I blogged a few months back on how we arrogant MDs needed to write an apology to our alternative medicine colleagues based on new discoveries that showed that craniosacral therapy works. Now another new study shows just how stupid we have been, finding new lymph connections in the brain that would further explain why craniosacral therapy is effective as well as chart a link between the immune system and the brain. Let me explain.
The craniosacral therapy research I shared with you in August showed that craniosacral therapy (CST) improved neck pain more than a placebo. There was also an improvement in physical function in the CST group.
How did they come to this conclusion? Fifty-four patients were randomized into two groups: one group received CST, and the other received a light-touch placebo therapy. This was a “blind” study, meaning that the patients did not know whether they were getting craniosacral therapy or the placebo (a sham treatment). The authors kept the patients truly blinded to which treatment group they were in, even telling patients that they were testing two different CST methods.
The lymphatic system falls under the umbrella of our circulatory system, which consists of the structures in our body involved in circulating blood (cardiovascular system) and lymph (lymphatic system) throughout our body. The structures that make up our lymphatic system include the thymus gland, bone marrow, spleen, lymph nodes, tonsils, and lymphatic vessels. The organs and tissues of the lymphatic system circulate lymph rich in white blood cells, such as lymphocytes, through the intricate channels of our lymphatic vessels, supporting our immune system. Think of the lymphatic system as both a waste disposal system and one that can help fight infection.
Cadaver dissection is a mess. The body has many delicate structures that the most careful anatomists destroy. This is what happened in this case. The delicate lymphatic vessels that ran with the arteries in the brain were so fine that they were being lost once even the most skilled anatomist tried to explore the brain’s structure.
Another reason we keep missing structures, like the recently discovered anterolateral ligament (ALL) in the knee, is a combination of arrogance and bias. First, we’re not looking because we believe that we already know all there is to know. That’s a very dangerous place to be, as the obvious can sail right past you and you wouldn’t recognize it. You can’t underestimate how believing that you know all there is to know destroys scientific insight and curiosity. I see it every day in medicine: physicians who don’t have a clue about how the human musculoskeletal system truly works despite excellent training in orthopedics, physical medicine, interventional spine, or other similar disciplines. Once they think they know everything, they simply stop looking.
Second, spending 20 minutes with an ultrasound probe that lets you look at surface muscle, tendon, and ligament anatomy with hundreds of times the resolution of an MRI will show you just how wrong our anatomy texts are. For example, a muscle tendon that you’ve seen a hundred times in a hundred separate images go from point A to point B does go that direction, but it often sails right by point B and then blends in with the next tendon down the line. However, trying to dissect all of this out in a cadaver just destroys this structure. Regrettably, almost all of our textbooks are based on those clumsy dissections.
A recent study out of the University of Virginia School of Medicine found channels of the lymphatic system in a place they were previously unknown to exist. These lymphatic vessels were discovered in the dural sinuses. They were easily missed all this time due to their proximity to the blood vessel and because they were so delicate and fragile. The study analysis states, “These structures express all of the molecular hallmarks of lymphatic endothelial cells, can carry both fluid and immune cells from the cerebrospinal fluid, and are connected to the deep cervical lymph nodes.” This forms a new connection between the central nervous system, specifically the brain, and lymphatic system and could impact the diagnosis and treatment of neurodegenerative conditions, such as Alzheimer’s disease and Parkinson’s disease. Why? Remember that this is one of the waste disposal systems of the brain. Waste that isn’t removed builds up; leading to toxic levels of chemicals that can poison brain cells.
The upshot? It’s exciting that we’re still discovering body parts and systems in the early 21st century. That apology letter to all of those craniosacral practitioners just got a little bit bigger and longer. In the meantime, never assume that you know all there is to know about any subject, especially medicine. That’s a surefire way to make yourself into a mediocre practitioner of whatever it is that you’re practicing. It’s also a surefire way to be an idiot.
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About the Author
Christopher J. Centeno, M.D. is an international expert and specialist in regenerative medicine and the clinical use of mesenchymal stem cells in orthopedics. He is board certified in physical medicine as well as rehabilitation and in pain management through The American Board of Physical Medicine and Rehabilitation.…