I often find that to explain injury or trauma to a patient it is best to use everyday language and references:
Imagine you are walking down a snow-dusted slope unaware of the icy surface below (it’s coming your way soon). Your legs fly out from under you and you land on your bum. A massive explosive force rips through your body and, with nowhere for it to dissipate, it tends to create chaos within the tissues. Think of it this way; imagine throwing a pebble into a calm pond. The ‘shock’ waves radiate outward in concentric circles and, should they meet a solid object such as a rock they then ricochet back causing an interference pattern, an area of chaos. In our bodies that rock might be a bone and, given that our bodies are over 70% fluid, impacts create similar disturbances within our fascia, organs, cavities etc.
The fascia is a vast support system encompassing all vessels, nerves, muscles, joints and organs. It is an information highway, a system for exchanging fluids between compartments and circulating blood. It is an absorber, coordinator and a dissipater of shock. When injury is too great it’s viscoelastic properties may change profoundly, even tear.
Imagine the fascia as a somewhat fluid saran wrap-like three dimensional body stocking that extends from your toes to the top of your head. Like stockings, it looses elasticity with age. With frequent ‘hits’ it tears more easily and requires ‘darning’ (a function of scar tissue) to repair the damage. And, as with stockings, each repair job makes the whole a little more rigid eventually leading to puckers in the tissue. These areas often entrap or compress nerves and/or vessels thereby obstructing the normal conduction of information, fluids and nutrition. These areas no longer absorb and dissipate shock/impact and become what is often referred to as an ‘energy cyst’, like a holographic imprint of the injury. It retains the memory of the stress/shock/trauma in an autonomous manner, independent of any higher control mechanism. Ultimately, in most cases, some kind of disease/pain syndrome sets in. When the pain starts to change your personality, shape your day or occupies your emotions and thoughts it has become a trauma.
Back to the fall on your bum. The shock will most likely travel all the way up your spine to your shoulders and neck and into the brain via the system of tissue that covers the spinal cord, a membrane called the dura mater. This membrane continues from the base of the spine where it is attached to your sacrum and then reattaches again in your neck and goes into your head through the foramen magnum (the opening at the back of your skull) creating some really funky architecture within. Depending on the angle of your fall and the impact zone, the shock waves travel through your pelvis and viscera (internal organs). Then as the injury settles in and establishes itself, you may experience headaches, a sore back or neck, a burning sensation between your shoulders, tingling arms maybe even a sore knee. Most likely nothing will show up on X-Ray or scans but you know you have pain and, no, it is not all in your head.
Try standing in front of a full length mirror and see if your body is aligned. Is one hip higher than the other, one shoulder higher. Is your head tilted or angled to one side? Does your belly button line up with the notch between your collar bones? Are your ears on the same plane? Your eyes? Your cheek bones? These are all bony markings that we, the ‘body detectives,’ notice and use as clues to help guide us in our treatments.