Since You Put It That Way
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Since You Put It That Way
What's Fascia Got To Do With It?
...a lot, as it turns out! And possibly not in the areas you'd think. In this episode, Dr. Louder talks with Dr. Megan Pass, a physical therapist, about how fascia is a whole-body organ, and the implications of that fact: how headaches can sometimes be due to lower back issues, how foot pain might be related to the glutes, and how patients and practitioners can help restore balance in the system to help us all live our best lives. Listen in!
Intro for "Since you put it that way" podcast.
Outro for "Since you put it that way" podcast
Welcome back everybody to another episode of Since You Put It That Way, and Megan continues to be our guest. And Megan our phys--our physical therapist who has joined my practice, Mary Louder DO and Cairn Medical and Megan Pass, PT, there's just too many vowels in there to share, so we're just going to put them amongst ourselves, play Scrabble, and we're going to continue our conversation about fascia. We're going to look at some of the important questions. And I think it probably starts out this way, a physical therapist and osteopath went into a bar, right? Something like that? And I don't know what we did after that. Probably, I don't know, did we do stuff at the bar? Did we stretch it? Maybe, I don't know.
Megan Pass:I don't know. Everyone came up to us and was like, my head hurts, my back hurts.
Mary Louder:Exactly.
Megan Pass:How do I fix this?
Mary Louder:Exactly. I think we perhaps just ordered a round of something, and then off we went. You know, something like that. So, well, and as we get into this continuing, there's some important facts about fascia that I thought were kind of fascinating. So fascinating fascial facts. How's that for alliteration? One truth about fascia is that it's considered a newly discovered organ system that permeates the entire body. When I think of that, I think of the old footballer basketball coach that always would say, drop and give me five. You know, when you had to, when you didn't execute the drill correctly, you had to, you know, you thought that you were strengthening yourself, and everything was linear. You did a sit up, or you did a push up, or you ran in a straight line and ran back. That's not even, you know, and fascia just doesn't even work that way.
Megan Pass:No, I find it so fascinating. So a new organ.
Mary Louder:Yes.
Megan Pass:But yet, it's been with us this whole time. We just decided to recognize it as an organ, finally.
Mary Louder:Yes. So an organ would be what? A collection of tissues and cells with a primary function. That was--that would be an anatomical definition. And it has 10 and also another fun and fascinating fact of fascia is that it has 10 times more proprioceptors than muscles, so proprioception for all of us is, where are we in space, with our eyes closed? We know where we are in space with our eyes open because the optic tract takes it back to the brain, and the brain figures it out. With our eyes closed, proprioception occurs, what we say is in the joint, and it tells you where you are relative to being up, down, left, right, bent over, standing up straight. So it tells you where you are in relationship, really, to your center of gravity type thing. So 10 times more proprioception--proprioceptors, which means the function, and the sensory is in more fashion than it is the join--joint. We always were driving things by where the joints said we were.
Megan Pass:Yeah, I think that's interesting, because that's what we were taught, but that's not how I practice. Because I always think about, okay, so then, what is a muscle? Like, let's break
this down. So, myofascial:muscle, fascial. So myo is muscle, but muscle is just the muscle cell, the contraction that happens within the cell, and then the fascia is what in like encases, and creates the different fibers, fibers within that muscle organ. So of course, the proprioceptors are going to be with, embedded into the fascia.
Mary Louder:Well, then the question I have is, fascia is supposed to be literally everywhere, because it's in the internal structure and support for surrounding tissue and, and we talked about last time, it being really the primary thing that moves us from point A to point B, and it's in organs like appendix. It's in your organs like liver. It's in your organs like thyroid. So are there proprioceptors in those organs? And if they are, what are they doing?
Megan Pass:I think they are. I mean, in my practice, I can feel the motility of an organ with my hands, and so, yeah, I think there would be because let's, let's think about this logically. If we have, if you eat something, and it comes into your stomach through your esophagus, which has smooth muscle that helps bring it down, and then it turns in your stomach, and your stomach and all the acids and enzymes and everything break it down, and then it exits through a sphincter, which has to open and close, and then it goes out into your intestines, which have all these other smooth muscles that help push it down--well, but then, how does the bile get out of the gallbladder? How? How does--it's a chemical. But then just thinking about the movement of fluids through the body--
Mary Louder:Well, it is also motion. It's probably mechanical, chemical movement, so mechanical and changes in stomach acid, content, pH, amount of stomach acid, what's broken down, enzyme levels, things like that, which would come from the exocrine function of the pancreas as well as the stomach and part of the small intestine. But if a person has acute pancreatitis, we gut rest them. Even water. If they have an acute gall bladder attack, we got rest them. Even water. Why? Because you have to digest water? No, all you do is assimilate that or absorb it, right? No, it's so that would be the mechanoreceptors that would stimulate and stretch. So that would be fascia as well.
Megan Pass:And so, with fluid moving through the body, why couldn't--why wouldn't our proprioceptors be able to sense the change of pressure mechanically within our organs?
Mary Louder:I think that they would. So that would even then push to blood levels. Blood pressure levels in the blood vessels, lymphedema, or swelling from lymph. Ah, all of a sudden, this is way more complex, from drop and give me five or running a straight line.
Megan Pass:Or "suicides".
Mary Louder:Yeah, oh my gosh. I remember those suicides. Shoot free throws, if you miss your free throws, you're doing a suicide. I remember those. Okay, let's do one more fun fact, and then we're going to go into some questions that we get from our patients, typically. There are four different types of fascia: structural, intersectoral, visceral and spinal, but they're all connected, which would make sense. So the structural would be more what we would think was the musculoskeletal, maybe a more linear, the intersectoral that would--I would think of that being diaphragmatic, whether it's a structural diaphragm, like your respiratory diaphragm, or a functional diaphragm across the joint or your thoracic area here and then the visceral means guts, organs, and then the spine. That makes sense? Yeah?
Megan Pass:Total sense to me.
Mary Louder:All right, so fun and fascinating fascial, fantastico, fun facts. I'm, can I say I'm out of the F words. I am known for, the F word, so we will leave that one there and keep this PG rather than going to R. All right. All right, here's a question. So, so I'm a patient, so if my why is it, if my pelvis is tight , why do I get headaches?
Megan Pass:It's such a fascinating question, and I'm actually really excited to also hear that from your perspective as an osteopath. But ultimately, so speaking about different types of fascia, the spinal fascia. And it--the Latin word for our dural tube, our dura mater, which is the fascist surrounds our brain and spinal cord, it looks like a tadpole for those people who are like, what, huh? Dura Mater means tough mother in Latin. So, okay, so let's think about this like it is the thickest piece of fascia within our nervous--within our bodies, and it attaches at very specific places to our skeletal system. The cerebral fal--falx, I always say that word wrong.
Mary Louder:Cerebri.
Megan Pass:Yes, cerebri, thank you, through the center of the brain. So it's the piece of fascia that creates the two hemispheres of the brain on our sphenoid, right near the pituitary gland. So like back this way, in the center of the head. The occiput, the base of our skull, where our spinal cord exits, and then s2 which should be our sacrum, so the triangle bone that points downward on the back of your pelvis, and your tailbone's at the very tip. And so if you're having pain in your pelvis or your hip, or of course, you're going to get headaches, because we're going to end up with tugs and pulls going all sorts, like all these different ways, and usually opposing. And the other interesting piece is all of our nerves exit this piece of fascia, and then that fascia then continues along the nerves. And so then we can end up getting these rotations, or torsions in my world, because our eyes will always try to keep us level. So if we have these bony--
Mary Louder:Horizontal, they seek the horizontal.
Megan Pass:Always. They're seeking the horizon.
Mary Louder:Yep.
Megan Pass:And so if we have a rotation or a torsion or an injury into a hip or pelvis, then it's going to create compensation injuries all the way up. And so of course, you're going to end up with headaches. Or if you have a lot of headaches, and you start getting relief with your headaches, and now all of a sudden you've got low back pelvic pain. Well, okay, so now we're actually treating your whole body, we're unwinding you essentially.
Mary Louder:Yes. So yes, I agree. And as an osteopath, what I would add would be that the dura Mata, the tough mother, reminds me of, you know, Columbia sporting sport clothes, mother, Boyle, right. She was a tough mother, but the dura Mata attaches inside the skull. If you look at this skull as a bowl, multi dimensional, so you're right, the falx Cerebri, which goes left to right hemisphere, then you've got the tentorium cerebelli, which goes horizontal between these cerebral cortex and their cerebellum, and roughly, it's in the mid portion of brain, and that then separates the top from the bottom. And so you literally, like, if you have paper, you can literally get a kink, and you can literally have things pull. And so when, and you know, I think one of the most fun things to do with folks as an osteopath is treat them with cranial sacral therapy, which, when I had my interview for med school, I told the dean that I thought it was voodoo, but I'm open, and it's not voodoo, and it was fantastic to learn that. But the cranial sacral, you're you're feeling the movement of the bones that are in the skull, and that we learned in fourth grade were fused. But they're not fused. They have a beveled joint to them, and so they move back and forth, and then where the dura is attached, it also can put a strain pattern or a torsion on the paired bones. If they're not paired left to right, so that means you've got two of them, then they're one, front and back. And that includes fine bones of the face, the bigger bones of the skull, and your frontal bone and back by the occiput. So those bones move in a very specific pattern. You learn the patterns of those and then you can literally feel, because you can give a little push and it--because it's considered a semi open hydraulic system. What that means is, if you have a boat, a row boat, and you put it on the lake and you go to step in it, and you're not really stable, the boat can scoot away in the water. If you put that boat on the concrete and you go to step in it, it ain't going nowhere. So that fluid there makes that boat move with just a little bit of a push. So when we do cranial sacral, and if anybody's ever had cranial sacral, it should be the gentlest of touch, the gentlest of feeling, and you're really feeling for not only what's happening there, but what it's reciprocating down the spine and other parts of the body. And as an osteopath, I can treat the base of the skull and release low back pain, because I can hold the occiput, have it go through cycles of movement, bring it to what's called the still point, which is a therapeutic positioning, and then the sacrum relaxes, and I never touched their low back, because it's fluid. And also, just as you were saying too, where the dura comes out each level of the spine and continues, that fascia is literally connected all the way out and back in. You know, so you think of all these, you know, spidey senses and things like that. So, you know, very often I would treat patients because they would go, patients would come in with headaches, you know, CAT scan, MRIs were negative, no infection, no reason for that. Their eyes were tested, everything's good. And they go, we can't figure out why I have chronic headaches. I would ask them, did you ever fall on your backside? They're like, it's my head, Doc. I go, I know. But did you ever, you know, it's Michigan? Have you been sledding, as we call it? Have you been sliding? Have you been sliding down the hill, and, boom, boom, boom, have you fallen on the ice? And, oh, yeah, last winter. Well, when did your headache start? Well, about two months later. Yeah, that would be right. So, and it wasn't, did you hit your head? No, I didn't hit my head. Just hit my backside. So, and that would be, you know, falling on your sits bones can jam the system all the way up. And so knowing the fluid mechanics, knowing how things work, knowing the movement of the bones, how the dura sits there, you literally can get a picture. And the cranial sacral system is so subtle in the fascial world that you can sit there and just hold the base of the cranium and think movements, and the body begins to release itself. And I remember I had a patient years ago, and the whole time I treated her, and she had chronic headaches and and I was treating no she had chronicled, yeah, headaches and low back pain. I was just holding the base of her head, and I was talking to her, talking to her about the farmer's market, and we were talking about all the great things. She goes, You know, I pay for this. And I don't think you should be talking. I think you should be telling me what you're doing. I'm like, okay, so then I began to describe the movement, the motion of the of the bones, and what I was feeling, and the pulsations, and where it was going. Now it's at this level, c5, c6, now it's down to t1, it's crossing the thoracic inlet, now we're going down to the respiratory diaphragm. Okay. Now here you're the the root of your mesentery is releasing--and then she goes, Okay, stop. She says, apparently you're working. Yeah, I go, I am working. But don't you think the farmer's market is much more fun to talk about?
Megan Pass:Yeah, it's amazing what can be done without actually touching the area, like also with, fascially as well. And I just, I love what you said about there's so much intersection between cranial sacral and osteopath and the type of manual work that I do, because it is that still point we are looking for, that still point, and because that's the space where the healing actually takes place, and where that, where the body and the nervous system can actually shift. And so I love that, you know, in a world where we have to feel, we have to feel, it has to hurt, it has to be productive or uncomfortable, you know--healing, especially with our fascial system and especially with our nervous system and our craniosacral system--like, thinking about our central nervous system, it can be subtle, and it can heal without it being uncomfortable. Yeah,
Mary Louder:I think that's good to think that overall. To reframe some of that, I was in conversation with someone recently about trauma, and they had a number of major traumas, and they said to go back to even consider any of those would be too painful. I said, What if there's a way to heal without having to go back and feel everything? Because the trauma we know is hidden in the fascia, stored in the fascia, it's not hidden, it's stored. Well, then you've got the idea of the subconscious relating to the fascia, and that can be in the amygdala, that can be in the basal ganglia and the cerebellum actually, which is the lower area, and that area is where the lot of the unconscious body is driven from. The brainstem area. So what if that connects to our bio field around us, where we maybe house our soul? I don't know. I know there's a bio field. Some people call it an aura. I tend to call it a bio field. And what if that's where the subconscious is as well? And then that's how we do all this connecting and go off into the woowoo part of you and me being one there, sister, you know, and we begin the Kumbaya, right?
Megan Pass:Right. I mean, in the many mystical traditions, the first body is our physical body, and the second body is our mental body, and then the third body is our, oh, it starts with an A, I'm forgetting a lot of words today, goodness, but it's essentially--
Mary Louder:Astral?
Megan Pass:No, it's different, but it's essentially our emotional body.
Mary Louder:Okay.
Megan Pass:The Astral body, I think, is number six. But if we think about it that way, then yeah, like, what if we don't have to relive our suffering?
Mary Louder:I think I'm up for that.
Megan Pass:Now, that doesn't mean we don't bypass what we've been through, right? And I think this is where that tricky piece is, is like, we can't bypass the pain. We can't bypass or ignore it, right? But what if we just acknowledged it, loved it, and move--and moved with it?
Mary Louder:Mm-hm. And the body has because the body has the inherent capacity to heal, and because what we've learned and seen the evolution of EMDR to tapping, to thought field therapy to Emotional Freedom Technique to, you know my Self Compassion and Connection, and now you know trauma response and repair, a new, new program that I'm learning that treats the subconscious. What if it just--because we're building on the shoulders and the collective literally of the next--I mean, we're kind of like in this vortex of healing for the soul, and there's this industry that wants to keep people traumatized because they can make money and we can rub your tragus right here, which is that bump off your ear, and therefore you can tra--treat your tragus, heal your vagus. You know--and I'm like, seriously, it's not if it were that simple, we would have figured that out a long time ago. It's not just one nerve does a trauma make. It's not only regulating the vagus. We've got to do other things. It's not just the polyvagal theory as it relates to fascia. And--
Megan Pass:All of it. And we cannot forget about the soul.
Mary Louder:Right. And that would be the same thing, by focusing on polyvagal, would be the same thing as drop and give me five, run in a straight line. Do a sit up and lift everything in a straight line. Then you'll get stronger, because that's how your muscles function. It would be that same type of reasoning. Linear healing, which is not at all how we got injured. We didn't get injured in a linear fashion either. Yeah. All right. Question number two, physical therapist and an osteopath go in, we went back into another bar, and then we got this question posed to us. This is kind of fun. I kind of like that little pretense there. So hey, why does my right sacroiliac joint hurt when you're telling me it's my left sacroiliac joint that's tight.
Megan Pass:Ah. I love this. I love this question. And this can go for almost any joint in the body. People, so like, yes, we're picking the SIJ the sacroilian joint, because in the least in the PT world, it is probably the least talked about joint, and it has so much implication, and it causes so much pain and dysfunction, and so, okay, so the right side is hurting, but I'm telling you, the left side is tighter. Let's think about this. Okay, if the left side is so tight that it's not moving, where, what do you think is moving?
Mary Louder:The right side. It's more mobile.
Megan Pass:It's more mobile. And so what has happened is that right sides either moving too much, actually, it is moving too much. And it's either moving beyond its threshold, or too frequently within its threshold, that it's caused irritation. Like, I can make it that simple with a patient.
Mary Louder:So where the--if, so, then, if the proprioceptors are in the fascia, you have an increased fascial strain on that side that's more lax.
Megan Pass:Yeah, and so there's gonna be more instability.
Mary Louder:Right. More instability and more pain through the fascial system because of the movement and just the strain. And then the chronicity sets up because the muscles that adapt the fascia tightens a certain way, and then we literally, because it just takes on the, you know, the--it shape shifts, boom, and then you always get those pain patterns there. Me, I think of everybody has tried to correct my right out-turning foot my entire life. I promise you I was like that in the womb. I know I was, and I love it, and quit trying to fix it, you know. And, and, do you know that your foot turns out? No, not aware of it. Of course, I'm aware of it. Back for my whole life, you know. And my, one of my grandmas walked that way. Say, you know, it's just the funniest thing. She had the same turned-out foot. Where'd it come from? I don't know, but I'm sure I sat that way in the womb. And then now, even now, stretching. And I know the patterns that are there is when I'm more tight, that hip does not like internal rotation as much, you know, and I have to spend more time really elongating that into, you know, internal rotation.
Megan Pass:And you know, this is the piece--we, we as a society, are just so stuck with perfectionism and symmetry. And our bodies are not that. I mean, our liver, our biggest organ, takes up how much space on the right side of our body? Like, it's just not possible. And then we have hand dominance, eye dominance, foot dominance. And it's not bad to have these imbalances. What becomes dysfunctional is when the imbalance is so big and we are not aware of it, so then we become a victim of our pain.
Mary Louder:Okay.
Megan Pass:And then that is then the piece of like, okay, so my right, si hurts all the time it hurts to take a step. It's like jabbing. Okay, well, let's take a look at why you're moving that way. Let's take a look of what is causing that instability. Yes, your left SI is tight, but that may not be what's causing your instability, because it's so much more multifactorial than that. It could be, it could be a past trauma, whether that trauma is physical, emotional or spiritual. And then, okay, we don't need to know necessarily what it is, but we do need to look at, how do we train out of it to bring you back into function? And I generally will use symmetry as a guide, but that's not my ultimatum. And I think, as an osteopath, you're probably pretty similar.
Mary Louder:Yes.
Megan Pass:Because it's about finding the function and the ease and the flow in the body to create the space to allow movement to occur that doesn't cause pain, because pain is what elicits the Warning, Warning, warning. And healing is not in that warning space.
Mary Louder:Right. So let's go down from the--so the sacroiliac joints, where the triangle bone at the base comes together between the hip bones, sacroiliac joint. So then if we go down to the foot, let's go to plantar fasciitis. Let's pick on that. I love this, because everybody wants to fix the foot. Now your feet can have--the feet have multiple arches in it, you know, that go across from your big toe to your small toe, from right, you know, in front of your heel bone, left to right, so the side to side, and then downward. So we've got, you know, transverse or cross arches and longitudinal arches. And it's a, really a work of beautiful architecture, our foot, to get our our different arches and structure of the foot, to leave those really cool hang 10 feet on the concrete when you're wet. You know, I love that, right? Did that as a kid, and I had, I have flat feet, but I really don't. I have a shallow instep, which is a different than flat foot. And I had to wear arches in, in orthopedic looking shoes when I was a kid, and they hurt so bad because they pushed my arches up, they pushed my foot and made it rigid, and I could hardly walk. And I was told I had to get used to it, and I couldn't. And every year I would get really expensive orthopedic shoes that I just couldn't wear, and all I wanted was loafers and tennis shoes, and I never had foot pain. That was the funny thing. I didn't have foot pain. My, my older sibling did, and they had really deep arches, and they didn't have to use arch supports because they had deep arches, but because I didn't, or was perceived to not have arches, I was given arches that made them hurt. My feet hurt, and I couldn't walk.
Megan Pass:I'm going to work really hard to stay on topic here, because feet and arches and kids and orthotics and all that stuff like sends me down on a soapbox, so we will table that for another day.
Mary Louder:But the point to fascia, when we look at orthopedics, when we look at plantar fasciitis, what's happening in the linear world is they're treating the foot. And you can end up the foot be where things end up feeling, but you actually need to treat up the chain, up the leg, up into the low back, up into the diaphragm, up into the base of the cranium. So can you address that?
Megan Pass:Yeah. So Tom Myers with Anatomy Trains, he really did, actually a lot of service, but also, I will say, a disservice to people who are looking for these constant solutions and these linear solutions. So there's the posterior longitudinal fascia and that--and what Tom Myers did is he's dissected multiple, multiple cadavers, and he's following the trains and the fiber lines through the fascia. And so the posterior longitudinal fascial chain runs from your toes up the soles of your feet, up the back of your heel, through your Achilles tendon, into your gastroc, up into, I think, the medial hamstring. It crosses the SI, then it goes up the paraspinals, and then up into the occiput. So paraspinals are those thick muscles that run up and--up and along the spine. And so yes, we do need to treat up the chain, but then I also take it the next step. So if that fascial chain is tight along the posterior line, what's happening on the front of the body? Why is the back so tight?
Mary Louder:I think the back is tight because the front is not engaged. And it's not--I wonder if it's so much front to back, if it's not big versus little? Ah, yeah, because the paraspinal muscles are thin. Think of like tenderloins, folks. That's our tenderloins, plus our hip flexors are tenderloins. But if we look at those spinal muscles like a tenderloin, they're, they're long, they're linear, they're, they go up and down. The broad muscles, like our gluteal muscles, our buttocks, as Forrest Gump would call it, right? And our get our hamstrings and our quadriceps are bigger muscles that are meant to hold us upright, but really it's our, it's our gluteal muscles, and those are most often inhibited in folks for a variety of reasons, and that's the muscles that tend to keep us up and walking, not the paraspinals. So I think because the gluteus muscles are inhibited, the front also shuts down, but then it just stiffens.
Megan Pass:Yep, yeah. And this gets into a really complicated
Mary Louder:Yes. conversation, because there's actually two fascial lines through the front of the body, according to Tom Myers, and
Megan Pass:We have--everyone knows about the rotator cuff or there's the deep anterior line, and there's the more superficial anterior line. And so this is us thinking like super linear, drop and give me 10. Because then there's also the functional lines. And the functional lines are your spirals. It's your glute max that then comes up into your lower obliques, which then crosses into your external obliques, which then crosses into your serratus anterior, which attaches into your scapula, and then crosses again across your rhomboids, up into your other shoulder. And it's those functional lines that actually turn on our glutes. It's a rotational stuff. It's the side stuff. It's the ability to have the movement, and, like you said, to stay out of the rigidity of it. And when we are so front and back, and we're so linear, then of course it's going to stiffen. Because we need those small stabilizers active in all of our muscles. Even our spine has muscles that span one to two segments that actually decompresses our vertebra and then allows that rotation to occur. where I lived in rural Oregon, the, the rotor cuff.
Mary Louder:Yep, Rotary cup.
Megan Pass:Rotary cup is another one. Our hips also have that same thing. And I would say in the majority of people, glute max is inhibited, but so are the hips. The hip stabilizers, and thinking about pelvic floor, then with hip stabilizers, the pelvic floor is just clenched. You know, 30 years ago, the pelvic there's all this conversation about Kegels, contract, contract, contract, contract. Well, now we are so tight. We are, dare I say, anal retentive. We are so uptight that we can't relax our pelvic floor, which then contributes to the rigidity, and I am finding actually really plays into what's happening along the back side of the body when it comes to fascia. So, plantar, fascia, yes, let's take a look like, let's have the conversation of, do you clench like you're trying to hold your poop in all the time.
Mary Louder:No. Oh, that wasn't a question for me. No, but hte answer's no.
Megan Pass:But like, that's these are the questions I will be asking, because it's not just what is happening at your feet.
Mary Louder:Right.
Megan Pass:That is just where your body is saying, Help, something's not working.
Mary Louder:So, so pain then, kind of like anxiety, is really a messenger, and we've developed and lived in a system that tries to treat the pain by going to where the pain is to make that pain stop, which would be something like an arch support, an orthotic, an orthopedic shoe, whatever. Something like that, to stabilize what we think is, but that is going to completely change the influence all the way up, not just what you're saying the back chain, but those rotation chains that make the hips fire. So you literally could block the ability for the body's--you could block the body's ability to fire by anchoring those feet, like in this set of, you know, concrete shoes, as it were.
Megan Pass:Yep.
Mary Louder:And you literally might not be able to accomplish that, which you're sent home to do by home exercises.
Megan Pass:Yep.
Mary Louder:Well, that's just a co pay that's gone bad, isn't it?
Megan Pass:And sorry to everyone who's just blowing the mind of like, but it hurts. Well, we need to start looking at pain as not being bad. There's different types of pain there, and we need to start creating a dialog and a conversation about what the pain actually is, and what that feels like? Is it truly acute injury--like injurious pain? Is it causing you injury, or is it pain that is saying you haven't been listening to the whispers, so now I'm going to hit you across the head with a four by four until you listen, or your feet.
Mary Louder:Yeah. And what's interesting there is our whole concept of pain management, that we've medicated causes further disconnect by using the neural pathways in the brain and immune receptors for morphine or hydrocodone or hydromorphone or things like that, that literally, or now the whole concept of either fentanyl or wait, what's the big one having a moment there too--ketamine that they're using for chronic pain, oral ketamine up to nine to 12 years, and or IV ketamine. And the whole goal of that, literally, is dissociation. So the thing that we're doing in therapy is causing more disconnect from where we need to just stop and ask the question, what does this mean?
Megan Pass:And what this what does this mean, may be more than just physical.
Mary Louder:Right.
Megan Pass:Most of the time it is.
Mary Louder:Right.
Megan Pass:And this is why having a great team and people that you refer to, and your healthcare providers, having a team and a referral source is so important, so that you're working as a team, because we are in a system that does require us to specialize, which is a good thing. So then, let's all work together with our specialties.
Mary Louder:Yes.
Megan Pass:To heal.
Mary Louder:And this is where folks like you and I literally don't fit in the system because of the fragmentation. So we do a disservice to our community. We do a disservice to our public, and this is something that, that, I--it does weigh in my heart a lot that how it's, how our system is structured, and that the folks who think holistically, like yourself and myself, are the ones that get marginalized. You know, we get pushed out. We get told we aren't doing enough work. We are told we're not billing right. We're not, you know, fitting in. And I never fit into that system. Even when I was a youngster in medicine, and even when I was learning medicine, I never fit into that because I just never thought that way. And so it's interesting that really now things may be catching up in our understanding that this is really the way to go, and that it is more complex because--but by complex, I mean interwoven. I mean holistic.
Megan Pass:Connected.
Mary Louder:Yes.
Megan Pass:That it's not linear, it's cyclical. And within this--in those cycles, there's going to be multiple cycles, and um, or more of a spiral, instead of cyclical, like, within these spirals, there's going to be multiple spirals, like I'm thinking fractals. And so with--if we approach the body in that way and the practice, because I too, have never fit in, then all of a sudden healing and--healing can occur in ways that didn't seem possible before. And I just am so grateful to be working with another provider who gets this.
Mary Louder:Yeah.
Megan Pass:Like, what a service to the people that we get to work with.
Mary Louder:Yes, it's much less lonely, and I don't hear crickets.
Megan Pass:Yes. Or peepers.
Mary Louder:Exactly, exactly. So, all right, so let's go back to, let's finish up with a couple more fascinating, fun fascial facts. Uh, it's fa--and it kind of it dovetails into exactly what we just talked about. Fascia has a living intelligence. It's described with living intelligence that adapts and responds to support of the body's inner architecture. When one part of the fascial web is injured, the entire system responds.
Megan Pass:Yes.
Mary Louder:Yep.
Megan Pass:It's been my my experience in my career, yes.
Mary Louder:Yes. And then some have even described the fascia as part of or housing or being the soul of the body. I can neither confirm nor deny that, because I don't have the tools to, but it seems kind of logical, kind of common-sensical, and yet no harm to believe that way, and it's actually maybe better to believe that way for outcomes by changing up perspective. So, what we're really doing here by looking at fascia from a holistic perspective is we're really changing paradigms, and we're really reframing what pain may be, a messenger. Anxiety may be a messenger. I know that it is rather than a diagnosis, and we--it causes us then to see where we've been disconnected, so then we can reconnect. In that reconnection to ourself, it's the safest place to be. From there we can go anywhere, because our fascia will get us there, right?
Megan Pass:Yep, yep. Our fascia is our mind, body and spirit.
Mary Louder:Yeah. So that's, that's pretty, should we say, fascia-nating? I did just come up with that one.
Megan Pass:Yeah, yeah, that was a good one. Mary.
Mary Louder:All right. So on that note, the practics are, if you are in our community here, West Michigan, find us out. Find the website, drmarylouder.com, make your appointments, get set up. Megan's got availability. I've got availability. We work as a team, and you can really get really good care for chronic issues, chronic pain issues, if you want to get off your pain medicines, I've got ways to help you doing that, by doing pharmacogenomics and looking really at what medicines will work and don't work for you that you've been prescribed. And as a physician, we can move all of that around. The key would be getting you off things that keep you dissociated and bringing you back into your body. And the physical therapy would work to do this very same thing through hands-on and all the moda--modalities. And multiple ways that Megan can help you. And we're located in downtown Holland, right above the JB and Me store, and we just moved spaces within that that office, we now oversee the west side and have a window, which is a beautiful view now out of our office, and so it's a great place to get treatment and care. And I just invite everybody and you know, get this is stuff to, you know, get your friends to listen to this. Get your friends, you know, follow us on Instagram, Facebook. Just look at our names on Facebook and Instagram. Follow us. You'll be seeing great information. But this is important because between an osteopath and a physical therapist, when you can get us out of the bar, not taking questions there, you can actually get very good care and have a good time doing it from a really holistic perspective, and I think that's just super important. And so, you know, take, take note of this, and know that there is a way through what you're dealing with without being stuck in a linear system, without--with answers and a bunch of stuff that just hasn't worked. There's, there's actually, you know, there's a reason that you're listening to our podcast today, for sure, I would say. So we look forward to being of service to you in our region and area of the state. So thanks for listening to us. Dr. Megan Pass, Dr. Mary Louder, on Since You Put It That Way, and we hope you guys have a great day and see you next time.
