Linda,

>Firstly, regarding disc healing: I always assumed that diffusion of
>nutrients from the vertebral end plate allowed healing to occur, as long as
>the disc material was maintained in its normal position. I have no
>evidence
>to back this up, I just assumed this was the case.
**I had always been taught this as well, that the compressive and
distractive forces on the disc allows nutrients to diffuse in and for
healing to occur. However, is there any research on how long this process
can take?? What then does the patient do in the mean time for this disc to
heal??

>Secondly, regarding the patient you mentioned: you say 'From his
>presentation, I knew that he had psoas problems.' Do you mean that he had
>an overactive psoas, and if so, do you think that other structures than his
>psoas were implicated in his symptoms? By what mechanism is psoas likely
>to
>cause irritable bowel sydrome? And by what mechanism does the iliacus
>muscle 'give severe migraines through a chain of muscles up the back ending
>up in the sternocleidomastoid.' I was under the impression that migraines
>(as opposed to other forms of headache) were not due to mechanical factors
>(such as the upper cervical spine, and its associated muscles, ligaments
>and
>fascia) and therefore not amenable to physiotherapeutic intervention.

**From what I understand after attending Aileen Jeferris course is that when
the psoas muscle is tight, it can physically irritate the colons since it
lies right next to the psoas muscle (if you get a chance, goto the anatomy
labs and look at a few cadevers - this is what I did to confirm this). Yes,
I would not be suprised from his long history that most of the major muscles
around his body would have active trigger points in them.

With relation to the iliacus muscle, it is part of the research that Aileen
Jeferris is undertaking at the moment, and it would be very exciting for me
to get my hands on her research once she release them - she seems to be very
convinced that it is where the migrains are coming from, and why accupunture
is usually more successful than western medicine in tackling migrains. From
what I know anyway (which isn't too much), a muscle that tightens will
affect other muscles, and hence forms a chain of muscle imbalance, usually
on the same side (explains why we get people who have right sided back pain
and right sided neck pain and right sided headaches/migrains)

I have successfully treated 3 people in the last 3 months who have had
migrains simply by treating the iliacus and psoas alone (and touching
nothing out at all), and this was enough to relieve their migrains by 70%.
Despite this, I am still fairly skeptical, but at the same time excited,
about what we are actually doing and would be great to find out. However I
agree with you, I had always been told that migrains were not treatable (and
this was from Ass. Prof Gwen Jull).

>My final question relates to psoas, the topic of much debate lately. I had
>been of the impression that psoas was more likely to be a stabiliser of the
>lumbar spine which becomes long and inhibited in cases of LBP. Is there
>any
>research to suggest that it may in fact become short and/or overactive?
>And
>finally, how do you perform a 'spray and stretch' technique on such a deep
>muscle? I personally don't do spray and stretch as I've only heard of it
>but not seen it demonstrated.

**Yes, the psoas muscle can be a stabilizer of the lumbar spine. You say
that it becomes inhibited and long in LBP - is there any references for
this??

There is 2 articles on the psoas muscle over the last 20 years (pretty
pathetic if you ask me) that I could find, and what they both did was took
12 people with chronic LBP (more than 2 years) and 12 people with no back
pain, and did MRI's of their lumbar spine. What they had found was a
decrease in the diameter of the psoas muscle in the LBP group. They deduced
from this that the psoas muscles atrophies with LBP.

As I mentioned before, a group of DR's developed a standing MRI this year,
which shows a picture of the spine, with the psoas and multifidus muscles
attached to it. I have seen one such film done on a guy who has had LBP for
the last 6 months - the psoas muscle was definitely atrophied, but had
tightened compared to the other side. The hypothesis that they formulated is
that when you have active trigger points in the psoas muscle, the psoas will
contract continuously. In turn, a muscle that contracts 30-50% of maximum
will cut off its blood supply, which in turn reduce the calcium pumping
mechanism, which will contract the muscles, and the cycle continues. Over
time, due to increased metabolism and ischaemia (which leads to hypoxia),
the psoas muscle will start to atrophy.

It would be great if there was other research to back up or refute these
hypothesis, but I guess this muscle has been mostly ignored in the last 20
years.

As with the cold spray, I read about it last night, and all I got up to was
that it activates the cutaneo-muscular reflex. What this reflex does I don't
know, but I will find out.

>I am glad that the patient's posture improved following treatment, but am
>still unsure of the precise reasoning behind your treatment. Do you expect
>the migraines and IBS to improve or change, and if so, by what mechanisms?
**From what I have seen in the last 7-8 months of using trigger points, I do
expect his migraines to definitely improve or change through the release of
the "chain of muscles". However, I have only seen one person with IBS, and
he went overseas after about 2 treatments, so I don't want to speculate on
that. Theoretically anyway, I do expect his IBS to improve based on what I
said - but it really depends on the duration of time that I can treat him.
As you know, having great techniques won't matter if the patient does not
return.
*********
Look, the only reason why I went on this mailbase was to see if there were
others using this stretch and spray technique, and to understand for myself
why this technique worked so well. I realize the simplicity of this theory
is beyond belief, but the clinical evidence is there! If anybody knows more
research that supports or refutes the integrate trigger point hypothesis,
please let me know. As Travell and Simons put it, "it is only through a path
of self learning and discovery that one comes to appreciate the significance
of muscles in the human body."

Henry***

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