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Here's The Transcript If You'd Rather Skim!

Greetings. This is Dr. Shiller, and welcome. We're continuing on our discovery of the six things that worsen pain and disability and prevent you from healing from injury, trauma, surgery, sickness, and we've talked already about the autonomic nervous system. And we talked about the nerve muscle imbalances that can happen, which can be synergistic with the autonomic imbalances and how important those are to chronic pain and chronic illness.

Please check those out if you haven't yet, you can get those by signing up below. Or if you're on the email list, you'll have gotten an email with a link to those videos already. Today we're talking about number three, which is your connective tissue system and the local and systemic issues. That can go off with the connective tissue.

And so, you know, what it comes down to is sometimes tissue is the issue. And I've seen hundreds of people who've come to me with that. Intractable, I've got pain, there's nothing we can do about it. I've done everything thing, and when I've looked more carefully at the tissue, locally or systemically finding issues and addressing them with a few different things that I'll talk about, um, and then like.

Walla, like the person gets a whole lot better. Um, so it's important to know if you've got chronic pain. It also has implications for chronic illness in a lot of different ways. Let's start to unpack this. It's an incredibly rich and complex issue. It's one that a lot of doctors don't have on their radar because we can't measure it unless you actually learn to see it and touch it and feel it, um, and then study the anatomy and it becomes extraordinarily real important.

So let's understand things. What do I mean by soft tissue? I mean, the connective tissue, like if you're looking at a steak, the white stuff in between the meat, um, it's part of the meat really. And, um, connective tissue is basically made of a building block called collagen. Collagen CRE is built into various kinds of connective tissue.

One of them is what you might call fascia, which is this stringy stuff, or it's the grizzle, it's the stuff that. First of all, holds your bo bones together and creates the structure around your joints, but it also holds your muscles to your joints. It wraps around the muscles, the connective tissue. It's not like it's separate.

It's embedded in your muscles. And it also creates the septa that separates various muscle, um, bundles and, and, and fibers that allows your nervous system and. Blood vessels and immune system to integrate with the whole body. So it is biologically metabolically active. It is got pain sensation, it's got contractile fibers.

It's alive. In medical school, we mainly cut it out of the way so we can see the importance stuff, but, but for all of time it's been known that it's important. And in recent years, conventional medicine, or I should say progressive researchers are studying to study fascia in more depth. So let's look at more of this a little bit.

Uh, this is like a more microscopic view. There's that, you know, bundle like a, a leg muscle, and you see these fascia and there's the bone in the middle. You see the fascia going all the way down to the bone. And here's that stringiness of connective tissue, and here's a microscopic view. You'll notice these little blue dots in there and red dots, and some of those are immune cells.

So we're talking about a real integrator. Of function throughout the whole body. Your connective tissue system, head to toe, bones to skin. If you took your body and somehow dissolved all of your connective, um, dissolved everything but your connective tissue, you'd see a three dimensional casting of your body.

It would be very like, Dense and heavy in your big joints where you've got these ligaments and tendons holding everything together. It would be medium density like in your muscles where you've got these layers of connective tissue wrapping around the muscle bundles. It would be very light in the organs like your lungs, where there's connective tissue that's support structure for the entire lung, but mainly the lung is moving and flexible so that you can breathe in, breathe out, exchange gases and all of that.

So really important stuff. Here's a view again of like a leg muscle that's the bone in the middle, and you see these septa, I think this is more of a, uh, interpretive drawing. It might be an actual picture of a dissection. I'm not sure. So what makes the tissue an issue? When does the tissue become an issue?

Well, healthy tissue is soft and pliable. It's flowing, it's mobile. When you look at ancient medical systems like traditional Chinese medicine, it's like all about fluidity and the right amount of fluidity. And fluidity is life, and water is life, and rigidity is death and sickness. And it's kind of true in a way.

Although we don't speak so metaphorically. We talk about things like fibrosis. We talk about scarring, we talk about other sort of, Pathological words that describe dysfunction in the connective tissue. Um, but we don't necessarily in a, in a sort of regular clinical practice way, conventional medicine doesn't necessarily think about the connective tissue as a issue in terms of creating pain and dysfunction.

We just don't. Um, so tissue with an issue is cross-linked. It's stuck. It's. Restricted. It's tight, it's sensitive, it's toxic. We know that our connective tissue has sensory fibers. It can sense pain. It's got contractile fibers. It can respond to injury, threat, danger, inflammation, pain, so it's alive. Um, and then really what causes these kinds of things, injury, surgery, inflammation, immobilization, chronic stuff or acute stuff.

And so you can have. Tissue issues that are local, like, okay, shoulder dysfunction. It's not always just whether or not there's a tear in the rotator cuff or a bursitis. Sometimes what's going on is you've got fibrosis or restriction in the connective tissue underneath the scapula. I. That keeps the overall shoulder from functioning properly and creates chronic pain and it doesn't fit the usual diagnoses.

If you've got a great physical therapist or massage therapist or osteopath, they're gonna sense that and work on that and free that up. But the typical, just like squirt it with cortisol, oh, it keeps hurting. It keeps hurting, let's through surgery, you're not really getting at the underlying issue, which sometimes is the tissue.

Okay, moving on. So let's talk some cases, some examples. I think that's what's going on here. Okay. This person had a huge surgery on their back, right? That's a long scar. That's not just like a takeout one disc thing, but that may have been some sort of infection. I'm not exactly sure. This wasn't my clinical case, but I've seen people with a scar like that.

And what goes on is that it's not just like, oh, we cut through and we cut the bone and we address the spine. Every layer of connective tissue underneath that is [00:07:00] affected by that. And so this is like a topic top view from netters atlas and anatomy. And there's the normal muscles on the surface. You pull those away, you've got deeper muscles, and the white stuff is connective tissue.

Most anatomy textbooks give like lip service to connective tissue. They show that it's there, but they don't show the depth and and extensively of it. And how. Um, how it crosses multiple joints and creates so many important functional relationships. But you go deeper in the spine. You've got long muscles going all the way up and down.

You know, that's underneath this. We got this, and layers and layers of muscle. All of that's wrapped in connective tissue. The connective tissue changes, the scarring happens that happens there. So we missed one. That's what I wanted to show. That's just like deep muscles that go from every vertebra to every other vertebra that control rotation and bending and side bending and all of that.

And so when there's trauma, when there's infection, when there's surgery, it's not just the muscle gets outta whack, but sometimes the connective tissue. And that's where [00:08:00] moving that stuck and getting it fluid is so much more important. So important. So this is a cross section just to show you. Here's the spine, bones, here's the back, right?

The spinous processes and all those deep muscles separated by layers of connective tissue, this white stuff in between them. If you can appreciate all that, that is tracking all the way up and down from the base of your skull all the way down to your butt. And here's another view of that and just reminding that like.

Your blood vessels are tracking in through those fascial layers. Your nerves are tracking in your lymphatics, your immune system. This is an integrated system. Um, this is someone with really bad venous stasis and chronic infections, and that connective tissue is completely messed up and not functioning.

And this is a classic thing where like, okay, the connective tissue gets so messed up and so scarred that the immune system can't function and that's why people with this, this kind of disease get all these horrible chronic infections and [00:09:00] worse. Um, just kind of an illustration like. Your shoulder's, not just like tinker toys with bones and muscles in a, you know, bursa.

Underneath the acromion there, there's layers of connective tissue that are invested muscles, the tissue, the blood vessels, and that stuff has contractile properties that responds to your experience, and that can be part of what generates dysfunction and pain. Okay, so a little case here. Jane was one of my first patients when I finished residency and here I was, Sparky, Harvard graduate and all that.

And I thought I knew everything. And wow, you know, she had was 37. She was disabled from her job as a teacher. She had, um, fallen and hit her head and shoulder by when she was trying to break up a fight among those two stu, two students. And she came to me with years of chronic headaches like. Tingling and numbness in her fingers, like pain in her shoulder.

She walked around like that, like someone who had had a stroke.  Her head was sort of like that and you know, she was getting the usual interventional treatment and drugs and all of that kind of stuff. And it wasn't really helping. They were planning on doing a surgery 'cause they had diagnosed a compression of her ulnar nerve and the connel right there.

Um, and so I examined her and checked her out and, you know, there was a much different picture that I saw. Um, I had already done a lot of training in myofascial stuff in rehab residency, and we get trained to think about myofascial patterns and her body read the book. This is Pictures from Rebel and Simon's Myofascial Trigger Point Man Manual or whatever the book's called.

But the point is like I pressed Hunter Sternal, Cleo Mastoid. And the pain like jumped up into her head and I reproduced her headaches. Exactly. Um, and then I found these trigger points around her shoulder blade that send pain down into her forearm and reproduce the pain going into her elbow, into, into her fingers, the tingling.

Um, you know, this is a, just to kind of give you the context that this isn't just sort of external observations based on physical exam. There are, there are. Anatomists, especially a group of Italian anatomists who are really into fascia and they're doing these deep live dissection of unal bod un embalm bodies and showing all these amazing fascial connections.

Here's that elbow with the cubital tunnel, and here's some of those fascial layers that can be involved in irritating and compressing the ulnar nerve nerve

and oh, so back to Jane. Sorry about that. So we got to work. I connected her with a physical therapist I knew who was really a master hands-on myofascial treatment person, and in three weeks her pain was like 50% better and she was moving her arm. I said three weeks, a little more like six, six to eight weeks I think it was.

She was able to move her arm and it was starting to become function functional again, like within about four months. She had full use of her arm. Her headaches were mostly gone. She went back to her neurologist. Who said what happened? You weren't supposed to get better. And so like, she's like, well, I saw this doctor and he told me I had myofascial pain.

What do you think of that? And she said, I don't believe in that. I'm a neurologist. Like what does that mean? You know, like we have a tissue diagnosis that's been documented enough, so that's actually in a textbook and we treat it specifically to treat that diagnosis and the patient gets better. What does it mean you don't believe in it?

You don't believe in people getting better. So these are some of the experiences that really brought me down this road of thinking differently than the way I was trained and thinking outside of the box. Granted, we can't measure ma myofascial dysfunction yet, like MRIs don't do it. Certainly CAT scans and X-rays don't do it.

Your hands do it good. And an anatomic knowledge does it. Um, understanding and being open to it so that you can see it. But you can't see what you're not open to. And so that just sort of is part of what pushed me towards [00:13:00] opening up my perspective and realizing that not everything that counts can be counted and that we need to have an open mind if we want to be practical about dealing with real problems that are causing people to suffer and not be stuck in the ivory tower about it.

So anyhow, let's think some more about this together. Okay, so system-wide issues. This is a insane anatomic dissection that somebody did. And basically this is the muscles, the fascia in your planter of your foot, the bottom of your foot going back up, the muscles of your calf, the hamstrings, the pelvic fascial structures going up the back to the muscles of the throat and the tongue showing fascial connection from top to bottom.

It doesn't make any sense if you're a doctor who just studies the anatomy from a textbook and from a cadaver, because this is living anatomy. My experience over decades is seeing over and over again how these relationships [00:14:00] are very relevant. And I, I've got hundreds of cases I could share about this. Um, one of the principles that's been put out there in the body work world, what we call myofascial meridians or anatomy trains, and it's still theoretical, but it's starting to get research developed around it to sort of.

Say, well, is this really demonstrable? Can different practitioners repeatedly see it in the same patient? And the whole idea through these patterns of muscle and connective tissue that go through our various aspects of the body and influence our function, um, I. This is that front deep line. This is the deep back line.

These are connectivity from top to bottom. And these are certainly things that I've seen in my own body and in the body of people I've been working on. Might be relevant for you if you've got a chronic pain syndrome. So these are some of those other myofascial uh, anatomy trains. Um, you know, a case in point for me, someone who came to me with really bad headaches, She was in her thirties and she was in a nursing home and she had headaches for about 10 years.

She said it's because of my encephalitis. She had lupus, which is an autoimmune immune disorder, and she developed brain inflammation and had horrible headaches from her brain inflammation and um, and was put on all these heavy drugs, was completely disabled, could barely do anything. She used to be a dancer.

She was like a very vibrant person, but she was just like a long-term care. Person who was gonna get sicker and sicker probably So, um, You know, she was on, I think 200 milligrams a day of Oxycontin. She was on 300 or 600 milligrams a day of Lyrica. If I took those doses without warming up to it, I would die.

It was a really heavy doses of drugs and people were trying to control her pain. She was convinced it was her encephalitis. I checked her labs. There was no inflammation in her body. I said, this is non encephalitis. This might be the long-term effects and the way it affected your body, but remember one of those things that affects fascia.

Inflammation. Right? And so before we go down there and tell you what I did, like, we've got these longitudinal fascial tracts going all the way down the back, down the throat, down the front of the body, and then the core of the spinal cord. You've got what we call your dura. Here's your brain. Wrapping around your brain, it's a connective tissue layer that goes down all the way to your sacrum.

And you know, this is something I never would've believed when I finished residency, but then I trained with osteopaths who just made me shut up and get my intellectual map outta the way and listen and start to feel this connection that you can feel going all the way down from the, from the skull down to the lower body.

And I did some work with her and worked with the tissues around her brain and. I experienced a phenomena that my teachers taught me about that I never had really seen before, where it's sort of like her whole system just sort of like closed up and exhaled and got quieter, quieter, quieter. It's almost like her brain went down into her sacrum on a sensory appearance.

I don't really mean to say that that's what happened physically, but her system got so quiet and she stopped breathing for what seemed like close to a minute, and I thought, oh my gosh, is she. Gonna breathe again. And then suddenly at once, the whole system just sort of opened and breathed. It felt like the tide was coming in.

Uh, there's, there's a special place in Alaska where the tide just like rolls for like 10 minutes down a particular fjord, like a little stream. That's what it felt like to me. And when it ended, she opened her eyes and started giggling. And she said, oh my God, I haven't exhaled in 10 years. And that was like the beginning of the end of her pain.

And to me that was a fascial phenomenon. The fascia was, was shocked, it was restricted, it was tight, and her brain wasn't able to. Move and breathe like it was supposed to. These are phenomenon that we don't have a scientific handle on, but they're phenomenon that clinicians see [00:18:00] every day in practice, and I see all the time in practice and it has incredible therapeutic, um, effect when worked with properly.

Another example, Janice. She came in with low back and li knee pain and you know, she had a CAT scan that showed a bulding bulging disc that maybe corresponded to her knee pain and she had the epidural injections. She was on all these drugs and blah, blah, blah, blah, blah, blah, blah, not getting any better.

So she sits down on my table and I put my hand on her feet and I go, Holy smokes. What happened to your ankle? 'cause her left ankle the same side as the knee pain, just felt like it was a brick. You know, your ankle's got like a fluidity and softness to it, but she felt like she had a brick there. She's like, oh, I had a long, really bad ankle sprain one time, blah, blah, blah, blah, blah.

How long ago was that before you developed knee pain? Oh, about six months or so. Oh, interesting. So I basically mainly worked on her ankle very gently. Invited those tissues and ligaments and connective tissues to release and open, and as her ankle's [00:19:00] unwinding, she's like, oh my gosh, I feel at my knee.

What are you doing? I feel up my back. What are you doing? It's like the treatment progresses and she like calls me. She's like, my knee pain is gone. I've had that for four years. What did you do man? All I did was release her ankle. I released her ankle and then the rest of the chain up to her knee. I could talk myself blue in the face telling you about cases like this.

It's like, it's astonishing. So the question is, what can you do about it if, are these things relevant for you? Do you have chronic pain that has been persistent? You know, I had a, a patient also early in my career who had really bad achilles tendon pain. And she had nsaid, she had injections. She had an orthopedic surgeon do surgery to extend and release her Achilles tendons.

So I put my hands on her feet and I listened and I'm drawn to her pelvis and her belly. I'm like, what's going on in here? Did you have some sort of injury or tremor accident? She said, oh, I had had seven kids and I had a pelvic release surgery. Oh, interesting. And, and when in relation to [00:20:00] that, did you start developing pain in your Achilles tendons?

Uh, I'm not sure it was within a year after that. Similar story. I refer to one of my colleagues who's a myofascial, visceral therapist who like worked on the tissues and the connective tissue in her pelvis, in her belly, and her ankle pain is completely better. She's back to her job walking up and down the stairs, four flights of steps every day as a paralegal in the office that she works in.

Why do you use the steps? So couldn't you take the elevator? I like going up and down the steps. It keeps me strong, but I haven't been able to do it for years, but now I can. To me, that's like getting life back. That's what I live for. It's awesome. Okay, so look, these are real cases, real things that happen to people.

It has to do with myofascial continuity. What can you do about it? How to think about it Again, it's back to the three M's. Mind, body. Your movement motor system as well as your me biochem, metabolic, biochemical system. 'cause they're all very relevant to this. Of course, the main thing is your movement motor system, your structure.

That's where your fascia lives, but the other systems influence it. I'll talk about that a bit. Let's start with movement motor. I'm a big fan of mindful movement. You may have heard me say this before, but you know these are yoga postures and you might notice the connection. Like imagine how you're stretching all the way from your foot.

All the way up to your back and that you're stretching through this other. Hamstrings. So like I've had this experience and I've felt that a million times. That's part of why it sensitized me to all this similar posture, doing that rotating triangle where you're not just stretching one muscle group, you're working on a whole interconnected chain of connective tissue and muscle connections.

And the important thing is the consciousness and the awareness, right? Um, sometimes yoga gets taught as this. Aggressive stretching, and I absolutely don't agree with that. Especially you have chronic pain. The nature of the system is that you've got fascia which can be restricted, and you've got neuromuscular con connections, which can get outta whack and restricted and tight.

You've got protective reflexes. If you, protective reflexes are turned on because of an injury or illness or whatever it is, and you aggressively try to stretch them, you're just activating those protective reflexes and you're actually potentially making it worse unless you just overdrive them. But usually what happens is you just put, you create damage.

You add damage. Damage. And a lot of people come to me with yoga injuries because they're doing stuff that's too aggressive for their body. If your body can handle it, then fine. Ashtanga, Bikram. Yeah, why not? But if you've got. Restricted painful areas. You need to be careful. And if those kinds of aggressive yoga practices are making it worse, don't just assume you need to do it harder.

It could be you need to do it softer. 'cause the nature of fascia is that it is visco-elastic. You put a slight, um, strain on it. And you just wait, and then it unwinds and opens. And if you're putting your consciousness into that tissue, even more so. [00:23:00] So the intelligent way to do yoga postures like this, especially if you have pain, is you meet that tension.

You meet the point where it says, okay, this is as far as we go. And you wait there and you breathe slowly and gently with a lot of compassion and joy, and your system opens up and then you get that energetic flow and you get that release and it feels really good. So this is accessible to you. There's ways to learn these things if you've got chronic pain.

The other thing of which I'm a big fan is Tai Chi, which does similar things, but in a different way. There's this unity of movement that happens in the Tai Chi postures and Qigong postures where it's your whole body moving and moving those fascial chains together as one movement. When I saw these diagrams in this book, I'm like, oh, that's like.

This move and that move and that move, you know, I can relate it to the actual movements that we learn in Tai Chi and Qigong. The other thing that's going on in Tai Chi and Qigong is these spiral motions when it's done [00:24:00] properly, that are really part of like opening and closing those fascial chains and the deep breathing that actually creates like a deeper irrigation so that tissues flow and the, and the, and the fluids flow through the tissues, and then manual treatment.

Again, P T O T, chiropractic, osteopathic, perhaps others. Massage. A very good massage therapist. It's a lot of it. It's about treating soft tissue. There are techniques called myofascial release. Sometimes when people do myofascial release, they have profound emotional release. Depends on how it's done and the consciousness of the practitioner and what's going on for you as the client.

Um, but you know, it's a systemic way of addressing all of these different issues that are affected with, that are related to your myofascial and fascial and soft tissue functioning. And then finally, your mind body things. We talked a bit about these sort of system-wide emotional patterns and. Many people, and this might be relevant for you, have had traumatic experiences or deeply emotionally painful experiences that get held into the posture, that get stuck in fascial patterning.

And you know, we can't measure this stuff. We have clinical experience of profound changes in function and comfort and ability for people who've done deep. Consciousness releasing and trauma releasing techniques through breath work, through imagery, through mindfulness. Um, there's, there's a, there's a kind of, kind of breath work that has different names, whether it's holotropic breath work or um, role breathing or circular breathing or rebirthing breathing.

It's a very deep, intense, prolonged breathing process needs to be done with the right supervision, but it creates biochemical shifts in the body. It creates fascial shifts in the body, and people have these openings. I've just seen it on many, many examples in many cases, and we're talking about not just release of emotional content and trauma, but release of pain.

The body being freer. You are one organisms. Everything's connected to everything else, and so there are pathways for exploring these things, and I encourage you if any of this resonates for you to explore it. So that's the conversation about the connective tissue or a fascial system. Your head to your toe, your bones to your skin.

Your entire system is one unit. It's alive, it's integrated with everything else. We can't measure it, so a lot of docs aren't thinking about it, but it can be a real source of pain and dysfunction. There's techniques that you can use, whether it's hands-on body work, stuff that someone does to you, or mindful movement type, exercise type things that someone, um, teaches you or shows you.

Or deep emotional, traumatic release type work that you might do with various contexts. Really important to explore these things. So I wish you well, and I hope that's helpful for you. Please share this video if you find it helpful, and thanks so much for joining me.