The Control of Tension on Your Human Spring

Baylor Heart and Vascular Hospital—The slim space between the collarbone and first rib is called the thoracic outlet. Blood vessels, nerves, and muscles that extend from the back to the arms pass through the thoracic outlet. If this space is too narrow, the blood vessels and/or nerves may become abnormally compressed, causing thoracic outlet syndrome symptoms, including shoulder pain, neck pain, arm pain, impaired circulation, tingling, numbness in the hands, and nerve compression symptoms. This is known as thoracic outlet syndrome (TOS). (1)

Johns Hopkins Hospital—The thoracic outlet is a bony ring formed by the topmost ribs, just below the collarbone. Threading through the thoracic outlet, from inside the rib cage, is the brachial plexus, along with veins and arteries that supply the shoulder and arm. (3) Thoracic outlet syndrome (TOS) occurs when these nerves or blood vessels become compressed, leading to pain, numbness, tingling, weakness, and circulation problems affecting the shoulder, arm, and hand. (2)

I think it's safe to say that most doctors and scientists believe that compression is the primary cause of thoracic outlet syndrome (TOS). Now, let me ask you two extremely important questions.

• What is the only tissue that can compress or move body parts? Answer: Muscles.
• What controls the tension on muscles? Answer: The brain and the nervous system.

The nervous system is the processing and control center of the body.

• The sensory nervous system provides information from the body to the brain through sensory receptors.
• The brain is the body's central control computer that processes this sensory information and adjusts muscle tension, muscle contraction, and movement.

The nervous system controls muscle contraction, which changes tension across the human spring mechanism. This change in tension can be experienced as increased muscle tension, increased spring stiffness, decreased muscle tension, or increased spring compliance. This is the normal neurological control of human spring tension and biomechanics.

The brain knows the precise amount of muscle tension required to absorb the force of stepping off a curb or landing from a three-foot box without injury.

The brain also knows the exact amount of tension to release so you can run barefoot, absorb impact safely, or increase tendon tension to store and recycle elastic energy so you can run faster and more efficiently.

When the nervous system creates an abnormal, damaging internal compression force, this muscle tension becomes an over-control of your human spring mechanism. I named this pathologic spring tension. This abnormal pathologic spring tension is, in my opinion, the most common cause of the muscle compression, nerve compression, and blood vessel compression that lead to thoracic outlet syndrome, compression syndromes, and many other painful musculoskeletal disorders.

The next two chapters explain in detail how your brain, nervous system, and neurological reflexes control this muscle tension. I assure you this knowledge is vitally important because it will shape your understanding of the daily activities, postures, movements, and repetitive stresses that cause and perpetuate the compression responsible for thoracic outlet syndrome, herniated discs, carpal tunnel syndrome, shin splints, joint degeneration, and the accelerated aging of joints.

What you learn in the next two chapters will also help you determine which of the 16 treatment options for thoracic outlet syndrome available to your doctor or healthcare professional are appropriate. It will also give you the knowledge necessary to better understand the self-treatment, self-care, and conservative treatment strategies recommended in Chapter 13, "What Works and Why."

In fact, it will shape every decision you make during your activities of daily living, because your brain and nervous system will use these neurological reflexes to either improve your health, reduce compression, and restore normal function—or increase compression, perpetuate chronic pain, and make your condition worse.

So, with that, let's "spring" into learning, so to speak.

Nervous System Reflexes and Learned Behaviors

Your body is an object that is controlled by your nervous system. The nervous system controls your movement, muscle tension, posture, balance, biomechanics, and human spring mechanics through learned behaviors and protective reflexes.

Following are five important functions of your nervous system involving tension on your body's spring and its effects on movement, posture, injury prevention, shock absorption, energy efficiency, and thoracic outlet syndrome.

• The nervous system can reduce the stiffness of the muscles and tendons that support the body's spring, reducing muscle stiffness to make the spring more compliant and better able to absorb the impact forces of walking, running, jumping, sports, and daily activities on different surfaces. However, when the spring is more compliant, your body requires more energy for movement and locomotion.
• The nervous system can also increase muscle tension and spring stiffness, allowing the spring to rebound the body from the ground with greater efficiency, speed, and athletic performance. Increased spring stiffness allows the muscles to stack the bones in a more perpendicular alignment with gravity, improving posture, balance, stability, biomechanics, and movement efficiency. With increased stiffness there is less wobble of the bones during landing and weight transfer across the spring. However, excessive muscle tension and spring stiffness reduce the body's ability to absorb impacts and may contribute to compression injuries, chronic pain, and thoracic outlet syndrome.
• The nervous system continuously adjusts tension on the body's spring to compensate for the forces of gravity and maintain balance, posture, equilibrium, joint stability, movement coordination, and efficient biomechanics while lying down, sitting, standing, walking, lifting, exercising, and performing activities of daily living.
• The nervous system automatically increases muscle tension through protective reflexes whenever the sensory system detects injury, pain, inflammation, stress, or perceived danger. For example, when your neck is injured in a motor vehicle accident (whiplash injury), the muscles tighten, producing a stiff neck. This muscle stiffness is a normal protective reflex that increases tension on the body's spring (the neck). However, prolonged protective muscle tension may contribute to muscle spasms, chronic neck pain, nerve compression, thoracic outlet syndrome, headaches, and other compression syndromes.
• The nervous system develops learned movement patterns (motor programs) by programming everyday activities into automatic movement patterns, including walking, running, talking, eating, reaching, lifting, sports movements, posture, and other activities of daily living. These learned movement patterns improve movement efficiency but may also reinforce poor posture, faulty biomechanics, repetitive strain injuries, and chronic musculoskeletal disorders if the movement patterns become dysfunctional.

Nervous System Reflexes

Gravity is constantly compressing your human spring. The human spring mechanism is constantly fighting gravity. Your human spring responds to changes in muscle tension relative to the directional pull of gravity through nervous system reflexes, postural reflexes, and muscle reflexes that continually adjust posture, balance, and movement.

In fact, astronauts in space can grow up to 2 inches or more (5 centimeters) while in orbit. That is because their bodies no longer have gravity compressing their human spring mechanism, vertebral discs, spinal joints, and thoracic outlet. (Maybe a cure for a herniated disc, thoracic outlet syndrome, or spinal compression could be to blast you into space for a few weeks.) (4)

Astronauts in space can grow up to 2 inches or more (5 centimeters) while in orbit. That is because their bodies do not have gravity compressing their human spring mechanism, spinal column, and postural spring system.

We have seen a measurable difference in height in patients after I performed several hours of treatment to remove the internal compression of their human spring mechanism, spinal spring system, and thoracic outlet. This occurred while treating thoracic outlet syndrome, thoracic outlet compression, and upper-body compression disorders. In fact, less than two months before the release of this book, I had two patients gain a considerable amount of height after the spring release component of treatment.

One 31-year-old woman went from 5'4" to 5'5½", gaining a full 1½ inches. Another patient, a 38-year-old man, got up from the treatment table and his wife said, "Oh my God! You are taller!" We measured his height and confirmed that he had gained a full 1½ inches. I would not have believed it myself had I not measured both patients and compared the measurements with the height listed on their driver's licenses.

You cannot practice better nervous system reflexes. However, you can learn how gravity influences postural reflexes, muscle tone, postural control, and human biomechanics, and then work with gravity to improve your posture and resting muscle tone. This helps you avoid unhealthy movements and postures that trigger reflexes capable of compressing your human spring mechanism, thoracic outlet, brachial plexus, and spinal joints.

Chapter 4 photo here

Nervous System Learned Behaviors

Your central nervous system helps you immensely by storing the patterns of the most common coordinated movements you perform through learned motor behaviors, motor learning, and movement patterns. Without realizing it, you have practiced these movements so many times that they become automatic and second nature.

Examples include learning to speak a language, write, drive a car, text a phone number, sing the words to a song, or hold a cup to your mouth.

Now it is not difficult for you to drive a car with your knee while singing a song, dialing a phone number with your right hand, and holding a cup of coffee with your left while taking a sip. It is not recommended, but it can be done almost automatically. This is called multitasking.

Learned behaviors, such as learning how to stand, walk, run, and maintain posture, develop during childhood and continue throughout adulthood. These movement patterns develop in a head-to-toe sequence. Children learn to control their heads, stabilize their trunks, stand, and then walk.

These skills require gradual improvements in postural control, postural stability, balance, coordination, muscle strength, and resting muscle tone. My daughter could not initially hold her head or trunk upright, which concerned me. Within weeks she could hold her head up, and within a few months she could sit, stand, and eventually take her first steps.

In fact, what your mother told you—"Sit up straight"—encouraged you to tighten your muscles into a rigid posture. That advice actually goes against the way the nervous system, postural reflexes, and human spring mechanism function most efficiently. She unknowingly taught you a learned behavior that overrides the body's more natural ability to achieve postural balance, equilibrium, and optimal posture through automatic nervous system reflexes.

Using learned behaviors to correct posture creates more compression, muscle fatigue, and stress on the human spring mechanism, thoracic outlet, and spinal joints than allowing posture to be regulated naturally through reflexes. Doesn't it feel good that you did the right thing by not listening to your mom for once?

Your postural reflexes provide a far more precise method of balancing muscle tension, maintaining equilibrium, and minimizing unnecessary compression than consciously tightening muscles in an attempt to improve posture. The best way to explain ideal posture and resting muscle tone is what I call "stack and relax." Stack your head over your spine, stack your spine over your pelvis, and then completely relax unnecessary muscle tension while allowing your nervous system reflexes to maintain balance.

Most people learned how to sleep, sit, stand, and walk through trial and error. Most likely, neither your parents nor your doctors taught you how to perform these activities without placing unnecessary stress on your human spring mechanism, thoracic outlet, spinal joints, and postural support system. If you do not understand how these systems work, you cannot work with them, and eventually they begin working against you.

There is an optimal posture that creates the least strain on your human spring mechanism, musculoskeletal system, and postural muscles. In Chapter 6, "Break These Laws... Get Sentenced to a Lifetime of Suffering," I will teach you the correct sleeping, standing, sitting, and walking postures that minimize compression while improving human biomechanics, postural alignment, and movement efficiency.

I tell my patients all the time, "If you do not learn how to use your human spring correctly with respect to gravity, it is impossible for any doctor to help you. Not even my approach stands a chance." In fact, whenever a patient's posture deviates from true vertical alignment, I immediately correct it because I do not want poor posture to prevent recovery from thoracic outlet syndrome, thoracic outlet compression, or other compression syndromes.

When the human spring mechanism must continuously fight gravity over prolonged periods, muscles weaken, fatigue, and may enter a pathological muscle contraction state. This produces a chronic compressive state that contributes to compression disorders, including thoracic outlet syndrome, herniated discs, nerve compression syndromes, and the accelerated degeneration of joints known as degenerative joint disease (osteoarthritis).

This was the primary focus of my keynote presentation, "The Sports Medicine Approach to Anti-Aging Medicine," delivered at the Seventh Annual Thailand Congress on Anti-Aging and Aesthetic Medicine in Bangkok, Thailand, in September 2015.

In this presentation, I said that pathologic spring tension, caused by predictable patterns of abnormal muscle tension, is the primary cause of compressive disorders, such as herniated discs, thoracic outlet syndrome (TOS), degenerative joint disease, spinal degeneration, nerve compression syndromes, and accelerated aging. No doctor in the audience disagreed.

As you age, if you don't maintain the integrity of your human spring mechanism, gravity will win the fight. This is when your spring suspension system fails, your joints lock and grind down your knee joints, hip joints, spinal joints, and intervertebral discs, requiring them to be replaced. It's also when people fall from a lack of balance. They might break their hip, leading to permanent disability or even death.

Once you learn how to work with these postural reflexes and muscle tension reflexes, you will finally be able to live a more stress-free and strain-free life, and your thoracic outlet syndrome symptoms will finally go away.

Reflexes

In many cases, tasks you take for granted are actually hard-wired into your nervous system. These are called neurological reflexes or protective reflexes. Reflexes react faster than learned behavior, which is a good thing, because they protect you from harm.

These are other examples of reflex actions we take for granted that are independent of conscious input from the brain: yawn, cough, blush, sneeze, shiver, pupillary light reflex, and blinking when something touches your eye.

Many voluntary learned reflexes support behavior tasks. So, it can be confusing what is a reflex, what is learned behavior, and what is controlled by both reflexive control and voluntary movement.

Poor posture has been mentioned by many top hospitals, such as Cleveland Clinic and Cedars-Sinai, and medical associations, as a primary cause of thoracic outlet syndrome (TOS). In my opinion, poor posture, forward head posture, and postural dysfunction are the number one most common causes of thoracic outlet syndrome and why thoracic outlet syndrome symptoms become chronic after an auto accident, work injury, or sports injury. Therefore, it's vitally important we understand how the nervous system controls posture, balance, and muscle tension.

Can we control our posture? Is posture reflexive or is it a learned behavior?

Neurophysiologist Sir Charles Sherrington made some significant scientific breakthroughs. His work, The Integrative Action of the Nervous System, published in 1906, is regarded as the founding text of modern neuroscience devoted to understanding how neurological reflexes, postural reflexes, and the nervous system work. He determined that perfect balanced posture is controlled primarily by reflexes. (5)

A pharmacologist and physiologist named Rudolph Magnus produced a definitive study of whether posture was something learned or based on postural reflexes in 1924. (6)

He found this out when he cut (in an animal) the connection between the area of the brain that held reflexes (the midbrain) and the area of the brain that controlled voluntary movement (the cerebral cortex). The animal still maintained balanced muscle tone (postural tonus), and the standing posture remained more or less intact and normal. (5)

Therefore, the majority of the corrections to your posture are reflexive.

F. M. Alexander, an Australian actor who studied neuroscience through Sherrington, developed the Alexander Technique, a method for understanding postural reflexes, body mechanics, and how to maintain ideal posture. By the early 1920s, Alexander was well known and taught the Alexander Technique throughout the United States and Great Britain.

Your nervous system is equipped with postural reflexes to ensure that your human spring body abides by the laws of physics and laws of nature. These reflexes ensure that you remain balanced in harmony with Earth's gravity while minimizing unnecessary muscle tension.

Postural habits, forward head posture, rounded shoulders, and other postural dysfunctions are extremely important in perpetuating myofascial trigger points, muscle spasms, chronic muscle contraction, and compression syndromes that contribute to thoracic outlet syndrome. In fact, poor postural habits are one of the leading causes of chronic compressive disorders, including thoracic outlet syndrome, herniated discs, and degenerative joint disease.

Therefore, understanding how your nervous system reflexes automatically change the tension on your human spring in response to gravity, body position, and posture is essential to understanding the cause of thoracic outlet syndrome and many other compression disorders.

Posture Manual

Your nervous system controls your posture, balance, and equilibrium. Posture is one of the most misunderstood concepts in medicine. For example, some people think evaluating how body parts stack up while standing next to a plumb line is the only way to assess posture.

Some people believe posture only applies during sitting or standing. However, posture is the optimum body position for working with Earth's gravity, where the least strain is placed on the supporting muscles while maintaining your head perpendicular to gravity and your eyes level with the horizon.

In reality, posture is better understood as a three-dimensional human spring structure. Posture refers to the optimum position of your body during static posture (lying, sitting, or standing) and dynamic posture (lifting, walking, running, jumping, and athletic movement), allowing your body to function in harmony with gravity while minimizing strain and nerve compression.

Lessons in Neurology Taught to a Vascular Surgeon That Performs Thoracic Outlet Syndrome Surgery

I met a vascular surgeon at a function and asked him at what point he decides to perform thoracic outlet syndrome surgery. He said, "When the patient comes back a few times with it." I asked him what he thought caused thoracic outlet syndrome. He repeated the typical textbook answers: "Repetitive motion, poor posture, and cervical ribs," as if he was reading directly from the textbook.

Then I asked him to place his hand on the scalene muscles of my neck while I sat upright, perpendicular to Earth's gravity. I then leaned backward, allowing him to feel my scalene muscles, neck muscles, and postural muscles contract and become increasingly tense.

I told him, "The muscles you surgically remove because they are chronically tight are actually tight because they must constantly contract to support my 10-pound head whenever I lean backward for prolonged periods."

He had an aha moment and said, "You mean to tell me scalene muscle spasms that lead to thoracic outlet syndrome are caused by leaning backward too long like that?"

Then I asked him how many thoracic outlet syndrome surgeries he had performed on patients who were never advised to avoid prolonged leaning backward or sideways for more than a few minutes, causing the underlying compression to return and their thoracic outlet syndrome symptoms to recur. He replied that he had performed 123 thoracic outlet syndrome surgeries during the previous year.

I know that few, if any, physicians truly understand the underlying cause of persistent thoracic outlet syndrome, chronic nerve compression, and thoracic outlet compression. That is because I have interviewed hundreds of patients who sought treatment from other doctors before coming to me. I always ask them what their previous doctor believed was the cause of the compression responsible for their thoracic outlet syndrome symptoms.

I got nothing!

So, following the advice of doctors who don't understand thoracic outlet syndrome (TOS), thoracic outlet biomechanics, posture correction, and nerve compression, and who provide advice on ways you can lessen the strain on your thoracic outlet by improving your posture is not a good strategy to lessen your pain and suffering.

The only way these misconceptions can be cleared is if we understand how the body functions in relationship to the world around it—a world governed by the laws of nature, engineering, physics and, most important, common sense.

• Your posture allows you to maintain upright alignment of the floors of your integrated spring mechanism, helping maintain an open thoracic outlet, healthy joint alignment, and normal nerve and blood vessel passageways.
• Your posture permits efficient movement patterns through the recycling of energy through a balanced human spring mechanism, improving movement efficiency, shock absorption, and energy conservation.
• Your posture allows your joints to be loaded symmetrically, decreasing abnormal loads and strains on your ligaments, muscles, tendons, cartilage, bones, fascia, and connective tissues.
• Your posture maintains the spaces between your joints and the openings and tunnels that allow your blood vessels, arteries, veins, and nerves, including the brachial plexus, to pass safely without compression.

The two main functional goals of postural behavior are—

• Postural orientation
• Postural equilibrium

Stress-Free and Strain-Free Postural Orientation

When you are standing or sitting, postural orientation is the orientation of the floors of your integrated spring mechanism, allowing them to stack with the least stress on the spring support mechanism, musculoskeletal system, and thoracic outlet. Postural orientation involves the active control of body alignment, whether strain-free or strained, of the seven floors of your integrated spring with respect to gravity, center of mass, and center of gravity.

When you are moving, perfect posture is the position you need it to be to achieve the task you are attempting, where your body segments stack over the center of gravity with the least amount of strain, maximizing movement efficiency, balance, and biomechanical performance.

We all know how doctors measure static posture. You stand next to a plumb line, and the doctor tells you how your body segments line up relative to this plumb line. This is how doctors evaluate static postural alignment and static postural orientation.

I take postural evaluation a step further into three dimensions. I videotape your walking gait, running gait, or movement pattern. Then you and I watch the video in slow motion to see exactly how your body segments line up in relation to gravity, how your integrated spring mechanism reacts to impact, how body weight transfers from one leg to the other, and how your body maintains alignment throughout movement. This comprehensive gait analysis, walking analysis, and running biomechanics analysis identifies abnormal strain placed on your human spring and thoracic outlet.

Postural Equilibrium

The human body is said to be in equilibrium when all forces or tensions are balanced. The body should have minimal mechanical strain when it is in a state of postural equilibrium.

• Static equilibrium is when all forces are balanced while lying, sitting, or standing still.
• Dynamic equilibrium is when all forces are balanced during movement, including walking, running, lifting, jumping, and athletic activity.

Your body is never completely still. In fact, research has found that the neck moves more than 600 times per hour, whether you are awake or asleep.

Balance

Our balance system helps us walk, run, change direction, and move without falling. Balance requires your center of mass or center of gravity to remain directly over your base of support. Balance is the ability to distribute body weight efficiently to prevent falls while maintaining postural stability and dynamic stability.

• When standing, your base of support is your feet.
• When sitting, your base of support is your buttocks.

Center of Mass or Center of Gravity

The point about which the distribution of body weight is symmetrical is called the center of gravity. Your center of mass is the point where every particle of your body's mass is equally distributed in all directions.

When standing still, your base of support is your feet, and your center of mass is approximately around the level of your bladder.

Balance, posture, postural control, and equilibrium are controlled by the central nervous system and peripheral nervous system. The sense of balance is regulated by a complex interaction between multiple parts of the nervous system.

The sensory system is the mouse and keyboard of your body's computer. It consists of specialized sensory receptors that continuously monitor your body position, movement, muscle tension, joint position, and environment to determine the position of your human spring and how it is moving.

The sensory system detects the following changes:

• Changes in light or dark (vision, eyes, visual system)
• Changes in the environment (temperature, hot, cold, wind)
• Changes in tension (muscle tension, stress, strain, compliance, stiffness, compression)
• Changes in pressure (light touch, deep pressure, mechanical pressure)
• Changes in position (joint position, body position, angle, horizontal, vertical, perpendicular)
• Changes in chemistry (inflammation, inflammatory chemicals, toxins, metabolic waste)
• Changes in speed, acceleration, deceleration, and direction (movement speed, acceleration, deceleration, direction of movement)

Your sensory receptors play an important role in the conscious and subconscious perception of your body position, body movement patterns, posture, balance, movement, and outside environment. These sensory systems are essential for maintaining proper biomechanics, postural control, movement efficiency, and the healthy function of your integrated spring mechanism.

Most people understand the concept of your taste buds sensing flavors, sensory receptors in your nose sensing odors, and the ability to interpret the information contained in visible light with the receptor cells in the back of your eye producing vision. These specialized sensory receptors continuously collect information that helps your brain coordinate posture, balance, movement, muscle tension, and body position.

Many of these same sensory receptors also sense your body weight, speed of movement, body position, and the changes of tension in your muscles, ligaments, tendons, fascia, and joints related to the positions of your bones relative to gravity. Doctors call this ability to sense body position and movement kinesthesia (7) or proprioception.

The most important sensory receptors for our purposes detect changes in the stress, strain, tension, compression, and stretching of tissues as your body changes position or moves relative to gravity. These sensory systems constantly monitor your integrated spring mechanism and help regulate posture, muscle tension, joint stability, and movement.

Your brain knows exactly what position you are in and exactly how much muscle tension to apply to maintain proper posture, balance, and movement while lying down, sitting, standing, walking, running, lifting, or performing activities of daily living. It receives this information from your body's sensory systems.

Sensory Systems

• Skin pressure receptors
• Visual system
• Somatosensory system
• Vestibular system

1. Skin Pressure Receptors

Skin pressure receptors, such as those located in the feet while standing, your buttocks while sitting, your back while lying down, and other body parts during movement, detect pressure, weight distribution, ground contact, and changes in body position. These pressure receptors help your brain determine which parts of the body are supporting your weight so it can maintain proper posture, balance, stability, and efficient movement against gravity.

2. Visual System

The visual system consists of your eyes and visual processing centers. Your eyes continuously monitor where your body is positioned in space, whether you are upright, leaning, rotating, or moving in different directions. Vision provides critical information about body orientation, posture, movement, and balance.

The visual system provides some of the most important information for maintaining balance and spatial awareness. Pilots who fly into clouds quickly lose their visual reference to the horizon. Without relying on their flight instruments, they may unknowingly become disoriented and even fly directly into the ground.

Most importantly, your visual system works together with your somatosensory system and vestibular system to activate automatic righting reflexes, which keep your eyes level with the horizon and your body properly aligned regardless of your position or movement.

3. Somatosensory System

"Somato" is the Greek word for body. The somatosensory system is your body's sensory system and is one of the most important systems to understand when treating thoracic outlet syndrome, chronic pain, nerve compression syndromes, and disorders of the integrated spring mechanism.

Because the somatosensory system functions almost entirely through automatic reflexes, you can influence how it responds by changing your posture, movement patterns, daily activities, ergonomics, exercise habits, and lifestyle.

Most importantly, the somatosensory system is one of the primary systems you will influence through self-treatment techniques designed to reduce abnormal muscle tension, relieve nerve compression, restore healthy biomechanics, and reduce compression on your thoracic outlet, thoracic tunnel, and other components of your integrated spring mechanism.

This sensory system is composed of microscopic strain sensors known as muscle spindles, Golgi tendon organs, joint mechanoreceptors, skin mechanoreceptors, and other proprioceptors. These receptors continuously monitor muscle tension, tissue stress, joint position, ligament strain, tendon loading, pressure, vibration, movement, and changes in body position.

Muscle and joint sensory receptors constantly report the amount of tension, stress, strain, compression, and movement occurring throughout your integrated spring mechanism. In many ways, they function as your body's built-in strain gauges.

These specialized receptor cells include muscle spindles (8), Golgi tendon organs (9), joint mechanoreceptors (10), skin mechanoreceptors (11), visual receptors, vestibular receptors responsible for balance and equilibrium (12–15), and receptors that help regulate blood flow, circulation, breathing mechanics, rib cage movement, and the function of your respiratory system. (15)

Receptors include:

• Muscle spindle receptors
• Golgi tendon organs (Golgi tendon receptors)
• Mechanoreceptors
• Joint mechanoreceptors
• Proprioceptors
• Cutaneous (skin) mechanoreceptors
• Hair follicle receptors
• Glabrous skin receptors
• Pressure receptors
• Stretch receptors
• Vibration receptors
• Ruffini endings
• Pacinian corpuscles
• Meissner corpuscles
• Merkel cells
• Nociceptors (pain receptors)
• Thermoreceptors (temperature receptors)
• Vestibular receptors
• Visual receptors

Muscle Spindle Cells—Introduction

Muscles themselves do not detect the strain or tension placed on your body. Instead, strain on muscles is detected by muscle spindle cells (muscle spindles), specialized sensory receptors and proprioceptors (strain gauges) that are interwoven between the muscle fibers.

Muscle spindle cells (muscle spindles) are sensory receptors and proprioceptors interwoven among the millions of skeletal muscle fibers throughout your body. They primarily detect changes in muscle tension, muscle strain, muscle stretch, muscle length, and the rate of muscle stretch. This sensory information is relayed to the brain and spinal cord through sensory nerves.

When this information reaches the brain, it is processed to determine body position (proprioception), posture, balance, movement, body alignment, and the tension placed on your integrated spring mechanism. The muscle spindle cell is one of the body's most important proprioceptive sensors, playing a major role in detecting tension and movement so the brain can rapidly adjust posture, maintain balance and equilibrium, coordinate movement, and respond to stressful motion, instability, or biomechanical imbalance. (16)

Muscle Spindle Cells—Density

How many do we have, and where are they?

We are born with essentially the same number of muscle spindle cells (muscle spindle receptors) that we have as adults. Their number does not significantly increase with age. The average person has approximately 4,000 muscle spindle cells, 2,500 Golgi tendon organ receptors, and several hundred joint mechanoreceptors (joint receptors). (17–19)

Large muscles, such as the quadriceps muscles and other lower-extremity muscles responsible for gross motor movements, contain a relatively low density of muscle spindle cells. Muscles responsible for fine motor control, such as those of the fingers, hands, eyes, neck, and the small muscles surrounding the upper cervical spine and base of the skull, contain a much higher density of muscle spindle receptors (20), allowing for extremely precise movement and postural control.

Although this sounds like a large number, it is actually a relatively small number of sensory receptors. For comparison, the human hand alone contains approximately 17,000 cutaneous sensory receptors (skin receptors) (21) responsible for detecting pressure, vibration, stretch, temperature, pain, and touch.

Muscle Spindle Cells—Anatomy

A muscle spindle cell (muscle spindle receptor) is a small, cigar-shaped sensory receptor surrounded by a connective tissue capsule containing specialized fluid. Its appearance is often compared to a miniature elongated light bulb.

Inside the spindle are approximately 10–12 intrafusal muscle fibers, specialized stretch-sensitive muscle fibers that attach at both ends of the spindle. These intrafusal fibers are relatively stiff in the center and more elastic near their attachment points, allowing them to accurately detect muscle stretch and changes in muscle tension.

Sensory nerve endings wrap around the central portion of these intrafusal fibers, continuously monitoring how much tension, stretch, and strain are placed upon the muscle spindle. Each muscle spindle receptor monitors the tension and stretch occurring within approximately 8–12 surrounding skeletal muscle fibers (extrafusal muscle fibers) that contract to produce movement.

Muscle Spindle Cells—Function

As muscles contract, lengthen, or are stretched, muscle spindle receptors continuously detect muscle tension, muscle strain, muscle stretch, muscle length, the location of the strain, and the speed (velocity) at which the muscle is stretched. This information is transmitted almost instantaneously through sensory nerves to the spinal cord and brain while changes in muscle tension are occurring. These sensory nerves continuously report both the loading and unloading of muscle tension. (22)

Signals from muscle spindle cells, Golgi tendon organ receptors, joint mechanoreceptors, and skin stretch receptors work together to provide the brain with continuous information regarding body position (proprioception), posture, balance, movement, joint position, and muscle tension. This sophisticated sensory system allows you to know exactly where every part of your body is located (23–24), even when your eyes are closed.

As tension increases, the intrafusal fibers stretch, stimulating the sensory nerve endings wrapped around them. This process converts mechanical energy into electrical nerve impulses (mechanotransduction). These nerve impulses carry precise information regarding muscle stretch and muscle tension to the spinal cord and brain, allowing the central nervous system to continuously regulate muscle tone, posture, movement coordination, balance, equilibrium, and the tension placed on (25) the body's integrated spring mechanism.

To summarize, whenever muscles are stretched or muscle tension increases, the muscle spindle receptor is also stretched. This activates the sensory nerve endings surrounding the intrafusal fibers. These nerves immediately transmit information about muscle tension and stretch to the spinal cord and then to the brain, where it is processed to continuously regulate posture, movement, proprioception, balance, and coordinated muscle activity.

Golgi Reflex Organ

The Golgi tendon organ (GTO) is another mechanoreceptor, proprioceptor, and spring strain gauge. This specialized sensory receptor sits as a strain gauge between the muscle fibers and the tendon (26). When a muscle is activated and contracts, this tension pulls on the Golgi tendon organ, which straightens some of the tissue strands, compressing and stimulating the sensory nerves. These nerves then send electrical signals to the spinal cord, central nervous system, and brain. (27)

If there is strain on the muscle-tendon junction that could exceed the tissue's yield point, leading to a muscle strain, tendon injury, tendon tear, or complete rupture, the Golgi tendon organ automatically alerts the brain. The brain responds by inhibiting or shutting down the muscle contraction through the Golgi tendon reflex, protecting the body from excessive mechanical stress and injury.

Mechanoreceptor Sensors

There are also mechanoreceptors, proprioceptors, and strain gauge sensors embedded within ligaments, joint capsules, and connective tissues. These specialized sensory receptors relay information almost instantly about ligament strain, joint position, joint movement, joint stability, and body position to the spinal cord and brain, helping maintain normal movement, posture, balance, and injury prevention.

Chemical and Pressure Sensors Nociceptors

Intertwined among muscles, tendons, ligaments, fascia, joints, and other soft tissues are specialized sensory receptors called nociceptors, commonly known as pain receptors. These peripheral sensory nerve endings detect harmful mechanical pressure, tissue compression, temperature changes, chemical irritation, and inflammatory chemicals within and around muscles and connective tissues.

According to the International Association for the Study of Pain (IASP), a nociceptor is defined as a high-threshold sensory receptor of the peripheral nervous system capable of transducing and encoding noxious stimuli. (28)

These nociceptors are highly sensitive to inflammation, pro-inflammatory cytokines, metabolic waste products, lactic acid, toxins, and other chemicals released by injured or damaged tissues. They are also sensitive to abnormal pressure, compression, stretching, excessive force, and temperature changes.

Nociceptors are essential for maintaining the body's integrity by sensing potentially harmful stimuli and triggering protective reflexes that help prevent injury. The body rapidly withdraws from painful or dangerous stimuli. Nociceptors protect you.

When the central nervous system receives signals from nociceptors, it interprets these signals as an alarm indicating abnormal mechanical stress, tissue damage, inflammation, chronic inflammation, chemical irritation, or compression injury within the body.

The brain may also interpret these signals as exposure to dangerously hot or cold temperatures capable of causing tissue injury. Nociceptors also detect inflammatory chemicals that seep into surrounding tissues following injury, repetitive strain, or chronic tissue damage. These sensory nerves transmit messages from peripheral tissues to the brain, while another network of motor nerves carries instructions from the brain back to the muscles and sensory receptors to coordinate protective movement responses.

Muscle Spindle Cells—Patterning of Reflexes—Position Sense

We have seen that muscle spindle cells, also called muscle spindles, are highly specialized stretch receptors, mechanoreceptors, and proprioceptors that provide the brain and spinal cord with continuous information regarding muscle length, muscle tension, rate of muscle stretch, and speed of contraction. They relay this information to the central nervous system, making it possible for you to sense where your body is in space (29), how fast you are moving, and how your muscles are functioning during movement.

These functions are collectively referred to as proprioception, position sense, and kinesthetic awareness. As discussed above, muscle spindles play an essential role in providing continuous sensory feedback to the brain regarding body position, posture, movement, balance, coordination, and every movement you perform throughout the day. (31) (30)

Proprioception is the body's ability to sense internal stimuli related to body position, joint position, movement, balance, equilibrium, and spatial awareness. Sensory receptors such as muscle spindle cells and Golgi tendon organs continuously send information about the position of your muscles, joints, and posture to the brain and spinal cord.

Your posture should always be evaluated according to how each body segment is positioned around the Integrated Spring-Mass Model and the Human Spring, ensuring there is minimal mechanical strain placed on any portion of the integrated spring mechanism, thereby promoting optimal biomechanics, efficient movement, injury prevention, and long-term musculoskeletal health.

1. The Vestibular System

The vestibular system, also called the vestibular apparatus, consists of specialized sensory organs located in the inner ear (labyrinth) within the skull. It contributes to posture, balance, equilibrium, coordination, and human biomechanics by interpreting changes in head position, head movement, body position, and body movement relative to gravity, as well as the direction, velocity, and acceleration of movement. This information is sent to the brainstem, which creates a response that allows your postural muscles, stabilizing muscles, and core muscles to automatically adjust your postural alignment, postural orientation, and body position.

The vestibular system is officially defined as the sensory system that responds to the position of the head relative to gravity. It senses when you are moving forward, backward, side to side, up and down, turning, accelerating, decelerating, or changing body and head angles while maintaining balance, equilibrium, and upright posture.

The vestibular system consists of the three semicircular ducts (semicircular canals), the utricle, and the saccule. Together these structures form the membranous labyrinth of the inner ear vestibular system.

This sensory system continuously monitors the direction of your movement, including turning, forward-backward, side-to-side, rotational, and up-and-down movements. It assesses the position and movement of your head relative to gravity automatically without conscious thought. Therefore, it functions primarily through automatic reflexes.

Vestibular Sense

• Provides information related to head position, head movement, body position, body movement, and orientation relative to gravity.
• Is essential for the development and maintenance of balance, equilibrium, coordination, postural control, eye control, motor control, body awareness (proprioception), attention, and confidence during movement.
• Maintains stable vision and gaze stabilization, allowing you to keep your eyes focused on a target regardless of the position or movement of your head and body.

The Sensors of the Vestibular System

The sensory organs of the vestibular system, like the muscle spindle cells and Golgi tendon organs, are mechanoreceptors that detect mechanical movement and changes in position. The semicircular ducts (semicircular canals) resemble three hula hoops positioned at right angles to one another and contain thousands of microscopic hair cells (vestibular hair cells) covered by a gelatinous material containing tiny calcium carbonate crystals called otoconia.

When your body or head moves, the gel shifts within the canals and bends the tiny hair cells. This stimulates the attached sensory nerves, sending signals to the brain that precisely identify changes in head position, head acceleration, speed of movement, direction of movement, angular motion, and rotational movement.

The ability of the nervous system to detect movement of the head is called dynamic equilibrium. The utricle and saccule detect the position of the head when it is not moving and detect linear acceleration, providing static equilibrium.

The brain continuously determines the exact position of your head relative to gravity through these vestibular signals. This process occurs automatically through vestibular reflexes without conscious effort. The human utricle contains approximately 30,000 vestibular hair cells, while the saccule contains approximately 16,000 vestibular hair cells.

The vestibular system is much more complex than this simplified explanation, but these sensory organs continuously determine the position and movement of your head relative to gravity. It is like having six living bubble levels or spring levels positioned at different angles inside your head that constantly measure the exact position of your head, its speed of movement, and its direction of movement. Their primary purpose is to keep your head level, your eyes level with the horizon, and your body properly aligned perpendicular to gravity.

The brain processes this vestibular information and automatically centers your head into an upright position so your eyes remain level with the horizon, much like a builder uses a level to construct a perfectly horizontal foundation.

The utricle and saccule detect linear acceleration, forward-backward acceleration, side-to-side acceleration, and head tilt relative to gravity, providing static equilibrium.

The semicircular ducts (semicircular canals) detect rotational acceleration, including nodding, turning the head left and right, tilting the head, and other angular head movements that produce dynamic equilibrium.

The vestibular apparatus of the inner ear serves three primary purposes in humans.

• The vestibular system plays the dominant role in maintaining balance, equilibrium, postural stability, and spatial orientation, constantly informing your brain where you are, where you are moving, and how fast you are moving.
• The vestibular system maintains gaze stabilization, visual fixation, and a stable image on the retina through the vestibulo-ocular reflex, regardless of the position or movement of your head.
• The vestibular system provides continuous information that regulates muscle tension, postural muscle activation, and spring tension within your Human Spring System, allowing your body to maintain efficient upright posture and movement.

The vestibular apparatus continuously provides information about the position of the head in three-dimensional space. These receptors can detect a change in head orientation of approximately 0.5 degrees from the upright position and approximately 5 degrees from the horizontal position.

The vestibular system activates multiple vestibular reflex pathways responsible for making automatic adjustments in body position, body angle, muscle tone, and posture relative to gravity. These adjustments occur continuously without conscious awareness.

The three most important vestibular reflexes are the vestibulo-ocular reflex (VOR), the vestibulospinal reflex (VSR), and the vestibulocollic reflex (VCR). Together with other postural reflexes, these reflexes maintain balance, equilibrium, head stability, eye stability, and upright posture. The most important of these automatic protective mechanisms is the righting reflex, which continuously returns the head and body toward an upright position relative to gravity.

Righting Reflex or Labyrinthine Righting Reflex

This reflex combines input from the visual system, somatosensory system, proprioceptive system, vestibular system, and vestibular reflexes. It can detect, within a split second, that the body is not erect, causing the head to be off perpendicular to the ground. Then it signals the neck muscles, cervical muscles, and postural muscles to contract to move the head back into the perpendicular position. Then the rest of the body follows, if possible.

It's not that simple. The brain interprets the signals from your eyes, visual system, muscle spindle receptors, proprioceptors, the neck muscles, and the vestibular system to determine if the head is tilted or the entire body is tipping. That is how it can make split-second postural reflex adjustments in tension in your cervical muscles and maintain your head perpendicular to gravity and your eyes on the horizon, no matter what position your body is in. So, all head posture, cervical posture, and postural alignment changes relative to your body angles are done automatically.

Posture Control by Learned Behavior

When your mom says, "Sit up straight!" you contract muscles to position your body and head where YOU think good posture is. By tensing your muscles, you are causing an abnormal compression of your Human Spring, spring mechanism, and human spring system. The muscle contractions will cause compression of the spring. The longer your muscles contract to hold your posture, the deeper the brain commits this pattern of contraction to memory through motor learning and muscle memory.

This will cause muscle contractions that can turn into reflex muscle spasms, trigger points, myofascial trigger points, painful muscle spasms, muscle tightness, muscle tension, and compressive muscle spasms. This can lead to neck pain, chronic neck pain, upper back pain, chronic upper back pain, shoulder pain, chronic shoulder pain, headaches, thoracic outlet syndrome, thoracic outlet compression, brachial plexus compression, cervical disc compression, vertebral disc compression, and herniated discs. This abnormal compression may also contribute to carpal tunnel syndrome, cubital tunnel syndrome, chronic pain, poor posture, postural dysfunction, and other compression syndromes. Walking or running with a tense spring will cause your body to bang into the ground rather than spring off the ground, reducing shock absorption, energy recycling, and movement efficiency.

It is medically necessary to learn how to work with these postural reflexes, righting reflexes, vestibular reflexes, proprioceptive reflexes, and postural control mechanisms so you can sleep, sit, stand, walk, run, and move without causing abnormal compression of your thoracic outlet, brachial plexus, vertebral discs, cervical spine, lumbar spine, and human spring mechanism. Through the information in this book, I can act as your trainer and coach to teach you the movement patterns, posture habits, and biomechanical principles that produce the positive and negative effects on your body's spring. You will learn that in Chapter 5, "The Cause of Compression!"

Static Posture Evaluation

Plumb line: 1: A line (such as a cord) with a weight (plumb bob) attached that is used to determine vertical alignment, body posture, spinal alignment, and postural symmetry. 2: A line directed toward the center of gravity of Earth; a true vertical reference line used in static posture evaluation, posture assessment, biomechanical analysis, and musculoskeletal examination. A cord with a lead bob attached to one end, used to determine verticality, perpendicularity, and postural deviations.

The Control of Tension on Your Human Spring

Some doctors have you stand on two scales to determine whether you have an uneven distribution of weight on either side of your body. These are static posture assessments, standing posture evaluations, postural alignment tests, and stationary biomechanical examinations that evaluate body posture but do not assess how the body moves.

Dynamic Posture Evaluation

My approach to posture evaluation, biomechanical assessment, and movement analysis includes both static and dynamic posture assessment. I videotape and study patients performing the movements required in their occupations and analyze the biomechanics, gait mechanics, movement patterns, posture, and athletic performance of athletes while they participate in sports activities.

Probably the single most important part of my thoracic outlet syndrome examination, biomechanical examination, and movement assessment is evaluating your walking pattern through gait analysis. I determine whether you walk using your Integrated Spring-Mass Model, Human Spring mechanism, spring biomechanics, and natural spring mechanics in harmony with gravity while maintaining balanced muscular tension and equilibrium, or whether you walk primarily as a lever mechanism, repeatedly striking the ground, increasing impact forces, twisting through the body, and creating abnormal mechanical stress.

You can watch my lecture, "Ways Physicians Can Detect the Earliest Signs of Aging via Gait Analysis," presented at the A4M Thailand Congress on Anti-Aging Medicine, which explains how gait analysis, walking biomechanics, movement assessment, and posture evaluation can reveal early biomechanical dysfunction.

The patterns of movement are stored in the brain as engrams, also known as motor engrams, motor programs, movement patterns, neural movement patterns, or motor control patterns.

The Engrams, Neural Development, or Brain Patterning—Your Body's Software Programming

Complex patterns of muscle activation that produce coordinated movement are generated by the central nervous system, including the brain and spinal cord. Even a simple movement, such as lifting your arm to reach for a computer mouse, requires coordinated input from thousands of mechanoreceptors, proprioceptors, sensory receptors, muscles, tendons, ligaments, joints, skin receptors, visual receptors, and vestibular receptors, all working together to develop movement patterns that become stored within the brain.

As explained above, these movement patterns are learned through repetition and stored within the nervous system for future use. These coordinated movement programs are called engrams. You possess engrams for your walking gait, running gait, posture, balance, smiling, laughing, coughing, speaking, singing, athletic movements, sports performance, and even playing a musical instrument such as the piano.

The existence of movement engrams is well established. However, scientists and physicians still do not fully understand the precise neurological mechanisms responsible for how engrams, motor learning, motor control, neuroplasticity, and movement memory are stored and retrieved, despite decades of neuroscience research.

Are Engram Patterns the Same as Muscle Memory?

Many people ask me about muscle memory. They assume that repetitive exercise trains muscles to remember movement patterns. In reality, muscle memory is simply a commonly used expression. Muscles do not store memories of movement. Instead, movement memory, motor learning, motor programming, and motor control are stored within the brain and central nervous system as engrams.

Therefore, when we train athletes to improve walking, running, posture, movement efficiency, sports performance, rehabilitation, or activities of daily living, we are actually retraining the nervous system, brain movement patterns, motor control system, and neural programming, rather than creating memory within the muscles themselves.

Don't think you aren't the only one who didn't understand muscle memory, movement memory, motor learning, neuromuscular training, or nervous system programming. In fact, after my presentation, "The Best Sports for an Anti-Aging Lifestyle," at the Anti-Aging Medicine World Congress in 2007 in Monte Carlo, Principality of Monaco, at least a dozen doctors met me in the hallway to share their aha moment when they learned that we are training the nervous system, brain movement patterns, and motor memory—not muscle memory—when we train athletes and develop proper movement patterns.

You can watch this lecture on our YouTube channel. You can find it at www.thoracicoutletsyndrome.org to learn more about muscle memory, nervous system training, movement patterns, biomechanics, and the Human Spring Approach.

You have positive engrams and negative engrams. These movement engrams, motor engrams, and nervous system memory patterns determine how your body moves and functions.

If you practice healthy movement patterns, healthy posture, and proper biomechanics, your brain will store healthy, positive engram patterns. It also stores destructive, negative engram patterns created by poor posture, repetitive strain, faulty movement patterns, and abnormal biomechanics. Your brain is your humble servant, in that sense. It stores the movement patterns you repeat, whether they are healthy or damaging to your body.

The movement pattern, posture, and motor program you communicate to the brain eventually become the movement pattern and posture your servant, the brain, considers normal and habitual. The stress, repetitive strain, poor posture, and abnormal movement you repeat will become the stress, strain, and movement dysfunction you continue to repeat. These faulty movement patterns will persist until you reprogram your brain, retrain your nervous system, and replace the old stressful pattern with a new stress-free movement pattern.

It is a fact that these movement patterns can be reinforced with repetition. That is what we call practice makes perfect in sports—or more accurately, perfect practice makes perfect movement patterns, proper biomechanics, and efficient athletic performance. Your nervous system functions much like a computer: garbage in, garbage out. Train poor movement and you develop poor movement. Train proper movement and you develop efficient, injury-resistant movement.

The brain is your humble servant, storing the motor program, movement memory, and engram for every single movement you make throughout life.

We've seen that the body's sensory nervous system, proprioceptors, mechanoreceptors, and thousands of sensory receptors constantly send information to your brain, providing continuous feedback about how your body is interacting with Earth's gravity, ground reaction forces, and the mechanical stresses placed upon your body.

As we've established, there is an engram, motor program, or movement pattern for walking, running, lying down, sitting, standing, lifting, throwing, jumping, and sports performance that is programmed into your brain. These practiced movement patterns allow you to use your Integrated Spring-Mass Model, Human Spring, and natural elastic energy recycling during activities of daily living and sports while minimizing injury, reducing joint stress, improving efficiency, and maximizing protection of your body's spring system.

Gravity is constantly pulling us downward, compressing the body's Human Spring. Your body's sensory receptors continually monitor the stress and strain placed upon muscles, tendons, ligaments, fascia, joints, bones, nerves, and other tissues as your posture and body position constantly change relative to Earth's gravity.

This concept is so important that I continually practice my walking mechanics, walking biomechanics, posture, and movement efficiency to keep my movement pattern as close to perfect as possible. I don't want to need knee replacement surgery, hip replacement surgery, or suffer from osteoarthritis, chronic joint pain, or unnecessary degeneration when I'm retired and trying to enjoy an active, healthy life.

There is much more to this fascinating subject, including motor learning, movement retraining, neuroplasticity, sports performance, and Human Spring biomechanics, which I plan to cover in much greater depth in my next book.

Conclusion

So, the control of the tension that maintains a wide-open thoracic outlet, thoracic tunnel, healthy joint spaces, and minimal stress and strain on your muscles, ligaments, tendons, nerves, bones, and joints is primarily controlled by your posture, movement patterns, daily habits, and the programming within your nervous system.

Remember, your nervous system will continually increase or decrease the tension placed on your Human Spring depending upon the posture, movement patterns, biomechanics, and lifestyle habits you practice every day.

Living a pain-free, active, healthy life requires living in harmony with nature—specifically Earth's gravity, the laws of physics, and proper human biomechanics.

Now that we fully understand how the Human Spring, Integrated Spring-Mass Model, nervous system, and movement patterns work together, let's finally discover what causes the compression of your thoracic outlet, thoracic tunnel, brachial plexus, and blood vessels.

Spring forward!