35. A Thesis on Hysteresis

Welcome Back: Navigating a Busy Life and Podcast Preparation Hello and welcome to another episode of An Osteopathic Journey. It has been quite a while since I've had a chance to actually sit down and and make a good recording, but not to worry, it's still coming. There's lots more on the way I've been. Speaker 2 Preparing a lot actually for for this episode. Usually I just kind of sit down sporadically and kind of like flusterly because I don't even know if that's a word flusterly, but I'm just going to sit down and, and I make an episode whenever I kind of feel like it. But lately, as we're kind of transitioning towards, you know, the physics side of things, it's been a lot more studying and a lot more deep diving into the literature. Or there's some of the newest literature that's coming out and really trying to decipher, you know, what is it talking about? And and more importantly, how do I use it clinically? So if you hear sirens today in the in the recording, my apologies for that. That car accident happened just right outside my office. Actually. I don't know how far it is, but I heard it. So hopefully everybody's OK. But I'm definitely hearing tons of sirens now. So I wasn't sure what happened, but but sure enough, minutes later I started hearing sirens. So I yeah, something's going down out there. So hopefully everyone is OK. We are coming fresh. Speaker 1 Off of the. Speaker 2 Pretty much busiest month I've ever had a March was just insane in terms of seeing patients and like I said, lots of personal stuff going on this year. Generally it's pretty much one of those years where like all of my friends decided to get married all at once and then obviously we're preparing for my own wedding as well. So lots of stuff on the go but that's OK and at the same time the clinic has just been bonkers absolutely crazy this week looks like it's going to be a little quieter. So I'm actually quite looking forward to having a quieter week, but I'm having said that I'll probably still see north of 50 patients this week, but that's that's considered a quiet week nowadays, which is pretty crazy. Even though I typically see anywhere from kind of 60 to 80 a week, depending on the week, it's still kind of fluctuates. And then it's funny because we had the symposium recently, which which I'm going to dive into shortly. Just talking to people at the symposium was a lot of fun. I think talking to a lot of graduates and their experiences and a lot of new, newer graduates as well. It's going to kind of fluctuate. And you know, some weeks you're going to be very busy and then other weeks you're going to be a little quieter. And then that's just part of the business and that's just how it goes. You know, patients are always kind of coming and going. Sometimes they need to be here very frequently. Sometimes they don't need to come back every for, for a couple of weeks if they're feeling better. So naturally you're going to have some weeks that are just absolutely crazy and then other weeks where, you know, things are a little quieter and, and that's totally fine. Take those quiet weeks as an opportunity to read up on things, study, refine the craft. And that's what I plan on doing this week. So I'm, I'm pretty excited to hopefully have a quieter week this week. Reflecting on the Symposium: Day 1 Value, Day 2 Challenges So we are coming fresh. Speaker 1 Off of these symposium. Speaker 2 Symposium. A symposium was the first time in six or seven years that we hosted a event and there was lots of people. There was a great turn out. I think it was over 400 people there between both students and practitioners. I think it was a pretty even split between students and practitioners. So it was really nice to kind of see everybody mingling and and kind of giving value to each other. The speakers were interesting as well. Day one I thought was a really good day. I got lots of value from John Jason Haxton, Sorry, John Lewis. They talked about kind of the history of osteopathy and, and how chiropractic came from osteopathy, which is already things that were kind of covered during our our history class while I was a student. But it was just kind of fun to see like the dots and the people and, and the records that actually exist that prove that chiropractic actually came from osteopathy and from doctor still where some of the original students or some of the students who studied under doctor still then ended up creating chiropractic. And so very interesting stuff if that's what you're into. And there's tons of stuff on it online. I'm sure the chiropractors don't talk about it, but that's OK. We're just going to focus on ourselves and, and kind of do you know what, what we do, which is osteopathy, right? So the first day also featured John Sharkey. So I thought his talk was very interesting. A lot of structure and function in the fascia kind of from superficial to deep and how, you know, even though we kind of divide the bodies into layers, there really is no layers because it is one continuous system from the cutaneous levels of the fascia right down through into the bone. So I thought that was very interesting. Lots to take away from that. And it did kind of change the way that I viewed tissue. And I'm actually going to talk about that in great detail today. So this is probably going to be a bit of a longer episode, I think. And some of the technical jargon that we're going to dive into is going to be quite in depth. So this might be an episode that might require a few listens in order to really actually grasp the concepts and also to start to learn and see how these can be applied to the table. And some of these concepts have been at the forefront of my mind over the last kind of two weeks. And I will kind of go over some of those thoughts. I've been writing a lot. Speaker 1 Over the last. Speaker 2 Few weeks as well just kind of writing about things that I've seen in in the treatment room, but also kind of applying some of the some of the new theoretical models that are coming out. And so I'm, I'm very excited to kind of jump into that and kind of put my my spin on it and give my two cents on how this is changing me as a. Speaker 1 Practitioner Back to the symposium. Just really quickly though, I thought Day 2 was a stark contrast. Speaker 2 To day one, aside from, you know, a few, you know, tough speakers who who were very consistent throughout the weekend, of course, like Gustav Corona was always going to give a great Aussie paddock talk and, and that was wonderful lots to take away there. I took I took some notes as well from that and stuff to kind of chew on for the next kind of week or so. Doctor Yasser Raymond's talks were were good too. I thought it was really interesting to learn about, you know, the the research side of things in osteopathy and how you know these things are translating into the literature from the scientific point of. Speaker 1 Having said that though. Speaker 2 We as a profession face a lot of difficulty quantifying our profession just because of the inter practitioner differences in the the treatment approaches. And also because osteopathy really cannot be standardized. Because it's really about changing your treatment according to the tissue that's on the table, according to the objective findings that you find on the table. Versus kind of the international state of osteopathy, which which was something that was talked about a lot during during the symposium and, and kind of doing a lot of kind of energy work versus structural work. And again, I don't want to, you know, disregard any of the kind of energy healers that are that are out there. I think there's a lot of value to to that and it can be very effective for certain individuals. But having said that, a lot of what was talked about with a few different speakers was just very difficult for me to extract things that I could actually apply starting Monday when I came back to the office. Because a lot of it is either very microscopic, it is very embryological. And it just takes a very deep dive into kind of the energy work side of things and kind of, you know, frequencies of tissue and things like that, which I just think is not very useful to me on the treatment table because I can't objectively measure that with my hands. And so although I think there is value to, to that, I think it is was just very difficult for me. And even at times it just got a little too crazy for me and I had to step out because it wasn't, it wasn't what I was looking for. Having said that, some, some people actually came up to me afterwards. Lots of people came up to me. And thank you for those who who came up to me during the symposium and talking about, you know, the the podcast and how they're how they're enjoying it. You know, I'm just, you know, in this room. Yeah. Speaker 1 For those of you. Speaker 2 Watching. I'm actually inside one of my treatment rooms, so that's why the backdrop is different. I figured I switch it up today. You know, I got some nice pictures on the wall. So I figured, hey, you know what, why not switch it up and try something different today? So anyway, I'm just in here by myself recording it. I, I edit the recordings myself and then I post it, right? So like for me, like this is kind of like just a me thing. But the symposium really did open my eyes in terms of like the effect that it's having and the ripple effects as having across our profession. And so thank you so much for those who came out and, and expressed that to me. And I do really appreciate that and also from individuals who I greatly respect as well, some of my mentors and, and things like that, you know, giving me the, the compliments for, for doing this and, and kind of stepping outside my comfort zone to, to deliver all this information to you. So, so from the bottom of my heart, yeah, thank you so much. And I will be continuing this, this journey for sure. Yeah, it's, it was just interesting to hear people's stories for me. Like I am very involved in the Occupy, the community here. I live Asyabi every day. I'm surrounded by it. You know, I, I teach at the school. I I talk to students all the time. Speaker 1 Time and like I talk to other practitioners around me all the time and so I'm very lucky to to have that. Not every practitioner have has that kind of luxury. Speaker 2 To be able to kind of bounce ideas and and even talk shop and we don't even really talk that much osteopathy with the people that I work with. But we really just talk about, you know, life and business and all that sort of stuff. But we have we share the same values and we share the same way of thinking, which is through all see by the principles. And so that is just very valuable to have people around you that kind of understand that perspective and to also provide value from their experience. So, yeah, so that I'm, I'm very fortunate to be in that position. And the symposium definitely helped me realize that, you know, the effect that this is having across, you know, the the country in terms of some practitioners are over on the West Coast, for instance. And, and they don't have very many people. There's not very many osteopaths over there. And the ones that are, you know, doing osteopathy are, are doing, you know, energy work and, you know, craniosacral. And then again, not nothing wrong with all those things, but we are very much structural and those are the things we focus on is, is objective findings. And so we're. Speaker 1 Going to talk about, we're going to talk about that a little bit more. Speaker 2 Today, because we are going to talk a little bit more about how tissue moves and from kind of the micro to the macro. Explore New Courses: Cranial, Study Groups, Seniors, and Athletes And then we're going to talk about, you know, how that has changed my thought process over the last few weeks or so. And like I said, I've been making lots of notes, which I'm actually. Speaker 1 Going to refer to today. I might even share my screen here and there as well. I've got some really kind of neat diagrams that I've I've come up with to kind of show the different concepts. Speaker 2 And bring them to life a little bit. So I'm very excited to to kind of share all those with you. But having said that. Speaker 1 If you are really. Speaker 2 Interested in kind of looking out, you know, more of a structural side of things. If you're an OS can member and you went to the symposium and you feel the same way that I do, you actually have the opportunity to come to the Cao and announce or come to some of the courses that some of the staff are actually offering. So I'm going to pull up some of these details for you because unfortunately and I'm sure this is going to change, but unfortunately we haven't done as good of a job as as I would like to advocate. Speaker 1 For these courses. Speaker 2 And actually like say that they're out there, but there's actually 1 coming up. So there's one coming up. We just had the symposium. But the next one is actually my friend Paul. So my friend Paul Tavares on Saturday, April the 18th, he is going to be doing cranial and sacral considerations within the field of osteopathy. So it's funny because I just kind of said, oh, cranial sacral, like, you know, it's, it's kind of a weird thing. But having said that, like. Speaker 1 Paul is going to bring it to life in a way that is very tangible and you can take to the table right away. He's actually going to be connecting the autonomic nervous system through balancing the upper and lower body through a principled approach. So it's going to focus on anatomy and also the involved and practice of controlled leverages. And then you're also be given the opportunity to hands on testing and treatment, so. Speaker 2 He's going to kind of I, I was talking to him about it a couple a couple months ago and he was kind of explaining to me how he was going to do this. And so I'm, I'm very excited to to go to it. Hopefully. Actually, I think I'm going to try to go because I'm. Speaker 1 I'm pretty sure my fiance is out of town that weekend so I can do whatever I want. So I'm going to go to his course and then I'm going to host a rager after that. So no, I'm just kidding. Of course I wouldn't. I wouldn't do that. I don't have that many friends anyway. So that's coming up on the 18th of April, a Brandon Stevens, who is a professor in osteopathic theory at the Canadian Academy of Osteopathy, he's going to be doing a osteopathic study group series and that's going to be available to those who graduated at different times. So the profession has really evolved over the last 25 years. And so those who graduated between kind of like the early 2. Speaker 2 Thousands and 2010, they kind of have a a different set of words instead of language that they use. At the end of the day, it's just anatomy, it's just a leverage, it's just osteopathic principles. But the way that they were taught is slightly different versus somebody who was like, say, between 2010 and 2020. Speaker 1 And then now between 2020 and then 2026, there's been a, you know, another kind of set of growth in the profession. And so the way that these people were taught is slightly different. And so he's going to kind of tailor to that and kind of hopefully bring people up to speed on, on all things osteopathy related. And so the first one for those that is, I think it is only for. Speaker 2 Graduates prior to 2010 is coming up in April and then he's going to be doing more for kind of the later groups later on in the year. So I think that's a good idea and hopefully he's going to, I'm sure he's going to do great. I'm not, I'm not worried about him. I like Brandon. He's a, he's a great, great guy and very, very knowledgeable when it comes to kind of the theory side of things on in osteopathy and from from global to focal. So that's going to be a good course, but I think the his isn't coming up until later. Speaker 1 We have another one coming up in a W actually. So Curtis Woodley is doing one on Saturday, April 11th. Osteopathic considerations for senior population. So I think that's pretty self. Speaker 2 Explanatory what that's going to be about that's going to be about seniors and osteopathy and how to you know kind of mesh those together and if they if I was teaching that course yeah it was definitely be very focused on you know getting things moving without actually. Speaker 1 Treating the pattern per SE. Speaker 2 And, and just kind of getting function back through, through the skeletal system from superficial to deep, as well as through the musculature and, and through the navel. But necessarily changing kind of the Bony layers and kind of getting everything, you know, moving like you would in a 20. Speaker 1 Year olds, that's. Speaker 2 Probably not going to happen because by then you know Wolf's Law. Speaker 1 Is kind of change, change things and and affected things. So that's kind of how I would teach it. But I'm sure Curtis is going to add his own kind of approach to it and I'm sure he's got lots of experience working in that field. So that is for those who are out West and that'll be on Saturday, April 10th. OK. Next we have Zach Marshallvan. He is teaching considerations in the legioned athlete, a look through collective mechanics of hockey players. So I actually treat a lot of hockey players. So I probably should go to this one. But I know he treats at a very high level like he treated like NHL athletes, for example. So, so for those who are who treat a lot of athletes specifically or, or even if you're just generally interested in that, you should definitely, definitely go and, and check. Speaker 2 That out, that is Saturday. Speaker 1 May 23rd and then there's more coming up later throughout the summer, which I will announce later. And then I'm actually doing 1 myself. So Saturday, September 12th is what it's scheduled for. I will keep you updated as far as you know, whether that's concrete, but it's in my calendar. So we're going to be decoding Dr. Zinc at the functional mechanics of internal and external respiration and applied treatment. So I was actually talking to some of the fourth years about this yesterday, but it's going to kind of look at Doctor Zinc's unique contributions to osteopathy. He's primarily known to be kind of like the fascia guy, but. Speaker 2 He was very much a DIO and and treated osteopathically and treated everything from the nose to the toes. I have his whole catalog and I've been kind of listening to it in the car and then kind of getting up to speed on on the way he thinks about things. And one of the converse, the one of the lectures that captured me most was his concept of internal and external respiration. And so it's kind of talks about gas exchange at the. Speaker 1 Lung level versus at the tissue level and how to coordinate those through kind of diaphragmatic movement. So we're going to be kind of taking a look at that and we're going to kind of guide you through the structural analysis of kind of like the breath and thoracic age compliance and and then also kind of getting diaphragms coordinated together. And then we're actually going to do that on the table as well. So that's going to be a lot of fun. So again, that's going to be just for off scan members and graduates of the program that's coming up on September 12th. So. Speaker 2 Mark your calendars. We're going to do it and it's going to be a great day. It's going to be so fun. I've I've kind of started putting it together in my brain already and it's I'm just going to chew on it throughout the summer. And then finally I'll I'll kind of put something formal together, that's all. A New Frontier: Documenting the Physics of Osteopathic Practice Coming up, so lots of things to look forward to in the world of osteopathy, and without further ado, we're going to get a little more serious and we're going to get into kind of the nitty gritty. Speaker 2 Of what I actually want to talk about today. Like I said, long episode might even divide it into two. I don't know. We'll see. Speaker 1 So now that we're kind of transitioning towards the relatively unexplored aspects of physics in relation to osteopathy, it kind of puts me in a very unique position where I have the opportunity to become one of the first professionals to effectively integrate this into their practice at a very high level. OK. And so. Speaker 2 When I think about it like that is just like to me, that's just like a one once in a lifetime opportunity. And like I just cannot say no to that. Like it's just I know it's going to be a very difficult journey and it's going to, you know, require lots of work and it's going to require me to dig on. So, you know, digging on is not an easy thing to do, right? And that's what Doctor still ultimately called upon us. Osteopath to. Speaker 1 Do is to say you need to keep. Speaker 2 Digging into this profession and digging into these philosophies and theories that I have proposed. And unfortunately, we haven't really done that up until, you know, the last kind of, you know, 20 years essentially. But osteopathy was very stagnant and it actually has regressed majorly from where it was in the kind of the early 1900s. And so we have to kind of come back to kind of doctor stills theories and kind of continue to develop them. And so that is not an easy thing to do, but luckily there are individual in the world who are. Speaker 1 Doing that here in Canada specifically, Yeah, this is, like I said, it's just an exciting opportunity and it's going to change my clinical application. And as I go, I'm going to document my journey and I'm going to spell it out to you so that you can hopefully get some value from it and you can hopefully think about it and change your own practice at the same time. So having said that, over the next few episodes, I will just kind of remind you that like this is an osteopathic journey. So one episode is going to continue to build on another. So if by chance this is your first episode, I do recommend that you start from the beginning because it will just make a lot more sense to you. Like, yes, the episodes aren't always related to each other, but generally you will definitely notice a progression in my thought process. And so if you kind of jump in at a time where you know, my mind is very far from where it was, while, you know, seeing the progression will actually help you as well. And, and my, my understanding is not for perfect, It's far from perfect. And even as I go through this, I'm going to make mistakes and that's OK because success is measured across your career. It's not measured. And one or two treatments is measured across your career. So my question is, you know, what are you doing to slowly improve yourself every single day? Speaker 2 And I would encourage you to do something it's if it even if it's small to, you know, start to work on your craft and start to improve on your craft. And, and that will ultimately lead to, you know, where you want to be, which is ultimately a busy practice and, you know, a fulfillment of life and then all that sort of stuff. OK. Speaker 1 So my understanding of the body from superficial to deep is is. Speaker 2 Not bad. I think I can do better in terms of the, you know, the anatomy and things like that. You know the concept that the body's a dynamic you know to function and and you know 1 cell eventually becomes an intricate set of interrelated system from the microscopic to the microscopic like that. Speaker 1 That stuff is all not really new to me. I have a good understanding of kind of mechanical transduction as well, which is a biological process by which cells convert a physical mechanical stimulus such as pressure, shear or stiffness into biochemical signals. Speaker 2 But frankly, like I didn't really care about those things that much because I always felt like they didn't really help me become a better practitioner. And I always thought OK if I just limit my understanding to theoretical models or microscopic models. Speaker 1 It's not really that useful. I need a tangible model that proves itself time and time again through action to be able to be successful in office. OK, so this is straight from all the notes that I've been kind of writing over the last few weeks. So it's going to be a bit of a deep dive moving forwards. But as, as I got into practice, like I kind of realized that I need to reconsider my viewpoints. And the truth is that, you know, very core and fundamental concepts in tissue such as, you know, viscoelastic behavior, the structure and function relationships in the cellular matrix, ground substance, mechanical receptors. These are actually crucial to the application of osteopathic principles. And in addition to that, having a foundational understanding of tissue mechanics is actually like step one to understanding. Speaker 2 Physics in the body in a way that actually is useful. Speaker 1 So I'm now realizing that I need to take a step back three steps back in order to move five steps forward. Speaker 2 OK, and that's not a fun realization, but it's OK. It's going to help me in the long run, and hopefully it will help you as well. So limiting ourselves to the understanding of the properties of fascia isn't really enough to be able to effectively use those concepts on the table. And so in order to kind of understand these concepts, we actually have to take a few steps back in order to move a few steps forward, which isn't really a fun thing as a busy practitioner realizing like shit like my understanding isn't as good as I thought it was, but that's OK. I'm going to do it because I know it's going to benefit me in the long run. And again, like I said, success is across. Speaker 1 Career not one week anyway. So with that in mind, like if we talk about say the four PS of fascia, for instance, like packaging, protection, posturing and and passageway, that's really like a very superficial understanding of connective tissue and how it moves and what it does. Speaker 2 And there also seems to be a debate whether like muscles and connective tissues like actually lengthen or shorten in the body or whether there's more of a shape change that governs the structure and function of the muscle. And so this is something that was talked about at the symposium actually. And that's what got me thinking about it. And then I had to actually like, I had this whole episode prepared and then and then the symposium kind of changed a few things. I'm like, crap, like I need to go back and add that in as well. And then we can move forward. So anyway, so. Speaker 1 There's a bit of a debate whether muscles actually lengthen or shorten, or whether there's just a shape change in in the muscle through its structure and structure and function relationships. When I started digging into this, I came across a concept called architectural gearing. Unpacking Muscle Movement: Shape Change vs. Lengthening Debate So the truth is that muscle and connective tissue actually move through a concept called architectural gearing. And so that refers to how a muscle's shape change such as the fiber rotation and the changing of the pinnation angle. So, so fiber orientation and, and how that changes as the muscle lengthens and shortens will affect how the shortening creates muscle shortening and force production. OK. So in other words, it describes how muscle fibers will move during force production because of their structure and function relationship. So I have an image here of architectural gearing and I'm going to pull it up so that you can have a look. Again, this is all thanks to a beautiful thing called artificial intelligence. So there we go. So now you can start to have a look at this concept of architectural gearing, right where we can see the picture on the left where everything is shortened. It's kind of like an accordion model. And so I thought I had a better one somewhere, but no, that's all I got. OK, no problem. OK, so we have this architectural gearing where when tissue is lengthened, you can see how the fibers are actually kind of like stacking on each other and sliding into each other, whereas when you lengthen it, the opposite happens. So it's kind of like a like an origami kind of model where things are kind of shortening and lengthening. And that's essentially how muscles and tissues will shorten and lengthen. OK, Now there's a bit of a debate whether there is only a shape change and the length and whether muscles actually shorten or lengthen. And so the ongoing debate is basically exploring the relationship between the two. What does the muscle actually do? Does it lengthen and shorten or is there simply just a shape? Speaker 2 Change between, you know, the 2. Speaker 1 And there's actually not a change in the length, the true length of the muscle, OK. And now I think it's a little bit of column A and a little bit of column B. Because if we take the bicep as an example, right, if we take this bicep right here, right now, the distance between, you know, the tendon, which is up here to the insertion, which is here, right? That length to me appears to be changing, not by a lot. I do think that there is more of a shape change than there is a lengthening. But having said that, my counter argument is that the position of the lever for the the argument for lengthening and shortening is that the position of the lever is actually changing. So my lever is here and now my lever is here. And so therefore, the, the position of the tendon will actually slightly change, but it's not by much because as when you look at the orientation of the muscle and where it attaches, the relationship between lengthening and shortening versus a shape change, there's actually going to be more of a shape change and less of a lengthening and shortening of a muscle. But again, there's there's a debate going on. So let me know what you think, you know, I'm interested to know. So if you see me, if you want to have that, that discussion, I think it's a little bit of both, but definitely more leaning towards the shape change. But having said that, my argument for lengthening and shortening is I think that concept is much more applicable. Speaker 2 To the treatment. Speaker 1 Table so regardless of whether a muscle actually shortens or lengthens our ability to conceptualize it that way will make it easier to treat on the table. And so that's why I'm kind of like, I think it's a bit of column A and column B maybe the muscle doesn't actually shorten or lengthen and, and there's only a shape change. But I think conceptually, the lengthening and shortening will actually help me better understand what I'm doing to a leverage and you know, what I'm changing and treating. And so ultimately that's what matters. I want, I want a model that I can use on the table that works, that I can actually, you know, help the patient with. And I think that's a good way to kind of think about that. With that in mind, architectural gearing is is kind of a word that describes how a muscle changes its shape. So especially the fiber rotation and the changing of the pinnation angle. So that will affect how shortening turns it to whole muscle shortening and force production. So for example, in panic muscles, the belly can shorten through a combination of fascicle shortening plus fascicle rotation. I think I'm pronouncing that correctly. Fascicle, fascicle. I think it's fascicle fascicle rotation, which is why the shape change is not just a side effect. It's actually part of the whole entire mechanism. And that's what we're talking about where, you know, when you flex the bicep, it's actually like the shape of it changes versus it actually kind of lengthening or shortening. So why does all of this matter? OK, well, OK. When we actually look at different muscles, all of them have different structure and function relationships. So now you can start to look at these and start to think about the nuances between muscle groups and how they might use architectural gearing differently. But the underlying principle is that different muscles will lengthen, shorten and change shape based on their structure. So now you can actually start to think of different muscle groups, whether it has like a parallel or like unipennate or bipennate or, or even like a circular muscle, right? So when you think about like a hamstring, for example, it has the kind of like a parallel orientation, where as if you think of like a unipennate, it has like like bassus lateralis, for example, right? It has a slightly different orientation and it's going to use these principles. Speaker 2 Of a shape. Speaker 1 Change slightly different than another muscle mite. And so it's just something interesting to kind of think about these structure and function relationships. And and you can also think about how you can utilize these principles to kind of lengthen, shorten shape change based on the structure of of any kind of tissue that you're interested in. But also you can start to imagine how each one might utilize the principles of architectural gearing differently through a change in shape and length based on either human movement. So while you're walking, for example, or even force or leverage induced by a practitioner, right? And so you can start to think about OK, do I do I really, if I'm doing like a facial treatment, do I go with the fibers or do I go cross fibers right? What would be the best way for you to get the change that you're looking for in order to create a concept called hysteresis, which is actually what we're going to dive into next? So do muscles lengthen, shorten or simply shape change? I think both are true. Muscles do lengthen and shorten in a meaningful kind of biomechanical sense. But I do think that inside the muscle, there's a near constant volume. And so the connective tissue, it's basically like a connective tissue constrained 3 dimensional system that when you observe clinically is kind of a reorganization of shape rather than like A1 dimensional stretch, right? So that's kind of what, what I'm kind of getting at here. And so muscle movement is not purely a length change or purely a shape change. The, the fascicles and sarcomeres can lengthen or shorten while the whole body kind of simultaneously reorganizes its shape through bulging and a pennation change. There's a fiber, it could be fiber rotations. There we have tendon behavior and then and we also have connective tissue constraints. And then at the clinical level, the shape change may be more of a visible expression, but it is often built on kind of real length changes with a within the tissue as well through a combination of lengthening and shortening. And like I said, kind of like that origami kind of accordion model that I showed in the in the picture earlier. So now for osteopathic treatment, this is the important part. How is this actually useful, especially a slowly sustained loading such a scene in myofascial work, which is, you know the part you're influencing most directly is less the active contractile shortening of the muscle fibers and more so the passive mechanical movement. So we're talking about the movement of fascia, apple neurosis, extracellular matrix, Titan related passive tension, interstitial fluid distribution and also the way that those constraints allow for the shape change to be limited. And so where we have issues in either the muscle or the connective tissue and we have changes in the properties of of it, which then affect the ability for the muscle to kind of go through its shape change appropriately. OK. And so we're going to dive into that a little bit more. But naturally, this kind of shifts the conversation towards more of a connective tissue and how its properties affect the picture of muscle movement that we've just created, because they're not separate entities, right? We have connective tissues and muscles kind of all wrapped together into a kind of a singular system. So they're very much related to each other. And so we can't really see one without the other. Memory Foam to Fascia: Understanding Viscoelastic Tissue Behavior OK, so that was a lot, and we're going to keep going. So we have principles that govern the movement. Speaker 2 Of fascia, so. Speaker 1 Whenever you lay your head on, say, a memory pillow, you are technically feeling the properties of what's called visoelastic behavior. So visoelasticity refers to something that exhibits both the properties of fluid and elasticity. So unlike a traditional pillow, the memory foam of a memory pillow doesn't snap back instantly. Instead, it's slowly flows or deforms around the point at which the force is applied, right In this case, your head on the pillow. The pillow kind of flows or deforms around the pressure point, which then distributes the weight evenly to reduce pressure. And now this is a property that is also seen in fluid. And once the pressure is removed by lifting your head, the material uses elasticity to regain its shape. So interestingly that is material is actually sensitive to temperature. So if the pillow is cold, it becomes more difficult for it to take on the shape of your head and warmth has the opposite effect. So Long story short, these visoelastic properties are also present in fluid. And so you can quickly kind of exemplify this by pressing your index finger into your abdomen. So when you press down, the body kind of gently deforms around that force and then when you lift up, the tissue will actually use a property of elasticity to regain its original shape. OK. And so which that kind of got me thinking like, OK, but if the structure and function relationships of these tissues are affected by some kind of lesion, say like a lack of blood flow or an issue in neurology, some kind of change in fluid dynamics, how will that influence the ability of the fascia to use this property? Or if, let's say, what if fluid dynamics are better in one leg than the other? Can we expect to see more visual elasticity in one leg versus the other leg? Or if the body's ability to kind of change temperature in different regions is being changed all the time, which it does all the time, you know, there's some areas are hot, some areas are cold. How might that affect the visceral elasticity of an organ or even a muscle or kind of any division of the body really? And so perhaps kind of the right question to ask is what happens when a force creating viscoelasticity is sustained for a long period of time? What if there's a force acting on the body through the either like a muscle or some kind of, you know, compression, tension, torsion or shear, How does that? And if it's sustained for a long period of time, how does that influence the body? And so before I could dive into this and kind of answer these questions, I had to kind of explore all the forces that are at play and then kind of layer them into microphysiology. And so our classic pillow example of our visoelastic system, the force loading, the way that the force loads and the way that the force unloads follows the exact same path. So for example, we apply the force of the pillow, say I push my palm into the pillow, the pillow deforms, say I lift the force, the force is removed and the pillow will return to the exact same shape in the way that it came in. So the way that the force comes in is the exact same way that the force comes out. But if we take a rubber band, for example, let's take a rubber band and if I stretch it and I release it, I stretch it, I release it, I stretch it and say I hold that stretch and then release it again. Now the elasticity of the elastic has changed and it won't come back to its original shape. So in other words, the way that the force goes into the elastic is different than the way that the force comes out. And so the energy you put into the system is not fully returned, and some of it is lost as either heat or internal friction of the material. And if I continue to hold that elastic, if I stretch and return it repeatedly, the resting length of the elastic will change. And if this is done often enough, or if it's held for too long or with too much force, what happens to the elastic snaps? Energy Dissipation: The Physics of Hysteresis and Tissue Change Biological tissue works by combining viscoelasticity with a concept called hysteresis. The way force is loaded into a tissue is not the same way that it takes to unload the tissue. So during this process or loading and unloading, some of the energy is going to be lost as either heat or internal friction tissue will resist deformation throughout the loading and the energy is generally dissipated through the internal friction, through the collagen, through the ground substance viscosity, fluid movement. And important for the osteopath is that when the force is held long enough, it will actually create a change on the tissue on the microscopic level, particularly when we're talking about the ground substance collagen fibers, remodeling of the tissues through a sustained load, which is what we call creep. So to understand this further, I wanted to see how, OK, how is this used in engineering and then how can I apply it to the tissue. So to understand this concept further, I started looking at diagrams in physics and that explained this concept starting with magnetizing force and flux density. And so for example, a magnetic hysteresis is commonly found in an electric motors where the constant magnetization and demagnetization of the battery, which is what produces energy in order to get the car to move. A lot of the energy is actually lost through that through that process. And engineers are working very hard to minimize the amount of energy that's lost in order to make batteries, you know, and electric cars more efficient. And so that was all cool. I'm like, OK, I understand that we're trying to, you know, minimize the amount of energy that's lost in some kind of, you know, energy cycle in. Speaker 2 Order to, you know, make a battery more efficient. That totally makes sense. Speaker 1 But it was still unclear to me how these concepts apply to the human body. And so I had to kind of look through all of the technical jargon and kind of translate it into applicable and not an anatomical language. And so when I tried to layer the concept of history sister tissues initially, I got so confused. I had never heard of this before, and I really wanted to understand it and how it applies to the body. And at the end of the day, austerity is rooted in principles, and understanding them to their roots will help a good practitioner understand the forces that you're dealing with and perhaps more importantly, understand the mechanism by which corrections are actually made on the table. OK, so with that in mind, we're going to go through this. I'm going to share my screen again, and we're going to talk about how this concept occurs in the body. And again this diagram you. Speaker 2 Won't find anywhere because once I understood it I had AI come up with a nice diagram for me. Speaker 1 OK, so here is the diagram. So what you're looking at is human tissue hysteresis where it kind of uses the mechanic, the magnetic style layout, but and then applied to tissue specifically. So all right, so the so on the X axis we have tissue deformation. So on the Y axis, we have a force directed into the tissue. So on that Y axis, you can think of that in a few different ways. You can actually think of that through the lens of barrier from from an, from the practitioner side of things. There's, there's many different sides. So the practitioner side of things, you can think of this as being barrier and you can think about this as leverage where as you as I'm applying a force to the body, I'm going up into the barrier. And then I'm also adding more force through any through a tissue right as you go up the barrier. The other way to think about this is from just a human movement side of things, OK, where say I lift this mug, right? The I'm directing a force into the tissue, right? And so it's the same thing as I'm directing, you know, a low amount of force or higher amount of force. The amount of change in the tissue is going to be different, especially as it's done repeatedly. So with that in mind, the blue line is going to represent the force going into the tissue. OK, so let's say I'm going to use a very, very simple example using barrier. I have my finger here. I'm holding up my finger for those of you who are just listening, I'm holding up my finger and I'm going to push on this parallels in my finger. So I'm going to push my finger back almost as if I'm kind of like stretching my index finger. And so as I go into this barrier, there is going to be small amount of change. And then as I get into a larger barrier, there is going to be more of a stretch into the tissue. I'm adding more stretch through the muscle that moves my index finger. And so if I hold that right here, that's important. If I hold this, that energy is going to be dissipated through fluid, through the elasticity of the connective tissue, and some of it is going to be lost through heat, the energy, OK. And so if I hold that long enough, it's actually going to create a change in the tissue, OK? So again, if I'm doing this as my blue represented by my blue line, as I add more force through my finger, there is going to be an increase in the amount of deformation that occurs in my connective tissue, right? And so if I hold that long enough and I create creep, then some of the energy is going to be lost. There's going to be a histological change through the tissue. And then when I unload it or when I bring my finger back to the middle, it's going to follow a, the force is going to follow a different pathway because the tissue has changed due to the loss of energy that I just talked about through fluid and all that sort of stuff. OK, So what I end up with at the bottom here of the graph is a residual deformation. And so that residual deformation is actually what creates the change in the tissue, which then stimulates the body's ability to heal itself because. Speaker 2 Through the fascia and through the connective tissue is where nerves, arteries, veins, and lymphatics live. Like I said, it's going to probably take a couple listens to to get a hold of all of this material. Speaker 1 Yeah, it took me probably a good six or seven hours of work to actually understand it, write it all out in my own words. And then now I'm just kind of reading through the notes that I that I have generated so. Speaker 2 That is the graph of hysteresis. There is more nuances to it than that, but I won't bother with it because it's probably already confusing enough. Speaker 1 The chart is also kind of divided into different regions. So you have the toe region, you have the plastic region towards the end of the barrier. And so it basically just represents the amount of force. So the the toe region is kind of like you're taking up slack in the tissue, whereas the linear region is where you're kind of engaging the barrier. Speaker 2 And then the plastic region is kind of moving towards the higher end of the barrier. And so it's really about creating a balance of, you know, enough force through the tissue to create change at fixed point that you're really looking at. And so we're going to talk about some of the clinical aspects of this as well because I understand right now this is all very, very theory. Speaker 1 Heavy, but I promise you if you stick it out, I will get to how this is actually useful and how you can create success on the table using these kind of models. OK, so once the tissue is deloaded, the residual deformation is kind of what's leftover, which essentially makes the essence of myofascia work in osteopythic treatment. That residual deformation, because the tissue has been loaded, you've changed it, you've stretched quote UN quote stretched it to the point where there's been a change to the structure and function relationships. That's what's going to free up the arteries, veins and lymphatics which ultimately reside in the fascia, which is going to stimulate the rivers of life into self healing and self regulation. Applying Hysteresis: Lesions, Fluid Dynamics, and Patient Healing OK, so these concepts really started to change the way that I thought about the barrier. So in my understanding of the way that the body moves as well. And so I thought, OK, surely this concept of hysteresis would apply to the osteopathic lesion pattern. If vectors of force aren't properly aligned within their planes of motion, well then you risk the chance of creating hysteresis in a repetitive fashion, leading to friction, leading to energy loss, leading to sensory nerve irritation reflexes and so on. And so I had decided, OK, at this point I've got enough knowledge or enough theory to keep this like at the at the forefront of my mind while I'm treating patients. So, and here's what I found. The striking balance was so important, striking balance and putting the right amount of barrier into the tissue to create the right amount of creep. But targeting the right area that you believe to be contributing to the lesion the most is also very important. So generally with people with the planar dysfunction, whether it's micro or macro will have altered visoelasticity due to increased friction. There's more energy loss within the joint. There's going to be fluid buildup because the nerve artery, venial lymphatic is being compromised leading to changes in in the structure and function relationships of the connective tissue and also from a cellular level as well. And so using leverage, you can influence the fluid mechanics inside specific joints through the use of visoelasticity. So for example, if I use the leg to apply, so say the patient's in supine and I use the leg to compress or contract or sorry, not contract. If I use compression or traction through the CFJ with the patient in supine position, well then that force is going to move the particularly ligamentous layer through the elastic, through the elastic and into the fluid components. And you can actually use that to kind of pump fluid in and out of the joint, because now I'm adding traction, which creates a pull and then I'm creating compression which compresses it and moves fluid out. So it's kind of like creating like a pump where I'm, as you traction, it brings fluid in and as I push, it pushes fluid out. OK. And so you can really use that as a way to kind of clinically get a result that you're looking for, if you're looking to bring, you know, some kind of fluid in, in or from an area. And so the next thing I noticed is that time is really crucial to understand. So what I didn't fully put into practice was that the elastic portion of the visoelasticity is almost instant, but the fluid takes time and so the amount of time is going to be dependent. And so therefore performing a fast manipulation won't get the result HVLA. Because by holding and giving the time body to redistribute the force vector and the fluid properly, that's what's going to bring a lasting deformation. So in physics, this concept is actually called rate dependence. And so a fast manipulation or even movement through a joint quickly will only use elasticity because the joint that's moves slow and efficiently will use visoelasticity. So you want to use both the fluid component and the connective tissue component, OK. And so This is why, like sometimes in HVLA, it can be very effective because if it's an elastic problem, then great. But if it's if the problem is with fluid, well, then you're going to miss out on, on all of the good change that you can get by holding kind of a slower, you know, lasting manipulation. This concept also got me thinking about to rhythm and in treatment and how moving quickly as an operator will influence this issue on the table. So fast operator will create faster manipulations which creates an elastic treatment. Speaker 2 Whereas a slow, meaningful operator will create a visceral elastic treatment, which is going to be much, much more effective because you're now using fluid and you're kind of getting the connective tissue to move better in a way that will actually stimulate the body's ability to heal itself, which is ultimately. Speaker 1 What we're after? So then the other question I started talking about was, OK, but that works all very well for direct approaches. But what about indirect approaches? What if I unloaded the tissue first in order to make it load differently? Can I use this concept of visceral elasticity in the indirect barrier? I haven't really been able to answer that just yet. I like to think that yes, especially through kind of like that pumping mechanism that I talked about by by taking it say if the joint is is quote, UN quote compressed, I could use that to kind of move fluid in and out. But the other thought was where's the nervous system and all this? Do you see what I'm getting at? It's complicated stuff because the fascia is ultimately innervated by the nervous system through gamma motor neurology. And so my thought was that, yes, you can use these concepts to bring about a change in the connective tissue, but it's going to be more so brought out through the neurology and changing kind of the the gamma motor nerves versus actually creating like a deformation using a direct approach. OK, so. Speaker 2 I think the answer is yes. You can still create a facial change using indirect but but how the change is brought about is going to be different. Speaker 1 Compared to using a direct approach. But again, this is up. I think this is up for the bait. So hey, we want to talk about it. Let's talk about it. So I spent four days keeping kind of these concepts like at the forefront of my mind while I was seeing roughly 20 patients a day. And it ultimately led to the unsurprising discovery that these concepts cannot be used in isolation. The whole point of osteopathy is to treat the body collectively, and so applying the viscoelastic model to every patient that walks in the door isn't useful. So when I found areas where force couldn't transfer very well, I was forced to ask, Like, finding a loss in viscoelasticity is kind of like, is it a symptom or is it a cause? Because what caused the loss of this property in the first place? Was it an increase in viscosity? Or is it is the stiffness due to changes elasticity? Or is it a problem to the distribution of the nerve artery, venal lymphatic, which then led to the tissue being starved or either venous stasis in an area which then creates the the changes of this elasticity. So all of these questions are, are kind of coming up, right? And so this is where it's kind of fun because now I'm like, OK, how does this all work and fit in the body? But it does help. It does help me explain why some of my patients are struggling with a particular issue. So I saw a specific case by involving a hip that just could not move and the lower right quadrant and the adductor region was just completely filled with legioning. And then once I started working on it, the patient was like, oh, and I of course not disclosed in the health history, but you know, it is what it is, but that we've, we'll find it anyway. Like as long as it's not, it wasn't a major red flag. So anyway, so the patient explained that she had an endoscopic surgery complication in the groin and that led to bruising all over the lower right quadrant, which lasted 6 months. So she had six months of bruising all down this right flank. OK, now when you think about what a contusion actually is, it's essentially a buildup of fluid, right? So the ruptured vessels leading to the bruising creates a change in fluid dynamics in the extracellular matrix and in the fascia, changing the properties of the tissue, which leads to a hip issue. Not right away, but one year later, because now the hip is loaded differently and the way force transfers through the hip is different. Speaker 2 And so I was starting, I'm starting to see like how these properties in fascia will actually like show up on the table and actually create problems in in a specific case. I had another patient who was left. Speaker 1 Very confused with a torn subscapularis. He didn't have a history of overuse and somehow the muscle tore. So I then reasoned, as an osteopath does, where the torsion through the upper rib cage, the CD junction and the inhaled ribs on the left affected the shoulder, creating poor blood supply. We've got compression forces affecting the subclavian rotator cuff. Speaker 2 As well as. Speaker 1 Brachial plexus, which led to a starved rotator cuff. Now we've got a starved rotator cuff where there's venous stasis where there's a change in property of the tissue, change in the pressure gradient. So the circulatory system contributing to the venous stasis, ultimately contributing to the muscle tear, even though the person didn't have a history of any kind of overuse or anything. This is just through daily activity. It's so this is this is I'm starting to put the pieces together like this is how lesioning occurs. And this is how it led to the problem. Now try explaining that to your patient is difficult. But basically I just told him, look, there's an issue. Speaker 2 Through the rib cage. Speaker 1 You know, affecting the position of the shoulder. Speaker 2 If I can the blood supply to the shoulder and then you know now, now you've got a, a subscapular tear. Speaker 1 And that was. Speaker 2 That was diagnosed by a physician, of course, and I don't do that, but it wasn't getting better. So I kind of urged him like, hey, like you should, you should get this looked at. And sure enough, there was. Speaker 1 So the practical implication is that the return of normal nerve, artery, venal lymphatic supply will allow the body to heal through the viscoelastic, the viscoelastic field of the fascia through creep. The practitioner is not directly reshaping the muscle itself. So we're back to our reshaping model. Now, we're not directly reshaping the muscle itself, but we're rather influencing the fascial and the fluid environment that the muscle sits in. This is going to alter the structural relationships surrounding the muscle, which then changes how the muscle expresses its shape, how the tension and motion occurs through the muscle, and all of this is brought about into the nervous system through proprioceptors so that the body can implement proper movement strategies. Now that the system has returned to normal through osteopathic treatment, the body starts moving better and the patient starts feeling better. Wow, that's a lot. It's a lot of stuff. Things are changing. The level is going up, folks. It's going up. So I hope you're joining me on this journey. Thank you so much. I hope you listen to it. I hope you listen to it a few times, you know, get to get this down into your brain, understand it so that you can actually start to view how tissue moves and and how how you can actually use it on the table. So again, thank you so much for listening. Thank you for sticking with me. I know this. Speaker 2 Was a lot of theory, but I will. Speaker 1 Catch you on the next one.