2019 será sem dúvida um ano de Libertação. E de Libertação Miofascial!
2019 será sem dúvida um ano de Libertação. E de Libertação Miofascial!
28 março 2018
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Direito de imagemJILL GREGORY / MOUNT SINAI HEALTH SYSTEM
As partes em azul escuro são feixes de colágeno fibrilar. Na imagem à direita, as fibras de elastina são as manchas pretas; as estruturas de colágeno estão em rosa
Ele sempre esteve ali, mas foi apenas por meio de uma tecnologia mais avançada que os cientistas finalmente puderam identificá-lo: um espaço repleto de cavidades preenchidas por líquido, presente entre os tecidos do nosso corpo – por isso, chamado de intersticial (entre tecidos). Um grupo de especialistas o classifica como um novo órgão do corpo humano, “uma nova expansão e especificação do conceito de interstício humano”.
Paradoxalmente, apesar de ter sido descoberto apenas agora, o interstício pode ser nada menos do que um dos maiores órgãos do corpo humano, assim como a pele. Os cientistas afirmam que essa rede de cavidades de colágeno e elastina, cheia de líquido, reuniria mais de um quinto de todo o fluído do organismo.
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A descoberta foi feita por uma equipe de patologistas da Escola de Medicina da Universidade de Nova York (NYU), Estados Unidos. Os resultados foram publicados na revista Scientific Reports.
Antes, se acreditava que essas camadas intersticiais do corpo humano fossem formadas por um tecido conjuntivo denso e sólido. Mas, na realidade, elas estão interconectadas entre si, através de compartimentos cheios de líquidos.
Estes tecidos ficam localizados debaixo da pele, recobrem o tubo digestivo, os pulmões e o sistema urinário, rodeiam as artérias, veias e fáscia (estrutura fibrosa onde se fixam músculos). Ou seja, são uma estrutura que se extende por todo o corpo.
Os pesquisadores acreditam que esta estrutura anatômica pode ser importante para explicar a metástase do câncer, o edema, a fibrose e o funcionamento mecânico de tecidos e órgãos do corpo humano.
Direito de imagemJILL GREGORY / MOUNT SINAI HEALTH SYSTEM
A camada de cima é a mucosa; as partes rosas são as estruturas de colágeno que criam as cavidades cheias de fluído (representado pela cor lilás)
Como não havia sido descoberto até agora?
Essas estruturas não são visíveis com nenhum dos métodos padrões de visualização da anatomia humana. Agora, os cientistas puderam identificar esse novo “órgão” graças aos avanços tecnológicos da endomicroscopia ao vivo, que mostra em tempo real a histologia e estrutura dos tecidos.
De qualquer forma, a descoberta foi uma surpresa.
A equipe de investigadores fez, em 2015, uma operação com endomicroscopia a laser – uma tecnologia chamada Confocal Laser Endomicroscopy (pCLE) – para examinar o conduto biliar de um paciente com câncer. Depois de uma injeção de uma substância corante chamada fluoresceína, foi possível ver “um padrão reticular com seios (ocos) cheios de fluoresceína, que não tinham nenhuma correlação anatômica”.
Em seguida, os cientistas tentaram examinar mais detalhadamente essa estrutura. Para isso, usaram placas microscópicas de biópsia habitual. Porém, as estruturas haviam desaparecido.
Depois de fazer vários testes, Neil Theise, coautor do estudo, se deu conta de que o processo convencional de fixação de amostras de tecidos em placas drenava o fluído presente na estrutura. Normalmente, os cientistas tratam as amostras com produtos químicos, as cortam em uma camada muito fina e aplicam tinta para realçar suas características chave. Porém, esse procedimento faz colapsar a rede de compartimentos, antes cheios de líquidos. É como se os pisos de um edifício desmoronassem.
Por isso, “durante décadas, (a estrutura) pareceu como algo sólido nas placas de biópsia”, disse Theise, que faz parte do departamento de patologia da Universidade de Nova York.
Ao mudar a técnica de fazer a biópsia, sua equipe conseguiu preservar a anatomia da estrutura, “demonstrando que ela forma parte da submucosa e que é um espaço intersticial cheio de fluído não observado anteriormente”. Assim, foram identificadas “tiras largas e escuras ramificadas, rodeadas de espaços grandes e poligonais cheios de fluoresceína”, descreve o estudo.
Os cientistas confirmaram a existência dessa estrutura em outros 12 pacientes operados.
Direito de imagemGETTY IMAGES
Os cientistas acreditam que essa nova estrutura anatômica pode ser importante para explicar inclusive a metástase do câncer.
Qual é sua função?
Até agora a ciência não estudou profundamente nem o fluxo nem o volume do fluído interticial do corpo humano. Por enquanto, a identificação desse “espaço intersticial” levanta várias hipóteses.
Os especialistas acreditam que essa rede de espaços interconectados, forte e elástica, pode atuar como um amortecedor para evitar que os tecidos do corpo se rasguem com o funcionamento diário – que faz com que os órgãos, músculos e vasos sanguíneos se contraiam e se expandam constantemente.
Além disso, acreditam que essa rede de cavidades é como uma pista expressa para os fluídos. Isso poderia embasar a hipótese de que o câncer, ao atingir o espaço intersticial, possa se expandir pelo corpo muito rapidamente. É a chamada metástase.
Por outro lado, os autores do estudo acreditam que as células que formam o interstício mudam com a idade, podendo contribuir com o enrugamento da pele e com o endurecimento das extremidades, assim como a progressão de doenças fibróticas, escleródios e inflamatórias.
Is the Interstitium Really a New Organ?
A study confirms that the spaces between cells are fluid-filled, rather than tightly packed with connective tissue, but pathologists say the findings’ implications remain to be seen.
By Abby Olena | March 28, 2018
Illustration of the interstitium, fluid-filled spaces supported by a network of collagen bundles, lined on one side with cells
JILL GREGORY, REPRINTED WITH PERMISSION FROM MOUNT SINAI HEALTH SYSTEM, LICENSED UNDER CC-BY-ND.
For years, scientists have fixed tissue and looked at it under the microscope in order to better understand the body. In a study published yesterday (March 27) in Scientific Reports, a team of researchers used a new in vivo microscopy technique to present evidence that the human interstitium—the space between cells—is more like a matrix of collagen bundles interspersed with fluid than the densely-packed stacks of connective tissue it appears to be in fixed slides.
News reports have suggested that this interstitium could represent a widespread organ in the body, whose connections with the lymphatic system might be involved in cancer metastasis. While researchers not involved in the study agree that the interstitium likely plays diverse roles in the human body, they are reticent to call it a new organ.
“It is fair to say that histologists [and] pathologists have long known that there is an interstitial space and that it contains fluid,” Anirban Maitra, a pathologist at the University of Texas MD Anderson Cancer Center who did not participate in the work, writes in an email to The Scientist. “The claim that it is a hitherto undiscovered organ, and the largest one ever at that, seems a stretch,” he cautions.
“Most biologists would be reticent to put the moniker of an ‘organ’ on microscopic uneven spaces between tissues that contain fluid. By this definition, the abdominal cavity and pleural spaces should be discrete organs” too, says Maitra.
Frozen human bile duct tissue imaged by fluorescence microscopy demonstrates the net-like pattern in the connective tissue of the interstitium.
BENIAS ET AL., SCIENTIFIC REPORTS, 2018.
According to coauthor Neil Theise, a pathologist at New York University’s School of Medicine, coauthors and physicians Petros Benias and David Carr-Locke consulted with him after they saw something unexpected while using a technique called probe-based confocal laser endomicroscopy to assess patients’ bile ducts for cancer spread. The endoscopic method allows for the exploration of living tissues within the body, rather than needing to wait for fixed slides. Benias and Carr-Locke noticed that bile duct tissue appeared as a net-like pattern that did not correspond to any anatomical structure that had been previously described.
When Theise looked at fixed bile duct tissue under the microscope, he didn’t see the pattern. But when the team examined live and freshly frozen bile ducts from 13 patients, there it was, an extended latticework of tissue. Upon further scrutiny, they determined that the lattice is composed of collagen bundles that support fluid-filled spaces and are lined irregularly with flattened cells that produce two markers, one endothelial and one mesenchymal.
“I was trained, and I’ve taught residents that I’ve trained, [that] the tissue tears a little bit when you’re making a slide,” says Theise. “We thought this was artifact. It turns out the dense connective tissue appearance was the artifact. These tiny cracks are actually what’s left of the spaces after the fluid has drained out when you fix the tissue.”
The researchers saw the net-like interstitium in other areas of the body, including the skin, the digestive tract, and the bladder. Histological examinations of colon, stomach, and skin cancers that had metastasized seemingly directly from the interstitial space to the lymph nodes suggested to the authors that the interstitium drains into the lymphatic system. The authors propose in the study that this connection between the interstitium and the lymphatic system could explain how some tumors rapidly metastasize once they reach the fluid-filled space.
“I am not questioning whether these spaces can be paths for egress of cancer cells to lymph nodes—they very well might be,” writes Maitra. “That would still require additional experiments to prove conclusively, but it is certainly within the realm of possibility.”
Image of fresh-frozen human bile duct (left) shows collagen bundles in blue; the asterisks mark fluid-filled spaces of the interstitium. Images of a fixed bile duct from the same patient (upper and lower right) show the collapse of spaces (arrowheads in bottom panel) and collagen bundles sticking together.
BENIAS ET AL., SCIENTIFIC REPORTS, 2018.
The study makes a good point that it’s important to consider to what degree the microscopy techniques currently in use reveal a true-to-life picture of what is happening in vivo, Radu Stan, a biologist at Dartmouth’s Geisel School of Medicine who did not participate in the work, tells The Scientist. He adds that the concept of a fluid-filled matrix is not “earth-shattering,” and that sectioning and imaging unfixed tissue as the authors did, which could tear and create artifacts, presents limitations.
“The paper presents an interesting description of a possible novel microanatomic structure of ‘pre-lymphatic’ or ‘interstitial’ spaces in normal tissues, which may play a role in normal function as well as tumor metastasis,” Xiaoyin “Sara” Jiang, a pathologist at Duke University School of Medicine in North Carolina who was not involved in the work, writes in an email to The Scientist. She cautions that the findings are limited to a fairly small number of patients and that most of the tissues the authors looked at outside of the bile duct were fixed, not live or freshly frozen. Overall, the work opens the door to additional study—in the hands of another group, as well as studying pCLE in other tissues—rather than being definitive, she writes.
Theise and colleagues are already investigating the developmental anatomy of the interstitium in mice, as well as looking more in depth at how it appears in other tissues in both animal models and people. Other future directions include the role of the interstitium in diseases, including cancer and liver disease.
P.C. Benias et al., “Structure and distribution of an unrecognized interstitium in human tissues,” Scientific Reports, doi:10.1038/s41598-018-23062-6, 2018.
THERAPEUTIC INSIGHT: THE JOHN F. BARNES MYOFASCIAL RELEASE PERSPECTIVE—THE DEVELOPMENT OF MYOFASCIAL RELEASEApril 24, 2015John F. Barnes, P.T., L.M.T., N.C.T.M.B.
ArticlesMore TechniquesTechnique Articles
Part 1 of a Series
john f. barnes myofascial release
People often ask me how I developed the John F. Barnes approach to myofascial release. I’ve had the opportunity to train more than 100,000 therapists and physicians in Myofascial Release, and this technique is being used on millions of clients a month and has been for decades, in a highly effective and safe manner.
The mind-body connection
I was an athlete when I was younger. I played football, ran track, went skiing, rode motorcycles, and got involved in competitive karate and weightlifting. I loved competition and motion. That was taken away from me in a blinding flash. I’ll explain the details of that very traumatic event in my life in the next installment of this article series.
As an athlete, I became fascinated with the concept of the mind-body complex, and it was one of the reasons I chose to go to physical therapy school at the University of Pennsylvania. When I started school, I was shocked that they had no perception of the mind-body concept. Here we are more than 50 years later, and they still have no clue. Physical therapy back in those days was pretty much focused on modalities: ultrasound, electrical stimulation, diathermy, infrared and ultraviolet. We also learned massage in physical therapy school then.
Learning to manipulate
Early in my career, I heard of a physician from England, John Mennell, M.D. His father was James Mennell, one of the early bonesetters in England. He taught his son John to manipulate; John then went on to get a medical degree and a number of other specialties under his belt. He decided to come to the U.S. to teach physicians how to manipulate, only to be sorely disappointed to find out that doctors in the U.S. don’t like to touch their patients.
John Mennell switched his focus to physical therapists and became the chief of physical medicine at Philadelphia General Hospital, which was just down the street from the physical therapy school I went to. I was one of the first physical therapists to take his courses on manipulation. I enjoyed it and became very good at it.
Over the years, John Mennell and I became friendly, and I started to help him teach manipulation. I also went on to learn muscle energy techniques, joint mobilization, biofeedback, laser therapy, neuroprobe therapy and electronic acupuncture for pain relief—and became very successful in my private practice.
Developing the John F. Barnes approach
My primary focus in my early career was manipulation, joint mobilization, muscle energy techniques and massage. I also began to teach manipulation and the other procedures I mentioned. As I began to explore the fascial system and apply some of the myofascial release techniques I developed, it became obvious to me and to my clients that myofascial release was doing 95 percent of the work as far as effectiveness goes. I flip-flopped my perspective then, doing mostly myofascial release and spending five to 10 percent of the time doing manipulation, mobilization and massage.
Before myofascial release, I had a successful practice and many therapists working with me. What began to happen was that all of the clients started demanding myofascial release once they experienced it. This was fine, but my therapists didn’t know how to do myofascial release, so everyone wanted to see me. This created havoc.
Teaching the John F. Barnes approach
I realized I would have to put aside a long weekend to teach my staff how to do myofascial release. Once I did that, I thought maybe I could open it up to the public. Everyone laughed at me because they said nobody knew myofascial release and nobody would come. There was a local physical therapy newspaper, Physical Therapy Forum, near my office in Pennsylvania. I called to ask if they’d be interested in writing an article about an approach I’d developed to help people in pain and suffering from headaches to restore their function. They sent a reporter over to interview me and I decided to place an ad in that newspaper after the article was published.
More than 200 people registered for that first myofascial release seminar. The next problem we ran into was that we didn’t have enough space. I had never spoken to more than 15 people at a time prior to this. We held two seminars, one weekend after the other.
My prior experience had been teaching TMJ specialists and therapists TMJ techniques for headache problems, and speaking to that group was a whole different animal than speaking to hundreds of people. The seminar went exceptionally well. I flowed with what I knew.
There’s something about myofascial release; as soon as they get involved with it, clients intuitively know that this is important for their recovery, and therapists know it is important for their practice.
John Barnes, MASSAGE MagazineAbout the Author
John F. Barnes, P.T., L.M.T., N.C.T.M.B., is an international lecturer, author and acknowledged expert in the area of Myofascial Release. He has instructed more than 100,000 therapists worldwide in his myofascial release approach, and he is the author of Myofascial Release: The Search for Excellence (Rehabilitation Services Inc., 1990) and Healing Ancient Wounds: The Renegade’s Wisdom (Myofascial Release Treatment Centers & Seminars, 2000). He is on the council of advisors of the American Back Society; he is also a member of the American Physical Therapy Association. For more information, visit myofascialrelease.com.
No nosso curso iremos falar amplamente da relação mente / corpo.
Este artigo em inglês que encontrei é super interessante!!! Vem de encontro ao que falamos, ensinamos e praticamos. E claro demonstra porque o trabalho de Libertação Miofascial consegue soluções espetaculares!!
A new way of thinking about consciousness is sweeping through science like wildfire. Now physicists are using it to formulate the problem of consciousness in concrete mathematical terms for the first time
There’s a quiet revolution underway in theoretical physics. For as long as the discipline has existed, physicists have been reluctant to discuss consciousness, considering it a topic for quacks and charlatans. Indeed, the mere mention of the ‘c’ word could ruin careers.
That’s finally beginning to change thanks to a fundamentally new way of thinking about consciousness that is spreading like wildfire through the theoretical physics community. And while the problem of consciousness is far from being solved, it is finally being formulated mathematically as a set of problems that researchers can understand, explore and discuss.
Today, Max Tegmark, a theoretical physicist at the Massachusetts Institute of Technology in Cambridge, sets out the fundamental problems that this new way of thinking raises. He shows how these problems can be formulated in terms of quantum mechanics and information theory. And he explains how thinking about consciousness in this way leads to precise questions about the nature of reality that the scientific process of experiment might help to tease apart.
Tegmark’s approach is to think of consciousness as a state of matter, like a solid, a liquid or a gas. “I conjecture that consciousness can be understood as yet another state of matter. Just as there are many types of liquids, there are many types of consciousness,” he says.
He goes on to show how the particular properties of consciousness might arise from the physical laws that govern our universe. And he explains how these properties allow physicists to reason about the conditions under which consciousness arises and how we might exploit it to better understand why the world around us appears as it does.
Interestingly, the new approach to consciousness has come from outside the physics community, principally from neuroscientists such as Giulio Tononi at the University of Wisconsin in Madison.
In 2008, Tononi proposed that a system demonstrating consciousness must have two specific traits. First, the system must be able to store and process large amounts of information. In other words consciousness is essentially a phenomenon of information.
And second, this information must be integrated in a unified whole so that it is impossible to divide into independent parts. That reflects the experience that each instance of consciousness is a unified whole that cannot be decomposed into separate components.
Both of these traits can be specified mathematically allowing physicists like Tegmark to reason about them for the first time. He begins by outlining the basic properties that a conscious system must have.
Given that it is a phenomenon of information, a conscious system must be able to store in a memory and retrieve it efficiently.
It must also be able to to process this data, like a computer but one that is much more flexible and powerful than the silicon-based devices we are familiar with.
Tegmark borrows the term computronium to describe matter that can do this and cites other work showing that today’s computers underperform the theoretical limits of computing by some 38 orders of magnitude.
Clearly, there is so much room for improvement that allows for the performance of conscious systems.
Next, Tegmark discusses perceptronium, defined as the most general substance that feels subjectively self-aware. This substance should not only be able to store and process information but in a way that forms a unified, indivisible whole. That also requires a certain amount of independence in which the information dynamics is determined from within rather than externally.
Finally, Tegmark uses this new way of thinking about consciousness as a lens through which to study one of the fundamental problems of quantum mechanics known as the quantum factorisation problem.
This arises because quantum mechanics describes the entire universe using three mathematical entities: an object known as a Hamiltonian that describes the total energy of the system; a density matrix that describes the relationship between all the quantum states in the system; and Schrodinger’s equation which describes how these things change with time.
The problem is that when the entire universe is described in these terms, there are an infinite number of mathematical solutions that include all possible quantum mechanical outcomes and many other even more exotic possibilities.
So the problem is why we perceive the universe as the semi-classical, three dimensional world that is so familiar. When we look at a glass of iced water, we perceive the liquid and the solid ice cubes as independent things even though they are intimately linked as part of the same system. How does this happen? Out of all possible outcomes, why do we perceive this solution?
Tegmark does not have an answer. But what’s fascinating about his approach is that it is formulated using the language of quantum mechanics in a way that allows detailed scientific reasoning. And as a result it throws up all kinds of new problems that physicists will want to dissect in more detail.
Take for example, the idea that the information in a conscious system must be unified. That means the system must contain error-correcting codes that allow any subset of up to half the information to be reconstructed from the rest.
Tegmark points out that any information stored in a special network known as a Hopfield neural net automatically has this error-correcting facility. However, he calculates that a Hopfield net about the size of the human brain with 10^11 neurons, can only store 37 bits of integrated information.
“This leaves us with an integration paradox: why does the information content of our conscious experience appear to be vastly larger than 37 bits?” asks Tegmark.
That’s a question that many scientists might end up pondering in detail. For Tegmark, this paradox suggests that his mathematical formulation of consciousness is missing a vital ingredient. “This strongly implies that the integration principle must be supplemented by at least one additional principle,” he says. Suggestions please in the comments section!
And yet the power of this approach is in the assumption that consciousness does not lie beyond our ken; that there is no “secret sauce” without which it cannot be tamed.
At the beginning of the 20th century, a group of young physicists embarked on a quest to explain a few strange but seemingly small anomalies in our understanding of the universe. In deriving the new theories of relativity and quantum mechanics, they ended up changing the way we comprehend the cosmos. These physcists, at least some of them, are now household names.
Could it be that a similar revolution is currently underway at the beginning of the 21st century?
Ref:arxiv.org/abs/1401.1219: Consciousness as a State of Matter
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