Autoimmune Disease, Root Causes and the Body’s Ability to Heal
An Integrative Manual Therapy approach to looking at what may be getting in the way
If you have an autoimmune disease, you have probably heard a lot about your diagnosis.
Hashimoto’s.
Rheumatoid arthritis.
Lupus.
Scleroderma or CREST.
Psoriasis.
Sjögren’s.
Multiple sclerosis.
And there are many others.
You may have been told that your immune system is attacking your own tissues.
That is certainly an important part of the picture.
But there is another question that I think is worth asking:
Why is the body in this state—and what can we do to improve the environment in which the body is trying to heal?
That is a very different question.
And it is one of the reasons I have spent so many years studying Integrative Manual Therapy.
Sometimes the Person Doesn’t Come to Me for Their Autoimmune Condition
This is something I see quite often.
Someone comes to me because they have Achilles tendon pain.
Or plantar fasciitis.
Or knee pain.
Or hip pain.
Or a hamstring problem.
Or shin splints.
Or a shoulder that won’t settle down.
They’ve been running, exercising, playing sports or simply trying to stay active—and something isn’t getting better.
So we naturally start by looking at the injury.
Where does it hurt?
What happened?
How long has it been going on?
What makes it better?
What makes it worse?
What has already been tried?
But then, somewhere in the history, I may hear:
“Oh, and I have Hashimoto’s.”
Or:
“I have rheumatoid arthritis.”
Or:
“I have lupus.”
Or:
“I have Sjögren’s.”
Or:
“I’ve been diagnosed with an autoimmune condition, but I don’t know if it’s related to this.”
And that gets my attention.
Not because I assume the autoimmune condition caused the injury.
And not because every tendon problem in someone with an autoimmune diagnosis is an autoimmune problem.
But because now I have more information about the person sitting in front of me.
And I want to understand the whole picture.
What If the Tendon Isn’t the Whole Story?
Let’s take a runner with Achilles pain.
The obvious question is:
What’s wrong with the Achilles?
That’s an important question.
But I may also want to know:
- How is the foot functioning?
- How is the ankle moving?
- How is the calf functioning?
- How are the knee and hip functioning?
- How is the pelvis moving?
- How is the rib cage moving?
- How is the diaphragm moving?
- How are the connective tissues functioning?
- What is happening with circulation?
- What is happening with lymphatic movement?
- How is the autonomic nervous system functioning?
- What is happening with digestion?
- How is the person’s sleep?
- What medications are they taking?
And if they have an autoimmune condition:
What else might be going on in the system that could be relevant?
This doesn’t mean we abandon the Achilles.
It means we don’t assume the Achilles exists in isolation.
The same is true for a knee, a hip, a shoulder, a plantar fascia, a tendon or a joint.
The injured tissue matters. But the person that tissue belongs to matters too.
The Body Is a System
This is where my Integrative Manual Therapy training has changed the way I look at physical therapy.
I’ve learned that sometimes the place that hurts is simply the place where the body is finally saying:
“I can’t compensate for this anymore.”
A tendon can become overloaded.
A joint can become painful.
A muscle can become tight.
A runner can develop recurring shin pain.
And sometimes the local tissue really is the primary problem.
But sometimes the local tissue is being asked to compensate for something happening elsewhere.
That’s when I want to look beyond the painful spot.
And when there is an autoimmune component, I want to consider the possibility that the whole-body environment may be relevant.
Not necessarily as the cause.
But as part of the picture.
The Body Is More Than the Diagnosis
One of the things I have learned over more than 40 years as a physical therapist is that the place where someone has symptoms isn’t necessarily the place where the problem began.
And with complex, chronic conditions, the body is not a collection of separate parts.
Everything is connected.
The vascular system.
The lymphatic system.
The nervous system.
The connective tissue.
The organs.
The respiratory system.
The digestive system.
The musculoskeletal system.
The immune system.
They are constantly communicating with each other.
So when someone comes to me with an autoimmune condition, I’m not just interested in the diagnosis.
I’m interested in the whole physical environment of the body.
What is moving?
What isn’t?
What has good circulation?
What doesn’t?
Where is there excessive tension?
Where is there compression?
Where might drainage be compromised?
How is the diaphragm moving?
How are the ribs moving?
How are the organs moving?
How is the connective tissue functioning?
And perhaps most importantly:
What can we actually improve?
I Like to Think of the Body as a House
This is one of the simplest ways I can explain what I mean.
Your organs and systems have to live somewhere.
They live inside your physical structure.
Think about your house.
If the foundation is distorted, the walls are compressed, the plumbing is restricted, the ventilation isn’t working well and things don’t have enough room to move, you wouldn’t simply tell the people living inside the house:
“Try harder.”
You would look at the house.
You would ask:
What’s restricting things?
What’s not moving properly?
Where is the flow being compromised?
What can we improve?
That is part of the way I think about the human body.
We are trying to create a better house for the organs and systems that live inside it.
Better Blood Flow In. Better Blood Flow Out.
This is a simple concept, but it is enormously important.
Every cell in your body depends upon circulation.
Blood has to get in.
Blood has to get out.
Oxygen and nutrients have to be delivered.
Metabolic waste has to be transported away.
The lymphatic system has to move fluid and cellular debris.
The nervous system has to communicate.
The organs have to move.
The diaphragm has to move.
The connective tissues have to have appropriate mobility.
And all of these systems have to work together.
This is one of the reasons the Integrative Manual Therapy model is so interesting to me.
The work developed by Sharon Giammatteo and Thomas Giammatteo looks well beyond isolated muscles and joints and includes the autonomic nervous system, circulatory system, lymphatic system, visceral structures and connective tissues.
For me, that leads to a very practical question:
Can we improve the physical environment in which the body is functioning?
Sometimes the answer is yes.
And sometimes even a relatively small improvement can be meaningful.
When an “Injury” Keeps Coming Back
This is particularly important with runners.
A runner may get Achilles pain.
They stop running.
They do exercises.
They get massage.
They change shoes.
They work on their calf.
They gradually return to running.
And then six months later…
The Achilles hurts again.
Or perhaps it’s not the Achilles this time.
Now it’s the plantar fascia.
Or the knee.
Or the hip.
Or the other leg.
At some point, I think it is reasonable to stop and ask:
Why does this person’s body keep producing the same pattern?
Sometimes the answer is training load.
Sometimes biomechanics.
Sometimes inadequate recovery.
Sometimes strength or mobility.
And sometimes there are additional systemic factors that deserve consideration.
If that runner also has an autoimmune condition, that is another piece of information I don’t want to ignore.
Again, I’m not saying:
“Your autoimmune disease caused your Achilles problem.”
I’m saying:
“Let’s look at the whole person.”
This Is Where the Functional Medicine Perspective Can Add Another Layer
The structural side is only part of the picture.
There is also the question:
What is going into the body?
This is where I find some of the ideas of functional medicine, including the work of Dr. Thomas O’Bryan, interesting.
O’Bryan’s work focuses on the relationship between dietary factors, environmental exposures, intestinal function and autoimmune conditions.
His approach asks questions about things such as gluten and wheat-related disorders, food sensitivities, intestinal permeability, the microbiome and environmental triggers.
Again, I don’t believe there is one universal food or toxin responsible for everyone’s autoimmune condition.
But I do believe it can be valuable to ask:
Is there something in this person’s environment that their body is struggling with?
And if we find something that can reasonably be changed:
Can we change it?
Structure and Environment
This is where the two approaches come together for me.
Integrative Manual Therapy looks at the physical environment.
How is the body structured?
How are the tissues moving?
How is circulation?
How is lymphatic movement?
How are the organs moving?
How is the diaphragm functioning?
How is the nervous system responding?
And the functional medicine perspective asks additional questions about the internal and external environment.
What are we eating?
What are we exposed to?
How is the gut functioning?
What nutritional deficiencies might exist?
What environmental factors might be relevant?
What is happening with sleep and recovery?
These aren’t competing ideas.
They can be complementary ways of looking at the same person.
We Don’t Have to Find One Magic Root Cause
This is important.
I don’t think every autoimmune condition has one hidden cause waiting to be discovered.
And I don’t think every chronic injury has one root cause either.
Sometimes there are layers.
A person may have a genetic susceptibility.
They may have dietary or environmental exposures.
They may have gut dysfunction.
They may have chronic stress.
They may not be sleeping well.
They may have mechanical restrictions.
They may have an old injury that changed how they move.
They may be training too hard.
They may have an autoimmune disease.
And all of these things may interact.
So rather than insisting:
“We have to find THE root cause.”
I often think a better question is:
“What can we improve?”
If we can find something that is contributing and we can improve it, that’s valuable.
The Goal Is Not to Fight the Body
I don’t think your body is your enemy.
Even when the immune system is behaving inappropriately, there is an incredibly sophisticated biological system underneath it that is constantly trying to protect you and maintain balance.
The goal isn’t to “beat” your body.
The goal is to help create better conditions.
Better structure.
Better movement.
Better circulation.
Better drainage.
Better breathing.
Better nervous-system regulation.
Better nutrition.
Better sleep.
Less unnecessary exposure.
Appropriate medical care.
And whatever else that particular person needs.
The Person Is the One Who Heals
This is something I want to be very clear about.
I don’t heal you.
Integrative Manual Therapy doesn’t heal you.
A supplement doesn’t heal you.
A diet doesn’t heal you.
A doctor doesn’t heal you.
Your body does the healing.
Our job is to create better conditions for that healing process.
Sometimes that means improving the structure.
Sometimes it means improving mobility.
Sometimes it means supporting circulation or lymphatic movement.
Sometimes it means finding a food that clearly doesn’t agree with someone.
Sometimes it means identifying an environmental exposure.
Sometimes it means improving sleep.
Sometimes it means getting the right medical diagnosis and treatment.
Sometimes it means all of these things working together.
Build a Better House
This is ultimately how I think about my work with complex chronic conditions—and even with the runner who simply walks through my door because their Achilles won’t get better.
The Achilles matters.
The knee matters.
The hip matters.
The tendon matters.
But the person matters more.
The tendon lives inside the person.
The joint lives inside the person.
The organs live inside the person.
The immune system lives inside the person.
Everything is happening inside the same body.
So let’s look at the whole house.
Let’s see if we can give the organs and tissues more room.
Let’s improve mobility where we can.
Let’s support circulation.
Let’s support lymphatic movement.
Let’s improve breathing mechanics.
Let’s look at the nervous system.
Let’s consider nutrition and the gut.
Let’s consider the environment.
Let’s look at the person’s training, recovery and lifestyle.
Let’s make sure appropriate medical care is in place.
And then let’s ask:
What is getting in the way of this person’s ability to heal?
We may not find one answer.
We may not be able to change everything.
But if we can find something that can be improved…
Let’s improve it.
Then we look again.
And we keep going.
That, to me, is what an integrative approach is supposed to be.
Not replacing good medicine.
Not promising a miracle.
Not blaming the patient.
Not pretending we know everything.
But being willing to look deeper.
Being willing to connect the dots.
And being willing to ask:
What can we do to give this body a better chance to do what it already knows how to do?
That is a big part of why I do the work I do.
After more than 40 years as a physical therapist and more than 25 years studying Integrative Manual Therapy, I still love looking for the things that haven’t been found yet.
Whether you come to me with an Achilles tendon problem, knee pain, plantar fasciitis, hip pain, a recurring running injury—or a much more complicated chronic condition—I want to understand you, not just the name of the condition.
Find what can be improved.
Improve it.
And give the body a better environment in which to heal.
— Ralph Havens, PT, IMTC
Beyond Limits Physical Therapy
Fairhaven / Bellingham, Washington
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