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Journey from Skin and Muscle to Brain - Sravani Mehta, MD

The brain essentially started as an outer layer on you when you were just a ball of cells, it eventually folded inward, leaving your developing skin layer on the outside, forming the foundation for a close relationship from the beginning. No wonder the skin and brain share such close personal ties, and can act like one another in a lot of ways. Now that I have your attention...

After finishing medical school, I took a detour into studying basic anatomy and pursued my interest in understanding body connections. This ultimately led me to my field and area of specialty - Brain Injury and Stroke. My field, Physical Medicine & Rehabilitation or Physiatry, deals with recovery after an injury to one's fullest potential. By the time I was close to finishing up my residency training in this field, I had gone through multiple anatomy courses and I had gone to seminars and conferences but I was still not satisfied with my knowledge of the recovery process in the human body. I knew all the muscles, where they started and ended, and how they worked but I still felt like I was missing something.

While I was in the final year of my Physiatry residency in Upstate New York, I observed that the same musculoskeletal pain or musculoskeletal dysfunction was being dealt with in different ways, depending on whom the patient consulted. I also noticed that most of the treatment options that we were offering to the patients did not get to the bottom of what was happening. Not only did I have a personal experience with this (read my story here), this was an all-too-common situation that I would see in my clinic as a trainee.

We would see many patients with history of shoulder, wrist or hand pain, may be from prior trauma, sports injury, lifting something heavy, repetitive wear and tear from their job or hobby which now presented as a barrier to doing what they had to do. The patient often reported muscle weakness and difficulty performing a task.

They may have noticed the pain develop suddenly or gradually. Often it was difficult to describe for the patients, sometimes it felt like a muscle pull, sometimes it was sharp, at other times it is dull. This presented a challenge for us to diagnose because these kinds of complaints didn't neatly fall into a treatment algorithm.

My line of questioning led me to understand that folks who had hand, elbow or shoulder injuries often also had neck pain or discomfort, and occasional headaches. They were stressed and often complained of low energy levels. By the time they got to see us, they had already had multiple rounds of blood work, various testing, expensive imaging, and had already started on multiple prescription pills including antidepressants which they did not feel really helped them or they experienced side effects.

I started seeing a pattern and I wanted to know more. The shoulder is connected to the neck which is connected to the head. Well that makes a lot of sense because they are close in space. But why was pain influencing energy levels and mood especially if the pain was somewhere far away like the foot.

Could these be connected even though they are so far apart? How can they possible influence one another? What could it be that connects these two remote structures? Well, I found out by reviewing countless anatomical texts and electrophysiological studies that they were very well connected, in fact in two ways – fascia and nerves. It was the common factor between all of our various body parts - Skin to nerves, muscle to nerves. Yes the white netty stuff.

Fascia.

It was described by Burns in the early 1800s. Modern textbooks of anatomy and surgery discuss this tissue of our body very briefly and often inaccurately due to discrepancies in observation, no description of fixed pattern and inherent difficulties in dissection of these structures.

It is rich in collagen and elastin. It connects organs to muscle to bone to cartilage to spine to nerves, surrounds all of our insides and underpins skin. It is sometimes in duplicate or even triplicate layers. It is everywhere in the body and it is extremely strong. So strong that in the 1800s, tennis strings were made from the fascia of cows.

Fascia is impenetrable to almost all biological substances, everything slides down it: water, air, blood, pus. The whole of fascia is one large net that is continuous - a sheath that works like a sleeve or stocking to bind together the organs. It helps to divide the body into compartments but also connects them.

By virtue of its composition mostly collagen and elastin, it is an electrical conductor and resistor but it also generates its own electricity. Piezoelectricity is when mechanical pressure on a solid is converted to an electric charge. This is not possible with all solids, it is only seen with asymmetric solids such as crystals, ceramics, and biological matter such as bone, collagen, DNA, even wood & silk fibers.

Everyday uses of piezoelectricity include cigarette lighters, quartz watches – where it is used in a reverse manner: the electricity produces small frequent vibrations. The same process is working in our body all the time. In our bone, collagen has crystals in it that allow it to generate small charges. We know that it is the orientation of the collagen fibers that allows to stimulate bone growth. Tiny electrical currents produced by deformation of collagen stimulate the bone cells called osteoblasts to lay down collagen in that direction.

For instance, when you land from a jump the bones in your leg subtly flex to absorb the shock, this flex is felt right away through the the most stressful flexible part of the bone in which the collagen fibers will also deform the most. So, they produce the most electrical charge relative to the surrounding areas this charge will then be detected by the bone cells which will start laying down new collagen fibers. As a result of this, the bone in this area gets harder and less flexible - the bone is stronger exactly where it needs to be. Even as you shift weight from one side to another in your seats, we are producing tiny little electrical charges that helps to maintain bone's metabolic activity. Amazing!

The science of this is still poorly understood but what it definitely known is that collagen produces electricity and it is this electricity that guides growth, strengthening and healing in many tissues. Collagen in triple helix and has been shown to conduct electricity similar to nerves but not as intensely.

So, we have several types of tissues connected to the nerves which connect to the brain, our control center. The best evidence of these connections comes from the world's most common complaint – pain – a problem that 1.5 billion people are afflicted with – even that is only 1/3 of all type of pain. In any painful condition, memory traces are created both at the level of the spinal cord and in the brain is the final dynamic perceptual product of higher cortical processing. Similar to the early years of nuclear physics, though there is no direct evidence, we have many pieces of the puzzle to point at what may or may not be happening.

Similar to the complexity of the energy contained in the nucleus of an atom, the number and various type of connections between neural pathways in our body have been infinitely difficult to define, which are often driven by our experiences - early learning and injury/recovery cycles. Western conventional medicine struggles to understand Chinese medicine's idea of channels in the body, while inadvertently using the same exact system in their descriptions of anatomy and surgery. Countless bodies have been dissected, probed, dyed, irradiated and cooled by anatomist and they have found nothing. This lack of objective evidence of the meridians has been used as a powerful tool to dismiss their existence.

What I've understood thus far is that the nervous system has multiple different checkpoints in the spinal cord and also a discrete area in the brain called the thalamus which is like the secretary of the nervous system. Whether the message gets to see the cerebral cortex interestingly the same reason why smells can be so evocative! Smell is the only sense that bypasses the secretary and has direct access to the boss - your consciousness.

After a signal reaches consciousness, it becomes involved in initiation of complex behavioral responses, and different interpretations of our sensory experiences. I have utilized this connection many times in clinical situations to control issues such as nausea or hiccups where patients are not able to tolerate the side effects of heavy duty medications.

Similarly, physical activity, controlled breathing, acupuncture, therapeutic touch, etc may have the potential to access the nervous system in a way a medication may not be able to.

In this blog post, this is what I've done so far:

  • I've started off looking at the body's connective tissue - fascia that wraps and joins or entire body which is in effect an interconnected living electrical web that is capable of acting as a conductor and a resistor.
  • I have also looked at how the brain is able to sense changes in peripheral tissue and how this may be able to influence neurologic activity.
  • I have also emphasized that there is not a straightforward scientific explanation to how the body is connected or justify how the system might work.

As a physiatrist, I see patients with a wide range of diagnoses, define patient groups by presentation rather than diagnosis. My experience treating brain injury has allowed me to learn a great deal from my patients and thus, recommend appropriate interventions to treat many different types of conditions, not just brain injuries, but also aid in the prevention of illnesses and disability, particularly that associated with aging. SO much of this has to do with the doctor and what they take upon themselves to investigate and I feel that it is my passion to bring things to light especially if it is an issue that is important to the person.

Sravani Mehta, MD practices medicine in Nashville, TN at Brain & Stroke Care. focuses on Brain Health in Aging, Brain Injury & Stroke.

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