It’s the Salient Detection System, Stupid

 Can you tell the difference among pain, depression, and pleasure? From a neurotransmitter perspective, the answer is no (see here and here). How is it that three very different states can be so neurologically similar? I feel the commonality that the nervous system purports reflects a system that responds to stimuli that are deviations from the norm. We call these instances by this word: Salient. Doesn’t that make your loins quiver? Let’s discuss how it works. Here’s your recommended reading. 1. The pain matrix reloaded: a salience detection system for the body (Thanks Sigurd) 2. Stress signalling pathways that impair prefrontal cortex structure and function (Thanks Son) 3. From the neuromatrix to the pain matrix (and back) [Note: Most of this article is an amalgamation of the three articles that I cited above and my own thoughts. Rather then cite every sentence AMA-style, I’ll give the credit to these guys above. Read ‘em and figure out how I put this together. For those who are sticklers for proper reference formatting, the type I am using is KMA-style citation.*] The Pain Neuromatrix Myth Hate to break it to you, but pain ain’t so special. Here’s why. If you follow modern pain science, you may often hear the term pain neurosignature or neurotag. This phrase is meant to describe a cluster of brain areas that are active during a pain experience. Information that can contribute to a pain experience travels to several areas. Some of the big players are the primary and secondary somatosensory cortices (all the

Read More

The Road to an Alternating and Reciprocal Warrior: Wisdom Teeth Extraction

This spans an entire treatment over a year’s time. Here’s part 1 Part 2 Part 3 The Saga Continues I’ve been through vision, I’ve had dental integration, I’ve put in the PRI activity homework, maximized my PRI testing, and feel a new man. Yet neutrality eludes me. It is a state of mind I could once feel by the power of glasses and splints, but the nervous system learns and accommodates. I topped out. But of course, I knew that would be the case from my very first session with Ron. “You gotta get those wisdom teeth pulled.” ~Ron Hruska By virtue of the dentist I integrate with, the time came. And here are the results. Zac B.E. (Before Extraction) So at this point in my life the large HRV gains I initially had were dropping and I was still having some neck tension. Training was feeling so-so. Test-wise, the videos below show what I look like. Here’s my squat And my toe touch. Upper quadrant tests And lower quadrant tests Mandibular movements And some cervical movements My pelvis is consistently neutral and I can shift and squat with the best of ‘em. But I still present with restrictions in my thorax, neck, and mandible (BBC/RTMCC). These limitations are likely present because of a  bony block called wisdom teeth. As you can see, the maxillary (top side) wisdom teeth limit the excurision of my lateral pterygoids for lateral trusive movements. My hope is by removing these guys I will get

Read More

9 weeks with Bane, I mean Zac…Oops Sorry Wrong CI

Note from Zac: This is my first guest post, and to start things up is the one and only Trevor Rappa. Trevor was my intern for the past 9 weeks and he absolutely killed it. Here is his story. It’s very exciting for me to get to write a guest post for Zac’s blog that I have read so many times and learned so much from. The experience I have had with him over these past 9 weeks has been incredible and I hope to share some of it with all of you that read this. He challenged me to think critically in every aspect of patient interaction: how I first greet them, which side of them I sit on, the words I use, and how I explain to the patient why I chose the exercises they’ll go home with. All of this was to create a non-threatening environment to help to patient achieve the best results they can. He also taught me how to educate patients with a TNE approach, incorporate other interventions such as mirror therapy into a PRI based treatment model, and deepened my understanding of the neurologic concepts behind performance. Therapeutic Neuroscience Education Perception of threat can lead to a painful experience which will cause a change in behavior. It’s the PT’s role to introduce a salient stimulus to attenuate the perception of threat in order to cause a positive change in experience and behavior (Zac and I came up with that, I really like it). Pain

Read More

Favorable Inputs: A Model for Achieving Outcomes

One Hot Model  Louis Gifford’s Topical Issues in Pain has an amazing amount of quality information, and has really inspired many thoughts. I’ve only read book 1 thus far, but this book can generate material to expand upon much like Supertraining does for fitness writers. I’m sure many of you folks have seen this picture before. Gifford called this schematic the “Mature Organism Model” (MOM) to illustrate how pain works. Inputs from the tissues and the environment travel up the spinal cord to the brain. The brain processes these inputs and samples information from itself to generate a corresponding output. These outputs are perceived as new inputs which reset the cycle. MOM was of course used to illustrate the three pain types (read here and here), but it is so much more than that. The MOM is a schematic for how the nervous system works. Any input that is processed by the brain may or may not lead to outputs of altered physiology and/or behavior. Viewing (your) MOM (ha) made me think a lot about working with individuals who are dealing with a threat response. How exactly are we helping these folks? I’ve come to believe that we do not treat outputs. At best we can only provide inputs that we hope are exchanged for new, desirable outputs. In patient care, we are hoping to alter perceived threat. We attenuate threat by giving an individual favorable inputs, which we hope leads to favorable behavior and physiological changes. Let’s look at what these

Read More

Course Notes: PRI Cervical Revolution

Where are all the People? I recently made the trek to Vermont for the first rendition of PRI’s Cervical Revolution course; a course in which the attendees doubled the population of the entire state. It was nice to go to the class with a bunch of old friends. You always learn better that way, and I couldn’t have been more excited to get the band back together. And even more so, I got to meet a lot of good folks for the first time. It was a real treat. This course was meant to update the former craniocervical mandibular restoration course (which I reviewed here and here), with extra emphasis on the cervical spine and OA joint. In this blog however, I will not touch much on the cervical spine positioning. I still have several questions regarding the mechanics. Some spots within the manual seemed to be conflicting; the blessing and curse of a first run-through. I will update this piece once I get these points figured out. That said, the revolution helped fine tune the dental integration process for me. I have been working a bit with a dentist, and I have a bit more insight in terms of what devices they are using for whom. Let’s go through my big a-ha moments. Smudging 901 The human body is symmetrically asymmetrical. When we have capacity to alternate and reciprocate, we are able to separate the body into parts to form a whole. If you lack integration, then there are

Read More