The amazing Anterior Cingulate

A trendy piece of the brain
A few centimetres above and in front of your ear and sitting on top and to the front of the corpus collosum is the anterior cingulate cortex (ACC). It’s a trendy piece of brain because it nearly always shows up as active in brain imaging studies, no matter what is being studied. Some examples are swallowing, pain, social interaction, stress, orgasm, problem solving, distraction, focused attention, doing “nothing”, obsessive compulsive disorder etc. etc. Remember that when “in action” the ACC could be inhibiting or activating and much action will be subconscious.

My best and bravest attempt of a summary of the function of the ACC would be…..a multiuse area of brain used when you need to work and sort things out, especially when you are really focusing on the task.

The clinical consequences
OK – so in comes a patient and you ask them to turn their head – it’s about one degree range all around, yet when they leave or dress, the head turns easily. Or they can’t bend forward during assessment (i.e. they are focussed on the movement and their brain is trying to work out what motor output to “show you”), yet they can bend over and put on their shoes.

Guilty bit
I admit that in the past I thought that there could have been a bit of “putting it on here” but an alternate view might be this hot little piece of brain (among many other parts) may be fired up when the focus is on a particular movement and “turned off” when the focused demand goes.

Use in management
Importantly, this variable finding means that the problem is real (as all pains are) and changeable. Distracted activities (ranging from “get a life” to “graded contextually variable activities”) are worthwhile, but maybe even more, the variable movements could be brought to the attention of the patient, the changeability emphasised and the patient told about this important piece of brain.

Sure – it is reductive, but the message should give hope….that there is a changeable brain and this small area called the anterior cingulate fires when you are stressed, focussed and panicky etc. and shuts off when you relax, work your problems out and distract should be good news to nearly all patients.

What about the scientists?
A brain scientist told me that sometimes ACC activity is not reported as it is a given that it will be in action. This multiuse is not surprising because it is linking area between cortical function and autonomic functions.

Those scientists still looking for dedicated functions for brain parts sometimes appear confused and the ACC is a good example of this.  Good recent writing for the more interested include Posner M et al (2007) The anterior cingulate gyrus and the mechanisms of self regulation. Cogn Affect Behav Neurosci 7: 391-5)

Explain Pain Posters
We’ve got the new look posters rolling out of here and they’re being approved by all! You can even watch David give his short, 5 minute perspective on the 4 posters which is great to see if you’re unsure about how they should be viewed or discussed and want to hear it straight from the horse’s mouth!

Last month’s carpal tunnel competition

Question – Why don’t pirates get carpal tunnel syndrome?
Thanks for all the answers, we enjoyed them all – plenty about answers about hooks and good aaaarrrghonomics and sharks and plank walking, healthy salt air, digging hands into the loot and lack of doctors and therapists to diagnose CTS and invulnerable brain cells die to all the treachery and pillaging.

Honorable mentions to:   “Parrots on shoulders modulating ascending afferent input”…… “They love their work therefore no need to grip the sword with excessive force”…. and “they drink rum, chase women and nerve glide the seven seas”

Dishonorable mentions to: “the warm poultice of parrot poop” ….and … misreading CTS for “Colorful Turd Syndrome”

And there was some nice poetry….

“There was a pirate Sparrow,
Whose sword was sharp and narrow,
Movements were swift
Pelvis did shift
And his trademark was like that of Zorro!”

And the more technical…

“Backhanded sword parlay reproduces median nerve glide: supination, wrist extension, elbow extension while rope swinging involves shoulder abduction, external rotation and elbow extension.”

Really interesting…

Did you also know that pirates wore a patch over one eye so that one eye was always dark adapted so that they could move the patch from one eye to the other when they moved from indoors (e.g., dark) to outdoors (e.g., light) and would not be temporarily blinded because their eyes were not dark adapted. A few second’s advantage could make the difference between life or death in a shipside battle!

But the winner is Ursula Crosby from the UK with..
“Pirates don’t get Carpal tunnel because they “swashbuckle” in a ZORRO like manner on a regular basis.( see page 47 of Neurodynamic techniques)”

and we couldn’t resist Hanna Lucas’ (Aus) answer either…
“Pirates don’t get CTS because they are really great ambidextrous sword fighters, they wear really cool shirts and never have to use a computer”.


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