A Postural Connection With MS? Please Answer Poll Questions

A forum to discuss Chronic Cerebrospinal Venous Insufficiency and its relationship to Multiple Sclerosis.

When are you most likely to notice a significant relapse /new symptom (RRms) or general deterioration / worsening of symptoms /new symptom (PPms)

Morning after sitting too long (Sitting)
16
15%
During or After using a wheelchair (Sitting)
6
6%
During the night while sleeping / trying to sleep (Horizontal)
6
6%
During or after standing (Upright)
5
5%
At night while trying to get out of bed (Horizontal)
1
1%
After or during Walking (Upright)
11
10%
Following a journey while sitting (Sitting)
12
11%
In the morning on waking (Horizontal)
23
22%
In the evening while resting (Sitting)
8
8%
Rising from bed in the morning (Horizontal)
18
17%
 
Total votes : 106

A Postural Connection With MS? Please Answer Poll Questions

Postby AndrewKFletcher » Sat Jan 16, 2010 3:17 am

Identifying A Postural Connection With MS CCSVI

Each person has one vote only so choose after carfully considering your past ms history and when you have noticed a deterioration in an old symptom or a new symptom.

In a 24 hour period, when would be your worse time of day. For example, when would you usually experience fatigue, new ms symptoms, paralysis, Spasms, numbness, weakness, visual disturbances, Headaches, neuropathic pain etc etc.

1: Morning after sitting too long (Sitting)
2: After using a wheelchair for several hours (Sitting)
3: During the night while sleeping / trying to sleep (Horizontal)
4: During or after standing (Upright)
5: During the night while trying to get out of bed (Horizontal)
6: After or during Walking (Upright)
7: Following a journey while sitting (Sitting)
8: First thing in the morning on waking (Horizontal)
9: In the evening while resting (Sitting)
10: Rising from bed in the morning (Horizontal)


Please elaborate about your own personal experience to help us understand and recognise any possible emerging patterns of ms onset.

POLL Question:
When are you most likely to notice a significant relapse /new symptom (RRms) or general deterioration / worsening of symptoms /new symptom (PPms)


For example, when would you usually experience fatigue, new ms symptoms, paralysis, Spasms, numbness, weakness, visual disturbances, Headaches, neuropathic pain etc etc.

Postural Paralysis and Inclined Therapy for MS CCSVI

http://www.ncbi.nlm.nih.gov/pmc/article ... 2-0012.pdf

History Of Postural Paralysis. This document from The British Medical Journal, Published Augus 8th 1938 is very interesting, and confirms the importance of posture for neurological function. It is a must read for anyone using or considering Inclined Therapy.


Plain Text Version

PARALYSIS DUE TO POSTURE
BY
E. B. CLAYTON, M.B., B.Ch.
DIRECTOR OF PHYSICAL TREATMENT DEPARTMENT, KING'S COLLEGE
HOSPITAL
The following cases of nerve paralysis, which are apparently
due to pressure during the maintenance of some
posture, have been collkcted from the notes of patients
attending the Physical Treatment Department of King's
College Hospital during the last ten years.
Anterior Tibial Nerve Paralysis
Case 1.-In a woman, aged 59, there was a sudden onset
of foot-drop when she was kneeling to clean a grate in April,
1926. On examination the external popliteal nerve was
found to be tender and thickened at the neck of the fibula.
Only the anterior tibial group of muscles were affected, the
peroneus longus and brevis being normal. The faradic
reaction was present but reduced, in April; by July it had
completely disappeared. However, there was return of fairly
strong foot dorsiflexion by September.
Case 2.-A man, aged 42, had a sudden onset of foot-drop
while gardening in a crouching position in March, 1926. Only
the anterior tibial group of muscles were affected. There was
a history of a wound in the thigh during the war, but there
was no paralysis at that time. The duration of paralysis was
sixty days.
Case 3.-A man, aged 23, had sudden foot-drop after
kneeling for over an hour in October, 1923. It lasted for
twenty-four days.
Circumflex Nerve Paralysis
Case 4.-A woman, aged 52, discovered paralysis of the
deltoid muscle on waking one morning in February, 1936.
She was suffering from fibrositis in the scapular region following
an attack of influenza previous to the paralysis, the
duration of which was two weeks.
Case 5.-A man, aged 37, discovered paralysis of the
deltoid muscle on waking one morning in March, 1936. The
paralysis disappeared in a short time, but returned the
following day. He had been previously suffering from fibrositis
in the scapular region, and for a fortnight before the
paralysis developed cramp if sleeping on either arm. The
duration of the paralysis was only a few days.
Ulnar Nerve Paralysis
Case 6.-A lad, aged 21, experienced a sudden onset of
ulnar paralysis when riding a bicycle in April, 1932. He had
had this before, when it only lasted one day, but the duration
on the second occasion was twenty-six days. The paralysis
only affected the intrinsic hand muscles, and was apparently
due to pressure of the hand on the handle-bar.
Musculo-Spiral Nerve Paralysis
Case 7.-A man, aged 52, suddenly developed wrist-drop
after lying down for about fifteen minutes with the hand
behind the head, in February, 1926. It was a wet evening.
On examination the musculo-spinal nerve seemed to be
thickened at the middle of the posterior surface of the
humerus. The paralysis lasted for eight weeks.
AUG. 8. 1936 PARALYSIS DUE. TO POSTURE THE RITISH 2
Case 8.-A man, aged 37, had a sudden attack of wristdrop
after sleeping in a chair on a Saturday night after
indulging in alcohol, in December, 1927. The duration was
thirteen days.
Case 9.-In a man, aged 31, there was sudden onset of
wrist-drop after sleeping with one arm hanging over the side
of the bed, in January, 1928. He denied alcohol as the cause.
He returned to work after fifteen days, not completely
recovered.
Case 10.-A man, aged 37, had a sudden onset of wristdrop
after falling asleep with his head on his wrist, in
January, 1933. It lasted for seven weeks.
Case 11.-In a man, aged 68, a sudden onset of wrist-drop
occurred from the pressure of an arm over a chair in February,
1935. His teeth were very septic. It lasted for two months.
Case 12.-A man, aged 40, woke up with right wrist-drop
in June, 1930. He came to hospital five days later, when
weak active extension of the wrist had returned. No note is
available as to the duration of treatment.
In the four following cases, wrist-drop developed suddenly
without any history of pressure on the musculospiral
nerve.
Case 13.-A man, aged 59, developed wrist-drop one Sunday
morning, with pains in the scapular region, in January, 1931.
It lasted four months.
Case 14.-In a woman, aged 32, wrist-drop developed suddenly
one afternoon in June, 1q32. There was a history of
rheumatism in the shoulder one month before, but there had
been no pain immediately before the onset of the paralysis.
No note was made of the duration of treatment.
Case 15.-A lad, aged 18, had wrist-drop one evening after
work, in September, 1932. It lasted for twenty-three days.
Case 16.-In a man, aged 58, wrist-drop came on suddenly
while he was resting his elbow on the padded arm of a chair,
in November, 1929. There was thickening of the musculospiral
nerve near the external condyle of the humerus. The
duration was five weeks.
The following two cases of ulnar nerve paralysis also
occurred without any history of pressure on the nerve.
Case 17.-In a woman ulnar nerve paralysis developed suddenly
in September, 1926. The hand had been " going
numb " over the ulnar cutaneous area for some time previously.
There was thickening of the ulnar nerve above the
elbow. The duration was ten weeks.
Case 18.-In a woman, aged 58, ulnar nerve paralysis
developed suddenly after she had finished her washing, in
September, 1935. The ulnar nerve was thickened above the
elbow. The paralysis lasted for seven weeks.
These last six cases show that paralysis, presumably
from perineuritis, may develop suddenly without pressure,
and, in some cases, without any previous pain or
numbness.
Transient Paralyses
An effort was made to discover to what extent minor
cases of pressure paralysis occur which do not last a
sufficient time to require treatment. Inquiries from
hospital out-patients showed that the foot may " go
dead" on crossing the knees, and that the hand or
occasionally the whole arm may "be dead " on waking
in the morning. This " deadness clears up quickly on
movement. In many cases it only occurs occasionally,
and seems to be associated with cold and damp weather,
or fatigue. I could not obtain any history of foot-drop
or wrist-drop.
By making inquiries from people with a knowledge of
anatomy I found that:
1. Ulnar paralysis on waking in the morning, after resting
the arms on the side of a chair, or from sleeping with
the hands behind the head, is fairly common.
2. The foot may " go dead," but only rarely do the
leg muscles become definitely paralysed by sitting with the
knees crossed.
3. In a few cases the whole arm is occasionally paralysed
on waking in the morning.
These paralyses always clear up quickly on movement.
In several instances they did not occur regularly, and
were more likely to occur in damp and cold weather or
when the person was fatigued. In one case the presence
of a septic focus increased the intensity and frequency of
occurrence, but did not seem to increase the duration.
Thus the causes are similar to those of fibrositis, with
which it is often associated. I could find no case of wristdrop
or of foot-drop from kneeling.
Points of Interest
The twelve cases of pressure paralysis due to posture
represent the total number which attended the Physical
Treatment Department of King's College Hospital during
ten years. Since, presumably, all patients of this type
who attended the hospital would be ordered physical
treatment, the number seems very small, considering that
several of the postures in which paralysis occurred are
regularly assumed.
No cases of ulnar nerve paralysis from pressure on the
arm, or of foot paralysis from crossing the knees, occurred
in this series, though these two types are frequently found
in the mild form which clears up on movement. On the
other hand, I could not trace any mild cases of wrist-drop
on waking in the morning, or foot-drop after kneeling,
which recovered too quickly to require treatment, either
among hospital patients or friends.
No patient came a second time to the hospital with a
recurrence of the paralysis. This is a point against any
anatomical peculiarity being the cause.
The fact that the majority developed in the colder
months of the year suggests that cold and damp may be
a predisposing cause.
The external popliteal division of the sciatic nerve was
compressed from kneeling rather than the internal division.
Presumably the nerve must have been compressed
between the biceps tendon and the fibula.
The six wrist-drop cases were in men, and of the four
cases of wrist-drop not due to pressure only one was in a
woman. In only one case was a history of paralysis
following indulgence in alcohol obtained.
The electrical reactions varied. In one case the faradic
reaction disappeared, but in the majority it was normal
or slightly reduced, and the galvanic reaction was rather
sluggish.
Conclusion
Some of these cases can be explained as perineuritis
with added pressure. A few were probably due to pressure
only. It seems likely that in the others fatigue, cold
and damp weather, or a septic focus may have been the
predisposing cause. It would operate by affecting the
circulation of the limb and making the nerve more sensitive
to pressure without actually causing a perineuritis,
since this variation in sensitiveness to pressure is found
to be of common occurrence.
H. Vignes (Progras Med., May 30th, 1936, p. 921)
states that according to WV. H. Perkins the gravity of
spirochaetal Jaundice in pregnancy is closely xrelated to
the height and duration of the fever. Renal involvement
is a bad sign. Haemorrhages are not specially
frequent at the time of delivery. Interruption of pregnancy
is not uncommon. Experimentally Mirto observed
it in 70 per cent. of his animals. In human subjects
abortion or premature delivery may be met with, especially
in the Tropics and under unfavrourable hygienic con1-
ditions. Abortion is particularly frequent in Japan, where
severe forms of spirochaetal jaundice are common. The
foetuls as a rule is infected. No special treatment iS
indicated. [/b]
Last edited by AndrewKFletcher on Sat Jan 16, 2010 1:45 pm, edited 1 time in total.
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Postby Asia » Sat Jan 16, 2010 12:11 pm

I have progressive MS and it's going slowly so it is very difficult for me to notice new symptoms immediately. However, as I looked at your question, I tried to find a time of day when my symptoms accumulate/get more annoying and it must be after a long time in a wheelchair; my spasticity gets worse (I have it in the mornings, too, but after a long time in a chair it gets much worse), then there's fatigue (I don't have to do anything, sitting itself tires me), eyesight I'm not sure about, you could tell I've been looking at the screen too long. Then there is something that's been bothering me only recently and only in the evenings; this strange tingling in my fingertips, it feels as if I'm touching my skin through a thin layer of paper. Back pains and head aches happen, too, but they aren't as frequent.

Was that good?
MS (progressive type, not sure which) since 1991
Current EDSS 8 (self-assessed)
Not taking any MS meds since 1998
Epilepsy (had 4 attacks to date) since 2004
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Postby AndrewKFletcher » Sat Jan 16, 2010 12:24 pm

Perfect response and a pattern that fits with Inclined Therapy perfectly.

Thanks Asia

You can edit your post as often as you like, so if anything else needs adding later it all helps to build a picture.

Your question about modifying a bed is answerd in the Frequently asked questions on the I.T. Facebook group.
http://www.facebook.com/group.php?v=app ... 5324668896
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Postby colapesce » Sat Jan 16, 2010 12:51 pm

I ticked 'in the morning after sitting for too long'.

but...
This is more so on a work day, at my desk, staring at a computer screen. By lunchtime when I have to go out to buy something to eat, I feel very dizzy/unstable and my mid torso aches. Also my vision is worse.

I have a decent desk chair, screen at the correct height, etc., so not sure what I'm doing wrong???

Same feeling both before and after starting IBT 2 weeks ago.
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Bottoms Up. Sitting posture and ms.

Postby AndrewKFletcher » Sat Jan 16, 2010 1:33 pm

SITTING PROPERLY
"Bottoms up", is the title given to the correct sitting posture, by John Simkins of the MSRC.
The ideal position ironically is that horrible slouching position which we all find so comfortable, despite being advised that it is not correct by our parents etc.
Your bottom must be higher than your knees when viewed from the side. Adding extra pillows to your existing chair might be all that is required.

According to I.T. The worst kind of seating is a bucket type position. Ironically this position is the best for keeping someone in their seat, ("In more ways than one"). It becomes enlightening to reason that the lousy sitting posture of the wheelchair might, prevent someone from walking again.
People are fearful of relying on a wheelchair on the premise that they might never be able to walk again after using one. And this sadly is frequently the case.

My own observations (non ms)
Another enlightening observation occurred when spending long hours at the computer. As I don't suffer from any kind of illness, I found it fascinating to develop numbness and pins and needles in my fingers, which on a couple of occasions lasted for two days. I realised what the problem was immediately, but continued to use the computer as before in order to study the effects.
The remedy was simple. I raised my chair high enough to allow my hands and arms to slope downwards rather than up or even level. This has eliminated the problem.

I heard an interesting discussion about a group of Monks in Tibet, who for some reason unknown to me, have taken this scenario to the extreme, by permanently raising one of their arms. Apparently as a sacrifice to their beliefs. The discussion took place on Virgin Radio and was initiated by Chris Evans in the Early part of January 99. The inevitable consequence of this unusual activity has been that the arm becomes totally useless and fossilised. Chris concluded that it must have been done to promote thought.
Gravity causes circulation without the need for a pump! If allowed to run in an uninterrupted circuit through the long head-to-toe tubes of the body, everything is hunky-dory. It makes no difference if your limbs are not straight, so long as there is a drop from head to toe. If a person’s body is aligned incorrectly, a pooling of concentrated liquids occurs. E.g. If a person is in a bucket type seat with knees above bottom, there is inevitable pressure which compresses the vessels, muscle and soft tissue as the pelvis together with your body weight compresses the buttocks against the seat. The same of course applies to correct inclined sitting posture so something else must be taking place with Inclined Therapy applied to sitting posture. Could density changes in the blood and fluids in the nervous system and lymphatic system. be compromised by interrupting the flow through the body? Remember that the lymph and cerebrospinal fluids are not affected by the heart! And respiration and posture have been identified as a cause of the circulation within both systems in the literature.

Analogy: Visualise a joined loop of water filled tubing attached to the side of a person in a bucket type seat. Add some coloured salt solution at the top of the loop at the head and observe it flowing down to the seat and prevented from flowing over the bent up knees. Now picture the same experiment with the body at an incline sitting posture, here the flow of salts would go right down from head to toe.
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Postby Katie41 » Sat Jan 16, 2010 1:34 pm

My neck is very weak, so when I'm sitting for prolonged periods driving or in front of computer screen, I get very sleepy. As soon as I stretch the back of my neck, I am instantly awake. When I relax into it again, I get sleepy, then stretch, awaken.
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Postby AndrewKFletcher » Sat Jan 16, 2010 1:42 pm

Katie

I lectured the main boardroom at Jaguar cars for 2 hours on why people fall asleep at the wheel. They were fascinated by my experiments with fluids and explanations, but sadly not enough to alter their seating (due they said to design constraints).

So I can identify with your tiredness driving. Place a foam wedge beneath you to take the dip out of the car seat and try again.

Andrew
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Postby Katie41 » Sat Jan 16, 2010 6:05 pm

Andrew,

I'll try it. Thanks.

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Re: Bottoms Up. Sitting posture and ms.

Postby thisisalex » Sun Jan 17, 2010 2:46 am

AndrewKFletcher wrote:SITTING PROPERLY
"Bottoms up", is the title given to the correct sitting posture, by John Simkins of the MSRC.


Hey Andrew
I answered your poll, i have the worst symptoms in the morning but only after a long sleep. 6-7 hours is just fine, but after 8-9 hours i feel really crap.
(i inclined my bed, i will follow up later for you)

Another thing is the sitting position.... i exactly found out the same as you... i had problems with my wrist because of wrong sitting position. ialso have bad posture which could be a case for a narrowed jugular... who knows?

and a third thing: my first SM issue was after a bending down... (sic). here is a thread for this: http://www.thisisms.com/ftopict-9242-bending.html

thank you for not giving up research Andrew!

alex
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Postby AndrewKFletcher » Sun Jan 17, 2010 8:24 am

Hi Alex

Read your previous post from the link.

You admit to being overweight and lacking exercise. Would it be right to presume you spent more time sitting / laying down than most people around your age group?

Your symptoms standing after kneeling down suggest orthostatic intolerance

http://emedicine.medscape.com/article/902155-overview

This may be related eventually to CCSVI and the onset of ms.

Hope this is helpful

Andrtew
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Postby thisisalex » Sun Jan 17, 2010 10:48 am

AndrewKFletcher wrote:You admit to being overweight and lacking exercise. Would it be right to presume you spent more time sitting / laying down than most people around your age group?

Your symptoms standing after kneeling down suggest orthostatic intolerance



Andrew,
thank you for your answer.
i think i didnt spent more time laying down... but i always sit, thats true. :)
yep, orthostatic intolerance was a find from me right after this issue... i will never know the truth ...
it is just interesting that my MS was starting with a postural episode which clearly fits your cases above...

regards
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Postby Vonna » Sun Jan 17, 2010 11:09 am

Not sure if it will fit within theory or not, but I'll try to answer the question.

My symptoms are worse the longer I am on my feet, walking around.

However, I have woke up during the night, and in the morning, to find my arm or hand asleep.

My very first symptom of MS that sent me to the doctor was my hand shaking, not able to hold the computer mouse still. Then, not being able to write, knocking things over, etc.
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Postby AndrewKFletcher » Sun Jan 17, 2010 2:17 pm

vonna

Your experience using the mouse lends me to ask was your keyboard higher than your elbows?

Your walking symptoms, is this fatigue you feel? Or are there any neurological symptoms like spasm, loss of sensation, or function?

Or are these symptoms while standing shooting stabbing pains, tingling, pins and needles?

Andrew
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Postby Sharon » Sun Jan 17, 2010 2:48 pm

Andrew -
Just a point of clarification:

There are many reasons for a person to have foot drop - you cited examples of people who had trauma to a muscle or nerve group in the lower body.
MS foot drop is caused by sustained damage to upper motor neurons or pathways to the spinal cord. I wear a WalkAide -- it only works for people who have upper motor neuron damage - it will not work on lower body damage.

The causes of foot drop, as for all causes of neurological lesions, should be approached using a localization-focused approach before etiologies are considered. Most of the time, foot drop is the result of neurological disorder; only rarely is the muscle diseased or nonfunctional. The source for the neurological impairment can be central (spinal cord or brain) or peripheral (nerves located connecting from the spinal cord to an end-site muscle or sensory receptor). Foot drop is rarely the result of a pathology involving the muscles or bones that make up the lower leg. The muscle that is designed to pick up the foot is the anterior tibialis. It is innervated by the common peroneal nerve, which branches from the sciatic nerve. The sciatic nerve exits the lumbar plexus with its root arising from the fifth lumbar nerve space. The descending spinal cord nerve that leads to the sciatic nerve is found in the anterior horn of the spinal cord and communicates from the brain—specifically, the cerebral cortex.

http://en.wikipedia.org/wiki/Foot_drop

I wanted to bring this to your attention because I do not want MS'rs believing that in all cases their foot drop could be caused by poor posture. It is caused by nerves in the brain and spinal cord that have been stripped of the myelin.

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Postby AndrewKFletcher » Sun Jan 17, 2010 3:23 pm

Hi Sharon

Just realised that you were referring to the 1938 paper from the British Medical Journal Archives, and not anything I had written about people on I.T. Sorry for not picking up on this before my hasty reply.

But you have raised several interesting points that need addressing in those old case reports.

1. Could the constriction of the nerves due to bending / kneeling down have an impact on the neurons in the head and spine?

In theory, this is essentially what we are addressing. Compromise the circulation in one area and it has a direct impact on the circulation elsewhere. We know the circulation in the nervous system does not have a pump and depends on posture and respiration. So could the act of bending , kneeling be enough to restrict this circulation and cause a temporary stagnation of flow in a susceptible person? It is not difficult to understand how this might happen when a leg is bent back for a prolonged period while kneeling. The muscles would be tense and this would undoubtedly constrict the nerves. It certainly does constrict the veins and arteries.

Standing in one position for too long without weight shifting from one foot to another for example can cause a person to pass out. We have all seen the funny videos of the bride or groom passing out at the wedding.

Could the pressure on the underside of the foot be causing a temporary interruption in the circular flow along with the constriction in the tense muscles? I believe this has merit.

PARALYZED IN CHURCH.; Stricken While Praying ;- Remains Kneeling for 14 Hours.
November 11, 1913, Tuesday
Page 2, New York Times
Shortly after Miss Hannah Moran, a seamstress, knelt for her morning devotions at 7 o'clock yesterday in a pew in the Church of St. John the Baptist, in West Thirtieth Street, she was stricken with paralysis and found she could not rise. Her hope, then, was in prayer, and she continued with bowed head hour after hour.
http://query.nytimes.com/mem/archive-fr ... 946296D6CF

2. Could this lower body constriction have a knock on effect leading to reflux back to the brain and the onset of lesions in ms? We have heard already that sitting at a computer can bring on the onset of ms symptoms.
3. Could sleeping on an inclined bed provide a means for the body to repair the damaged myelin? Given the overwhelming evidence of 2 pilot studies and this 3rd study, which is showing identical patterns of recovery, without any need for surgery or indeed a drug based regimen, it certainly looks plausible.

I will add more about the liquid crystal state of myelin and it’s behaviour under the influence of gravity and temperature later.

That old paper was cited to shown a loose connection with posture and paralysis

The case I mentioned was exactly as you described, scars /plaques in the spinal column and brain not in the lower extremities. Long term ms problem not trauma.

We will have to wait and see if anyone else decides to test this using a dehumdifier and an inclined bed.

We shouldn’t have to wait long to test it either.

Can you point me to your reference of where I attributed recovery to lower body trauma? Was I referring to spinal cord injury, if so then I could not have referred to dropped foot.

I.T is also about how circulation in the nervous system can be stimulated by maintaining the direction of gravity so that it can influence an imbalance in density on the downward flowing side and in doing so induce a return flow.

many reports now confirm improvements in circulation. How can this be if there is no density imbalance? If all is equal then gravity will influence both sides of the circulation and no net-improvements in circulation will take place.

We have heard already from people reporting skin colour and tone changes from purple to normal looking skin colour. Does this say nothing about circualtion? Or does it confirm improvements in circulation?


Thanks

Andrew
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