Skeletal, Muscular, Tendon, Ligament and Joint Problems:



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Introduction
Injuries and Muscle Tension
Therapies
Body Stress Release
Osteopathy
Shiatsu
Acupressure
Chiropractic




Introduction:

CFS patients and those of related conditions often have a specific injury, or at the very least too much muscle tension. This is particularly exaccerbated in those with poor protein digestion and inefficient amino acid synthesis/conversion abilities, low magnesium and creatine levels, poor mitochondrial function, and those with excessive inflammatory response, who are more prone to injury and have very long recovery periods or experience no recovery at all (but simply accumulate more injuries). This page is not looking to explore all the different possible physical injuries and skeletal, muscular, tendon, ligament and joint problems.

Common supplementation and treatment regimes to assist muscle or tendon recovery rates after injury or physical stress include taking the amino acid Glutamine, which makes up a bulk of the muscle and tendon tissue protein, up to 2g three times a day; the Branch Chain Amino Acids L-Leucine, L-Isoleucine and L-Valine are also a major constituent of muscle together making up 33% of total muscle amino acids; taking Magnesium supplements (e.g. Magnesium Glycinate or Citrate), applying Magnesium cream to the afflicted area (e.g. Epsom Salts cream or Dead Sea Salts skin lotion) and/or soaking the afflicted area in a warm Epsom Salts or Dead Sea Salts bath for 20-30 minutes. I have also found that Shaolin Osteopathy Essence sprayed onto the afflicted area of muscle soreness alleviates symptoms, promtes healing and blood circulation very well indeed. Dit Da Jao may work effectively also, and perhaps a number of balms on the market too.

Dr Martin Pall theorises that physical injury or trauma, often to the head and neck, may result in an excessive inflammatory response by the body resulting in a vicious cycle of oxidant/free radical production, of Nitric Oxide, Superoxide and Peroxynitrite, which may be responsible for many (but not necessarily all) of the symptoms associated with CFS, ME, Fibromyalgia and Post Traumatic Stress Disorder (PTSD). Please see the Nitric Oxide Cycle page for more information.

In addition, the muscles may well fatigue early, on account of poor mitochondrial function, poor cell membrane fluidity, low oxygen levels and too high CO2 and lactic acid levels. This latter aspect is examined more on the Acidosis page.

The Dartmouth Medical College's Human Anatomy Learning web site is listed below. It contains diagrams of skeletal/muscular/tendon connections for various joints and those involved in individual movements.

http://www.dartmouth.edu/~anatomy/index.html

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Injuries and Muscle Tension:

Whether the physical injury contributed to the condition of the patient in the first place, or is a result of the condition through decreased physical strength, muscle wasting and sensitivity, or whether it is an old injury that becomes worse because of one's condition, or whether one's body becomes stiff and tense because one is ill and cannot sleep (self-perpetuating some of the problems of the CFS sufferer), the approach should be the same. Case history is useful up to a point. We are most interested in what is going on now in the patient. Therefore, if the patient is experiencing any kind of joint or muscle/tendon pain or is concerned about aches and pains (regardless of cause), or has a poor posture or is unable to keep a good posture, a visit to a physical therapist is recommended.

Muscular and skeletal health and correct alignment/tone, and the ability to exercise gently are important to maintain one's metabolism and immune system, and recovery generally. One cannot just treat the muscles and skeleton and ignore bio-chemical problems described in previous sections. In some severe CFS cases, the physical therapy may not make any significant progress. And conversely, just treating the biochemical causes may help greatly with physical problems, but it probably won't help the patient to relax and relieve the building up of stress in the body over time etc. If there are any spinal problems, then they will need to be treated in the course of a CFS treatment programme. Spinal and posture problems and excess muscle tension may well have a corresponding impact on the functioning of the body's organs, and other biochemical and energetic systems. For example, areas of severe muscle tension may well correspond to a perceived area of energetic blockage by an energetic practitioner. Treatment of all aspects of the body and mind are required for optimal recovery.

The area of muscular and skeletal problems and CFS or FMS is often like the chicken and egg question. Did the muscular and skeletal problems occur as a result of the CFS or FMS (and greater susceptibility to injury and slower recovery periods)? Or did the CFS or FMS occur as a result of postural or skeletal misalignment, as a main contributing factor? Or as a 'trigger' in a myriad of other predisposing biochemical factors prevalent concurrently? In some patients, treating a postural/skeletal problem may appear to clear up most of the FMS symptoms. In other patients, treatment has very little effect until the body's mitochondrial efficiency has sufficiently improved through other types of treatment (discussed elsewhere in this site). Clearly the best approach is to look at the entire body and try to determine the relative severity of problems and tackle them accordingly.
When the body is injured, it has a built in defence mechanism (initiated by the brain/spine/nervous system) to tighten up all the muscles surrounding the injured site, to help protect the tissues (and also the spine if the injured site is on the back). Also, when a muscle or muscle group is being over-worked or subject to manipulation, if this occurs for more than a short period of time or 3 repetitions, it may result in the muscle treating it as a permanently 'threat' and tightens up to protect itself. This mechanism is often over-zealous, and results in too much muscle tension, which stops the joint or muscle functioning properly and may have knock on effects in terms of compensating with other body parts, posture, skeletal alignment etc. Often chronic muscle tension reduces the range of motion of certain joints and parts of the skeleton such as the lower back and pelvis; it can also tighten the muscles so much in key places that it distorts the skeleton. Tendon and ligament inflammation is often self-perpetuating, and the use of a natural anti-inflammatory (such as Nutri's Prozyme or Serrapeptase) can be very useful as part of a recovery programme. Simply snapping the vertebrae back into place may not necessary fix the problem, as the muscle tension is still there and will soon stiffen up the vertebrae again. With all this muscle tension and stiff vertebrae in the spine, undue stress can be put on the freer vertebrae, increasing the risk of injury. Having continuously tight muscles (24/7/365) in certain parts of the body clearly uses up a great deal of unnecessary energy in the body (much in the same way as excessive stress and negativity uses up unnecessary amount of energy, when being relaxed and calm is so much easier!).

We often think that we can 'do an emotion' and the effect is just in the mind, but the body is a vessel of expression of the human mind. The body is not just a tool used for carrying around our modern human minds! The body's expression and mirroring of what is happening in the mind ranges from changes in body language, hormonal changes to changes in muscle tension. Stress, anger, tension, sadness, depression, frustration or any other negative emotions create muscle tension in the body and often this may centre on the shoulders, neck and lower back, without us even noticing. It may cause back and spinal problems in itself and/or exaccerbate existing muscle injuries and muscle tension around injury sites and/or areas of skeletal misalignment. The muscle tension caused may also help to lock the person into a tense and unrelaxed mental state, self-perpetuating negative psychological states and the resultant source of muscle tension. Most people are unaware of the muscle tension they create or continue to carry around with them through stress etc. until it is released. Poor posture is also a huge contributary factor or exaccerbator. Persons suffering from CFS or related conditions are often unable to deal with stress inputs so well on account of hormonal dysfunction, in addition to the fact that living with such a condition is a source of stress in itself, with its ups and downs. This can help to perpetuate muscle tension, in a catch 22 situation. Depending on the exact nature of the injury or tension/irritation/inflammation, energetic blockages can develop which can have affect the overall energetic and biochemical state of the individual. The idea of most physical therapies is to break down the muscle tension, which is often the main cause of the pain, not the actual injury itself. Some seek to actually manipulate the skeleton as well, which can cause damage to the vertebrae if not performed correctly. There is much debate about whether manipulation of the skeleton should be done at all, as opposed to gently encouraging the skeleton to correct itself, but this is up to the individual to figure out and decide for themselves.

Partly on account of the advertising antics of gyms and 'health' clubs, there is a common perception that if you are physically fit, then you are also healthy. This is not necessarily the case. The marketing succeeds as it lulls people into a false sense of security that they can eat a poor or average diet and pollute their bodies, but stay 'healthy' by going to the gym a couple of times a week. Physical fitness no doubt helps to stimulate the body's processes, but it cannot overcome poor nutritition and a heavy toxicity load!

Mental stillness, a clear mind, suppleness, openness, relaxation, stretching, flowing movement, non-attachment, and increased mental awareness all help to relax the body and allow the muscles to operate as they are supposed to, without any excessive tension, and allow the meridians of the body to open up, to ensure optimal health.

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Therapies:

There are many different types of physical therapy, some orthodox, some unorthodox, and the individual must really make up his own mind as to which is most suitable and which technique works best and which the body responds best to. Some work on the muscles, tendons and skeleton (and thus indirectly on the energetic system). Some work on the muscles themselves. Some work on the body's energetic system, which in turn can alter muscle tone and skeletal alignment to varying degrees (indirectly but in some cases profoundly, some energetic treatments are better at this than others). I have chosen to include a broad range of treatments to discuss in this section, not strictly those that are optimum for skeletal, muscle or tendon problems. I will only describe those fields I have direct experience of and can personally endorse, and over time and exposure to new techniques and new information, will update this section accordingly. Many energetic/physical treatment therapists are in this field because they care about people and are often very interested in their clients and are surrogate agony aunts, who can listen to your problems and lend a sympathetic ear and be your friend.

Because of the complex nature of severity of many energetic problems in CFS sufferers or those with related conditions, a few sessions may not be enough, and it is likely that a large number of regular sessions are required to make any real progress. The effectiveness of course depends on the therapy. Many therapies, such as body stress release, may still be effective after a large number of sessions, but appear to be at their most effective for the first 5 times or 10 times when the body first experiences them. After this the body will probably still respond to the treatments, but probably not as greatly as it used to. Of course, the responsiveness of the body varies between individuals and the individual's energy levels. It may therefore be sensible to use such treatments at the appropriate time, when you believe that conditions are such that they will be most effective. For example, if you have chronic nutritional deficiencies, harmful micro-organism overgrowth or toxicity issues, then it is best to deal with these prior to commencing such a course of treatment. Otherwise you may 'waste' the 'optimum window' for such treatments and also your own money. However, as said above, this varies between individuals.

The body in CFS patients and those with related conditions tends to be very run down, and the muscles very unresponsive, so what works best at one time may not work best later on during treatment, and responsiveness to different treatments varies between individuals. So unless you are getting consistently positive results over time with any particular therapy, do not feel that you need to stick to it alone out of loyalty. Try a few different therapies and see what works best for you. Each type of therapy may have its place for specific applications. Often, combinations of different types of treatment may help, as the muscles are exposed to slightly different stimulation. It really depends on the exact nature of the problem, the therapies and the actual practitioners themselves. Links to various therapy association home pages for those listed below and also other therapies not discussed on this page can be found on the CFS links page in the Physical Therapy section and Other Approaches section, where you can find a registered practitioner in your country/area or read more about it.

Other energetic therapies that do not strictly affect the skeleton, muscles or tendons directly or indirectly to such a great extent, that are not mentioned below, are discussed on a separate page, Energetic Therapies.

Some practitioners hold that heat treatments (e.g. saunas), but specifically, brief, consecutive and repeated exposure to hot and cold assists in promoting the body's circulation, if applied locally or to the whole body (hydrotherapy).

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Body Stress Release:

Body Stress Release (BSR) was developed by a South African Chiropractor, and is a type of non-intrusive therapy designed to help correct skeletal problems, help release muscle tension throughout the body, and to help to release muscle tension at injury sites to allow for proper and full mobility and recovery. By releasing muscle tension, BSR may also help general mental health and also help to lightly encourage qi circulation and the opening of the meridians. By testing muscle response, a BSR practitioner is able to identify where muscle tension and stress lies in the body. It often originates from the lower back, pelvis or neck or diaphragm, but not always. Muscle tension has a rotational component and direction, which is released by the practitioner by a twisting action in the opposite direction. A point of pressure may also be briefly applied to relieve an area of muscle tension. BSR practitioners often use a small wooden tool to perform the presses and rotations. Heavy exercise is discouraged after a BSR session for 24-48 hours.

BSR is also good for those who just wish to unwind and feel totally relaxed, and have a better night's sleep. Often BSR patients have a number of health complaints which vanish after a couple of treatments. The progress with CFS/FMS patients may well be much slower than 'normal' clients on account of the lack of muscle responsiveness in ill patients. BSR is relatively young as a treatment, and there are not BSR practitioners in every major industrialised country. This is a great reason to go on a training course and start a practice in your own country! A list of practitioners in your country/area can be found on the BSR web site.

There is an exercise one can perform at home. It should be performed last thing at night. Basically one takes a wooden spoon and pushes the handle end into an area of muscle tension, and rotates it in both directions. Ideally one would identify the direction of muscle tension and only use one direction. However, by applying the force in both directions, the 'wrong' direction (i.e. same as the tension) does not really aggravate the muscle tension significantly. One can go over the area of muscle tension in a number of different places. A maximum of three rotations in each direction should be performed on any one spot, after which one may instigate more tension and not less as a defensive reaction by the body!

There is another exercise that BSR practitioners often recommend, called 'tummy tucks'. When one is laying in bed, prior to getting up in the morning, whilst laying on one's back, raise your knees up slightly so your feet are 10cm away from your bottom. Put your hands on your lower abdomen just above your groin. And repeatedly clench and relax the abdominal muscles closest to your groin. Your hands feeling what is going on should help you isolate these muscles. The idea is to perform rapid successive clenches of these muscles, as many as you can do. You may be able to achieve 100 to 200 with practice. This exercise is intended to strengthen the adominal muscles for the day, to provide additional support to the lower back (counteractive muscles). Apparently one needs to have been laying down for at least 2 hours for the muscles in the abdomen to relax enough to make the exercise effective.

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Osteopathy:

Osteopathy is a treatment that works on the muscles, tendons and the skeleton. It works on the basis of correcting structural problems, and their effects on the rest of the skeleton and musculature. This is achieved by deep tissue massage and pressure on tight muscles and sometimes manual manipulation of the skeleton if vertebrae are immobile.

It is worth seeing a good osteopath if you suspect you have a complicated mechanical joint problem, for example broken cartilage in the knee. Once the osteopath has reset the knee, in this example, and pushed the cartilage back into its correct position, treatment with BSR or other less intrusive therapy can be continued - it is up to the individual what pattern of treatments they find the most beneficial. For conditions such as RSI, you may wish to alternate treatments of BSR and osteopathic muscle massage, to alternative the stimulus you give to your muscle tension/tendon inflammation. A good osteopath can perform a series of mechanical tests to determine which joints of parts of the skeleton or muscle groups are not functioning correctly, and can feel where inflammation or stiffness is in the muscles and tendons. If you feel you have a mechanical problem that the above practitioners cannot address, you may wish to be referred to a specialist or have have x-rays taken. As usual, a methodical approach is required, to eliminate possibilities. Like many other types of physical therapists, quality and style of treatment varies considerably, even amongst those belonging to official bodies. Some are excellent, some mediocre and some even cause more harm than good. This is why you might want to see a highly qualified, highly experienced and highly recommended Osteopath.

Neurostructural Integration Technique (NST) is a form of holistic massage developed from the famous osteopath Tim Bowen's Bowen Technique by applied Physiologist, Michael J. Nixon-Livy from Australia in 1995. It combines disciplines like Kinesiology with Osteopathy and many others. It is reputed to enable body to 'communicate better with itself' through stimulating the nervous system in a specific manner. Some claim it to be a refinement of the Bowen Technique (or perhaps it is a 'trademark' issue). A find a practitioner tool can be fond at the second link, although it is best to use a national rather than regional search as some practitioners do not appear to be correctly categorised at present. The third link is from Dr Joseph Mercola's web site, including an article by Nixon-Livy. Mercola believes NFT to be a useful tool in treating CFS and Fibromyalgia patients.

www.nsthealth.com

www.nsthealth.com/pract.php



The Bowen Technique is an osteopathic technique that was created by famous osteopath Tim Bowen.
http://www.thebowentechnique.com

I have yet to try NST, but will report back and relay his experiences once I have done so.

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Shiatsu:

Shiatsu is a Japanese art, with many overlapping areas with Traditional Chinese Medicine (TCM), Acupressure and Acupuncture, with the same concepts of meridians and qi (see below). It differs somewhat in that the shiatsu practitioner works on the whole meridian rather than just on acupuncture points. The shiatsu treatment can also help to release muscle tension as well as unblock meridians and increase energy flow in weak organs, perhaps like the spleen, stomach, liver, kidney and lungs. The practitioner uses massage, hand and sometimes elbow manipulation, and certain assisted stretches to unblock energetic blockages, to work a specific meridian or meridians and to release muscle tension.

Shiatsu does not actually put any more or new energy into the body, but merely redistributes what the body has to level out imbalances and work on blockages. It is therefore unwise to have too many shaitsu sessions too close together or one can deplete the body's qi levels, even though the body is more 'balanced' energetically. The sessions rely on the patient building up their energy levels in between each session, so there is more energy to work with and rebalance.

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Acupressure:

Acupressure is a Chinese art that works on the basis of massaging acupressure/acupuncture points on the body's different meridians to release energy blockages and thus to promote harmonious flow of qi (or life force) around the body. Each meridian corresponds to a real or imagined organ, for example, the Spleen meridian or the Triple Burner meridian. In addition, the function of the meridian does not necessarily correspond to the function of the organ, for example, the pancreas determines the quality of digestion but it is the spleen meridian that determines this also. Acupuncture is normally given in conjunction with Acupuncture and Cupping Therapy. Acupressure is regarded by practitioners of Traditional Chinese Medicine (TCM) as being inferior to Acupuncture, and so a practitioner will rarely give just an acupressure massage in isolation, but in addition to an acupuncture treatment (on the same day or on an alternative day). Acupressure does however have the advantage of relaxing the muscles, and a good hour long acupressure session can be very relaxing and therapeutic.

Acupuncture and acupressure do not actually put any more or new energy into the body, but merely redistribute what the body has to level out imbalances and work on blockages. It is therefore unwise to have too many acupuncture sessions too close together or one can deplete the body's qi levels, even though the body is more 'balanced' energetically. The sessions rely on the patient building up their energy levels in between each session, so there is more energy to work with and rebalance.

Acupuncture is discussed more on the Energetic Therapies page.

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Chiropractic:

Chiropractic is the treatment of the spine and skeletal system to correct vertebral subluxation through manipulation and manual treatment. Chiropractic is generally considered to be a form of alternative and complimentary medicine. I have not tried Chiropractic himself, but from my experience with family members, the treatment was not particularly effective and if anything made my family members worse. The treatment would make their skeletal system feel better afterwards, but it would feel extremely sensitive, so much so that the slightest bump or movement would completely upset the work done and render the muscular/skeletal system much worse than it was before the treatment. This is not something that they have experienced with any other therapy. This may be due to the practitioner of course and the predisposing factors behind their conditions.

I am not entirely dismissive of Chiropractic, and is sure that there is some good Chiropractors out there. He tries to keep an open mind. As described above, Body Stress Release was created out of Chiropractic, so it must have been a good starting point.

The whole book 'Bonesetting, Chiropractic and Cultism' (1963) by Samuel Homola, which examines the history of Chiropratic is shown at the link below.

www.chirobase.org/05RB/BCC/00c.html

Dr John Bergman is a Chiropractor that has treated some Fibromyalgia patients for spinal and neck misalignment, which has in specific cases resulted in recovery from 'FMS'-type symptoms.
www.bergmanchiropractic.com

A video featuring Dr Bergman discussing spinal and neck problems and their effect on certain Fibromyalgia cases can be seen at the link below.



The Whitcomb Method is a spinal-based treatment for FMS, devised by Dr Paul Whitcomb, a Chiropractor. The Whitcomb Method promotes the idea of specialist spinal treatment (focussed on the occipital ridge) to resolve all biochemical problems, regarded as the chief causative of these problems, as opposed to examining a patient's biochemical problems and treating these. Some (but not all) FMS patients do appear to have skeletal problems as a factor in their overall condition (including a history of whiplash). Are the rest of FMS sufferers actually suffering from postural problems with no accident history? Clearly this is strongly debated. The second web site is an interview with Dr Whitcomb. As of 2008, Whitcomb has not taught anyone else his technique.

www.stopfibro.com

www.newstarget.com/008526.html

This information about Dr Bergman and Dr Whitcomb is reproduced from the Links page, in the Alternative Approaches section.

Some doctors believe that chronic Sacro Occipital misalignment/structural problems can result in a disruption in the flow of the sacral and cranial fluid and Fibromyaligia like symptoms (especially increased sensitivity in the tissue areas immediately adjacent to the spine) but that it is not the same condition. In other words, the main causative factors are largely different.

http://en.wikipedia.org/wiki/Occipital_bone

www.becomehealthynow.com/faq.php?cat=chirotechniques&id=7

www.sotoeurope.org

This might explain why some 'FMS' sufferers become well with Sacro Occipital work and others do not or require other forms of treatment in parallel. This is not to say that some FMS cases do not have both conditions simultaneously, or rather to say, they have biochemical, toxicity and also structural causatives to their condition. However it could be argued that Fibromyalgia is just a term used to describe a set of symptoms rather than the causatives and processes in the body that result in these symptoms, and that the causes in each case are unique in severity and exact nature, so whether the term Fibromyalgia should be used in all such cases is not important, but only when it causes confusion and prevents people from identifying the main causative factors.

My own Osteopath has however stated that true structural issues (as opposed to minor soft tissue tension/problems) in the area around the Occiptial Ridge are very rare, and he has only seen 4 cases in 15 years of practice. He believes that ideas about the widepsread prevalence of true occiptal problems are grossly exaggerated.

One technique for addressing Sacro-Occiptal problems is of course Craniosacral Therapy as described above. Another is Sacro-Occipital Technique (or SOT).

An extract from a 1963 book by Samuel Homola, examining some aspects of Sacro-Occipital Technique (a Chiropractic variant) is listed at the links below.

www.chirobase.org/05RB/BCC/11d.html

Other skeletal conditions that may aggravate this include Chronic Sacroiliac (SI) Syndrome - affecting the area immediately above the buttocks. The SI joint is basically the pelvis. There are perhaps other skeletal conditions which may exaccerbate the above problems, and the nature and severity is dependent on each case itself.

www.yourmedicaldetective.com/public/406.cfm

It is important to appreciate what the original root cause of one's ill health is, and tackle that original root cause, but also to recognise the downstream and knock on effects of the original problem(s); and if they are of such a severity that they may need treating in additional to the original root cause. In cases where Fibromyalgia is brought on largely by a skeletal injury (perhaps in combination with a number of other background factors operating over a large period of time), then it may be necessary to treat the skeletal as well as biochemical to restore full health to the patient.

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