Thread by @BadgleyLaurence

UPRIGHT MRI NEEDED!
@rolypeck, @camrichards, @epkedj,
@nosweatswife, @luvenice_h
@roomcmo, @verybendy, @ody011
@kirafae, @zorgsaam, @bloomswest
@fearless_dining, @uncoveredmyths
@luludj12, @karensuek65, @emilywill
@friendasking4a

Hopefully there is an interested reader with the skill set to organize this thread into a Thread Reader.

UPRIGHT MRI: It makes perfect sense to image tissues upright; while all body parts stream to earth’s center at 32 feet per second per second, the velocity imparted to these body part masses by gravity (elementary Physics). Heads weigh ~10#, arms ~15#, legs ~25#.

Anatomical deformations incited by forceful bio-mechanical onslaught of gravity are of particular concern within anatomical posts that hold the body upright; especially the vertebral spine (lumbar, thoracic, & cervical). The pelvis is giant hinge & platform vs leg posts & spine.

When MRIs were first invented & enabled disks to be imaged, the back surgeons (formerly Orthopedists) were usurped by Neurosurgeons (an interesting tale of doctor turf warfare) who incorrectly diagnosed disk “bulges” as abnormal neural-impinging pain generators.

Countless unsuccessful back operations ensued. We now know disk bulges are normal physiological events in flexible tissues, in disks made of connective tissues, which are specialized ligaments. Disk bulges change with shifting postures, from side to side, & from day to day.

Since back & neck pain are amongst the most common reasons for patients to visit doctors, one would think the diagnostic techniques to determine causes of back pain might be well-honed doctor skills. Unfortunately, this is not the case.

Diagnosis of chronic low back pain remains mystery to many medical doctors; especially those who neglect to unclothe & physically examine patients; with ill regard that 2-D static snapshots, called X-rays, tell the etiologic tale. These simple imaging studies commonly do not.

The bigger mischaracterization is “Degenerative Disk Disease”, DDD, a term routinely entered into spine Image Reports by radiologists because people over 30 years old commonly have age-related DDD.

Even though many doctors know that DDD is not a pain generator, many other doctors, desperate for an explanation for their patients’ pain, conveniently use this scary sounding term to explain to patients why they hurt & need Ibuprofen for their back pain.

Between 13-30% of chronic low back pain is generated by the sacroiliac joints, largest joints by far, in the axial spine. Each sacroiliac joint is 17 square cm in area; space between two fingers as the thumb tip touches to tip of the index finger.

Doctors, by and large, do not know how to diagnose painful permanent injuries to ligaments that tether sacroiliac joints.

These are large ligaments & when stretched beyond their inherent capacity they permanently loose their strength to firmly tether Sacrum to Ilium of Pelvic Girdle; enabling chronic sacroiliac joint subluxation.

Sacroiliac joints are largest joints within bony ring known as the pelvic girdle, which sits on two major body support posts, the legs. The pelvis is foundation for the bony post of the vertebral spine. If the pelvis foundation is unstable, so will be the spine.

Unstable spines are pained spines, because para-spinal ligaments, myofascia, & muscles all strain to support wobbly bony structures, & in the process generate chronic spasms in order to continuously support a tipsy turvy spine.

Body musculoskeletal parts residing within the ambient gravitational field have enough difficulty holding up even an uninjured & stable pelvic girdle. The entire contraption is an amazing bio-mechanical instrument.

Injured & unstable spine parts incur chronic painful soft tissue spasms induced in attempt to armor the spine. These soft tissue abreactions are the etiology of Chronic Widespread Pain in conditions like Fibromyalgia.

In 2013 (Dubai), at the 8th Interdisciplinary World Congress on Low Back and Pelvic Girdle Pain, I presented the first World announcement of an imaging study that showed subluxation in people with unstable sacroiliac joints (N=20).

The trail to discovery involved traditional evaluation of sacroiliac joints by means of Provocation Maneuvers & Fluoroscopic Guided Diagnostic Blocks; all well reported in the orthodox medical literature
as worthy diagnostic examinations of the sacroiliac joints.

My invention of a novel radiologic technique involved X-raying people’s pelvic girdles while they were seated on the X-ray table, & then passing the X-ray beams across the table & through their pelvices.

I used their upper body weight, shifted within the gravitational field by ischial bolsters I applied, to focus gravity onto each of their hemi-pelvices in turn; to impress each sacroiliac joint separately and independently.

Unstable sacroiliac joints collapsed into joint bio-mechanical shifts called Nutation & Counter-nutation. These shifts were observable by shifts in upper leg positions and in stations of the acetabulum.

I have long considered the use of upright MRIs as having extraordinary ability to make similar, but more precise, sacroiliac joint observations, & with all the fine soft tissue definitions that are absent within X-ray images.

Why was it important for me to gather objective evidence for sacroiliac joint subluxation? Reason is that the sine qua non of Fibromyalgia is pain in both upper and lower back regions. Fibromyalgia commonly exists absent significant lumbar spine disorders.

My clinical studies of Fibromyalgia patients taught me that most, if not all, had laxity of their sacroiliac joints. Attempts to find disorders of their spines, & which might be ameliorated by surgical correction of the spine, failed.

What I came to realized was that Fibromyalgia patients first incurred low back pain (pelvic girdle pain cannot be differentiated from low back pain), & then months to years later began to experience upper back, shoulder, & neck, face, and head pain patterns.

The natural history of Fibromyalgia evolves over months to years. Most doctors do not have the luxury of studying patients for years; much less in 10-12 minute scheduled clinic visits.

During my decades-long evaluations of patients with Fibromyalgia, I noted that most Fibromyalgia patients had a scoliosis when their spines were palpated while they were in a neutral upright stance.

Whenever I requested an upright X-ray to show this curvature, radiology protocols, which required that scoliosis images be taken lying down, did not support my request, and my hypotheses & clinic observations have remained absent of objective data.

Even my doctor credentials could not overcome long-standing traditions & to obtain X-rays of my patients’ spines while upright. Medicine is an unholy alliance of past beliefs & resistance to new ideas.

I am hopeful that, with the advent of upright MRI, I will be able to obtain images of curved spines in upright hypermobile-flexible patients.

Most persons w. Fibromyalgia have curvature (scoliosis) of their thoracolumbar spines. Bio-mechanical principles would predict that an unstable pelvic girdle platform might induce functional spine scoliosis; is not an intuitive idea; derives mostly from empirical observations.

The idea is that scoliosis would be elected to be evoked, by brain proprioceptive centers, to maintain a medial-central station of the body within the ambient gravitational field. This idea seems, to me, to be intuitive.

Another way to state this principle is that scoliosis of the spine is a proprioception-driven event; whereby the central nervous system directs muscles that control the spine to selectively contract; to curve the spine to maintain a medial station of the body’s center of gravity.

In life it is all about station of the body within the continuum of space and time. Both body postures & exposures to mechanic forces over time wear the tissues in a process called aging.

The spine is easily given to flexibility & curvature because the spine is a flexible unit consisting of a stack of bones (vertebrae) held together by flexible ligaments (vertebral disks). Disks are cartilaginous & made of connective tissue; similar to all body ligaments.

NASA spent $1,000,000 (verbal communication from Dr. Andry Vleeming; world-class sacroiliac joint expert) trying to prove sacroiliac joint subluxation using 3-D fluoroscopy. They tried to do this in standing individuals & failed.

NASA chose the wrong posture. I did it for the cost of my time to examine a group of patient & to order & review X-rays of sacroiliac joints in my patients as they sat on the X-ray table.

I employed cross-table lateral X-rays with ischial bolsters under each hemi-pelvis in turn; to bio-mechanically stress these joints using the patients’ own body mass (weight).

Sitting postures evoke vectors of gravitation that cause the pelvis, stabilized on a platform, to be stressed (seat surface ground force) into joint shifts called subluxations of nutation and counter-nutation.

If the spine is curved due to pelvic platform instability, what happens to the shoulder girdle? Over time shoulders droop on one side; usually side that harbors a loose sacroiliac joint. It took me years of observations to finally realize this simple common non-intuitive patten.

X-rays are limited to defined regions. X-rays of entire body at one sitting do not exist; except as exercises perhaps attempted by Chiropractors. What is any medical doctor to do with wide angle views of the human body?

There is too much information in such images to wrap one’s brain around.

Defined regional X-rays comport with modern medical proclivities to divide the body into small circumscribed arenas of knowledge; whereby specialists & sub-specialist hold sway over closely guarded micro-domains of knowledge.

By maintaining dominion and turf control of separate body regions, specialists become sought after as “experts” of certain closely-held secrets of nature. They gain stature and financial worthiness.

“There is precious little value in observations that anyone can make with their own eyes”, some might say. “Everything has all already been discovered”, others might say.

Why would a doctor with post-graduate training in countless micro-boxes of biochemical, biologic & physiologic systems waste time on such unsophisticated pursuits as close examination of body postures with regard to vectors of gravity?

Back to the subject at hand. When you look at people with Fibromyalgia & from across the room, you will find they are commonly tilted & that one shoulder is lower.

Often, the head is tilted toward the lower shoulder side. Again, this is a non-intuitive appreciation; a pattern gained from countless empirical observations.

Another observation is that the Superior trapezius on the higher shoulder side is hyper-dynamic; hypertrophic, spastic, & pained to palpation; from supporting a #10 pound head all day; as the head falls to earth’s center at 32 feet per second per second (elementary physics).

Muscles of the shoulder & neck are soft tissues & able to be imaged by MRI. Upright MRI will be able to distinguish a Crossed Muscle Syndrome (unequal mass of Superior trapezium; plural) of the neck & shoulders from one side to the other side.

An important observation because people with “daily headaches” have Crossed Muscle Syndromes in these regions. An hyper-dynamic Superior trapezius (singular) on the higher shoulder side causes stress at entheses (tendon attachment sites) of Superium trapezium on occipital skull.

Chronic pull of spastic muscles upon sites of attachment (entheses) on bones arouse inflammation. Inflammation of occipital skull sites of entheses are termed “Occipital Neuritis”; etiology of daily “muscle tension headaches” (my finding & hypothesis).

It is a curious phenomenon (my observation) that persons with chronic Occipital Neuralgia experience frequent Migraine Headaches. I have a theory about this association, but that is another story.

With the advent of upright MRIs, we will finally be able to see living tissues during their foremost common bio-mechanically stressed state; while the body is upright; as tissues sag under the onslaught of gravity.

Tilted neck & head in persons with Fibromyalgia are also bio-mechanical underpinnings of Temporal Mandibular Joint (TMJ) disorder & Thoracic Outlet Syndrome (TOS). I have already reported on bio-mechanical etiology of these disorders in past tweet threads (7/10/19 & 4/6/19).

TEMPORAL MANDIBULAR DISORDER:
In the case of TMJ, the upright MRI will enable direct evaluation & comparison of Masseter muscle (jaw muscle) masses from side to side.

Muscle hypertrophy is a surrogate marker for muscle spasm. Spasms of the Masseter muscles is key to understanding disorders of TMJs.

What my examining fingers have taught me, as I have palpated countless Masseter muscles, is that etiologic inception of TMJ is a Crossed Muscle Syndrome within the bilateral Masseter muscle system.

Masseter muscle Crossed Muscle Systems derive from the efforts of these muscles holding up mandibles every day, when their owners are upright. Mandibles have mass and fall to earth’s center at 32 feet per second per second.

In order to be highly mobile, mandibles insert into a shallow jaw socket of the skull and just in front of the ear. In order to more firmly contain & guide mandible condyle movement, Mother Nature built a cartilaginous rim around the socket.

Are the TMJ socket cartilaginous rims of hypermobile people more flexible and more subject to subluxation and dislocation of their mandible condyles? Upright MRIs of mandibles in different postures of jaw opening might answer this question.

Unbalanced status of the Masseter system fosters asymmetric jaw closure & excessive bio-mechanical forces of wear upon one or both of the TMJs.

Asymmetric TMJ closure wears down the cartilaginous rim of a TMJ; thereby promoting subluxation & chronic painful ligament strain of ligaments of a loose TMJ.

What I discovered is Masseter muscle within face-up side of a person w. chronically tilted head (secondary to curved spine whilst upright) develops hyperdynamic function & hypertrophy; result of weight lifting bony mandible via thousands of reps each day; as jaw opens & closes.

The brain likes to keep bilateral dental occlusions symmetric; probably a proprioceptive thing. Perhaps, despite being tilted, the brain wants to direct head mechanisms & jaw functions just as it would if the head were not tilted; if that makes any sense.

Continual unconscious efforts maintaining a closed dental occlusion within the up side of the face is my hypothesis for development of asymmetric Masseter muscle tone & mass in people with TMJ; a gravitational consequence.

It might be interesting to monitor jaw function in upright MRIs. People with hypermobile joints are particularly prone to TMJ disorders because a slipping and sliding TMJ predisposes the cartilaginous TMJ rim to subluxation & wear. These are my novel ideas.

THORACIC OUTLET SYNDROME:
The costo-clavicular dimension between underside of the clavicle & top of the first rib is a tight space through which all nerves, arteries, & veins serving the arm pass through as they transit to & from the arm.

In cases of Thoracic Outlet Syndrome, upright MRI will enable direct view of proximal clavicle impingement of the subclavian artery & neurovascular bundle during shoulder-arm abduction.

This impingement is etiology of neuro-arterial brachial plexus impingement, which arouses distal arm coolness, paresthesias, & dysautonomic changes within arms of people with TOS. Is sometimes possible to see unilateral Pectoralis vein engorgement in fair skinned women with TOS.

My examining fingers have been able to feel radial artery pulse extinguishment at precise stations (degrees) of elevation during shoulder-arm abduction in persons with TOS. I have ultrasound proof, in many patients, of this subclavian artery constriction event.

With upright MRI, it will be satisfying to finally be able to prove, with objective images, brachial plexus & neurovascular bundle impingement occurring in people with TOS, & then demonstrate this to legions of doctors who disbelieve in reality of Thoracic Outlet Syndrome.

The space in the shoulder where soft tissue neuro-arterial brachial impingement occurs, the costo-clavicular dimension, is ~1.0 cm in height. This has been determined by MRI views in persons who are reclining. I wonder what’ll be whilst upright?

As the ~18 cm long clavicle abducts, it can rotate around a fixed point (sterno-clavicular joint).

A few mm of distal clavicle inferior shift (caused by a loose AC joint in hyperflexible people & hyperdynamic Superior trapezius or Pectoralis minor muscle functions) can close the costo-clavicular dimension by 30% (simple geometry).

In people with joint hypermobility, the acromio-clavicular (AC) joint, which steers distal clavicle drive, enables slight rotation of clavicle around the longitudinal axis; motion which shifts inferior clavicle flange into space of the costo-clavicular dimension: etiology of TOS.

FIBROMYALGIA:
All these observations have led me to: Fibromyalgia is body-wide Repetitive Stress Disorder; condition of widely ranging painful soft tissue (myofascia & muscle) spasms causal of Chronic Widespread Pain (CWP) & associated painful intermittent neural impingements.

Fibromyalgia is a painful condition whereby a myriad of overly reactive peripheral pain generators fire in concert, arousing Chronic Widespread Pain. Rheumatologists have detailed the anatomical loci of 18 major pain sites in Fibromyalgia.

That Fibromyalgia is due to central sensitization is a theory. When you touch people with Fibromyalgia they hurt right where you touch them. Doctors who numb these peripheral pain points via myofascial trigger point injections abort these loci of pain generated-by-touch.

Injections of these myofascial points and loci of inflamed entheses are far distant from the brain. There is no physiological explanation how these peripheral tissue injections could alter functions of “centrally sensitized” brain tissue.

Functional MRIs purport to show lit up areas of the brain in people with chronic pain disorders. The lit up areas seen on functional MRIs (fMRI) of the brain are probably simply brain areas where sites of excessive peripheral pain reception are being registered.

Perhaps upright MRIs taken as soft tissues are stressed by gravity, & technically w. assistance of certain intravenous dyes, will demonstrate lit up areas in soft tissues & loci not manifest when body is lying down; favored & comfortable posture of many persons w. Fibromyalgia.

CHIARI MALFORMATIONS:
The upright MRI will become particularly useful to image Chiari deformations of the brainstem, the medulla oblongata (MO), as it sinks into the bony ring of the foramen magnum opening at base of the skull.

This is important because a squeezed (by gravity) MO contains the NTS nerve nucleus; origin of the Vagus nerve. Pathophysiology of dysautonomias & ME/CFS are likely associated with pressure on the MO in people with HSD & laxity of ligament connections between skull & upper spine.

The dramatic symptom reversals recently reported in patients with ME/CFS & who have had skull/spine fusions might be proof of the Principle that “Cure Proves the Cause”.

Conclusion:
The advent of upright MRI portends an entirely new field of diagnosis that is destined to dramatically alter the diagnostic arena of many chronic musculoskeletal disorders; especially in persons with HSD, hEDS, Fibromyalgia, & ME/CFS.

Persons who appreciate my thoughts & theories within this thread might enjoy my tweet thread discussion, “EXERCISE & HYPERMOBILITY SPECTRUM DISORDER”, 9/21/2019.