Muscle Splinting Psychology & Foot Keystones

An Impetus to Psychological Splinting:
Muscle splinting is a phenomenon where the body will try and protect itself by causing certain muscles to become hypertonic or stiff in order to help protect underlying visceral or somatic tissue.  A couple examples that come to mind would be in the case of appendicitis or whiplash.

Considering appendicitis, when a doctor performs an abdominal exam they will palpate and percuss four quadrants of the abdominal region, in the lower right quadrant is an area known as McBurney’s point which is about 1/2 way between the umbilicus and anterior superior iliac spine (ASIS) or about 2/3rds of the way down for doctors practicing in Europe.  The muscles superficial to the appendix will tighten up to help protect an inflamed appendix and this point will cause pain when palpated in a pt with appendicitis.

McBurney's Point

McBurney’s Point

A similar mechanism takes place in a whiplash patient regarding the muscles around the neck.  Again, the body is trying to protect itself.

As I wake this morning there is a bit more stress and anxiety inherent with another trip and another round of reviews for my impending Part III boards testing.  In the medical community the Part III analog is called Step 3.

Steps 1 and 2 for MDs or Parts I and II for DCs are essentially test which cover basic sciences like chemistry, physiology, anatomy, biochemistry, pathology and the like.  For chiropractors I know Part 1 consist of 9 hours of testing spread out over a two day period of time and part II is a bit longer and also spread out over two days.  Part III is only a 4 hour exam with half given in the first two hours, then a 20 minute break then another 2 hours of testing to finish up.  Part III is more clinical in nature and among other things covers all the basic exams, such as the aforementioned abdominal exam.

I’m not exactly sure why but some things stick very well the first time I hear them while other things take considerable focus and effort to get in my brain.  One thing that stuck when first learning the abdominal exam is a condition known as Caput Medusa.  I guess it has a catchy name that’s hard to forget.  Caput Medusa (CM) is a distention of veins around the umbilicus and although it can be caused by increased pressure in the inferior vena cava the liver is usually what I think of first regarding CM and portal hypertension.

Patient with Caput Madusa

Patient with Caput Madusa

My writing has gone a little tangential but my original thinking was engaged in finding insight into a possible phenomenon I’ll refer to as psychological splinting.  The brain is a visceral organ but instead of thinking in terms of a physical insult or any type of trauma we may also consider psychological insult or trauma and ways we, as humans may and up splinting ourselves psychologically in order to help protect ourselves.

As mentioned earlier, I am currently in a position which allows me an opportunity to use myself as a kind of living laboratory in order to examine my own responses to increases in stress and anxiety.  In order for my brain to help figure out a scientific type allegory I was lead to the concept of muscle splinting and have just started to ponder and consider implications associated with such thinking.

However, I am pressed for time so I’ll have to allocate portions of my four and a half hour trip to Kansas for further evaluation and pondering of psychological splinting.

 

Foot Keystones
There are three arches in the foot; a lateral and medial arch as well as a transverse arch.

Three Arches of the Foot

Three Arches of the Foot

In each of these arches, one bone in each arch acts as a keystone to each arch, the place where maximal stress and load takes place.

In the medial arch the navicular bone is the keystone.  In the lateral arch it’s the cuboid and the transverse arch most commonly has the 2nd metatarsal as the keystone.  An interesting part about this is that those bones, particularly the navicular and cuboid bones are bones that we, as chiropractors, have specifically learned to adjust.

The second metatarsal bone is most common in people with normal biomechanics however that load might also be found on the third or sometimes even as far over as the 4th metatarsal depending on the particular individual.

Morton Neuroma is found along the transverse arch, usually between the 2nd and 4th metatarsal and most commonly between the third and fourth metatarsal.  It is a perineural fibrosis (a thickening of tissue around one of your nerves) and causes nerve degeneration of the common digital nerve.  This usually results in a burning pain (which is common for nerve injuries) and often refers to the dorsal or top surface of the foot.

High heeled shoes have been linked to the development of Morton’s neuroma.  However, it should be noted that when referring to something like high-heeled shoes we come back to a basic situation of altered biomechanics.

One type of psychological splinting discovered for myself. 
Today, it looks like I’ve managed to put off final packing for my trip by writing in this blog so, avoidance may be considered one type of psychological splinting (PS) that I employ in my own life.  Beyond that, however, I’ve taken note of the method employed for my own method of PS which would have to do with reaching out to others and communications.  I would consider avoidance to be a general manifestation of PS while the mode employed i.e., communicating, to be a subset of that general mode.

That insight comes about as a result of recalling that, in the past, when I would be driving to school and have a particularly imposing and intimidating test looming that I would often text my girlfriend at the time and that communication frequency was much higher than normal communications under less stressful circumstances.

As a further offshot and tangent, I know have to wonder if the artificial manufacturing of stressful situations in a coupled relationship is done so that increased communications does take place and as such may be somehow perceived as a benefit to the one who might instigate say, an argument when no perceivably real genesis for an argument or altercation exist to begin with.

 

Reference: for those interested in some of the neuromusculoskeletal (NMS) aspects of Muscle Splinting:  The role of autogenic inhibition in the reduction of muscle splinting by Herbert Miller, PhD

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