As I covered in my Crohn’s Protocol, and The Science Behind the Crohn’s Protocol, the big elephant in the room in Crohn’s is that biomechanical dysfunction from joint misalignments is probably the missing ingredient in Crohn’s that no one is paying attention to.
You’re right and treatment/exercise can and should be highly specific not only to personal weak links (within the tensegrity system) but to the specific anatomy of the immune system. For example, the gastrosplenic ligament and splenorenal ligament, gerota fascia and zuckergandl fascia as it relates to spinal and rib position etc. etc. the vast majority of practitioners lack the assessment, treatment and analytical exercise tools to maximize effectiveness.
Could you elaborate on how practitioners can learn more? Or how patients can discern whether a practitioner may be able to have this expertise? Asking for a friend :-)
It’s a tricky thing because the standard at the university level is low so that practitioners need to stumble upon better information to gain their skills through continuing education. I did an 8 year + program with many PT’s and chiros.
The above is the 4 year continuing education program that a professional can take. It’s my no means the only one out there. The critical pieces are understanding biotensegrity and relational anatomy and having complex assessment and treatments tools.
Regarding immune health there are two categories of skills a practitioner needs - 1- to know the physiology/anatomy of the immune system and how to test and work with it. -2- to know how the other systems relate to the immune system structurally and functionally. So for example, the liver, brain and GI tract may be relevant.
You can ask a practitioner questions as it’s relevant to you. So for example, if you had a TBI 10 years ago and still have some autonomic dysregulation you’d want to ask “how does this relate to my immune health?” “What are the structures that you would want to assess?” The person should know about the ALL, spinal and sacral ganglion, vagus nerve, diaphragm, dura mater, etc. and have an understanding of how to work with it.
Regardless, you’ll want a practitioner with understanding of the fascial connections between the spine, skull, rib cage and the thymus, spleen, lymph nodes and a bare minimum.
There’s a lot of lymphatic drainage practitioners and fascial manual therapists that can help you with the low hanging fruit of your immune health through a structural lens.
What about the Midwestern Doc who is always on about flow. I can't recall the term right now, but the MWD talk a lot about stagnant flow and the impact on health. I think it was the zeta potential?
Yes Midwestern Doc mentioned liquid crystalline water/zeta potential as helping move fluid through the body. He mentioned potassium compounds like potassium citrate as helping zeta potential. And aluminum as being bad for zeta potential. He also mentioned trampolining as being a particularly good exercise for moving fluid. And he suggested that DMSO helps fluid movement.
We started Myoactivation therapy, which focuses on breaking down scar tissue and releasing muscles, a kind of intense acupuncture. It has helped pain levels miraculously, but no change in our food and chemical sensitivities yet. We may need to give it time.
Chiropractors have been seeing improved immune function since 1895. I’m not talking about manipulation that’s been around for centuries…cause pushing the wrong spot can also harm the body if you think about it. The founder of chiro taught to find one place in the spine for maximum benefit. Anyways. You mention physical therapists but please don’t forget Chiropractic (after decades of scrutiny and misunderstanding- some credit from society would be nice)
I cited a chiropractic article in the Crohn’s article. I think chiropractors are generally more correct in their holistic view of the integration of skeletal and non-skeletal health, but are usually too focused on the spine.
I would not discount osteopathic providers as well, specifically those that continue to practice through their philosophy and osteopathic manipulation approach, rather than simply jumping ship to conventional medicine.
Historically, the founder of chiropractic medicine is reportedly to have received mentorship / training from, or at least visited with, early osteopathic physicians, before publishing on his own approach. Their initial philosophies were very similar.
I wouldn't discount them, but I feel like their manipulation is very cervical spine oriented and more limited even than a chiropractors, except for NUCCA chiropractor, and I think we need to be looking at the whole body.
To focus on f.x. cervical spine misalignment is not just about the cervical spine, because cervical spine misalignment will cause compensating patterns throughout the whole body including joint misalignement in other parts of the body, and vice versa. It's not always easy to find the root cause(s) of misaligments, if any.
If I understand your comment to be directed at osteopathic physicians, that's not my experience at all. My experience is that osteopathic physicians have a more comprehensive modality "toolkit" and understanding of the body, including the cranium, pelvic girdle, and the limbs then chiropractors. Overall, though, it's *very* provider dependent across all of what I would call "manual medicine" (to include physical therapists, chiropractors, osteopaths, massage therapists, craniosacral therapists, etc) - how much experience they have, how much they "buy" their own philosophy and are open to truth from other perspectives, and how much continuous learning they have sought after graduation.
As a physical therapist, I appreciate the idea about mechanical forces being a major factor in Crohn's, and I am not at all surprised to hear that there is a sweet spot of mechanical tension that maximally stimulates the immune system. The problem I see is that there is a massive amount of debate in the field about what constitutes "optimal" movement patterns and joint alignment, and a lot of skepticism that such things actually exist. For example, you'll find very experienced and competent practitioners who are convinced that any amount of lumbar flexion under load is terrible for you and inevitably working toward disc herniation, and then there are equally competent therapists who are big proponents of purposefully loading spinal flexion for therapeutic purposes.
I honestly think that most of the time, an annual "checkup" with a PT ends up just pathologizing things that aren't necessarily wrong or harmful. The healthiest and fittest person in the world could get on my treatment table and I can probably find some things biomechanically "wrong" with their movement patterns, but I don't think anyone can say for sure that they would actually be any kind of problem or cause any issues. People with so-called "perfect alignment" have plenty of pain, and people with "terrible" biomechanics can feel great and have zero issues, at least within the lens and context in which I work with them.
Like I could absolutely believe there are optimal ways to align joints and soft tissues to minimize risk of Crohn's and totally amp up our T cells, but who's to say what that looks like? Is there any research on joint alignment and immune function beyond the single chiropractic study? The field of PT and chiropractic is rife with pseudoscientific BS because getting your patient out of pain doesn't necessarily mean you "fixed" their biomechanics or got them moving "optimally," so it's very hard to take anecdotal accounts seriously unless there is some really compelling underlying data to support them.
What you highlight is that the issue needs to be studied. What I highlight is that the issue is being totally ignored and is probably massively important. These two ideas are completely compatible.
In the meantime, the average person has horrible problems in biomechanics and would benefit from optimizing them, even if there are major gray areas and dispute. The average person is crooked as heck from doing nothing but sitting.
The path forward is to do serious study.
The individual left in the mix would benefit from being proactive and staying ahead of the evidence basis, because the evidence basis moves slow and the people in charge of moving it are way behind the curve.
I agree, and I'm certainly not saying that people should do nothing until evidence shows the precisely right way to optimize movement. I just think that right now we can't rightfully say anyone is able to teach "optimal" biomechanics because we don't know what they truly look like and what works best.
I feel most people would be better served by going to a decent personal trainer who emphasizes taking all the joints through a full range of motion through appropriately dosed resistance training than going to a PT annually for a checkup, in all honesty.
I'm interested to see where the research goes and I appreciate that you are highlighting this concept that is not being talked about enough. It's definitely a conversation worth having and worth serious consideration.
I see a lot of ways that people can stay ahead of the evidence basis in health, but how would one stay ahead of it in this case, if we don't know what optimal movement looks like? Or if nobody can really agree on what it looks like? I'm not trying to be argumentative, I'm genuinely curious how one would stay ahead of it when it doesn't seem like there is very much to go by right now. I'm all for it if I can find the right direction to stay ahead of the evidence, but the PT world is full of so many opposing theories, conflicting evidence, and complex body system interactions, so I find it hard to navigate outside of established research with any kind of certainty (but I still try my best).
Look at The Gokhale Method (Esther Gokhale) that shows you how to take each of your bones home. This methodology is based on biophysics and evidence-based biomechanics.
How S-shaped Spine is compressed spine. We are more closer to J-Spine(pain free) that we see in ancestral populations, non industrialised cultures and young children world over.
I suspect your general thesis conflates biomechanics at meso and microscales and completely overlooks the myriad of genetic markers associated with immune dysregulation.
The importance of interstitial flow/flux has long been understood to underpin immune function with some early articulations coming from Alfred Pischinger (1899-1982)
Your suggestion that physical therapists could possibly enhance immunological health is dangerously speculative - you really are on some very thin causal ice here - we cannot even establish causal relationships between biomechanics and back pain.
Thank you!!! So grateful for this article!! Excited to take action and make it a priority to improve my poor movement patterns. Sadly, wearing poor fitting shoes while working out has been a major contributing factor to the mess I’ve gotten myself into. Thanks again.
Interesting. Since COVID I have done a lot of working out at home. I work out barefoot whenever possible, and otherwise in minimalist broad-toed shoes.
this is very interesting stuff. i want to add that forward head posture which would directly contribute to or be a symptom of suboptimal biomechanics can inhibit the vagus nerve directly. it also gets inhibited by a compensatory breathing strategy that uses the neck muscles. vagus nerve happens to be a key contributor to proper immune function and maybe t cell modulation.
forward head posture also inhibits the flow of csf and blood flow from the brain which i think is related here. good posture is a very neglected piece of the puzzle, more than nutrition imo. what do you think about this?
Forward head posture has gotten tremendously worse since iphone and laptop have replaced desktop computers. Until people accept that you MUST have an external keyboard and laptop at eye level when working with a laptop, the knowedge class will have their health demolished by it.
I don't know much about the vagus nerve connection you bring up, but I don't doubt its contribution.
Not in this article. I should have sent a comment on the article that I received but it’s gone now. As soon as politics becomes something that I might be subjected to without warning in any article, I don’t really want any part of any of them. It is his prerogative to write whatever he wants, as it’s his forum, but for me, I don’t really want to have to deal with politics when I am trying to improve my health.
I really wish that you had left politics out of your writings. As a physician, I have my political views, but I leave my medical care based on science. When you made this political, I no longer wanted to read. We all need to respect one another, and I feel like you bringing politics into it ruined it for me, which is a shame because I have followed you and enjoyed your writings for years.
It makes a strong case for things like Taichuchuan, Baguazhang, etc. Thanks Chris.
You’re right and treatment/exercise can and should be highly specific not only to personal weak links (within the tensegrity system) but to the specific anatomy of the immune system. For example, the gastrosplenic ligament and splenorenal ligament, gerota fascia and zuckergandl fascia as it relates to spinal and rib position etc. etc. the vast majority of practitioners lack the assessment, treatment and analytical exercise tools to maximize effectiveness.
Could you elaborate on how practitioners can learn more? Or how patients can discern whether a practitioner may be able to have this expertise? Asking for a friend :-)
It’s a tricky thing because the standard at the university level is low so that practitioners need to stumble upon better information to gain their skills through continuing education. I did an 8 year + program with many PT’s and chiros.
https://www.somavoyer.com/somatherapy/overview
The above is the 4 year continuing education program that a professional can take. It’s my no means the only one out there. The critical pieces are understanding biotensegrity and relational anatomy and having complex assessment and treatments tools.
Regarding immune health there are two categories of skills a practitioner needs - 1- to know the physiology/anatomy of the immune system and how to test and work with it. -2- to know how the other systems relate to the immune system structurally and functionally. So for example, the liver, brain and GI tract may be relevant.
You can ask a practitioner questions as it’s relevant to you. So for example, if you had a TBI 10 years ago and still have some autonomic dysregulation you’d want to ask “how does this relate to my immune health?” “What are the structures that you would want to assess?” The person should know about the ALL, spinal and sacral ganglion, vagus nerve, diaphragm, dura mater, etc. and have an understanding of how to work with it.
Regardless, you’ll want a practitioner with understanding of the fascial connections between the spine, skull, rib cage and the thymus, spleen, lymph nodes and a bare minimum.
There’s a lot of lymphatic drainage practitioners and fascial manual therapists that can help you with the low hanging fruit of your immune health through a structural lens.
Very interesting article.
What about the Midwestern Doc who is always on about flow. I can't recall the term right now, but the MWD talk a lot about stagnant flow and the impact on health. I think it was the zeta potential?
Yes Midwestern Doc mentioned liquid crystalline water/zeta potential as helping move fluid through the body. He mentioned potassium compounds like potassium citrate as helping zeta potential. And aluminum as being bad for zeta potential. He also mentioned trampolining as being a particularly good exercise for moving fluid. And he suggested that DMSO helps fluid movement.
How do you get a mouse to do stretches??
We started Myoactivation therapy, which focuses on breaking down scar tissue and releasing muscles, a kind of intense acupuncture. It has helped pain levels miraculously, but no change in our food and chemical sensitivities yet. We may need to give it time.
If you mention good flow than grounding should be advised
and i thought i heard it all
Chiropractors have been seeing improved immune function since 1895. I’m not talking about manipulation that’s been around for centuries…cause pushing the wrong spot can also harm the body if you think about it. The founder of chiro taught to find one place in the spine for maximum benefit. Anyways. You mention physical therapists but please don’t forget Chiropractic (after decades of scrutiny and misunderstanding- some credit from society would be nice)
I cited a chiropractic article in the Crohn’s article. I think chiropractors are generally more correct in their holistic view of the integration of skeletal and non-skeletal health, but are usually too focused on the spine.
I’ll peep that article Chris thank you, and I agree. Extremity adjusting (including the cranium) is a game changer.
Amen, brother! Chiropractic first!
I would not discount osteopathic providers as well, specifically those that continue to practice through their philosophy and osteopathic manipulation approach, rather than simply jumping ship to conventional medicine.
Historically, the founder of chiropractic medicine is reportedly to have received mentorship / training from, or at least visited with, early osteopathic physicians, before publishing on his own approach. Their initial philosophies were very similar.
I wouldn't discount them, but I feel like their manipulation is very cervical spine oriented and more limited even than a chiropractors, except for NUCCA chiropractor, and I think we need to be looking at the whole body.
To focus on f.x. cervical spine misalignment is not just about the cervical spine, because cervical spine misalignment will cause compensating patterns throughout the whole body including joint misalignement in other parts of the body, and vice versa. It's not always easy to find the root cause(s) of misaligments, if any.
If I understand your comment to be directed at osteopathic physicians, that's not my experience at all. My experience is that osteopathic physicians have a more comprehensive modality "toolkit" and understanding of the body, including the cranium, pelvic girdle, and the limbs then chiropractors. Overall, though, it's *very* provider dependent across all of what I would call "manual medicine" (to include physical therapists, chiropractors, osteopaths, massage therapists, craniosacral therapists, etc) - how much experience they have, how much they "buy" their own philosophy and are open to truth from other perspectives, and how much continuous learning they have sought after graduation.
As a physical therapist, I appreciate the idea about mechanical forces being a major factor in Crohn's, and I am not at all surprised to hear that there is a sweet spot of mechanical tension that maximally stimulates the immune system. The problem I see is that there is a massive amount of debate in the field about what constitutes "optimal" movement patterns and joint alignment, and a lot of skepticism that such things actually exist. For example, you'll find very experienced and competent practitioners who are convinced that any amount of lumbar flexion under load is terrible for you and inevitably working toward disc herniation, and then there are equally competent therapists who are big proponents of purposefully loading spinal flexion for therapeutic purposes.
I honestly think that most of the time, an annual "checkup" with a PT ends up just pathologizing things that aren't necessarily wrong or harmful. The healthiest and fittest person in the world could get on my treatment table and I can probably find some things biomechanically "wrong" with their movement patterns, but I don't think anyone can say for sure that they would actually be any kind of problem or cause any issues. People with so-called "perfect alignment" have plenty of pain, and people with "terrible" biomechanics can feel great and have zero issues, at least within the lens and context in which I work with them.
Like I could absolutely believe there are optimal ways to align joints and soft tissues to minimize risk of Crohn's and totally amp up our T cells, but who's to say what that looks like? Is there any research on joint alignment and immune function beyond the single chiropractic study? The field of PT and chiropractic is rife with pseudoscientific BS because getting your patient out of pain doesn't necessarily mean you "fixed" their biomechanics or got them moving "optimally," so it's very hard to take anecdotal accounts seriously unless there is some really compelling underlying data to support them.
What you highlight is that the issue needs to be studied. What I highlight is that the issue is being totally ignored and is probably massively important. These two ideas are completely compatible.
In the meantime, the average person has horrible problems in biomechanics and would benefit from optimizing them, even if there are major gray areas and dispute. The average person is crooked as heck from doing nothing but sitting.
The path forward is to do serious study.
The individual left in the mix would benefit from being proactive and staying ahead of the evidence basis, because the evidence basis moves slow and the people in charge of moving it are way behind the curve.
I agree, and I'm certainly not saying that people should do nothing until evidence shows the precisely right way to optimize movement. I just think that right now we can't rightfully say anyone is able to teach "optimal" biomechanics because we don't know what they truly look like and what works best.
I feel most people would be better served by going to a decent personal trainer who emphasizes taking all the joints through a full range of motion through appropriately dosed resistance training than going to a PT annually for a checkup, in all honesty.
I'm interested to see where the research goes and I appreciate that you are highlighting this concept that is not being talked about enough. It's definitely a conversation worth having and worth serious consideration.
I see a lot of ways that people can stay ahead of the evidence basis in health, but how would one stay ahead of it in this case, if we don't know what optimal movement looks like? Or if nobody can really agree on what it looks like? I'm not trying to be argumentative, I'm genuinely curious how one would stay ahead of it when it doesn't seem like there is very much to go by right now. I'm all for it if I can find the right direction to stay ahead of the evidence, but the PT world is full of so many opposing theories, conflicting evidence, and complex body system interactions, so I find it hard to navigate outside of established research with any kind of certainty (but I still try my best).
Would it be possible to discuss peroxynitrites and best ways to reduce their effects on the body (for example, using antioxidants)?
Hi Chris,
Look at The Gokhale Method (Esther Gokhale) that shows you how to take each of your bones home. This methodology is based on biophysics and evidence-based biomechanics.
How S-shaped Spine is compressed spine. We are more closer to J-Spine(pain free) that we see in ancestral populations, non industrialised cultures and young children world over.
Yes I like her contribution.
I suspect your general thesis conflates biomechanics at meso and microscales and completely overlooks the myriad of genetic markers associated with immune dysregulation.
The importance of interstitial flow/flux has long been understood to underpin immune function with some early articulations coming from Alfred Pischinger (1899-1982)
Your suggestion that physical therapists could possibly enhance immunological health is dangerously speculative - you really are on some very thin causal ice here - we cannot even establish causal relationships between biomechanics and back pain.
Thank you!!! So grateful for this article!! Excited to take action and make it a priority to improve my poor movement patterns. Sadly, wearing poor fitting shoes while working out has been a major contributing factor to the mess I’ve gotten myself into. Thanks again.
Interesting. Since COVID I have done a lot of working out at home. I work out barefoot whenever possible, and otherwise in minimalist broad-toed shoes.
this is very interesting stuff. i want to add that forward head posture which would directly contribute to or be a symptom of suboptimal biomechanics can inhibit the vagus nerve directly. it also gets inhibited by a compensatory breathing strategy that uses the neck muscles. vagus nerve happens to be a key contributor to proper immune function and maybe t cell modulation.
forward head posture also inhibits the flow of csf and blood flow from the brain which i think is related here. good posture is a very neglected piece of the puzzle, more than nutrition imo. what do you think about this?
Forward head posture has gotten tremendously worse since iphone and laptop have replaced desktop computers. Until people accept that you MUST have an external keyboard and laptop at eye level when working with a laptop, the knowedge class will have their health demolished by it.
I don't know much about the vagus nerve connection you bring up, but I don't doubt its contribution.
Not in this article. I should have sent a comment on the article that I received but it’s gone now. As soon as politics becomes something that I might be subjected to without warning in any article, I don’t really want any part of any of them. It is his prerogative to write whatever he wants, as it’s his forum, but for me, I don’t really want to have to deal with politics when I am trying to improve my health.
I really wish that you had left politics out of your writings. As a physician, I have my political views, but I leave my medical care based on science. When you made this political, I no longer wanted to read. We all need to respect one another, and I feel like you bringing politics into it ruined it for me, which is a shame because I have followed you and enjoyed your writings for years.
Very odd post to leave this comment.
Where did Chris mention politics in this article??
This is such a political comment. We want our scientists to be themselves, to be allowed to think the way they think.
It's up to you to compartmentalise what you like and don't like.
You're shooting yourself in the foot by letting the fact that he has different political views affect your appreciation for his scientific work.
He won't miss you, but you've expressed you'll miss him. There was no need to do that to yourself.