In the first article in this series, "Early Detection Reduces Hip, Knee, & Shoulder Replacements," I described time tested screening procedures and perspectives as indicators of when to encourage your patients to seek further medical evaluation. Additionally, I described the anatomical relationships that have evidenced themselves to contribute to the degeneration of these joints.
Joints Prone to Partial Dislocations
The hip and shoulder joints have a genetic propensity for subluxations, which is to say they are pre-disposed to slip from the center of their joint surfaces. When these subluxations occur, it is common for a protective contraction or spasm of the surrounding soft tissues to also occur in order to prevent acute dislocation.
Protective spasms result in reduced joint mobility and range of motion, and usually pain, as blood supply is diminished by their tensions. In the shoulder, this usually involves the humeral head slipping forward toward its anterior capsule, while for the hip joint most often it is the femoral head slipping towards its posterior capsule.1
For any who may have experienced a fall from almost any height, our human reflexive tendency is to tuck and roll involving a sudden movement forward of one shoulder and a corresponding posterior movement of the opposite sided hip. From viewing the 2018 Winter Olympics earlier this year, we can appreciate how these superb athletes harness this pre-disposing anatomical capacity and large body reflex to create endless combinations of flips, spins, tucks, and rolls.
Stress & Degeneration
Commonly, patients seek you out who have had pre-disposing injuries that factor into the progression of these joint degradations, among them: rotator cuff tears, shoulder dislocations, strained hips and a host of possible knee injuries. And surprisingly, many who are progressing toward joint replacement do not have an injury history that allows such a simple explanation of cause and effect.
This is because these same degenerations may be the result of the insidious effects of chronic stress. My clinical experience has evidenced that stress affects our visceral suspensory ligaments first in the chain reaction within the human body. In response to the intensity, repetition, or duration of various stressors, our bodies respond internally by the "cringing" of the major sacs around our brain, heart, lungs, and the peritoneal sac within the abdominal-pelvic cavity, while the tubes that comprise our organ structures and those that connect them, "shorten, narrow, and sometimes even twist."2-3 All of these forces compress the axial skeleton and pull our extremities "down and forward" toward the body's solar plexus and pelvic floor. Repeating for emphasis, it is this "down and forward" stereotypical response to chronic stress that shifts the positioning of especially the hips and shoulders as described above toward subluxations.
Here, I will look inside the human structure to comprehend how visceral relationships typically contribute to the degenerations of these joints. Below is a listing of the major visceral structures that my clinical experience has evidenced as being most affected by chronic stress. These anatomical relationships are under-recognized contributors to the degeneration of the hip, knee, and shoulder:
The esophagus has its originating attachment to the occipital bone of the cranium so when its longitudinal and circular fibers shorten and narrow, it pulls the head down and forward upon the neck.3 This postural distortion activates a war between the body's flexor / extensor reflex systems that contribute to somatic symptoms potentially anywhere along the axial spine. The same progression occurs as in the hip and shoulders, internal distortions potentiate vertebral and rib subluxations then the soft tissues spasm to protect their respective joint(s).
The ligament of Treitz is a fascial extension of the crus of the right hemi-diaphragm which wraps around the lower esophagus and extends its attachment to the doudenal-jejunal flexure. I propose that this becomes an under-recognized extension of the length of the esophageal influence to pull the cranium down and forward. Imagine the weight of the small intestine added to the pull of the esophagus attachment to the occiput down upon the cervical spine.
The mesenteric root of the small intestine, a connective tissue organ, formed by a double fold of the peritoneum, "is narrow, about 15 cm long, 20 cm in width, and is directed obliquely from the duodenojejunal flexure at the left side of the second lumbar vertebra to the right sacroiliac joint.
The root of the mesentery extends from the duodenojejunal flexure to the ileocaecal junction. This section of the small intestine is located centrally in the abdominal cavity and lies behind the transverse colon and the greater omentum."4 When these central and oblique fibers contract it pulls the torso down and forward as well as contributing to the rotation of the pelvis.
So to reprise, the connection beginning at the base of the cranium extends all the way to the pelvic floor via the fascial connections between the esophagus, ligament of Treitz, and the mesenteric root.
The attachments of the vertically oriented ascending and descending tubes of the colon may further contribute to the compression of the axial lumbar spine, a quality of twisting the torso in relation to the pelvis and to the rotation of the pelvis if one vertical colon is more contracted than the other.
Subluxations of the Hip & Shoulder
These four visceral relationships along with others are so very important because their tensions pre-dispose the subluxations of the hip and shoulder. The common language to convey the building tensions of stress often includes: "I feel twisted up inside," or "I feel so tight inside that it's hard to stand up straight." These utterances are more accurate than people realize.
Knowledge of this architecture and its implications for how the human body responds to stress anatomically is crucial to our ability to more fully assist patients to stabilize the daily function of their hips, knees, and shoulders. The key concept is that there exists a Central Linkage of visceral suspensory ligaments from the base of the occiput all the way to the pelvic floor. There is another Central Linkage that begins from the front of the cervical spine to the pelvic floor as well, the subject of the final article in this series.
References
Chronic pain afflicts over 20% of the adult population. Sadly, most MDs have essentially no education in treating pain, beyond offering a few toxic medications. Then they tend to steer people with pain away from those health practitioners who are trained. This puts the acupuncture community on the front lines for addressing this epidemic.
When the body is going through a stressful event, the sympathetic system is activated. This activation will help the body with a life-threatening situation. If this state is activated for prolonged periods of time, it starts to consume energy. These traumatic events that generate stressors in the autonomic nervous system (ANS) will eventually become internalized.
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One of the things that makes acupuncture so difficult to measure is that the medicine actually does contain some esoteric aspects. There have been numerous studies that demonstrate the neurochemical reasoning behind why acupuncture points stimulate the autonomic nervous system to enact change However, not all the benefits of TCM can easily be measured by randomized, controlled trials. But does that make them fundamentally and definitively untrue?
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