The Thinking Practitioner Podcast:

Episode 157: What Happens When the Body Lets Go? (with Werner Klingler)

Whitney Lowe  

Welcome to the Thinking Practitioner podcast, 

 

Til Luchau  

a podcast where we dig into the fascinating issues, conditions and quandaries in the massage and manual therapy world today. 

 

Whitney Lowe  

I'm Whitney Lowe 

 

Til Luchau  

and I'm Til  Luchau. Welcome to the Thinking Practitioner

 

Til Luchau  

The Thinking Practitioner podcast is proudly supported by ABMP, Associated Bodywork and Massage Professionals, the premier association for dedicated massage and bodywork practitioners like you. When you join ABMP, you're not just getting industry leading liability insurance, you're gaining practical resources designed to support your career, from free top tier continuing education and quick reference apps like Pocket Pathology and five-minute muscles. ABMP equips you with the tools you need to succeed and grow in your practice. ABMP is committed to elevating the profession with expert voices, fresh perspectives and invaluable insights. Through CE courses, they're all in ABMP podcast, Massage and Bodywork magazine, sponsoring this podcast and featuring industry leaders like my co host Whitney Lowe, who is not here with us today, and myself Til Luchau in their magazine. Thinking Practitioners, listeners like you can get exclusive savings on ABMP membership at abmp.com/thinking Join the best and expect more from your professional association. My guest today is Professor Werner Klinger from Ulm University in Germany. You, Professor Klinger, you are a physician anesthesiologist, fascia researcher, and your work bridges muscle physiology, pain medicine and the body's connected tissue system. Dr Klinger spent much of his career exploring how mechanical, neural and fascia properties interact, from the way anesthesia affects muscle tone to how connective tissue tension and sensory feedback shape movement, pain and perception. He's been part of the Fascia Research Group in Ulm with Dr Robert Schleip, who's also been a guest on the show, helping connect the laboratory and the treatment room, bringing insights from physiology and anesthesia into dialog with what hands on practitioners observe every day, and as someone who guides patients through profound physiological shifts and studies the body's, subtle states of tone, tension, and relaxation. He brings a fascinating lens to the questions that might matter to all of us who work with touch, what actually happens when the body lets go, and why do these states like anesthesia, trance, deep relaxation, ecstatic states, perhaps, or the quiet openness, sometimes we witness in body work, often feel so meaningful or so healing. And what can we as practitioners learn from the physiology of these states about supporting change, recovery, integration, all those good things. Professor Klinger, thanks for your patience through the introduction and welcome. It's great to have you here with us. Okay, so from your research, what's happening at the tissue or fascia or muscle level when we relax deeply, not just mechanically, but perception interception those levels.

Werner Klingler  

So just to turn it around, if you just look at the muscle value of the of the person. So as an anesthesiologist, you might ask, What do I have to do with muscle? I just care for brain and nerves and just to I care for local anesthetics. However, we do a lot of muscle muscle relaxation, because if people are operated, they we cut out, we cut the bowels open. And so people need to have a full relaxation of the connective tissue of their muscle tissue. And so this is what the anesthesiologist does. And so what we do, what we do, we supply a drug which basically stops neuromuscular excitation, contraction, coupling. So by stopping the acetylcholine attaching to the muscle tissue, so the motor end plate, the muscle is not able to contract, and so we measure this. Of course, we have sort of an EMG measurement, which helps us to get an idea of what's happening again. But again, we have roughly 30 isoforms of myosin. Myocene is one of the main at PSIS, the one of the main enzymes in our muscle, which gives, let's say, the tonicity and interaction between between actin and myosin as the contractile elements of the muscle. So basically, we have not this one and only muscle. We have very, very different way of muscle tissue in our bodies. And so these, these muscle tissues even differ with content of connective tissue, and they differ with the amount of nerves per muscle spindle and per muscle. So there are a lot of variables which we have to take care about, and so we have specific muscle analogies which we know. So let's say, if you want to look at the neck, we use the small hand muscles. If you look at the bowels, we look at the diaphragm. So there are several ways of just getting an idea of how the muscle is in the relaxed state. If we, if you've inject a very, very high dose of muscle relaxant, then we can make sure that all muscles are just paralyzed. And so what really rests are, is the resting muscle tone, which is basically the tissue property of muscle. There are titine molecules, there are actin molecules, there are myosin molecules, there are sex bands connecting these together. And then, on the other hand, outside the actual muscle fibers, there are connective tissue, collagen fibers, and there are nerves. And interestingly, nerves have a biomechanical stability, which which you can even notice when you just stretch your arm as fast as you can as far. As you can you, yes, what happens? You get at a point where you might get, might feel some neuro tension, some tingling in your fingers. So this is because this element is the nerve which is just causing the restriction. So it's we call neuro tension.

 

Til Luchau  

So you the anesthesia inhibits the muscle firing contraction, and there's lots of different ways that happen. So you monitor different muscles to see what's going on, and then you're also dealing with neural tension in the limbs as well. Am I following you so far? 

 

Werner Klingler  

Yes. So basically the three columns of anesthesia is muscle relaxation. So it's one part, and we do muscle relaxing traps, which we inject to keep muscles relaxed. Then the second column of anesthesia is more or less the brain control we we just make it unconscious where people are sleeping. And the third column is pain control. And even if people are sleeping, they suffer pain, of course, and so we do not want them to suffer pain even if they are sleeping, because this influences a lot of processes which we might to help, which we might help to understand, even if you have a brain dead person and so and we just take out the heart, we take out the lung. Then, even then, we've got a physical reaction in even if, by definition, this patient has no brain anymore, he or she is dead, and this person, even then, we apply drugs which are painkillers, just to prevent this autonomic nervous reaction with which occurs even without a subjective brain pain feeling. So these are the three columns pain, muscle relaxation and unconsciousness or the consciousness.

 

Werner Klingler  

Til thanks for having me

 

Til Luchau  

I met you for the first time. I'd known of your work for some time, but I met you the first time at the Fascia Research Congress in New Orleans recently, where you were talking about the altered states that involve anesthesia, and you captured my interest in your description of them. I've been looking forward to this conversation, but people use a lot of different terms for these states, like altered states, top down, regulator states, trance, restorative states. Do you have a term you prefer and why? What do you like to call them? 

 

Werner Klingler  

Well, this is a debate which is going on in my specialty for quite a while. So roughly 10 years ago, a colleague of mine, he's he said, as an answer to this question, a patient is not a submarine, because when you talk about a submarine, you have different levels of diving deaths. So in other words, you just say 100 meters below the sea level. This is a diving debt. And so what many people talk about, they just shared this thought about the mental state. So he is in deep sedation or less severe sedation. So more or less, this is not a correct way of just describing what's happening to the brain. Why not? So basically, even if it's easy to think about a submarine so of different states of consciousness, we should rather think of an octopus, because an octopus have several has several arms, and just one arm is above on the sea level, the other arm is very low in the deep sea. And so basically, this describes much better what's happening in our brain in different states of trans if different states of consciousness. So what we do in anesthesia, we measure the level of consciousness, consciousness by measuring an EEG, an electroencephalogram, which. Is basically the electrical currents which are produced by the neurons, and we just process them. So it's not so easy to just have an overlay of these different levels, as you might have seen an EEG reading before, this rather looks a bit complicated. However, if you look at these states of different states of anesthesia, you find out that different frequency bands get up regulated. Others get down regulated. Interestingly, so the Alpha spectrum is divided in Alpha one Alpha two, and this ratio, alpha two versus alpha one is a strong indicator of basically what's happening in the brain. And so we use this ratio in modern anesthesia as a as a method of just giving an estimate what's happening in the brain. And so we have different areas in the brain which disconnect during anesthesia. And so I could go on for hours, but choose to answer your question in a very short way. So basically, what happens it's a dissociation of different parts of the brain, and they don't talk to each other as we are talking to each other right now.

 

Til Luchau  

So the octopus's arms stop communicating with each other. Or perhaps, like you said, there's in different places or different depths, is that the analogy you're describing

 

Werner Klingler  

as exactly the metaphor for this just what's happening in the brain with our different parts and neurons.

Til Luchau  

All right, so we're talking about anesthesia. How do those map out onto other states like trance or deep relaxation and body work or sleep or ecstatic states? What's similar or different about those different states?

 

Werner Klingler  

Well, basically with with our drugs which we inject, we just influence different parts of the brain, as I outlined in this, let's say the metaphor with this, let's suppose and so we also influence the different levels of our hormones in the brain. And so the the main circuits which we influence are these movement circuits which are regulated by dopamine system and the serotonin system. Then we of course, all the metabolic system is just regulated by adrenaline system, nor adrenaline system. And then we have this relaxation system which is, which is by GABA, the GABA system, which is another important system. And the most important stuff about all these different hormonal circles which we control on neuro anesthesia is that those different hormones, they all interact with, the choliner system and the choleric system. Yeah, the choliner cholinergic system in our brain is responsible for thinking. So maybe you know that Alzheimer leads to reduced choline arch system, then we also know that the metabolism is strongly linked to this choline arch system as such. So this is what we influence. So basically we can we know about our different drugs, and we know what kind of system we can influence. And so furthermore, what's it's even more important that our hormonal system works at the certificate as a specific pH level. So if you look in textbook, you can see all different kind of drugs, they have a PK value. So at what pH value there is the optimum dissociation of the drug, and the active ingredient is just taking action in the body. And so we strongly influence this dissociation activity by just monitoring the CO two level in our bodies. And so we even use this to to just to regulate the mode of action of the drugs. And so we in daily life, we even can do this. And you, you probably you did. This before, if you do the take breathing activities, you can easily get into different, let's say, pH levels. It's only a slight difference, of course, if you don't do it artificially, in the artificial ventilator, but it's effective enough to change the mode of action and the activity of drugs. So in other words, if we are in an

 

Til Luchau  

amount of action, sorry, mode of action of drugs, but also of the physiology itself, because there are altered states, becomes with different breathing patterns, like breath work,

 

Werner Klingler  

or exactly so if you, if you use breath work when that's what we do in anesthesia. So at the very beginning of anesthesia, we try to to keep people in a very, very relaxed state. We want them to have, let's say, a mode of the drugs working very well. So what we do we we do a slight hyperventilation, so we just try to lower the CO two level, so what leads to a slight increase in pH value? And we know from our chemical studies that this helps the metabolism, so we can save drugs, because the action is better in these conditions. On the other hand, if we want to just get the activity back of the body. So we use this mechanism to revert the whole process. So we just try to develop a sort of an acidic environment in the body, and this helps the metabolism to kick in. And so when, we when we just tell people, or when we try to finalize the general anesthesia so we stop, or we lower the breathing rate, and then the CO two levels rise. In other words, the pH level drops a bit, so they get a bit more acidic, and the metabolism kicks in, and so when they wake up, they feel actually, they feel fresh because all this, let's say the stored CO two has been ventilated out of their bodies before. So, but we can do this, or you can do this at home easily, because if you, if you do your breathing exercise, you get rid of your stored CO two, and this may last so in in COPD patients, if we do this for an hour or so during controlled anesthesia conditions, they feel fresh for at least even one or two weeks after, because all these CO two, let's say stores are emptied, and so they have a problem with their CO two control anyway, because of the COPD. And so this helps that, so we can do this.

Til Luchau  

So increased breathing helps empty out these stores of CO2. And these effects can last quite a while. That's right, that's correct. Okay, back to the question of the differences between the states. And if you, I know you're an anesthesiologist, and you know a lot about that, I'm wondering if you can help us think about just the relaxation we witness in body work, how is that the same or different from what we're talking about with anesthesia?

 

Werner Klingler  

Well, so all we learned just recently, just now, is the, let's say, the scientific backbone of how we can control muscle tension and connective tissue tension. So finally, we have a very different system. So the muscle tissue is dedicated towards active work. So we use this active contractor elements to do motor work. So all of oh, so maybe two thirds of our body or brain and nerves are just dedicated to muscle work. The others. On the other hand, connective tissue around muscle and nerves, they support the muscle. Muscle work, and they work differently. So when muscle tissue gets active, so connective tissue gets loose and just takes itself back in its action, because muscle tissue gets warm, temperature rises, and so the muscle tissue takes over. So if you would, would just compare it, you have maybe 100% tension when in total and you compare a warm and a cold condition under warm condition, when muscle is heated up, and so our temperature is not homogeneous in our body. So when we are talking right now, our muscle in the arms are maybe 33 or 32 degrees Celsius. However. If we do physical work, then we heat them up, maybe to 38 degrees Celsius, 39 degree even, even higher up, because this is just work we're doing with our muscle. And so then, in warm conditions, muscle takes up 80% of the load. However, in cold conditions, connective tissue takes up the load. Takes up 80% of the load. So this is how our system is regulated, very smart, and it's a sophisticated system. So if you would think of all components you need to influence the neural system. So if you just use your breathing techniques, as I outlined before, if you use your, let's say, power output in the muscle machinery. So if you, if you heat it up, then your your connective tissue has the chance to get loose. If you don't heat it up, the connective tissue can't get loose. And then in the end, if you if you have the third component, this connective tissue, nerves and muscle, they can have time for relaxation. So first, get the muscle, muscle worm, and then do this relaxation, and do even the breathing technique, and you get a better relaxation. So, but I think this is what you know much better than I how to do it. But this is the physiological background.

 

Til Luchau  

You've broken it down into some very specifics, with the breathing, with the relaxation, with the warmth and the temperature. And you're saying, when all those things are online, we get more arms of the octopus involved in this process.

 

Werner Klingler  

Is that right? Exactly, because the link between all these issues, which are very technical, is the autonomic nervous system. And the autonomic nervous system, basically is, is the most prominent reflex circuit in our bodies. And so when, if just to compare it with anesthesia, I can just use this reflex circuit very often in our in our daily life. So if we just, just just to give you an example, if you do an eye operation and you turn the eye around, you take just a little fork, you you place it under the eye muscle, and you turn the muscle so this is a strong activator of the parasympathetic axis. And so the heart will stop beating. And so what you do? You just release the muscle tension. Heart gets again, starts beating again, and I'm

 

Til Luchau  

my heart stopping just listening to you describe,

Werner Klingler  

if you want, I can send you a video afterwards, just showing this rough briefly. And then if you if you look at other sides of our body. So if we open up the belly, then there is the omentum, which is basically a big network over all these bowels. And so if you just take a tear on this omentum, which is, again, an autonomic, let's say structure fracture, and it's an autonomic stimulus. Again, the same thing happens. What? What do I tell the surgeon? Please stop tearing the momentum, and the heart will go on. And so we have a lot of these autonomic systems. But the point is, if you stimulate this nerve system, even if there's an parasympathetic, sympathetic nerves or to other other nerves. So our human beings are just at the parasympathetic axis, always is the first to react. So in our in our world around us, the first reflex, and the most prominent reflex is just to stop. And the heart stops for a second. And then after this, it gets fast, and we run away, whatever. And so this is what we can observe in anesthesia, very well. And so we make use out of this. 

 

Til Luchau  

You're saying the free, what we sometimes call the freeze reflex, or the stopping reflex is the first thing, and then the side or flight kicks in. Steven Poh just calls dorsal vagus, I don't know.

 

Werner Klingler  

Yes, exactly. That's it. And so, and we can observe this. And so what happens if we, if we use this, then we try, of course, to get people in an autonomic state where they can relax if they are frightened and the emotional state is elevated so they they are afraid of suffering from pain or the aberration does not go well, then. Then we have an altered sympathetic chest axis. And so this doesn't help us, because then the pain tolerance is reduced. And so we try to use the autonomic nervous system a lot just to influence people's process going through this operation in the period. And so what we do, we try to give them acupuncture, maybe during this period. And the best is to have a close communication, and we even do some autonomic work. So either, but just a very, very

 

Til Luchau  

this pre op, pre anesthesia on the press, preparing the context or the state of the client.

 

Werner Klingler  

Yeah, very, very, very easy exercise. If you have a patient which is well, you can communicate very well. You just tell him to take cold water three days in just before the operation, take cold water in the in the face every morning, just to activate this axis. And so this health water

 

Til Luchau  

in the face reactivates the vagal reflex and slows things down, parasympathetic elevation, etc, exactly.

 

Werner Klingler  

And this helps to helps people to get through these period, world period. So this is what, basically what we do.

 

Til Luchau  

It's fascinating to me to think about, as an anesthesiologist, that you're preparing the client or patient state for the intervention, for the treatment itself. And I remember very sophisticated like visualizations. I was with my wife through many surgeries, but getting ready for that and like sitting on the beach, imagining things your favorite place, where do you want to go get it? Yeah, taking, taking these, taking the time to really prepare her mental, autonomic, emotional context for the medical procedure. And I'm thinking we as bodyworkers could learn that a lot too, that we're working not just with fascia or just tissue or muscles, that there's a lot we could learn about preparing the autonomic and emotional context for what we're working in.

 

Werner Klingler  

So if you actually, this is a very good way to for describing it actually, if you look at the brain again, and so you look at the emotions. So we have different areas of the brain. All of you know about this. And there is this limbic system where emotions are, well, they are produced. I don't know if you can tell it like this, but emotions are just just circulating novel activities in our in the lower parts of our brain. And so this is called puppets circle or limbic system. And so what happens so during an epileptic seizure I will just briefly describe because if you look at the temporal part of the brain, which is obviously very prone to epileptic seizures, for some reason, because there is sort of a very sensitive area there, we observe that the emotional system is part of the epileptic seizure. So if we do an epileptic seizure in hospital, so we observe exactly the Ask the clients, and so I can send you again if you want. I can send you a video. Then what happens this elliptic epileptic seizure involves the emotional feelings of the person, and what happens they the maximum neural activation is all over the brain. The person is shaking and give a guess, what emotion do they suffer? Because the epileptic seizure also is a maximum activation of this limbic circuit. And so what kind of

 

Til Luchau  

scare sounds like? I would be afraid at that moment, but i

 

Werner Klingler  

Yes, you got it. So the most prominent emotion which which is displayed in our brain is fear. And so if you just stimulate, as I told you, if you do as maximum stimulation on our body in the nervous system, you get this response the, as you told us, the dorsal vagal compartment. And so we stop, and this is the same. We have a lot of fear, if the maximum emotion. And I don't want to go into terms just metaphors, but if you look at some politicians, they exactly know how to use this well. Society, the this idea. Yeah, of this frightening for for controlling societies. Look at some parts of the world,

 

Til Luchau  

sure, well, and then there's the reverse or converse. How do we engage other parts of the brain? Do we have some powers as a conductor of these different instruments, or these different arms of the octopus, do we have the power to bring online different parts of the brain, besides the dorsal system, or besides the sympathetic Is there a ventral vagal pathway, for example?

 

Werner Klingler  

Yes, of course. So basically, if you look at the higher function of the brain, so this is what we call cognitive reserve. So if you use a lot of connections, so if you train it basically as you would train a muscle, then you can just improve not only of pneumotoric system, but also your brain, your pain tolerance, and so you can also improve your, let's say, longevity, and this has been proven very well.

 

Til Luchau  

Let's go back to the state that bodywork produces, where you know when you're very relaxed, say or altered, or a sense of floating or timelessness that clients describe or that we know from receiving it ourselves. What's happening in these terms, what's happening with the octopus, or what's happening with these different parts of the

 

Werner Klingler  

brain? Yes, so if you would use an EEG measurement during such a treatment, you would observe that different spectra of your frequency bands, they change. So we have different areas in the brain with different sine waves, and so

 

Til Luchau  

the use electrical activity within the electrical activity

 

Werner Klingler  

will change, and so the bands will lower. And you could even measure this very easily. However, this is just to show that your mental state is altered. You do not know exactly which parts of the brain interact and which doesn't. So I think research hasn't, is not, is not. So we can't prove this, and I can tell you that even in anesthesia, where a lot of research is going on about this brain connectivity, we have a lot of boundaries. Because if there is in with between the age of 20 and, let's say, 60, we have a roughly good understanding what's happening. As I told you, the alpha two level is rising up. Alpha One is going up down, theta is going up, and so on. However, if you look at some individuals, this doesn't fit at all. So there are a lot of individual changes, which is a very individual system. And so I think it's similar to the pattern if you look at back pain people. And there is, I think it was Paul Hodges from Australia, who tried to find a system if you have back pain on your left lower back which muscles are compen are the compensatory activation for compensating this low back pain on the left side. And so he made a map and tried to find out, okay, left lower back pain, I always have more tension on my other side. It's opposite side. However, what came what was the result of the study? Everybody has own compensation mechanism, so the one has on this side more tension the other ones. So there is not a clear picture. I think this is what makes us being human, because we have so many different ways of compensating. And even if you look at the stress, so we are as I'm anesthesiologist, we are into delirium, post operative delirium. So what happens we have, let's say 60% they are hypoactive, and 40% or 30 or to 40% hyperactive. So if you look at the anesthesia experience subordinately In the positive room, they get agitated, they are unwell, the blood pressure is rising. They are talking some crazy things. So they're just in another world. And 60% they are hypoactive. And so basically, if you do the same procedure the next week, at the same patient, and. But you can't guarantee that next time he's hypoactive or hyperactive, maybe he's different, and so look at your at your personal condition at home, you might get, you might have a fight or an argument with your partner. One day, you just fight with your partner. You shut the door, and so leave me alone. I don't want to hear anything, and just I'm quiet in my room, quiet in my own the other day, two weeks later, you have the same system. There is a scratch in the beautiful car, and you get an argument with your partner, and then you start fighting. You are an idiot. You made a scratch in my brand new car, which is very expensive, and you start fighting. And so the same person can react completely different. And so this is this decision is made in our autonomic nervous system within milliseconds. And so we try to learn how we can influence through for giving a hypoactive or hyperactive and actually, what we do in the operating theater, in the in the post operative care room, we inject a drug which heightens the cholinergic system. So we try to improve cognition. So basically, what, what you can do in your body work, feel, if you improve the cholinergic system, so the way of thinking. So as you do just the fantasy traveling relaxation, you just go from relaxation to activation and back. So what you improve, you improve the college system, and you avoid that. You even get into this decision of arguments, or just leave me alone, a hypoactive state. And this is what we can prove in anesthesia. So if you have a person which is very well educated, which has a high cognitive reserve, as we say, So, the probability for getting into this very agitated state is lower than if you have a person who does not well, does not do some, Some, I would say, body can go cognitive first, has no positive body, let's say relationship to his body.

Til Luchau  

Okay, I need to catch up. This is fascinating. You're saying that one way that you help patients regulate post operatively is by engaging their cognitive parts of the brain. Yeah, exactly, yeah. In trauma work, we talk about reassociating with the body, but there's another branch of trauma work that says, Ask a question that the amygdala cannot answer, and so at that moment, if we start actually perceiving or looking or thinking about things, that's another way of dealing with hyper activation is that along the same lines,

 

Werner Klingler  

it's the same line, but all the everything you're saying is true, so I can just add a few comments. So what we do in this situation? We try to get the thinking going in the correct way, so we help them with their hearing aid. We help them with reminding them of their partners and so on. We try to do this to just improve cognitive activity, and this helps. In many cases, 

 

Til Luchau  

I'm thinking how after a body work session, there's we're often in a non cognitive place. We're very much in our bodies very relaxed, and there's like a I don't want to take people into thinking too hard. I remember back when we had written checks in the US. We don't have them anymore. People sent electronic payments, but no one wants to pick up their phone and do like payments after a session like that. But you're saying they're in an operative post op session. Do you want people able to function again? So maybe a little different?

 

Werner Klingler  

Yes, maybe what you could consider is to ask your colleagues about their own experiences. Because I'm very sure that if you do body work, so if you just practice from getting from a relaxed state into a very active state during such a session, I would guess, and or I'm rather sure, that during an operation, in the period operated stare state, there is a less probability or lower risk for getting into post op delirium.

 

Til Luchau  

Okay, so that's what's being about. Is post op delirium. I think we're might have different goals in body work, of course, but

 

Werner Klingler  

I'm sure maybe, maybe it is. This is something you could ask your colleagues. I'm curious. That's a great suggestion. If they had an operation themselves, did they? Did they go through anesthesia? Very well. Did they go through anesthesia? Not so well. So this is probably what you can ask

 

Til Luchau  

so many questions here. One is that I'm remembering the kind of emotional states that can happen for people post operatively, too. I mean, I experienced that myself recently with colonoscopy. So it's conscious sedation. It wasn't deep anesthesia, but upon waking waking up, there was a very tender sadness that emerged for me and and my companion who was driving me home was a little concerned, but for me just weeping away, it was actually very cleansing, and there's a sweetness to it that was part of that reemerging into conscious world. You see that in anesthesia too, don't you? Other kinds of anesthesia?

 

Werner Klingler  

Yes, so this has to do with this different hormonal systems in our brain. So what we influence is our serotonergic or serotonin system, which is linked to our just well being and feeling good. And so of course, this has to do with the drugs which we apply, because they just induce rise of serotonin levels, and then after this they get lower. So this might, might has, have to do with the sadness you were experiencing. On the other hand, every operation is sort of a stress for the body, even if it's just a small intervention. What happens? Corticosteroids are getting flushed through our body. And so if you're just, is just a rule of time for every anesthesiologist. So it's one level, one unit of cortisone per per kilogram. So in my case, roughly 100 units of cortisol I have in my body every day. And so during session operation this 100 units of cortisol are maybe doubled, or at least 150% and so cortisol usually is a strong emotional enhancer. So when you're getting the cortisol levels rising, then your emotional state is probably getting in a more positive attitude. Why you're on this just rising axis? However, after this, you get sort of a lowering of this cycle, and then many people have a feeling of feeling depressed, and even even worse during birth and delivery. So this is what many people observe, that during just pregnancy, finally, a baby gets delivered, everybody's very happy. After this, all these positive hormones just get flushed away. And so people have sort of a sadness, even if they have a newborn baby,

 

Til Luchau  

like a hormonal hangover.

 

Werner Klingler  

That's a very good word. I like this word.

 

Til Luchau  

Okay, so this is something to think about and be aware of. There. I that experience. I know this is not uncommon that people report beneficial insights or emotional experiences after deep body work or anesthesia, or these other kind of trances or breath work, like we're talking about, and I'm thinking about how that hangover risk is there, that there's a possibility of also being depressed or lower afterwards.

 

Werner Klingler  

I won't think that bodywork has an angle. I would pause. I because I can just give you a reason why. So if you look at any sort of beneficial training, our body is more or less a cyclic system. So we have a blood pressure, it's going up and going down. We have the hormonal cycle, cortisol in the morning going up. We're going on. So everybody, everything in our body, is cyclic. And so if we forget about this cyclic pattern of our body, we have a problem. So, and this is basically what's happening in our modern society. Look at me. I am to died. I'm having this phone call tomorrow and Sunday, I've got hospital work, then I'm on call in the night, and so my just my Biorhythm is disturbed. What happens my system between activation deactivation doesn't work as it should work, or it's it's as it's constructed. By nature, I tend to increase my blood pressure, my blood sugar level is increased. Everything is out of balance. And so if. We, if we want to rebalance, we should just know about the cyclic nature, and we should train the cyclic nature, coming back to blood pressure. Our blood vessels are controlled by the autonomic nervous system. They are controlled by adrenaline, noradrenaline and all those, let's say neurotransmitters causing the metabolism. So the blood vessels contract. Blood pressure is high. Blood pressure blood vessels relax. Blood pressure gets low. We can see this. Even if you drink a cup of coffee, you can see the differences. So what happens? You need to train the psychic nature and people in very, very, let's say, 50 years ago, or 100 years ago, they knew about this system. So they stepped their feet cold water, then warm water, cold water, warm water, cold water, warm water. So basically, they trained this cyclicity of the blood vessels. And so

 

Til Luchau  

this can like push ups, like autonomic push ups, somehow,

 

Werner Klingler  

yes, autonomic push ups, yes. Maybe this is a good word against you are so, so good and find the correct words so. And this happens in many, many aspects of our life. Just, just think about sexuality. You have an excitation, then orgasm, relaxation. So same thing. And this happens throughout all of body on we should, we should try to practice this autonomic push up. This is a very good word in in any way we can, even in daily life. And if you do body work, in my opinion, this is part of this cyclic training that makes a lot of sense, sleep, awake, excitation, relaxation, and so try to through, let's say, think about this in a word, of in a way, of the manual treatment. Basically what you're doing, more or less is, is treatment of the autonomic nervous system 80% or 50% of your effects.

 

Til Luchau  

You've given me a lot to think about, and there's a lot of information here, as well as these descriptions of the processes involved. There's one particular thing I'm still puzzling about and thinking for myself. And that's the way that these states dissociate the different parts of the brain, you say, or produce a disruption to our usual way of assembling things. It's almost like things get less associated, less constituted, less constellated in the usual way, and then that process of coming back together after returning to ordinary life, or something like that, there's a possibility of coming back in a different way. There's like, it's almost like a reset or reassembly as possible after a body work, or after one of these deep experiences. You have any thoughts about how we steer that, or how we might actually positively influence that.

 

Werner Klingler  

So I'm just talking about you, because I know the extremes, of course, and in in the hospital work, we have people who have extreme problems with their brain, so they are deeply depressed, or they are in a stupor. I don't know if this is the correct English word, but stupor means that they even can't move because they are in a deeply psychotic phase of their life. They just think you need to do to give them artificial nutrition because they can't move. They are in a stupor, or or they are deeply depressed. What we do? We give, we try to give them drugs, of course, and then after a while, the drugs they they even, are not strong enough to help. And so basically, we place electrodes around the brain, and so we give them sort of electricity through the brain. And so what happens, similar to an epileptic seizure, all these neurons will release their neurotransmitters, and it's sort of a reset. And so basically, this is what you were describing. This is an extreme version, and it's in high percentage. Is very helpful, because all these neurotransmitters are cleansed more or less. And so it's possible to do a re assessment, a resetting. And so in our daily life, the resetting is done on a different way, because you just introduced me, I'm a physiologist, then that's true. And so guess how we do the cleansing in daily life? We we use our tears, if you analyze the tears that are a lot of neurotransmitters inside. So basically, the cleansing is not only just losing water or something to change the volume of your lift. A brain. So we just change the neurotransmitters in our brain. And so we just try to get rid of mix them out. So to come refresh this is, this is basically the extreme. And so if you, if you use body work, I think you're doing this on a much better and softer scale, not an extreme version, as in a cardiac arrest. You would do the defibrillation exactly the same. To do the defibrillation, then the all neurons, or all heart cells arch, putting a put at rest, and then the heart can start over on a regular rhythm. And basically a similar thing is happening in the brain.

 

Til Luchau  

It brings up really interesting questions for me about how muscular relaxation is related to our perspective or our emotions or our insight, because we talked about them just now, is almost like they're separate arms of the octopus, or the octopus, or have separate functions, almost. But it's interesting to me that when we relax deeply, we come back in a different way, that there's a whole different perspective that emerges too. This is some of the puzzle that I wanted to unpack with you.

Werner Klingler  

Well, if you if you look at children, you can observe this very well. So I do a lot of children anesthesia. So if, if you work with four year old or three year old, they are in a complete state of being connected to their parents. And so then they fall asleep, and you give them an idea of, let's say, a fairy tale, or some pet they like. And so when they wake up, they they have very, very large pupils. And these very, very large pupils, they show us that the state of their brain is cognitive. Cognitive function is coming back into the brain. And so in adults, you can see it, but not so clear, because it's the time course is shorter. However, in children, had they have two or three minutes, the pupils are wide open, and this is the cognitive system has just a fight with the other hormonal systems in the broad in the brain to kick in back cognition. And so this is an indicator that cognition is coming back. And then after the pupils get smaller, and the children they get to back to life, they have this perspective and completely different perspective. And so it's even, it's you can even see when they sleep, when the connection between the parents and this cuddly toy and so on, is a very calm, calm situation. And so you can even see that this, they can take up this idea when they wake up again. However, it's a constant fight between these symptoms, and it's not always. I cannot always just steer it in the correct direction. I try, of course, to give them as much as positive input as possible, but sometimes they are still the emotion fear is overwhelming. To avoid this by giving them cognitive aid as much as cognitive symptoms as well. So I think the answer is to improve this cognitive cycle. Relaxation, activation, relaxation like this, cognitive push ups and ocean.

 

Til Luchau  

Nice, nice. There's, I know that Robert Schleip has speculated about this some, but there's questions about the value of sensation in the changes we see in body work and for example, under anesthesia, people's range of motion at their shoulder gets much bigger, and there's questions about, would body work under anesthesia produce the same effects as someone who's not anesthetized? Does the sensation of the work have an impact as much or more than the tissue and objective tissue effects?

 

Werner Klingler  

Well, we did this, and with Robert, we did a video about this, so I took Robert with me in the operating theater. So we had this nervous system compartment syndrome, which what is basically a connective tissue thickening around the nerve. It's an overall entrapment syndrome. So people have in their arms, they have a nerve running down this arm, and then basically they feel some tingling. And so it's, it's not very pleasant. And so what we did, we took a camera, as we do an operating theater. We take, took the camera inside this novel chef. We looked under the skin, and so we saw the restriction. And Robert did this manual therapy on this compartment, and then we found out that there are loose connective tissue bundles which cause this noble entrapment. And so you can even with this massage, Robert could just break some of these connections. However, then we got further up where this entrapment was even worse, where the nerve was even swollen, and then he did really strong manual therapy. But even then, in this very single case study under camera, we couldn't just get rid of the of this very tight entrapment. So then we had to use the scissors just to open up this, just this novel entrapment. However, on this part where it's just a partial entrapment, it was helpful. So I'm very hurt, and so you can it does work, of course,

 

Til Luchau  

to do manipulation under anesthesia. So there are actual tissue effects, yes, of

 

Werner Klingler  

course. Okay, tissue, their tissue effects. You can even do it a bit more effective, because the patient has no pain, because you want to do a biomechanical you have several aspects the biomechanical work to loosen up restrictions. If you have a scar to lose restriction, you can do manual work, or you can inject some saline just to loosen up the tissue. This will work under anesthesia, for sure. Then there is the second aspect. This is the sensory component. If you want to use the sensory component for getting a rebalancing of the autonomic nervous system, I think this is better without anesthesia, but it might be. It might work with anesthesia as well, because if you look at the reflex circuits under under your anesthesia, they stay are still okay, they still work. So we we do reflex circuits under anesthesia. We just check them, the H reflex and so on. And this is still working, and the anesthesia under anesthesia. And so if you do this, if you do venal work, and you influence this reflex circuits, which is altered in in pain, in chronic pain, then you can influence this as well. I'm sure

 

Til Luchau  

that's it's fascinating to think about the different targets we have in our work. Is it tissue? Is there reflex arch? Is it sensation itself? Talk about the sensory rebalancing that could happen under a non anesthetized state, or the tissue effects might even be we can go farther with an anesthetic sedate. Okay, so what about working with people that have just had surgery? Other things body workers should know about themselves or their patients, their other clients who have just come from surgery or have recent anesthesia? Any any thoughts about that?

 

Werner Klingler  

Well, the thing is, if you analyze all surgery patients in the Western world, so in the developed world, so I think the US, Europe and so on, so the mortality after surgery is 2% so it's quite high. So if he I look at my operating theater, we have, let's say, maybe 5050, patients getting operated every day. So we lose one in the time span of three months. So I think we you, you should if you want to improve mortality. From my perspective, it's probably another topic. However, then you need to look at the autonomic nervous system, because if you look at those people who die, in 90% of the cases, they die because of the cardiac problem after surgery. So what mental therapists can do? Because surgery is obviously is done in elderly people most of the time, they can care for the cardiac system, and the cardiac system needs to calm down. So we know that if the heart frequency is below 60 or 55 then the mortality is much lower. And I'm very sure that manual therapists can very effectively influence the heart rhythm. So just if you lower the sympathetic activity and you lower the heart rate, then the person has a significant benefit.

 

Til Luchau  

Maybe there's a role preoperatively too. Maybe surgery preparation, body work would have a role in that as well. Yeah,

 

Werner Klingler  

there. Unfortunately, there was a study in the UK examining, I think, three or four different systems of versions of physiotherapy and just checking if the outcome is better and they could not prove a benefit. So I don't think that this is. End of the of the story. However, in this preliminary, first, first data sets, we're getting the effect that the scientific proven effect is lower than, as we expected. Unfortunately, interesting, curious about the study, probably, probably this is not yet investigated in a very maneuver.

 

Til Luchau  

Well, thank you for talking us through these points, and thanks for the speculation. Final thoughts, summary, things you'd like people to go away with.

 

Werner Klingler  

Well, I think the final thing is that you should be sure, or you should be aware that fascia is a very important part of our body, and fascia is alive. It's not just connective tissue, which is passive so we can work with it. It's restructuring. It's remodeling, and it's very important for sensory aspects, for our autonomic nervous system, for our biomechanical stability and for our humoral and hormonal system.

 

Til Luchau  

Thank you. Thank you. Werner, we'll put some links into those videos you mentioned. Maybe this study, how can people find out more about these topics, or what are the resources would you like to leave people with?

 

Werner Klingler  

So I mean, the best way is to look into the books which have been edited by Robert Schleip, because all the content I was talking about is in these books. However, if you have more more details, then you can even follow Til Luchau's, just the block, and Til Luchau's work. I think you have a lot of extra literature as well.

 

Til Luchau  

Thank you. Werner, how about the Fascia Research Society? We should give them a mention here too. We should make people aware of that. What do you want us to know about the Fascia Research Society?

 

Werner Klingler  

But a Fascia Research Society, basically is has been built to foster science and networking between researchers and manual therapists. So basically, I would encourage everybody to support the society, because they are, I know that they are working as a nonprofit organization to try to make events happening. And so the last event in New Orleans was obviously quite difficult. I don't know details, but it was difficult to to get it going. And so the next conference will be in Europe, I hope, because for me, it's easier to travel. And so you might be interested in coming to the next Fascia Research Congress. 

 

Til Luchau  

We don't have a date yet, but, yeah, it's coming. We know. Yeah, the last

 

Werner Klingler  

December 2028

 

Til Luchau  

November. 2028,

 

Werner Klingler  

I said, September, 2028. Okay, sure, I'm not involved. Is not the official announcement. Speculation, great. And there's Yeah, they do it in September. 

 

Til Luchau  

and then the challenges to getting the last conference started, there was concern that various logistical, financial et cetera challenges would get in the way. But in the end, it ended up filling. It ended up being amazingly well attended and quite quite well received in many ways. Werner, you had a another resource for people, or another idea for people, what was it?

 

Werner Klingler  

So everybody who is interested in sharing his expertise is invited to join FRECLS project. So FRECLES is an abbreviation and stands for fascia researches consensus and liaison statement and basically what we're doing, we try to get knowledge from basic manual therapists and researchers, and to include this into a big database, and to get people talk to each other, and just even, even if they just read about different strategies researchers have and manual therapists have, this will help us. and so I just want to invite you to be part of something bigger. And this bigger project is this joining together, this networking between all these different specialties. And so finally, you can even be co Archer on a scientific publication, which is basically the product of this network working process. And so if you could, if you would like to join, just register@frecls.org F, R, E, C, l, S.org,

 

Til Luchau  

Okay, we'll put a link to the Fascia Research Society. We'll put a link to these things you mentioned in our show notes. Thanks again, Dr Klingler, for talking with me. I'll go ahead and thank our sponsors, and then we'll say goodbye. Books of Discovery has been a part of the massage therapy and bodywork world for over 25 years. Nearly 3000 schools around the globe teach with their textbooks, e textbooks and digital resources, books of discovery likes to say, "learning adventures start here". They find that same spirit here on the Thinking Practitioner podcast, and they're proud to support our work, knowing we share the mission to bring the massage and bodywork community thought provoking and enlivening content that advances our profession. Instructors of manual therapy. Education Programs can request complimentary copies books of discoveries, textbooks to review for use in their programs. Listeners like you can explore the collection of learning resources for anatomy, pathology, kinesiology, physiology, ethics and business mastery at booksofdiscovery.com where Thinking Practitioner listeners save 15% by entering "thinking" at checkout. Thanks to all of our listeners, you all out there and to our sponsors. Stop by our sites for the videos, the show notes, the transcripts, the extras. Whitney Lowe will be back. Here's a site, though, where you can find those things, academyofclinicalmassage.com, my site, advanced-trainings.com, and we want to hear your ideas. We want to hear your feedback. We want to hear your input. Email us at info@the thinkingpractitioner, or just look for us on social media under our names Til Luchau and Whitney Lowe, as always, would appreciate it if you would rate us on Spotify or Apple podcast. It really does help the sponsors know that their their support is well given, and it helps other people find the show, which is always great to take a second now just to go give us a rating and thanks, as always, for telling a friend. Thanks again. Dr Klingler for joining me today. Goodbye.