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Inside-Out Paradigm

By Dale G. Alexander, LMT, MA, PhD

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Additional Stealth Factors in Chronic Somatic Dysfunction

For all massage therapists who treat clients with chronic somatic dysfunctions and pain, I invite you to consider sub clinical infections as a possible contributor to the perpetuation and persistence of their long term condition. Until one understands that such a category of possibility exists, it doesn't. Here are a few examples from my 35 years of private practice to highlight the idea:

  • Chronic elbow pain eventually resolved when a tooth and gum infection was addressed.
  • Ten years of neck pain found to be associated with a chronic sinus infection.
  • A systemic lock down of the pelvis related to a previous Mersa staph infection which hadn't been eradicated completely.
  • A 25-year low back condition related to a stealth kidney infection.

These are but a few of the situations that have presented themselves in my clinical practice. One tip-off that this may be a relevant variable is to ask prospective clients if they have ever had a serious infection. Serious, meaning that they were hospitalized or stayed home for more than a week. For so many, infections can take months to overcome. Yes, those which occurred during their childhood still do matter even decades later.

My premise is that once a person has had a serious infection, their probability of contracting another is much more likely. And, my corollary premise is that all micro-organisms, in their never ending evolution to survive themselves, figure out ways to "hide" and eventually re-build their population(s).

ecoli - Copyright – Stock Photo / Register Mark Wikipedia defines sub clinical infections as "an infection that is nearly or completely asymptomatic (no signs or symptoms). Since sub clinical infections often occur without eventual overt sign, their existence is only identified by microbiological culture, electromagnetic frequency detection or DNA techniques such as polymerase chain reaction."1 Further, Wikipedia lumps microbes, parasites and viruses under this same heading as we would be wise to consider doing so as well in our thinking when dealing with clients presenting with stubbornly chronic somatic profiles. I would also include fungi which is mentioned yet, downplayed in most medical texts, especially as it relates to potential stealth urinary tract and kidney infections.2

All too often, it is not even a consideration that musculoskeletal problems can be an expression of the immune system's efforts to contain bacteria, viruses, fungi, and parasites. I am here to shout from the mountain top that this is an important category for us to consider as practitioners when addressing clients with chronic profiles.

The human nervous system often uses the joints and their associated soft tissues as "back door communication channels" via the spinal cord to get our attention that something is amiss internally. The viscero-somatic reflex arcs are the biological communication system for such expressions of internal distress. These reflex arcs are neural circuitries shared between organs, joints, and their soft tissues.3 Everything is connected to everything.4

The notion of attending to the possibility of sub clinical infections emerged over many years as my "hands-on work" with clients would reduce the number of their somatic complaints only for them then to report other significant, perhaps even debilitating, non-somatic symptoms. Or, having gone to their doctor as I encouraged, they discovered that they did indeed have an infection that had been flying under the surface of their chronic troubles. Or, encouraging them to request that their physicians prescribe an extended run of antibiotics or, to consider treating them for suspected parasites ... their chronic somatic symptoms resolved.

How could this be?

My conjecture, as previously stated, is that bacteria, viruses, parasites, and fungi have learned to "hide." It's a simple idea. I also propose that the immune system often has so many "fires to put out" that its attention is distracted by other more immediate and threatening assaults.

As humans we prioritize activities where we expend energy and resources in our lives, we space out, we ignore, we go into subconscious and conscious states of denial. We wish for this not to happen internally but my clinical experience increasingly leads me to consider that this continuum of external behavior reflects how our immune system works ... a possible manifestation of the principle "As within, so without."5

The importance of developing "hands on skill sets" that facilitate an awareness of a communication within the nervous system from the brain and spinal cord to the internal organs, and an ability to amplify this voice so it may be heard clearly by the Central Nervous System is our highest privilege and challenge.

Let us remember that the internal viscera have, on average, only 25% of the sensory neurons of the musculoskeletal system and the skin.6 The voice of the viscera is a quiet one. Easily, dysfunction and pain of the musculoskeletal system and those of our skin drowns out the muffled cry of the viscera that evolution gave a reduced capacity to signal distress.

I propose that we are in a transition phase of our collective evolution where we have the opportunity to decipher the elegance of our human design given our present extended longevity. When the human nervous system locked in its current functioning our ancestors were still on the menu of many predators. Individual survival and the collective preservation of our human species made the task of passing on our genes the ultimate priority. And, survival in that environment required the ability to flee, fight, or neither ... that is, to freeze.

Who could forget the scene in the movie Jurassic Park where the T. Rex searches for the young protagonists standing silently still right in front of him. Freezing once served a survival purpose, literally. To my perception, hiding is our modern version of this survival strategy both physically and psychologically. And, cooperation, so needed now, is construct of consciousness and choice. It is the new kid on the block within our nervous system.

I perceive these seeds exist in all of us yet, they are less hard-wired and require love and compassion of self and others to find their way to consistent expression. Let us remember that we are born without an instructional manual to show us how the human body really works. We are actively creating theories and practices which potentially reveal how our body systems interactively function as an integrated whole.

Let us consider that the coherence within us is established to use the musculoskeletal system both to distribute the strain of internal distress and as a communication device to point the way back to its source(s). We are Atlantis embodied, endeavoring to remember all that we once understood. Or, perhaps we never did possess this understanding and are having to sort it out through trial and error by resourcing the discoveries of our progenitors and the technological advances of our present time.

This notion of distribution of strain is inferred by the generally accepted referral pathways for pain that is found in most medical text books. The notion of the connection between organs, joints, soft tissues and fairly specific levels of the spinal cord are further validated by more than 150 years of their daily use. Both the professions of osteopathy and chiropractic rely upon these in guiding their treatments using manual therapy means.3 Surgeons also use these relationships in making differential diagnostic decisions.7

It has been my clinical experience however, that once the distribution of strain influences have been normalized using manual therapy, the voice of the organs and that of the immune system become more easily interpreted in more classic medical symptom profiles. It is similar to the orthopedic notion of centralization wherein as spinal nerve pressure is released, radicular pain symptoms into the extremities subside, while the more central area which is still afflicted becomes the remaining and more obvious symptom.8

The most common sub clinical infections I have encountered over my 35 years of professional practice include those related to the brain and spinal cord, periodontal troubles, the sinuses, ears and throat, the lungs, the stomach and duodenum, the gall bladder, liver and pancreas, the urinary bladder, kidneys, the small and large bowel, the uterus and ovaries and the prostate gland. Apparently, all organs and tissue structures have a vulnerability to infection.

The immediate take-away is that when a client makes progress only to then regress in their improvement without apparent cause, then the presence of one these factors needs to be considered and a referral to their physician encouraged.

One last example to highlight how quickly the immune system can respond to treatment: a pregnant woman came to me with internal left abdominal pain that would get worse after eating. She responded quite well to the first session reporting that her symptoms had gone away when I called to follow-up a few days later. However, when she arrived for her second session, 10 days later, there was obvious swelling and heat in the area where her symptoms had been. It was clearly an abscess. She was not happy when I said that she needed to see her physician before I could work with her again. When the culture came back, it was diagnosed as an E. Coli infection. Again, it is so important for us to refer our clients to physicians when we suspect internal difficulties or infections.

Since beginning to expand my awareness of the many possible influences that perpetuate chronic musculoskeletal dysfunction and pain, my ability to assist my clients has improved steadily. May it also be so for you.


  1. clinical infections.
  2. Fungal Urinary Tract Infections: Urinary Tract Infections,
  3. Reflex Activity - Principles of Manual Medicine - Michigan State
  4. Everything is Connected to Everything...Concept presented by 2 Chiropractors during my Soma Neuromuscular Training in Gainesville, Fla in 1980 and repeated by another set of Chiropractors at the 1991 Florida State Massage Therapy Convention.
  5. The Universal Law of "As Within, So Without" | Healing and Love
  6. Are there Fundamental Differences in the Peripheral Mechanisms of Visceral and Somatic Pain ?, Stephen B. McMahon, Dept. of Physiology, St. Thomas Medical School, London, England, Behavioral and Brain Sciences (1997) 20, 381-391.
  7. Cope's Early Diagnosis of the Acute Abdomen, revised by William Silen M.D., Oxford University Press, 2000.
  8. McKenzie method - Wikipedia, the free encyclopedia
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