How We Learn, Literally.

Brain neuron

Normal Neurotransmission:  

     The cells in the brain can send signals from one region of the brain to another.   Nerve cells communicate with each other at a region between them called a synapse.  At the synapse, signals move from the one neuron (sending cell) to another neuron (receiving cell).  The small space between the two cells, the synaptic cleft, is where communication takes place.  The cell that will send the message is loaded with sacs called vesicles that are filled with neurotransmitter molecules.  There are many types of neurotransmitters.  The cells that receive the message are coated with receptors specific for a particular neurotransmitter.   An electrical impulse triggers the vesicles to release their content into the synaptic cleft.  Once the neurotransmitter molecules are released into the synaptic cleft, they collide with and lock into the receptor molecules on the receiving cells.  When the neurotransmitter is docked, the receptor sets into motion a cascade of chemical reactions resulting in the production of a second messenger molecule.  Once the neurotransmitter has done its job it is released from the receptor and travels back to the sending cell through reuptake transporters.  It is either repackaged for reuse or broken down.  Back in the receiving cell, the second messenger initiates a nerve impulse which travels down the axon of the neuron.   Once the impulse reaches the end of the neuron, vesicles with neurotransmitter are stimulated and the process starts over again.  The receiving cell becomes a sending cell.  An impulse will stop if there are too few neurotransmitters to bind receptors or if the neurotransmitter is inhibitory in nature, preventing further reaction.   We are born capable of normal neurotransmission.

 

Synapse - vesicles release neurotransmitter

 

 

 

 

 

 

 

 

 

 

 

 

Plasticity

     Plasticity is the capacity of the nervous system to develop new neuronal connections.  This includes the ability to change and adapt, especially the ability of the central nervous system to acquire alternative pathways for sensory perception or motor skills.  Neuroplasticity defines the ability of the nervous system to change its capabilities by experience and plays a major role in compensating for the loss of neurons with age.

 

Nerve cell

 

 

 

 

     Following birth, the brain of a newborn is flooded with information from the baby's sense organs.  This sensory information must somehow make it back to the brain where it can be processed. To do so, nerve cells must make connections with one another, transmitting the impulses to the brain. like a basic telephone trunk line strung between cities, the newborn's genes instruct the "pathway" to the correct area of the brain from a particular nerve cell. For example, nerve cells in the retina of the eye send impulses to the primary visual area in the occipital lobe of the brain and not to the area of language production in the left posterior temporal lobe. The basic trunk lines have been established, but the specific connections from one house to another require additional signals.

 

     Over the first few years of life, the brain grows rapidly. As each neuron matures, it sends out multiple branches (axons, which send information out, and dendrites, which take in information), increasing the number of synaptic contacts and laying the specific connections from house to house, or in the case of the brain, from neuron to neuron. At birth, each neuron in the cerebral cortex has approximately 2,500 synapses. By the time an infant is two or three years old, the number of synapses is approximately 15,000 synapses per neuron. This amount is about twice that of the average adult brain. As we age, old connections are deleted through a process called synaptic pruning.

     Synaptic pruning eliminates weaker synaptic contacts while stronger connections are kept and strengthened. Experience determines which connections will be strengthened and which will be pruned; connections that have been activated (used) most frequently are preserved. Neurons must have a purpose to survive. Without a purpose, neurons die through a process called apoptosis in which neurons that do not receive or transmit information become damaged and die. Ineffective or weak connections are "pruned" in much the same way a gardener would prune a tree or bush, giving the plant the desired shape. It is plasticity that enables the process of developing and pruning connections, allowing the brain to adapt itself to its environment.

 

Plasticity of Learning and Memory

     It was once believed that as we aged, the brain's networks became fixed. In the past two decades, however, an enormous amount of research has revealed that the brain never stops changing and adjusting.  Learning is the ability to acquire new knowledge or skills through instruction or experience. Memory is the process by which that knowledge is retained over time. The capacity of the brain to change with learning is plasticity.  At least two types of modifications occur in the brain with learning.  First, one sees a change in the internal structure of the neurons, the most notable being in the area of synapses.  Second there is an increase in the number of synapses between neurons.

     Initially, newly learned data are "stored" in short-term memory, which is a temporary ability to recall a few pieces of information. Some evidence supports the concept that short-term memory depends upon electrical and chemical events in the brain as opposed to structural changes such as the formation of new synapses.  One theory of short-term memory states that memories may be caused by "reverberating" neuronal circuits.  This means an incoming nerve impulse stimulates the first neuron which stimulates the second, and so on, with branches from the second neuron synapsing with the first.   After a period of time, information may be moved into a more permanent type of memory, long-term memory, which is the result of anatomical or biochemical changes that occur in the brain (ie learning).

 

Injury-induced Plasticity

      During brain repair following injury, plastic changes are geared towards maximizing function in spite of the damaged brain. In studies involving rats in which one area of the brain was damaged, brain cells surrounding the damaged area underwent changes in their function and shape that allowed them to take on the functions of the damaged cells. Although this phenomenon has not been widely studied in humans, data indicate that similar (though less effective) changes occur in human brains following injury.

     We are a long way from being able to safely manipulate neural growth and behavior.  Perhaps the intricacies and complexities of the human neural networks make the task an impossible one. Or if not impossible, perhaps limited.  But there are now known ways to influence, beyond a doubt, improved function to some degree in some systems.  Intuitively we have known this for centuries.  This is why we have practiced anything to become “better”.  Only now we “know” more about why it is worthwhile to practice.  And perhaps we are learning ways to manipulate practice.  The list of clinical examples is long, showing how healing, performance, growth and development can all be enhanced through optimal neural learning.  Do the research if you find yourself intrigued.  If overwhelmed by the concept, well, just keep practicing.  Don’t worry about why it works.   

It’s Pronounced ab DO men

Patrick Helm - SnootyFoxImages

You are told, strengthen your abdomen and you think, no problem, I am toned.  Or you are one of those who feels hopeless, knowing that no matter what you try, that area will never respond to your efforts.   You know, you have tried.  Or maybe you are not quite hopeless, you could build strength and develop great muscle tone, if only you would do the work.  What should you do to strengthen the abdomen?  When did you learn what works most effectively?  What do you know about your belly? 

      The rectus abdominus flexes the trunk (bends it forward).  The internal and external abdominal obliques and transversus abdominis muscles flex the trunk and bend the trunk laterally (sideways).  These muscles are innervated by intercostal nerves 7-11, subcostal, iliohypogastric and ilioinguinal nerves (the rectus receives innervation from the intercostals and the subcostal alone).  When you contract these muscles, it is the obliques and transverus muscles that flatten the abdomen (bring your front toward your back).  The rectus muscle brings the top toward the bottom (the chest toward the pelvis).

        Crunches are popular, portable, affordable and accessible but are they effective?  If done correctly, they can be.  Yet there are limitations.  It is difficult to exercise all the fibers of each abdominal muscle doing only crunches.  The abdominal muscles are large and cover a lot of body surface area.  To exercise them efficiently, one has to accomplish full extension and contraction at some point during the motion to actually strengthen the fibers of the target muscle.  When lying on the floor, the floor itself limits your extension to zero degrees when you might benefit from a starting point of a bit more (slight trunk hyperextension).    One cannot bend back past the floor.   And crunches are not a true functional motion, unless you are a wrestler, or unless you spend an unusual amount of time getting out of bed or up off a floor.  More effective are exercises that work the muscles through longer ranges of motion, against gravity, in more functional positions, such as standing or sitting.  Motion in all planes around a central axis will assure development of all the abdominal muscles as well as the accessory muscles.   The best way to exercise the abdominal muscles is to combine simple single or multiple plane exercises during your normal routine.  You can do the crunches on a stability ball increasing your range of motion beyond that possible on the floor, but you must be aware of your body form!  Then changing your plane of motion, and performing a torso twist will also work the obliques (as well as a few leg muscles).   

     Simple side bending can be done with or without weights (free weights, or at a cable apparatus) to work the internal and external oblique muscles. 

You can use a cable apparatus to perform the torso twist move as well.  There are benefits to varying the way you work the muscles since in life you use the muscles for so many different functions (for motion and for stability). 

     The list of existing known abdominal exercises is long, and most are reasonably effective.  The key is performing any exercise correctly.  Most people do not use their abdominal muscles as well as they should when doing crunches or other “abdominal” exercises, wasting a lot of time and energy and sometimes doing some real harm.  You have to learn to use the muscle you are targeting in isolation when you exercise (when you are weight or strength training, anyway).  This is extremely important when targeting the abdominal muscles.  Otherwise you use the neck, back or legs instead.  If you are unsure if you can isolate your abdominal muscles during a crunch try this exercise.  I call it “Belly, Butt, Back of the Legs” (it is my own creation and could use a better name, I know).  The starting position has you lying on the floor, knees bent, feet flat on the floor with arms at your side.  Take a deep breath, and as you exhale, squeeze your belly, and only your belly sucking it in as deeply as you can toward the floor (nothing else moves), then relax.  Next take a deep breath and as you exhale, contract your buttocks, as tightly as you can (but nothing else moves-keep your legs and belly soft) and then relax.  Finally take another deep breath, and as you exhale, contract the back of the legs (the hamstrings, keeping the buttocks and belly soft) and then relax.  This usually takes some practice, if you have never thought about using these body parts in isolation before.  And if you are having a hard time doing this, you are probably contracting both the buttocks and the back of the legs every time you do a crunch, and this is wrong.  And, you are also probably using the low back muscles for part if not most of the motion of your crunch.    If you are, this would mean that for every crunch you do, you are working your abdominal muscles a lot less than 50% of your effort.    Ok, I am making a lot of presumptions here but this is a general statement and I get no individual feedback through this venue, but I think you get the point I am making?! 

           When starting a crunch, or any abdominal exercise from a supine position (lying on your back), you should start by first inhaling, and as you exhale, before you move anything, start contracting the abdomen.          

                Once the abdominal muscles have begun to contract (we in “the biz” refer to this as the muscles being engaged) start moving. In the case of a crunch, the head, neck, shoulders and upper trunk should all fold up off the floor in one piece.  Yes, I said fold, not roll.  The motion is a simple lift upwards.  Okay, I think I have exhausted the crunch in words.  Need anything more and I will just have to show you.  There is more to know but I cannot imagine you wish to read anything more on this subject right now. Come back again!

     

Rolling Along

          Nearly every athletic training room and most physical therapy facilities contain an array foam rollers of different lengths and consistencies.  These serve as tools for hands-on soft tissue care as part of massage therapy in caring for injury.  Techniques like massage, Muscle Activation (MAT), and Active Release Therapy (ART) can work wonders for sore or injured patients.  The foam roller enables one to self treat, manipulating soft tissue yourself in ways a therapist might.  A foam roller is simply a cylindrical piece of extruded hard-celled foam.  They usually come in one-foot or three-foot lengths.  They are also now available in a number of densities from relatively soft foam, to newer high-density rollers that feel much more solid.  The denser the user, the more dense the roller should be.  Large, heavily-muscled users will do better with a very high density roller whereas a smaller, younger user should begin with a less dense product. 



Basic foam roll



The application techniques are simple.  Pressure can be applied to tender areas.  Or the user can roll the injured area over the roller in a sweeping stroke for a massage effect.  The sweeping stroke can act to stretch the soft tissue.  Users are instructed to let the roller search for tender areas or trigger points and to roll these areas to decrease density and over-activity of the muscle (cramping).  Most users, however, require instruction on where to find the tender spots and on the positioning of the roller, such as parallel, perpendicular, or 45 degree angles, depending on the muscle.  There is no universal agreement on when to roll, how often to roll, or how long to roll, but generally, techniques are used both before and after exercise.  Foam rolling prior to exercise can help decrease muscle cramping and promote a better warm-up.  Rolling after exercise may help muscles recover from strenuous exercise.   Foam rolling is hard work that can border on being painful.  It is important that one learn to distinguish between a moderate level of discomfort related to working a trigger point and a discomfort that can lead to tissue injury.  When someone has completed foam rolling, he or she should feel better, not worse.  Rollers should never cause bruising.  Massage therapy remains a better therapeutic option but foam rollers do offer a cost effective alternative.  If you do not have the strength to manipulate your full body weight over a foam roll, consider other manual tools like “The Stick” or “Body Balls”.  These offer the same myofascial release with much less exertion.   Foam rollers can be a very useful tool specifically when treating the spine instead of the soft tissue.   One can achieve gentle spine segmental mobilization by rolling over a medium density roll with no significant adverse effects and good benefits.

Good use - simple spine mobilization

The Dancer's Injury

     Technically, by definition, we recognize Art as the quality, production, expression, or realm, according to aesthetic principles, of what is beautiful, appealing, or of more than ordinary significance¹ , and Sport as an athletic activity requiring skill or physical prowess and often of a competitive nature¹.  Artists and athletes are viewed as being from two distinct subspecies.  Today Dancers perform and compete quite regularly so that boundary between artist and athlete has distinctly blurred.  Professional dancers get hurt just as often and suffer just as serious injuries as athletes in contact sports.  The practices, so often segregate, as performing arts medicine or sports medicine must coalesce when considering a dancer’s care.    For the last twenty years a special group of dedicated clinicians have worked targeting the special needs of the performing artist (See PAMA - Performing Arts Medical Association).

 What is it really that makes the dancer prone to injury?  Their bodies are conditioned so perfectly to their craft.  Their endurance is profound.    In part it is the need for repetition, the essential mandatory rehearsal of a set of moves performed until the sequence flows from their bodies without requiring thought.  Simultaneously they concentrate on sequence as well as form and music not to mention expression though this is more a feeling than a thought but still, it is part of the dancer’s awareness as they move.  Each element contributes to the motion they produce, to the energy being transferred through the trunk and limb and this is what a dancer must master.  It is so common to hear them say “it was silly really, how I hurt myself” and one will almost always be able to trace a dancer’s injury to a moment of distraction.  The moves themselves are obvious.  The injuries themselves fairly predictable. 

     The statistics do not seem to change over time.  A dancer sprains ligaments and strains muscles. Partners will see disc injuries and more traumatic ligament and muscular damage.   Degenerative changes will plague older dancers, with joint diseases affecting the spine, ankles, knees, hips, feet and shoulders.  In approximately this order one sees clicking hips, hallux valgus (bunion), patella disorders,  stress fractures, scoliosis, coxarthrosis, and spondylolysis as the usual leaders. Competent clinicians know how to treat these.  The trick is realizing that successful treatment of a dancer requires acknowledging more than just the injury as part of the problem to be overcome.  The successful treatment of a dancer involves artful negotiation between the clinician and patient, compromise that will allow adequate healing as well as continuation of their performance.

1.       Dictionary.Com

Workout Basics

     The potential variations are endless, but here are the underlying principles.

Aerobic exercise increases metabolic rate, burns fat and improves cardiac function.

Anaerobic exercise pushes beyond pure aerobics increasing metabolic rate, building endurance, enhancing power and further improving cardiac health (in those who are healthy enough to tolerate this).

    When one performs aerobic exercise for up to about 30 minutes, one taps into purely aerobic mechanisms (as a generalization).  Beyond the 30 minutes one starts tapping into anaerobic metabolism which is a more efficient calorie burner.

Weight training: as a topic can be overwhelming. In an oversimplified summary:

 Lower weight/more repetition:  builds some muscle, builds endurance, burns calories to a lesser degree, increases muscle metabolism.

 Higher weight/few repetition: builds muscle, builds strength, builds power, ultimately enhances the long term metabolic rate.

          Aerobic sessions should be at least 30 minutes long, but 45 – 60 minutes will allow one to accomplish more.

          Weight training sessions should include enough work to fatigue at least 4 major muscle groups.

          You can combine aerobics and weight training through calisthenics…. Call these mixed sessions.  I call them boot camp exercises.

          Abdominal strengthening should be viewed as its own category and should (my opinion) done at every workout.

Aerobic workouts should be vigorous enough to get the heartrate up to at least 130 and no more than 160 for 25 minutes or longer.  You get more cardiac and metabolic benefit from an aerobic workout if the intensity is varied throughout the session (It also makes them less boring). Straining for a few minutes at a higher intensity makes a lower level exertion seem easier.  In this way a medium intensity that seemed hard, done after a few minutes of a really hard exertion, now seems easier…. You end up tolerating a higher average intensity by the end of the session.  Not a bad way to progress your workouts. 

Aerobics:  At least three sessions a week, though 4 – 5 are the ultimate goal.

Walking: Walk for 30 minutes at a medium pace (2.5 miles/hour).

          When this gets too easy, add two to five minute intervals of walking as fast as you can.  Once you can do 3 five minute intervals at a speed pace in a 30 minute walk, increase the length of the walk.  You can also use three levels of intensity, in the same way ( for example: 3 minutes warm up, slow pace, 5 minutes medium pace, 2  minutes fast pace, 3 minutes medium pace, 2 minutes slow pace, 5 minutes fast pace 3 minutes medium pace, 2 minutes slow pace).

          A 30 minute speed walk with no slow intervals is a good “medium to hard” aerobic workout when you don’t have a lot of time.  This would be a session where you do not vary the intensity, but keep it high the whole time, but for a shorter workout time.  This is a good thing to do at least once a week.  When 30 minutes at your highest intensity gets too easy, you’ll need to find something to do that is harder than walking ( ie run, bike, swim or join a gym to have access to other aerobic equipment)

For any other type of aerobic workout, the same system of varying intensity can be applied.

Add calisthenics to a walk:  Add 30 second to 2 minute intervals of lunging steps, or broad jumps or skips.  Walk backwards for segments, jog, or sprint.

An excellent way to build functional power and endurance is to interrupt an aerobic walk with 2-3 minutes of abdominal crunches, pushups, or other stationary calisthenics.

Just Breath

Take a deep breath.  Are you sure you did the best you could?  You should be standing or sitting with good posture while you do it.  So, back straight, head on top of your body, shoulders back, pelvis in neutral, stomach in, knees soft and fingers and toes relaxed.  Now for some of you this is a delicious position of release and for other, TORTURE.  The latter group should read on. 

      The body prefers a neutral posture like the one I just described.  And when you start any breath or movement from that position you will find it so much easier.  But for now the goal is just to breath. 

      First, tackle the back.  Make yourself as tall or long as you can be, reaching up toward the ceiling and down toward the floor at the same time with the opposite ends of your spine.   Once you are convinced you cannot stretch any taller or longer release the tension without losing any of the length.  In doing this you probably bent your head forward so please replace it back on top of the shoulders.  And the shoulders, notice that with the head now neatly on top of the neck, you can easily see both of them in your peripheral vision?  Well this is wrong.  You see them because they are in front of you, and their place is at the side almost aligned with each ear (almost but not quite that far back).  You will want to “roll” the shoulders slightly (we call this direction outward, and when I say we I mean the <cough> experts - doctors, therapist, trainers, dancers, movement specialists etc).

If you are having trouble rolling the shoulders, here is a tip: first straighten both arms in front of you as if you were about to imitate a zombie walk, then bend them both at the elbows (your elbows should be touching your sides).  Turn the forearms so that the palms are turned up without moving the elbow.  Now again, without moving the elbows, move the hands, right to the right, left to the left, to the sides of your body in a horizontal motion.  Voila, this rotated the shoulders.

     Top done, here comes the trickier parts.   Without formal dance training, many people have issues with the concept of pelvic neutral.  Forget everything else for a minute and focus just on your hips.    Standing is probably preferred here but you can do this seated.  To find your neutral pelvic position, arch your back as hard as you can pushing your hips backwards (do not move your head or your feet) and then relax.  Next, curl your hips under you, pushing them forwards as far as you can, again without moving your head or your feet and then relax.  Do this a few times.  That place that the hips comes to rest every time?  That is your “pelvic neutral” position.  Tadah!  With a little practice you learn what that position feels like and you just know when you are in it.  It becomes easy to assume “the position”. 

        Stomachs prove another trouble area for many, compromising so many simple motions unnecessarily.   Dancers brace and this is a worthwhile trick everyone should learn.  To brace you pull the stomach in as you inhale (nice deep breath).    As you exhale, let the air out but keep the stomach in (keep the muscles contracted, the stomach flat).  I know, yet another thing that will require some practice but well worth it.  Practice moving around after bracing and eventually you will find it quite simple.

The term “knees soft” refers to knees held in a position slightly bent so that there is no tension in the legs at all.  If you try standing on fully straight knees and then bend then just slightly you will see the difference.    When isolated a straight knee does no work, but in conjunction with a braced abdomen, a neutral pelvis, a straight back etc, etc more work is needed to keep the legs completely straight, and so a correct posture requires soft knees.

      Finally. We must not forget, after all this work, that our endpoints, the fingers and toes should not be gripping at those last bits of tension we subconsciously cling to, so always take a second to remember to relax the fingers and toes.

      

Now, you have your posture and can take a breath.  Inhale through the nose.  Take a nice forceful breath of air that fills your lungs.  Your chest should move and should lift your arms a bit.  Your spine will feel as if it gets a little longer. When you cannot comfortably take in any more air, pause for a second and then with an even flow of air, exhale through your mouth.   Do not be afraid to purse your lips slightly.  Feel your shoulders slope downwards as you exhale.  Your arms lower and your hips sink slightly.  If you have done this all correctly you may even feel your body sway slightly.   That makes sense.  If you fill something with air, it gets lighter, right?

      

         Good Luck!

      

The Neck Pain Saga –Part 1 – The Trapezius

    The trapezius muscle originates at the base of the skull as well as from a thick ligament (ligamentum nuchae) that arises from the neck vertebrae and from the spinous processes of thoracic vertebrae.  It is a large muscle that is theoretically divided into three parts because its fibers lie in three directions and move differently.  The upper portion’s fibers insert on the lateral (outer) third of the clavicle.  The middle portion’s fibers insert on the acromion process (outer top portion) of the scapula.  The lower portion’s fibers insert on the spine of the scapula.  The upper trapezius (traps) works to elevate the scapula (shrug the shoulders upwards).  The middle fibers of the traps retract the shoulder blades (pull the shoulder blades back and together).  The lower fibers of the traps depress the scapula.   These actions set the shoulders in their proper position. In their proper position, the shoulder blades (the scapulae) form a support like a cup to cradle the head on top of the body.  So it is the trapezius muscle that forms this support meant to hold the head in an erect posture.  When we thrust our head forward we render the trapezius fairly useless of this major duty.   With our head forward, we use the muscles of the neck to support the head instead, dangling it in front of our shoulders.  These neck muscles are not meant to work this way.  Their fibers are aligned in other directions so that their optimal forces pull down toward our shoulders and chest not to push upwards toward our head.  When we use the muscles improperly, they fatigue, and even become damaged and this is the source of so much neck muscle pain and pathology commonly seen.  To correct, or better, avoid developing unhealthy posture and neck pain, one should maintain a healthy trapezius muscle.  Attention must be devoted to all three portions of the muscle.  Shoulder shrugs are a common exercise, well known to most that will exercise the upper traps.  Reverse flys are an example of an exercise that strengthen the middle trapezius though care must be taken to elevate the arms in a “Y” pattern and not simply extend them behind them horizontally because this will emphasize working the rhomboid muscle.  It is harder to find examples of exercises to strengthen the lower traps.   There is an excellent example pictured on the website :(http://www.staceyjaffmd.com/trunkwork.html) Standing with knees bent, slightly flexed at the waist with a straight back, keeping both arms straight, you hold a single weight in both hands and then raise and lower the weight for 12- 16 repetitions.  In the exercise pictured a simultaneous squat is performed to maximize the work accomplished.  There are other trapezius exercises as well, these are just examples. 

      With a strong, healthy trapezius you set yourself straight, literally, correcting, at least, one plane of your posture.