzie published about the segmental structure of the body: Headse zones may be assumed known.
Palpation (hypertonic muscle, stretched skin) and observation (wide pupil) are techniques to trace segmental responses of the body. But also what the patient tells you during the anamnesis can be an indication for a skilled diagnostician.
Neural therapy is a good example for the relationship between body surface and organs. For more information I refer to the textbooks on embryology.
In making an additional diagnosis based on segmental research there are two important rules:
- The Seitenregel (Siderule): Zones of certain organs are found mainly left or mostly right, and
- The Segmentregel (Segmentrule): some agencies have their own segment.
MacKenzie already suggested in 1900 that an organ aberration can manifest itself in three different ways:
1. Structural changes in the body: visible, palpable and researchable. The impulse is generated in the intestines; via the CNS emergence reflexes or other interactions, resulting in detectable responses to the body surface (e.g., pain on left shoulder and arm in angina pectoris).
2. Functional change as a result of the organ disorder: for example, cardiac arrhythmia. Atrophy of a muscle group or analgesia of a skin section.
3. Reflex Symptoms: reflexes and interactions through the nervous system get started as a result of an organ dysfunction. A local skin disorder or muscular response sends signals to the corresponding spinal cord segments: functions within the segment may be affected: a diagnostic astray.
Referred pain can be felt in the corresponding segmental dermatome.
Relationships of the skin areas are displayed on so-called dermatome schemas. In an analogous manner may also myotomen and salerooms be mapped.
One can now distinguish these reflex pathways:
• Viscerosomatic an organ illness causes reaction. Through the spinal cord motor neurons local hypertonia of a particular muscle or muscle group might arise. In the beginning of a disease process this reaction is often limited to a segment; Progression usually occurs in a longitudinal extension. Based on these hypertonic muscle zones the diagnosis can often take place at an early stage: for example, ‘Defense musculaire' with acute stomach problems.
• Viscerosympatic: within the spinal cord also sympathetic neurons are activated at the lateral horn. Often clearly visible: dilated pupil, zone of vasoconstriction, increased perspiration (sudomotor) or zones of Goosebumps (pilomotoric): viscerocutane reflexes.
• Somatovisceral: the stimulus is given to the skin, the muscle or to the skeleton. Within the spinal cord is now, depending on the location, the autonomic (para- or orthosympatic) nervous system triggered, and possibly causing reaction of organ function. Segments C8 t / m L2 give orthosympatic reactions, stimulation of the brain stem or the segments S2 t / S4 give parasympatic responses. The skin is with these interactions involved in more ways: therapeutic: stimulation of a dermatome and diagnostic: when orthosympatic phenomena in the skin occur.
Proprio- or exteroceptive?
By 1991, fellow podo-orthesist and physiotherapist Jaap Wijnand wrote a brochure about Podo-Orthesiology.
After describing the 'method Bourdiol' together he placed the vision Oomens next. Quoted below:
"Oomens came after many years as podo-orthesist to some interesting views about the posture influencing, so-called proprioceptive insoles. He wrote the book 'Regulation Therapy from the feet’ published by "De Tijdstroom editors”.
Oomens:
Oomens left the basic model of Dr. Bourdiol and introduced another model. This model is based on a number of assumptions:
• First:
The body struggles with gravity. Starting from the fact that man is a 'set quadruped', the fight against gravity is backward. We tend however to lean forward.
• Second:
Any change of position leads to adaption of the central gravity point and to a compensatory displacement of another body part.
• Third:
There is a "mirror response" instead. A displacement below L 3 enters into an opposite movement above L3.
In his 3-D vision the changing center of gravity lead to a related load of the feet and as such to related ground reaction forces.
Oomens divided the body in the frontal plane into smaller planes which correspond to the drawn planes of the plantar surface of the feet.
He called this the quadrant theory.
Neurophysiologic explanation Oomens:
(Peer reviewed)
With respect to the hypothesis of Dr. Bourdiol Oomens conclude, based on literature, that Bourdiol's hypothesis concerning the gamma loop is not tenable.
Recent insights are partly in conflict with the γ -innervation within the Dr. Bourdioltheory. (Prochazka, 1985 and Vallbo, 1979). Furthermore, it is unlikely that one and two millimeters thin cork elements through the dermis, epidermis, subcutaneous tissues, and the solid plantar aponeurosis could excite the muscle spindles directly.
However by placing these pieces of cork measurable, observable and reproducible change of posture can be found. Presumably this is the result of the stimulation of baroreceptors in the skin on the plantar side of the foot. Actually, there is more talk of exteroceptive stimulation than proprioceptive (Oomens, 1989).
The stimulation of baroreceptors leads at spinal level directly to contraction of the intrinsic foot muscles.
In essence, there is a facilitating technique. A direct inhibition does not take place according to this hypothesis. This is in contrast to the hypothesis according to Dr. Bourdiol.
(Note: Was this in 1991, still a hypothesis, recent literature seems to support this now).
Effect of vision, proprioception and the position of the vestibular organ
on postural sway
Eva Ekvall Hansson RPT, PhD Anders Beckman MD, PhD Anders Håkansson Professor all Lund University, Department of Clinical Sciences in Malmö/Family Medicine/General Practice. Address for correspondence: Eva Ekvall Hansson Lund University Department of Clinical Sciences, Malmö/Family Medicine/General Practice Malmö University Hospital, entrance 72:28:11 SE-205 02 Malmö Sweden e-mail: telephone:+46 40 391358 fax:+46 40 391370
Abstract Conclusion:
When measured together, it seems that vision and proprioception as well as position of the vestibular organ affect postural sway, vision the most. Mediolateral sway does not seem to be influenced by the position of the vestibular organ.
Objective: To investigate how postural sway was affected by provocation of vision, by the position of the vestibular organ and by provocation of proprioception, when measured together.
Method: Postural sway was measured by using a force plate. Tests were performed with eyes open and eyes closed, with head in neutral position and rotated to the right and to the left and with head maximally extended, both standing on firm surface and on foam. Measures of mediolateral (ML) speed (mm/sec), anteriorposterior (AP) speed (mm/sec) and sway area (SA) (mm2 /sec) were analysed using multilevel approach.
Results: The multilevel analysis revealed how postural sway was significantly affected by closed eyes, standing on foam and by the position of the vestibular organ. Closed eyes and standing on foam both significantly prolong the dependent measurement, irrespective of whether it is ML, AP or SA. However, only AP and SA were significantly affected by vestibular position, i.e. maximal head movement to the right and extension of the head.
Keywords: Postural control, balance, vestibular system
This very interesting article can be downloaded:
http://www.posturologie.nl/fileadmin/user_upload/InformaHealthCare_EkvallHansson.pdf
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Next time:
Special on neurosciences part 2, with special attention to the neuroscientist Dr. Ben van Cranenburgh.
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