BOTOX: A PRINCIPLE OF MEDICAL DIAGNOSIS & THERAPY? Several insidious medical disorders encompass similar pathophysiology seeming amenable to #Botox therapy: #Migraine, #TMJ, chronic neck pain (#cervicalgia), & Thoracic Outlet Syndrome (#TOS).
The pathophysiology found within all these disorders is the phenomenon of “crossed muscle” syndromes. Dr. Victor Janda is possibly first to describe this curious syndrome, which is easily discovered by simple physical examinations.
When the body musculoskeletal tower is asymmetric (tilted) within the ambient gravitational field, muscle pairs symmetric from side to side or which oppose in individual body part functions, become dissimilar in dynamic action; one muscle stronger & hypertrophic. The other weak.
For each of the pathologies, I have one or more extended essays in my library of threadreaders. The ideas expressed herein are my own novel findings; based on years of independent clinical medical research.
Within this current essay, I merely summarize the pathophysiologies that I have discussed at length in my several threadreaders.
Many of these findings were first made in women with Hypermobility Syndrome & who are particularly subject to the chronic injurious force that gravity imposes on musculoskeletal towers of lesser stiffness; due to widespread loose joints from inherited connective tissue variations
It is no coincidence that Fibromyalgia is highly associated with Hypermobility Syndrome & that Migraine, TMJ, chronic muscle tension headaches, chronic cervicalgia, & TOS are common in those with Fibromyalgia.
Sine qua non of Fibromyalgia (FM) is both chronic upper & lower back pain. Chronic muscle tension headaches & chronic cervicalgia (due to Superior trapezius muscle spasm) & TOS are common elements of the upper back pain component of FM.
The element of lower back pain in Fibromyalgia is sacroiliac joint (SIJ) subluxation chronic pain disorder syndrome (named by author), which is often due to chronic ligament laxity of one SIJ, but that is another story (see my threadreaders about Fibromyalgia).
Back to chronic pain syndrome subsets of Fibromyalgia & which each evolve differently & with specific chronic spastic painful hypertrophic/hyperdynamic muscles as result of chronic biomechanical gravity stress:
TEMPORAL MANDIBULAR JOINT (TMJ): My clinical research has identified unilateral Masseter muscle hyperdynamic function as etiologic for chronic wear, injury, & dysfunction of a TMJ. The medically correct name of this disorder is Temporal Mandibular Disorder, TMD.
TMD commonly evolves on side of the face most uppermost within a head that is chronically tilted; wherein weight of the higher mandible evokes dynamic Masseter function & asymmetric jaw function; as brain motor centers attempt to maintain symmetric right to left dental occlusion.
The tilted head/neck can be discovered to result from asymmetric hemi-girdles of the shoulders (each shoulder has an hemi-girdle) overlying an underlying functional scoliosis (common in those with Hypermobility Syndrome).
CHRONIC CERVICALGIA: Commonly one Superior trapezius (ST) is hypertrophic (greater girth anterior leading edge) & hyperdynamic; due to chronically tilted 10 pound head; supported mostly by stronger ST of cervical/shoulder Superior trapezium pair; supporting becomes hypertrophic.
CHRONIC CERVICALGIA is manifestation of entheses at insertion sites of Superior trapezius (ST) upon Occiput & upon Superior Scapula Spine plus painful muscle spasm impinging ST muscle mid-body motor point, a neural network in the mid-part of Superior trapezius upper aspect.
MIGRAINE HEADACHES: A pain syndrome that commonly expresses in those persons who have daily muscle tension headaches; due to chronic cervicalgia as explained above.
MIGRAINE HYPOTHESIS: Migraine represents brain tissue arteriolar wall smooth muscle spasm; resultant from autonomic neural feedback initiated within a chronically spastic Superior trapezius muscle.
THORACIC OUTLET SYNDROME: An hypertrophic & hyperdynamic Superior trapezius (“shoulder elevation” muscle) evokes hypertrophic development of opposing shoulder muscle of shoulder “draw-down”, the Pectoralis minor muscle; a true crossed muscle syndrome.
When arm abducts, Superior trapezius folds/relaxes & an hyper-dynamic (from chronic opposition to an hyper-dynamic Superior trapezius) Pectoralis minor muscle draws distal clavicle forcefully/excessively in inferior direction; as a bone radius fixed at sternoclavicular joint.
One cm of excessive inferior shift of the distal clavicle (18 cm & fixed at the sternoclavicular joint) closes the costo-clavicle dimension (Thoracic Outlet) by 30%; therein impinging the contained brachial neurovascular bundle, i.e., evoking the Thoracic Outlet Syndrome.
As a unilateral muscle of a symmetric pair (or one muscle of an opposing pair of muscles) is hyperdynamic/etiologic for a chronic pain disorder, we might hypothesize that Botox would be a natural application for crossed muscle conditions; a true Principle of Diagnosis & Therapy.
In medicine when a therapy dedicated to a theorized diagnosis then successfully evokes relief of the symptoms of the diagnosis or otherwise cures the suspected diagnosis, it can be said that the “treatment proves the diagnosis”.
Botox is a natural organic substance that in large doses is a poison to the human body, but in small doses is a miraculous treatment. Botulinum toxin is a true Principle of Treatment & Diagnosis.
In the future, physicians will be able to gather clinical data to prove the diagnostic and treatment hypotheses espoused within this essay. They will then demonstrate certain singular Principles of human functioning and Pathophysiology.
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