Rehabilitation VS inhibition of symptoms
This post discusses Boris’ article
MANAGEMENT OF POST-CONCUSSION SYMPTOMS AND POST-TRAUMATIC ENCEPHALOPATHY WITH MEDICAL MASSAGE. PART II
Thus, prior to proceeding further, we recommend you to read the article by clicking at the link above.
For approximately the last seven years, the interest of my practice shifted to post-concussion rehabilitation. I am glad and proud to report that in most of those cases I succeeded. Appropriately utilizing methods of post-concussion medical massage a practitioner could achieve sustainable results. Today it became evident by observing hundreds of post-concussion cases.
I used words rehabilitation rather than inhibition of symptoms because one should not view inhibition of symptoms as a successful result of the therapy; especially when the goal of the therapy is in the prevention of brain dysfunction developments, such as dementia, movement disorders, etc.
If you read my article, you might notice that I am stressing irregularity of autonomic activities, as a biomarker to diagnose concussions/brain dysfunction, as well as objectivity marker in assessing rehabilitation. As you understood from my article, in order to achieve a complete post-concussion rehabilitation, one must follow a specifically designed step-by-step medical massage protocol.
As you know from your own experience when you massively seeing patients who are suffering from specific disorders, in some cases, we are facing difficulties achieving sustained results. In certain cases, the same diagnostics and the same 100% of your involvement do not produce sustainable results.
Here in the greater Los Angeles area, we have numerous outpatients post-concussion rehab centers, that deal with patients suffering from very difficult post brain trauma encephalopathies, as well as rehabilitating brain dysfunctions not related to brain trauma. I have very good working relations with these professionals. One of these centers referred me to a 49-year-old patient, whose case I will discuss below.
Do migraines lead to the development of encephalopathies?
Four years ago, one of the rehab centers mentioned above invited me to have a talk on post-concussion rehabilitative Medical Massage. Among the people who attended my presentation were two neurologists, three physicians, board-certified in physical medicine, four DPTs, three PhDs neuroscientists, numerous clinical psychologists, social workers, and five occupational therapists. They used a multidisciplinary approach in their rehabilitation. I felt that my presentation has awakened a real interest in these professionals.
One young occupational therapist asked me if this the post-concussion protocol would work for migraine cases, especially on patients that demonstrate brain dysfunction.
This question has really struck my attention. It took a short while of pondering, after which I started presenting/speculating, why the protocol must work in cases of severe migraine headaches.
I always knew, but never acknowledged it to myself that migraines are an inflammatory condition. It made no difference whether brain trauma triggered an inflammatory response, or, like in most cases of migraines, blood vessels dilate, allowing fluid leaking into sapace, in some cases including white blood cells leak. This leakage was supposed to trigger an immediate increase of cerebral spinal fluid secretion, the increase in intracranial pressure, the decrease of blood perfusion to the brain, etc.
Today, after successfully treating many patients suffering from long time migraines, including demonstration of brain dysfunction, I can claim with the certainty that migraine headaches and further encephalopathy develop is a result of the same inflammatory chain reaction. Chronic migraines can possibly lead to brain dysfunction in the same way as post-brain trauma does. At this point, I would like to refer you to my article to read about a chain of posttraumatic inflammatory events.
Since my presentation 4 years ago, many patients with difficult poorly manageable migraines were referred to me, including those with obvious symptoms of brain dysfunction. In most cases, applying post-concussion protocols, I was achieving sustainable results. My claim of sustainable results is based on many months of observations after discharged patients. Equally important was the fact that a Dermographism test showed a normal functioning of the brain. The treatments lead to a restoration of normal blood perfusion to the brain that in turn restored the normal brain function and reflected in the elimination of autonomic irregularity.
Now let’s discuss the case presentation about the 49-year-old patient, who suffered from severe migraines. He, practically, became disabled. During 4 years prior to receiving my treatment, he couldn’t sleep, drive, work, or function. He was confused, experienced the loss of memory and suffered from other cognitive dysfunctions. He never sustained head trauma.
The dermographism test is a reliable test allowing to assess autonomic activities. In this case, as I have suspected, it suggested significant autonomic irregularities. I saw this patient twice a week. After the fourth treatment, he started exhibiting clinical improvement such as he could fall asleep and didn’t wake up every hour and a half. His memory improved, he appeared more alert and experienced less disorientation. From my experience of repeatedly performing dermographism tests, after five treatments, I usually observe less severe autonomic irregularity, such as white dermographism sustained for a shorter period of time, and when it changes to red dermographism, less edema, etc…
In the current case, after providing seven treatments, the patient exhibited obvious objective improvements, such as an increase in range of motion in the neck area. In addition, the subjective report by the patient was excellent. Yet, the dermographism test was positive, suggesting autonomic irregularity.
I couldn’t understand what I was not doing enough to move toward sustainable results. When fighting encephalopathies, autonomic irregularity is a biomarker of brain dysfunction, and if a therapist not achieving some balance in autonomic activities, temporary improvements mean nothing. It would only be a question of time, when a patient would develop dementia, psychiatric behavioral disorders, chronic headaches, movement disorders, etc. if not treated adequately, it could lead to degenerative brain diseases, etc.
I have provided ten treatments for this patient and witnessed an excellent symptomatic improvement. Yet, dermographism test suggesting less severe, but still autonomic irregularities. From many previous experiences, at this stage of the treatment, the results should have already been different.
The full-body medical massage is the most powerful methodology to balance sympathetic- parasympathetic activities, but only in case of adequate blood supply to the brain.
For two weeks (three times a week), I decided to provide medical full body massage treatment. Not much has changed. The dermographism test was still showing an autonomic irregularity. I started thinking about it and analyzing it. For me, it was obvious, that something was fueling an inflammatory response. I talked to a referring neurologist. He suggested that it was possible that some viral infection was involved, or maybe the patient needed more time as he improved tremendously. “Give him more time,” he said. I wasn’t convinced.
Referring to my article, where I am discussing Manchurian acupressure. This is how Professor Dembo, explained his decision to include these techniques into the post-concussion protocol: ”Somehow this Oriental method of massage, affecting positive autonomic activities. It is unexplainable but this is a clinical fact. Not to include these techniques into the protocol would be a mistake.”
If you would carefully review positions of my hands during the performance of Manchurian acupressure techniques, you‘d see considerable stimulation of skull muscles. Please also pay attention to the proposed by Dr.Turchaninov head compression. These techniques are not a part of the original protocol. Dr.Ross suggested including them as additional techniques. Prior to agreeing, I tried including the head compression techniques for a certain group of patients, while continuing treating the rest of the patients with the original protocol. Many patients reported pleasant experience at the time of compression, and in my article, I decided to include compression techniques. After all, in no case, it could cause harm but could be a significant positive influence.
With time, in my regular practice, however, because head compressions are quite a time consuming, I excluded them.
When searching my mind, on what could be fueling an ongoing inflammatory response, I suddenly remembered how a long time ago I had a private discussion with Dr. Ross, on tension VS migraine headaches. I remembered him expressing a belief that most migraines headaches are the result of neglected, not adequately treated tension headaches. Suddenly, I clearly remembered him speaking that tension within skull muscles also leads to vasoconstrictions of extra-cranial blood vessels, while intracranial blood vessels reacting first by constriction and then significant intracranial vasodilation.
This was my Eureka moment. I couldn’t wait to see my patient again. The following three treatments, I spend on performing massage on neck, upper back, Manchurian acupressure, Ross’ head compression, and different massage techniques on head/scull muscles, fascia, and periosteum. In one week the dermographism test evidently supported the significant improvement of autonomic activities. The subjective patient’s report was also very good. In total, I have provided him with eighteen treatments. It’s already four months since I discharged him. He is back to normal life working as a mechanical engineer, driving, sleeping well. Hallelujah. Every two weeks he is coming to me for a maintenance treatment. What a privilege is it to be able to make a difference in human life, by providing side effects free massage.
I would be wrong not to mention an occupational therapist, who simply connected post-head-traumatic inflammatory response, brain dysfunction, and inflammatory response to migraines headaches. I mean, for some reason, I could not connect post-concussion protocol being 100% effective in migraine headaches. She asked me “Why wouldn’t post-concussion protocol be effective in the same inflammatory response but triggered by different factors?” She was 100% correct.
What did it take? Broader and simpler thinking. In my opinion, we all have to try developing habits of these practical clinical oriented simple thinking. Four years ago, at the presentation, the same occupational therapist asked me, what, in my opinion, was the factor that in difficult cases of migraines headaches, triggered inflammatory response? At that time, I couldn’t offer anything, but a possible infection.
Today, after evaluating and treating many migraine headaches patients, I can claim that in most cases, the sources of migraine headaches are emotional stress, a static position on the front of the computer or smartphones for many hours, resulting in a significant tension buildup in muscles and fascia in the neck and upper back area.
This tension actually it’s muscles becoming shorter and wider, not only compromises nerves and triggers tension headaches but also obstructs the drainage of cerebral spinal fluid, creates intracranial pressure and insufficient blood supply to the brain. In addition, it initiates the increase of cerebral spinal fluid secretions, immediate intracranial vasodilation, etc.
In other words, it is indicative of a well-known vicious cycle, the almost identical reaction to brain trauma. The sequence of developments is different, but in the end, it is the same condition. That is why the post-concussion protocol works so well in difficult cases of migraine headaches.
From the neurological perspective, a concussion is a head injury that causes brain trauma, triggering an inflammatory response. As I stated in the article, the injury demands an increase in the blood supply, while the actual supply shrinks.
Due to the decrease in blood supply to the brain, cells are in the mode that is called “stunned brain” or “hibernating brain cells.” These terms describe the state when some brain cells go into hibernation, i.e. metabolism decreased to minimal consumption of blood in order to allow other neighboring cells to have enough blood supply to survive. Again, the main reason for hibernation phenomena is an immediate decrease in blood supply to the brain, due to an abrupt increase of cerebral spinal fluid secretion and an increase in intracranial pressure. The purpose of hibernation is a decrease in cellular function to the point when fewer resources of blood supply, such as oxygen, glucose is required for some cell function thus allowing the neighboring cells a chance to survive.
It is crucial to understand that during hibernation brain cells don’t die. Moreover, in most cases, hibernation is a reversible process. However, in many concussion cases and, especially, in cases of repeated concussions, if left untreated, this resurrection could never happen and people who suffered concussions could develop movement disorders, psychiatric behavioral disorders, chronic headaches, dementia, etc.
As stated above, the hibernation is an initiation of a degenerative change that is reversible. However, the only way to prevent reliably neurons from going into permanent degeneration is to increase cerebral circulation. Remember … some brain cells go into hibernation, because of the decreased amount of blood supply.
The same phenomenon happens in severe cases of migraine headaches. Restoring adequate blood supply to the brain, not only eliminates severe headaches but also prevents brain degeneration, dementia, Alzheimer’s, foggy brain, and more. All techniques in the proposed protocol help restoration of normal perfusion of blood.