Dear Editor, 7/1/2006
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This is in response to Dale G. Alexander’s article in Massage
today magazine "The Phrenic Circuit" June 2006. I would prefer a warning label on
all articles from smart kind gentleman such as Dr Dale Alexander. Dr. Alexander
exudes a trustworthiness, which other less experienced therapists may accept as
truth. The article suggests certainty when there is none and proclaims theory
without telling us. My concern simply put is that although peoples thinking may
very well create headache and heartache (actually shoulder and neck pain) we
cannot be certain of this. The warning label would read as follows; Avoid
telling clients that their adhesive Capsulitis is caused by their dark moods.
Avoid assuming the role of psychotherapist without losing our role as a coach
for a positive outlook. Well meaning therapists armed with Dr. Alexander’s kind
assurances may want to help clients think more positively. This is got to be
part of what comes naturally to most of us nurturers. Certainly all of us have
reminded our clients gently and lovingly how thoughts can make them sick. Most clients would agree. Many clients with a little gentle prodding
are on the road to health. We may want to exercise caution with clients who
don’t respond to simple suggestion. There are a number of personality/thought
disorders or worse that require professional psychotherapy. However we are
massage therapists not psychotherapists. Know when to refer to a competent
professional. This can be a slippery slope indeed. I’m quite sure Dr. Alexander
would not recommend massage therapists start practicing cognitive psychotherapy
with techniques like thought stopping and cognitive restructuring added while
doing a soothing effleurage down the back.
Dr. Alexander’s theory that the
phrenic nerve transmits psychological stress to constrict the sacs & tubes within the viscera is neurologically
impossible. The Phrenic nerve supplies motor filaments (the part of the nerve
that constricts) to only the diaphragm muscle (helps us breathe better by
increasing chest cavity volume). Therefore the phrenic nerve cannot constrict
the organs within the chest cavity and beyond (Heart, Lungs, Liver, Gall
Bladder, Pancreas, ect.) There are extensive phrenic sensory nerve fibers (the
part of the nerve that receives information but does not constrict) to some of
these organs. The sensory fibers of the phrenic nerve supply structures, which
are related to increased exertion e.g. the heart, large veins, membranes in the
chest (Mediastinum), heart valves, abdominal membranes attached to the
diaphragm, ligaments which are attached to the diaphragm, and endocrine glands,
which give us the energy for exertion. The motor portion of the phrenic nerve probably
forms a reflex arc (sensory nerves paired with motor nerve in spinal
cord=patellar reflex=knee jerk) with the sensory nerves coming from the
aforementioned structures. This gives more juice to the diaphragm (to increase
O2 delivery) during intense aerobic activity. If the heart is pumping away
because we are on the last 100 yards of a killer marathon this feedback loop is
just what the doctor ordered. The phrenic nerves sensory fibers become excited
by all of the activity of the heart, lungs, ect thus exciting the phrenic motor
nerve, which increases contraction of the diaphragm to deliver that last burst
of energy as we cross the finish line.
Another theory proposed by Dr.
Alexander is that many of these “phrenic
relationships are associated in most upper extremity dysfunction and pain
syndromes” with the phrenic nerve transmitting psychological stress which then
constricts the sacs & tubes within the viscera. As a result of the this
constriction the phrenic nerve may be at least in part responsible, says Dr.
Alexander, for a host of orthopedic problems; Cervical dysfunction/pain, frozen
shoulder, encapsulitis, chronic rotator cuff problems, radicular symptoms (pain
and numbness) into the arm, elbow, wrist, hand and fingers. Although the
phrenic nerve cannot constrict sacs and tubes, as aforementioned, the sensory
portion of the nerve does refer pain to a number of the structures mentioned by
Dr. Alexander. For example heart disease (angina pectoris) may be felt in the
chest and or down the left arm. Liver or Gall bladder problems near the
diaphragm may be felt in the right shoulder. Pain in the shoulder or down the
arm from irritated visceral structures does not constitute prima facie evidence
for phrenic nerve transmission of psychological stress nor does it necessarily
imply a role in more complex orthopedic, muscular and or skeletal problems.
There is no doubt a connection between our ever-busy minds
and the kaleidoscope of emotions we generate and the sometimes deep-felt
heartache, which really does ache in our chest. That connection is probably
more nuanced and complex than Dr. Alexander surmised.
Ted Nissen M.A. M.T.
Long Beach California
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