Sacrificial Joints: Understanding the True Source of Instability
Restoration of Joint Stability with Matrix Repatterning - The Role of ‘Sacrificial Joints’
By Dr. George Roth, DC, ND, CMRP
Over the years, I have often noticed that athletes, from professionals to weekend warriors, are outfitted with some rather unusual equipment, in order to compete or participate in their designated sport. For some it is a knee brace, whether in the form of a tensor bandage or an elaborate ‘Robocop’ affair, complete with stainless steel hinges and reinforced stays. For others, it consists of multicolored, neon tape adorning their shoulder, or various types of wrist and ankle supports. Many people, even non-athletes, wear lumbar supports and back braces to deal with low back pain and disc-related injuries.
From time-to-time, people from all walks of life find the need to overcome painful and limiting conditions, through the use of assistive devices to support painful and unstable joints. These supportive devices come in all shapes, sizes, colors and designs, but they all have one thing in common: they are designed to stabilize, support and limit movement in a particular part of the body, because, for some reason that joint has lost the ability to regulate or control its own function. Many of the most common joints affected by degenerative osteoarthritis (as opposed to proliferative OA) are the lumbar spine, the knee and the shoulder. Interestingly, these joints are also the most susceptible to instability. The question I have asked myself over the years is: WHY?
A Surprising Result
About 17 years ago, a patient came to see me regarding a condition of low back pain. He also happened to mention that he was scheduled for knee surgery, to repair the ACL. As part of my examination, I checked his knee stability. I noticed that it was extremely unstable, but thought nothing more of it. I proceeded to treat him using a new technique I had been developing, called Matrix Repatterning (MR). I found a number of injury patterns associated with the lower extremities, the pelvis and the thoracolumbar spine and rib cage, and treated these accordingly. A few weeks later, after a series of about six sessions, the patient reported that his back pain was gone. He also happened to mention that his knee also felt much better. “As a matter of fact,” he stated, “when I went back for my pre-operative examination with the surgeon, he checked my knee and couldn’t find anything wrong with it anymore. He said that he didn’t know why I was told I needed surgery in the first place!” I didn’t know how to respond, but decided to go ahead and recheck his knee stability. It was perfect!
That case got me thinking. How had his knee regained stability? Did my treatment have anything to do with the improvement? I started monitoring knee stability in my patients, and noticed that it often improved when I treated certain areas of the body. Slowly, a pattern began to emerge demonstrating a rather consistent association with certain injuries that somehow seemed to be associated with knee instability. Once these areas of focal tissue injury, which we refer to as primary restrictions, were resolved, unstable knees would become stable. ... and stay that way. At the time, other than observing this rather startling clinical manifestation, I had no way to explain the mechanism of improvement.
A New Theory of Joint Stability Emerges
Several years later, a podiatrist came to see me for his chronic knee pain. As I performed my initial assessment, I was able to demonstrate how his knee instability was directly associated with an injury to his pelvis. As I positioned the electronic device (Matrix Scanner1) I use to determine the location of primary restrictions, on his pelvis, he was quite astonished that I was able to literally turn his stability on and off! “How was that possible?” He asked. In the past, I had considered some type of compensatory alteration in the tensile properties of the ACL and PCL. But this was an immediate change, and I could not understand how ligaments that had been lax could suddenly increase in tone. And, here was a fellow health professional, someone highly respected in the field of podiatric medicine, and who worked closely with a number of orthopedic surgeons. I needed to consider my explanation carefully.
I considered the evidence:
1. The knee was initially profoundly unstable.
2. I temporarily neutralized the primary restriction in his pelvis, using Matrix Scanner. 3. The knee instantly stabilized.
4. I removed the Scanner.
5. The knee once again became unstable... instantly.
I thought: what works that fast in the body? Could it be a neuromuscular response? What muscle could possibly be affecting stability of the knee? How was this being mediated?
Recent studies have postulated the popliteus as an important dynamic stabilizer of the knee 1, 2. It is intricately attached to several internal structures of the knee, including the lateral meniscus, the posterior capsule of the knee, the PCL and the MCL3. I decided to look into the possible role of this muscle on the function of the knee. I also decided to investigate the possible role of appropriately targeted treatment, such as Matrix Repatterning, which might help restore stability to the knee, and thus promote healing of this joint.
The typical clinical approach to an unstable knee is through exercise of the large muscle groups, or if all else fails, surgery for the so-called “torn ACL or PCL”. The purported incidence of actual tears of these ligaments appears to be much less than indicated by radiological reports. Surgical reports often contradict the reported findings of radiologists in these cases 4. Recently, I have also discovered that anterior instability of the knee is often accompanied by reduced tone of the biceps femoris, and that treatment of the pelvis, often restores tone in this muscle as well as knee stability, as measured with an anterior drawer test. Additional muscular and fascial associations appear to mediate ankle stability. In the shoulder, a similar mechanism was identified regarding the possible role of the supraspinatus as a stabilizer of the gleno- humeral joint 5.
1 Matrix Scanner: Proprietary Device (Electromagnetic Field Generator), used to localize areas of reduced electrical conductivity associated with tissue injury.
Joint Stability as a Symptom of Core Injury
Matrix Repatterning assessment is designed to determine the location of focal areas of tissue restriction, referred to as primary restrictions (PR’s). PR’s are often located in areas of the body remote from the area of symptoms, which may be compensatory to the effects of the PR’s. As I reviewed the areas containing the primary restrictions that seemed to be associated with instability, I noticed that they were invariably located in the torso and pelvis – the so-called core structures of the body. Treatment of these areas usually resulted in restoration of stability in the involved joints, which appeared to occur primarily in peripheraljoints. The one exception was the lumbar spine, which is located in the core region. But this one exception, proved to be a key to my understanding of this important mechanism.
I postulated that the purpose of instability was to protect the core structures from additional mechanical strain and potential debilitating or even life-threatening damage. In particular, I reasoned that one of the primary goals of this protective mechanism might be to protect a particularly vital structure, namely the spinal cord. The knee, ankle, shoulder and wrist joints, completely dependent on soft-tissue for stabilization, could serve the role of “sacrificial gears”. This is a term used with industrial machinery, such as printing presses, where specific gears constructed of less robust materials, are situated at non-critical points in the device. These are deliberately designed to fail and disintegrate should the machinery become severely jammed, thus protecting more critical components.
Could the unstable joints in fact, be sacrificial joints? (see Figure 1) But, what about the lower lumbar spine? The spinal cord is a key, core structure that must be protected, however as we know, the spinal cord ends at the level of L2 or L3. Thus, the neurological structures of the lower lumbar spine, composed of separate nerve tracts, each protected by the meninges (cauda equina), are much less vulnerable to serious damage. People with lower lumbar injury tend to have much less debilitating impairment, than those with direct spinal cord injuries. Thus, the response of the lower lumbar spine fits the model of instability that I had been formulating.
Figure 1. Sacrificial Joints (Red), Core Structures (Blue)
An Emerging Paradigm in Structural Therapy - Turning Joint Stability Back On
Matrix Repatterning is a gentle form of manual therapy, based on a recent understanding of the ultrastructure of the body, specifically the intracellular and extracellular matrix, and their influence on structural, mechanical and physiological properties of the body. The basic premise is that gentle manual therapy applied to areas of the body identified as primary restrictions, can help to restore the functional capacity of tissue, restoring its elastic and electrochemical properties 6, 7, 8. Primary restrictions are often located in the deep core structures within the skeletal frame (referred to as intraosseous lesions), and the fluid-filled thoracic and abdomino-pelvic areas, directly related to the spine, pelvis and rib cage. These injury patterns are often associated with impact injuries, such as falls, sports injuries, and motor vehicle collisions.
Remarkably, treatment of primary restrictions, often located in remote parts of the body, using Matrix Repatterning, appears to immediately restore stability in the affected joints. What could account for this response? It is my current theory that there may be a feedback mechanism, mediated by spinal reflexes or mechanical-electro-chemical signals generated within the extracellular matrix (ECM) 9. These systems may be able to monitor potentially threatening injuries, and respond by triggering inhibitory or excitatory efferent neurons (spinal/neurological level), or via the production of electro-chemical signals to activate specific tonal structural proteins within the ECM. Whatever the mechanism may be, it appears to allow the body to rapidly modulate stability of the peripheral, appendicular joints.
Practitioners, trained in Matrix Repatterning, have confirmed that joint stability is often restored when the underlying primary restrictions are properly addressed. In this way, they have been able to help many conditions associated with joint instability, resulting in significant clinical improvement. Further research is also required to assess the effectiveness of this approach on the possible reversal or prevention of degenerative changes associated with these joints.
- Anatomy and Function of the Popliteus Muscle, I MacIntyre, E-book, 2009.
- Electromyographic Study of the Popliteus Muscle in the Dynamic Stabilization of the Posterolateral Corner Structures of
the Knee, K Schinhan, et al, Am J Sports Med, Vol. 39, no. 1, 173-179, January, 2011.
- The role of the popliteofibular ligament and the tendon of popliteus in providing stability in the human knee, Pasque, C, et al, University of Cincinnati, J Bone Joint Surg Br. 85 (2): 292-298, March 2003.
- Imaging the Knee: Ligaments, DB Nissman et al., Applied Radiology, Vol 37, Number 12, Dec. 2008.
5. Journal of Bone and Joint Surgery, Vol 45B, No. 4, November 1963, pp 750–754.
- The Architecture of Life, DE Ingber, Scientific American, Vol. 1, January 1998.
- Streaming and piezoelectric potentials in connective tissues. LA MacGuintie, In: Blank M (ed) Electromagnetic fields: biological interactions and mechanisms. Advances in Chemistry Series 250. American Chemical Society, Washington DC, ch. 8, pp 125-142, 1995.
- The Matrix Repatterning Program for Pain Relief, GB Roth, New Harbinger Publications, Oakland, CA, 2005.
- The Extracellular Matrix and Ground Regulation, Basis for a Holistic Biological Medicine, A Pischinger, North Atlantic
Books, Berkley, 2007.