Hi. Apologies for not following up sooner—my dad’s been in the hospital.
Muscle tissue blending with connective tissues is very hard to describe in full detail but, ignoring the pelvic floor for a minute, the other 4 main muscles are big and easy to palpate. We know their attachment points to bone and connective tissue structures (minor variations in individuals have been noted and no doubt there are more that have not).
The is enough information for someone to find the muscles on their own body, to touch them and increase conscious awareness of them.
Okay. Abs, butt, quads, traps. I’ll try being more mindful of those, and see if anything suggestive appears. But I also feel like Dr Scott Dye’s failure-of-homeostatis model is more specific to what I’m going through ATM, and gears-y and prescriptive.
Seeing live/freshly dead tissues, feeling them in your hands, is a very different experience from learning from a textbook, histology slides or studying bodies prepared for dissection. They can’t compare in giving understanding of how a body is put together, of what it really consists of. These experiences give me lot of confidence in what I say about the role of connective tissues, also the knowledge that defining and delineating is very difficult so I’m stic
This honestly sounds amazing. Is there a way for a civilian to get access to large mammal [human?] dissections? I’m assuming med schools don’t just let you enroll in a single course or audit the anatomy offerings?
I read the abstract “Patellofemoral Pain: An Enigma Explained by Homeostasis and Common Sense” and found myself nodding along…
overload and/or injury produces pain. Bone overload and synovial inflammation are common sources of such pain.
Patience and persistence in nonoperative care results in consistent success. Surgery should be rare”
I agree with all that. I’d classify it as common sense as they say in the title.
But after reading the article a couple of times I don’t feel the authors were saying anything new.
Our Hypothesis: Loss of Homeostasis Causes Pain
We hypothesize that pain is the result when load applied to musculoskeletal tissues exceeds the ability to maintain homeostasis. Loss of tissue homeostasis from overload and/or injury produces pain.
which the authors are describing as “loss of homeostasis”. The use of “homeostasis” feels unnecessary.
Injury/overload = damage. simples.
However, the inflammatory processes are anything but simple. Inflammation is a rabbit hole I avoid looking to deeply into, I’d be lost for a very long time!
Pain anterior knee. —a consistent set of symptoms, signs, and test results—that does not exist.
I agree with this, and it happens to fit with my ‘individual trauma imprint’ explanation for pain-related symptoms. What our bodies have been subjected to, the damage sustained. With innumerable positions the body has a massive capacity for adaptation. As damage builds up, patterns of symptoms will emerge throughout the body but we’re all a bit different.
Emotions play a role in pain as well, and somatization resulting in knee pain is a well-known phenomenon, particularly in adolescent women related to stress or even abuse.
I checked the article’s references for more details about somatization but found nothing listed. (I also noted the references are mostly to other articles by the authors.) Whilst I do believe emotions and the physical body are intertwined, this statement feels more like a dismissal of knee pain when reported by the young and female. Adolescent women being told “it’s all in your mind” when nothing shows on exam or standard imaging. I wonder how often adolescent men with knee pain are told it’s due to their emotions too, or do they get a “diagnosis” of patellofemoral something or other? I didn’t find anything to back up this as a “well-known phenomenon”.
I say: The knees are joints that are under a lot of stress with little slack so problems appear here first when the body is not aligned and fully balanced. Stress/abuse affects positioning of the body.
Poor positioning can be subtle but it takes its toll. Knee pain—slight adjustments in the joints above and below i.e. hip and ankle to avoid the pain. It affects the whole leg, which then affects the body-whole over time. The body is very adaptable, able to cope with a lot of misusage and abuse but the imbalance and misalignments are cumulative.
The treatments listed: activity modification, cold therapy, anti-inflammatories, physical therapy. are (or at least should be) standard protocols. I’m cringing at the thought that surgery might be pushed in some parts of the world (without good reason), and thankful I wasn’t prescribed opiates as a teenager.
I was going to comment more on cold therapy but I thought I’d check some things I’d always been told, turns out it’s an another rabbit-hole to go down.
I hope your Dad is doing OK. No worries with timeframes—less than immediate responses are one of LW’s strengths IMO.
Abs, butt, quads, traps. I’ll try being more mindful of those,
Fricking awesome! Feel for positioning, freedom to move, and balance in left and right. Just to expand a little …
abs. All good. Imaging extending the linea alba between the rectus abdominis every in-breath. Pubic symphysis to sternum.
butt. fair enough. Big ass muscles—gluteus maximus.
quads. What makes you say “quads” here? It would be very useful for the insight. Focus on the rectus femoris, shin to hip bone. The quadriceps share a distal insertion (common ligament of quads.-patella-patellar ligament-tibial tuberosity) but the rectus femoris is only one of the quads to cross both hip and knee joints. image here. or in the post main muscles made easy. I think of the rectus femoris as the guide muscle of the quadriceps, positioning the leg so the 3 vasti muscles ‘fall into line’ (I don’t like that phrase - but have nothing better).
traps. Excellent. The trapezius muscles should free to support the head and arms through a full range of movement. Movement starting from lower trapezius.
(coughs) Pelvic floor. The base foundation of the body.
It would be useful to me to know how much is “the pelvic floor muscles being important” common knowledge here?
This honestly sounds amazing. Is there a way for a civilian to get access to large mammal [human?] dissections?
Commenting here got me thinking about who has the opportunity to handle really really fresh tissues like I’ve had. It’s not a long list: Anyone who turns animals into meat. Anyone performing autopsies on the freshly dead. Euthanasia and immediate post-mortem is possible in the veterinary world but human corpses are likely to be older when examined and it doesn’t take long (1-2 hours) for connective and adipose tissues to change consistency—temperature and humidity dependant. A certain class of serial killer (skip over that one). Anyone who turns animals into meat. Surgeons, especially those dealing with mass trauma injuries. Removing dirt out of fuzzy connective tissues is a bitch...
I imagine most human dissections aren’t fresh enough to really appreciate “live” tissues. So, how to get in on the action? If you can find a farmer/small-holder type willing to let you watch a butchering, a hunter that processes the carcass, a fresh meat butcher. Or a friendly large animal/equine vet that’s willing to call you when the chance to do a fresh post mortem arises.
I’ve been fortunate with the opportunities I’ve had to increase knowledge and understanding of mammals ‘in the flesh’, something I appreciate a lot more now that I’ve stopped to think about it.
I have quite a lot to say about the link you provided, so will be back with a separate comment. Have you worked through “DAMN-IT” (from one of my previous comments) and seen where that gets you?
I have quite a lot to say about the link you provided, so will be back with a separate comment. Have you worked through “DAMN-IT” (from one of my previous comments) and seen where that gets you?
Yeah, informally. I don’t really have a lot. I saw a physiatrist a few weeks ago, she felt there may be a little arthritis in the joint, but it wasn’t the main problem.
I’ve got an order from my GP for blood work, including looking for markers of systemic inflammation, but haven’t had a chance to fill it yet. In general I don’t feel like I’m very inflamed—my other joints don’t really have a lot of issues (well.. a bit of tendency to rotator cuff soreness from climbing, but it generally seems well managed).
I lost a lot of leg strength with lockdown, bec I lost access to bit barbells, which has been shown to be a risk factor for knee pain. I’ve been working on rebuilding hip flexor and abductor strength, altho more in the high-reps/body-weight range.
There was no major mechanical incident or change; I’m pretty careful with my diet (like, careful enough to worry about omega-6/3 ratios, and to eat sardines a couple of times a week. I don’t really eat industrially processed or produced foods, except for tofu, which is a staple and canned beans).
They seem to respond well to icing and voltarine, which makes me slightly more confident in the “low grade inflammation” theory.
Hi. Apologies for not following up sooner—my dad’s been in the hospital.
Okay. Abs, butt, quads, traps. I’ll try being more mindful of those, and see if anything suggestive appears. But I also feel like Dr Scott Dye’s failure-of-homeostatis model is more specific to what I’m going through ATM, and gears-y and prescriptive.
This honestly sounds amazing. Is there a way for a civilian to get access to large mammal [human?] dissections? I’m assuming med schools don’t just let you enroll in a single course or audit the anatomy offerings?
Thank you for your engagement : )
Some comments on Dr Scott Dye’s failure-of-homeostatis model:
I read the abstract “Patellofemoral Pain: An Enigma Explained by Homeostasis and Common Sense” and found myself nodding along…
I agree with all that. I’d classify it as common sense as they say in the title.
But after reading the article a couple of times I don’t feel the authors were saying anything new.
Overload/injury = stresses beyond tolerable levels --> damaged tissues & inflammatory processes,
which the authors are describing as “loss of homeostasis”. The use of “homeostasis” feels unnecessary.
Injury/overload = damage. simples.
However, the inflammatory processes are anything but simple. Inflammation is a rabbit hole I avoid looking to deeply into, I’d be lost for a very long time!
I agree with this, and it happens to fit with my ‘individual trauma imprint’ explanation for pain-related symptoms. What our bodies have been subjected to, the damage sustained. With innumerable positions the body has a massive capacity for adaptation. As damage builds up, patterns of symptoms will emerge throughout the body but we’re all a bit different.
I checked the article’s references for more details about somatization but found nothing listed. (I also noted the references are mostly to other articles by the authors.) Whilst I do believe emotions and the physical body are intertwined, this statement feels more like a dismissal of knee pain when reported by the young and female. Adolescent women being told “it’s all in your mind” when nothing shows on exam or standard imaging. I wonder how often adolescent men with knee pain are told it’s due to their emotions too, or do they get a “diagnosis” of patellofemoral something or other? I didn’t find anything to back up this as a “well-known phenomenon”.
I say: The knees are joints that are under a lot of stress with little slack so problems appear here first when the body is not aligned and fully balanced. Stress/abuse affects positioning of the body.
Poor positioning can be subtle but it takes its toll. Knee pain—slight adjustments in the joints above and below i.e. hip and ankle to avoid the pain. It affects the whole leg, which then affects the body-whole over time. The body is very adaptable, able to cope with a lot of misusage and abuse but the imbalance and misalignments are cumulative.
The treatments listed: activity modification, cold therapy, anti-inflammatories, physical therapy. are (or at least should be) standard protocols. I’m cringing at the thought that surgery might be pushed in some parts of the world (without good reason), and thankful I wasn’t prescribed opiates as a teenager.
I was going to comment more on cold therapy but I thought I’d check some things I’d always been told, turns out it’s an another rabbit-hole to go down.
https://www.physio-pedia.com/Cryotherapy
https://thesportjournal.org/article/the-r-i-c-e-protocol-is-a-myth-a-review-and-recommendations/
Cold—good or bad? It does numb the area for a while but what’s the deeper effects on the tissues...
I hope your Dad is doing OK. No worries with timeframes—less than immediate responses are one of LW’s strengths IMO.
Fricking awesome! Feel for positioning, freedom to move, and balance in left and right. Just to expand a little …
abs. All good. Imaging extending the linea alba between the rectus abdominis every in-breath. Pubic symphysis to sternum.
butt. fair enough. Big ass muscles—gluteus maximus.
quads. What makes you say “quads” here? It would be very useful for the insight. Focus on the rectus femoris, shin to hip bone. The quadriceps share a distal insertion (common ligament of quads.-patella-patellar ligament-tibial tuberosity) but the rectus femoris is only one of the quads to cross both hip and knee joints. image here. or in the post main muscles made easy. I think of the rectus femoris as the guide muscle of the quadriceps, positioning the leg so the 3 vasti muscles ‘fall into line’ (I don’t like that phrase - but have nothing better).
traps. Excellent. The trapezius muscles should free to support the head and arms through a full range of movement. Movement starting from lower trapezius.
(coughs) Pelvic floor. The base foundation of the body.
It would be useful to me to know how much is “the pelvic floor muscles being important” common knowledge here?
Commenting here got me thinking about who has the opportunity to handle really really fresh tissues like I’ve had. It’s not a long list: Anyone who turns animals into meat. Anyone performing autopsies on the freshly dead. Euthanasia and immediate post-mortem is possible in the veterinary world but human corpses are likely to be older when examined and it doesn’t take long (1-2 hours) for connective and adipose tissues to change consistency—temperature and humidity dependant. A certain class of serial killer (skip over that one). Anyone who turns animals into meat. Surgeons, especially those dealing with mass trauma injuries. Removing dirt out of fuzzy connective tissues is a bitch...
I imagine most human dissections aren’t fresh enough to really appreciate “live” tissues. So, how to get in on the action? If you can find a farmer/small-holder type willing to let you watch a butchering, a hunter that processes the carcass, a fresh meat butcher. Or a friendly large animal/equine vet that’s willing to call you when the chance to do a fresh post mortem arises.
I’ve been fortunate with the opportunities I’ve had to increase knowledge and understanding of mammals ‘in the flesh’, something I appreciate a lot more now that I’ve stopped to think about it.
I have quite a lot to say about the link you provided, so will be back with a separate comment. Have you worked through “DAMN-IT” (from one of my previous comments) and seen where that gets you?
He’s dying. Likely going into palliative soon.
Yeah, informally. I don’t really have a lot. I saw a physiatrist a few weeks ago, she felt there may be a little arthritis in the joint, but it wasn’t the main problem.
I’ve got an order from my GP for blood work, including looking for markers of systemic inflammation, but haven’t had a chance to fill it yet. In general I don’t feel like I’m very inflamed—my other joints don’t really have a lot of issues (well.. a bit of tendency to rotator cuff soreness from climbing, but it generally seems well managed).
I lost a lot of leg strength with lockdown, bec I lost access to bit barbells, which has been shown to be a risk factor for knee pain. I’ve been working on rebuilding hip flexor and abductor strength, altho more in the high-reps/body-weight range.
There was no major mechanical incident or change; I’m pretty careful with my diet (like, careful enough to worry about omega-6/3 ratios, and to eat sardines a couple of times a week. I don’t really eat industrially processed or produced foods, except for tofu, which is a staple and canned beans).
They seem to respond well to icing and voltarine, which makes me slightly more confident in the “low grade inflammation” theory.