ON Chiropractic
Segmental Inflammation:
Beyond MSK
C
-Sens can also induce a response
called neurogenic inflammation.
In other words, if a spinal
segment is centrally sensitized, the
muscles and organs connected to that
segment can also become inflamed.
A research review from RRS Education
describes this process:
“This neurogenically mediated
inflammation refers to the discharge
of inflammatory mediators and
neuropeptides (such as substance P or
calcitonin gene-related peptide) from
the peripheral terminals of nociceptors
in tissues (both visceral and somatic) that
are neurologically linked to a primary
pathology.b“
The review continues, “Neurogenic
inflammation has also been linked to
other non-musculoskeletal pathologies
(e.g., irritable bowel syndrome, cystitis
and changes in both uterine and bladder
contractility).b” Dr. Srbely refers to a
2007 rat study wherein distension of the
colon led to an inflammatory response
in the bladder.Q The colon and bladder
are neurologically linked and this study is
an example of neurogenic inflammation
spreading between organs. Given that
the dorsal horn of the spinal cord is the
location where somatic and visceral
pathways converge, it is hypothesized
that C-Sens is a key mechanism linking
disrupted musculoskeletal and organ
health.
“You could have a simple disc
herniation,” Dr. Srbely says, “and if we
allow the sensitization to remain, the
neurogenic inflammatory response will
kick in. It will augment the inflammation
locally at the disc but then it will begin
to spread to other tissues that are
segmentally linked.” So, not only might
the perceived pain of an MSK issue
become amplified and sustained once
it triggers C-Sens, this sensitization may
send altered signals to muscles and
glands in the same segment “where
they may initiate abnormal physiologic
responses and, potentially, pathogenic
processes if allowed to persist.”:
injury would. If you continue applying
pressure to this area, the clinician feels
a relaxation response in that muscle
and the patient actually desires more
pressure. Initially it might be sore but
if the pressure is maintained, patients
describe it as a ‘feel-good pain’.” This
“You could have a simple disc herniation,”
Dr. Srbely says, “and if we allow the sensitization
to remain, the neurogenic inflammatory
response will kick in. It will augment the
inflammation locally at the disc but then it
will begin to spread to other tissues that are
segmentally linked.”
Dr. John Srbely
Myofascial Pain Syndrome and
Trigger Points
C
-Sens may lead to myofascial
pain syndrome, a condition
commonly encountered by
chiropractors. Dr. Srbely’s neurogenic
hypothesis suggests that neurogenic
inflammation is a primary mechanism
underlying the pathophysiology of
myofascial trigger points and myofascial
pain syndrome., Rather than being
caused by local overuse or chronic
injuries, emerging evidence suggests that
trigger points may be a result of a central
mechanism.
“Any clinician will tell you that one
of the key clinical differences between
a local injury and a myofascial trigger
point is the nature of tenderness,” Dr.
Srbely says. “When a clinician presses on
a myofascial trigger point, it does not
induce a withdrawal reflex like a local
was one of the first observations which
suggested to Dr. Srbely that trigger
points may be the result of an underlying
neurogenic phenomenon rather than a
local injury.
In a 2010 journal article, Dr. Srbely
covers several more indications of the
neurogenic nature of myofascial trigger
points including:
∞∞ “Referred pain” which suggests
a centrally mediated network of
sensitized trigger point circuits,
∞∞ The way trigger point formation
follows segmental patterns, and
∞∞ The previously mentioned “soothing
ache” of trigger point pain which is
differentiated from the sharp pain and
withdrawal reflex of local injuries.
OCA members may also be
interested in reading RRS Education’s
review of Dr. Srbely’s article on this topic.b
www.chiropractic.on.ca
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