How it works

Two muscle groups work alternately. While one group contracts, the other relaxes. They are organized in such a way that they mobilize the joints and tissues permanently. This allows them to assume their drainage.

By contracting and relaxing, the muscles will rhythmically increase and decrease the pressure in almost all areas of the body. Including in the “interstitial spaces”.

At the capillary level

This will increase capillary circulation and promote trade.

Referring to “Starling’s second law“, the increases and decreases in pressure at the exit of the capillaries will favour exchanges between the blood contained inside them (the capillaries) with the extracellular liquid and vice versa.

At the lymphatic level

Increases and decreases in pressure in the interstitial spaces will allow the extracellular fluid to better penetrate into the lymphatic ducts. Thus MMP becomes a determining element of lymphatic circulation.

All the muscles in a muscle chain react in the same way. If one muscle or joint in the same chain is injured, then all muscles and joints in the same chain will be injured as well. Even if there are several lesions in the same chain, they will all have the same lesion pattern (loss of rhythm, loss of amplitude or desynchronization).

Muscle chains, when they are injured, will induce dysfunctions in the exchanges between blood and cells. They will considerably impact the lymphatic return as well as the functioning of all the joints of the body, including the skull. They will lead to congestive phenomena at all levels.

All these dysfunctions will generate a multitude of symptoms. Some of these symptoms will require the participation of several lesions at several levels.  This is the case of hallux valgus which will appear (possibly) during the lesions of the 9th and 10th ribs on the same side.

The PMM is a multi-function engine

The various activities of Permanent Muscle Motility

MMP is a motor that produces contractions and decontractions at the local level (the muscle itself), but also at a distance through the fascias, tendons, etc…

These remote actions will make it possible to manage physiological processes at the level of most organs and functions of the body.

  • At the Articular level

The MMP will produce alternating axial rotational movements at the joints.

These alternating internal and external rotations will cause minimal compression and decompression within the joints, thus promoting exchanges between the synovium and the cartilage. Thus facilitating the nutrition of the cartilage.

  • At the level of the tendons

The tendons of the muscles are not vascularized, or very little (for 1/10 only). They are “nourished” by the supply of syntony produced by nearby ligaments. It is conventionally accepted that it is our movements that bring the ligaments’ syntony to the tendons…

The PMM by its activity will replace these voluntary movements to ensure this nutritional function during rest.

  • At the cellular and tissue level

By contracting and relaxing the muscles during PMM, the muscles will train their envelopes (the fascias) which will transmit these micro-movements to the whole body. Our limbs are compartmentalized in boxes that will be permanently compressed and decompressed. These permanent pressure differentials will be able to participate in intra- and extra-cellular exchanges.

  • At the capillary level

A pressure differential, especially at the capillary outlet, will promote exchanges between the extracellular medium and the blood contained in the capillary. See Starling’s second law.

The different tissues of the body can thus be drained thanks to the activity of the PMM.

  • Concerning thermoregulation

MMP rhythms are sensitive to the surrounding temperature…

Heat slows down the rhythms of PMM, which is why, by reducing muscle tone, muscle pain can be partially alleviated.

Cold increases the rhythm of PMM, the joints and tendons will be better drained and congestion phenomena will diminish…

For more information

Some files that will allow you to better understand the reasons for our efficiency:

About Classical Theories of Venous Return

Permanent Muscle Motility and Venous Return

To go further

Today the classically taught theories about:

The heart circulates blood only in the arteries, capillaries and very slightly in the veins. After the capillaries, there is almost no pressure for the blood to flow back to the heart. So the blood needs a different motor to get back to the heart than the heart itself.

Classical theories propose rhythmic motors whereas the flow of blood in the veins is linear. Moreover, none of the solutions proposed classically is powerful enough to explain the venous return…

The costo-diaphragmatic mechanics works like an accordion that unfolds upwards and downwards. The space between the ribs will, like the space between the folds of an accordion bellows, move apart during inspiration. However, it is classically taught that certain muscles located between the ribs contract during inspiration. But this contraction would have the effect of bringing them closer together, and therefore of exhaling…

For the last 5 ribs, which are therefore lowered to increase the thoraco-abdominal volume, it is said that they are raised by the action of the diaphragm. But these last ribs, as we will see, will logically slide down to increase the total lung volume thanks to the lowering of the diaphragm inserts. The elevation of the middle ribs, up to the 7th rib, being due to the elevation of the upper ribs, as do the folds of the accordion bellows caused by the musician’s hands being spread apart. The contraction of the diaphragm does not raise the ribs. Place your hands sideways on the lower ribs and take a diaphragmatic breath, the ribs will not rise. Take a deep chest breath and the lower ribs will rise…

The last ribs, on diaphragmatic inspiration, will go down. There is often confusion, as to palpation, related to the differentiation of thoracic and abdominal

Classically, it is supposed to maintain the posture of the limbs and in particular against gravity in an erect position. But for this, a few joint receptors would be more than enough. But the receptors present at the level of the musculo-tendinous system are numerous, hyper qualified and complex and their presence presupposes a much more important activity than a simple management of muscular tension. Nothing tangible in the classical theories could explain the phenomenon of nocturnal lumbago or even tendinitis.

Much has been written and discussed about the origin of these motives. But the theories have never coincided either with the clinic or the physiology… We observe under our hands asymmetrical movements, loss of local rhythms or simply physiological mobilities that are neither taken into account nor explained by classical osteopathic theories.

It is to this set of questions left unanswered that we will try to answer with the tools of palpation (so much decried) and the clinic which will be our guides in the course of the remarks that will follow.

The Osteopathic substitution theories that we propose

Concerning venous return

On palpation we feel the muscles contract and relax permanently. (Tens of thousands of osteopaths feel that the body is constantly moving). It is generally accepted that when a muscle contracts, it propels the blood it contains in its venules into the general venous system and thus participates in venous circulation. The muscle at rest has all the necessary characteristics to make it an ideal candidate for the role of motor of venous circulation when the muscles do not contract voluntarily. That is to say, when you actively use your muscles, walking, writing, etc., the muscle at rest has all the necessary characteristics to make it an ideal candidate for the role of motor of venous circulation when the muscles do not contract voluntarily.

There is therefore a muscular activity, during rest, which allows you to assume the role of motor of venous return. We have called this phenomenon Permanent Muscular Motility (PMM). Thus, this PMM will be the main motor of venous return.

Thoraco-abdominal mechanics

Anatomically, there are three types of intercostal muscles that produce three different actions. Their actions are:

To slide the upper rib forward…
Slide the top dimension backwards
To bring the two ribs together during forced exhalation

At the thoracic level

The first ribs are drawn upwards and will pull the underlying ribs like the folds of an accordion bellows. The first 7 ribs rise upwards and forward and sideways. The upper rib slides forward in relation to the lower rib.

At the diaphragmatic level

The ribs will lower, pulled down by the loin muscle. The 11th and 12th ribs will pull down the 8, 9 and 10 ribs. So our accordion opens on both sides… But the lower rib slides forward in relation to the upper rib. This will lower and bring forward the front part of the ribs and thus the diaphragm inserts. As the diaphragm contracts, the abdominal bag will be lowered.

The understanding of this physiology will allow a much better understanding of thoracic deformities and how to respond to them.

Muscle tone

It manages muscle tension for hemodynamic and postural reasons. The muscle is no longer a simple organ that is controlled by locomotion but the main actor of blood circulation. For muscle tone, it is a question of managing intramuscular pressure in order to optimize intra-capillary venous pressure and beyond. Muscle tone is cyclic and is a manifestation of MMP.

The motility we feel

We feel under our hands asymmetrical movements which are what we call desynchronization lesions. They are treatable only by us. We perceive loss of rhythm due to joint, muscle or other injuries. The movements produced by these mobilities correspond perfectly to the muscular functioning described by the MMP theory.

What are we observing about this MMP?

On palpation, an exercised hand feels the muscles swelling and deflating, contracting and relaxing. We have also noted that there is alternating functioning between agonist and antagonist muscles. While one group contracts and bleeds out, the other group relaxes and fills up. This is what we have called “Alternating”.

The muscles are combined into muscle and joint chains that will work together, causing the joints to be permanently mobilized. We have named this phenomenon “Permanent Joint Drainage” (PAD). Thanks to this alternating phenomenon, all the joints of our body (including the skull…) will be permanently mobilized and drained, even at night when we sleep.

When we focus our attention on the motility of a joint, we observe that it is regularly swept in three different sectors, one internal, the other medial and the third external in the longitudinal axis of a joint. It takes three back and forth movements to go from the most internal amplitude to the most external amplitude and the same number of back and forth movements. This is clearly a “sawtooth” movement. That is to say that we feel the joint go in one direction, then stop, then start again and this three times in a row to then start again in the other direction. We call this phenomenon “sweeping”. A joint is therefore scanned in its entirety once or twice a minute.

The physiological characteristics of MMP

Normally the contractions and decontractions during PMM are symmetrical. The biceps brachialis contract and relax at the same time. However, when we put a joint in extreme rotation, for example a dorsal vertebra, we desynchronize the entire muscle chain that depends on it. Thus a right biceps can contract while the left biceps relaxes. By returning the position of the vertebra to neutrality, the muscles are automatically synchronized again.

When we do an apnea, the PMM seems to freeze. But this is not the case, in fact depending on the type of apnea (inspiratory or expiratory), depending on the muscle (antagonist or antagonist) and depending on whether it is in desynchronization lesion or not, the muscle will shorten or lengthen completely and will continue to contract and relax but with very low amplitudes (almost imperceptible).

PMM is sensitive to internal and external influences.

  • Cold increases the speed of the PMM.
  • Hot weather slows it down.
  • The effort increases it until it triples.
  • The fact of thinking of contracting a muscle (without doing it) increases its speed by about 10%, even in a tetraplegic (adaptation of the work of Ataëv), but not in case of a total rupture of the nervous plexus (only one case studied).
  • The magnets will increase the speed or slow it down depending on the pole of the magnet in contact with the skin.
  • Acupuncture needles will increase the speed or slow it down depending on the direction in which they are placed.

Collateral physiological effects

The tendons will also be permanently mobilized, thanks to this PMM, allowing the surrounding synovium to feed them. Tendinitis is the consequence of a muscle spasm which renders ineffective the exchanges of the tendon with its surrounding space due to a lack of movement (amplitude and rhythm).

Thanks to the motor that is MMP, almost all body tissues will be subjected to minimal changes in tension and length. Minimal but just large enough to affect the exchange of fluids and molecules in the tissues.

Exchanges at the capillary level

Pressure increases and decreases should in all likelihood allow better exchanges between the extracellular and intra-capillary space on the venous side. Starling’s second law applies here.

Participation in lymphatic circulation

The lymphatic circulation, these movements and pressure changes will allow the extra cellular liquid to penetrate inside the lymphatic vessels. This would explain the very good clinical results on lymph migration concerning edema due to Venous Insufficiency once treated.

Cellular exchanges

It can be assumed that cyclic pressure differentials can promote exchanges between the intra- and extracellular medium.

The PMM will intervene during thermoregulation. The cold increases the rhythmicity, the muscular pumping, so more blood will circulate under the skin, warming up the underlying areas. Heat decreases the rhythmicity, so the blood will flow more slowly, avoiding overheating the skin.

PMM lesions

This PMM can present several types of malfunction.

Rhythmicity can be halved for reasons of articular origin (adhesions of the periarticular tissues), muscular origin (areas of permanent intra-articular contractures) or various pathologies, diabetes, Raynaud’s disease, etc.

Venous Insufficiency (see Starling’s 1st law, adapted to the muscle), the more the heart fills with blood, the more effective its contraction is. It will be the same for the muscle. A muscle that is too short will have more difficulty filling up and it will contract more to assume its function as a pump or joint drainer. It is a vicious circle.

We’re not talking about physiological desynchronization here.

Some lesions produce an inversion of the contraction time of certain muscles. These are lesions that we call primary, that is to say, original. They can be at the origin of the lesions previously described. It is, among others, the lesion of plagiocephaly.

Other lesions or pathologies of various origins, visceral, neurological, etc., may disrupt the functioning of PMM.

The musculoarticular chains

To determine these chains we compared the muscles in loss of rhythm with vertebral or vertebro-costal lesions. Joint normalization leads to a normalization of the rhythm of the whole muscle chain.

However, we have not yet determined whether all the muscles belong to their respective muscle chains. There is still a lot of work to be done. But our knowledge is sufficient to produce completely satisfactory therapeutic results.

Muscles work in groups of muscles and joints (the same joint can accommodate several muscles from different chains). A musculoarticular chain can include several joints. A joint can be controlled by several different muscle chains. The musculoarticular chains necessarily depend on one joint in perpetual motion. That is to say a joint linked to thoraco-abdominal respiration.

So far we can count 12 vertebro-vertebral joints, 12 vertebro-costal joints, one sterno-costo-clavicular joint, and one sterno-xiphoid joint (with or without a xiphoid appendix). Let 27 times 2 = 54 muscle chains. But there are others.

Muscles and joints in the same chain will all have the same lesional characteristic. If a 5th dorsal vertebra is out of synchronization, the 5th cervical vertebra will automatically be out of synchronization, as well as other joints and all the muscles of the same chain will be out of synchronization in the same way. Resynchronizing one of the joints will resynchronize all the others as well as all the muscles of the same chain.

A restricted joint in a part of the chain can be released by working a muscle or joint placed at a distance on the same muscle chain. That is to say that we can try to treat, at a distance, fractured joints or under plaster… Or we can treat a hyper-algic joint without touching it.

  • Desynchronization of the first intercostal space = plagiocephaly, congenital torticollis, etc.
  • Loss of rhythm of the 2nd rib = Epicondylitis.
  • Loss of rhythm of the 5th dorsal = decreased drainage of the ethmoid = Homolateral nasal congestion, ophthalmic migraine, vector of asthma. When the loss of rhythm of the 5th dorsal fin is lifted, the nasal obstruction will most often stop within a few minutes, or else the migraine, etc.

Notion of symptom

For example, according to the principles of muscle chains, it takes two lesions to produce a hallux valgus. In this case we should have a lesion on the 9th and 10th rib. This is what we find clinically.

But the fact of freeing these two ribs will not necessarily correct the lesion morphologically, or very little, but it will stop the process of evolution or even reverse it and reduce the resulting pain.

You can also have a second lesion without suffering from epicondylitis, but not the opposite.

The same chain can be subject to several types of injuries (loss of rhythm, desynchronization, loss of amplitude) at the same time. This makes learning difficult, at least in the early stages.

Even if all the joints and muscles in a chain appear to be injured, it does not mean that all of them are the cause of the lesions. There may be several lesions, whether muscular or articular, that are involved in the lesion. If only one specific lesion is treated, we will either have no results or we will have a temporary result related to the information given to the muscle which will return to normal activity but only for a certain time (a few minutes to a few hours).

For example, the joints of C3 and D3 may have a lesion on the left, giving a tingling symptom in the palm of the left hand. Treating only one of the two lesions will not necessarily give a definitive result. If you manipulate C3 alone, the chain will not necessarily be sufficiently restored to free D3. And the symptom will reappear, with the loss of rhythmicity linked to D3 remaining blocked. In this case the treatment of the whole chain will put an end to the symptom.

Which PMM control centres can be used?

Let us note in preamble that PMM is effective in tetraplegics or even when all the nerves have been severed. The same is true in the case of ortho and parasympathetic inhibition. The muscle is therefore an autonomous organ whose function is controlled by complex upper nervous pathways (most certainly the gamma loop and the sub thalamic nuclei).

The fact of thinking of contracting his biceps allows a quadriplegic to see the rhythmicity of this one being increased by 10%. This is not true in case of a complete rupture of the brachial plexus. There is therefore a control of the upper nerve centers. But the activity of the PMM is intrinsic to the muscle, just like the heart, but in a different way.

Muscle through PMM requires autonomous and continuous activity that is not dependent on neural excitation.

Since 1978 research has been done on muscle motility demonstrated in vitro by Fabiato and Fabiato on cardiac muscle fibers. Subsequently Okamura and Ishiwata demonstrated the same phenomenon on skeletal muscle myofibrils in 1988. They then named this muscle activity SPontaneous Oscillatory Contraction or SPOC. We find many similarities in the rhythms and in the waveform we feel under our hands when we feel the muscle activity. It’s a piece of the puzzle that seems to fit perfectly into the physiology of PMM.

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