Show Notes:

12: Coronavirus symptoms range from mild to fatal. Though still mysterious, in many patients it seems to be the patient’s own inflammatory reactions that tip the scale. Til and Whitney explain this, and talk about the implications for massage and manual therapy.  

In this episode,

  • What is the deal about COVID-19 and cytokine storms? 
  • What is a cytokine, and why do I care? 
  • As massage therapists and bodyworkers, where does this leave us? 

Join two of the leading educators in manual therapy, bodywork, and massage therapy, as they delve into the most intriguing issues, questions, research, and client conditions that hands-on practitioners face. Stimulate your thinking with imaginative conversations, tips, and interviews related to the somatic arts and sciences. With Whitney Lowe and Til Luchau

Resources discussed in this episode: 

Sponsor Offers:

Your Hosts:

Til Luchau Advanced-Trainings        whitney lowe
Til Luchau                          Whitney Lowe

Thanks for listening and subscribing to the podcast! Make sure to connect with us on Twitter, Instagram and Facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on Apple Podcasts!

Your Hosts:

Til Luchau Advanced-Trainings
Til Luchau

whitney lowe
Whitney Lowe

Thanks for listening and subscribing to the podcast! Make sure to connect with us on Twitter, Instagram and Facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on Apple Podcasts!

(The Thinking Practitioner Podcast is intended for professional practitioners of manual and movement therapies: bodywork, massage therapy, structural integration, chiropractic, myofascial and myotherapy, orthopedic, sports massage, physical therapy, osteopathy, yoga, strength and conditioning, and similar professions. It is not medical or treatment advice.)

Full Transcript:

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The Thinking Practitioner Podcast:
Episode 12: The Cytokine Storm of COVID-19

Broadcast date: 4/22/2020
©Copyright The Thinking Practitioner Podcast, Til Luchau & Whitney Lowe

Til Luchau:

Hi. This is Til Luchau and today's episode is sponsored by Handspring Publishing. When I was looking for a publisher for a book I wanted to write years ago, I was lucky enough to have had two offers. One from a huge international media company and the other from Handspring, a small publisher in Scotland, run by four great people. I'm really glad I chose Handspring as not only did they help me make the books I wanted to share with you, the Advanced Myofascial Techniques series, but their catalog has emerged as one of the leading collections of professional level books written especially for bodyworkers, movement teachers and professionals who use movement or touch to help patients achieve wellness.

Whitney Lowe:

Yes, and I'm Whitney Lowe here. I just want to also say Handspring has a new instructional webinar series, Moved to Learn. It's a regular series of 45-minute segments featuring some of their amazing authors. So head on over to the website at handspringpublishing.com to check those out. And while you're there, have a look at their excellent catalog and be sure to use the code TTP, that's like The Thinking Practitioner at checkout and we appreciate the sponsorship of Handspring. Thanks again so much.

Til Luchau:

Yeah, that code gives you a discount off the stuff you buy from them. Thanks, Handspring. And thanks, Whitney. How you doing?

Whitney Lowe:

I'm doing well. Good to see you once again. We've been on opposite sides of the world for a couple months now. You've been doing some major traveling, so I want to welcome you back home and welcome you back to the podcast. I've missed doing these for a while. It's good to get going again.

Til Luchau:

Likewise.

Whitney Lowe:

How was your trip?

Til Luchau:

Trip was just astounding. We started 68 days ago. I just got back yesterday. Started 68 days ago in Thailand and had our Advanced Trainings retreat there and then taught classes in Taiwan, which was on full lockdown at that point, dealing with the coronavirus spread. They did a really good job of, it was probably the last in person event there they're going to have for a while. We taught 80 people, all masked and gloved. Everything else was quite an experience.

Whitney Lowe:

Wow, yeah.

Til Luchau:

And then went on to Australia, where we ended up sequestering for about a month in a beautiful spot up in the Blue Mountains and had some great, from a distance support from people living in Australia and it was a good place to watch all this unfold and see how the world is adapting to these things coming forward.

Whitney Lowe:

Yeah, we had couple of events we did and I notice you did some Facebook live events, doing some things to reach out and connect with everybody and it certainly has been interesting to watch everybody's attempts to find new ways to connect with each other. And I've been especially doing a lot of work with the schools and trying to find ways to help maintain ongoing classroom things over the distance here too. Innovation has certainly been one of the big key things that's come out of this I think for sure.

Til Luchau:

I bet that's keeping you busy.

Whitney Lowe:

Yeah, indeed. Indeed. I've been banging the drum about the validity and importance of online education for many years. I think now it's really coming to be evident how important that can be if it's done well. But I would certainly prefer to have it happen under different circumstances and not this kind of emergency freakout try to get it done with no planning whatsoever. That's been a challenge for lots and lots of people.

Til Luchau:

It has been and yes, you're doing it well is the key. And I know you've been leading that vanguard for a long time.

Whitney Lowe:

Yeah. One of the questions I wanted to ask you was just I find this so fascinating to the intersection of our field in difficult cultures. I know we talked earlier on one of the other episodes quite a while back when you had been over in Europe. And I want to know from a curiosity standpoint, what did you find to be most interesting about what's going on in the bodywork communities in these countries and Asia where you were? Asia and Australia? Anything stick out as particularly fascinating or interesting about the way things are done differently?

Til Luchau:

Well, Taiwan is really a unique culture. It really is a confluence of Western influences and Eastern influences. And the practitioners there were very well educated and very familiar with a lot of approaches that are taught here in the states and in Europe. And that was a real joy to work with, their deep background in the sciences and what we were teaching and what we're bringing to them. And then Australia is just such a unique place. It really is. In some ways, it's the place in the world I think is the most like the US and Canada. And yet, it's its own parallel universe there. If you just think about the flora and fauna, so many of the things there are familiar, but then you look at them a little closer and you realize, "Wait a minute. This is a really different animal, a really different  that I'm used to."

Til Luchau:

And the culture's like that too. At first glance, it seems fairly familiar and then the more time you spend with it, you realize there's a very distinct take on life that comes from living down under.

Whitney Lowe:

I think again those things are colored a great deal by the geography and the other aspects of life that are different in those places too. I think that kind of stuff is really fascinating. It is incredible, I think, the way that things like the internet has allowed us to communicate in almost, well, in real time with people on the other side of the world and get far more connected with those cultures and with things that are going on in our community. Because early on in the days when you and I first got started doing this, we would always hear about things that were going on in other parts of the world. What are they doing in Australia or New Zealand and maybe you might learn some things once you go down there see it, but there wasn't the regular ongoing connection that we have now with this real time communication. It's bringing us all closer together.

Til Luchau:

It drives home that we're living in a global culture. And they're familiar with exactly what's current just like we are in this country and we're living in this, the epidemic is showing us we're connected all around the globe in real time.

Whitney Lowe:

Yeah. I think that is absolutely true and we're going to try to touch base on that a little bit today and that takes us into our topic today is that degree of interconnection of how we're all vulnerable in many different ways. Because of the time limits and what's going on as we're recording this here in early April, we are in the midst of the coronavirus. We're probably not at the peak here in the United States yet. We're having some very serious hot spots, but some indications that we may be starting to temper it a little bit. But still, it's a very, very serious concerning public health situation going on here.

Whitney Lowe:

We're go talk a little bit today about some facets of this and maybe touch base too on how that's impacted our professional communities and ways that we can look at what we're doing on the other side of how this all comes out as well. Today, we're going to talk a little bit about cytokine storms, a term that some people may hear a little bit in talking about this. So, tell me about this, Til, because I know you've been doing a great deal of study on inflammatory issues for some time want to fill us in a little bit more about what is a cytokine storm? What are cytokines? And how does this relate to what we're hearing about in the public health news.

Til Luchau:

Well, in context too, the topic is timely. We pushed this topic up in our publication schedule because we wanted to talk about something related to the virus and yet I'm thinking by the time this is published, I think mid to late April of this same year, we'd have to think about the fact that we're learning so much as we go. Everything we know is being figured out along the way and is up for grabs. And the same is true for the cytokine storm issue. It was first, I first saw it in Vox back in early March and in the New York Times just a few days ago published a big article on it. But the concept there, cytokine storms, the concept is that at least a certain number of the fatalities that result, it's not the virus that kills people, it's actually people's own immune system that goes haywire and causes their death.

Til Luchau:

There's a little bit of a reluctance even getting started to talk about this, because I just really want to emphasize there's such a broad range of reactions that people have to the virus. From zero symptoms and we're learning as we go, but it looks like there's a large number, maybe the majority of people, have zero symptoms who are exposed to a sore throat and a cough. But then, of course, all the way to the minority who do end up seriously ill, having to be hospitalized and some of those even die.

Til Luchau:

So, the cytokine storm turns out we're not sure how many of those people that die have this going on, but a number of them seem to and yet, the cytokine storm isn't the virus killing you per se, it's your own reaction to your own immune systems fighting the virus that ends up killing in those cases.

Whitney Lowe:

Yeah. Let's back up a little bit for those who may not be as familiar with what we're talking about here when we mention the cytokine storm. Tell me a little bit more. What are cytokines and what role do they play in both the coronavirus as well as numerous other compromised health conditions where cytokine storms can also occur.

Til Luchau:

Yeah. Cytokines are signaling molecules. They're little bits of protein that basically signal immune processes. They're released by immune cells when they detect damage or they detect a pathogen like a virus or the damage caused by a virus. These immune cells release cytokines, which are signaling molecules. They go out and they signal immune processes and other immune cells, which come in and help fight the infection or repair the damage.

Whitney Lowe:

When we hear the term cytokine storm, what you were referring to just a few moments ago to, is this is a situation where maybe the instructions that the cytokines are giving to the system are not correct of not being handled correct and that is causing the system's reaction to be excessive and essentially is what we're saying. Is that accurate?

Til Luchau:

The instructions are probably correct. The cytokines just say, "Hey, come over here. I need some help," or "Attack," or whatever it is that they say, but the instructions are correct. What happens though, the storm part is that first wave of cytokine goes out. White blood cells, for example, come in and attack the damage and the virus. When the cells are attacked and destroyed, they're release more cytokines, which go out and send more white blood cells, which release further levels of cytokines and for whatever reason in this minority of cases, that escalating storm of cytokines isn't being regulated and turned off as it would in a normal inflammatory reaction. And it keeps building until the system essentially becomes overwhelmed by that acute phase of inflammatory response.

Whitney Lowe:

It would seem, it that is really the case, then our primary strategies for trying to tackle something like this, and this is from also some of the things that I've been hearing in the discussions from the public health officials about the investigations and the research as they're trying to find treatments, have focused a lot of attention on anti-inflammatory treatment strategies because that will try to mitigate some of this cytokine storm. But it appears that we really haven't been that effective in finding a good anti-inflammatory treatment strategy. Is that also... again, this seems like part of the systemic problem, because it's not just the way we think of inflammation as being a local problem where we could just slap some ice on this or take some corticosteroid or something like that in a localized area. There's something that seems to be much bigger happening here.

Til Luchau:

You said a few things that I should respond to there. And I'm really pacing myself, because inflammation gets complicated really quickly. And it's hard to talk about one aspect without talking about all of it. But first of all, it's not just about anti-inflammatories it turns out. And you're right, we haven't found effective ways to use anti-inflammatories to regulate this kind of thing. Part of that is the model. It turns out that cytokines themselves can be anti-inflammatory or pro-inflammatory or pro-resolution. And it's probably the case that what we need is resolution, not anti-inflammatories to end something like a cytokine storm.

Til Luchau:

Now, we can turn it off temporarily by using things like steroids and that's what intensive care units are using for patients that are dealing with this. They use a steroid to essentially turn off the immune system, which stops or slows down, rather, the cytokine chain reaction, but it doesn't help with fighting an infection. Because you've turned off the immune system and the immune system is what you use to fight the infection. So, it's a complicated situation.

Whitney Lowe:

Yeah, that seems like that would be one of those things which is a difficult balancing act of how much do you turn off the immune system, because then you are susceptible to flaming up of other things that might be potentially putting your life in jeopardy, but then obviously you need to turn down the heat on the response from the cytokines.

Til Luchau:

Let me get back to that. Because it's essentially the same quandary you face when you have an achy joint or a chronically inflamed musculoskeletal issue. Should I take and anti-inflammatory or not? Because the anti-inflammatory, it's pretty common here in Colorado for people that are skiing to dose up on vitamin A, in other words, Advil, before they go skiing so that their achy joints or whatever don't bother them during the day.

Til Luchau:

Now, the problem with that is 1) You might do things that are mechanically stressing you more than your mechanics can take. 2) You're turning off the healing processes. Not only are you turning off the pain and sensitivity, but you're turning off the benefits of inflammation too. Inflammation has a really bad rap. That's like the bumper sticker that would come out of the inflammation training that I do is that really we need inflammation to heal. We need inflammation to repair things.

Til Luchau:

Now, in the cytokine storm situation, it's gotten out of hand. And backing up a little bit more too, there's different phases of inflammation and that's important to understand when you're thinking about this too. The acute phase when those white blood cells come in, is basically about attacking, destroying, breaking things down, either the invader or the damaged tissue from the mechanical damage or from the invader itself. So, that first phase, you got the white blood cells and a bunch of other things, peptides and enzymes and oxidative mechanisms that are basically tearing tissue apart. When that goes on too long, that's what causes the damage.

Til Luchau:

Usually in a healthy inflammatory reaction, those things, the brakes are being put on almost immediately, within minutes of that initial acute reaction. Other cells come in, other cytokines get released that start to slow that thing down and actually start to repair the damage as it's being done.

Whitney Lowe:

This sounds very similar to a lot of the arguments that we've seen in the research literature in the last few years about whether or not ice is a good idea after an acute injury, talking about well, there really is some potential benefit to the inflammatory response that happens after that injury and maybe we shouldn't be tamping it down with ice. But this seems to be happening on obviously a much more systemic and global basis than the localized inflammatory response of an acute musculoskeletal injury.

Til Luchau:

That's right, we have inflammation going on all the time. All the time in multiple places in our bodies at multiple levels in our bodies. It's good. We need that. That's basically called healing. Called repair and healing throughout the body.

Til Luchau:

Now, the ice... yeah, the ice debate. If I want to start an argument in a room full of therapists, I can bring up ice or I can bring up diet in terms of inflammation, right? There's going to be different opinions about that.

Whitney Lowe:

And there's probably some other good hot topics 

Til Luchau:

There's a few other hot topics. But those around inflammation, those seem to be a couple of the key hot spots so to speak. And yeah, the ice debate goes, "Well, should we actually be stopping or slowing down inflammation because that's the healing process? And my takeaway from all that and not that I want to short circuit any of those important debates and questions, but at the end of the day, my takeaway is if the goal is temporary pain relief, then ice has some benefit for some people sometimes. If the goal is long-term healing and strengthening and adaptation, then you don't want to slow that down. You don't want to inhibit that. You want that cycle to run its way through.

Whitney Lowe:

And then also, I think there's a lot of that that seems like it would be relevant for the look into whether or not anti-inflammatory pain medications such as corticosteroids are really a strategically good idea in many types of musculoskeletal disorders. They tend to be very effective as pain management, but they may be... there's a good bit of evidence that there's, in many situations, causing a longer term delay in really good tissue reparative processes because of the other physiological processes involved with them.

Til Luchau:

Absolutely. Yeah, there's good research showing that. That steroids, for example, or corticosteroids do help some pain and they probably prolong the healing process. And in some cases, repeated exposure, like a couple of cortisone shots or more end up causing their own set of damage issues that come later. They're powerful drugs and it's good if I'm in an emergency room or rather intensive care unit with inflammatory storm, then I'm glad the doctors have that in their toolbox. But the answer isn't just anti-inflammatories. That's like the acute response. That's the lifesaving mechanism.

Whitney Lowe:

Yeah. Yeah. I think in so many of these situations, we see that we're running up against judgment calls of weighing those benefits of how much are we going to compromise this one system in order to save this other system and then tilt the scales back in the other direction. And those are very complex decisions that I think they're having to make under some incredibly difficult stressful circumstances. Just watching the news that these hospitals with people in the hallways and out on these emergency hospital, makeshift hospital environments, just incredibly difficult situations in which they're having to make those kinds of very challenging life or death decisions for people.

Til Luchau:

And there isn't research to fall back on, really. And the cytokine storm idea has actually been around since, I think it was 1993, that it was first named in that way. And it was studied in terms of transplants and grafts because that can happen there too. And there's a few other conditions where it's happening. It's suspected in schizophrenia and in major depression as well as Alzheimer's Disease and some kinds of cancer, there probably are cytokine chain reactions going on in those things as well. But the big one is the Spanish flu from 1918. That big epidemic. The thinking now is that it killed most of its people through cytokine chain reactions other than direct viral effects.

Whitney Lowe:

Now, I read some things about that recently in looking into some of this stuff and I was curious and this gets probably into something like forensic epidemiology or something like that, how in the world do you come up with those ideas for something where the information is 100 years old of what happened to all these people? It's pretty fascinating.

Til Luchau:

I just read in one of these studies I've been looking over, I just read a quote from somebody writing... this was a few years ago from before the coronavirus issue. He was writing about the 1918 Spanish flu. He said it's too bad virologists don't live for 200 years because then we'd see if our theories are true. But they actually have reproduced the Spanish flu virus from fragments. They've essentially cloned it to study it. And there's been a lot of going back and looking at tissue samples and reanalyzing and reconstructing what probably did happen there. And it turns out, yeah, it was probably cytokine storms and that flu killed young people more than old people, which is interesting. And in the case of the cytokine storm effect, that's stronger in young people who have a strong immune system. So, if you have a strong immune system, you have a stronger reaction.

Whitney Lowe:

Yeah, fascinating stuff. Well listen, I want to also come back and look at some other issues, especially how this is touching us in the massage and bodywork community here a little bit in our second half. We're going to take a brief moment to hear from our halftime sponsor.

Whitney Lowe:

And today, our halftime sponsor is ABMP, the Associated Bodywork and Massage Professionals. An ABMP membership includes 50+ member discounts on everything from massage tables and supplies to cell phone service and all the members can access over 200+ continuing education courses with free CE hours. You can read ABMP's award-winning member magazine Massage and Bodywork at www.massageandbodyworkdigital.com and I would just comment that Til has a really good article coming out this month, probably very shortly. By the time this episode airs, it's probably out there on the cytokine storm and the issues related to coronavirus. Listeners who join ABMP as new members can save $24 on their membership at abmp.com/thinking. From ABMP, you can expect more.

Til Luchau:

Thanks to ABMP too. Yeah, they did a great job of reshuffling their priorities and they're really offering a lot in terms of both information and coordination for the bodywork and massage communities. So, thanks to ABMP.

Whitney Lowe:

Yeah. Right. I want to touch base on some of the things that we were just getting to here as we start to look at this in terms of how it's affecting some of the things that we're doing. I want to hear some more about the things that you've been looking into with your study of inflammation recently. Just in a higher up level, we hear a lot frequently about the potential benefits of massage in helping the immune system. What are your takes on ways in which... now, obviously we can't be doing massage right now because of the danger of spreading the virus, but at the time when people are able to start getting back to work, what kind of things do we see as potential benefits of something like the soft tissue manipulation work that we do being beneficial for and helping to manage some of these kinds of reactions with inflammatory responses?

Til Luchau:

That's a super important question and to answer it, I just want to repeat that distinction between acute and chronic inflammation and local and systemic inflammation. And it's probably the case, I'm sure, in fact, that bodywork and massage, immunotherapy as only indirect benefit for situations like corona and like you said, we're not even going to try to work on people while there's danger of infection. But even other systemic acute reactions like, think about allergic reactions, think about other kinds of flu, think about autoimmune issues. Those are in the same realm of systemic inflammatory reactions.

Til Luchau:

And you don't massage someone with the flu and make them feel better. At least not using pressure. And the same is true say with a bee sting that's getting a strong allergic reaction. You're not going to rub that better. And so that model really applies to all kinds of inflammatory reactions. It's not about pressure, it's not about rubbing, it's not about thinking of specific tissue effects for most of those systemic inflammatory reactions and most of the acute ones as well. We can benefit those situations, but we do it through the systemic effects that massage and bodywork have.

Til Luchau:

There's a lot of things we can do to support systemic immune competence and that's really emerging as the key concept here in both coronavirus and in overall health is how competent is your immune system? How well can it respond? How resilient is it? It is a function of people's wellbeing and their overall level of health.

Whitney Lowe:

Yeah. That really taps into something that makes us think about, or at least makes me think about the potential preventative role that we might be having for this kind of thing. Because it appears the people who are most vulnerable to succumbing to the symptoms of the coronavirus have been those with immunocompromised systems where the immune system is not able to really let's say work at its optimum function and gets overrun and overcome. Maybe trying to look at massage as a treatment per se.

Whitney Lowe:

For example, we think of massage as a treatment for soft tissue musculoskeletal disorders after they have occurred. But in this situation, we may see some things like the idea of massage and manual therapies that we are applying being really effective in helping to maintain good consistency in strengthened immune systems overall just by decreasing the stress levels and increasing senses of wellbeing and all of those things that are very subtle, very hard to measure, but we do know they have an impact on the immune system. And so maybe it's one of those things that's not as clear cut a direct line for a cause effect benefit of the treatment, but it's something that has a lot of power to help encourage healthy immune systems that can fight this off and keep that cytokine storm from getting out and spinning out of control.

Til Luchau:

Perhaps could be. You bring to mind Ida Rolf, who was adamant... My background's a rolfer, steeped me in this. She was adamant that we're not fixing problems, we're integrating the whole system. And she's not the only one who has that point of view, but that's reemerging as a holistic health point of view that says, "Let's think about the health of the whole person, the whole system." And there are, like you said, very clear documented effects of both one time intervention of manual therapy and receiving it regularly, the role it can play in someone's overall health and wellbeing.

Til Luchau:

Now, I should also say and I know you're aware of this too, that there's controversy around the claims that people make about come in for treatment and prevent getting coronavirus. Take care of the immune system by getting my treatment. It's not that clear. You can certainly exaggerate those claims as well. But it's true that we have a role to play in people's overall health and will prevent things including susceptibility to disease.

Whitney Lowe:

Yeah. Prevention in general is a very difficult thing to prove, because it's hard to say, "Well, if you hadn't don't this, you would have gotten so and so." That is, of course, from a logical and statistical standpoint, extremely difficult to prove. But we can make some generalized assumptions when we know that there are some significant benefits. And again, just to put this plug in here, this really is a very good example of the importance of supporting research in our field to help look into what are some of these more global and systemic physiological effects of the work that we do so we can make some determinations about how we would most appropriately apply this in situations that might be helpful for people. These kinds of things that we're looking into, this is why it's so important. This is why it's so important for us to do that.

Whitney Lowe:

I want to backtrack for just a moment too, to talk a little bit... we've obviously most of us are focusing a whole bunch of attention right now on the coronavirus, but cytokine storms are not unique to the coronavirus. You touched base on this just a little bit earlier, but what other kinds of things occur where we see these cytokine storms happening. What are the type of problems might people be on the lookout for and what are some of those key indicators that would indicate something like that's going on?

Til Luchau:

Key indicators for an immune system overreaction like the cytokine storm.

Whitney Lowe:

Right.

Til Luchau:

Well, I mentioned some of the other medical issues and even psychological issues that are suspected to be related to this kind of cytokine storm reaction, like schizophrenia, major depression and Alzheimer's, some kinds of cancer. But stepping back a bit, inflammatory dysregulation is a factor in almost all musculoskeletal complaints. So anytime someone comes in with a sore, achy joint, there's probably an inflammatory component. And that inflammatory component doesn't mean inflammation's bad, it means that it hasn't been able to resolve. And so-

Whitney Lowe:

And is that inflammation in those situations simply because the body is sensing, "Hey, there's something wrong here. I need to try to fix this and this is our standard protocol for fixing things." Or what tends to have kicked off that inflammatory response in let's say a relatively simple musculoskeletal issue that doesn't necessarily involve torn, damaged or significantly impaired tissue structures?

Til Luchau:

All right. We're talking about things that don't involve that on a musculoskeletal level. Just to be clear, we're dialing it down now to acute local inflammation. By the way, the mechanisms are the same across systemic, chronic, acute, etc. it's just the magnitude and the pervasiveness of them. In an achy shoulder joint, say, we didn't fall, you didn't strain it, but it's achy. It's been achy for a while. The role that inflammation might be playing there is the, again, it's the body's attempt to protect and repair threatened tissues.

Til Luchau:

Just like pain itself which is probably the brain's attempt to protect that part of the body, inflammation is your immune system's attempt to protect that area physiologically through these cytokines and through cells that look for damaged tissue, tear it out and build new tissue like fibroblasts where it might be needed.

Whitney Lowe:

What got me thinking about this is I'm just running from my hip thinking about lots of the different common musculoskeletal disorders we hear about all the time and just wondering there's probably some, like you said, degree of inflammatory reaction happening in almost all of those things to some degree and in many instances, it may not be apparent. We tend to think about this, "Well, I don't see any puffiness. I don't see any redness or swelling in there, so there's probably not inflammation," but so much of this 

Til Luchau:

It's hard to find conditions where it's not involved. The list of exceptions is very short. And in those cases, it's usually genetic or a tissue based thing where it's not an inflammatory reaction of the body to damage or perceived damage or that kind of thing. It's a more innate response or an innate quality of the tissue. Those are rare. Most of the things that people experience on an ongoing basis musculoskeletally have an inflammatory component. And the problem there is not resolving. Inflammation not resolving.

Whitney Lowe:

Yeah. And that's why the person has... I go out in my yard and I do a whole bunch of yard work on the weekend and lift a bunch of heavy rocks and my back hurts for two days. No matter what I do, there is some degree of overload on those tissues that have caused some degree of irritability to kick off some inflammatory response attempting to address the acute overload on those tissues. And even though I haven't necessarily strained or torn them or caused what we would consider to be characteristics of a strain injury, there's an inflammatory response in there that's just going to take a couple of days for that to resolve.

Til Luchau:

The soreness you get after you go to the gym, after you do some yard work you're not used to, after you do anything you're not used to, that soreness afterwards is inflammation. Delayed onset muscle soreness is an inflammatory reaction in the muscles themselves. The body resolves that. That's part of strengthening and adaptation process. It clears up any damage that did happen, it builds some new strength and tissue and your nervous system gets used to that kind of stimulation as well. The pain cycle is part of the inflammatory thing. But I can tell, you're going to get me talking about this. I'm going the whole other episode if we're not careful.

Whitney Lowe:

Right? Well, and I want to always bring this back to the put you on the spot question again, which is does massage or soft tissue manipulation or structural integration, rolfing, whatever it is that is your tool, does it do something for the inflammatory processes here? For these types of inflammatory issues. What can we think about in terms of the major physiological responses of what we do that might be beneficial. If I wanted to, let's say, talk to my clients about why what I'm doing is helpful, what's the simplest easy things that I can say to them about here's why this is really good for you?

Til Luchau:

It helps inflammation resolve. That's the short answer. The real answer is the longer episode, where we go through the different ways that it helps inflammation resolve.

Whitney Lowe:

Okay, can I poke that a little bit and just say, "How? What's the major mechanism?" Can I do that without getting into the other episode?

Til Luchau:

Oh man. I'm not trying to avoid the question. I love the question. It's just I'm resisting this cook it down to a simple answer. Because I want to be able to go into it and explain when the answer is simple and what the other options are. I don't want to over-complicate it either. If we get back to COVID storms, for instance, it's a systemic reaction. Again. It's acute and probably bodywork doesn't have a direct role in that. It has indirect effects. But there are acute inflammatory reactions and especially local inflammatory reactions where bodywork can have a really clear beneficial effect. It "really does do something," quoting your question. Again, that is a bigger discussion.

Til Luchau:

But back to COVID for sure, we're going to learn a lot about what it's like to recover from this. If you've had the infection and if you've been in isolation for a while. That's a recovery process as well. So, we're going to be learning a lot about what it takes and the role that hands on work has in recovering from having had a flu like this or from having been inside and been separated for so long.

Whitney Lowe:

I wish we had infrastructure in place to be able to have some really good studies that we're following and tracking, these kinds of things in the post virus outbreak situation. I'm sure it will be a lot of informal, anecdotal evidence about things. But hopefully at least, it will maybe stimulate some ideas for some very important things to be studying.

Whitney Lowe:

I was just thinking about, the other day, I can't remember. Somebody had passed along to me a study that had come out that was in the physical therapy field, looking at the question about how important manual therapy and hands on approaches were because there's been a trend amongst a number of practitioners to move towards more education oriented practices and less manual therapy interventions. And this article was saying there still is a lot of value and importance in a lot of things that happen from systemic healing processes that really happen just from the processes of simple touch and the therapeutic touch interactions that go on there. We obviously have been carrying that banner for a long, long time. But I think this is another one of those examples of how we may have an opportunity to really emphasize and highlight this a lot.

Til Luchau:

I got an idea. Let's do an experiment where everybody has to isolate for a while and see if they want touch as a result of that. And then see if they want to touch. And I think we're already getting results of that. I'm just reading and hearing from so many people that say, "My hands are restless. I'm feeling touch deprived." All these kinds of things start to build. And then yes, the actual act of touching in all the different skilled and unskilled ways has really clear and beneficial effects. And that's one of the foundation stones of our work and our approach that we can really rest on.

Whitney Lowe:

I would imagine there is probably a lot of very happy pets in the houses with all these manual therapists who are getting a lot of attention right now for 

Til Luchau:

Say that again Whitney, my sound cut off for a second.

Whitney Lowe:

Yeah, I was just saying there's probably a lot of happy pets in many of the situations where manual therapists are living at home and doing a lot of work on their domestic creatures there since they're not working in their clinics nowadays.

Til Luchau:

Oh boy. And then happy partners who... not everyone's isolating from their partners, but yeah. My wife is certainly my guinea pig for all kinds of stuff these days.

Whitney Lowe:

Yeah, right. Well, I think we've hit on some really key factors here and of course opened up, peered into the can of worms that we should delve into in some of our later episodes as well. These are some real key factors. Anything that you want to leave us with today in terms of things to think about like from the immediacy of what we're looking at with COVID right now and the responses immediately to how people are going to be moving on on the other side of this as we look at it?

Til Luchau:

Yeah. Now, we're watching and waiting. We're on the sidelines now. Manual therapists are on the sidelines. This is not our battle to fight. We need to step back. But we're going to learn a lot from this and we're going to have a role to play as recovery happens. And as the stress of people's return to life happens too, we're going to have a huge role to play. But in the meantime, we're going to do enormous studies, infinite studies on self care and on educating ourselves and in resilience and adaptability. That's where our work really lies right now.

Whitney Lowe:

Yeah. Important stuff and really good stuff. I think that'll give us some time for reflection about what we're all about and all the practitioners who are really struggling right now with loss of an income. Somebody had posted something the other day that I saw that said, "Well, right now you don't have the gift of clients, but you do have the gift of time to do some other things you haven't been able to do." Self care things, self reflection, work on yourself. Take some courses. Read some books. See some videos. There's a lot of things that you can do to continually enrich yourselves and get yourselves fired up and ready to jump back into this. Because I certainly do have a sense when this thing is over and we're coming out on the other side of it, people are really going to be needing the things that we're doing. I think that'll be very important for everybody.

Til Luchau:

Looking for the opportunities. Yeah. Looking for the opportunities this opens up. And there's lots of them. There's a lot of down side, it's huge. Don't want to minimize that at all. And a lot of challenges facing us, but lots of opportunities. I know that we're offering some free and low-cost access to things that previously were much more expensive. I know that you're doing the same. I know a lot of options out in the field now that weren't there. Should we do our wrap up stuff?

Whitney Lowe:

Yeah. That sounds good. That sounds good and we'll look forward to seeing everybody again and we'll jump back into this again in two weeks. If you want to make sure to stop by our site, thethinkingpractitioner.com for show notes and other information that's over there, Til, where can people find you?

Til Luchau:

Our site advanced-trainings.com. What's yours, Whitney?

Whitney Lowe:

And you can find information for us on our courses that we've got, online courses and the things happening over at the academyofclinicalmassage.com. And of course, you're always welcome to email questions to us over at info@thethinkingpractitioner.com or look for us out on social media. Til, where can people find you out there on social?

Til Luchau:

Just my name, @tilluchau. How about you, Whitney?

Whitney Lowe:

Okay. Same thing, just Whitney Lowe over on Facebook or also at the Academy of Clinical Massage on Facebook. And if you will, please remember to rate us. Take a look and rate us over on Apple Podcasts or wherever else you're listening to this. And please tell a friend. That really helps get the word out about it. And I would like to lastly just say a big thank you to everyone who's been listening to the show. We really appreciate the input and feedback we've been getting from everybody and hope this is providing some valuable thinking for everybody as well.

Til Luchau:

Indeed. Thanks, Whitney.

Whitney Lowe:

All right. That sounds good. We'll see you again in two weeks.

Til Luchau:

Bye-bye.

Whitney Lowe:

Okay.

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2 Comments

  1. Linda Lowry

    Excellent cytokine podcast information. Looking forward to part 2. Thank you!

    • Thanks for listening, Linda!
      –Til

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