Fascia and Sensory Emotions

So I'm very happy to be back at the Pilates studio here at Padura Beach after the several years of, not being able to communicate as much in person as we are able to do it now again. And in the past, in my past presentations, I was focusing more on the mechanical aspects. So there is a lecture that's still available at Pilatus anytime on Davy's Law, how to train fascia as a movement instructor. And this time, I will focus on fashion as a sensory organ. And that is at least and as intriguing and enriching aspect for movement practitioners, but also for manual body work practitioners.

In the past, fashion has been considered by classical anatomists to be, to have as much or limited importance as a wrapping has in relationship to the present that is envelope by the wrapping. So if you get a nice present, it comes with a nice envelope. You look at the envelope, say that's very nice. You put the envelope to the site, and then you don't need the envelope in order to get your smartphone to work. Or whatever it is. And that has been the classical assumption in Western medicine.

But in the last 10, 15 years, we learned that the muscles work very, very different if you keep them with the facial envelope. Because, for example, one third of the muscle fibers, sometimes it's a little bit more, sometimes a little less, But on average, one third of the muscle fibers goes into the envelope, and the envelope then transmits the force 1 or 2 joints further away. So if you want to know what function the Gludeos maximus has, you better keep the facial envelope involved. But that has already been known. And in sports sciences has has been considered.

But now we realize that it's not only the forced transmission, but also the sensory capacity. And recently, Professor Mensse at Heidelberg University did a histological calculation that you see on the slide on the upper right, where you stain with dark brown, all the sensory nerve endings in the tiny piece of the lumbar dorsal fascia. So the piece that you see on the upper right is maybe 2 millimeters by 3 a half millimeters, and you see dozens of dark brown stained sensory nerve cell. So that means in every millimeter of a facial tissue, you have dozens of nerves who are possibly terminating there. So based on these histological pictures, but then using more three-dimensional ones.

Carlos Decco and me got together as a German scientist. And we did the calculation. How many nerve endings in the body wide fashion net do we have? And we came to the very surprising conclusion. It is approximately 250,000,000 nerve endings in your body wide fashion net.

So if you stretch your arms, if you stretch your legs, You have not just a few dozen, you have millions of nerve endings, which are then sending stretch stimulation signals to your brain. And that means that treasure is not our largest, sensory organ because the muscles may be larger or other tissues. But it is our richest sensory organ in terms of the sensory richness. How many sensory nerve endings are included? And it's even richer than the skin. Skin is about 100,000,000, and it had been argued that the skin, because it's so rich, can be understood as a sensory organ.

And now we know that the body wide fashion net is even richer than the skin, even richer than the sense of seeing. So Up to now, we thought that homo sapiens is primarily a visual orientation animal And we add the other senses in addition. In in the dog, it's it's usually the other way. So if your dog dreams of you, Probably they don't have your blue t shirt in in front. They have your smell, and then the color comes in addition. But in humans, unless we apply, but if we are seeing, we used to think that we, primarily orient by seeing And then we use, proprioception, touch, smell, etcetera. But now we have to rethink So we are primarily a facial sensory animal, and, that that has an influence how we foster children education in schools, how, how big, restrictions in a fashion net, For example, if 2 membranes that normally slide in relationship to each other, if they glue together, then you have less rich feedback coming back to your, to your brain. And then we have to think how, how is that influencing also how alive you feel and and how much year you you perceive from the world.

So that is now the inspiration for this lecture. So we know that the fashion net is our richest sensory organ. And the question is, what sensory functions do these 250,000,000 nerve endings fulfill? And one function is to feel your body in relationship to space. Where is my arm? But also in relationship to gravity.

So do I have more weight on my right sit bone? More weight on the left sit bone. And that's usually called proprioception. And the majority of proprioceptive nerve endings are not embedded in muscle fibers or in bones. They are in the body wide fashion net.

Including the intramuscular connective tissue, like the endomuseum or the peri museum. A lot of our proprioceptive nerve endings are embedded in fashion membranes. And, that is very important because they give us a sense of how are we arranged in relationship to the space around us. And that is not a surprise that if you have a different feedback. If if you make yourself taller, then you also feel taller. And that was already a very nice emotional link that, Harvard psychologists, Amy Cuddy did.

In 2010, she published a study on power posing, where she had a group of students to assume a more expanded posture. And she did several psychological test with them, and they felt more comp confident. But also when they were judged by other people, they thought this is a very competent person. But the big surprise was when they measured hormones, particularly testosterone, which also in women is associated, how confident you are. And, how and, how how willing you are to take risks.

And when people were in an expanded, power oriented posture where they make made themselves taller and to put their arms not close to their body. But further away and stood at a wider stance. Then men and women had, within one minute, more testosterone and less cortisol. And that was a very profound, surprise because then just take a changing your posture in an artificial manner. Would have a profound, even hormonal effect on the way how you feel and how you can relax.

If you have done a mistake, for example, cortisol is good if you are able to lower that at night. Even if you've, even if there has been an email that you didn't answer. And, but if you have a high cortisol level, then often you cannot relax if you go to sleep at night. And you feel like this one email or you didn't do one thing, not so perfect. And, so that has been seen as a very positive, emotional and even hormonal effect of being more in an expansive posture versus to be in a contract out posture.

And you can try that, you know, out yourself. If you make yourself bigger, you're more AB ducted with your legs, with your arms, You make your body taller, not only in vertical dimension, but in all three dimensions, after a while, you feel different. You have a different relationship to their environment. When they try to replicate this study later on, they were not able to replicate this study, and many people don't know that. Because when she published the study, it was so popular, that she became a bestseller author, her books sold, more than a million time.

And even today, her talk from Amy Cuddy on power posing, and how you can use that as a tool to change not only your psychology and your emotional tendency, but even your biochemistry, her related attack talk is still number 2. Among all the TED talks in the world. So more than 60 million people have have looked at that lecture. So in terms of, psychology making an impact on people's life, she is one of the most successful psychologists that ever lived on this planet. But what many people don't know is if your daughter ecology now and goes to a university.

She will hear the name Amy Cuddy as a warning because not in the popular field, Ted Talk, millions of books, but in the field of academics, she has become a learning example that we need to do our studies more precise. Because when they try to replicate the study later, their hormonal effects didn't show up. Their behavioral effects were all there. And that led to a big crisis in social science more, more than 10 years ago. Where not only this study, but that became like, paradigm example that we need to do psychological studies with better controls.

And later they replicated her study, the exact study, with 10 times more patients, And the hormonal effect, was not replicable. So they looked exactly how she did the controls And it was done at the standard of that time, but not to the standard of what we do, I would do today. Where you define beforehand, what parameters are you taking, you define beforehand, where they exclusion criteria, if a client misses one session, do they include them into their statistics or not? But at that time, it was general behavior. If a client misses a session, you, you decide whether that's, important or not, Even if you know that he has been a very well performing client in terms of the hormonal response, but then you are biased.

So her example became a teaching, that if you do psychological research, you need to have the scientific control, very, very, strict dogmatic that no decision is done For example, about inclusion, exclusion criteria, by by anybody who has seen the result. And she acknowledged, I, that she could have done it better at that time. Her assistant knew the hypothesis And their assistant was able to say you are included. You are not included. And there are always some borderline cases.

So, it means the hormonal effect is not replicable, but the behavioral, effect is replicable. And, that actually counts. So now inspired by that big crisis. So in social science, people learn the name Amy Cuddy. You want to become a millionaire where millions of people, are touched by your speaking, but your colleagues are no longer respecting you because you didn't play the rigor of science to the level that is required now.

So that became a teaching example, but now they replicated her study. And recently, last year, they have even done a meta study. So there are several studies like the slides that you see here where you do physical changes. So one study, for example, is you hold a pen with your lips and you look at some cartoons and charts where they are funny or not. And then you look again at, dozen cartoons, but you hold the pen with your teeth. And you're not aware that holding it with your teeth is, from the muscles associated with a fake smile.

And then the same cartoons look more funny. So if you do a fake smile, everybody sees this is not honest, But still, it influences the way how a cartoon or maybe the cartoon of your neighbor, how funny you think your neighbor is. So it means that, slight changes about different tension patterns stretch receptors in your face can have a profound effect on on your psychology. And now recently, they did a large study where they looked at all different studies. It was dozens of studies.

Where they had looked at postural changes, intentional changes in the body affecting your psychological behavior. And they showed it does have, in the majority of the study's, profound effect. But to my surprise, this newest meta study that just got published last year, it showed that the effect of positive, of spacious, of extensive postures, is weaker than the effect of, contracted postures. And I would have thought it goes both ways. But interesting, this meta study showed the influence of a different postural feedback from your stretch receptors in your facial body on your psychology is more profound when you are in a contracted posture.

So that is a new insight that maybe rather than saying three times a day, I pump up my chest and I become a hero. You can still do that, but maybe it's even more potent to say let me observe when I'm in a contracted posture. How I do that? And in what situations I do that, and what strategy I can choose with a friendly witnessing, I to observe my contractile, postural habits, and find the transition from them. Because they seem to have a more strong or potent training effect.

Maybe it is because our brain is more likely to form a memory from negative experiences. Because that's good for survival. And then they stay with you forever and positive experiences often, unfortunately, they don't stay with you so long. So if you have a very positive experience, And 20 years later, you come to the same spot, you may have forgotten it unless it was really, really profound. But if you really got scared, you remember it 10 years later.

So that may be a possible explanation. For this surprising finding in this new meta study, that it is the contractile postures shaping your psychology that this aspect has a more strong correlation as opposed to how potent it is if you become a optimistic, large, space oriented, a postural orientation. So that meta study stimulated me to become a more friendly witness when I'm sitting at my desk in a contractor posture. And then staying in the posture a few breathing cycles longer in order to taste how my eyes are, how my breathing is, how my legs are squeezing together, and the whole physiology and psychology associated with it. And then to look for a friendly transition because it will be likely that I will be doing this contractile posture for several minutes or hours in the next week.

And if they are shaping my psychology, my emotions, more than the minutes in which I feel great about myself and in which I'm in an expansive posture. That can be used as a very profound tool for that. So I thought this is a great insight. And then I was very pleased when one of the main author of that new meta study contacted me 3 years ago, because he is very engaged in depression and has been studying that more from a psychological attitude. And he wanted to collaborate with our team in Germany to see if there's also a involvement in the in depression.

So we did for 3 years. We did a study together where we measured myofascial stiffness with a tool that our group had developed. It's called the indentopro. And it's basically a palpating finger made from a technological tool. So if you want to know how stiff or how soft your muscles are, you're not just, carassing them. You vertically push into them, and you measure the resistance for 1 millimeter indentation 5 millimeters and so forth.

And, stiff mattress will give you more resistance than a soft mattress. And that is what we did with these depressive patients. We had a palpating digital finger. Press into the erector spina and the surrounding fascia and skin, 8 millimeters and to measure the resistance force in it. And to compare that in the erector spinae, in the mid thoracics, but also in the upper trapezius, how stiff these depressive patients are, in comparison, with age matched non depressive patients of the same gender and of the same age. And the study showed very, very significantly, they have an increased stiffness in the myofascial tissues.

So we cannot say whether it is the fascia, whether it is the skin that has gotten sickle, Whether it is a subcutaneous loose connective tissue that you can also call superficial fascia, or whether under the fascia Pufunda, the muscle fibers may be more tight. So we don't know yet, but we know the myofascial stiffness in the upper millimeters under the skin is harder in these tissues. A big surprise happened, when we did the indentation 5 times in a quick succession, in order to measure dampening or elastic recoil. In a perfectly elastic rubber like material. If you push it 5 time, the 5th time, you get the same response as in the first time.

But in pathological misuse, if you push it five times, you need to wait for the tissue to recover. Because it doesn't have a 100% elastic response, It is more like a piece of dough or a pudding. So you push into it, And you need to wait until it comes back. And that is what we found out in the depressive patients. So the the tension is stiffer, but the energy gets lost.

Or you have more dampening. And, that is the first study that I'm aware, where one tissue gets stiffer, But by doing so, it gets less elastic. Normally, if you have, a piece of rubber and you make it stiffer, It will also be more elastic. It will swing longer. So the same material you put more tension, it has less dampening.

But here, it looks like the material changed. As if the rubber became some kind of pudding, hard putting or concrete or something like that. So so that is now a challenge for us to find out how come they have a stiffer shell around their body, but the shell is not in an elastic way. It is more like in pathological situations. If, for example, you had an injury and it's slightly swollen on the left, And you compare it with the right, on the right side, the tissue will recover very quickly.

If you push your finger in it, you go out, in half a second, the indentation is out. But on the pathological side, you see, it comes out with a delay. So we call that dampening or loss of elastic recall capacity. And that's what we found in the in the depressive patients. And now, of course, we want to do many studies. And now already 2 big studies are now under inspired by the first study with much more patients And one thing is, when you see these less, these depressive patients walking, how they go up the stairs, how they go, down the stairs, They have less pounds. They have less elastic recoil.

Maybe that's not only a psychological movement coordination. Maybe that is even a tissue quality. At least that is the the question that we are having now. So when we published that study, about these tissue changes being associated with a psychological pathology. Some of my old friends from Heidelberg University, where I had studied psychology long ago, they contacted me and said, Robert, do you remember me? Yeah.

Do you remember the drugs we used to take? No, I don't. But you remember Wilheim Ryi. Do you remember primal scream? And I hesitated. Do I want to remember this? Of course, I remember. And they pointed my my attention again to this very popular concept 20, 30 years ago.

From Wilhelm Rai, a student, and later competitor to Siegfroid. Who emphasized in psychotherapy, you need to include the body. And Siegfried didn't want to have any physical contact with the patients. And he shaped the field of our psycho analysis to a very big degree. But William Marai said you need to include the body.

And he developed a typology of 5 different character types. And one character type, the so called masochistic, right hand character type, was described on having a strong outer body armor. As a protecting shell. And the prediction was that this would be a high stiffness but the high dampening quality at the same time. So that's what you have in bulletproof vests.

You don't want elastic material there. You want to dampen, movement energy in in this outer layer. So, we are now continuing with studies where we are, where we want to find out to what degree is this elastic recall capacity influenced by muscle toners To what degree is it influenced by biochemistry, by different cross links in the collagen fibers, But that is now a very intriguing concept. Of course, as a academic psychologist, you need to look for evidence based studies And I did that in response to my, and friends. And right now, we have several studies that have looked, how is the superficial extra reception?

And, superficial proprioception from the skin and from superficial tissues, indipressive patients, and how is their intero reception. And, this new meta study has shown Yes. It is actually in the way, quite similar to how Willem Rai and the body armoring has been describing it. They are less sensitive on the outside. So the proprioception, if you come and touch them very gentle with 2 little sticks and ask them, is it 2 sticks or one stick?

So in terms of two point discrimination, They are less sensitive in terms of proprioception, but also in terms of feeling relationship to the environment. So if if if you touch them on the skin from the outside, So it means they are dampened in terms of extra reception and proprioception. But they are more sensitive on the insight in relationship to interoception. And that is, is, so they are much more activated when you have a physiological change on the inside there. And that was a surprising finding from that study.

So I looked for more reliable newer studies, whether there is a difference in proprioception and extra reception and in intero reception in depressive patients, And there is now a systematic review where they have summarized dozens of individual studies. And in this review, they have actually showed that the proprioception, whether something is painful that you have on the outside and, how you perceive temperature stimulations on your skin is more sensitive on the outside. But in the way how depressive people feel themselves, their heartbeat, any temperature changes on the inside of the body, which is called intero reception, there, they are actually diminished. So they don't feel their own vitality. Their physiological life aliveness expressions.

They are actually dampened on the inside. But the outside, actually, it's stiffer we know, but it is also more vulnerable, more sensitive on the outside. And maybe that is one of the reason you can now speculate. If they are hypersensitive on the outside, then they harden up at the outside because things can become very sensitive to them, and they want to avoid that. So that's why this body armor, if it exists, would actually make a lot of sense.

So they showed depressive people have a diminished interoception in terms of how you feel your body from the inside. And that is now a good transition for us to not only look at Fascia as a proprioceptive sensory organ and actoceptive, how we feel the air around us the space around us, how tall we feel in terms of the environment, like the study of Amy Cuddy, But how do I feel on the inside? And that is called interoception, and it's describing how I feel my body in relationship, not to biomechanical demands and to the outer space. But in relationship to physiological needs, so temperature, hunger, air hunger, not being able to breathe sufficiently, thirst, even tingling, is an interoceptive body sensation. And that is processed differently by the brain and by the central nervous system.

And I have to admit in my many years in which I worked as a rolfing practitioner, focusing on postural and postural awareness, but also as a fellow Christ Movement teacher, We have been phrasing 80, 90 percent of our curiosity inspiring questions. To the client? Do you feel your right shoulder touching the ground? What, which leg do you feel is closer to yourself? Do you have more weight on the right foot on the left foot? So 80, 90 percent of these questions were shaped to train.

To support proprioceptive signaling and perception. But we are not very good on interoception. And that's why many of us went back into neurophysiology in the last 10 years. What do we know about intero reception? Because it follows different pathways in the central nervous system.

A lot of the interoception comes from our enteric brain that some people call your gut brain or your gut feelings. So if you have to make a difficult decision and you sleep over it and your rational brain can only help you to a specific degree. Successful, mature people. Also, when you visualize, I'm moving to Brazil, I get my children there into school. I will have a new environment.

I tell my boss that I'm moving. You have to live without me. But you do that all with your rational projection, but you also sense your gut feelings when you're doing that. And you may have an inner voice, but maybe it's not a voice. It's a gut contracting.

Or gut is telling you that you are close to vomiting, that tries to be an adviser for your decision making. And that has been shown that these gut feelings project to the insula in the context. And that usually, the gray matter in the brain is on the outside. And you have the white matter with the cables on the inside. But there is one area where you have gray matter on the inside, and that is called insular cortex.

And that is where the interoceptive body sensations are projecting. The proprioceptive ones that I've been focusing on for a long time. They project more to the Sumato motor cortex where you have the where you have a a body map, etcetera. But when the question is, how much kingling you feel how does a certain fantasy make your stomach feel good or contract of, get to vomiting. That projects, not to them with some automotive context, but to the insular.

And the interesting thing is the insular in opposition to the somato motor cortex, which is more proprio reception, whereas my body in space. But the insula, how how is my gut feeling? About a certain, situation. The is much more connected to other brain centers. Everything is connected in the brain.

But the insular has much more stronger influences, particularly from brain centers that are associated with emotions. And that is a big difference. So interoception always has an an emotional, judgment, attitude associated. So next time you're in the base, in the bathing tub, you can do a German scientific experiment. So you find out the slightest change in temperature, a little bit more cold water, a little bit more warm water, that you can feel. You know, if if it's a 100th degree of Celsius, you will not feel it.

But the tiniest change a little bit more, a little bit warmer. You know, how much do you need? So I so I can feel, a a tense degree of Celsius, getting a little bit more warmer. So whenever you get the tiniest little change that you can feel, ask yourself, can I also say whether it is more pleasant or less pleasant? And at least in my experiments, I've done many bathtub experiments as an intro reception researcher. Whenever you feel a difference, in terms of temperature, you can also say I like it more or I like it less.

And that's unique for intero reception. Whatever you feel has a, I like it more. I like it less. In proprioception, that is not always the case. So if you bend your knee at a tiny angle different, or you put your, right elbow further in space, Sometimes you can say I like that more than the other situation.

But sometimes if you put your foot more out or in, You say it's different, but it's not better. It's just different. So that is a big difference. That the insular always is associated, is influenced by other brain centers telling you whether you should like it or not like it. So it always has an emotional flavor associated with it.

And, this is very interesting for us now because we have learned in the last 10, 15 years, that some of the health dysfunctions that you experience yourself or as a therapist you are supporting in order to get them more into a healthy functioning. That some of these health dysfunctions are primarily associated with a diminished proprioception. For example, chronic low back pain. They they always have a diminished low, proprioception. So if you do a tiny difference in pelvic tilt, they may not feel a difference.

They may may need a larger difference in it. So chronic low back pain, is a proprioceptive dysfunction. The interoception may may not always be disturbed. And that is why, and that is, one example. And then it would be good if you have a chronic low back pain patient, that you focus on proprioceptive refinement in them. But there are other functions For example, post traumatic stress disorder.

So if a client had a car accident and they talk about the car accident, And you can see in their face that not only the TBR was broken, they were also shaken emotionally. And even when they now talk about the injury 5 years later, you can see it in the face. You will, you can see it in the, you can hear it in the voice. That also their emotional self regulation has been injured as well. And that, and that you could call a post traumatic stress disorder.

And the research has shown post traumatic stress disorder, tends to go along less with a disturb a distribution in proprioception, but almost always with a diminished, less good interoception, similar like we had with the depressive patients. And, that is important to know because then you can shape your support on which aspects of feeling yourself more the proprioceptive changes or more the interoceptive sensations, that can shape which, bodywork or which yoga style you may recommend. So on this slide, I have put on, that's a non exclusive list. From my, experience with different, more of, body work and movement therapies for which health dysfunction would they be particularly potent? For example, the basic lessons in Ayenga yoga, not only in Germany, but Internationally, they tend to be on average more proprioceptively precise.

So if you do an arching of your back, they tell you at which area of the thoracic spine. You should be doing that spinal extension. And in other hata yoga classes, they just tell you do it in the middle of the spine, but not exactly where you do that. So if you have a client who has low back pain, I would expect other factors will, of course, also influence it. But if you do a yoga that has a strong proprioceptive refinement emphasis, may possibly be better than a yoga that, basically doesn't include such a probioceptive feedback refinement as you have in these beginner lessons in Ayanga.

On the other side, if you have a client with post traumatic stress disorder, If they have 30 hours of Propriosceptively refined felton Christ lessons, or Ralph Movement, postural orientation, which is also mostly proprioception. It may make them happy, but it may not be a very potent support for their primary dysfunction. And then it may be better for them to go next door, into a lunar yoga where they have no idea about academics, and they believe into chakra and energy flow, no matter whether these chakra exist or not, but just inviting the client to feel an energy streaming. So if you ask the client, you do an exercise with a left leg. And afterwards, you ask the client, do you feel more alive Do you feel more tingling?

Do you feel more energy streaming? Whether they say yes or no is not important. But the the quietness, if you ask that question, where they say which leg Do I feel more streaming? Maybe. Oh, yes. I do.

So even before you get the answer, you're listening So your indoor, your insular is trying to orient itself to receive and process again, signaling from free nerve endings. Which are related to microcirculation, to temperature regulation, and, and maybe even to fluid flow that you have in the tissue. So that would be, a nice conclusion out of that, that it would be nice to shape whether you do a body work or movement therapy that has a more physiologically energetic, more introceptive, refinement associated with it. And then I would suggest to do that with eating disorders, with post traumatic stress disorders, with depression. But if you have somebody with chronic low back pain or with whiplash injuries, it would be much better in most cases that you give them a little laser pointer, and they have to do very slow figure 8 movements with their head where they get immediate feedback if there is a certain area in their head where they have less good movement control.

So that would be already one nice outcome, coming out of that study. Interception is such an interesting area. So, mostly it's a topic in psychology, and now more and more physiotherapist body work or movement teachers are learning from the intro reception research that mostly happens in academic psychology research institute. In this, academic research institute, In the last few years, the emphasis has been on predictive coding. As having a strong influence on intro reception.

And that means, what you expect to perceive is shaping to a very large degree what you then perceive. We know that's always the case. That is the case with you hear, what you see, but also with proprioception. But with interoception, it seems to be much more profound. So if you look at the architecture of the insulae, as you see on the slide, So you have a posterior lope, a middle lope, and an anterior lope, and they always have six areas.

So you have 18 areas altogether, and only 3 of them And they are very, very thin, have any relationship to your body outside of the brain. So it means if you are sitting down, so let's say you are king or you're the president in the White House, and every day you meet with your 18 advisers. And they tell you, Robert, the country loves you keep doing what you're doing, etcetera. Or this is happening in Afghanistan. And you listen to them, and then you make your decisions.

It would be a big crisis, hopefully, if after 2 years you find out, none of them has any information what's happening out there. They are not reading the newspaper. They haven't left the castle. They have no idea whether the country still exists, or whether people have died. Only 2 of your advisors And they are not the loudest, have any relationship to what's happening outside of your brain, castle.

All the other advisors are making up a story. Last time when you did that, it had this or the smell of this person I heard is very bad. So he must have an evil character, etcetera. But it's not related to any real peripheral, nerve endings, below the neck there. So that means when you are working with intero reception, the context And whether the client is in an attitude to experience healing, and something positive, or whether they are afraid that this could be injuring to them is not just an interesting add on effect, it is the main factor influencing whether your movement, your yoga stretch, or your touch, has a beneficial functioning on their post traumatic stress disorder, on their circulatory control, or whatever you have.

So for me, that is a crisis because as a scientist, I want to be more objective, and you don't want to ask rhetoric questions. For example, in Falden Christ, you do a movement with a left leg, And then you do it on the right leg, not with real movement, but just with mental imagery. And you have the client to compare it. But when you ask the client to compare the right side with the left side, you are instructed to use the same neutral voice. So that the client has to feel and not expect, oh, Robert thinks the second side is better.

So it, it will most likely be better. So for proprioception, it is good not to do rhetoric questions as a teacher. Feel your left side and feel your right side and see whether any is, heavier or whether they are the same. You're not doing any, biased, storytelling feel your left side and now feel your right side. So for proprioception, it would be good that you not doing rhetoric questions and that you stay neutral, that you don't expect that you don't create an expectation so that they have to listen to their body and not to their expectation.

But with introspection, that is impossible. Because whatever you feel is already shaped by your expectation. So if you work with post traumatic stress disorder clients, you should pay at least four times more attention on the contact factors, how the client feels when they enter your building. The flowers in the waiting room, your smile, when they come too late, Oh, nice that you made it today. Where they feel like this is gonna be a healing environment.

And if there is any kind of tingling happening or narrowing happening, or you give them a fasting diet and they feel a little shaky afterwards, that they are in an attitude, whether you say it or not, or whether it's just your warm voice and your eyes where they feel like this is not dangerous. This is a transition. It's my body waking up to something like that. So it means the context factors and, the expectation of the client, whether they feel, whether they expect your touch before you have, touched them even to have a beneficial effect just by your facial expression, by the temperature of your hand that you had before is very, very potent for them. So for me, that is also a challenge because it means when you work with interoceptive dysfunctions, how good your hands are, how good your yoga instruction is, whether whether you do the right angle in order to open up the right area is important, but 8 or 10 times more important is your storytelling.

Storytelling is predictive coding. Today, we are opening. Your body has been sleeping for a long time. So, this is more as holistic, Helos have been working. You offer the client a narrative context. And usually, the narration is You give them an easy.

You don't say it, but you don't contradict them when they come come up with a story. I got this pain because I I've been not living in harmony with the laws of nature. That is usually the storytelling in the esoteric healing. So they get an explanation. As a scientist, you know, that's not reliable.

But the client feels like I got this low back pain because I have been not in tune with the laws of Nature Health's evolution. I've been sitting too much on my desk. And now Robert gives me these wonderful, exercises and these wonderful stretches, etcetera. And now my body is opening up. And it may be a little bit shaky at the beginning.

It it may be not always very pleasant. But that is when the body comes back into nature. So that is a story. Scientifically, very questionable, But whether the client fabricates at Troy or not should be something that you should notice And that you should invite that the brain, all these other areas of the brain, that are shaping how they feel their body, are done in a healing associated storytelling context. And that is the story of the predictive coding that you have there. So in the interoceptive research, there has been a significant addition 10, 15 years ago by the discovery of free nerve endings in the skin and in the superficial under the skin, which are for social touch.

And they had not been known 20 years ago. So wherever you have hairy skin, which is almost everywhere in our body, except for the face and, the bottom of the feet and the hands, for example, we have free nerve endings which are waiting for a carassing social touch. And they fulfill a very important functions. In many mammals, it is part of social stress regulation. And in primates, so in chimpanzees, and in other human associated gorillas, orangutans, etcetera.

They have a very big function. And there have been studies, for example, that on average, a pavilion has 6 hours of social grooming, it is called. It was originally developed for hygiene. Because of fleas and of parasites in their, furry skin. But then it became used for stress regulation, and they do it in order to, calm each other and to strengthen their social bonds.

And when they have several hours in a week, Then their immune system is healthy. Their wound regulation is working very well, and their cortisol drops when they sleep at night. But when they don't have sufficient carassing grooming touch, then you can see that their stress regulation is less good. So it has a big function. And that was the discovery of the tactile C fibers.

And, it's not important exactly where you touch the upper arm, whether it's on the back side or on the lateral side because they are not so much wired with proprioception. This tactile, touch fibers. They are wired to the insular, and they give you a sense of, I'm, I'm, I'm connected. I'm not in a big isolation, and therefore, I'm I'm I I I I I feel more safe. And it's it's good for stress regulation, social bondage, and other introceptive self regulations associated with it. And many touch practitioners have now been working with these tactile C fibers.

And the research has shown, it's usually a speed between 1 centimeter per second, and 10 centimeters, but not 20. And also not keeping your hand there for one minute. That's pleasant. But it's not the tactile C fibers where you can measure in the insular that the insular feels there is a social connection there. Also, the hand should have ideally 34 degrees Celsius, so a little less in body temperature.

And it only works if you had eye contact and a social, resonance interaction before. So you cannot come into the, patient room and touch them without making a joke and smiling and and doing, a brief, oh, it's nice to see you again. I like your shirt. The weather is beautiful. Etcetera. And then I can touch you.

But if I come in and I do that without that social resident interaction, then the insular doesn't like it. So that has all been studied in the last few years. There are training programs. And, and they are quite potent. So you can take take somebody who has not been a body work practitioner before.

Who has been a cleaning lady computer person, and you give them a 2 hour tactile C5 or touch training. Where they learn about the speed, about safety, about the right temperature, and they can do very potent healing. So they come into the hospitals, and they give you, for 10 minutes, just a social touch, and client's recovery is significantly better. So that has been a big contribution for manual therapy. And, many osteopires are using that now.

Because when you then touch the client, you know it's about the connection to the insular, not to the body's schema. Exactly. This is the back of your arm that is the side of the arm. That is not so important. But the speed, the gentleness, that is very important. So many of you know that about the tactile C fibers, And of course, you can make up your mind.

You know, many, how many hours did you have last week? Where somebody in a non threatening way has been giving you this social touch. And then the question is, how how so so how can we organize that in our society? And in the COVID pandemia, many people didn't get the hugging, the touch that they had in the years before. And there is already some psychological studies that that may have had an an effect on our children and their social behavior.

Their immune system, their autonomic nervous system regulation that they had there. So that is the gentle caries in touch. But now a few years, there was a very exciting discovery, partly by the same Scandinavian researchers where they found out there must be nerve endings. For strong touch. Because when you put a pneumatic cuff around the lower leg, And you pump it up with several kilograms, not gentle carassing, but several kilograms of pressure, but circular pressure, distributed over the whole lower leg. So it feels like a strong squeeze but not painful.

And you do that slowly for 6 seconds, and then you lower it, and then you build it slowly up. The client says, this feels nice. Keep doing it. And when they measured it, they found out it was exactly or almost exactly the same areas in the insular as in the kerosene touch. So we have some interoceptive, it's called pleasant, deep touch, And when you give somebody a stronger hug or you squeeze their hand when they are sharing something emotional with you, And you are carassing the hand like this. It's very nice.

You have been doing it 16 times, 17 times. But if you look at them and you squeeze it a little bit more, you may be reaching this pathway. And they showed actually, it's almost the same areas in the insular, except they are more anterior, so more to the front. And that is associated with how meaningful something is. So the psychologists, they talk about salience whether something is the figure or something is in the background. And now since a few years, we are studying strong, meaningful touch as having an interoceptive functioning.

And that is very exciting. Because before in my fountain Christ community, they said gentler is always better than stronger. And in some dimensions, that is true. So if you can do the same stroke, even gentler, it is more powerful. But now if you want to involve these pleasant deep touch receptors, you may want to have a stronger, contraction that you have there.

So they haven't found the nerve endings yet. So they are probably not in the skin and very surprising. They found out in a recent studies It's not free nerve endings. All other introceptive nerve endings are free nerve endings. They don't have a capsule around it.

So temperature signaling, etcetera. And also the tactile C fibers for the grooming, they are free nerve endings. But the nerve endings wherever they are in your lower leg, that send a positive signal to your insular about I'm connected. I can relax. They are, apparently, some Ruffini, pacini, muscle spindles, so we don't know it.

But that is very exciting because as a roughing practitioner, sometimes we use stronger pressure, but in the same context. Where you make eye contact, where the client feels safe with you. And sometimes you feel like after doing superficial carassing touch 20 times. And then you do a stronger one. They go, oh, this feels different.

And I can relax even more with the with the deep touch that you have included. So that new discovery, which is quite exciting, citing. I'm waiting for the day to find out whether these nerve endings, Ruffini receptors or other non free capsulated, myelinated nerves, whether they are in the endomiesium, or in the Peri Museum of the intramuscular connective tissue, we don't know yet because it's a new discovery. So pleasant deep touch is now a new area of research for interoceptive stimulation, not so much for proprioceptive stimulation. And we know that has a more emotional effect on these people.

And now based on this new research, which is just a few years or, old, people are now doing more specific research, for example, on weighted blankets for children with autistic spectrum disorder. Or for attention deficit hyperactivity disorder. And not for all of them, But for a significant portion of them, if you make it an option to where a heavy vest in school, not a loose shirt, they can relax better some of them. And, if you want to experiment, maybe not in the hot season, but, to make your blanket a little bit heavier, In times of tension, I feel that actually quite sedating. So they are now doing inspired by this new research.

About the placentep touch receptors that have a primarily interoceptive functioning, We are now doing more systematic studies where you have squeezing machines. I've been studying with these compression socks that they use for lymph drainage. Or after running in a marathon, you have these dramatic cuffs. And I've been remeasuring my heart rate variability, and it's significantly more relaxed when I get the right kind of of squeezing pressure in my legs. And that is just one application that they are now doing based on this new research there. Another important aspect is how the fashion network is linked with the autonomic nervous system.

And why are the autonomic nervous system also with immuno regulation? And why are the autonomic nervous system also with stress and emotional parameters. And that was a big surprise. When they looked at what nerve type is the most frequent among the 250,000,000 nerve endings. They found out the most frequent nerve type is not proprioceptive functioning, not the muscle spindles, not the ruffini receptors, or the patchini, It was also not the temperature sensitive nerve endings, for example, that are related with intero reception.

But they were nerve endings from the autonomic nervous system, and in particularly from the sympathetic nervous system. So the sympathetic nerve endings in fascia make up almost half of them. And no other category can come close to them. And that is a surprise. We knew that they are autonomic nerves in fashion.

But why is it so important for evolution or for anatomical physiological functioning to have at almost every cubic millimeter a sympathetic nerve and not a proprioceptive nerve or a potential noseyceptive nerve for signaling tissue damage or something like that. And that is a big surprise. So, it seems to be very important for our physiology. That the sympathetic nervous system reaches every nuke and corner that it's present at every little niche of your facial net. And if you look at where are the sympathetic nerves are, and this is a beautiful image I got from Professor Neuhuber, where you see in yellow color, the sympathetic nerves, and you see the majority of them around an artery in red color or a small bean in blue color. And then most neurophysologists think they know what they are doing because they are regulating blood flow.

So they are vasoconstrictors. So it seems to be very important that you regulate blood flow in a regionally specific manner so that you can have the blood flow in your small finger different to the 4th finger or to the 3rd finger. And, that is interesting. So that's related partly to temperature regulation. But it's also related to how much oxygen, but also how much water you have in which area of your body.

And that is apparently a very big function for the body that it evodes more than 100,000,000 nerve endings into regulating blood flow, not so much in the big arteries, how much blood is in your aorta, But in the tiny atrials that go in in very little hidden corners, And that is regulated by the autonomic nervous system. So that is interesting, of course. So how warm a tissue is how much, fluid flow, how much stagnation you have, how dry it is, is influenced by the autonomic nervous system and particularly by the sympathetic nervous system that goes there. So that has been known before, but it's still very impressive to see how how important that is. But there are also some sympathetic nerve fibers.

You see them further down and marked with a single arrow. That are not associated with blood vessels. And that is now the $1,000,000 question in fashion research. What are the sympathetic nerve endings in fascia that seem to have no association with microcirculation So what is the other function of the sympathetic nervous system in our fashion innovation? And most of the neurophysologists assume it has a trophic function.

Trophic means biochemistry So it changes, for example, the pH, the acidity, or how much inflammatory or anti inflammatory cytokines, biochemistry you have in this area and in this area, not just in lower arm, But in thousands of different regions, you are regulating the biochemistry in that regional environment. And there is also speculation that these biochemical interactions are used to interact with the immune system, and we will cover, cover that later. So that reminded me of an article that inspired me to become a scientist when it was published in the late 1990s by a German phlebotologist. He studied the circulation in the veins in the lower leg. And to his surprise and to the surprise of pretty much everybody.

He found lots of sympathetic nerves in the fashear prafulfundra of the lower leg. And at that time, that was not known. But in addition, he found lots of contractor cells, that looked like smooth muscle cells. And normally, smooth muscle cells in your guts or in your arteries, they are not innovated, by the normal volantaries, somato sensory nervous system, they are regulated by the autonomic nervous system, of which sympathetic nervous system are a big part. So he put forward the hypothesis that the body has 2 separate or complimentary tension regulating systems.

In acute stress, you can increase your muscle tonos contraction. So that would be the somato sensory regulation where your trapezius tightens in terms of muscle fibers in milliseconds. And we know how that is regulated with, ulphomotor neurons, etcetera. But star was enthusiastic under chronic stress, your fascia contracts. Not via the skeletal muscle cells, but via the smooth muscle cells, which he found.

In dense fashion sheets. And he thought they are regulated by these free, by these sympathetic nerve endings that he found. And that is a very intriguing hypothesis. And it fit to my 20 years of roughing practice. Experience that I had there. If a client has acute stress, they have an exam on Friday.

On Wednesday, you already see how they are more nervous. And on Thursday, you cannot touch them. But when the exam is over, afterwards, often the subpoena is is relaxed again. And that would be muscle toners. But when they have chronic stress, Since 2 years, they have mobbing at work, the daughter goes into puberty and she lets the mother know that, everything is wrong.

And she has a divorce with her husband and the, and the parents, are getting crazy and want to, in disparity her or or do, do others threatening things. So so that happens sometimes. And I had that with some clients, where it's not a temporary stress. It's, since 2 years, there is chronic stress there. And I felt this is a different stiffness. It felt like not, the trapezius muscle fibers, but the facial envelope is different.

And that was, why I was so intrigued by that new hypothesis that facial tone is is regulated by the autonomic nervous system. And that inspired me actually to look for these smooth muscle like contractile cells. And we found them, but they are not smooth muscle cells of a regular type. They are called myofiboblast and they are smooth muscle like connective tissue cells. And they had been discovered already many decades ago.

In relationship to wound healing and also in relationship to pathological scarring like frozen shoulder, like, dupatory and contraction. It's not the muscles that are stiffening and shortening. In the Viking sand, in Dupuytren Contracture. It's a fashire that contracts. And the main cells to make that facial contracture in frozen shoulder in Dupuytren Contracture, are smooth muscle connective tissue cells, which are called myofibroblasts.

And in our study, we found these myofibroblasts, and that was new, also in healthy fashion. We found them in all fashion that we examined, but to very different densities. And that was interesting because the highest density was in the human thorough columnar fascia in the lower back. For some reasons, humans tend to have a higher density of these smooth muscle like contract ourselves. More than in fasure from other human regions, and also more than the lumbar fasure in animals that we use.

So that we speculate that some cases of low back pain that seems to be more frequent in humans than in in, other animals, could be associated with a stiffening of the fascia and not of the muscle, primarily. Similar like frozen shoulder, it's not the shoulder muscles, which are stiff. It is the capsule as a dense, facial fibrotic pathology that you have there. So we speculate that some cases of low back pain could be a stiffening of the thoracolumbar fascia that we have shown there. But very interesting when we stimulated these cells to make them contract and I tried it first with adrenaline, but I couldn't get them to contract.

So we put fresh pieces of treasure. Into what's called an organ bars. So that is kind of a little artificial bathtub or or like a petri dish. And you put the fascia under tension, and then you measure the resistance force. And then you stimulate them with, the adrenaline or with caffeine or with other biochemical stimulators.

And we found some substances where fascia stiffens. But they were not hormones. They had more inflammation or wound healing associated factor. But basically, we showed pressure can contract, but the contraction speed is very slow. So when all the myofibroblasts in your lower bag contract.

It will start to contract at a speed of 1 centimeter per month, not per minute, not per second. So it is ridiculous in terms of doing a dynamic movement. But it's not ridiculous. If you look a month later, how is the mobility of your arm as you see inflows shoulder? So it's a ridiculous, contraction speed. At a short time frame, but it can be very, very potent if you see how stiff fascia can be after several weeks, for example.

And that's what we found. But we were first disappointed because we didn't have a link to the autonomic nervous. Them. But then outside of our laboratory group in the field of psycho neuroimmunology, That is already in established field since at least 20 years where you study how do emotions influence your immune system. And that was known, and that is, clearly there is no doubt about it in chronic stress. You have different T3 cells produced or expressed in your lymph nodes.

And that means you are you have a a different immune system protection. You may know that. When you have a very important exam or very important, date, which which you have been preparing since many weeks. And if the children bring some, flu virus, from kindergarten, everybody in the family gets it, but you are the last woman standing. You cannot afford.

You know, this is your week. You know, a husband, has a cough, the children have it, but you are the last fighter until you had the big day, your big formats or your marathon or your rehearsals singing in Carnegie or all or whatever it was that you have prepared for weeks. But what you also probably have seen or have had yourself when you finally had the stressful peak performance and you rest the next day because you have deserved it. So you go to the swimming pool, put your legs up, and you don't do any jogging anymore. If there is a ridiculous flu virus that nobody gets it, in the bar or wherever it is. Your immune system 1 day after the peak stress will be so weak that you get the most ridiculous virus or bacterial infection.

And that has been known as weak and flu, etcetera. And that has been known in psychonurimmunology. Because under stress, your outer shield is stronger. Your inner one is weak. And the outer one falls down immediately.

But the inner one would take time to come up, and you're totally vulnerable. So the advice I would give you, if you have a peak performance stress, delay the recovery a little bit. On the next day, don't lie on the couch, lazy. Do a vigorous walk where you get into sweating or clean up your basement for 1 hour. Or do something which is physically and maybe also emotionally demanding so that the transition from the outer stress shield or protection shield to the inner one is more gradual.

And, so that is something that has been known before fashion research in psychotherapy monology because it had been shown that chronic sympathetic stress, tends to weaken some of the immune cells and strengthen some of the other. What was not known was how does the autonomic nervous system communicate? With, the immune system and the lymph nodes. It was clear. It does communicate. You also knew the outcome.

But they didn't know the messenger substance. And when they finally found the missing link messenger, the function was known. It was a surprise because it's not a hormone. It's a cytokine. A cytokine is a chemical produced by the cells in order to communicate with each other. So it's not produced by a gland.

And that cytokine with a strange name TGF beta 1 for transforming growth factor 1, It's not a hormone. It's a cytokine that the fibroblasts produce in order to communicate and to influence each other. That had been the cytokine that in our contractual test had the strongest contractile response. But we were not aware that it is associated with the immune system and particularly with the sympathetic nervous system. Now, that meant Starbucks and was right.

There is a link from the autonomic nervous system to facial stiffness regulation. Via chronic sympathetic activation, but it's not apparently directly done via hormones. It is actually more complicated. And that is actually very intriguing because this TTF beta is not produced by a gland. It is produced by the fibroblasts themselves, and they store it in a mechanical nest in the ground substance.

So in the jungle around it, and they store it there in order to have it available, in stressful times. So when the war is, they go out and open these nests and they drink in parenthesis, the miracle drink that they have created, themselves, And within a few hours, they transform into myel fibroblasts. So fibroblasts are actually quite nice, multipotent cells. They are like an old fashioned, husband in the renaissance. In a renaissance, you were hoping to have a husband who can fight, who can sing, who can cook, who can be a good lover and who is also a, a great gardener and also a great children teacher.

But a modern man often only have one functioning. And the fibroblasts normally are a little bit like a renaissance husband. So they are not stem cells. They are not omnipotent, but they are, pluripotent cells. But when they drink this TTF better, they transform into a contraction machine.

And then they are no they are no longer a renaissance man because then they are stiffening. They can produce collagen type 1, to make your surrounding stiffer, and they can't contract it. And they are 4 times stiffer than they have been before. And that is good for wound healing. So when you have multiple wounds, you want to close them so so that you don't get a blood infection. That's could be so, threatening to your survival.

So the quicker you close the wound, the better it is. And that is the function of these myelofibroblasts. And they have this smooth muscle acting embedded. And, that is very interesting, because these say the same miracle drink is also a transmitter from the, autonomic nervous system to the lymph nodes, so to the immune system. So the chronic sympathetic activation influences the immune system, but it's also influencing facial stiffness regulation.

And even more, the influence from the sympathetic nervous system to the immune system needs the contribution of the facial fibroblast. So the effect that I described that when you have chronic stress activation, that your immune system changes does not happen if the facial fibroblasts are not offering to contribute to TGF better. It's, it's not an edit. It's, required element of the influence from stress activation on the immune system. So we know chronic stress influences your immune system, but only through fascia. And fascia needs to contribute to that.

So that is now a very interesting that we have the autonomic nervous system linked not only with the immune system, but also with facial stiffness regulation. It went even more exciting when a laboratory group, did contractility tests with fibroblasts and with myel fibroblasts, in an environment where you can keep the cells alive for much longer than we were able. So in our environment, the cells were only viable for a couple of hours, and then they don't function anymore. Even if you give them enough nutrients, and oxygen, etcetera. But they did it in a petri dish in which they are swimming in a doping soup So you can keep the cells alive for a much longer time. But you also need to be careful to then say this is happening in the human body.

Because it's very artificial. But in that environment, they found out if you stimulate the adrenaline receptors that the fibroblast have. We knew that before they have adrenaline receptor. But when we stimulated them, we couldn't find any effect. But when they stimulated the adrenaline, receptors, they saw after 48 hours, then the cell produced more TGF better.

And the TTF better is the miracle drink that can make fascist stiffer and change the immune system. So now Professor Star Wars Hunt is even more right that it's even a hormonal effect. So chronic stress activation, not in a matter of a few hours. But after 1 or 2 days, leads to an increased production of this very potent miracle drink called TGF beta. Which will then make a link with immune system, but also with special stiffness regulation.

And now the question is, can you translate what they did in a petri dish to the living human body? And you then need to work with living people and see how does chronic emotional stress influence them. They had done that with animals. So they they gave, rats a stressful environment where they are in bright light, and they cannot move because they're in a plastic container. And then they found out that their touch touch sensitivity was much more vulnerable for them, but you don't want to do that with humans. To get them into waterboarding and to emotional torture and then see how pressure sensitive they are.

So this is a stew, a former student of, Professor Menza, and he didn't put people under stress. He's, he selected from approximately 200 low back pain patients. He gave them a questionnaire Are you one who had a post traumatic stress disorder in childhood, some kind of childhood maltreatment? And that is one type of post traumatic stress disorder where psychology has the best measuring instruments. Because they are questionnaires. So we know in our environment, approximately 18 people report about a sexual abuse.

At least they will report about it, and they are nervous system seems to be influenced by that. And, almost half of them had some kind of emotional abuse in their childhood that they report in these questionnaires. And what, Doctor. Tesouts did is to examine 7 types of touch sensitivity in relationship to whether they had a childhood, maltreatment stress disorder or not. So half of them had some kind of post traumatic stress disorder, 20 years before. They had, all of them had low back pain.

But some of them, in addition to the acute low back pain, had also in their nervous system, a post traumatic stress disorder. 20, 30, 40 years before. And from the 7 different, pain sensitivity tests, 2 were significantly sensitized. Not how cold is something, not pinching, not needle, it was vertical pressure, pressure threshold sensitivity, So if you push vertically with a sum and you start to push only with 100 grams, then 500 grams and you increase, And you notice at what kind of pressure, do the patients say, and now it starts become uncomfortable? And all over the body, they had a lower threshold or higher sensitivity for pressure pain threshold. Sensitivity.

And that is interesting. And they had done that with the animals before. The second one is called windupphenomen. And you tap them with, let's say, 100 grams, and that is not painful. But if you do that at a steady rhythm sooner or later, they say stop. This is getting to irritate me.

And it happens faster that moderate stimulations add up to an unbearable challenge in the post traumatic stress disorder clients. So already after ATAPs, they would say stop it and unstressed people could, could tolerate it, 30 taps or 40 taps. Now, that is very beneficial to know. Because it means if you do a challenging roofing stroke and normally you wait 5 seconds, 10 seconds, before you do it again. You may need to pause much longer with somebody who is in living in a nervous system or with a nervous system that had, that is shaped by post traumatic stress disorder.

It may also be that your intuition is no or your empathy is not the best adviser how much pressure you can put on somebody because you feel like what's good for you should be also good for the client. If you didn't have childhood maltreatment, but they had, please don't use your empathy. And your mirror neurons and your intuition, please calculate that maybe for them, 500 grams of pressure is already at the edge. And not only in the lower bag, maybe everywhere in their body. And and that is actually a sign that a chronic sympathetic stress activation, in this example, childhood maltreatment is changing my official, biochemistry or neurophysiology.

How exactly it is doing that. That is now an, an, an intriguing field that we will get into. There is one open uncontrolled field study happening in California, mostly in the United States, where thousands of people have been using the so called fashion blaster which is used for vigorous fascist stimulation for anti satellite treatment, not so much for health, but more for beauty, at least by some of the applicants. And the interesting thing is because it's not used in a gentle manner. People use it until they get bruises.

And you don't stop until you get bruises. And then you're proud of it and you show the bruises on your social media. And in some of them, it seemed to have positive effects. So they show on their Facebook side is, I used to have satellite on my lateral side. And now the skin and the fascia has more collagen density.

And that is not surprising because if you do moderate challenge, you may add up TCU stiffness in the TCU. So there are thousands of women who claim this has helped them, but they are approximately 100 women who got the same lawyers to say this treatment was not good for me. And I'm not the judge to say whether they are right or wrong. But as a scientist, I wanted to know what is the most common complaint. Because this is interesting. There is no fashion treatment or no other positive health treatment, which may also have negative effects if somebody does it too much at the wrong time and at the wrong dosage.

So whether drinking water is good or not a walking is good is a question of dosage. Even water drinking people die from it. Also, in general, it is good. So, that some people are able to injure themselves is not an absolute, judgment against that treatment. But we wanted to know what is the most common negative side effect if people are doing too much mechanical stimulation. And that's why these law files were very good. Also, in Germany, we have a lot of discussions of whether foam rolling on the lower lags should be for prohibited Because if you have vulnerable liens and you have a likelihood for thrombosis, you should be careful with doing foam rolling.

But now after many years, we have found 2 cases of a life threatening thrombosis associated with, foam rolling. And I had expected there were, there there there would be more cases. And I, and we found more cases of broken ribs than of thrombosis. And that's not what I had expected, but that's how we are learning. Yes. Many things are possible in terms of negative effects. If somebody does a mechanical stimulation, without mindful self sensing feedback regulation.

And that's why the study was so interesting. It's not a study But at least, you can look at what are the most common health complaints from these women who are saying, I want my money back. Or I want pair penalty. Very interesting. It's not thrombosis that's most common. It's, also not broken up wounds.

It's a flare up of old bacterial or viral diseases that they had years before. So a flare up of, Lyme disease, a flare up of epstein bar virus, and suddenly you get the shingles all over your body. And you knew once you have the epstein bar virus, the virus will be in your body for the rest of your life, but at a very small magnitude, And this virus is not hiding in your microbiome in your gut. It's hiding in your body wide fashion net. And usually they are hiding in the facial envelope around, the neurovascular bundles in the APNurium. And that's where these bacteria viruses are hiding.

Once your immune system has been strong enough, to get you back into healthy functioning. You had the shingles. You had, all kinds of, pathological science as a child. But now you live with it because your immune system is strong. But these viruses, these bacteria are waiting in your body wide network for a lucky day.

And a lucky day means, you know, immune system is as at sleep or is weak. And then they can break out. And that has been shown, for example, with the shingles. If as an adult, you have a single breakout and you go to the dermatologist, as I had several years ago, the dermatologist asked me, whether I had any unusual stress in the last days or weeks. And I told her, who do you have? These were the most stressful, etcetera, and she smiles because that is not always the case, but quite often the case.

Because then your immune system is weak, And, these viruses have their lucky day, and then they conquer the body. So apparently, in some of these cases, with a fashion blaster because of the, probably overdone mechanical stimulation the immune system was so busy or so weak with the many inflammatory changes that people had been putting on their body, that the Borellia bacteria or or or the epstein bar virus or help us virus. They had their lucky day, and that led, apparently, to some life threatening flare up of Lyme disease and of of of other bacterial, reactions in it. And, that is actually, in, in, intriguing field now, how your immune system can be influenced, can be weakened, or strengthened by mechanical stimulation. So several months ago, a study was published where they examined the immune system of more than 30 astronauts who had spent several months in weightlessness on the ISS in outer space.

And they found out that their immune system was significantly weaker. So a lot of the genes for the leukocytes were significantly less strong express. But in addition, similar to the Fasha Blasters story, They had a higher frequency for a flare up of Lyme disease, epstein bar virus, shingles, help us virus, etcetera. So it means that, bacteria and, viruses that we all have in our body, they found a weaker immune system, And, that led to the, increased likelihood to have a flare up of these microbiome associated, pathologies that they had in their body. And that is now an intriguing topic.

That we don't only have a enteric microbiome that we have been learning in the last few years, how important it is. We have more tenants, more foreign microorganisms living in our guts, then we have cells in our body. And they shape our, our behavior. So, if you take the microbiome from a depressive rut, and you give it into the guts of a healthy rat, it it will develop some, the depressive symptoms. So this is a very intriguing field.

But I thought this is mostly in your guts. But now we realize We also have millions of microorganisms living outside of our gut in our body wide fashion network. Including the, envelopes around the newer vascular bundles where a lot of them hiding. And I made here a list of some of these, microorganisms and how potent they are to influence our behavior, including psychological behavior. For example, toxoplasma, most cat owners have that.

And it's been shown in animal very clear that it can influence psychology. So a mouse that has the toxic plasma which is neither a bacteria nor a virus. It's a very archaic, micro organism form is not afraid of cats. That is not good for the survival of the mouse, but very good for the toxic plasma because they found their new host And there are strong indications, also that humans who have the toxic plasma living in their facial body are more prone for psychological disorders. So that means if you are working, if you have psychological problems, you get more irritable or, you have different, you're more angry than you used to be.

That could possibly be influenced by a less good balance between your immune system and these millions of microorganisms hiding in your body wide fashion network here. So this is a new dimension. There are probably also some of these microorganisms are positive ones. We know that from the enteric microbiome, but now, some people think that the lipid layer in the cell membrane some of that lipid fat, material comes from the bacteria that we make to produce it for ourselves. So this is a new intriguing field. That we not only have an enteric microbiome that influences our behavior, including psychological behavior, but also a body wide, fashion microbiome that may also influence our psychological behavior and more.

And now I made this chart here where you basically see that the autonomic nervous system communicates with the immune system, either via the microbiome in your gut or in your body wide fashion network, or why are the fibroblasts? Which are then producing the TTF data in it. And, that means whenever you have a dysfunction in one of these 4 elements, Please look at the other 3 siblings brothers and sisters because most likely they are involved as well. And that is now a new orientation. And I give you one example where that orientation already has been very helpful.

Fibromyalgia. These, people, have, lots of movement as functions. But, so far, no clear explanation has been found. Yes. The endomuseum is 10% thicker, but 10% doesn't explain. The severity of the functions.

Yes, serotonin is a little bit less good, but that doesn't explain. How severe the dysfunction is. But now they looked, how is the autonomic nervous system? And they found a severe change, not 10% more. So they found in the superficial fascia under the skin, a significant reduction in sympathetic nerve endings that are regulating blood flow. And that makes sense because a lot of the fibromyalgia patients, their secondary complaint, not their first complaint, is temperature regulation. So if they have cold feet, they suffer more under it and longer than you do.

The same if the room is too hot, they need to leave. So their temperature regulation is less good. And it's also been shown if you give them temperature stimulation, like contrast bars, cold showers, cryochambers, Kanibian. In many of them, their fibromyalgia tends to improve for a few weeks. So if they do the cryo chamber where they go in a high school water, room, and they do that four, five times on a weekend, for the next weeks, 2 thirds of them have less fibromyalgia symptoms.

And then they need to renew it. So some people think maybe the microcirculation regular problem is maybe the primary dysfunction And the soreness that they have after, after exercise is maybe a secondary outcome of it. But basically, it's, autonomic nervous system dysregulation of microcirculation in it. So that is now a new indication. And that's very helpful. So you may actually do, therapy that are oriented to microcirculation.

For example, cold showers, warm showers, etcetera. But when they found out that the autonomic nervous system is involved, and that is a new finding with fibromyalgia, a couple of years old, Because of the chart that I've been shown here, all the insight behind the chart, that the autonomic nervous system, and the immune system are playing pingpong with each other via the facial cells. Then after they had found out that fibromyalgia is a sympathetic nervous system, microcirculation oriented disorder, then they didn't wait much long to say, if there is the autonomic nervous system is involved, then what is happening with the immune system? So a couple of months ago, they took blood share room from healthy, from not healthy but from human fibromyalgia patients and gave it to mice. And the mice developed fibromyalgia symptoms.

And then they thought, what is it in the blood serum? Maybe it is the antibodies which are in there as immune system. And they, and then they knocked out the antibodies, and the effect was not happening. Also, if you give blood serum, we'll see antibodies from healthy humans to mice, they are also not developing it. So now we know fibromyalgia, you have the autonomic nervous system involved, and you have the immune system involved.

And that is a very nice example to, to, to show that outcome. So this is now an, a new model. If you work with any kind of soft tissue pain, Whether it's a neck ache, whether it's, low back pain. This is a new child that the group around Paul Hutch has developed you should always work as a family therapist, not as a monocarsel where is the problem I fix it. But that you know if one element is, is distorted, most likely the whole family is out of order.

And I recommend to work with this child. So if you have a fibrosis, it is influenced by a changed regional inflammatory milieu. And that is influenced by a body wide systemic inflam, chronic inflammation that you may have. And the chronic inflammation in the body, not so much in the region, is influenced again by your lifestyle, by your autumn, by your chronic stress, by your your lack of sleep, by your lack of exercise, but also by nutrition. So if you have a client with low back pain, please have that chart in your mind and find out who are these family members and how strong are they involved.

And dependent on how far they are from the symptom, you may need to wait longer until a behavioral change leads to an improvement. For example, the lack of sleep may be influencing the systemic inflammation And that is maybe one out of several factors for the regional inflammation. So you have treated the right family member But you cannot expect that already the problem is gone on the next day. Because on the child, it is further away of it. So that is very nice.

You have the autonomic nervous system involved. You have, the biochemistry of the inflammatory. You have a nutrition involved. And, I highly recommend that you include also the psychological factors. Shortly until Porges Group published that, there has been a very similar proposal, and I think an even better proposal, from the group around Chase Shah.

And he is also a hero, particularly in trigger point research. And Brian Tuckie and several other researchers, they came up with a a chart that looks very similar But, the chart includes the element. The chart is not shown here, but it's included in the article from them. Where they look at tissue stasis, how is the ground substance water flowing per minute? How is the micro circulation in the blood vessels? How is the lymph flow? And they say there is one family member who is not optional, he is involved in every problem.

And that is the amount of fluid flow you have through the extracellular matrix. So whenever you have a painful dysfunction, The microcirculation may lead to a swelling, but the exchange of fluid per hour is minimal. Because the fluids are stagnant. And the tissue stasis of the fluids leads to an accumulation of free radicals of inflammatory proteins. And that leads to a sensitization of the autonomic nervous system.

And you have a vicious circle. And that is an element that was not included in the previous chart. And he says, This is the main culprit of my official pain, that the liquids are stagnant. And when he published that, it reminded me of this great book by Dean Sewer and Jobs spotty. And I know Tom Myers, also the founder of anatomy trains, has been strongly influenced by the insurance and an anatomist who wrote this wonderful book.

And he wrote stagnancy breeds pestilence. Which is a very, very strong statement. But when I went hiking a few days later, I looked in nature if you see water that doesn't move, it will not be healthy after a few weeks. You see it will you don't want to drink that. Water. It's most likely not healthy.

And if you look for a way that the water can start to flow again, That would be your influence on that. So that would be my take home message. If you want to have a healthy immune system. If you want to have a healthy microcirculation, If you want to have a healthy autonomic nervous system, prevent this stagnancy breathing pestilence. As a main mafia boss, always involved family member in the interaction between the different systems.

So now we are looking at fresherautonomic nervous system and mechanical influences. This is my last slide. As a take home message, how can we use, movement and manual therapy and nutrition in order to have a healthy immune system. And I listed some of the features here. So it would be, in the past, people believed that you should keep your children away from dangerous bacteria that they should wash their hand very carefully when they come from the farm and you eat there.

But now we found out that children who grow up on a farm where there are lots of microorganisms around them, have a significantly lower likelihood for asthma, for example, as a immune system overreaction later on. So it's advocated that you give the body moderate challenges in a large variety. You want to have a rich micro biome that has many, many different microorganisms living in your body. And you may also one microorganism living there. So, the whole concept is now called Hall Macy's where rather than protecting your body from dangerous challenges, you look for how can you train your body to master, to conquer, threatening stimulations, and that makes your body healthy.

In nutrition, that has been shown, some, some time ago, the most healthy foods foods which are actually slight poisonous. So if you give a baby for the first time, broccoli, or green tea extract, they will vomit because it's very difficult to digest. But if you train your digestive system, not to vomit these really nasty plants, then you become very healthy in it. So you are not doing that with nutrition. The best foods are those that are the most challenging to the body, to the digestive system, then they make you work more than sweeping chocolate.

But if you train your body to break up to challenge, to handle these challenges, you become strong or or healthier. And the same is now recommended with temperature challenges, but also with physical challenges. That you do not overloading. You don't run a marathon until you're totally exhausted and then are sick for the next 2 weeks. But you train your body to handle that. So intermittent fasting, for example, is part of that home home is this concept.

And maybe also a vigorous massage could be part of, how mazes health oriented stimulation that you give to your body. So that is a, intriguing new direction that how you, even, even not only temperature, but holding your breath anoxia stretch may work by depleting the body in a regional specific manner from blood flow. And from oxygen. And then when you open the TCO to blood flow again, it has an increased capacity. To take in the oxygen. Again, similar like you have with intermittent fasting or with other challenges that you have in your body.

So I find that very intriguing. And, I thank you for your attention, and I hope you will develop some of your own ideas. How to use, how ways is principle to improve the interaction between the autonomic nervous system, facial stiffness regulation and the immune system.