Thread by @BadgleyLaurence

HYPERMOBILITY & FIBROMYALGIA
@endfatigue

Fibromyalgia is a multi-factorial disorder with a variety of causes: femaleness, Hypermobility Syndrome, pelvic girdle injury, sedentary & reclusive lifestyles, low Vitamin D, non-restorative sleep, & severe incapacitating illnesses.

A unifying factor is instability of pelvic girdle joints that lead to a slightly tilted upper body tower & wherein multiple muscles that support the upright body tower incur asymmetric mechanical stress that differs from one side of the body to the other.

All body parts constantly fall to earth center at 32’/second/second (basic Newtonian Physics). Numerous ligament proprioceptive sensors send brain a stream of feedback about the body’s position in space.

The brain guides a multitude of constantly shifting muscle tension changes to keep the body tower vertical in the face of gravity; a most wondrous bio-mechanical feat.

Chronic asymmetric bio-mechanical muscle stress leads to inflammation at sites where muscle tendons insert upon bones that support the upright body tower & these sites are called “entheses”, & are etiology of the Fibromyalgia soft tissue pain foci. To be continued…

Doctors have identified 18 anatomic sites where entheses evolve in response to an asymmetric & tilted upright body tower trying to maintain a vertical posture. At least this has been my long-held clinical insight; which fostered my ability to diagnose many chronic pain syndromes.

After countless long-term physical exams & histories of chronically pained patients over decades, I originated a novel method of chart shorthand & recognition of symptom associations which enabled me to diagnose Fibromyalgia & the syndrome subsets listed below.

Women with hypermobile soft tissues (~15% of women; 1/7) are more prone to entheses of several regions of the upright body tower. These entheses occur due to injuries that destabilize horizontal station of the pelvic girdle platform which supports the upright body tower.

Pelvic platform stability relies on stability & integrity of sacroiliac joint ligaments which hold pelvic girdle together. Med lit. reports occurrence of destabilization of female pelvic girdle by menial lifting/falling injuries that mechanically stress pelvic girdle bony ring.

Hypermobile ligaments, a predom. female trait, more easily stretch, tear, & permanently lose sacroiliac joint tethering integrity from mechanical injuries; thereby evoke unstable pelvis platform & an upright body tower that constantly sways/tilts; arousing soft tissue entheses.

Sacroiliac joints (“SIJ”; 17cm square in area; largest axial spine joints) of the upright body tower are nearly vertically aligned vs. sacrum/ilium. Loose ligaments of a damaged SIJ allow same side of lumbar spine to droop downward; thereby causing the upper body tower to tilt.

At each menses, female organs secrete hormone Relaxin, which softens soft tissues in preparation for possible pregnancy & need for pelvic girdle expansion; a double whammy of loose ligaments in those women already genetically imbued with hypermobile ligament soft tissues.

Pregnancy & childbirth (especially multiple) more easily injure pelvic girdle ligaments in hypermobile women. Injured & non-injured ligaments both generate severe low back pain during 3rd trimester in these women as pelvic girdle expands under fetal weight.

Being a bony ring, the pelvic girdle, no matter what reclined posture is operant, meets ground surface force of sleep surface & translates that force around pelvic ring to loosest sacroiliac joint; wherein damaged ligaments are wrenched/torqued evoking intense pain.

It was no coincidence that Spanish Inquisition priests chose the rack to extract confessions. Better to confess & be put to death than to suffer repeated torture of ligaments being pulled asunder.

Evolution created pain-signaling ligament transducers to protect ligaments from being stretched. Animals bereft of ligament integrity lose locomotor skills, cannot keep up with the herd, fall behind, & are eaten.

Persons with injured sacroiliac joint ligaments have terrible pain when lying down, toss & turn all night, surface sleep, lose REM sleep, lack dreams, wake exhausted, suffer extreme daytime fatigue, & have “fibro-fog” (confusion).

Chronic & repetitive non-restorative sleep naturally induces chronic depression, another sentinel sign of Fibromyalgia. No need to invoke mental weakness. Loss of restorative sleep is a tragic physiologic event all by itself.

An unstable pelvic ring naturally induces functional scoliosis (present when upright; absent reclined), & drives a proprioceptive event that maintains a medial station of the center of gravity of the upright body tower.

Within months to years of incurring an unstable pelvic ring & chronically tilted upright body tower, the shoulder girdles, which sit atop the body tower, incur chronic tilt, asymmetric stress, & spasm of muscles (Superior trapezium) which support the shoulder girdles.

This long delay in evolution of chronic spasm within the shoulder girdle regions after precedent pelvic girdle injury is one reason that etiology of Fibromyalgia has long been overlooked. It is also explanation why both upper & lower back pain is required to make the diagnosis.

Another reason the etiology of Fibromyalgia has been overlooked is that understanding requires an in-depth analysis of the mechanism of injury; to regard which soft tissues experienced extraordinary stress & bio-mechanical injury.

When it comes to soft tissue injury, it is important to understand vectors of force of the instant or of repetitive injury bio-mechanism. It is also important to know what posture body was in at the time of injury. All this information needs to be recorded for proper analysis.

Another reason etiology of Fibromyalgia has been overlooked is that physical examination of persons with Fibromyalgia requires detailed palpation & study of soft tissues as they function through range of motion in real time & while maintaining constant regard for gravity vector.

The interpretation of soft tissue function requires firm knowledge of anatomy & direct examination of the tissues in the clinic. The modern 15 minute examination is woefully sparse for the type of examination & history being espoused here.

Contemporary physical diagnosis amongst doctors has overly relied on interpretations of static 2-dimensional X-rays & scans. Soft tissues are 3-dimensional, have motion, & are relatively radiolucent.

Sensitive palpation of soft tissues can provide information about functions that are not provided by images.

Finally, the etiology of Fibromyalgia has been elusive because modern medical sciences expect to find a single germ, gene, or pathological biochemical pathway to explain each medical disease or disorder. As described herein, the cause of Fibromyalgia is multifactorial.

The author has invented a method of diagnosis called Biomechanical Functional Diagnosis (BFD). The method includes shorthand cartoons to capture complex physical findings, novel anatomic functions, & novel imaging protocols to document abnormal physical function of body parts.

Chronically stressed/stretched Superior trapezium muscles evolve a multitude of anoxic painful (reactive substances) tissue foci & entheses; especially at insertion sites on the Superior Scapula Spines; another sentinel sign of Fibromyalgia.

A criteria that is a sine qua non of Fibromyalgia is chronic pain in the soft tissues of both upper & lower back: regions of pelvic & shoulder girdles. The bio-mechanical model of Fibromyalgia I present herein solves this criteria.

In various precedent Twitter threadreaders, I have discussed in detail the etiologies of Migraine, TMJ, TOS, chronic Cervicalgia, Costochondritis, MVP, Gastroparesis, IBS, IC, Chronic Sciatica, CRPS, & Patellofemoral Syndrome; all subsets of the Fibromyalgia Syndrome.

A common thread in etiology of many subset Syndromes of Fibromyalgia is attendant dysautonomias. My discussions of Fibromyalgia subsets include notations that spine & girdle (shoulder & pelvic) joint subluxations create impingements of contiguous autonomic nerves & plexi.

NOVEL THEORY: intermittent impingement of regional autonomic nerve tracts is explanation for seemingly disparate collection of symptoms & syndromes associated with Fibromyalgia. These same dynamics explain why different sufferers vary in their symptom constellations.

It is no coincidence that women are beset with Fibromyalgia more than men. Women have various penetrance of genes that perpetuate soft tissue hypermobility. Women have delicate musculoskeletal pelvic structures compared to men.

Men come to Fibromyalgia via an etiologic pathway that commonly includes severe bio-mechanical injury to the pelvic girdle sacroiliac joints caused by lifting, falling, & crush injuries that are decidedly non-menial.

Those who debate the absence of mechanical injury in persons with Fibromyalgia oft overlook soft tissue injury attendant with a few weeks or more of intense bedrest due to an infection or other debilitating illness. This etiologic dynamic applies to both men & women.

After about two weeks of serious sedentary status, humans commonly develop severe fulminating soft tissue atrophy that begets profound generalized weakness. Weak muscles become pained with spasm & promote additional sedentariness.

Severely weak & spastic muscles do not foster activity nor preserve muscle tone. Evolution of Fibromyalgia is a self-begetting dynamic. Reclusiveness indoors begets Vitamin D deficiency. Profound weakness prohibits gathering & preparation of nutrient dense foods.

Inanition seems to promote a physiological state whereby attempts at exercise lead to such profound exhaustion that hosts necessarily avoid further exercise attempts, & the opportunity to reverse tissue energy exhaustion becomes perpetually lost.

It is curious to learn that ~30% of COVID-19 suffers develop an ongoing & profound exhaustion & symptoms which have dysautonomic qualities. A name being given to this Syndrome is “Long-COVID”.

There are certainly mysteries to be uncovered in the arena where Fibromyalgia, ME/CFS, & Long-COVID all seem to intersect and/or reside.
THE END

@threadreaderapp unroll