Friday, November 28, 2014


I moved my office this week to a new location, patients booked for Monday morning.

This morning (Friday) it's all about the phone/internet install. The installer showed up at 8am, as did I.. full of anticipation that the process would be relatively quick & painless.
It's an old building, probably from the 1950's. Probably the same age I am, roughly.. The phone lines are in an office on the other side of some firewall (a physical one, not an internet one) that bisects the building. Neighbouring office doesn't open until 9-ish. The installer went away, scheduled himself to return at 9:30 after the neighbouring company arrives at work and opens their office.
Not so quick and painless after all. Luckily I can kill time here at home until 9:30 rolls around, in about an hour from now.

I used to be able to distract myself easily from hurrying up and waiting. There was always something I could be doing.
Now, I can't, so much. Over a lifespan I've taught myself to focus, and like anything that becomes a positive feedback loop, it feels, in circumstances like this, uncomfortably runaway.
I can feel each second float slowly by, slowness like some kind of punishment for existing, a seemingly endless succession of seconds forced to be beholden to some process outside myself, dependent on external conditions.

I guess that's what I get for painting myself into the corner of life I chose to paint myself into.. trained my brain into. Usually it's more interesting to me, because at least I can feel something moving, some succession of this "now" being slightly different from the now that came before it, and the one before that.. I can feel unseen rivers moving under my hands, placed on somebody's physicality.

This kind of waiting, more social, more dependent on other people in their social realm of existence, I have less capacity to endure gladly. I have to trust that their ordinary lives will fall into place so that mine can.
So, I write about stuff, even about being bored, because it kills outside time just a little bit easier.


Wednesday, November 26, 2014

Top-down causation and the emergence of agency

Top-down causation and the emergence of agency

A fabulous blogpost by Kevin Mitchell, in Wiring the Brain

Rarely does one see entire whole nervous system function, from peripheral to frontal lobes, explained in all its hierarchical glory, linked to reality and thermodynamics and evolutionary biology, all in one easy-to-read beautiful blogpost. Thank you Kevin Mitchell.
Not that there aren't quibbles. See the comment section.

The assemblage art of Bernard Pras is a good visual metaphor for how brains work, for watching how one's own brain works.

Bear in mind this happens with every sense, every kind of input, not just visual. Mostly there is a big moving pile of junk coming in all the time; the brain tries to figure out how to make sense of it, and succeeds enough of the time that life and events seem seamless and natural. Pretty cool trick when you think about it. It's had plenty of time to develop the ways of doing this, a good 500 million years. Ever since Devonian fish first invented spinal cords. 


Is the process intelligent? It certainly feels that way. Especially in us.

However, is it really? or is it just a well-honed, most-efficient way to transform physical energy within the constraints of the laws of thermodynamics?

I found another video yesterday that depicted a gob of some sort of goo ingesting a magnet, and immediately thought of macrophages in the body. They probably are about this intelligent. Life isn't necessarily required for this sort of behaviour. Just some sort of gradient.

"Nature abhors a gradient",  a quote by Dorion Sagan and Eric Schneider, from their book, Into the Cool: Energy Flow, Thermodynamics and Life, one of the best books I have ever read in my entire life.

Here is the goo video. 


On the other side of the neuroscience universe, people are building neurons these days in order to better study them. See Blanchard et al 2014, and this news story, Scientists convert human skin cells into sensory neurons.   Ignore the usual foible, nociception conflated with pain, while reading Pain and itch neurons grown in a dish, about Clifford Woolf's group, who just published Modeling pain in vitro using nociceptor neurons reprogrammed from fibroblasts


Let's never forget that as therapists, we input new sensation, new "junk" for our patient's brains to sort. We have to wait long enough for those brains we treat to sort through new junk.

The good news is, this process is completely automatic. 

Check out the video of Alan Watts, discussing how to not fight nature, instead, how to work with it.
Instead of rowing, which requires a lot of effort, just throw up a sail and wait.
The brain of your patient is the wind, and your contact with their physicality is the boat: let that person's brain move that boat itself.
Don't wear out your hands trying to row their boat for them. 


One last thing, a new paper on the insula, by Lucina Q. Uddin.
In the critter brain metaphor, insula is quite the chooser of which raw input to pay attention to and why. Very picky.
I like to think of it as a mid-level stage processor of raw data in, from every sense.

I try to make sure I'm not displeasing the insula of the brain of the patient at any stage along the way.

Not that it doesn't happen from time to time, despite my best efforts.
I live in a conservative small prairie city. Most people are religious, or at least go to church to see their friends, and quite a few think "evolution" is an idea from the vice category. I've lost a few people on that alone. The thing is, none of any of this information about how brains make sense of things, or might end up in pain, makes any sense without that key piece of reason in the story line.

Fortunately the bell curve here contains enough people who don't care one way or the other, that I continue to make a living, a reasonable living, no matter how science-based I choose to be. 

Yes, I chose the word "reasonable" deliberately, for both its meanings, in that sentence.


1. Joel W Blanchard, Kevin T Eade, Attila Szűcs, Valentina Lo Sardo, Rachel K Tsunemoto, Daniel Williams, Pietro Paolo Sanna, Kristin K Baldwin. Selective conversion of fibroblasts into peripheral sensory neurons.  Nature Neuroscience (2014)

2. Brian J Wainger, Elizabeth D Buttermore, Julia T Oliveira, Cassidy Mellin, Seungkyu Lee, Wardiya Afshar Saber, Amy J Wang, Justin K Ichida, Isaac M Chiu, Lee Barrett, Eric A Huebner, Canan Bilgin, Naomi Tsujimoto, Christian Brenneis, Kush Kapur, Lee L Rubin,Kevin Eggan, Clifford J Woolf. Modeling pain in vitro using nociceptor neurons reprogrammed from fibroblasts.  Nature Neuroscience (2014)

3. Lucina Q. Uddin Salience processing and insular cortical function and dysfunction Nature Reviews Neuroscience 19 November 2014
"The brain is constantly bombarded by stimuli, and the relative salience of these inputs determines which are more likely to capture attention. A brain system known as the 'salience network', with key nodes in the insular cortices, has a central role in the detection of behaviourally relevant stimuli and the coordination of neural resources. Emerging evidence suggests that atypical engagement of specific subdivisions of the insula within the salience network is a feature of many neuropsychiatric disorders."

Saturday, November 15, 2014

Pain results in motor impairment, not the other way around.

Pain results in motor impairment, not the other way round. 
"Our study demonstrated that simply inducing experimental pain over the posterior sacro-iliac ligaments in painfree people resulted in the kind of findings often reported in patients with pelvic pain; a positive active straight leg raise (ASLR) and muscle guarding. This indicates that pain alone, regardless of the position or mobility of the pelvic bones, can mimic the clinical findings previously associated with ‘pelvic instability’ or lack of ‘ force closure’. The findings have implications for how we interpret what we find among patients in the clinic. It has often been assumed that these findings when present in patients with pain are the cause of their pain. In contrast, these findings suggest the opposite – that simply experiencing pain causes the body to move in slightly unusual ways, and these are signs of pain, not necessarily the cause of pain."

"This study demonstrates for the first time that pain and hyperalgesia arising from a structure superficial to the sacroiliac joint complex increases the subjective effort, activity in stabilizing muscles, and lifting quality during the active straight leg raise test. Moreover, the pain caused by hypertonic saline is related with the increase in perceived difficulty and muscle activity during the test. These data indicate that pain and hyperalgesia per se can give similar responses to the ASLR test as seen in different clinical groups and challenge the diagnostic value of the test." 

I *love* when my confirmation biases find outside confirmation! 

Now, substitute "pain caused by hypertonic saline" for "nociceptive input from a nerve, cutaneous or motor, but probably cutaneous, that can't drain and is backed up with its own metabolites because of mechanical deformation of its venous drainage coupled with the fact nerves have no lymphatics", and I think this paper is onto something.

Also, don't miss the brilliant chiro-turned-PT, Greg Lehman's, presentation (see above) which deftly deconstructs the biomechanical model in a way that it doesn't even know that it's been sliced to ribbons until it tries to stand up and falls down in a million pieces.

Palsson TS, Hirata RPGraven-Nielsen T. Experimental Pelvic Pain Impairs the Performance During the Active Straight Leg Raise Test and Causes Excessive Muscle StabilizationClin J Pain. 2014 Aug 12.

Just in case you may have missed the point:

Downfall of the biomechanical postural structural model