NAMTPT Blog Winter 2024: Hidden in Plain Sight

Most muscles of the human body were identified and named centuries ago, if not millennia. In the mid-nineties a new muscle named sphenomandibularis was reported. You can figure out where it is by the name. When Stuart Hinds visited us from Australia in 2019 he brought to our attention a muscle called iliocapsularis. I’ve been using his treatment technique for it ever since.

The last 2023 edition of the ABMP magazine revealed a muscle that is a new one on me; tensor vastus intermedius (TVI). Where has it been all this time? It was first proposed in 2016 by Grob, and could be an addition to the giraffe collection of muscles; small bellies and long necks. The belly is attached to the proximal anterior femur, between vastus intermedius and lateralis. It seems to be there to counteract the pull of vastus medialis and may be implicated in knee pain. If there’s now five quads what are we going to call them? Quins? Quints?

And now hidden in plain sight is a new human cell. In the first edition of David Lesondak’s book Fascia there were a couple of paragraphs describing new cells called Telocytes (TC). Telocytes were first described in 2010 (Popescu), but not formerly announced until 2016 (Cretoiu). Can you believe we are still finding new cells (and muscles) in the body?

One reason for the delay in recognition of the telocyte is that they have a very small oval-shaped cell body and long, thin projections (telopods), making them hard to image or dissect. That is until the use of the transmission electron microscope (TEM).

They are part of a group of so-called interstitial cells (IC) some of which are fixed and some of which are migratory. The former include fibroblasts, fibrocytes, microfibroblasts, mesenchymal cells, mast cells and adipocytes. The migrating cells include macrophages and other immune cells.

In the past telocytes were thought to be fibroblasts, but unlike fibroblasts it is now known that telocytes don’t lay down collagen. Telocytes are so named because of their communication function (e.g. telephone, telegraph).

There are many ways the body communicates; via nerve impulses, hormones, other chemicals, energy systems and now telocytes. So, think of this connective tissue matrix as the body’s world wide web. They’re everywhere; organs, bone, muscle, GI tract etc. Could it be that every telocyte is aware of what’s happening to every other telocyte?

Lesondak describes these mechanosensitive fascial cells as being vital for stem cell upkeep, tissue repair, and immune function. But, I want to ask you to consider that they may provide an explanation for the referred pain phenomenon of myofascial trigger points. How is it that you can press a taut band in the soleus muscle and feel something in and around the SI joint, or further up into the jaw?

What we have been told up to now is that referred pain zones (RPZ) of trigger points are an outcome of peripheral and central sensitization. The spinal cord is bombarded by sensory (peripheral) nerve input; it is too much for one segment to handle, there is an expansion of receptive fields, an awakening of sleeping dorsal horn neurons, the formation of new functional connections with decreased thresholds and a resulting secondary hyperalgesia. I.e pain and other paresthesia are perceived elsewhere (distant) from the original source.

But, what if telocytes are involved? Would that be an interesting explanation of when a filiform needle was inserted in my thoracic multifidi on the right side I felt a sharp pain in my lateral ribs on the left side, more than once. In 1979 Karel Lewit published a paper describing the analgesic results of the insertion of a needle, that came to be known as the ‘needle effect’. (see “The Needle Effect In The Relief Of Myofascial Pain)

What if the needle (finger, thumb) is contacting and stimulating telocytes. Via their communication processes could one or two telocytes make the whole body of telocytes become aware of this intrusion? Could they then fire up in other remote parts of the body? I’m just putting it out there. I’ve found nothing in a Google Scholar or PubMed search regarding TCs and referred pain zones. But, it’s early days in the life of a telocyte.

Cheerio for now,