Proprioception and Balance: Part 2

George is improving his balance.  Because of a previous sprain to his left ankle, he wants to reconnect some of the proprioceptors torn away along with the ligament.  Sometimes he works extra slowly (even for Tai Chi!) so that the signals may be strengthened.  Often, he does “River Walking” just for this reason. 

He opens his right foot to 45 degrees, bends his knees and picks up his right foot to rest near the left ankle.  Slowly he steps out “empty” with the right foot, so that his weight is not committed to that side yet, and places his foot down, toes pointing straight ahead.  Just to prove to himself that the foot is empty, he picks it up again and puts it back beside his ankle, then steps out again and allows his weight to shift to the right foot.  Rocking back, he now opens his right foot to 45 degrees and picks up his left foot, letting it hover near his left ankle…

Proprioception is information coming into the brain from various parts of the body.  This allows us to know where the head and limbs are located and how they are moving.  Much of this information originates in the head through the oculomotor and vestibular systems.  While these are part of the Central Nervous System (CNS), the proprioceptors discussed here are located throughout the body.  They form part of the Peripheral Nervous System (PNS) and are linked to the brain via nerve fibres running through the spinal cord. 

Information going to the brain is afferent, and carrys sensory signals only, where information in response from the brain to the body part is efferent, carrying both sensory and motor responses.  This creates a feed forward/feed back system that influences reflex reactions, such as pulling away from a hot stove, as well as consciously controlled actions like changing the position of a muscle or joint.

Afferent receptors feed information of different types and at different speeds.  These include cutaneous (skin) mechanoreceptors for touch sense, thermoreceptors for temperature, nociceptors for pain and proprioceptors, which are deep mechanoreceptors located in the muscles and tendons and in the joint capsules and ligaments surrounding each joint.  Proprioceptors allow us to experience joint position as well as the perception of motion, or kinesthesia.  We experience the rate of movement of one part of the body in relation to others, acceleration and deceleration and the overall speed of movement.  They allow us to estimate the weight of objects and determine how much effort to use if we want to lift or push them.  Proprioceptors tend to be most active while we are moving, even slightly.  It becomes harder to sense what position we are in when we are resting and extremely still.

Somatic Sensory (Afferent) Pathways

Cutaneous mechanoreceptors are broadly classified as two types and are located both close to the skin’s surface and deep in the dermal layer. Type I sensors measure touch and the degree of pressure being exerted on the skin.  For our discussion, these are most important in the feet, in reading pressure signals to report position of the foot, centre of mass, weight shifts, surface contours, etc.  Type II measure the amount of stretch undergone by that part of the skin, either as a result of lengthening – stretching the skin surface – or from pressure on it, rather like bending a note on a guitar string.  Type II receptors are also found in ligaments and tendons.

Muscle spindles are located in the skeletal muscles.  Each spindle is made up of nerve endings that wrap around muscle fibres. These respond continuously to stretching and shortening, measuring the length of a muscle.  How vigorously they respond to stretch allows the brain to set the overall tone of the muscle in action, and even when it is at rest.  Reactions to stretch sensations are sent back to the body part to adjust the movement.  This might be a gross (large) movement such as swinging a leg out in front of you, or a fine movement such as tapping a finger.  The more finely controlled the movement in an area, the greater the number of spindles and receptors there are present. 

The sensory information is picked up by receptors deeper inside the muscle and sent via afferent nerve fibres along the spinal cord to the cerebral cortex of the brain.  The response is given along efferent fibres to more surface muscle fibres which control contraction of the muscle as a whole.  The only skeletal muscles in the body that lack these muscles spindles are the tiny muscles in the middle ear.  Otherwise they are in every muscle that is under voluntary control.

Golgi tendon organs are located in the tendons, right at the junction with the muscle.  These measure the amount of tension put onto the tendon by the force of the muscle contracting.  Tendons form the anchor between a muscle and a bone and have the ability to stretch somewhat.  However, because their job is anchoring, stretch is limited, so the receptors measure tension being created between muscle and bone.  Their task is to protect the muscle against excessive stretch so their response is usually to decrease or limit the muscle force, causing the muscle to either relax or give out altogether to protect it from damage.

Ligaments also have the job of anchoring, but they act around joints to limit excessive bending.  Ligaments, however, do not stretch.  Their function is basically to strap down the articular capsule that surrounds a moving joint and anchor it to bone.  A ligament may be attached to the joint capsule or independent of it.  This allows a joint to move freely until it is restricted at the end of its range by the outer layer of the capsule and the surrounding ligaments.

Moving joints are generally synovial articulations, meaning that two bones meet end to end and move in partnership.  Each end is covered with smooth articular cartilage and the joint is mummy-wrapped on all sides by a tough, fibrous capsule.  Joint kinesthetic receptors on the capsule send information to the brain that tell about the angle of the joint, the degree of tension, stretch and compression it is experiencing as well as the amount of change (acceleration or rotation) it may be going through.  There are four types of receptors surrounding all joints which help not only in controlling movement but which send signals about the relative strain the joint is experiencing. 

  • Type I receptors tend to be found in higher numbers near the core of the body (think vertebrae).  They sense the angle of a joint through its range and report its position.  These receptors, called Ruffini endings, are found in the superficial layers of a joint capsule.  They are low-threshold (it doesn’t take much to stimulate them) and are slow adapting, meaning that the afferent fibers are continuously measuring angles are constantly feeding signals into the spinal cord.  Efferent messages stimulate minute adjustments for balance and coordination.
  • Type II receptors on the other hand are fast adapting and are most active at the onset and termination of a joint’s movement.  These are the ones that sense any change in position and are found in the deep layers of the joint capsule.  They are also easily excited (low threshold) but when the joint is not moving they’re not active.  Type II receptors (Pascinian corpuscles) are found in high densities at the end of limbs and help the brain to control fine movements, adjusting quickly for coordination and precision.
  • Type III are high threshold, so it takes a lot to upset them.  These Ruffini corpuscles are found in the individual ligaments surrounding joints and can inhibit the action of surrounding muscles by relaying the message of excessive stretch when the joint reaches the end of its range.  At that point the capsule and ligaments on the stretched side pull tight and send a “that’s enough” signal.  In this way they serve to protect the joint from damage caused by overstretch, as long as there is no sudden impact force applied.
  • Type IV are nociceptors.  Found in all the tissues of the body except the brain, these are free nerve endings that respond to pain (noci = harmful).  Rather than causing a fine adaptive reaction, nociceptors create an intense, non-adapting response in all the structures surrounding an injured part.  This creates protective reactions in muscles to either pull quickly back or restrict movement at a joint.  These are at work when we instinctively guard an injury.  Nociceptors also stimulate the release of noxious chemicals that irritate structures when they are moved.  This can work against us later on when an injury has healed to the point where it needs to be moved, stretched and strengthened.
Photo: Matthew Henry from Burst

Somatic Motor (Efferent) Control

Bearing in mind that sensory input originates at the various types of mechanoreceptors and feeds from the PNS to the CNS, the CNS must respond either by finely adjusting movement or inhibiting it.  This response happens at three distinct levels in the CNS.

In the spine, this system operates below the conscious level.  Here, reflexes are able to engage quickly, without reference to higher levels and yet may be inhibited either by conscious control or by pain.  Some inhibitory messages are sent by muscle spindles and act to smooth out control of muscular movement.  This helps to coordinate rhythmic movements such as walking.

The second level of control comes from the brain stem, which includes the cerebellum and the basal ganglia which balance one another with excitatory and inhibitory signals respectively.  The cerebellum measures the difference between intended movements and movements that are actually performed.  It is a powerful coordinator of complex muscle contractions, as well as a maintainer of posture and balance. 

The basal ganglia is a collection of three complex nuclei (masses of grey matter) whose circuits connect with other areas of the brain, notably the cerebral cortex, the powerhouse of information relay.  The task of the basal ganglia is to help initiate and terminate movements, inhibit unwanted movement, cleaning up the excitatory signals of the cerebellum, and help maintain normal muscle tone.  It is also a link between movements anticipated but not yet initiated by the body.  This, then influences planning, attention and memory.  It is also thought to interact with the limbic system to affect emotional behaviour.

Finally, the cerebral cortex holds the maps for sensory input and conscious motor control of the body, linking (as previously discussed) the primary somatosensory and primary motor areas in the brain.  This pinpoints the exact location of static and dynamic sensation.  It is the major area for planning and initiating voluntary movement, which allows for proper muscle function for daily living, sport, etc.  It is interesting to note that movement patterns that are repetitive and those practised over a long period of time are no longer coordinated here, but are stored elsewhere in the brain as subconscious control commands.  This means they can be performed without deliberate attention to the movements.

Though the sensory and motor pathways are generally well understood, there has been little testing of functional proprioception.  Studies that do exist pay most attention to shoulder, hip, knee and ankle joints, which, as we have seen have far less going on in terms of sensory fibre activity and sensory or motor response due to the small number of connecting structures.  One can only imagine the level of activity in the foot, with 26 bones (and a joint for each), more than 30 muscles and over 100 ligaments, each one equipped with the receptors mentioned above.  Each vertebra also forms multiple joints, as we begin to discover when we begin to mobilize them so that Tai Chi movements come from the core of the body, and the practitioner is not just waving his hands around.

Understanding how these receptors function can also help us to understand post-injury recovery.  When muscles are strained, ligaments sprained or joints injured, afferent nerve fibres are also usually torn away.  For this, there is the lovely term deafferentation (a great word, which now needs no explanation).  It becomes clear how important proprioceptive training / re-training is alongside traditional physiotherapy to restore nerve pathways to and from the brain.  This is not only for regaining the balance and finesse of previous movements, but also in preventing re-injury. 

George will eventually step out to exercise his efferent nerve signals.  These signals tell the joint how to land, how fast to move, and how much tension should be maintained. These are distorted (or completely torn away) after a sprain, leaving the joint poorly aligned and therefore vulnerable to re-injury.  He uses this technique along with his physiotherapy.  Poor joint alignment is also blamed for various osteo-arthritic problems later in life.

In developing a rehabilitation program that addresses proprioceptive deficiencies, the focus would be on stimulating receptors to maximize afferent signals.  This is often done with one foot stances and the use of wobble boards.  It is found that balance and postural activities stimulate reflex stabilization (efferent signals) and so enhance motor function at the brain stem with conscious postural correction.  After a while, of course, this is transferred to other areas in the brain so that alignment as well as movements become internalized in the body.

George’s practice is therefore a powerful tool for gaining or regaining the clarity of proprioceptive signals to the brain, for balance control and postural change.

This was first published in 2005 for a local Tai Chi magazine and on the Queen Street Wellness site (now defunct).

Proprioception and Balance: Part 1

George lifts his sword over his head, looking to the left in the direction of the blade.  He stands high on his right leg and lifts his left knee to chest height and pointing out to the left.  Slowly, his left hand sweeps out and, with two fingers, also points to the left.  He looks quite grand and, if he can stop wiggling, a little intimidating.  Oh, and George, point your toe a bit and hold it right there.

Balance training

We balance every day with every step.  Why is it so difficult to balance on one foot for more than the few seconds it takes to put the other foot down in front of us?  Balance, whether we are moving or standing “still”, is a dynamic process filled with movement and signals going back and forth between the body and the brain.

Proprioception in the body is a feedback system that allows us to sense where our head and limbs are situated in space and in relation to the body, whether they are moving or still.  Balance is the equilibrium established by the body in response to proprioceptive information gathered in the brain.  The response is then sent from the brain to skeletal muscles and joints to make conscious and unconscious corrective adjustments.  This controls the body’s centre of gravity over its support base.  There are basically three centres that provide this sensory input; the vestibular system – for vertical and horizontal position and motion, the oculomotor system – for the relative position of the body in space and the somatosensory (proprioceptive) system – information from skin, muscle, ligament and joint receptors.  In this first part of two parts we will examine the vestibular and oculomotor systems and their effect on balance.

‘Vestibular’ refers to the workings of the inner ear, while ‘oculomotor’ deals with how the eye moves and fixes images onto the retina.  These are not directly related to either hearing or vision, although these do help the body in its orientation.  Balance is therefore possible without the aid of hearing or sight.

Sensory Input

In the vestibular system proprioception is measured by hair cells located in the bony labyrinth of the inner ear.  The semicircular canals are situated on three planes, one straight up and down, a second lying horizontally and the third leaning out to the side, each one at 90° to the next. These make up the dynamic receptors and tell how the head is moving in space.  Each canal is filled with a type of lymphatic fluid.  At the bulbous part near the opening of each canal is an ampulla that is lined with tiny hair cells.  As the head moves in a certain direction, the hair cells are pushed over in that direction by the fluid as it moves past them.  Dynamic receptors also detect linear acceleration and deceleration, as experienced in an elevator or car.

The inner ear

In the vestibule just next door are the static receptors.  These tell about the position of the head when it is not moving.  If anyone has ever told you that you have rocks in your head, well, it’s because you do.  Inside the vestibule are two pouches called the utricle (“little bag”) and the saccule (“little sac”) positioned perpendicular to each other.  The alignment of the utricles is largely horizontal and the saccules basically vertical.  These too are lined with hair cells suspended in fluid and scattered along them are the otoliths (oto = ear; liths = stones), which are deposits of calcium carbonate crystals.  These are suspended near the top of the hair cells so that they slide “downhill” in the direction of tilt, exerting a shear force on the hairs.  Otolithic organs sense the position of the head in space and are essential for posture and balance. 

The position and movement of the eyes play an important role in the function of balance.  In the oculomotor system the nerves supplying the muscles around the eye convey impulses for non-visual perception of the movement and position of the head and body.  The vestibulo-ocular reflex helps to maintain a steady image on the back of the retina, especially during head movements.  This information is sensed “before” signals are sent to move the eyes.  Some of the information has simply to do with the eyes’ ability to hold a steady gaze in order to sense steadiness in the environment. While reading this page, you can shake your head as if to say ‘no’ and still focus on the print. This allows us to track with the eyes, independent of head movement. 

Try this – look from the page / screen to an object to your right.  Did you notice that your head moved with your eyes instead of your eyes scanning over independently?  At certain times we look at an object separate from its surroundings.  In this case the eyes tend to move the head along with them.  At other times we look at a specific object within a field of gaze, as when we are driving.  Then the eyes move more independently and the entire field is held centrally, as though the face were focussing instead of the eyes.  It’s difficult to tell sometimes where conscious control of eye movements and some of these involuntary reflexes begin and end.

Proprioceptive information collected from eye movements and vestibular feedback both travel to the vestibular nuclei and from there have a wide-ranging effect on conscious and unconscious balance in the body.

Yoga balance training.
Photo: Matthew Henry from Burst

Output Pathways

From the vestibular nuclei, signals are sent to areas that regulate balance in five specific ways: 

  1. Projections descend from the brain stem into the spinal cord and plug into neurons the entire length of the cord.  This ensures muscle tone to the muscles of the back that maintain upright posture.
  2. Some of these stop off in the neck to co-ordinate head movements in relation to the body. 
  3. There is direct output to the muscles surrounding the eyes for co-ordination of eye and head movements.  These account for the ‘righting reflex’ that attempts to keep the eyes level with the horizon when the body is in a non-upright position.  The most obvious example is watching a biker take a corner; his body stays with the bike, but his head remains with the horizon.
  4. Signals travel through the thalamus at the centre of the brain to the cerebral cortex, a powerhouse of information relay. The cortex holds primary areas that integrate sensory experiences and generate patterns of recognition and awareness (taste, smell, etc.).  One of these is the primary somatosensory area (somato = body) which contains a “map” of the entire body.  This is a receiving station for the special senses from all kinds of receptors, and can pinpoint the exact location of a sensation’s origin.  Information to this area from the vestibular nuclei translates into the awareness of balance.
  5. Finally there is information passing back and forth from the cerebellum, at the bottom of the brain, to maintain muscle tone at an unconscious level for balance, with the front part of the cerebellum specifically controlling the lower limbs.  The cerebellum is the area so easily disturbed by empty wine bottles.

Paired with the primary somatosensory areas (in 4 above) are association areas.  Two of interest to us are the somatosensory association area and the premotor area.  The role of the somatosensory area is to integrate and interpret sensations.  It helps you determine the shape and texture of something without seeing it. 

For example, sitting in your chair, you can sense clearly in your body the difference between walking on concrete or on dry sand, without setting foot on either one.  It also interprets the orientation in space of one object to another  (hold one hand out flat, the other at an angle) as well as relationships within the body of one part to another (how far away is one hand from the other?.  It puts these sensations into memory so that you can compare current sensations with past experiences. 

The premotor area is a motor association area that deals with learned movement that is complex and sequential.  Nerve impulses from this area cause specific muscle groups to contract in specific sequences.  It also serves as a memory bank for these complex movements.  

For example, learning Tai Chi, which is usually a long sequence of steps and postures, we engage the brain in memory work and the body in retraining at many levels.  We try to remember the steps consciously, but also by direct input from the sensory information through the sequence, as it is repeated over and over.  After a while, the conscious involvement of the brain diminishes so that movement may be practised without paying so much attention. 

We also rely heavily on proprioceptive information that comes from sensors in the limbs, which will be explored later.  But there is an often overlooked chunk of sensory information and interpretation that begins in the neurons surrounding the brain.  These work together with the rest of the body’s receptors for a complete picture.

Meanwhile, George is beginning to sweat.  His eyes are fixed on the horizon, he’s steady on his feet with good information back and forth through the cortex.  But we should let him relax now, step down behind and left, and turn back to the right, pulling his sword out of the air for a strike downward.  Then he’ll try to remember the next move.

The Misery of Headaches

We don’t often think about how heavy our head is until it starts to ache. Then it feels like a fifty pound stone rolling around on top of our shoulders.

And every movement hurts.

It can range from a nagging background pain to the life stopping throb that erupts with each heart beat, until all you can do is lie down and shut the world out. Statistics range from 47% to 86% of people who will be experiencing headaches, either occasional or chronic. But where do they come from and how can we avoid them?

In most cases, the headache is the condition. That is to say, it is the problem, and not the symptom of a bigger problem. If you go to a doctor about it, he may run lots of tests to find out if there is an underlying problem. This is the case in only a minute percentage of people, so that’s a good thing.

But when they find out that there’s no big scary condition that is causing the headache as a symptom, doctors tend to dismiss the rest as though the pain is no longer important. This can be frustrating.

Some of the usual causes are:

  • head trauma
  • muscle tension
  • minor ailment such as cold, flu or sinusitis
  • lifestyle factors such as stress, skipped meals, lack of sleep and poor posture

In our modern lives, it is this last point that makes up the majority of headaches I see in my office.

Stress can lead to tension headaches.
Photo: Matthew Henry from Burst

Stress can lead to the other habits, causing us to eat poorly or in a rushed way, sleep badly and hunch our shoulders in response to chronic tension. Computer postures can also lead us here, especially when there are deadlines to be met and we neglect to take those breaks every fifteen minutes to stretch. (Seriously, does anyone do that?)

Postural faults can create patterns of tension that lock in trigger points which make pain travel to other areas, notably the head and neck. People often say, “I hold my tension in my shoulders.”

A trigger point is a knot that gets so tight it can cut off its own circulation. When that happens, there is always pain, not always right over the spot. If you press on it, you may feel extra tightness or pain, but it may not actually hurt in general.

Trigger points have the nasty attribute of referring pain to other places.  Upper back and shoulder trigger points can refer into the head.  Voila – you have a tension headache.

There are a couple of reasons why this pattern can lock in. One is holding the shoulders up, just one inch for many hours. If you imagine someone making a loud noise behind you suddenly, the sort of reaction you would have creates that tension. Daily tension in the office will do the same.

Another common reason is postural. You can start your day nice and straight, but as we sit in front of the computer, gradually the head comes forward and the chin lifts up. Then the whole head sinks down into the chest. The nice straight line from the collar bone to the back of the head becomes elongated, causing the muscles to pull back and hold on tight. The muscles and vertebrae in the back of the neck get squished, short and angry.

So what can we do about these sorts of headaches?

Relaxing in nature refills the body's energy and calms the mind.
Photo: Brodie Vissers from Burst

1. Rest and Relax

Yes, the farthest thing from our modern minds, and yet so important. Relaxing means letting go of at least a short time’s worth of stress. Getting away from the city and into a nature setting, even a park, refills the body and mind, and has a calming effect. Some call this earthing. If you can get your feet safely onto grass or into mud, even better!

Releasing tension may happen at a tai chi, yoga or dance class when you let go because you are concentrating on something else. Relaxing with friends means laughter, redirection of our attention. Anything that brings us away from the stress will be helpful and often gives us support in the form of community. How about a tension time-out every night? This is really living.

Resting is also important. Good quality sleep for at least 8 hours every night is thought to be vital to good health. If you are routinely getting less than this, you may survive, but your body will tell you that you are not strong and comfortable.

Cup of coffee
Photo: Matthew Henry from Burst

2. Caffeine

Coffee comes in and out of fashion. Demonized by some, it is actually an ingredient in many pain medications. Caffeine has various effects on the smooth muscle cells of blood vessels and can produce both constriction and dilation, or tightening and expanding. It’s hard to sort out why either one may help, but if you’re trying to avoid taking medication you could experiment with coffee or black tea to see if it helps. Benefits may increase if it is something you don’t drink every day.

3. Breathe and Stretch

The last time someone said to you, “just breathe”, you probably wanted to punch them in the nose. But the truth is, those 5 deep breaths will significantly change your blood chemistry.  It has an immediate effect on your sympathetic nerve (the fight or flight system) firing, so that even if your mind is still raging, your body will have begun to calm.

In addition, you can drop your head down and allow your neck to stretch, then gently roll side to side to include some stretch into the shoulders.

Stretch and relax.
Photo: Matthew Henry from Burst

4. Massage it Yourself

You can see your favourite massage therapist for an hour of bliss, but you can also try a few things out at home.

Press your fingers in gently under your cheek bones and slide them towards the jaw. A lot of tension in the jaw is translated up into the sides of the head and face. Massage back and forth for a bit and see if you can feel where the tension sits from the extra pressure. From here, massage up around the ears and sides of the head. Hold and move the skin around rather than trying to slide through your hair.

Tie two tennis balls into a sock and lie down with them just under the skull into the soft tissue. Golf or squash balls may work in more specifically for you. Try just lying still on them to stretch the muscles, or gently move your head around, nodding or moving side to side until you can feel them working into the tough spots.

Grab hold of your opposite shoulder and feel around for “that spot”.  It will be about three finger-widths from your neck.  Just give it the weight of your arm to pull it down. Then gently rotate your shoulder around. You may feel a trigger point under your hand as it seems to rise and fall with the shoulder rotations. This won’t actually dig it out of there, but you should get some temporary relief.

This approach is better than trying to massage it with your hand, which can cause your wrist and arm to hurt.

5. Take it Easy

Above all, remember why you’re here. Try to relax into your life. It’s short. Change what you can. Accept what you can. Make a plan for the rest. Laugh with friends and family as much as possible. Good connections make everything easier.

(This article was first published to LinkedIn on November 9, 2015.  It has been updated for its home turf.)

Polishing Your Summer Bod

Getting into your spring routine for the summer swimsuit parade?  Along with other getting in shape routines, one of your secret weapons will be the Dry Brush.

Dry brushing is the use of a dry natural fibre brush to stimulate the surface of the body in a specific pattern.  Because it is excitatory to the circulation, it is best done in the morning.  Dry brushing in the evening may hinder sleep.

Effects :

Dry brushing reflexively stimulates the organs and increases lymphatic flow, thereby encouraging immune activity.  It sloughs off dead skin cells, toning and softening the skin.  Circulation is improved overall.  If you are dieting and your system feels sluggish with the reduction in calories and sugars, this will help enliven it.

4 Basic Uses :

natural bristle dry brushes

1. Elimination

About a third of all body impurities are eliminated through the skin.  This is said to be more than a pound of waste per day.  The skin ‘breathes’ as well as the lungs, with oxygen absorbing and carbon dioxide releasing through the pores.  Increasing circulation in the skin, therefore, helps to relieve us of general toxins and acidity.

2. Detoxification

Detoxification occurs first and foremost through the lymph. Our bodies contain more lymph than blood.  The lymph nodes filter and remove invading organisms, abnormal cells and cellular debris from the lymphatic fluid and process them so they can be eliminated.

3. Circulation

Brushing is a good toner for rough, dry skin by helping raise circulation to the skin.  Use before a sauna or a run to help skin sweat more easily.  Follow with a contrast shower (hot alternating with cold, if you’re brave enough!) to enhance flushing.

4. Best of all, cellulite!

Cellulite is a non-scientific term defined as deposits of subcutaneous fat material and fibrous tissue that are not easily eliminated.  These cause a dimpling or orange peel effect on the overlying skin. Most commonly occurring on the thighs and hips, these deposits can affect any body weight or size.  There is some thought that these deposits are encouraged by estrogens.  These days, with xeno-estrogens (foreign/artificial estrogens) popping up in our plastics and leeching into our foods, even men are getting cellulite.

Cellulite lies in the superficial fascia right under the skin layers. Small fatty deposits get stuck in the weave of fascia, which is a structural material. When the tissue is rehydrated, both from drinking water and from hydration rising through these layers as a result of brushing or exercise, it can help to release the small fatty deposits.

Select your brush

Though often called a bath brush, you will not be using this in the bath (or getting it wet).  Select a long handled, natural bristle brush (usually wood) with a brush pad roughly the size of your hand.  These can usually be found at pharmacies, health food stores and salons and run from $10 to $15.  Brush the

Lymphatic system, showing major lymph nodes and collection areas.

whole body from the extremities towards the centre in brisk circles or long strokes.  Include the soles and palms, groin and armpits.  Brush towards the heart, not much pressure is needed.  Brush gently around the breasts, avoiding the nipples.  The stomach and back are said not to have a specific direction, but imagine brushing towards the centre, between the thymus and liver in the picture above.  This is where the main cisterns are that gather lymph and direct filtration.  Gently brush the neck, but not the face.

Moisturizing

Of course, skin is more radiant when it does not appear dry.  Moisturizers can be tricky, though, with myriad additives and preservatives, most prevalently parabens.  If you want to avoid these, try oil.  Pick a good pure oil and spread it sparingly over the skin while you are still damp from a shower.  Favourites are coconut oil and pure olive oil (from the pantry).  Olive oil sinks quickly into the skin without leaving a greasy film, while coconut is usually a little heavier and can be good for older skin and really dry areas.  See your favourite aesthetician for specifics.

Runway Models

Most of all, try not to worry about whether you look impossibly beautiful.  You know all those models are heavily made up and then airbrushed well before you see them in their skin, right?  There’s the Dove commercial showing the post-production changes to a model who is actually very cute before makeup and photo-shopping.    Don’t be fooled by manipulated images of women.  We’re real.  The pictures are not.

A healthy body is always beautiful, almost regardless of shape, age or size.  Remember Bo Gilbert, who posed for Vogue’s 100 year celebrations.  She is also 100, with no modeling experience.  But her poise and grace are stunning under the cameras.

So stand and walk like royalty.  Allow yourself to shine!

This post was first published to LinkedIn on June 19, 2016.  It has been refreshed and updated for its home turf.