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moderate pain — and may be able
to sustain arousal over extended
periods of determined effort:
although this may be more typical of
sport than of typing.
When all these delaying effects are
exhausted, they may still not bring
on a complete loss of function.
There is an even more global way of
continuing to use the parts—after a
Under some circumstances we can
substantially reduce the vitality of
whole areas, parts and functions of
the body. This is equivalent to
turning the volume control right
down to a barely intelligible
whisper. Here the blood circulation
is much reduced, and muscle power
becomes greatly enfeebled. Sensory
awareness of the area is also
markedly reduced to a dim and
distant ghostliness.
The person has had to retreat
inwardly from their normal healthy
‘outwardly directed’ contact with
the world. To hold back and
attempt to avoid painful stimuli is,
of course completely normal. But
here at least one whole aspect or
part of themselves is in permanent
recoil and profound withdrawal
from rich responsive sensorial
engagement with their human
environment. This is sometimes
visible in their postural stance, and
in the way that their limbs are held:
as if they had just grabbed hold of a
hot stove; or stamped on a nail.
In the longer terms this can only
be achieved if a substantial chunk
of their beingness is disowned
(psychologically and
physiologically) and cut off from
the mainstream of their self-fullness.
An important part of this will be a
disconnection from the combination
of muscular senses studied in my
earlier work (Latey 1979) and in the
first issue of this journal (Latey
This means that we cannot make
any lively contact with the person
when we handle the parts that are
‘in withdrawal’. Be it perhaps a hand
or a foot, it feels lifeless, pale, dull,
flacid and feeble to us — and
without the feeling of warmth,
motility and sensitivity to pressure
usual for the meeting of our flexor
surfaces. Compared to the physical
‘presence’ of the more normal
bodies that we handle daily, there is
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hardly any feeling of connectedness
between us and the patient.
Proximal to the limb affected we
might look for rings of deep
contraction in the muscles of the
pelvic or shoulder girdles. These
may be very numb and unresponsive
in chronic states; but can be very
sensorially alive and painful to
pressure in more recent and
acute states of withdrawal.
Metaphorically we could imagine
these muscles ‘choking off’ and
occluding vitality. By a further
analogy the muscles are forming a
‘clenched fist’ (Latey 1979) that only
offers the coarse, numb extensor
surfaces of the hand for contact with
the world.
In the more extreme states of
withdrawal there is such lifelessness
that the tissues may resemble the
atrophic states seen in ‘reflex
sympathetic dystrophy’ or similar
pathologies. Autonomic and
neuro-humeral processes may seem
to be widely disrupted or stuck. In
any case the effect of lowered vitality
may be enough to stay below the
threshold of an inflammatory
response. So we would probably see
the typist’s hands flopping loosely
over the keyboard, working slowly
and lackadaisically: with an
error-prone and distracted manner.
Brittleness and
Tissues with low eciency in their
inflammatory response are also
those that warm up for physical
activity most slowly. We are all
aware of stiffness after sitting for too
long in a cramped position. If we
stand up after an hour or so spent in
lotus position, or start to walk after
sitting through a long movie, our
knees will take a while to get
moving; and can even be quite sore
for a minute or two. This pain is
commonly localized at either edge of
the infra-patellar tendon, or right in
the middle of it above the insertion.
Many tissues are unusually brittle
and fragile after periods of sustained
compression. The joints between the
carpal bones and the tendons around
the wrist are often surprisingly sore
after a relatively short time leaning
our weight through the hand.
Similarly the acromio-clavicular
ligaments and rotator cuff tendons
complain after leaning on the elbow
for longer periods.
Some tissues are prone to
crowding, and easily become
crimped and pinched; their natural
pliability and elasticity are
anatomically vulnerable to
compression. Deep structures that
lie just anterior to the hip joint are a
common source of trouble.
Mechanical or ergonomic habits of
sitting with the hips flexed beyond
90 degrees with little abduction, and
failure to use fuller extension
movements in the gait will
predispose to trouble here.
One commonly overlooked tissue
anterior to the hip is the origin of
the reflected head of rectus femoris
— that I often find involved in
‘groin strain’ and general hip
problems. The hip may seem
relatively free until we flex the hip
fully with adduction and slight
internal rotation: the pain and
restriction from compression
become obvious straight away.
Postural habits of the head
and neck will often over-compress
and pinch structures lying deep to
the occipital triangle muscles.
A sustained ‘myopic’ posture while
sitting at the computer is a typical
source of chronic trouble here.
The extensor tendons at the wrist
are crowded and compressed against
the distal end of the ulna when the
hand is used in full pronation (as in
reaching sideways to the computer
All of the ‘low eciency’ tissues
seem to be prone to early
degenerative changes. This is not
just the ‘normal wear and tear’ of
ageing that we associate with
osteoarthritis; particular sites seem
to be more vulnerable. The common
‘rotator cuff syndrome’ is a good
example. Occurring most often in
the fifth and sixth decades of life,
the large tendon shared by the
supraspinatus, infraspinatus and
teres minor becomes so ‘inecient’
that it is no longer able to repair any
local microtrauma — and becomes
Here the combined effects of poor
posture, thoracic kyphosis, upper
chest tightness, inwardly rotated
shoulders and diminishing
cardiovascular eciency form a
highly resistent set of predisposing
factors, that are also factors that
maintain the problem. Very
challenging to the therapist!
The hip joints often wear fastest
— not just because they dissipate
heat poorly, and become crimped in
the anterior soft tissues. The
sufferer, often overweight, has
usually earlier in life adopted a
stomping ‘saddle sore’ forceful type
of gait: sometimes in response to
injury. There is no easy flow to their
walking movements; no graceful
rotation and extension movement
that makes good use of the foot and
spine. Here impact and wear are not
well distributed: they are confined to
the central weightbearing area of the
hip. Attrition is confined to the
uppermost part of the hip joint
before spreading more widely.
Patterns of habitual gait may
be responsible for another
inflammatory condition that a‚icts
the same age group. Plantar fascitis
is quite common in late middle-aged
men. These are the senior workers
whose uniform includes very rigidly
heeled leather shoes — with which
they have inflicted the stamp of
authority on pavements, floors,
themselves and their view of the
world. It may be hard for them to
get over the feeling of ‘degenerating
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Aspects of in£ammation
into a slob’ when they finally accept
really comfortable ergonomic foot
Chronic in£ammation
Sites of chronic inflammation are
often very interesting to palpate.
Very long-term overuse of tendons,
for example, leads to failure of
lubrication and a very distinctive
‘ribbing’ of the tendon sleeves. De
Quervain’s disease, the late-stage
degeneration of the extensor/