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Bugs, Gut, and Glial

Advancing Understanding of Nutrition’s Role in…..Well….Everything

Gratitude filled my heart after being able to take part in the pre-conference course sponsored by the APTA Orthopedic Section’s Pain Management Special Interest Group this past February. For two days, participants heard from leaders in the field of progressive pain management with integrative topics including neuroscience, cognitive behavioral therapy, motivational interviewing, sleep, yoga, and mindfulness to name a few. It’s exciting to witness and participate in the evolution of integrative thinking in physical therapy. When it was my turn to deliver the presentation, I had prepared about nutrition and pain, I could hardly contain my passion. While so much of our pain-related focus is placed on the brain, I realized acutely the stone yet unturned is the involvement of the enteric nervous system (aka the gut) on pain and….well…everything.

Much appreciation is due to those on the forefront of pain sciences for their research, their insight, their tireless work to fill our tool boxes with pain education concepts. Neuroscience has made tremendous leaps and bounds as has corresponding digital media to help explain pain to our patients. One such brilliant 5-minute tool can be found on the Live Active YouTube channel.

What I love about this video is how intelligently (and artistically!) it puts into accessible language some incredibly complex processes. It even mentions lifestyle and nutrition as playing a role in what is commonly referred to as a maladaptive central nervous system.

"Maladaptive central nervous system"

Ok. I’ll admit, I struggle with the implications of this term. However, what doesn’t sit right with me is the concept of chronic or persistent pain being entirely in the brain as though the brain is a static entity. We know the brain to be plastic but often do not identify just how this is so.

Glial Cells found in Nervous SystemWhat about the role of our second brain…. the one with 200-600 million neurons that live in that middle part of our body (right next to / inside our pelvis)? Termed the enteric nervous system, this second brain both stores and produces neurotransmittersTurna, et.al., 2016, serves as the scaffolding of interplay between the ENS, SNS, and CNS. This ENS is home to the interface of “bugs, gut, and glial” which are “not only in anatomical proximity, but also influence and regulate each other…interconnected for mutual homeostasis.”Lerner, et.al., 2017 In fact, part of this process then directly impacts the brain. “Healthy brain function and modulation are dependent upon the microbiota’s [gut bugs] activity of the vagus nerve.”Turna, et.al., 2016. Further, “by direct routes or indirectly, through the gut mucosal system and its local immune system, microbial factors, cytokines, and gut hormones find their ways to the brain, thus impacting cognition, emotion, mood, stress resilience, recovery, appetite, metabolic balance, interoception and PAIN.”Lerner, et.al., 2017

So, by process of logic, it requires little convincing to conclude that the food we eat or fail to eat directly impacts the health or dysfunction of this magnificently orchestrated system. One that directly and profoundly impacts our brain, our body, our being. And it’s a concept that our patients, our clients, ourselves, know in our gut to be true.

And it’s thanks to all the hard work of those who have come before us that we can share in the advancing understanding for the benefit of thousands who need your help, expertise and guidance. Please join me for Nutrition Perspectives for the Pelvic Rehab Therapist. The next course will be in Springfield, MO on June 23-24, 2018. Vital and clarifying information awaits you!


Live Active. (2013, Jan) Understanding Pain in less than 5 minutes, and what to do about it! https://www.youtube.com/watch?v=C_3phB93rvI Retrieved March 28, 2018.
Lerner, A., Neidhofer, S., & Matthias, T. (2017). The Gut Microbiome Feelings of the Brain: A Perspective for Non-Microbiologists. Microorganisms, 5(4). doi:10.3390/microorganisms5040066
Turna, J., Grosman Kaplan, K., Anglin, R., & Van Ameringen, M. (2016). "What's Bugging the Gut in Ocd?" a Review of the Gut Microbiome in Obsessive-Compulsive Disorder. Depress Anxiety, 33(3), 171-178. doi:10.1002/da.22454

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Upcoming Continuing Education Courses

Parkinson Disease and Pelvic Rehabilitation - Remote Course

Jul 23, 2021
Location: Short Form Remote Course

Athletes & Pelvic Rehabilitation - Remote Course

Jul 24, 2021 - Jul 25, 2021
Location: Replacement Remote Course

Pelvic Floor Level 2B - Self-Hosted (SOLD OUT)

Jul 24, 2021 - Jul 25, 2021
Location: Self-Hosted Course

Pelvic Floor Level 2B - Lisle, IL Satellite Course (SOLD OUT)

Jul 24, 2021 - Jul 25, 2021
Location: Ivy Rehab Physical Therapy

Acupressure for Optimal Pelvic Health - Remote Course

Jul 24, 2021 - Jul 25, 2021
Location: Replacement Remote Course

Pelvic Floor Level 2B - Belle Chasse, LA Satellite Course

Jul 24, 2021 - Jul 25, 2021
Location: Rehab Access Belle Chasse

Pelvic Floor Level 2B - Warwick, RI Satellite Course

Jul 24, 2021 - Jul 25, 2021
Location: Performance Physical Therapy

Pelvic Floor Level 2B - New York City, NY Satellite Course

Jul 24, 2021 - Jul 25, 2021
Location: KNOSIS Center for Physiotherapy & Wellness

Pelvic Floor Level 2B - East Norriton, PA Satellite Course

Jul 24, 2021 - Jul 25, 2021
Location: Core 3 Physical Therapy

Pregnancy Rehabilitation - Remote Course (SOLD OUT)

Jul 25, 2021 - Jul 26, 2021
Location: Replacement Remote Course

Pelvic Floor Level 1 - Self-Hosted

Jul 25, 2021 - Jul 26, 2021
Location: Self-Hosted Course

Pelvic Floor Level 1 - Berrien Springs, MI Satellite Location (SOLD OUT)

Jul 25, 2021 - Jul 26, 2021
Location: Andrews University

Pelvic Floor Level 1 - Chamblee, GA Satellite Location (SOLD OUT)

Jul 25, 2021 - Jul 26, 2021
Location: Revelle Physical Therapy Atlanta

Pelvic Floor Level 1 - Meridian, ID Satellite Location (SOLD OUT)

Jul 25, 2021 - Jul 26, 2021
Location: Idaho State University

Yoga for Pelvic Pain - Remote Course

Jul 31, 2021 - Aug 1, 2021
Location: Replacement Remote Course

Pelvic Floor Level 1 - Marietta, GA Satellite Location (SOLD OUT)

Aug 14, 2021 - Aug 15, 2021
Location: Southern Pelvic Health

Pelvic Floor Level 1 - Smyrna, TN Satellite Location (SOLD OUT)

Aug 14, 2021 - Aug 15, 2021
Location: Benchmark Physical Therapy - Smyrna, TN

Pelvic Floor Level 1 - Hilo, HI Satellite Location

Aug 14, 2021 - Aug 15, 2021
Location: Big Island Physical Therapy

Pelvic Floor Level 1 - Portland, OR Satellite Location (SOLD OUT

Aug 14, 2021 - Aug 15, 2021
Location: Bridgetown Physical Therapy & Training Studio

Pelvic Floor Level 1 - Bradenton, FL Satellite Location (Sold Out)

Aug 14, 2021 - Aug 15, 2021
Location: Children's Therapy Solutions

Pelvic Floor Level 1 - Findlay, OH Satellite Location (SOLD OUT)

Aug 14, 2021 - Aug 15, 2021
Location: Quality PT

Sexual Interviewing for Pelvic Health Therapists - Remote Course

Aug 14, 2021 - Aug 15, 2021
Location: Replacement Remote Course

Pelvic Floor Level 1 - Tulsa, OK Satellite Location (SOLD OUT)

Aug 14, 2021 - Aug 15, 2021
Location: Physical Therapy of Tulsa

Pelvic Floor Level 1 - Self-Hosted

Aug 14, 2021 - Aug 15, 2021
Location: Self-Hosted Course

Oncology of the Pelvic Floor Level 1 - Remote Course

Aug 15, 2021 - Aug 16, 2021
Location: Replacement Remote Course

Pelvic Floor Level 2A - Troy, NY Satellite Course

Aug 21, 2021 - Aug 22, 2021
Location: The Green Room Physical Therapy

Pelvic Floor Level 2A - Lakeland, FL Satellite Course (SOLD OUT)

Aug 21, 2021 - Aug 22, 2021
Location: Leading Edge Physical Therapy

Pelvic Floor Level 2A - Wichita, KS Satellite Course

Aug 21, 2021 - Aug 22, 2021
Location: Summit Physical Therapy

Pelvic Floor Level 2A - Baldwin, WI Satellite Course

Aug 21, 2021 - Aug 22, 2021
Location: Western Wisconsin Health

Pelvic Floor Level 2A - Jonesboro, AR Satellite Course

Aug 21, 2021 - Aug 22, 2021
Location: Arkansas State University