The brain uses vision, the vestibular system and proprioception (VVP) to build sensory maps of the body and environment. These maps are the basis of all movement. When there’s a change in vision, the vestibular system or proprioception, the sensory maps change. Movement changes. We change.
Sensation and movement are a two way street. Sensation drives movement. Movement drives sensation.
Movement can be divided into mobility and stability. When you look at a hypertonic muscle, restricted mobility, a fixation, subluxation, whatever you want to call it, what you’re really feeling is the brain’s attempt to balance mobility and stability. If the brain perceives that a joint is hypermobile, regardless of whether it really is or not, it will increase muscle tone to stabilise that joint.
Of course trauma and illness can be a significant cause. A broken leg will naturally result in less movement. Resulting in disuse of both the muscles but equally the neurons providing sensation and control. As the muscles atrophy so the neurons associated with sensation and movement of the leg become less skilled. Rehab has been traditionally been focused on the health of the muscles, but of course, any improvement will also involve helping neurons regain precise control.
In today’s culture most changes in the VVP system probably come through bad habits. We all sit to much, move to little, and spend too much time using computers, tablets and phones. Our ancestors evolved through movement and for movement. Life was change. One day was spent running, jumping and climbing trees. The next a steady walk and building a camp. We didn’t even sleep in the same place for more than a couple of weeks. We used and tested our VVP system to it’s full.
This sedentary lifestyle means that we don’t drive sensation. We don’t create movement. Everything in the human body is Use It or Lose It. Sitting behind a computer screen for 9 hours, plus another 3 hours for TV, 1 for sitting on the train, and whatever is left is spent staring at a phone. The visual system has less need to maintain long distance vision because we’re always focused on a screen <1 meter away. We spend so long with our heads in one posture that some eye muscles become dominant and others weak. The extraocular muscles have a profound effect on posture. The brain will always sacrifice posture to ensure good vision.
The semicircular canals of the vestibular system are only activated through movement. When they are stimulated they activate extensor tone in the trunk and limbs, keeping our joints stable and body erect. Without frequent rotation of the neck extensor tone will reduce. The flexor systems have historically been dominant and so they once again bend us forward into an ape posture.
Last but not least, all that sitting around means there is a profound lack of proprioception. You can only control what you can sense. Poor sensation causes poor movement so we start to experience aches and pains. Pain further reduces proprioception…
Chiropractors live in the realm of proprioception. Regardless of whether you use diversified, AK, SOT, gonstead, dry needling or taping, you are driving proprioception. This should, hopefully, improve the sensory and motor maps, resulting in a change in mobility, stability and pain. The change should be quick.
However, if the problem isn’t a proprioceptive deficit but instead a vestibular one, then treatment will be sub-optimal. Equally, you could be a vestibular rehab master but if the issue is a visual one then we’ve got the same problem. The key is to evaluate the visual system, the vestibular system and proprioception. Assessing both their sensory and motor pathways.
Everyone wants to learn treatment techniques but without diagnosis treatment is worthless. Without an accurate diagnosis and treatment plan we are reduced to a shotgun approach. We adjust every joint that feels stiff. Massage any muscle the patient points to. Bound them with tape from head to toe. With a skilled assessment this becomes much less stressful. You can confidently tell the patient what you can and can’t achieve together. Set realistic goals, and help them find other solutions for anything you aren’t best placed to help with. You’ll save yourself time and money by knowing that any “new” technique must work through the sensory and motor systems and you can decide how likely it is to be more effective than what you currently use.
If you identify something you can’t treat that’s great! Patients love to know that you’ve been thorough and honest. It also helps to build connections with local professionals in your area, helping you to become a trusted name.
Neurology used to be hard to learn, that’s no longer the case. All you need is a little motivation and consistency.