Rate of blood flow. 6 Rate of blood flow

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1 What causes pain? In my quest to discover the true causes of many pain patterns over the past 21 years, I have been fortunate to come across many a sufferer of dis-ease (I use the hyphenation as I feel it removes somewhat the label the word disease gives as if permanent). I have made it a personal goal to look beyond the obvious and find out the changes in the body that are responsible for pain to manifest, including chronic pain, e.g Fibromyalgia. This approach led me to become aware of a system in the body that very seldom, if ever, was assessed in Physiotherapy, not to mention treated. This system, despite being well-known in medicine, was seemingly assumed to be functioning well and thus was overlooked in any painful condition by many. The system I am referring to is the Autonomic Nervous System (ANS), which is made up of 2 main parts, the Sympathetic Nervous System (SNS) and the Parasympathetic Nervous System (PNS). This specialised nervous system controls mostly the automatic functions of the body such as perspiration, goose bumps, hairs standing on end, gut motility, heart rate and the subconscious form of breathing. Yet, one of its most important responsibilities is the control of all the blood vessels in the body, controlling the tone of the muscular walls and thus the ability of the blood vessels to pump or squeeze the blood through the vessels to and from the cells of the body. This means the SNS in particular, is in control of the speed at which the blood flows around the body. Now, there is one thing we need to understand here, and that the above statements mean the SNS is in control of ITS OWN BLOOD FLOW RATE. To be able to function optimally, the SNS must be delivering a sufficient rate of blood flow to its own cells, not just those of the rest of the body. So why is this important? Well, in my studies and work over the past 20 years, I have found what seems to be a common denominator in the majority of painful conditions I have treated (and experienced personally), a factor often overlooked, but one which is so vital for recovery that if untreated may lead to more severe, chronic conditions manifesting where they should not. Where painful conditions were previously reaching a plateau, now, with correct treatment of the Sympathetic nervous system, these conditions are able to reach a fuller state of recovery, and have a more permanent resolution. This is relevant in cases where the problem only seems to reach about 80 to 90% recovery, pain eases then returns some time later, injuries recur, or you experience episodes of pain with relief in between. To make this a bit clearer, let us use an example of a typical condition, low back pain, and trace the path backwards to a possible starting point and the process that follows which results in pain starting out of the blue.

2 A patient will often describe their pain as starting for no reason, no physical strain was obvious, no trauma, they just woke up one morning and the pain was there. Now, logic would suggest that there has to be a starting point for this. In most cases, it is an accumulation of smaller stresses over a lengthy period. This period of time can vary from days to months, even years, and the accumulation and compensation depends on the intensity of the stress and on the individual s body s ability to cope. So where does it all begin. My hypothesis is as follows: The initial stressors, be it poor posture, repetitive physical stress/exercise, even something as simple as missing a step, slowly but surely irritate the body both physically and mentally, and this puts a greater demand on the SNS to increase the rate of blood flow to the areas involved. The more regular the stress, the more accumulative the load on the SNS, and at some stage this system begins to feel the pinch, and will start to tire. Naturally, a strong one-off trauma like whiplash can be the starting point and may not manifest as symptomatic until later, but generally we are concerned with nontraumatic pain. As the stress progresses, the SNS becomes more fatigued until it reaches a point where it cannot recover from this state of fatigue and loses control of the rate of blood flow to itself and to the areas it controls (arms, legs, organs, etc.). If this continues the problem then becomes physical and one of the first signs is stiffness. Our entire body is made up of a network of soft connective tissue called fascia. This is a magnificent tissue and it is one piece of continuous tissue from top to bottom. It has actually been found to communicate with every cell of the body actually entering the cells and it acts as a major communicator between different parts of the body. The speed of communication is believed to exceed the speed of light! (sorry all you scientists) This fascia is made up mainly of water and that water is supplied by the blood, so you can imagine if the rate of blood flow slows to any area of the body, the fascia will become dehydrated, resulting in what we feel as stiffness. This stiffness could show in the morning, after sitting for a while or after sport/exercise. How often have I heard the tale of stiffness in the morning, easing during the day and then getting worse in the evening? In a normal day the blood flow rate is relative to the demand you put on it, so for the average person, the rate will start off slower in the morning and increase during the day as you become more active, then decrease as you slow down at the end of the day. Naturally in that time if you increase your activity through exercise or strenuous physical work, or even from sitting all day in one position (which also demands higher than normal blood flow to get through inactive tissues), then the rate will rise accordingly.

3 Your general circulation pattern goes as follows where the figures on the bottom line are the hours of the day and those on the right side the rate of blood flow (no actual measurement, just an indication of rising rate). 12 Rate of blood flow Rate of blood flow The rate of blood flow at either end of the chart indicates resting rate, for instance when you are in bed about to get out or in the armchair watching your favourite soapie. The chart will continue beyond 20h00 at a similar resting level until it gets to 02h00 in the morning, where between then and 04h00 it will drop even lower, into what is known as the deep sleep time. This is a critical time, as it allows the body complete rest, after which it begins to wake up. Having spent 2 years in the army, I know from personal experience that this is the time where guards on duty often fall asleep, and is a good time to attack the enemy. It is also at this time where problems may manifest themselves more acutely. Many a patient has complained of their symptoms getting worse at this time of the morning and it has forced them to wake up and move. Apart from pain there could also be a sudden increase in brain activity preventing you from sleeping, so some people sit up and read a book! This waking process is actually the body s emergency mechanism which is initiated to ensure the oxygen levels do not drop too low which will end in death! Increase in pain or brain activity both force you to get up and move, and it is this movement that increases the blood flow rate, therefore resulting in a relief of pain or the possibility of reduced brain activity to resting levels and thus the chance of falling asleep again. However, if the control of this blood flow rate is insufficient for this to occur, sleep is almost impossible, but we will talk about that later.

4 So our low back pain patient describes pain and stiffness in the morning, finding it difficult to get out of bed, but once up and moving, feels easier. Work is manageable, but the pain is never gone, and when the day ends and the patient returns home, the pain increases. It may take time to get to sleep as it is difficult to find a comfortable position, but then sleep comes, but can be interrupted by pain. The pain is then worse at about 03h00 after which sleep is impossible. Let s say this patient is a builder for argument s sake (could just as well be a desk jockey) which entails physical work on a regular basis. This repetition asks a lot of the muscles, but the muscles require blood flow at optimum rate to work at that level. This in turn demands a lot from the Sympathetic nervous system, and can be accommodated for some time, but at some stage this demand is too much and the SNS becomes fatigued. Slowly the patient begins to tire more easily, muscles fatigue, recovery from a day s work is slower, stiffness becomes more apparent, and eventually pain begins. Now this could take months to progress to this stage, and the process can be so slow that it is not noticeable in the early stages. Often stiffness is ignored, usually because it gets easier with activity, but this is an early danger sign, and should not be ignored!! One of the results of stiffness is weakness, an often overlooked aspect of the entire pain episode. When muscles are not allowed the space to operate due to tightness of their own fascial sheath (container of the muscle) then the muscle cannot fully contract, leaving it weak in some ranges of movement. Weakness then forces the body to incorporate other muscles to do the work, and this compensation increases the pattern of dysfunction, spreading the problem to other areas. Herein lies the secret to most pain, it is often in these compensatory areas that we get the pain! Pain itself has another downside. It also forces the body to further compensate by changing how we do things, how we walk, how we sit and sleep to reduce pain patterns. All of this brings on further changes in the soft tissues, further stiffness and weakness, and eventually more pain. Hopefully now you can see that treating the pain could be treating an area that is far from the original problem area, and this will be unsuccessful in relieving the pain. Understanding that the cause could be elsewhere is the secret to a complete treatment and recovery. Understanding the starting point of all this is the most important secret in the relieving of pain patterns and conditions that have many variable symptoms, such as Fibromyalgia.

5 Just like a fuel pump in a car (for those car nuts), the fuel pump pumps fuel to the engine which in turn supplies the electricity that drives the fuel pump. If the fuel pump malfunctions, then the fuel does not reach the engine correctly, which in turn cannot supply sufficient electricity to the pump to continue.