Follow up on the pterygoids.Ricerca e scienza
Di Maximilien Girardin
Robert started this by sending me a big mail, he just gave me a thumbs up thus it is ok that you see where our minds went wandering…Reading this makes no sense if you haven’t read the pterygoid’s article first. (Context)
Dear Robert, copied your answer, so that I can answer to what you say clearly step by step, thanks for the interactions. (This is max talking)
I enjoyed your article and thought it was well written (That is Robert talking)
Thanks that is really nice, because I am always uncertain when writing in English for an English reader, my vocabulary and grammar being very poor and probably outdated (learned English in Rhodesia later Zimbabwe in the seventies, Zambia and even later more with Scottish guy’s living in Kenya their whole lives that was the eighties and nineties; since then it is mostly south Africans that filled in the language gaps up until today; then chatting with my buddy Walter McKone in his fast London English, makes me sound like a mentally challenged person makes me very uncertain (because I don’t know if that what I intent also comes out that way ) So a sincere thank you for that
and gave good context to your argument.
That is EVOST kicking in, that is a principle we try to train our participants in: “first set the environment or the context before talking about the system, without the context-environment, the system makes no sense whatsoever. It becomes actually nonsense.”
Which by the way, is one of the biggest illusions and dangers in our profession actually I think.
Science publications tend to focus on the novelty, leaving the background and context out of the picture usually, but most people have a poor fundamental knowledge among others of the concept FORM, A.T.Still talks about.
Thus when they are reading articles, the constant new novelties are just blowing up a bubble with mostly hot air as content; and in extremely few cases is there an incentive to reflect and self reflect upon their comprehension and knowledge. Result is in many cases: they have opinions, sometimes very strong ones, without really understanding what they are talking about. Thank you, streamlining and simplification on many levels , the worst probably on anatomy because there it is going on since+-1920’s and it is painfully demonstrated each time we do the dissection courses in Heidelberg.
In my Evolutionary physiology course I am always flabbergasted how little comprehension the participants have because of lacking knowledge…they can’t ride a mind-bike comfortably through the dimensions, it is all cut up in pieces… Knowledge is sometimes there but all like a dusty attic…not ready for use
It was fascinating to read about the importance of the pterygoids and how bruxism can therefore effect the cranial and spinal venous circulation. Are there other habits or effects that we do that can also effect the pterygoids?
Yes teeth clenching, although that affects the temporalis and masseter muscles too (sometimes affecting the superficial temporal artery badly) and not just the pterygoids. Easy to recognize in patients, look at their teeth before starting to palpate them:
· Ground off on a flat line = usually bruxing,
· Cracks in the enamel and little pieces broken off here and there = usually clenching
How do you manage to access the lateral pterygoids with big hands?
HAHAHA the one million dollar question, try this one I have big sausages instead of fingers too:
· sit on the opposite side of the one you are doing. Sit!!!
· It is a question of angulation thus stress on the mouth (set the table and your chair height so that when you put the finger in the mouth your relaxed elbow and forearm are level with the patients maxilla front teeth+-),
· Wet your index and finger-cot thoroughly with the patients saliva, it is a penetration thus it is smoother when lubricated; the whole process is gliding and not forcing.
· From the opposite side your finger can now follow with its articulations the curvature of the maxillar bone much easier. You adapt to the environment.
Hand position!!! Hold your hand relaxed but in the position like you were playing cowboy and your hand your gun, remember as a kid?
Other important notice:
· You use the left hand to do the right side and your right to do the patients left side. Thus this picture is for the left pterygoid while sitting on the patient’s right side at the height of his shoulder.
· Now supine until horizontal, wet the finger and then pose it gently on the line of where the front teeth come out of the maxillar gums, gently oppose your thumb as to wrap it around the mandibular, this will become very important!!!
· Now wiggle a bit so as your index is lying on the teeth covered by the upper lip and test if you can shove to and fro in a silky smooth way that it glides and not that you pull the lip or mouth corner along, it must be smooth!!!!
· Relax your index and follow while penetrating deeper, FOLLOW the natural curve of the maxillar bone, finger relaxed gliding like a snake of the sand.
· Just before the end of the teeth you’ll bump against the angular part of the mandibular bone (with kids and women, with men it is often wide enough so that you feel the hole in between maxilla and mandibula)
· Now it is often helpful and certainly for kids or women that you induce by your thumb a little lateral shift of the mandibulla towards the side you are working with the index, but without tensing or stressing the whole, in practice once you get it, it is actually a smooth flexion gliding of the whole hand in the wrist: the shift and going deeper into the opening are simultaneous and silky smooth.
· Now your fingertip probably just passed the last tooth: !!!!! stay on your line !!!! don’t slide up or downwards!!!! Follow the natural line with your index fingertip without tensing it, the finger cup as a snake gliding relaxed on the sand following the contours without any tension….your intention must be : think silky smooth snake: natural and supple.
· Now your fingertip slides smoothly over a little ditch (between palatine and sphenoid) and you reach the pterygoid process and bump in a ‘cul de sac’ (dead end in English I think) formed by the lateral pterygoid muscle and tensors with the fascia of Hyrtl or the ‘ignominious’ fascia crotaphitico-buccinatorius (the name is ignominious not the fascia itself)
· Now if the whole is smooth and supple, even elastic it is ok. (Most young osteopaths have no clue of what living bone means; on this place, if it is healthy you will think it is an elastic cartilage feel, a little stiffer than your soft palate but barely, feel yours to have a living picture.)
· If you feel hard stuff on the pterygoids it is in trouble and the patient will feel pain (a lot), just gently push as your snake was moving (same direction not finger flexing!!! Not hooking – PUSHING gently)
· Tell the patient to start breathing deep and swallowing it alleviates the pain a little (taking the attention away) but mostly the muscles and fascia will surrender and give up the contracted stressed condition much faster with swallowing and breathing. Worst case I ever had: it takes +-40 seconds, if they don’t, it can take minutes of agony…don’t ask how I know it is another long story in writing))
· Usually just before or during the release the eyes start have tears rolling down, Influence on the lachrymatory nerve that passes there, it is a good sign.
· Beware sometimes this rolls over into a heavy somato-emotional release if the patient has strong retained troubles in their life.
· What do you feel as it releases? I describe it usually as a balloon deflating or butter out of the fridge on a summers day, it becomes smoother under your fingertip and suddenly you just smoothly glide deeper in it, it becomes less dense and melts away… you get what I mean?
The patient feels the awful pain provoked by you fleeing away as it relaxes and after that they are grateful because, boy you have not got a clue yet of what is going on there…breathing, the whole circulation reorganizes, it is almost like the brain gets high on oxygen and a washout….unbelievable.
About that when you have done both, let the patient breathe and relax and then sit for a few seconds to help the reorganization but hold them firmly it would not be the first to get all dizzy and do strange things like falling on their nose (don’t ask how I know, had it once in the eighties…learned from that)
I think it is important that we don’t throw the baby out with the bath water though as ANS has a very important impact on the circulation to the organs. Circulation to the visceral tissues is effected by osteopathic spinal lesions or somatic dysfunction which has been demonstrated by Louisa Burns work over a 50 year period as well as a number of other researchers. The general effect of the induced lesions was vasospasm, fatiguing of the reflex, passive congestion, oedema and ischaemia followed by infiltration of fibrous tissue.
Ha ha ha that is your probably British education talking not the osteopath in you…I suspect
The form is one, so you cannot throw any of it away, even if you would like it sometimes getting older
When you study Still’s work, he uses the word FORM: 907 times on a total of 1293 pages, the word Lesion 28 times and the word adjustment 13 times…where was his intent and focus do you think?
His probably most forgotten quote through the forcing of ‘J.M. Littlejohnism’ in Britain is: “Osteopathy is founded on nature, osteopathy is found in nature, osteopathy is nature.”
Thanks to J.M. Littlejohnism the consequences of this quote were also kept out of view: Here is a copy of one of my slides for June when I’m invited at the SCCO conference about the ANS:
As you all know for sure osteopathy is based on evolution
• Osteopathy as representative of a process is the application of certain evolutionary forces. …on which we depend for our (practical) daily work…
• Evolution and osteopathy represent parallel lines, or rather one is part of the other. Osteopathy is applied evolution.
• We know both evolution and osteopathy to be facts, and they both deal with the welfare of the living body. ( While molding it…)
• One thing is certain, it is inviolable law that both evolution and osteopathy represent…
( C.P. McConnell :Osteopathy in the light of evolution, Journal of Amer. Osteo. Associaton, vol 12, ° 9, May 1913)
• He (Dr. A.T. Still) had worked those (principles) out along similar lines with Darwin, Wallace and Spencer at a time when the ideas of these researches were not common knowledge.
( Edythe F. Ashmore on the death of A.T. Still, “ The Western Osteopath, Vol.12, no. 7, Dec. 1917 )
Anyhow, Osteopathy is about Nature; its principles and characteristics (Form and not the moronic structure and function but anatomy in all its dimensions and the same with the physiology: integrated structure and its characteristics); its history (Evolution, developmental principles, embryology)
As said before when one takes something out of its environment or context, one is busy with nonsense. The ANS by itself and certainly the way it is promoted in education and osteopathic education certainly is absolute nonsense
When one takes a system out of its environment it becomes impossible to get it, because one is creating a virtual bubble away from biological reality, which is always bound to Space-time.
What do I mean with that?
Space-time and evolution demonstrates that there is one continuity, one red tread, and that is the principle of Hierarchy and Chronology.
A living picture to make it easy:
A house is built first by the foundation, it will disappear beneath earth and you won’t see it anymore…but that is what carries and maintains the stability for the rest of its existence saffie? (get it?)
It is not because it is not in your attention or sight that it changes its role in the whole and that is the danger, most of us loose sight and awareness of it and its role.
Recent article demonstrates that the Vagus is important for the vascularisation through….Vasoactive Intestinal Peptide…a paracrine and endocrine hormone if you want …
The red tread of the communication – feedback systems is roughly:
o Motor nerve system
o Sensory nerve system
o Central – brain
The ANS is the bloody new kid on the block, all the rest (older) is running the show and the ‘news kids’ just do the end managing of the stage … don’t overshoot its role.
It is really too much to write all that down here but I sincerely hope you get the picture.
The only reason why I go hard on the ANS is not because it is not important, but it is really end of the story not the fundament, so it is to throw in some counterweight to the sickening blindness of virtuality.
Make people reason again in context maybe…. As Drew used to say: ‘Never give up but die in the last ditch. This is a war not for money, nor power, but for truth, love and humanity…’ or something similar as I remember it.
That is what I try to do.
Orthostatic control does use all these systems when changing postures, especially going from lying to standing and sitting to standing positions (valsalver probably has a bigger part to play in this than the ANS though) but that is only a small part of what the ANS does. It has a huge effect on gut blood supply for example, especially after a meal (we are told that the mesenteric circulation can hold nearly all the blood)
Yes and no, what you describe is the end of the story, not the hierarchy nor the chronology, overshooting the most important…the foundation, fundament or how you call that…
Dig into the basis: the pericytes of the capillaries, dig brother, dig… we all have a lot of knife work to do in our trenches or ditches if you want.
or plays a very important role with the interplay between the para and sympathetic component parts in sexual arousal, erection and ejaculation for example
Agree but it is not hanging there alone in the ether, anymore than your house…..dig brother, dig and reason and keep an overview of the whole.
On top of this we have the hypo-pituitary-adrenal axis and its effect on circulation, this is also something that effects pericytes too. Cortisone has an effect on the tightening up the blood brain barrier for example, perhaps long term effects of this may effect cerebral atrophy or some dementias and other degenerative conditions caused by a local ischaemia?
Agree to all that, but I am a bush boy, an ecologist in essence, in the soul, not the trendy BS they are making of it today.
My nickname in several countries of Southern Africa is ‘Crocodile Belgium’, ‘snake man’ (because I use to caught them on the farm and ‘locasie’ so that they would not be killed and released them in the bush, the blacks are usually terrified by them and kill at sight) or the ‘bosgefok boykie’ in Afrikaans (bush fucked mind guy)
Nature is my teacher and the most important of how the processes are going is not always as seen by the eye…depends of your knowledge and awareness…
I took three times several weeks the evost students with me in the bush and deserts of Namibia (The Evost Namibia Field Expedition) and every time between the Omaheke desert and the Kalahari, while camping wild (to keep their awareness on the tips of their toes) after a day of bushwalking and looking at the raw nature and animals there, I asked them by the campfire what was the most important flora or fauna they have seen manifold that day was? The most important to make the difference there, it is bush between two deserts, so what makes the difference?
And every time they called out the names of all mammals, birds and snakes they had seen…. The answer is the termites
They had seen the mounts of them everywhere but not the insect itself, thus not seen, soon forgotten, as it goes so often in our virtual world….
They are because they are the only big abundant biomass that takes the dead biomass (grasses) and work it back deep into the dead sandy soil while transforming it and metabolizing it and by that make it conserve or hold water or moisture under the sand which maintains all the other flora and by that way fauna alive. No termites and the water just seeps through … that is desert.
Dig on the principles:
· Hierarchy of life
· Chronology of life
· Its complexification
· Its developmental story and what are the principles at work
· What is the mechanism (the puppeteer behind the curtain)
That was my road and the only one I can advice strongly…and spend aware time in nature, she is our mother and what we are, even our profession…
Thumbs up brother