The cerebrospinal meninges - a key structure for our skeletal and nervous systems.

 

Hello!

I invite you on an extraordinary journey into the land of the meninges!

Sounds like a journey into the unknown?!;)

It would not surprise me at all ... Imagine that when I left the university with a master's degree in physiotherapy, I knew little more about it than the average layman. The meninges are more commonly associated with tick and meningitis, which cause viral inflammation. But what do we know therapeutically about it ?? THREAD??!!! Well, I humbly admit to you that for the effectiveness of your therapy, failure to include meninges in the treatment would be a huge loss and inhibit the achievement of a good result!

To see if this disinterest in treatment of meninges is common in the medical community, I traced the Internet with a detective flair. The result of the search is kind enough to me as it somewhat absolves me from this lack of knowledge at the start of my career. In short, I have not found a single YouTube physio that would even mention a word about meninges and their adhesions.

 

So let's tackle this niche in the market!

 

I invite you to the performance entitled "Meninges" !!

A thunderous applause for the main actors👏👏👏

 

It's gonna be hot! Because we will take them apart anatomically. (this is what you can easily google).

Meninges consist of three layers (for the sake of simplicity, we will treat them as one structure). They act like a flexible vertebral column stabilizer. They surround the spinal cord from the sacrum to the cranial opening (where they adhere tightly to the inner surface of the skull and the back of the cranium), further encircling the brain. Meninges made of soft tissue are connected to the bones of the spine column and the spinal cord through denticulate  ligaments that tighten or relax depending on the adopted body position.

 

Okay, the actors go to action :)

 

Nervous system mechanics - what do we know about it?

 

We know quite a lot, thanks to Dr. Alf Breig, who describes it in his book "Adverse Mechanical Tension on the Central Nervous System". 

Surprisingly! The position in the medical literature of this recognized Nobel Prize winner is hard to find in university medical libraries! Breig did physical experiments to find out exactly how the mechanics of the neural structures in the spinal canal work and how movements affect the nervous system.

The facts about the mechanics of the neural structures in the spinal canal were investigated and subjected to numerous experiments in the late 70's and 80's by Dr. Breig. So we're not talking about any new discoveries! In the millennium, surgeon Yamada published the results of surgical treatment (cutting of the cauda equina's tail fillum terminale) of spinal cord syndrome in adults, which turned out to be worse, less effective than the Breig's assumption, in which the therapy was to keep the head slightly in hyprextantion, although it permanently limited head bend.

 

Action!

In a situation where the body assumes a flexion position or is mechanically locked in a forward tilt (e.g. faulty stance), the front side of the meninges is stretched. Often, as a result of maintained bending of the spine, the meninges adhere (stick together). The meninges are then tense and they also tighten the surrounding brain, as well as the back meninges and cranial nerves, and hold the spine bones in a flexed position. Releasing such a stuck dura causes less stress on the brain and increases blood flow, which allows the brain to work better.

We are not successful in an important project? Can't we focus? Heavy head? Maybe it is advisable to release the meninges? 🤔

 

Let's move on to the practical act and see how the individual structures behave depending on the adopted body position (data based on Breig's experiments). When the body is tilted to the left, the right side of the meninges is stretched and the left side is relaxed.

 SO WHAT HAPPENS TO THE CORE ??? (Such a black horse on stage).

 Interestingly, the core behaves completely opposite to the meninges mechanics. This is due to the participation of the dentate ligaments.

 

The body bends to the right side:

- the left side of the meninges and the dentate ligaments are stretched

- the right side of the meninges along with the dentate ligaments on the right side are relaxed

- stretching of the meninges and dentate ligaments pulls the spinal cord to the opposite side of the flexion of the body

 

Such knowledge is crucial when we work with the nervous system, when we have compression of the spinal cord or spinal nerves, either on the basis of a clinical picture or images such as MRI. Thanks to this, we know what to do to rectify the situation and relieve the stressed nervous system, which is not mechanical and physiological.

 

At the end, a practical peuta !!

Avoid keeping the head bent! And our meninges will be satisfied and happy :)