This is the Program I proposed to Dr. Mittman back in 2015,
which he put the OKAY on. There were some issues we had
to work through, but they were being handled. Then, my Mom
had a bad stroke, Dad had a bad reaction to a surgical procedure,
and I had to move out to Surprise, AZ to take care of them. So,
the project went onto back burner. Then, COVID-19(84) came
along. SO, it never got going. … BUT, it is still a possibility!
Summary of the DSL Method of
Yoga / Bodywork / Whole Health (YBWH)
Educator & Therapist Training and
Naturopathic (ND) Interface Program
by David Scott Lynn (DSL)
PURPOSE of the PROGRAM:
Provide an Evolution in Soft Tissue Health Care while supporting Expansion of Naturopathic Services. Provide NDs with working knowledge & application of DSL Method of soft tissue work. Train a higher level of competence of Mindful Medical Massage, BIO-Structural Balancing, Yoga, & Whole Health Therapists in Psycho-Neuro-Musculo-Fascial & Joint Therapy.
1-A.) One or more groups of YBWH Practitioners will be trained to provide a comprehensive, integral, & scientifically based approach to resolving complex, long-term chronic, neuromuscular & myofascial issues of Clients presenting with a wide range of psycho-neuro-musculo-fascial, myo-structural, and other “soft tissue issues” resulting from “C.E.M.&.N.T.” or Chronic, Excess Musculo-Fascial & Nerve Tension & Stress. …
Initially, except for decreasing generalized & specific conditions of C.E.M.&.N.T., these trainings will NOT be overtly symptom oriented, but general strategies for Myo-Structural DE-Compression & Postural Balance conducive to any Client’s overall well-being. (Reduces risk of accusations of “practice beyond scope.”) Symptoms might well clear up, however, that is a by-product, not an intent of diagnosis or treatment.
1-B.) As Trust between Physicians & Therapists is developed, Therapists will be further trained in more specific conditions and symptom resolution, to become increasingly useful to the Patients of the Naturopathic Physician.
2.) YBWH Practitioners will also be trained as Guidance Counselors in a wide range of basic, common, well-established, metabolic & nutritional practices supporting general health care needs of Clients, yet also NOT be symptom or condition specific. … They will prepare Clients for better use of ND services.
Practitioners will provide an integrated range of whole health services for their Client’s well-being, making them more valuable than “single track” therapists, teachers & coaches.
3.) YBWH Practitioners will be further trained in understanding Naturopathic Healthcare, and how to educate their Clients in the basics of such care, such that practitioners become a Referring Network to NDs for their Clients, when appropriate, for more complex or symptomatic issues.
4.) Conversely, NDs may serve to clear YBWH Practitioners’ Clients for possible issues not likely to be responsive to soft tissue therapy — preventing instances of Failure To Diagnose — so YBWH Practitioners do NOT attempt treating conditions better addressed by physicians or other therapists. …
In addition, Clients referred by the YBWH practitioner as Naturopathic Patients would be more educated patients, therefore improving the overall quality of care delivered and received.
3 PHASES of the PROGRAM:
1.) Initial Training of Practitioners will be in DSL’s approach to Soft Tissue Therapeutics:
[Please SEE Addendum, Next Page]
Later trainings educate Practitioners as Effective Counselors in metabolic, nutritional & other whole health principles & practices, and preparing Clients to be “Educated Patients” for Naturopaths.
2.) In-Service Seminars for NDs providing insights into C.E.M.&.N.T. and how to integrate such knowledge into their Patient Evaluations & Strategies. Also how to manage interactions between their Patients & Practitioners whom they’ve referred such Patients to. … Ideally, NDs will clear all Practitioners’ Clients who have any indication of pathology beyond what soft tissue therapy can reasonably help.
3.) Educational Seminars for the General Public — in-person & online, initially conducted by DSL — educating them in the Nature of C.E.M.&.N.T. and how DSL Trained Practitioners can help them, and the part NDs play in the process (supervisory). … Also, the overall value of Naturopathic Medicine.
Ultimately, there will be a network of YBWH Educators providing regular, free, educational seminars to the General Public in various locations, also funneling more Clients & Patients to participating NDs.
ADDENDUM
Components of Practitioner Trainings
A. Physical, Mental & Relational Yoga: Regular Personal or Group Practice & Yoga Therapy
• Benefits for Practitioners as Self-Care
• Useful for Clients for Enhancement of Therapy & Self Maintenance
• Effective as a Stand-Alone Therapy / Self-Maintenance System
B. The Nature of Chronic, Excess Musculo-Fascial & Nerve Tension & Stress
• Primary Cause of many musculoskeletal and soft tissue issues & Resolution
C. Principles & General Physiology / Neurology of Psycho-Neuro-Musculo-Fascial Release
D. BIO-Structural Analysis & Postural Evaluation: Structural DE-Compression & Postural Balance
• Specific Strategies on determining which muscles to work & sequencing
E. Advanced Myo-Structural Anatomy & Functional / Postural Kinesiology
F. Neuromuscular & Myofascial Principles of Therapy (Revisited & Refined)
G. Yoga-based, Hands-on Myo-Structural Bodywork for C.E.M.&.N.T. not responsive to Yoga
H. Tai Chi/Chi Kung-based Movement Therapy for integration between Yoga and SECC (J. below)
I. Internal & External Ergonomics & Work / Life-style Design, integrating Yoga into daily actions
J. SECC: Strength, Endurance, Cardio & gross Coordination exercises (with Yogic principles)
K. A Philosophy, Psychology & Science of Being Human (relevant to the above elements)
L. In-depth on the Nature of Thought, Feeling, Meditation, Action & Education / Communication
M. Principles of Breathing, Relaxation & Meditative Self-Awareness w/ Parasympathetic Activation
N. Principles & Practices of Practice Management and Collaboration between Disciplines
Ultimately, a Primary Objective will be to support & facilitate participants in becoming Leading Edge, Creative Thinkers, discovering how they can become THE Leaders in their Field. The deeper nature of Education & Learning will be emphasized throughout the program.
Here is a Letter I provided to the Physician of
a Client (whom you might have heard of) he
was treating. Based on things I had done for
the Patient in the past, the Patient asked me
to come to West LA to help him. We were
making progress, and I offered this detailed
description of what and why I was doing for
the Patient. It’s a little long, but if you have
the time, it well describes my thinking
process and strategy for such Clients.
Letter to Dr. Shimuzu (a Leading Physician at UCLA Medical Center, Los Angeles)
Describing DSL’s Therapy Process for His Patient / Client:
[**Being a Highly Orthodox Physician at a Prestigious Medical Facility, I was as diplomatic and unpresumptuous as possible with Dr. Shimizu. So my language was a little more “humble” than I might speak with physicians who are more familiar with and accepting of alternative medicine. But I did not want to offend a Lead Physician at a place like UCLA! Massage Therapists are not known for high-level competence in physiology or neurology. … I have, of course, concealed the name of the Client / Patient [now passed away] who has, in the past, been somewhat well-known in many countries. He was not secretive about my work with him, but I wanted to respect Him & HIPPA and such other parties.**]
Hello Dr. Shimizu,
I’m writing this summary to inform you of what my strategies & practices are in my attempts to help [Patient Full Name] with some of his health care issues, such as his Foot Drop. Several of his physicians say he is one step away from a wheelchair, but he brought me in from the Phoenix area to see if he can avoid that. (He has had significant results in the past from my therapy back in Chicago in the 1980s and since.)
I began working with [Patient First Name] about 29 years ago, then lost touch in 1999 when he moved to L.A. We recently reconnected, and I’ve been here in L.A., at [Patient First Name] request, since June, mostly to work with him. While knowing his background has helped, I must admit his condition might be the biggest challenge of my 30-year career, yet we do appear to be making progress, despite a few set-backs.
Specifically, we’ve primarily been working with restoring his ability to fully dorsiflex his right foot (and to a much lesser extent his left foot), restore his overall balance & strength, and eliminate significant hip pain fluctuating dramatically and migrating around a bit (although it’s been a lot less lately). There have been some short-term bouts with sciatic-like pain, which in years past he used to have quite a lot of. …
Most recently, [Patient First Name] right big toe has been dragging more than his foot. We’ll be starting to isolate that last one today (Friday, 27th).
[UPDATE, after working with it, the big toe issue is apparently due to the fact I was working more on the foot plantarflexors, and had not worked much on flexor hallucis longus (FHL). So we had to get FHL relaxed & lengthened sufficiently to catch up to the progress in overall foot flexion. More to do on that, but we appear to be on the right track.]
I have a few questions you might be able to shed light upon, allowing a more accurate and/or realistic approach to [Patient First Name] healing process.
The first question, of course, does the perspective I outline below make sense to you? … And does it fit within known physiological & neurological science? I’ve come across conflicting information in medical texts, and am admittedly not 100 percent sure about everything stated below. If there is anything I’ve got wrong here, in substance as well as terminology, it will be greatly appreciated and might well influence how I proceed with MB.
A Very Short Summary of the Therapeutic Modalities I use, and have been using almost exclusively for more than thirty [now forty-four] years, are **conscious stretching therapy** (AKA yoga therapy, yet a more Western approach, I’m not into the Eastern mystical or cultural elements) and **hands-on, manual, psycho-neuro-musculo-fascial therapy** (a highly nuanced, mindful massage or bodywork technique, using relatively steady pressure on specific skin & underlying muscle fibers, with little or no lateral movement, for often very long periods of time. I also use a NO Pain, MORE Gain approach, further described below).
The main hypotheses are that we are — through relatively gentle manual pressure in the muscle belly, or by low-intensity stretching — activating Golgi tendon organs (GTOs) to inhibit motor stimulation at the respective local cord level. Also, such GTO stimulus communicates via the spinocerebellar and spinothalamic tracts, inhibiting excess irritation in the reticular formation*, and also stimulating Renshaw’s cells in the spinal cord, to produce inhibition of efferent motor impulses to relevant effector cells.
* A question here is the theory that the long, ascending tracts [spinocerebellar & spinothalamic] of the Golgi tendon organs can affect, actually inhibit, activity in the reticular formation. If so, IF one can stimulate the Golgi tendon organs without triggering a stretch reflex, or other countervailing forces (such as stabilizing or protective actions of muscle cells), can the inhibiting reflex of the GTOs produce that effect in the brain stem? It’s clear, of course, they can at the local cord level. Neurological research, as well as results in extensive clinical practice, strongly suggests they can produce a generalized, systemic inhibition of excessively facilitated synapses in the reticular formation. That in turn reduces generalized motor output to the entire body. If true, that explains much of why mindful manual therapy and conscious stretching appear to produce the wide-ranging, systemic effects they appear to do.
The Main Objective is to Reduce Hypertonicity, or what I call C.E.M.&.N.T. (Chronic, Excess Musculo-Fascial & Nerve Tension & Stress) in neuromuscular units. I adhere as closely as possible to a NO Pain, MORE Gain philosophy, preventing, as much as possible, any stretch reflexes, or pain-induced reactions, or other counterproductive effects. The initial focus, in all cases, is as complete a Deep, Radical Relaxation — a DE-contraction & DE-facilitation — of the neuro-musculo-fascial pathways involved with the Client’s current concerns.
The Secondary Objective, but possibly more important, is systemic stimulation the parasympathetic system, initiating or enhancing the Self-Healing Capacities of the BodyMind.
The Third Objective is to restore full sensory-motor function by DE-facilitating over-active descending sensory pathways that inhibit accurate information being transmitted to higher levels in the CNS & Brain.
Because this process is, in most cases, so relaxing, even though we often spend a LOT of time on specific skin & underlying muscle tissues, there is little or no **Burn Out** on the part of the Client (nor the Therapist). While there are a few exceptions ([Patient First Name] being one of them), most Clients experience significant levels of relaxation during and after therapy. In his case (as it appears to me), there is so much historical irritation from so many accidents, more than a dozen surgeries, and other stresses, strains & tensions, that we are often re-triggering old, stored-up irritations that it is not always a smooth path back to normal. Therefore he is not so tolerant of as much work as we’d like to do.
Unfortunately, with the amount of work needing to be done in such a short time (helping him get ready for a trip to NYC), we did appear to reach an overload level and had to cut down on the amount of work he was receiving. We are now doing about 2 hours, three times per week, rather than every day.
So, here is the way I look at [Patient First Name] history and account for it with my therapy:
1.) [Patient Full Name] at the young age of 7, suffered his first severe & painful injury, a broken elbow joint requiring four surgeries (yet subsequently becoming permanently fused), from a horse accident. Thus began a life involving a total of 17 significant injuries and surgeries. Some of these events were very painful, as well.
Additionally, 35 years of playing polo involved many patterns of neuromuscular activity putting large amounts of strain and imbalance into various pairs of muscles. These significant amounts of neuro-musculo-fascial contractions, strains, and compensations produced significant re-patterning of those systems, at some point leading to more generalized & chronic stress & tension patterns. Much of that involved, eventually (due to accumulated habitual tension patterns), noxious inputs to, and outputs from, the CNS and reticular formation.
I operate under a hypothesis that each of those injuries & compensations maintain (possibly for life) some degree of residual facilitation of involved neuromuscular pathways. Especially since some of these facilitated pathways began at an early age, and with 17 traumatic events, plus the major recurring physical strains from playing polo regularly for 35 years, then tennis, it would seem that [Patient First Name] CNS & reticular formation has been comparatively well- and more-or-less permanently saturated (both temporal & spatial facilitation) with irritation.
Given that the reticular formation controls pain as well as balance, postural orientation, and movement, it seems likely much of [Patient First Name] trouble is now emanating from here, as all of those are overt factors (problems) in his current condition. This perspective also says that such facilitated overloads would keep the sympathetic nervous system in a hyperactive state, inhibiting parasympathetic activity, and therefore inhibiting self-healing mechanisms, although [Patient First Name] is generally in an otherwise state of great health, casts some doubt on that. Yet much of that high state of health appears to be constitutional and genetic.
My own work involves, as much as possible, the reduction of these historic, residual irritations, to whatever degree possible. The jury, apparently, is still out on what degree that can be done. But it is clear that while many, or most, of them do not just go away over time, they can be affected toward a less facilitated state. For the more severe irritations, some intervention is necessary to de-facilitate those chronically facilitated pathways and restore anything like normal, pain-free function.
2.) Upon my arrival in June, based on my history of high levels of results in relatively short times with Clients’ significant body issues, I was thinking I’d spend a few weeks working with MB. I was unprepared for the apparent condition of partial foot drop, which might not be a technically correct diagnosis (I am not qualified nor licensed to perform any kind of medical diagnosis) but he certainly has significant troubles in limited dorsiflexion when walking. It was not a total loss of ability to dorsiflex, but significant enough to make walking problematic and occasionally dangerous.
Interestingly, as we’ve had progress with the right leg, MB has been very recently reporting some degree of foot drop in his LEFT foot. I see that as a positive sign, in that even in physical therapy, if a client’s condition begins to cross over to the opposite side — I believe PTs call it **centralization** of the condition — it is viewed as a positive indicator. Yet it also indicates, I would think, that whatever is interfering with [Patient First Name] sciatic and peroneal nerves, this originates, at least in part, in the CNS. It might not have started there, it might have originated in the limb itself (due to injuries and surgeries, etc.), but having worked with this phenomenon before, this crossing over indicates to me a positive development, though temporarily complicating treatment.
Then we have the fact of four significant breaks and surgeries over many years of the right lower limb — the ankle, just above the ankle, the femoral shaft, then the femoral head. I’m inclined to believe much of what he’s experiencing is a result of those injuries & surgeries, an accumulation of multiple facilitated pathways over many years. Yet according to many of my clients, some medical doctors seem to deny that injuries that old can have such lingering effects. Both my personal & professional experience do NOT agree with that conclusion.
Also, [Patient First Name] current breakdowns did not start till several years after that last surgery. It might have been the passage of time, and those neuromuscular units kept getting increasingly active. Yet there are other factors, as already mentioned, indicating something more systemic issues going on.
Also, [Patient First Name] has spoken of an epidural injection at the time of the femoral head operation, and we’re wondering if that was an initiating factor that could have been a **straw that broke the camel’s back** event. (Or maybe an entire log instead of a straw?) But the question here is, could that epidural have some slowly developing negative effects that, over a few years time, eroded the integrity of his CNS, therefore contributing to his current problems? If that’s the case, it might indicate I should do more that produces more low-level sensory input in a more generalized, whole-body way, rather than staying more focused on the right lower limb, with some attention to the left.
And with 17 serious injuries & surgeries, any one of them could be hyper-irritating the CNS & brain stem/reticular formation. All of that, of course, adds elements of complexity I realized would take a lot of time, but it has, so far, been more time than expected.
3.) Another issue that comes up is that of exercise.
[Patient First Name] soleus and gastrocnemius muscles were EXTREMELY tight, VERY wiry, possibly the tightest I’ve ever felt. We’ve gotten a lot of improvement, but they are still pretty tight. Yet he had up till my arrival been doing plantar flexion exercises with resistance via a rubber strap, which in my mind further contracted his already too tight soleus & gastrocnemius muscles. My dilemma then, was the question: is his significantly reduced ability to dorsiflex because:
a.) his peroneal or sciatic nerves, or something higher up the CNS and/or brain, was inhibiting firing of the tibialis anterior, OR …
b.) was the hypertonicity in soleus & gastrocnemius so high that anterior tibialis (and other dorsiflexors) just could not overpower the plantarflexors?
There was always, however, SOME activity in the tibialis, so it did not seem to be completely inhibited or in atrophy.
All that is further complicated by several decades of, for example, forcing his heels downward in the stirrups and strong gripping of the saddle with thigh and gluteal muscles while riding, with large amounts of added in and somewhat random & stressful movements & contortions, causing excessive, habitual contraction & imbalance in his various involved muscles (most or all of them, actually), and a high likelihood of chronic, active insufficiency in most of those muscles. Tibialis anterior was especially & extraordinarily tight, and took much work to get loosened up, and still has a way to go. That did help dorsiflexion, however. And it was always at least somewhat active, so I was not resigned to complete loss of function.
Overall, the out-of-balance state between foot flexors and extensors would, in my mind, lead to active insufficiency in both sets of muscles, and much compression in various joints of the ankle & foot.
All of this has further chronically facilitated his neuro-pathways, including the CNS and reticular formation.
I therefore suggested he NOT do those exercises for a while, as it appeared in direct opposition to what I was trying to accomplish. I offered alternative, tai chi-based *exercises* to keep those muscles moving but not under such high loading (such as the contractions the rubber strap exercise would require). The tai chi element makes the movements more gentle, less stressful, and less likely to over-contract muscles for the time being.
(I have great doubts about the strength/weakness theories about posture and pain, which I’ll not get too much into here. But one neurologist with 25 years of practice experience, after observing our clinical results and attending my in-service seminars, told me she thought my ideas would reverse much of how paralytic and other lost function & “weakness” conditions should be treated. FYI, I think in terms of muscles being short or long, not weak or strong. They can appear to be weak, but that’s often only an illusion, leading to what zi call pseudo-weakness.)
4.) Overall, MB’s medical history has produced (at least) two coincident phenomena affecting his ability to function:
A.) Life-long, chronic, heightened neurological, efferent output from the reticular formation has kept many of MB’s muscles in a state of active insufficiency.*
* Active Insufficiency: I know that’s what physical therapy calls that phenomena, not sure about neurology. But in physical therapy active insufficiency refers to excessive or inadequate overlap of the actin-myosin cells, therefore limited or no ability to further contract and generate muscular force. … Also, I am referring to a more physiological aspect of active-passive insufficiency, rather than the kinesiological definition, such as two-joint muscle actions. … (Frank Netter, in one of his much older books specific to the neuromuscular system, had one of the few good illustrations I’ve seen of this phenomena.)
This active insufficiency produces the phenomena of what I call **pseudo-weakness.** Yet it misleads any evaluator of MB’s **strength** because while active insufficiency prevents a muscle from generating much or any force, it does not mean the fundamental capacity is actually diminished or gone. And, any attempts to **strengthen** the allegedly **weak** muscles usually involve contraction-based exercise which increases neurological activity and further facilitates the already excessively facilitated neuromuscular pathways.
(I have alternative views as to why strengthening exercises do work, or sometimes making things worse, in many cases. But what positive results do or might occur have little or nothing to do with the overt strengthening itself. I think the repetitive, rhythmic nerve activity & muscular movement during exercise **resets** the nerve activity to a less chronically facilitated level, allowing the actin-myosin units to return to their more normal, neutral [proper level of overlap] state. Overall muscular balance plays a part, too. There’s more to all that, of course, but I don’t want this *summary* to get too long, which it probably is already.)
B.) Descending sensory pathways have, to whatever degree possible, attempted to isolate the cerebral cortex from conscious experience of as much of that life-long pain and other noxious inputs as possible. This has increased MB’s level of chronic desensitization, preventing much of the possible communication from occurring in his neuromuscular system. This has been evident in all the years I’ve been working with him. Until recently, he has generally been unable to report lower levels of irritation or pain in the therapeutic process.
(The theory here is that full neuromuscular function requires relatively un-interfered with sensory-motor feedback loops. In layman’s terms, what you cannot feel, you cannot change.)
Much of my focus is on restoring the sensory-motor feedback loops in two ways:
A.) producing low-level stimulation into areas that have not had much or any touch-based sensation, therefore expanding his sensory experience. This means, pressing on a muscles does produce local tissue effects, but it is the stimulation of the sensory nerves where the bigger results come from; AND,
B.) relying on the low-level intensity of touch to initiate inhibition at the cord level and reticular formation. This is in part based on the possibly questionable idea that the parasympathetic system responses better to weak to mild stimulation* than to strong stimulation.
* Weak to Mild Stimulation: That principle used to be in medical books prior to the 1970s under the term Arndt-Schulz Law. It was utilized by old-time manual medicine and more recently NMT practitioners. The modern term is now *hormesis,* but it has been applied more to metabolic factors. Its application to neuromuscular therapy has not, to my knowledge, been much explored, though I believe it should be.
There is evidence MB is responding to this strategy. Overall, he has somewhat restored feeling in his legs and feet. He feels a general, though mostly non-specific sense of improvement. There are subtle signs his balance & coordination are improving. He still, however, feels weakness in his thighs, and is far from being fully confident of walking normally.
I also believe that MB’s life long process of de-sensitization makes it difficult for him to be more precise in describing his state on a day-to-day basis, making it more difficult to target a specific, in-session strategy.
5.) I would have preferred to do more therapy in MB’s abdominal and trunk regions. There were a few times when I did some relaxation of his abdominal wall and psoas muscles that he had a sense of improvement. I’ve read reports that drop foot often emanates from the lumbar region of the spine, and I’ve had success with what appeared to be neurological problems by relaxing the psoas tensions, which, I am assuming, reduced entrapment or other source of irritation to the sciatic pathways. Yet we’ve been mostly focused on the drop-foot problem.
BTW, I am aware of the controversy on the idea that muscular interference can cause irritation of the nerves except in locations of overt entrapment, which are somewhat limited. However, from a clinical point-of-view, it seems very clear that such irritations of nerves by overly tense muscles are possible, even if not involving the more obvious affects of overt entrapment (direct compression, such as clavicular pressure on the brachial plexus initiated by muscular contractions pulling the clavicle toward the first rib leading to thoracic outlet syndrome and carpal-tunnel like symptoms).
6.) I am not here discussing the severe pitting edema he had in both lower limbs, from the knee down, for the last year and a half which I significantly improved in approximately 2 weeks. That after several therapists having attempted to do so over the last year and a half.
Okay, Dr. Shimizu, I apologize for the length of this letter. But I hope it was of some interest or use to you in attempting to fine-tune [Patient First Name] therapeutic process. Please feel free to offer any comments or criticisms, as I’m more concerned that I correct any errors in my thinking than protecting my ego.
Thank You Very Much, and I look forward to meeting you Friday the 4th.
David Scott Lynn
928-255-6677
d@davidscottlynn.com
https://davidscottlynn.com
