vestibular testing

[structural75]

It gets pretty complex, but in short... Disturbances within the inner ear (including some of the examples you mentioned, but not necessarily a deformity) can disrupt the signals being sent from the inner ear to the brain to the postural, tonic musculature of the spine. To put it another way... If the inner ear is dysfunctional for one reason or another, its interpretation of what is level/horizontal etc. is disturbed, thereby causing an imbalance in tonic function of the vertebral muscles... which are autonomically responding to align the spine vertically according to that proprioception. If the vestibular system is sending a skewed inaccurate signal, the spine will deviate from the central axis even though it 'thinks' it's straight. The cerebellum is the rear and lower portion of your brain that controls equilibrium, coordination, etc. and receives these messages from the vestibular system.

The eyes are also at play here.... if the inner ear and eyes are receiving different information (the eyes are level but the inner ear says you're not - or vice versa), this will also potentially lead to the same problem. The eyes are also 'hardwired' to the suboccipital muscles, which are tiny muscles located at the base of the skull where it meets the cervical spine in the back. They help to move the head instantaneously when you move your eyes and ultimately orient the head on the neck so that your eyes are level.

The rehab is aimed at correcting or minimizing the imbalance/problem/interpretation of the signals. By resolving or minimizing the vest. system disturbance, the body will be better able to naturally find its proper orientation and the signals creating or contributing to muscular/soft tissue imbalance will begin to equalize.

Try this... If you're fingers are sensitive enough you can feel it yourself. Sit upright or lay down. Place your fingers on both sides of the back of the neck, just below your head (C1,C2). Now move your eyes all the way to the left and right without actually turning your head. You will feel these muscles engage as you move your eyes, but not your head.

Sorry, it just seemed like something fun would be refreshing ...

Curvy, sorry if my language is too technical... if you don't understand me please just let me know.. I don't want to be talking over anyones head.

Regards,
Structural.

[gerbo]

but remember (and I am sure that structural agrees with this) that although this is a fascinating and attractive theory, it has never been shown in practice that this "vestibular rehabilitation" makes any difference to the outcome of the treatment of scoliosis. It is also possible that noted disturbances are a result of the scoliosis rather than "the" or "a" cause.

[CurvySAT05]

Structural...I had to reread some of the statements a couple times, but ultimately I was able to understand what you are saying. I am going to school to become a Physicians Assistant and have already taken Medical Terminology so can (for the most part) break down the words.
I was reading what you were saying about the tonic changes of the spinal musculature and thought about a test that I have seen before called a surface EMG (sEMG). It uses the same technology as an EKG or ECG (whichever you prefer to call it) to detect imbalances in spinal musculature. I was wondering if you had ever heard of this type of test and what your thoughts are on it. Also, could something like this be used kinda in reverse to determine tonic changes before doing vestibular testing so as to possibly save money?
Is it right of me to assume that if you are talking about scoliosis as a tonic muscular change of the spine (either from car accident, falling, or other etiology that causes muscular imbalance) that it is a functional curve that can be stabilized, because the etiology is all muscular? I know that chiros commonly say that the vertebra are "subluxated" and manipulate them. You say that you practice SI, what is this and how does it help to correct the deformity? Sorry if you have already gone over this...I didnt catch it between all the other posts.
Mandy

[structural75]

Hi Gerbo,

Yes, I certainly agree with you... I think we've agreed on that several times before. Remember, I am not contemplating the "cure" for scoliosis here. I believe this is one relevant factor in some cases that is worth consideration and use, along with others. I think I'd be one of the first on this forum to express the belief that ideopathic scoliosis affects far more than just one system, or one specific aspect of a system, in the body. I hope I can have an intelligent and peaceful exchange with someone here without further hassle... please.

I know the following doesn't apply to you Gerbo, but I think it clearly shows the importance of what we (Curvy and I) are talking about. It could possibly help many from escalating to more serious states, and I think anything to help children in the future is worthwhile to consider.

This study does in fact show that vestibular imbalances are known/proven to occur prior to the onset of an ideopathic scoliosis. So it's not completely outrageous to consider the possibility that some who have ideopathic scoliosis already actually had this to start.

ARE ASYMMETRIC OTOLITH VESTIBULO-OCULAR REPONSES A PREDICTIVE FACTOR FOR IDIOPATHIC SCOLIOSIS IN CHILDREN?

Sylvette R. Wiener-Vacher, and Dominique Antolini., Nn. 1

In idiopathic scoliosis spinal deformities start to develop at the time of the initial rapid growth at the onset of puberty. A suggested cause of IS is a disequilibrium in the otolith vestibular control of the trunk muscles. Supporting this hypothesis our previous results (2) showed that 67% of children with IS, but no other inner ear or neurological abnormalities, had an asymmetry of their otolith vestibulo-ocular reponses to the Off Vertical Axis Rotation test. These were significatively greater than in a control age-matched
group of normal children. We suggested that this asymmetry was a central otolith vestibular system disorder and could lead to a vestibulospinal system imbalance, which would then provoke IS.

The goal of this study was to determine if this asymmetry exists prior to the appearance of the spinal deformities. Our preliminary results show that the vestibulo-ocular asymmetry appears before the spine starts to show any significant clinical and radiological deformity. In patients at risk for IS(e.g. a family with IS history) screening for otolith functional asymmetry could be used as predictive factor of scoliosis and help for earlier prescription of IS preventative treatment.

1 Thanks to the Cotrel Foundation (Fondation de France) for supporting this research.

2 S.R. Wiener-Vacher, K. Mazda. Asymmetric otolith vestibulo-ocular responses in children with
idiopathic scoliosis. J. Pediatr 1998 ;132:1028-1032.

[structural75]

Mandy,
Yes, I'm familiar with EMG testing. Its primary usefulness is in showing before and after tonic changes following various therapeutic intervention. Unfortunately it will not be of use as a replacement/precursor to vestibular testing. Even someone with a non-scoliotic spine and normal vestibular function can end up with unequal EMG tonic output readings, as we all usually have dominant sides of preference in our bodies. The following explanation is also the primary reason why EMG testing wouldn't be very helpful.

In scoliotic spines there is an uneven tonus and development between the sides naturally. (Barring any possible neurologically derived ideopathic scoliosis) I'm sure you've heard this discussed by other folks before... One side appears to be overdeveloped relative to the other. The convex side will develop greater tonus and mass as a functional response of the body to try and self-correct the curve...

For Example: As it bends to the right, the musculature on the left side of the spine will eccentrically contract(elongate while contracting, such as lowering your arm doing a bicep curl) to attempt to prevent the curve from going further (as gravity pushes downward). This constant use of the muscle will cause it to increase in both tonus and mass. In the right bend scenario here, the musculature on the right side of the spine will be autonomically inhibited by the nervous system thus causing atrophy and decreased muscle mass/development on the concave side. If the body didn't do this autonomically and you increased the tonus of the muscles on the concave side it would actually end up pulling the spine further into a sidebend..., making it worse. So all of this change in tonus is, first and foremost, a necessary and functional compensation/adaptation by the body and nervous system to attempt to self-correct the curve in resistance to gravity and the internal forces that are causing it. Functionally speaking, it would be impossible and unhealthy to have equal tonus left to right in a scoliotic spine. That's why I cringe when I hear people talk about trying to "strengthen" the concave side of their curve. It will be a major impediment to any form of correction. And therefor it won't give you any accurate indication of what the vestibular system is doing. It could possibly be normal for some, when EMG will definitely, always show a difference.

I think one of the factors that is commonly ignored is gravitational influences. Once a spine begins to curve gravity amplifies the progress because the spine is no longer self supporting (vertebrae are no longer stacked in relative alignment in the vertical plane) This is just my opinion now, but I think that this is one of the factors involved in why some progress and others don't... or why some progress faster. How able is each individuals body to resist that force...? Some are more adaptable than others and some have more severe internal forces acting on it than others.
I know Gerbo... just theories at this point... no studies.

more in another post...

[structural75]

Mandy,

Part II

Unless there is a known neurologic disorder, I don't believe ideopathic scoliosis is necessarily caused soley by muscular tonal imbalances. Usually there is a more primary condition present that will end up influencing/dictating the neurologic tonus output to the muscular body. Other systems preceed the muscular body such as the ligaments, organs, joints, cranial system, nerves, etc.. In the case of accidents as you mentioned, injury to one or more of these more primary components will end up causing an autonomic muscular response in an effort to brace or protect the compromised region. If it's a disc or soft tissue surrounding some vertabrae then the muscles will respond with irregular tonus to postion the spine in such a way as to protect/inhibit/restrict certain movements. If these underlaying problems can be addressed properly, then there is probably a good chance that you can stop and/or reduce the curvature with stabilizing effects. These would be "functional" forms of scoliosis. It's impossible to cast generalities about the ability to stabilize them all, but some are certainly amenable to change.

As for subluxations.... that's opening a can of worms... . I don't know that I'm willing to go too far with this one given my most recent experience on 'chiropractic' issues. Let's just say that I don't think it's as black and white as subluxation theories suggest. Vertabrae have natural ranges of motion. They can become 'fixated' in any number of ways within any degree of movement. Again, this is the bodies way of protecting/bracing that region to prevent further irritation of something, further excessive range of motion at that joint, or as a result of chronic asymmetric loading on the joint. Sometimes these fixations are mechanically induced (sudden movements and the back 'goes out'. And others are neurologically induced as the ligaments and such inform the nervous system that there is too much stress/load on the vulnerable joint and there is a need for muscular stabilization/contraction, thus fixating it into position.

Scoliosis puts tremendous strain on the individual segments of the spine as well as the whole. At some point it is not unlikely to develop fixations in specific regions or transition zones of the curve where these forces tend to be the greatest. Adjustments of an intelligent sort may be helpful in re-establishing proper mobility and/or reducing pain associate with it. However, as long as the curve remains present, these forces will always exist and therefore any long-term effect of the adjustment might prove futile. I think it has its place, but it doesn't seem to present a viable option for correcting the curvature as a whole... seeing as it's being held in place by enormous quantities and spans of fascial and muscular tissues. Just my thoughts... .

I know these posts are a bit too long... sorry folks. But you ask some good questions Mandy. Hope that was helpful in some way. As for SI... I'd be happy to describe its intent and how it works with scoliosis, but I'm not certain if others will feel it's a bit of advertising or promotion on my part. Maybe I'll private message you about it.

Kind Regards,
structural

[gerbo]

Yes, I certainly agree with you... I think we've agreed on that several times before. Remember, I am not contemplating the "cure" for scoliosis here. I believe this is one relevant factor in some cases that is worth consideration and use, along with others. I think I'd be one of the first on this forum to express the belief that ideopathic scoliosis affects far more than just one system, or one specific aspect of a system, in the body. I hope I can have an intelligent and peaceful exchange with someone here without further hassle... please.

its just that me (like you) want to make sure that people who read your explanation understand this, so that they do not spend a disproportionate amount of effort, time and money on treatment based on this theory.

And don't worry, i'll keep it peaceful, you've got an interesting perspective on things so don't want to have any "arguments"

[tonibunny]

Hi Structural,

I've followed this discussion with interest, but was wondering how problems with the vestibular system could explain idiopathic scoliosis in infants who have yet to sit upright? I was first diagnosed with scoliosis at the age of 6 months, with two idiopathic curves of about 62 degrees (thoracic) and 40 degrees (lumbar); my mother noticed there was a problem before I even sat up, so it's difficult to see how vestibular problem could have been responsible. Is it likely that infantile idiopathic curves have a different pathology to adolescent idiopathic curves?

[gerbo]

I know Gerbo... just theories at this point... no studies.

Interesting theory, but my "theory of the relevance of muscular imbalances in scoliosis" goes different.

I think that we both recognise that a muscular imbalance develops as scoliosis develops and that they are somehow linked.

You are saying that

The convex side will develop greater tonus and mass as a functional response of the body to try and self-correct the curve...

suggesting that somehow the body will try to correct the curvature of the spine. I don't believe this; I believe that the body isn't bothered whether the spine is straight or bend, it hasn't got an inbuild blueprint dictating that the spine needs to be straight. I think however that the body will try to keep itself balanced, regardless of what happens to the spine.

If that is true, then the greater tonus etc on the convex side isn't necessarily beneficial to the spine, and could even be detrimental. To me it makes perfect sense that a mass of muscular tissue, lateral to the spine, which has a higher tonus and might move and contract with a higher strength due to its greater mass and different histological composition, could well, through its many attachements to the spine and its connecting tissue, pull the spine towards it and thereby exacerbating the curve. So instead of stabilising the curve, I think the muscle imbalance actually exacerbates the curve, contributing to the vicious cycle which inenevitably makes scoliosis worse.

Functionally speaking, it would be impossible and unhealthy to have equal tonus left to right in a scoliotic spine. That's why I cringe when I hear people talk about trying to "strengthen" the concave side of their curve. It will be a major impediment to any form of correction.

This is were a little bit of "proper" evidence comes in
vert mooney's study confirmed a emg differential between concave and convex side of the curve (other studies have done the same).

mark asher (reputable spinal surgeon) also studies rotational strength and found this was weaker towards the concave side

both findings fitting in with the known weakness of muscles on the concave side we are talking about.

This then even becomes more interesting once both mooney and asher address this strength differential. These are the torsorotation exercises which strengthen rotational strength towards the concave side.

Findings are that
1) emg differences even out
2) rotational strength equalises (concave side becomes stronger) and most importantly, contradicting

That's why I cringe when I hear people talk about trying to "strengthen" the concave side of their curve. It will be a major impediment to any form of correction

3) scoliosis either stabilises or even (marginally) improves (based on proper measurements with xrays etc)

Indeed, just a theory, like yours, worth considering though I think.

[structural75]

hi tonibunny,
Just to be totally clear on this, although I do find the vestibular component relevant in some cases, I definitely don't believe that it is the primary cause or influence in all ideopathic cases. I just believe that it is playing a role (for which we're unable to determine accurately at this point - primary or secondary), and is worth looking into and possibly addressing. Every case is so different than the next that I don't think there are many generalities possible with this condition.

... just like some are structural (fusion), or a boney anomoly (extra rib or hemi vertabrae), etc.. Some are neurologically induced - alteration in motor function or neural deficits beginning prior to birth... . It certainly doesn't sound to me as though yours was caused by vestibular imbalances. There are so many potential aeteologies for IS, vestibular dysfunction is only one possibility... I'm not suggesting it's always the culprit.

Kind Regards,
Structural

[tonibunny]

That's fine Structural, I'd guessed as much - thanks for clarifying things

[structural75]

Hi Gerbo,

I want to say first off that I wish you could hear me speak these words because I mean them in the most sincere of ways... no offense at all meant by the following.
First, I'm not suggesting that uneven tonus is"beneficial" for the spine, just an inevitable self-adaptation with many consequences, good and bad.

I see what you're getting at, but it's completely biomechanically incorrect.
There is NO muscles lateral to the spine that is capable of bending it to the opposite side as you're suggesting. It is simply anatomically, biomechanically impossible. Please take the time to look through an anatomy atlas to confirm this for yourself. If you can find ONE muscle that performs the action of bending the spine to the opposite side of its loacation, please let me know(My three surgical atlases and lab dissection experiences have not found this to exist). The musculature/soft tissue on the right side of the spine (attaching amongst the vertebrae, ribs, pelvis) laterally flexes (sidebends) the spine to the right, and vice versa. Simple as that. If that said musculature increased in tonus and mass (mass will reflect its need for use) and acted in a consentric fasion (shorten while contracting), it will indeed pull the spine into a sidebend to the same side.

This is were a little bit of "proper" evidence comes in

"Proper" evidence begins with understanding proper muscular/soft tissue action. I'm very sorry, but the theory you've proposed is flawed right from the start, as there are NO muscles capable of doing what you claim they do.
In other words, if the spine is bending left (C curve), the muscles on the convex side(right) will usually present with more tonus/development due to their effort to prevent further left sidebending (gravity pushing downwards is part of this equation as well as the internal forces). Our spine cannot bend to one side and effectively 'float' in space without having eneven muscular tonus... eventually the muscles will fatigue on one side, causing a demand for greater mass/histological changes and a build up of more collagen fibers (connective tissue) to add strength to meet the demands necessary to try and preventthe imbalance from getting worse.

I wish there were another professional or PT, whom who people respect, to confirm this biomechanical inaccuracy. I certainly don't mean this with any offense, but it is impossible for the muscles on the convex side of the curve to pull it further into the concavity. What you're "thinking" is not very well matched with what is anatomically possible.

suggesting that somehow the body will try to correct the curvature of the spine. I don't believe this; I believe that the body isn't bothered whether the spine is straight or bend, it hasn't got an inbuild blueprint dictating that the spine needs to be straight. I think however that the body will try to keep itself balanced, regardless of what happens to the spine.

Well, I find it hard to believe that the body doesn't care whether the spine is laterally bent. The bodies musculoskeletal system is striving for the most efficient balance and biomechanics possible, the same way it seeks a homeostatic state physiologically. Homeostasis is a scientifically credited phenomenon, why wouldn't that apply to the rest of our being/physical body? Besides, barring abnormalities/conditions, when was the last time you saw a child, shortly after learning to walk, walking around with their spine bent to the side constantly? Children have the most efficient and upright posture of us all. It's not until the slings and arrows of misfortune hit us in life that we begin to deviate from this starting point.

If it didn't matter to the body, or it somehow didn't know how to orient itself most efficiently and stabily (enter the purpose of the vestibular system/cerebellum ) then why aren't we all walking around as adults bent every which way(w/out scoliosis of course)? And why does every imbalance in one direction have a compensatory correction in the opposite if the body didn't have a sense of what's ideal? Furthermore, when you consider that structure influences function, and function influences structure(as seen in severe instances with cardiothoracic complications with sever scoliosis)... it is far more stressful on all systems of the body to manage anything but a vertical positioning... Also, the articular facets of the entire spine (joints of the vertabrae) are NOT positioned or designed for that type of chronic 'functional' positioning that you're suggesting is not bothersome. I mean the entire morphology of the shape of our vertebral bones would not fair well if this were the case... you would end up with tons of people herniating discs, disc pertrusions/extrusions, degeneration, stenosis, etc.. . I think the body is far more intelligent than you're 'theory' is giving it credit for.

Also Gerbo, we develop our prmary and secondary curves (anterior - posterior/ kyphosis - lordosis) as we learn to crawl, sit and walk. The development of those curves are beautifully written into us somewhere ??? We were meant to have them for proper function of the spine, is that not part of some "blueprint"? After all, we're NOT born with them, they develop late during infancy. How do cells know what to differentiate into during embrtologic development? This is all part of what we could call a "blueprint".

vert mooney's study confirmed a emg differential between concave and convex side of the curve (other studies have done the same).

Of course it would confirm a difference in tonus... I agree that's the case.

mark asher (reputable spinal surgeon) also studies rotational strength and found this was weaker towards the concave side

I'm unclear about direction here.. ?Could you clarify this for me? What direction in relation to the concavity... concave on the right with right rotation? Is that what you mean?

The rest... Yes, you can strengthen both sides and move towards equalizing EMG readings in a rotational manner. The torsorotations are helping to lengthen the inhibited short weak side, and dynamically engage the long, overactive strong side. When a muscle is shortened to capacity (the weak/inhibited ones on the concave side) it naturally lacks physiologic capability to strengthen beyond a certain point. As is the case when the "stronger" bunch on the convex side... they are 'locked long', also compromising their strength potential as well. So In doing torsorotations toward the concave side you are lengthening those concave muscles, therby giving them a greater physiologic range of motion and thus increasing their strength. The benefit comes from their lengthening which will help reduce the severity of the rotation aspect of the scoliosis. The strength aspect is a secondary functional effect.

3) scoliosis either stabilises or even (marginally) improves (based on proper measurements with xrays etc)

Is it the lateral curve or the rotation that is shown to improve using torsorotations, or both?
Yes, absolutely.. torsorotations done properly will help scoliosis, I agree. The biomechanical reason that curves/rotations will possibly improve is because the deep postural muscles that are responsible for rotating the spine are also the same ones responsible for sidebending it as well. For instance, a rotation to the RIGHT is caused by the multifidi and rotatores on the LEFT(there are more, no need to mention them all). At the same time, those multifidi and rotatores on the LEFT (same ones/same side) will also sidebend the spine to the LEFT. So when you do a torsorotation toward the concavity and presumably against the natural scoliotic rotation, as you described, this is being achieved by the engagement/contraction of the multi/rotat. on the convex side, all the while lengthening the ones on the concave side... giving them a more dynamic range of motion and creating length in them which will potentially reduce the amount of sidebending they are causing and increasing their strength potential and "normal" tonal activity. I agree with the end result of those findings, but you're interpretation of the findings is a little off.

2) rotational strength equalises (concave side becomes stronger) and most importantly, contradicting

Quote:
That's why I cringe when I hear people talk about trying to "strengthen" the concave side of their curve. It will be a major impediment to any form of correction

My statement is anatomically and biomechanically sound and correct, it's not my opinion, its just anatomical fact. The strength aspect is a secondary effect of what you're doing because the primary muscles on that concave side are lengthening, not contracting when you rotate to that side. If you were to actually "strengthen" those muscles, via shortening contractions, you would end up rotating further away from the concavity... into the scoliotic rotation. Or in the case of sidebending, if you contracted the already shortened muscles on the concave side to "strengthen" them, you would FURTHER sidebend into the concavity. This is what I'm saying is NOT GOOD, and it will exacerbate or hinder other corrective attempts being made.

Sorry for the lenght of that one... it just isn't as simple as you might think.
kindly,
structural

[Bish]

Hi Structural

I think you are definetly on to something here. In regards to your statements on equalizing muscle strength in a scoliotic spine. Despite the fact that logic might suggest equalizing muscle strength to straighten the spine is the way to go, I believe this may be the major flaw in attempts at many types of treatments for scoliosis. I know in my case T11 and possibly others have slight wedge shape to them, the convex side is overdeveloped and I think it is that way to compensate for a structural problem not common to a straight spine. To attempt to equalize convex and concave musles could in fact complicate the problem and or increase the degree of rotation. Nay sayers may want to think about why all these trestment programs are not yielding conclusive results. All the best, Dave

[structural75]

Gerbo,
Truly sorry for that exhaustive reply... I admit it was a bit more than you were asking for.

I wanted to say that I don't encourage further strengthening of the convex side to try and correct the curve... I'm of the opinion that we should look to 'lengthen' the shortened aspects of the curve first, before looking to add strength anywhere. Strength will inevitably come through functional use of the spine as long as equilibrium in length is being achieved between sides. Much like wringing a towel out by twisting it... as you twist further, the length of the towel gets shorter... unraveling the twist/bends will add length and functional strength/activation will follow suit.

Also, I read your post on spincor thread. I'm glad to hear you're daughter is improving. Just wanted to comment on the secondary curve that was detected. When it's not structurally induced, I've seen and heard from others the same occurence. In many of those cases we've had success reducing and eliminating the secondary curve... with some of the 'logic' I was describing in the previous post.

That 'tension' arising from the convex side transmits all the way up and down the spine longitudinally, as many of those muscles span lengths well beyond the local region... and the fascia of course is completely continuous. So strain/pull around the convexity is transmitted into the spinal segments above on the same side thus pulling it into a sidebend on that side... creating a concavity above the convexity. ...Yet another good reason not to further attempt to strengthen the convex side more.

This is one reason to be very careful and precise with stretching and so forth. If we stretch/lengthen the concave side in a general manner, it may cause lengthening in the portion of the spine above the concavity as well (where the spine is relatively straight). This could contribute to what I described above, from the other side... ultimately becoming the long convex side of that secondary curve.

Regards,
Structural

[structural75]

Gerbo,
I enjoy conversation with you, even if we don't always, or rarely, see 'eye to eye'.(had to get a little ocular/vestibular reference in to keep this post on topic.... )

The following comment really sends me into a tail spin...

suggesting that somehow the body will try to correct the curvature of the spine. I don't believe this; I believe that the body isn't bothered whether the spine is straight or bend, it hasn't got an inbuild blueprint dictating that the spine needs to be straight.

Do you truly believe this? If the spine were bent on a consistant basis you'll end up with uneven compression on the discs, uneven articulation at the facets... just to name a couple. We all know what happens when these situations present themselves... disc problems, facet issues... . How is it that the body wouldn't be bothered by that. Sounds irritating to me, I can only imagine what my body would think. It's" blueprint" is called the cerebellum, that important part of the brain in the back... ! That is what tells us to orient the spine in a "straight" fashion.

Why is the body not capable of trying to autonomical self-correct the curvature?(I'm not saying that it is always successful, but it is certainly trying to resist efforts otherwise.. or else we'd find ourselves bent over on the ground.) It's no different than you're body keeping you balanced as you walk and stand... I think it's obviously bothered when we start to lose balance, that's how you can stand in line at the grocers without thinking about not falling over. It simply wants, ad knows, that it needs to be as erect and aligned as possible for efficient, functional and easeful being.

I'm just very confused about why this seems so unlikely.. after all, what we refer to as 'compensations' are the reflection of this process.

kindly,
structural