Sensible advice for aches, pains & injuries

Article Index

A searchable, sortable list of hundreds of articles and blog posts on


Type topics like “back pain” or “stretching” into the search box. Keywords are suggested as you type — choose one, or ignore them and type anything.EXAMPLEExample: To find featured and controversial articles about back pain, you want to enter “featured, back, controversial” — but you don't have to type it all. First type “feat” and then press enter to autocomplete the “featured” keyword. The list now only contains featured articles. Now type “bac” and press enter to completed the “back” tag. Finally type “contr” and choose the “controversial” keyword. The list now contains more than 200 articles that each have at least one of these tags, but the ones with two or three sort to the top. The list always sorts to show the best matches for your search at the top, but you can re-sort the list. There are many tags, like “fun” and “research.” MORE TAGSTag (keyword) suggestions popup as you type. Start typing knee pain and you’ll see that there are many items about knee pain! There are many other subject matter tags for all kinds of painful problems, like back pain, more for treatments like massage or chiropractic, plus dozens of other kinds of tags. Try typing size to pick a size tag. Searching for featured articles is a good way of finding the best. Some other useful tags are tags for specific areas: leg, head, knee, etc. Or tags for the tone of a post: fun, debunkery, deep for mind blowing items, or pro for more advanced content. And tags for different types or sizes of items are handy: search for little blog posts, or large tutorials, or excerpts from my books.

Trigger Points & Myofascial Pain Syndrome+

Myofascial trigger points — muscle knots — are increasingly recognized by all health professionals as the cause of most of the world’s aches and pains. This detailed tutorial focuses on advanced troubleshooting for patients who have failed to get relief from basic tactics, but it’s also ideal for starting beginners on the right foot, and for pros who need to stay current. 186 sections grounded in the famous texts of Drs. Travell & Simons, as well as more recent science, this constantly updated tutorial is also offered as a free bonus (2-for-1) with the low back, neck, muscle strain, or iliotibial pain tutorials.

  A guide to the unfinished science of muscle pain, with reviews of every theory and self-treatment and therapy option
updated   Feb 20, 18Feb '18 137,500
Anxiety & Chronic Pain   A self-help guide for people who have both anxiety and chronic pain updated   Feb 20, 18Feb '18 9,000
Chronic, Subtle, Systemic Inflammation+Chronic, subtle, systemic inflammation is a possible factor in stubborn musculoskeletal pain. It can have many underlying causes, from bad genes to mild autoimmune disease (including allergies), smoking or other severe biological stresses, chronic infections, and even just getting old (known as “inflammaging”). The greatest culprit is metabolic syndrome: a set of biological dysfunctions strongly linked to poor fitness, obesity, aging, and likely emotional stress and sleep disturbance as well.   A possible insidious cause of mysterious chronic pain updated   Feb 19, 18Feb '18 4,500
Pain Relief from Personal Growth   Treating tough pain problems with the pursuit of emotional intelligence, life balance, and peacefulness updated   Feb 16, 18Feb '18 3,000
Save Yourself from Neck Pain!+

Who hasn’t had a crick in the neck? This tutorial isn’t the last word on this surprisingly complex subject, but it is a detailed, sensible and scientific survey of what makes a neck crick tick — and your treatment options. Ideal for any frustrated patient with a jammed cervical spine, it’s also helpful for many a therapist not really sure how to treat this quirky phenomenon. Ships with a free bonus,’s valuable trigger point tutorial!

  All your treatment and self-help options for a crick in the neck explained and reviewed
updated   Feb 14, 18Feb '18 71,000
Save Yourself from IT Band Syndrome!+

ITBS is an infamously stubborn lateral knee pain common in runners. Therapy hasn’t been working? You’re not alone. This exhaustively researched tutorial shows that most medical “facts” about the condition are wrong — supported by 180 footnotes analyzing as much of the science as you can stand. Cures cannot be guaranteed, but this tutorial offers both patients and pros 25 detailed treatment options and more insights than you can find anywhere else, as well as a free bonus:’s valuable trigger point tutorial.

  All your treatment options for Iliotibial Band Syndrome reviewed in great detail, with clear explanations of recent scientific research supporting every key point
updated   Feb 11, 18Feb '18 58,000
Zapped! Does TENS work for pain?+

Transcutaneous electrical nerve stimulation (TENS) tries to treat pain by passing alternating current through superficial tissues causing tingling sensations, with brief and minor benefits that are probably just a “sensation-enhanced” placebo. It has been a therapeutic staple in physical therapy and chronic pain clinics for decades, and there are many consumer TENS gadgets. They are safe and fairly cheap at about $100 for a typical unit.

It’s not as scientific as it seems, but it may not be useless either: interesting sensations can always get something done when presented in the right way to patients. The tingling and vibrating might “drown out” pain, “distract” the nervous system from it, or get the brain to “reconsider” pain. It’s remotely possible that TENS stimulates actual tissue behaviour change (healing) and not just sensation. In theory, the right setting could make all the difference, which makes the topic endlessly debatable, even though most TENS obviously doesn’t work many miracles.

TENS has always also been seen as a form of relaxation therapy, similar to a vibrating massager, but it’s probably a minor effect. It doesn’t seem to be able to prevent (for instance) jaw muscle clencing in TMJ syndrome.

There’s not much scientific evidence that TENS helps pain and it’s surprisingly well-studied as these things go (much better than ultrasound, oddly). As of 2016, there are five disappointingly non-positive reviews, two spankings of TENS for for back pain and osteoarthritis, and just one positive review (also the oldest). Despite this, some experts remain remain optimistic that the right TENS for the right kind of pain could still be good medicine.

There are many other electrotherapies. Electrical muscle stimulation (instead of nerve) might help keep muscles fit during rehab from injuries, but it’s probably no better than just clenching muscles yourself. Pulsed electromagnetic field therapy (PEMF) is a fascinating cousin of TENS that seems to actually directly stimulate cellular repair, and is an evidence-based method of speeding up fracture healing; it probably has other uses, but none have been confirmed yet. Central nervous system stimulation using surgically implanted electrodes is basically “deep TENS,” and is an area of active research. Old-timey galvanic baths were an old-timey whole body direct current stimulation, “spasm baths” with no clear purpose. People do seem like to like shocking themselves!

  The peculiar popularity of being gently zapped with electrical stimulation therapy
updated   Feb 11, 18Feb '18 5,500
12 Surprising Causes of Pain   Trying to understand pain when there is no obvious explanation updated   Feb 10, 18Feb '18 3,750
Quite a Stretch: Stretching Hype Debunked+Stretching just doesn’t have the effects that most people hope it does. Plentiful research has shown that it doesn’t warm you up, prevent soreness or injury, enhance peformance, or physically change muscles. Although it can boost flexibility, the value of this is unclear, and no other measurable and significant benefit to stretching has ever been proven. Regardless of efficacy, stretching is inefficient, “proper” technique is controversial at best, and many key muscles are actually biomechanically impossible to stretch — like most of the quadriceps group (which runners never believe without diagrams). If there’s any hope for stretching, it might be a therapeutic effect on muscle “knots” (myofascial trigger points), but even that theory is full of problems.   Stretching science shows that a stretching habit isn’t doing much of what people hope updated   Feb 10, 18Feb '18 13,000
The Runners Knee Diagnostic Checklist   How to tell the difference between the two most common kinds of runner’s knee updated   Feb 9, 18Feb '18 1,300
Why do Muscles feel Stiff and Tight?   Maybe your range of motion is actually limited, or maybe it just feels that way updated   Feb 6, 18Feb '18 2,300
Five Ways To Prevent Sports Injuries   Manage load, warm up, sleep well, train for co-ordination, play smart! updated   Feb 2, 18Feb '18 1,500
Insomnia Until it Hurts+Almost everyone needs to take sleep deprivation more seriously. We are used to thinking of insomnia as a symptom, but it can also be hazardous in itself in many ways. Chronic pain is probably aggravated by insomnia or even mild but chronic sleep deprivation.   The role of sleep deprivation in chronic pain, especially muscle pain updated   Jan 29, 18Jan '18 3,000
The Insomnia Guide+

Serious insomnia is nothing to mess around with. Pain and insomnia in particular are trapped in a dysfunctional relationship, each causing the other. Fortunately, insomnia is often basically a bad habit that responds well to behavioural conditioning (just be sure to eliminate medical causes of sleep troubles first, especially the common sneakier ones like delayed sleep phase syndrome). There are many simple ways to improve sleep “hygiene” (rituals and behaviours that affect sleep) and the challenge is mainly in being thorough and consistent. Sleep compression therapy is more difficult but critical: temporarily cramming sleep into limited hours to force consistent, habit-building timing of falling asleep and (especially) waking up.

  Serious insomnia-fighting advice from a veteran of the sleep wars
updated   Jan 29, 18Jan '18 7,500
You’re Really Tight   The three most common words in massage therapy are pointless updated   Jan 27, 18Jan '18 2,300
My own chronic pain story   new   Jan 25, 18Jan '18 170
Frozen Shoulder Guide+

Frozen shoulder (adhesive capsulitis) is a common, disabling, painful loss of shoulder movement. The “adhesive” description is standard but wrong: the fibrous capsule doesn’t get stuck, but rather shrinks and thickens, a contracture. The cause of this is a mystery, but intriguingly it happens to people with diabetes much more. It can also be triggered by immobility, an underuse injury (instead of the much more common overuse injury). The joint is clearly mechanically stuck in many patients, but it’s also possible it also becomes neurologically shut down. Fortunately, frozen shoulders usually thaw, but it can take months, years, or even be permanent. Although usually easy to diagnose, frozen shoulder does often get confused with other conditions. Most treatments are controversial, and vary with the stage of the condition. Surgical options include ripping or cutting the adhesions, but only make sense for the worst cases. The usual non-surgical treatments include pain-killers and steroid (oral or injected), exercise, manipulations, and blowing the joint capsule up like a balloon. Massage may be helpful in some cases, and there’s some hope that anti-inflammatory nutrition might be useful. Operative options include manipulation under anaesthesia and arthroscopic release and are generally reserved for refractory cases.

  A readable self-help manual for one the strangest of all common musculoskeletal problems, adhesive capsulitis
updated   Jan 25, 18Jan '18 13,000
Save Yourself from Tennis Elbow!   Not just for tennis players, straight-talking advice on healing from this common tendinitis (lateral epicondylitis) updated   Jan 22, 18Jan '18 4,000
Is Running on Pavement Risky?   Hard-surface running may be risk factor for running injuries like patellofemoral pain, IT band syndrome, shin splints, and plantar fasciitis updated   Jan 21, 18Jan '18 7,500
Save Yourself from Low Back Pain!+

There are thousands of low back pain books — what’s special about this one? The problem is that 90% of doctors and therapists assume that back pain is structural, in spite of mountains of scientific evidence showing … exactly the opposite. Only a few medical experts understand this, and fewer still are writing for patients and therapists. Supported by 442 footnotes, this tutorial is the most credible and clarifying low back pain information you can find. Ships with a free copy of’s trigger point tutorial!

  Low back pain myths debunked and all your treatment options reviewed
updated   Jan 20, 18Jan '18 102,500
A Guide to Sciatica Treatment for Patients   A guide to buttock and leg pain (which may or may not involve the sciatic nerve) updated   Jan 19, 18Jan '18 6,000
Does Acupuncture Work for Pain?+

Acupuncture is the poster child of alternative medicine: charismatically exotic but less absurd than homeopathy, and heavily researched, people assume there “must be something to it,” including many skeptics until surprisingly recently. But acupuncture gets its support only from junky science, while all the good tests show that it’s no better than a placebo, for pain or anything else. This has been conceded even by many acupuncture researchers (although they bizarrely try to spin it as good news). Even NCCAM admits that acupuncture “works no better than a sham treatment at easing symptoms like pain and fatigue.”

We shouldn’t be surprised: acupuncture’s popularity comes from easily debunked myths and propaganda, and it’s based on a “vitalism,” a naive belief in an undetectable energy system in biology (like the Force, from Star Wars). It is not based on ancient Chinese wisdom, but a surprisingly modern invention. And Traditional Chinese medicine was never “wise”: it’s a patchwork of superstition, habit, and guesswork. Acupuncture is not and never has been used for anaesthesia (journalist James Reston did not, by his own account, contrary to legend); its use for that purpose was grossly exaggerated for political reasons during the Cultural Revolution. Finally, acupuncture isn’t even safe: aseptic technique (disinfectant, gloves) is often poor, and infections can and do happen.

Acupuncture’s glory days are over. It is supported only by ideologues and the uninformed. More study is not needed.

  A review of modern acupuncture evidence and myths, focused on treatment of back pain & other common chronic pains
updated   Jan 17, 18Jan '18 7,500
Don’t Worry About Lifting Technique   The importance of “lift with your legs, not your back” to prevent back pain has been exaggerated updated   Jan 16, 18Jan '18 3,250
Pain is Weird+Modern pain science shows that pain is a volatile, complex sensation that is completely tuned by the brain and often overprotectively exaggerated, so much so that sensitization often becomes more serious and chronic than the original problem. All of this has complicated “all in your head” implications: if the brain controls all pain, does that mean that we can think pain away? Probably not, but we do have some “neurological leverage” of great value — we can influence pain, if we understand it.   Pain science reveals a volatile, misleading sensation that is often more than just a symptom, and sometimes worse than whatever started it updated   Jan 15, 18Jan '18 11,000
Water Fever and the Fear of Chronic Dehydration   Do we really need eight glasses of water per day? updated   Jan 14, 18Jan '18 3,750
Save Yourself from Plantar Fasciitis!+

Plantar fasciitis is a stubborn pain in the arch of the foot. Yet scientists have proven that certain treatments are effective for most patients — so why don’t more professionals recommend them? Much of the science is new, and old myths die hard. This tutorial debunks the myths and reviews of all the common treatment options. Incredibly detailed, 52 sections in all, and thoroughly referenced.

  Plantar fasciitis explained in great detail, including every possible treatment option, and all supported by recent scientific research
updated   Jan 13, 18Jan '18 43,000
Mobilize!   Dynamic joint mobility drills are an alternative to stretching that “massage with movement” updated   Jan 12, 18Jan '18 6,000
Does Fascia Matter?+

Fascia is widely regarded as an exciting scientific frontier, with well-attended fascia conferences featuring gurus in the world of massage and manual therapy. The main idea is that fascia — tough connective tissue wrapping around all muscles and organs — can get tight and restrictive, and needs to be “released” by pulling on it artfully. Unfortunately, although fascia science may be inherently interesting as biology, and fascial compartment syndrome is certainly a real and scary medical problem, no subtle property of fascia has yet been shown to be clinically relevant. No fascial pathology seems to be a factor in any common painful problem, and no method of fascial manipulation is known to “fix” fascia or even change it.

I have challenged fascia fans to cite clinically relevant fascia science, with no result years now. This article reviews three key candidates: well-known studies about fascia’s toughness, its contractility, and its fibroblasts. None confirm any clinical relevance of fascia, and one actually undermines it, showing that fascia is too tough to “release.” I also discuss the irrelevance of piezoelectricity, thixotropic effect, and contradict Gil Hedley’s popular fascial “fuzz” theory of stiffness. The article criticizes fascia excitement from a scientific perspective.

  A detailed critical analysis of the clinical relevance of fascia science and fascia properties
updated   Jan 10, 18Jan '18 20,000
Post-Exercise, Delayed-Onset Muscle Soreness+

Delayed Onset Muscle Soreness (DOMS), AKA “muscle fever,” is the muscle pain and weakness that starts up to a day after unfamiliar exercise, peaking up to two days later. The strongest trigger is a lot of eccentric contraction (e.g. quadriceps while descending). DOMS is much weaker after the next workout, but the first bout can be so fierce that people avoid starting valuable exercise programs, especially strength training. It’s worse for some people due to genetic factors and other biological stresses (especially sleep trouble).

Medical science can’t explain DOMS, let alone treat it. Many athletes believe that massage helps, but that’s not what the evidence shows. And many take ibuprofen as prevention, but that doesn’t work either. Drugs will only take the edge off the pain. The only promising treatments are heat and Indian food (curcumin), but not confirmed. Excessive DOMS may also be a symptom of other health problems, some of which can be treated, most notably vitamin D deficiency and insomnia.

DOMS is probably not caused by micro-trauma — a popular old idea — although it might be a mild form of “rhabdomyolysis,” which is caused by mucle proteins spilling into the blood. Some kind of “metabolic stress” may be a more likely culprit, and yet there is no clear link between DOMS and any specific biological marker (and definitely not lactic acid). There are even clues that DOMS is neurological. Certainly it is not straightforwardly inflammatory: evidence suggests that inflammation is what reduces DOMS pain as you continue to exercise. Mysterious indeed!

  The biology & treatment of “muscle fever,” the deep muscle soreness that surges 24-48 hours after an unfamiliar workout intensity
updated   Jan 5, 18Jan '18 9,500
A Rational Guide to Fibromyalgia+

Fibromyalgia is an unexplained and mostly untreatable illness of chronic pain, fatigue, and mental fog affecting about 1–2% of the population. A few recover naturally. It is often not diagnosed when it should be, and even more often these days it is diagnosed when it shouldn’t. Fibromyalgia is associated with (and may be related to) conditions like irritable bowel syndrome, migraines, mood disorders, inflammatory arthritis, and especially the pain of “trigger points” (sensitive patches of muscle). Its non-specific symptoms are routinely confused with many more conditions.

Controversy, stigma, quackery, and junky science swirl around fibromyalgia like a bad smell. No medical speciality specializes in it. Rheumatologists and neurologists often get “stuck” with fibromyalgia patients, but most have no idea what to do with them. Alternative medicine has flooded the knowledge gap with many bogus theories and related cures (infections, vaccinations, excess phosphate, adrenal fatigue, and “bad energy” are all major examples). Too many professionals of all kinds still assume fibromyalgia is “all in your head” or a character weakness, but that’s obsolete nonsense: fibromyalgia is a verifiable phenomenon. Patients have an extensive inflammatory profile and are clearly neurologically sensitized, and a lot of them also have slightly pinched cervical spinal cords (myelopathy), one of the most fascinating findings of recent years. Small-fibre neuropathy may also be involved.

There are only few firm evidence-based treatment recommendations: regular moderate exercise is helpful, with some caveats (moderation, timing, and enjoyment can be critical). Patients need to stay as healthy as possible otherwise, especially protecting sleep as much as practical, and avoiding drugs/alcohol/smoking. Vitamin D supplementation is a worthwhile experiment for many. No medications are proven to be helpful, but marijuana is worth trying.

  The science of the mysterious disease of pain, exhaustion, and mental fog
updated   Dec 23, 17Dec '17 11,000
Pseudo-quackery in Chronic Pain Care+Not all quackery is obvious — not even to skeptics. Subtler snake oil is actually a more serious problem in musculoskeletal health care, because it’s harder to spot and much more common, but probably generates even more false hopes and wasted time, energy, money, and even direct harm.   A field with a large gray zone between overt quackery and evidence-based care for chronic pain and injury rehabilitation updated   Dec 20, 17Dec '17 3,000
A Historical Perspective On Aches ‘n’ Pains   We are living in a golden age of pain science and musculoskeletal medicine … sorta updated   Dec 20, 17Dec '17 2,100
Placebo Power Hype+Placebo is fascinating, but its “power” isn’t all it’s cracked up to be: the power of belief is strictly limited and accounts for only some of what we think of as “the” placebo effect. There are no mentally-mediated healing miracles. But there is an awful lot of ideologically motivated hype about placebo!   The placebo effect is fascinating, but its “power” isn’t all it’s cracked up to be updated   Dec 18, 17Dec '17 5,500
Do Nerve Blocks Work for Neck Pain and Low Back Pain?   Analysis of the science of stopping the pain of facet joint syndrome with nerve blocks, joint injections, and nerve ablation updated   Dec 9, 17Dec '17 2,500
(Almost) Never Use Ice on Low Back Pain!   An important exception to conventional wisdom about icing and heating updated   Dec 9, 17Dec '17 3,000
The Trouble with Chairs   The science of being sedentary and how much it does (or doesn’t) affect your health and back pain updated   Dec 9, 17Dec '17 8,000
Save Yourself from Shin Splints!+

Do you know why your shins hurt? Shin splints are often not what they seem. With several possible underlying problems, patients often end up barking up the wrong tree. There are four very different types of shin pain. This tutorial breaks it down for you and goes through all the treatment options and recent science. About 20 times more information about shin splints in one place than you can get anywhere else. Ships with a free copy of’s trigger point tutorial!

  Causes and treatment options for shin splints explained and discussed in great detail, especially shin pain caused by myofascial trigger points, compartment syndrome, medial tibial stress syndrome, and stress fracture
updated   Dec 8, 17Dec '17 24,000
Does Epsom Salt Work?+

Epsom salt (magnesium sulphate) in your bath is cheap and harmless and it makes the water feel “silkier,” but it probably doesn’t do anything else you hope it’s doing. Contrary to popular belief, it probably has no significant benefits for most common kinds of aches and pains. Oral magnesium supplementation may be helpful for some types of chronic pain for some people (with magnesium deficiency), and it probably works much better than trying to soak in it. Topical delivery via creams is scientifically controversial, and absorption from baths is virtually unstudied: it may not work in a bath at all, or only modestly and erratically. For pain, the soothing heat of a nice bath is probably far more therapeutic than whatever magnesium might be absorbed. Bathing in a magnesium sulfate solution also has no other known medical benefits other than treating skin infections. Most theories you hear about how Epsom salt baths work are oversimplified and meaningless (for instance, nearly everyone says it is absorbed by osmosis, which is definitely wrong). The case for the healing powers of Epsom salt is mostly made by people selling the stuff, or recommending it as carelessly as an old wives’ tale. If relatively dilute home salt baths were actually medicinal, then far more concentrated sources like The Dead Sea would have clear health effects, which they definitely do not.

  The science of Epsom salt bathing for recovery from muscle pain, soreness, or injury
updated   Dec 8, 17Dec '17 11,000
The Functional Movement Screen (FMS)+The Functional Movement Screen (FMS) is a set of seven physical tests of coordination and strength, especially “core” strength, invented in 1997 and now in widespread use around the world. It was originally proposed as a trouble-detection system, which is baked into the name: it’s a “screen.” Its use in the wild seems to over-reach this stated purpose.   The benefits of the popular screening system for athletes might be over-sold by some professionals updated   Dec 6, 17Dec '17 4,250
Save Yourself from Patellofemoral Pain Syndrome!+

PFPS is a common kneecap pain problem — and yet almost universally misunderstood. Patients are often given exactly the wrong advice. There is no miracle cure for patellar pain, but this tutorial is much more detailed than anything else you can find, weighing in at 40,000 words. Both patients and pros can greatly improve their understanding of the options — and maybe that is a kind of miracle. Inspired by the work of surgeon Scott Dye and firmly grounded in readable analysis of the science.

  Patellofemoral pain syndrome (aka runner’s knee) explained and discussed in great detail, including every imaginable self-treatment option and all the available scientific evidence
updated   Dec 4, 17Dec '17 71,000
Healing Time+

Healing speed is of great interest, and people often believe that treatment X helped them to heal faster. It’s also a common marketing claim. Unfortunately, most patients aren’t the least bit knowledgeable about what constitutes a normal healing time, and should probably defer to clinicians who have seen hundreds or even thousands of examples — except that they don’t really know either, because they do know that healing time varies wildly depending on countless variables. People often recover faster or slower than expected for reasons no one can ever know. We also seem to recover faster or slower depending on which psychological “goggles” we have on (optimistic, pessimistic, etc).

The bottom line is that the natural variation in healing times tends to obscure the effects of treatments, and simply isn’t actually possible to know if any treatment helped us heal “faster,” because we can never know how long it would have taken without it. You also don’t know what will happen the next time. The only possible way to settle such questions and confirm a faster average recovery time — especially if it’s only a little bit faster — is with carefully designed scientific testing, and quite a bit of it.

  Can healing be hurried? Would we even notice if it was?
updated   Dec 4, 17Dec '17 1,300
Does Ultrasound Therapy Work?+

Ultrasound therapy is the use of sound waves to treat medical problems, especially musculoskeletal problems like inflammation from injuries (sprains, tendinitis, bursitis). It has been a popular therapy for decades, its use so widespread that it almost defines physical therapy. Unfortunately, although mainstream, it is not as scientific a treatment as most people assume. It has been condemned or, at best, damned with faint praise by one scientific review after another for a quarter century. Authors had almost nothing good to say about ultrasound. Conclusions like this one (from van der Windt et al) are the rule: “As yet, there seems to be little evidence to support the use of ultrasound therapy in the treatment of musculoskeletal disorders.” Some modern variants of ultrasound are expensive, hyped, and totally unproven for any or many conditions.

  Many concerns about the widespread usage of therapeutic ultrasound, especially extracorporeal shockwave therapy (ESWT)
updated   Dec 4, 17Dec '17 4,000
IT Band Stretching Does Not Work   Stretching the iliotibial band is a popular idea, but it’s very hard to do it right, and it’s probably not worth it updated   Dec 1, 17Dec '17 3,000
Knee Surgery Sure is Useless!   Evidence that arthroscopic knee surgery for osteoarthritis is about as useful as a Nerf hammer updated   Nov 29, 17Nov '17 1,500
Should You Get A Lube Job for Your Arthritic Knee?   Reviewing the science of injecting artificial synovial fluid, especially for patellofemoral pain updated   Nov 29, 17Nov '17 1,100
Your Back Is Not Out of Alignment+

“Structuralism” is the excessive focus in the physical therapies on crookedness or “mechanical” problems in the body — what I call the biomechanical bogeymen. It is the source of much bogus diagnosis — things like tilted pelvises, short legs, abnormal spinal curvatures, or “misaligned” anything — and the cause of much therapeutic barking up the wrong tree. Such factors are much less important than many people still believe.

Structuralism has been challenged by many medical researchers and experts like Dr. Lorimer Moseley Moseley, Dr. Scott Dye (knee surgeon); or back experts Drs. Richard Deyo, John Sarno, and Nickolai Bogduk; soft tissue pain experts like the late Dr. Janet Travell, Drs. David Simons and Seigfried Mense (see Muscle Pain), or Dr. Chann Gunn, and on and on.

Many key scientific studies over the years have undermined major structuralist assumptions, like Finan’s finding that knee pain correlates more with pain sensitivity than arthritis; Grundy’s conclusion in Lancet that short leg length differences don’t correlate with back pain; or Grob’s findings that abnormal neck curvatures do not predict neck pain; or Moseley’s finding that a placebo for knee osteoarthritis is just as good as real surgery; or numerous MRI studies showing terrible correlation between structural problems and back pain (see Boden, Jensen, Weishaupt, Stadnik, Borenstein); or the astonishing finding by Haig that even narrowing of the spinal canal does not necessarily cause stenotic back pain; or the clear evidence that even dislocation of the upper cervical spine is often asymptomatic (Swinkels); and so on (and on and on).

  Debunking the obsession with alignment, posture, and other biomechanical bogeymen as major causes of pain
updated   Nov 23, 17Nov '17 16,000
Save Yourself from Muscle Strain!+

Got a muscle strain? Maybe … and maybe not. Probably 75% of so-called muscle strains are actually something else. Doctors routinely diagnose muscle strain incorrectly. The muscle strain tutorial is guaranteed to sort it out … and it is just about only the source of information that does. For the majority of readers who’ve been misdiagnosed, the muscle strain tutorial ships with a free bonus tutorial about the problem they most likely do have — myofascial trigger points.

  Muscle strain (pulled muscle) and muscle pain explained and discussed in great detail, plus every imaginable treatment option
updated   Nov 18, 17Nov '17 19,000
💩 Massage Therapists Say   A compilation of more than 50 examples of the bizarre nonsense spoken by massage therapists with delusions of medical knowledge new   Nov 16, 17Nov '17 8,500
The Art of Bioenergetic Breathing   A potent tool for personal growth and transformation updated   Nov 16, 17Nov '17 2,500
Trigger Point Doubts+

People often experience acutely sensitive, aching spots in their muscle tissue that we call “muscle knots.” They can be surprisingly severe, and massaging them often seems to help quite a bit. What’s going on? The dominant theory is that a trigger point is a patch of tightly contracted muscle, an isolated spasm affecting just a small patch of muscle tissue. Unfortunately, after a few decades it’s still just a theory, and trigger point science is a bit half-baked and somewhat controversial. It’s not even clear that there is really a problem in the meat at all; it could be a sensory “disturbance,” for instance. Meanwhile, people keep hurting, and there is little doubt that there is an important, almost epidemic phenomenon here in need of explaining and treating. Massage — especially self-massage — remains a safe, cheap way of trying to deal with it, and there is some evidence that it can provide some meaningful relief (e.g. Furlan 2008 is probably the best example). That’s why I have a large tutorial devoted to how to self-treat “trigger points” — whatever they really are. But it’s important to keep in mind that they are not well understood.

  Do muscle knots exist? Exploring controversies about the existence and nature of so-called “trigger points” and myofascial pain syndrome
updated   Nov 11, 17Nov '17 11,000
Basic Self-Massage Tips for Myofascial Trigger Points   Learn how to massage your own trigger points (muscle knots) updated   Nov 11, 17Nov '17 2,400
Can Massage Damage Nerves?   It is possible, but hard to do, rare, and the damage is usually minor updated   Nov 10, 17Nov '17 1,600
When to Worry About Low Back Pain+

The pain of back pain almost always makes it seem worse than it is. The most worrisome causes of back pain rarely cause severe pain, and many common problems (like slipped discs) are usually much less serious than people fear. Only about 1% of back pain is ominous, and even then it’s often still treatable. Most of the 1% are due to cancer, autoimmune disease, or spinal cord damage.

Don’t medically investigate back pain until it’s met at least three criteria: (1) it’s been bothering you for more than about 6 weeks; (2) it’s severe and/or not improving, or actually getting worse; and (3) there’s at least one other “red flag” (age over 55 or under 20, painful to light tapping, fever/malaise, weight loss, slow urination, incontinence, groin numbness, a dragging toe, or symptoms in both legs like numbness and/or tingling and/or weakness).

Red flags do not confirm that something horrible is going on, just that it’s time to talk to a doctor.

  And when not to! What’s bark and what’s bite?
updated   Nov 10, 17Nov '17 4,000
Does Massage Therapy Work?+

Therapeutic massage is expensive but popular and pleasant, with obvious subjective value, and proven benefit for anxiety and depression… but no other clear biological or medical effects. Most notably, the evidence that massage can help back and neck pain is sketchy, and there is no reason to believe that massage can help much with any other common musculoskeletal pain problem.

Training and certification standards for massage therapists are all over the map, and most practitioners have barely scratched the surface of musculoskeletal medicine. The profession is rife with pseudoscience like crank theories about the causes of pain, the myth that massage detoxifies, or that painfully “deep tissue” massage is needed to “release” tissues (which is stressful or even harmful for many patients).

And yet some medical benefits are plausible despite the lack of evidence. For instance, many apparently successful treatments may be due to the effects of pressure on “muscle knots,” which are a likely factor in many common pain problems, but poorly understood (and difficult to treat). And regardless, the effects on mood and mental health are so profound that patients can’t really lose — it’s a valuable service whether it “works” for pain or not.

  A review of the science of massage therapy … such as it is
updated   Nov 9, 17Nov '17 16,000
Dupuytren’s Contracture   The tip of a mysterious pathological iceberg updated   Nov 2, 17Nov '17 1,300
Massage Therapy for Low Back Pain (Again)   Perfect Spot No. 13, The Most Classic Low Back Pain Trigger Point updated   Nov 1, 17Nov '17 1,100
Blog hibernation post script   new   Oct 27, 17Oct '17 140
Science versus Experience in Musculoskeletal Medicine   The conflict between science and clinical experience and pragmatism in the management of aches, pains, and injuries updated   Oct 24, 17Oct '17 1,800
The “Impress Me” Test   Most controversial therapies are fighting over scraps of “positive” evidence that damn them with faint praise updated   Oct 24, 17Oct '17 2,100
Blog hibernation   new   Oct 18, 17Oct '17 190
The Pressure Question in Massage Therapy+

There is no clear justification for painfully intense “deep tissue” massage, and it’s actually hazardous to many patients, but the pressure question is greatly complicated by the fascinating paradox of “good” pain, wildly varied patient pain tolerance and preferences (often timidly repressed), and popular faith in the “no pain, no gain” principle.

“Good pain” is at the heart of the pressure question: a strange, potent sensory paradox that many people actually seek out as the goal of therapy, consciously or unconciously. Either it isn’t literally painful (just intense), or it’s painful but desired anyway because of relief or belief: an actual biological relief or at least the belief that there is one. But it’s important to note that not all satisfying, relieving sensations are genuinely helpful (e.g. scratching a mosquito bite).

“Bad pain” is unpleasant but manageable and probably safe — tolerate it cautiously, to a point.

“Ugly pain” is dangerous both physically and neurologically, causing a “fight or flight” reaction — always avoid it.

People do have clear pressure preferences: they often fire massage therapists who give treatments that are too painful or too fluffy. Pressure that’s fine for you may cause severe pain, emotional distress, “sensory injury” (sensitization) in others, or even physical injury, so pressure should be customized but often isn’t. Brutal massages might be appreciated or even helpful, but most people can’t tell the difference between the kind of pain that might be a necessary part of therapy, and ugly pain that is just abusive and dangerous.

Some possible justifications for painfully intense massage (these aren’t endorsements) include the destruction of motor end plates to “de-activate” trigger points; somatoemotional release (pain often strongly “resonates” with strong emotions like grief); moving tissue fluids; or just creating a strong, novel sensory experiences (which may have many subtle benefits).

  What’s the right amount of pressure to apply to muscles in massage therapy and self-massage?
updated   Oct 18, 17Oct '17 4,750
How Many Muscles In the Human Body?   A slightly tongue-in-cheek tally of our many muscles updated   Oct 13, 17Oct '17 1,300
Deep Friction Massage Therapy for Tendinitis   A guide to a simple self-massage technique sometimes helpful in treating common tendinitis injuries like tennis elbow or Achilles tendinitis updated   Oct 9, 17Oct '17 3,250
Why Do We Get Sick?   The curious and tangled connections between pain, poor health, and the lives we lead updated   Oct 7, 17Oct '17 2,750
Alex Hutchinson’s “7 pillars of running wisdom”   new   Oct 3, 17Oct '17 130
Is Diagnosis for Pain Problems Reliable?   Reliability science shows that health professionals can’t agree on many popular theories about why you’re in pain updated   Sep 23, 17Sep '17 2,750
When to Worry About Neck Pain…and when not to!+

The most worrisome causes of neck pain rarely cause severe pain, and common problems like slipped discs are usually much less serious than people fear. Sharp and stabbing pains are usually false alarms. Only about 1% of neck pain is ominous, and even then it’s often still treatable. Most of the 1% are due to cancer, autoimmune disease, or spinal cord damage.

Don’t medically investigate neck pain until it’s met at least three criteria: (1) it’s been bothering you for more than about 6 weeks; (2) it’s severe and/or not improving, or actually getting worse; and (3) there’s at least one other “red flag” (age over 55 or under 20, painful to light tapping, fever/malaise/nausea, weight loss, nasty headache, severe stiffness, very distinctive pain, and numbness and/or tingling and/or weakness anywhere else). Note that signs of arthritis are not red flags.

Red flags do not confirm that something horrible is going on, only that it’s time to talk to a doctor.

  Tips, checklists, and non-scary possible explanations for neck pain
updated   Sep 22, 17Sep '17 3,500
Pain & Injury Survival Tips   Dozens of ideas (and links) for evidence-based rehabilitation and self-treatment for common pain problems and injuries updated   Sep 20, 17Sep '17 9,500
“Fascial release” is not emotional   new   Sep 19, 17Sep '17 200
Accessibility upgrade   new   Sep 18, 17Sep '17 190
New review a bit less bullish on cannabis   new   Sep 16, 17Sep '17 160
Is statin myalgia actually a thing?   new   Sep 15, 17Sep '17 350
Report on swimming benefits   new   Sep 14, 17Sep '17 75
Fresh evidence that sitting is not “the new smoking”   new   Sep 13, 17Sep '17 550
Pain is immune to logic   new   Sep 7, 17Sep '17 210
Bogus Citations   11 classic ways to self-servingly screw up references to science, like “the sneaky reach” or “the uncheckable” updated   Sep 6, 17Sep '17 2,300
Patient advocacy is naturally at odds with professional tribalism and boosterism   new   Aug 29, 17Aug '17 210
Tissue Provocation Therapies+

There are two “laws” of tissue adaptation, one each for hard and soft tissue. Wolff’s law is that bone will change and strengthen in response to loading. This was first noticed by Julius Wolff in the 19th Century, who got the naming rights. It was greatly refined in the mid 20th century by Dr. Harold Frost, an American surgeon who studied bone biology, and published scientific papers more often than I change my socks. The full details of how bone responds to stress are described in his Mechanostat model. The corollary in soft tissue is the obscure and much less developed Davis’ law. (No one even seems to know who Davis was.)

Although there’s no question soft tissue does adapt to stress, the responses of muscles, tendons, and ligaments are much more complex and less well understood. Many treatments are based on the idea of forcing adaptation or “toughening up” tissues by stressing the tissues. It has always been a reasonable idea, but the devil is in the details: what constitutes the “right” amount and kind of stress is difficult to know, and the results of such therapies have generally been highly inconsistent.

  Can healing be forced? The laws of tissue adaptation & therapies like Prolotherapy & Graston Technique
  Aug 16, 17Aug '17 3,000
Vitamin D for Pain   Is it safe and reasonable for chronic pain patients to take higher doses of Vitamin D? And just how high is safe?   Aug 15, 17Aug '17 5,000
Does Spinal Manipulation Work?+

The idea of “adjusting” the spine refers to many different manual therapies that wiggle, pop and otherwise manipulate spinal joints. The correct umbrella term for these treatments is “spinal manipulative therapy” or SMT. Expert opinions on SMT range widely, with some prominent medical scientists expressing strong concern and skepticism. Its provenance in chiropractic subluxation theory is dubious, its benefits are minor at best, and yet there are serious risks, even including paralysis and death in the case of SMT for the joints of the neck.

Despite all the controversy, there has been little high quality scientific research to determine whether or not SMT is safe and really works. Major science reviews have either been thoroughly discouraging. Thus, SMT fails the “impress me” test — it can’t possibly be working any miracles.

And yet spinal joint popping in particular is something that people crave, and most clinicians believe that some forms of SMT can be helpful to some of their patients, some of the time. There seems to be almost no doubt that there is something of therapeutic interest going on in SMT, at least some of the time.

  Spinal manipulation, adjustment, and popping of the spinal joints and the subluxation theory of disease, back pain and neck pain
  Aug 14, 17Aug '17 14,000
Strength Training Frequency+Research shows strength training is much more efficient form of exercise than most people realize, and almost any amount of it is much better than nothing. You can gain strength and all its health benefits fairly easily.   Less is more than enough: go to the gym less frequently but still gain strength fast enough for anyone but a bodybuilder   Aug 10, 17Aug '17 8,000
Two good, clashing studies of the link between back pain and obesity     Aug 3, 17Aug '17 400
The Unstretchables+Many muscles are too awkward to stretch effectively for biomechanical reasons — you simply can’t good leverage, or another body part is in the way. There are several interesting examples.   Eleven major muscles you can’t stretch (no matter how hard you try)   Aug 1, 17Aug '17 1,900
Supplements are not safe     Jul 26, 17Jul '17 100
Homeopathy Schmomeopathy+

Homeopathy is a 200-year-old medical philosophy that has been thoroughly debunked, and survives today thanks to wishful thinking, ignorance, and because it is too useless to be very dangerous. It is the flagship in the alternative medicine fleet: the most profitable, absurd, and snakey of all snake oils.

Most people have no idea just how strange homeopathy is. The deal-breaker for many consumers is the discovery that it’s not just an “herbal” or “natural” remedy, but a “magical” one, based on a principle that reeks of flaky physics and old-timey snake oil flamboyance—much farther out in left field than herbs. Some people, of course, are quite happy citing quantum physics to explain alternative medicine, but you really have to be a card-carrying new age sort to go there. For most people, that crosses a line.

But they have to find out first! Fortunately, doctors, scientists and skeptics are unanimously and harshly critical of homeopathy, and have published many good quality critical reviews. For instance, see my own article about homeopathic arnica — the most popular of all homeopathic products, intended to treat inflammatory pain.

  Homeopathy is not a natural or herbal remedy: it’s a magical idea with no possible basis in reality
  Jul 26, 17Jul '17 1,500
Can Supplements Help Arthritis and Other Aches and Pains?+

Many nutritional supplements, are taken like drugs as a treatment for muscles and joints and aches and pains: the “nutraceuticals,” like glucosamine, chondroitin sulfate, and bromelain. Unfortunately, many of them make little or no sense even in principle, and modern supplement research has been extremely disappointing and even ominous, due to the discovery of risks and serious problems with quality control in a virtually unregulated industry that is just as profitable as “Big Pharma,” and even more corrupt by most measures (even just on the basis of the massive involvement multi-level marketing, a fundamentally fraudulent business model).

Glucosamine is the most popular supplement, and has been slammed by large, decisively negative trials. Chondroitin has fared no better. Only one of the popular nutraceuticals, creatine, is quite a clear winner — but it’s main benefit is muscle fatigue resistance, which may not have anything to do with pain. There are still decent rays of hope for Vitamin D, curcumin, and a few others might be worth experimenting with for some kinds of problems, like magnesium for fibromyalgia. But the bottom line is that there is not a single supplement that is clearly beneficial for any common kind of pain.

  Debunkery and analysis of supplements and food-like medicines (nutraceuticals), especially glucosamine, chondroitin, and creatine, mostly as they relate to pain
  Jul 26, 17Jul '17 7,500
Does Arnica Gel Work for Pain?+

Homeopathic (diluted) herbal ointments featuring Arnica are supposedly good medicine for muscle pain, joint pain, sports injuries and bruises, but their effectiveness has been questioned by many experts. Known to most customers as “herbal” cream, most contain less than 10 micrograms of actual arnica per dose — much less that what’s needed for most substances to be considered a chemically active ingredient. Homeopathy is based on a fanciful interpretation of physics that involves ingredients having medicinal effects even after being diluted to the point of actually removing any trace of them. Some of the herbal ingredients are less diluted and may be chemically active and more useful.

A few tests of homeopathic pain creams have been slightly encouraging, but only the poorer quality ones. In all good quality, modern scientific trials so far, they do no better than a placebo. It is still possible that a benefit might be proven, but it is quite unlikely.

  A detailed review of popular homeopathic (diluted) herbal creams and gels like Traumeel, used for muscle pain, joint pain, sports injuries, bruising, and post-surgical inflammation
  Jul 26, 17Jul '17 9,500
Shooting the messenger’s website     Jul 25, 17Jul '17 1500
Cervical myodural bridges: an obscure cause of neck pain?     Jul 21, 17Jul '17 400
Complete Guide to Tension Headaches+

Headaches are one of the top 10 most disabling conditions and tension headaches afflict almost half of all people. This article compares tension hadaches to migraines and other kinds of headaches in detail. (Safety first: unusually severe, persistent, sudden, or strange headaches need medical investigation.) Headaches have dozens of major causes and complications but “simple” tension headaches are strongly associated with stress, fatigue, and neck pain, and are usually caused by pain radiating from sensitive structures in the neck, face, jaw, and scalp, especially the suboccipital muscle group — self-massage in this “perfect spot” is the most neglected easy treatment option. Others include relaxation, insomnia treatment, heat and ice, breathing exercises, and both general and specific exercise (especially neck strength training). Vision correction is sometimes an overlooked opportunity. There are some over-rated treatment ideas: dehydration is often suspected but trivial and easy to fix; poor posture probably doesn’t matter much and it’s hard to fix (although a few ergonomic factors can be important); the evidence on chiropractic therapy (spinal manipulation) is discouraging; pain-killers barely work, and even backfire with chronic use (analgesic rebound). Botox injection is an exotic and sketchy option, but possibly worth pursuing for serious chronic cases.

  Detailed, readable self-help for stubborn tension headaches, especially due to muscle pain in the neck and shoulders
  Jul 21, 17Jul '17 8,500
Massage Therapy for Tension Headaches   Perfect Spot No. 1, in the suboccipital muscles of the neck, under the back of the skull.   Jul 20, 17Jul '17 2,100
The Basic Types of Pain+

There are two main classifications of pain: the common sensical sort that arises from damaged tissue (nociceptive pain), and the more exotic kind that comes from damage to the system that reports and interprets damage, the nervous system (neuropathic pain). This is the difference between engine trouble and trouble with that light on your dashboard that claims there’s engine trouble. Oddly, there is still no official “other” category for the pain of conditions like fibromyalgia and irritable bowel syndrome, which involve dysfunction of the nervous system, as opposed to damage; names like nocipathic or algopathic are on the table.

  Nociceptive, neuropathic, and “other”
  Jul 12, 17Jul '17 3,250
Cramps, Spasms, Tremors & Twitches   The biology and treatment of unwanted muscle contractions   Jul 11, 17Jul '17 4,250
Understand chronic pain before operating     Jul 6, 17Jul '17 80
Repetitive Strain Injuries Tutorial+Repetitive strain injuries have (at least) five surprising features: (1) they aren’t exactly “inflamed” despite giving that strong impression, (2) they are mostly not caused by biomechanical failures or alignment problems, (3) even stubborn cases usually just need more rest (more specifically, savvy “load management” erring on the side of less in the short term), (4) they are routinely complicated by muscle pain, and, the weirdest of the bunch, (5) they play “head games” to a shocking degree (that is, they are profoundly modulated by the central nervous system, both psychological factors we can affect and neurological ones we can’t).   Five surprising and important facts about repetitive strain injuries like carpal tunnel syndrome, tendinitis, or iliotibial band syndrome   Jul 6, 17Jul '17 13,000
Stretching for Trigger Points+Although stretching is the first thing everyone tries to do for stiff, sore muscle, in practice results are erratic and usually minor at best. If trigger points are “mini cramps,” stretching might help some of them — or it might be like trying to untie knots in a bungie cords by pulling on them.   Is trigger point release a good reason to stretch?   Jul 1, 17Jul '17 2,200
Frozen shoulder bombshell: it ain’t self-limiting     Jun 29, 17Jun '17 220
Shoddy back pain information from Consumer Reports     Jun 28, 17Jun '17 250
The corrective exercise trap     Jun 14, 17Jun '17 700
Kinesio Taping Review+

Most therapeutic taping is either practical (stabilizing a sprained ankle), or aims to tinker with more subtle biomechanics. Taping has gotten a lot hotter in the last few years with prominent new products and branding, and lots of hype and claims about therapeutic effects, prevention, and performance enhancement. But even Olympic athletes can be fad and fashion victims, and the evidence shows only trivial effects. New materials may achieve different and possibly superior benefits, but probably not much. Taping does not work biomechanically or biologically, as many proponents explain it. It’s more likely that the odd sensations change function and reduce pain, a neurology hack that tends to be upredictable and minor.

  A quick analysis of that colourful therapy tape that was so popular at the Olympics. Does it help?
  Jun 9, 17Jun '17 2,200
Dubious study     Jun 7, 17Jun '17 100
MRI and X-Ray Often Worse than Useless for Back Pain   Medical guidelines “strongly” discourage the use of MRI and X-ray in diagnosing low back pain, because they produce so many false alarms   Jun 2, 17Jun '17 1,100
Morning Back Pain+

Morning back pain is rarely serious and most of it is probably caused by low-grade inflammation which ramps up with age and is notoriously worse at the start of the day. The back may be one of the most vulnerable areas both to the “inflammaging” and to mild strains from awkward sleeping postures, which are the most obvious and underestimated factor in back pain.

There are some possible pathological causes. Trigger points are poorly understood sensitive spots, common in the back muscles that may be caused by awkward sleeping positions. Fibromyalgia also seems to have a thing for both backs and mornings. The main serious (but rare) cause of morning back pain is “inflammatory back pain,” and is more likely to be severe and actually wake you up. Finally, nocturnal disc swelling often gets the blame, but it shouldn’t—too speculative.

Treating inflammaging is difficult or impossible, but there are worthwhile anti-inflammatory strategies such as a heart-healthy diet, reducing anxiety, better sleep, and avoidance of exercise and metabolic extremes — all of which is also surprisingly similar to how fibromyalgia is treated. Trigger points may yield to simple self-massage with a ball. Improving sleep posture boils down to doing your best to stay in a “neutral” position, and particularly avoiding face down sleeping. There is no best mattress for back pain except, perhaps, just a good quality new one.

  A thorough review of possible causes for this frustrating symptom
  May 25, 17May '17 6,000
Paleo sleeping (critical analysis for a laugh)     May 24, 17May '17 300
Fibromyalgia guide updates     May 19, 17May '17 130
Lifting technique article upgrade     May 18, 17May '17 250
The Power of Barking   A silly metaphor for a serious point about correlation, causation, and how we decide what treatments work   May 17, 17May '17 1,700
New free book: Recovery Strategies     May 15, 17May '17 90
Massage Therapy for Bruxism, Jaw Clenching, and TMJ Syndrome   Perfect Spot No. 7, the masseter muscle of the jaw   May 15, 17May '17 3,500
Massage Therapy for Back Pain, Hip Pain, and Sciatica   Perfect Spot No. 6, an area of common trigger points in the gluteus medius and minimus muscles of the hip   May 15, 17May '17 1,700
Spinal Fracture Bracing   My wife’s terrible accident, and a whirlwind tour of the science and biomechanics of her spine brace   May 12, 17May '17 1,800
Does barefoot running prevent injuries?   A dive into the science so far of barefoot or minimalist “natural” running   May 1, 17May '17 5,500
Are Orthotics Worth It?   A consumer’s guide to the science and controversies of orthotics, special shoes, and other allegedly corrective foot devices   May 1, 17May '17 4,500
Does Posture Correction Matter?+Posture matters a little, but not a lot. Most “poor posture” is just bad ergonomics and postural strain—a different problem. Postures that do harm and have easy fixes are rare; many postures are the result of long-term adaptations and nearly impossible to change. Although many people do seem to be vulnerable to postural strain, but they have a problem with vulnerability, not posture. If your main issue is unexplained or stubborn aches and pains, working on posture is not the best way to spend your time: just get more exercise generally, especially tasks that require coordination, and anything you enjoy (inspiration, not discipline). “Advanced” methods taught by posture gurus are mostly highly experimental and over-priced.   Posture correction strategies and exercises … and some reasons not to care or bother   May 1, 17May '17 13,000
The sneaky pain of arterial tears     Apr 28, 17Apr '17 425
What Happened To My Barber?   Either atlantoaxial instability or vertebrobasilar insufficiency causes severe dizziness and vomiting after massage therapy, with lessons for health care consumers   Apr 28, 17Apr '17 3,000
It’s the inflammation, stupid     Apr 26, 17Apr '17 300
Icing for Injuries, Tendinitis, and Inflammation   Become a cryotherapy master   Apr 22, 17Apr '17 5,500
Does ice impede healing?     Apr 21, 17Apr '17 150
Natural Imperfection   Evolution doesn’t care if you have back pain … just as long as you can breed   Apr 21, 17Apr '17 4,250
The Great Ice vs. Heat Confusion Debacle   A quick guide that explains when to ice, when to heat, when not to, and why   Apr 18, 17Apr '17 1,400
Organ Health Does Not Depend on Spinal Nerves!+Are the little bundles of nerves that exit your spine the wellspring of all visceral vitality? Will your organs wilt like neglected house plants if those nerve roots are slightly impinged? No: cut a nerve root completely, and you’ll certainly paralyze something, but not an organ, because organs simply don’t depend on spinal nerve roots. And yet this is what many chiropractors believe, and would like their customers to believe, after a century of contradictory evidence.   One of the key selling points for chiropractic care is the anatomically impossible premise that your spinal nerve roots are important to your general health   Apr 16, 17Apr '17 3,250
Iliotibial Band Syndrome: Location, Location, Location!   There is no such thing as “IT band syndrome” that is not at the knee   Apr 15, 17Apr '17 1,200
New article about unwanted muscle contractions     Mar 22, 17Mar '17 200
Surprising Pain Science   Counterintuitive results and the fallibility of “common sense” about pain, injury, and rehab   Mar 12, 17Mar '17 1,200
Evidence and practice at odds     Mar 9, 17Mar '17 250
Get in the Pool for Pain   Aquatic therapy, aquajogging, water yoga, floating and other water-based treatment and injury rehab options   Mar 8, 17Mar '17 2,500
Accidental voice mail records visitor struggling with my website     Mar 6, 17Mar '17 375
A fibromyalgia success story     Mar 6, 17Mar '17 300
Poisoned by Massage+

Massage is not a detoxification treatment in any sense, contrary to a popular belief. Ironically, it may be the opposite: post-massage soreness and malaise (PMSM) might be caused by mild rhabdomyolysis (“rhabdo”). True rhabdo is a medical emergency in which the kidneys are poisoned by myoglobin from muscle crush injuries. But many physical and metabolic stresses cause milder rhabdo-like states — even just intense exercise can do it, and probably massage as well. This is substantiated by a case study of acute rhabdomyolsis caused by intense massage (see Lai), by many documented cases of exertional or “white collar” rhabdo, and from strong similarities between PMSM and ordinary exercise soreness. So a rhabdo cocktail of waste metabolites and by-products of tissue damage is why we feel a bit cruddy after biological stresses and traumas, including sometimes massage. And you can’t “flush” the rhabdo away with massage or by drinking a little extra water. PMSM is just an occasional side effect of strong massage.

  Rather than being DE-toxifying, deep tissue massage can probably cause a slightly toxic situation in the body
  Feb 28, 17Feb '17 5,000
Being female and other ways to get neck pain     Feb 24, 17Feb '17 240
What Could Possibly Go Wrong With Massage?+Massage therapy is mostly extremely safe, but nothing’s perfect: sometimes it causes new injuries or the aggravation of old ones (mostly mild, but not all, especially around the neck), and deep tissue massage, which is often too brutal, can actually “poison” patients (rhabdomyolysis) and traumatize their nervous systems.   Risks and side effects of massage therapy are usually mild, but “deep tissue” massage can cause trouble   Feb 23, 17Feb '17 2,300
Two different takes on the same massage evidence     Feb 22, 17Feb '17 160
Digital Motion X-Ray+

Digital motion X-ray (DMX) is an X-ray video: many X-ray images strung together to make a movie. The output is impressive. In theory, it can reveal serious problems that somehow eluded diagnosis otherwise. In practice, this unregulated and banned-in-Canada technology is primarily sold to neck pain patients by chiropractors, often for evidence in personal injury lawsuits, and is eschewed in medicine because of concern about radiation exposure. DMX undoubtedly has some potential to show important things, but is it worth an increased risk of cancer to diagnose conditions that, mostly, can and should be diagnosed any other way? It’s not completely out of the question, but you should get multiple medical opinions and think hard before resorting to this exotic diagnostic method.

  What’s the risk from the radiation exposure? Is the diagnostic potential worth it?
  Feb 22, 17Feb '17 1,300
Central Sensitization in Chronic Pain+Pain itself often modifies the way the central nervous system works, so that a patient actually becomes more sensitive and gets more pain with less provocation. This is called “central sensitization.” (And there’s peripheral sensitization too.) Sensitized patients are not only more sensitive to things that should hurt, but also to ordinary touch and pressure as well. Their pain also “echoes,” fading more slowly than in other people.   Pain itself can change how pain works, resulting in more pain with less provocation   Feb 19, 17Feb '17 4,000
The mind and inflammation     Feb 15, 17Feb '17 140
Surrounded by assholes     Feb 7, 17Feb '17 220
Psoas, So What?+The iliopsoas muscle (“illy-oh so-ass”) is a two-in-one hip flexing pair, mostly only palpable through the guts. Its clinical importance is often curiously exaggerated, but sometimes it does need a massage.   Massage therapy for the psoas major and iliacus (iliopsoas) muscles is not that big a deal   Feb 3, 17Feb '17 2,000
Modality Empires+

“Modality empire” is my own term for an ego-driven proprietary method or mode of manual therapy — a sub-discipline — championed and promoted by a single charismatic entrepreneur. Most of the “emperors” have healer syndrome, lack humility, make big promises, and make their money from unusually expensive therapy, workshops and books. Professionals are sold on the opportunity to purchase credibility in the form of increasing “levels” of certification, but the quality of these certifications is completely unregulated and often dubious. A modality empire is as much a business model as a method of helping people, and many are quite unoriginal, just branding old ideas for a new generation of workshop consumers. Obviously there is a lot of overlap between modality empires and quackery, but (just as obviously) they aren’t all bad.

  The trouble with the toxic tradition of ego-driven, trademarked treatment methods in massage therapy, chiropractic, and physiotherapy
  Feb 3, 17Feb '17 1,700
Spectacularly unreliable MRI “results”     Feb 1, 17Feb '17 325
Massage Therapy for Low Back Pain   Perfect Spot No. 2, in the erector spinae and quadratus lumborum muscles in the thoracolumbar corner   Jan 27, 17Jan '17 1,500
When To Worry About Shortness of Breath … and When Not To+

Difficulty breathing is a common complaint and a tough diagnostic challenge, and there are some serious causes to be aware of. However, the great majority of mild and moderate cases, and even a few more serious ones, are probably caused by minor muscle knots (trigger points), respiratory dysfunction, and/or anxiety: all of which are relatively simple and cheap problems to try to self-treat. Relief may even be surprisingly easy for some patients. It’s safe and cheap to experiment with self-massage for muscular trigger points. Although changing bad habit is always tricky, respiratory strength training is an effective and worthwhile fitness activity in itself. And learning better anxiety management is something almost anyone can benefit from, even if it doesn’t help the breathing.

  Three minor causes of a scary symptom that might be treatable
  Jan 26, 17Jan '17 4,000
Do You Believe in Qi?   How to embrace a central concept of Eastern mysticism without being a flake   Jan 26, 17Jan '17 1,000
Ugly Bags of Mostly Water   The chemical composition of human biology   Jan 25, 17Jan '17 1,500
Wobble Cushions for the Chair Bound   Why and how people who have to be in a chair all day should sit on a stability cushion like the Disc o Sit or SitFit   Jan 24, 17Jan '17 1,100
Wrong again, sort of, this time about vastus medialis isolation     Jan 20, 17Jan '17 250
Patellofemoral Pain & the Vastus Medialis Myth   Can just one quarter of the quadriceps be the key to anterior knee pain?   Jan 14, 17Jan '17 1,700
1000 Updates     Jan 13, 17Jan '17 275
Weed works for pain—major new report     Jan 13, 17Jan '17 150
The simplification trap     Jan 12, 17Jan '17 100
New Coyne of the Realm     Jan 10, 17Jan '17 85
Citation impossible for “sitting a lot causes back pain”     Jan 6, 17Jan '17 300
Microbreaking   Lots of little breaks may compensate for too much time spent in chairs   Jan 5, 17Jan '17 2,400
The 2016 Lars List: Best Content for Health Professionals     Jan 2, 17Jan '17 850
How does massage work?     Dec 31, 16Dec '16 160
Citation badly needed for “running on pavement is risky”     Dec 22, 16Dec '16 170
An anecdote about the trouble with anecdotes     Dec 21, 16Dec '16 700
What’s your problem? New category indexes     Dec 19, 16Dec '16 160
Massage Therapy for Neck Pain, Chest Pain, Arm Pain, and Upper Back Pain   Perfect Spot No. 4, an area of common trigger points in the odd scalene muscle group in the neck   Dec 10, 16Dec '16 2,750
The Tyranny of Yoga and Meditation!   Do you really need to try them? How much do they matter for recovery from conditions like low back pain?   Dec 8, 16Dec '16 2,750
“Movement quality” still does not clearly predict injury     Dec 6, 16Dec '16 130
The massage pressure question (topic summary example)     Dec 1, 16Dec '16 400
Does vitamin D treat pain? Unknown! Maybe?     Nov 30, 16Nov '16 400
Chiro for migraine fails     Nov 28, 16Nov '16 120
Nervous-wreck monkeys are inflamed     Nov 28, 16Nov '16 85
Objectivity is Overrated   A response to the common accusation of bias and the mythical virtue of objectivity   Nov 26, 16Nov '16 475
We’re not just missing some pieces from a puzzle     Nov 25, 16Nov '16 220
Therapeutic ultrasound science is still lame     Nov 25, 16Nov '16 90
Why is exercise healthy?     Nov 24, 16Nov '16 200
Lots of updates about vitamin D, stretching, structuralism and more     Nov 21, 16Nov '16 425
Smoking and Chronic Pain   We often underestimate the power of (tobacco) smoking to make things hurt more and longer   Nov 18, 16Nov '16 1,100
A Lump in My Throat+

Globus pharyngeus is the sensation of a lump in the throat in the absence of any physical obstruction in the throat, often considered psychosomatic. It’s common and may just be a minor sensory anomaly, like tinnitus. For a sensory phantom, globus can be serious bully, interfering with swallowing and even breathing in the worst cases, and usually causing serious anxiety about the possibility of scary causes like cancer. Unfortunately, it’s almost impossible to confidently rule out a physical cause in the short term.

Globus probably is “all in your head,” unless it isn’t. Unfortunately, the diagnostic challenge of is immense. Many subtle or obscure problems can be at the root of it, but some globus sufferers eventually get answers and relief from the discovery of causes like tonsil stones (in my own case), acid reflux, minor injuries to pharyngeal stuctures, Eagle syndrome, cysts and cervical osteophytes, and other miscellaneous anatomical abnormalities, mostly minor — anything that irritates the throat, probably.

  A globus hystericus story, with a side of science
  Nov 16, 16Nov '16 6,000
Why So “Negative”?+I criticize many poor ideas in health care, so I often seem “negative,” especially to people who truly believe in treatments I debunk. But defending patients from false hope and fraud is a Good Thing, I also report on many effective treatments, and I have fun taking my subject seriously. Not so negative after all!   Answering accusations of negativity, and my reasons and methods for debunking bad treatment options for pain and injury.   Nov 16, 16Nov '16 5,000
Do not offer     Nov 14, 16Nov '16 90
Strength Training Surprises   Why building muscle is easier, better, and more important than you thought, and its vital role in injury rehabilitation   Nov 12, 16Nov '16 4,250
How much evidence is enough?     Nov 9, 16Nov '16 950
Delayed onset muscle soreness — topic summary example     Nov 7, 16Nov '16 375
The Chiropractic Controversies+

The chiropractic profession has a long history of scientific and ethical controversies swirling around it. Why is chiropractic perpetually contentious?

  • Aggressive marketing, especially unethical pre-paid treatment packages and other forms of over-treatment, even of children and babies.
  • The original “big idea” of chiropractic, still alive and well, is that nearly any health problem can be cured by spinal manipulation — an extravagantly too-good-to-be-true promise.
  • Doubts about the efficacy of treating even just ordinary neck and back pain, plus particularly serious concerns about the safety of neck manipulation.

Many chiropractors share these concerns. The profession is strongly divided between progressives and traditionalists — and it’s hard for patients to know which is which. But at the centre of all the controversy is a service that many people are happy to pay for: a spinal joint “pop” can be super satisfying, like “scratching an itch you can’t reach.” Whatever explains this and whether its medically meaningful or not, I believe it’s the true source of chiropractic’s viability as a business.

  An introduction to chiropractic controversies like aggressive billing, treating kids, and neck manipulation risks
  Nov 6, 16Nov '16 7,000
An article in Men’s Health by “Paul Ingraham”     Nov 4, 16Nov '16 500
Hotshot in the dark     Nov 1, 16Nov '16 240
Osmosis sucks water, not toxins     Oct 25, 16Oct '16 95
Summaries on the go     Oct 24, 16Oct '16 325
The revenge of the son of the myth of “placebos without deception”     Oct 18, 16Oct '16 140
Voltaren® Gel Review+Voltaren® Gel is a particularly safe and useful medicine. It’s a topical anti-inflammatory medication, so it can be applied only where you need it, instead of soaking your entire system with medication, avoiding or minimizing common side effects like indigestion, and some serious safety concerns associated with the oral version of the drug. In the US, it’s FDA-approved to treat osteoarthritis in “joints amenable to topical treatment, such as the knees and those of the hands,” but it probably also works for some other painful problems, such as some repetitive strain injuries and back pain. The evidence shows that it “provides clinically meaningful analgesia.” So this product actually works and it gets a pass from skeptics and critics — a rare thing indeed in the world of pain treatments!   A useful rub-on anti-inflammatory medication for arthritis, tendonitis, bursitis, runner’s knee, and muscle strain   Oct 15, 16Oct '16 2,500
The journal Manual Therapy will change its name     Oct 14, 16Oct '16 110
Mind your words     Oct 12, 16Oct '16 275
The one about “your article”     Oct 11, 16Oct '16 85
The mole rat’s superpower     Oct 11, 16Oct '16 120
Shortness of breath, now with more anxiety     Oct 11, 16Oct '16 150
The Trigger Point Identity Crisis   The biological evidence that a trigger point is a lesion in muscle tissue   Oct 11, 16Oct '16 3,250
Emoji debut     Oct 8, 16Oct '16 25
Phantom acupuncture!     Oct 7, 16Oct '16 45
The wilderness of the medically unexplained     Oct 7, 16Oct '16 120
What’s new? A new “What’s New?” page, that’s what     Oct 6, 16Oct '16 180
Mysterious vanishing frozen shoulder     Oct 6, 16Oct '16 55
Do IT Band Straps Work for Runner’s Knee?   The science of knee straps for iliotibial band syndrome (runner’s knee)   Oct 6, 16Oct '16 1,300
A tale of two papers about structure and back pain     Oct 3, 16Oct '16 150
Healer Syndrome+“Healer syndrome” is a common delusion of grandeur in alternative medicine, especially massage therapy, naturopathy, and chiropractic, where many afflicted professionals like to be known as “healers” with allegedly unusual curative powers, vaguely defined, pseudoscientific, or based on the exaggerated importance of a single idea. Such lack of humility is tragically common. Healer syndrome has reached its most extreme in some of the founders of methods of therapy, what I call “modality empires.”   The problem with health care professionals, especially in alternative medicine, who want to be known as “healers”   Sep 23, 16Sep '16 1,700
Tennis Ball Massage for Myofascial Trigger Points   Some creative tips on using a tennis ball (and other tools) to self-massage myofascial trigger points   Sep 17, 16Sep '16 1,800
Statistical Significance Abuse+Many study results are called “statistically significant,” giving unwary readers the impression of good news. But it’s misleading: statistical significance means only that the measured effect of a treatment is probably real (not a fluke). It says nothing about how large the effect is. Many small effect sizes are reported only as “statistically significant” — it’s a nearly standard way for biased researchers to make it found like they found something more important than they did.   A lot of research makes scientific evidence seem more “significant” than it is   Sep 15, 16Sep '16 3,500
Ioannidis: Making Medical Science Look Bad Since 2005   A famous and excellent scientific paper … with an alarmingly misleading title   Sep 15, 16Sep '16 2,500
The Respiration Connection   How dysfunctional breathing might be a root cause of a variety of common upper body pain problems and injuries   Sep 13, 16Sep '16 7,500
New article about pain types     Sep 7, 16Sep '16 250
Myths and Misconceptions about Explaining Pain     Sep 6, 16Sep '16 600
Toxic Muscle Knots   Research suggests myofascial trigger points may be quagmires of irritating molecules   Sep 6, 16Sep '16 1,700
Micro Muscles and the Dance of the Sarcomeres   A mental picture of muscle knot physiology helps to explain four familiar features of muscle pain   Sep 2, 16Sep '16 2,750
A shitty, freaky feeling     Sep 1, 16Sep '16 85
An avalanche of useless fibromyalgia research     Aug 31, 16Aug '16 190
Massage Therapy for Upper Back Pain   Perfect Area No. 11, the erector spinae muscle group of the upper back   Aug 30, 16Aug '16 1,100
Source of sources: how I find the good science     Aug 23, 16Aug '16 180
Patellofemoral Tracking Syndrome   The beating heart of the conventional wisdom about patellofemoral pain is mostly nonsense   Aug 23, 16Aug '16 2,500
Studying the Studies   Tips and musings about how to understand (and write about) pain and musculoskeletal health science   Aug 23, 16Aug '16 3,250
Heat for Pain   When and how to apply heat for therapy … and when not to!   Aug 19, 16Aug '16 3,750
Opioids for Chronic Aches & Pains+

The infamous opioids are drugs like codeine (found in small does in Tylenol IIs and IIIs) and the more serious “hillbilly heroin” drugs like Oxycontin, Percocet, and Vicodin. They induce deep relaxation and euphoria and make you not care about the pain. Unfortunately, not caring is not a cure, and their efficacy is surprisingly dubious. And of course they also have grim risks like life-altering addiction and death by overdose, which is shockingly common. The danger can’t be overstated: more ordinary Americans have started to die from opioid overdose than car accidents. The CDC declared in early 2016 that opioids should not be an option for chronic musculoskeletal pain: there’s just too much danger, and too little evidence of benefit.

On the other hand, not everyone gets addicted and some people get real relief, so despite “the opioid crisis” — which is all-too real — there’s plenty of grey area here. If you have a good relationship with a cautious doctor who respects the risks, it’s not unreasonable to consider a short term opioid experiment: it could provide some much needed emotional relief from chronic pain, and maybe even break a vicious cycle. But the need for caution and medical supervision is as high as it gets.

  The nuclear option: “Hillbilly heroin” (Oxycontin), codeine and other opioids for musculoskeletal problems like neck and back pain
  Aug 18, 16Aug '16 2,750
So many updates! Bloggin’ and loggin’ about new content     Aug 15, 16Aug '16 250
Axioms of Function     Aug 11, 16Aug '16 120
Massage Therapy for Shoulder Pain   Perfect Spot No. 14, The Most Predictable Unsuspected Cause of Shoulder Pain   Aug 10, 16Aug '16 1,900
Vagus nerve stimulation as an anti-inflammatory     Aug 5, 16Aug '16 220
The ultimate paradox of pain and therapy     Aug 5, 16Aug '16 700
Icing, Heating & Tissue Temperature+Heating pads and ice packs are supposed to work by warming or cooling underlying soft tissues and joints, but can they overcome the bodies powerful mechanisms for maintaining tisue temperature? The science is incomplete, but suggests that we can change tissue temperature by a few degrees Celcius up to a couple centimetres. That’s just enough to care for some muscles and smaller joints, but definitely not enough for many of the bigger ones. Also, almost any amount of fat over the target tissue will render superficial heating or cooling pointless.   How much do ice packs and heating pads change the temperature of muscle and joints?   Aug 1, 16Aug '16 1,500
Hydrotherapy, Water powered rehab   A guide to using warm and cold water as a treatment for pain and injury   Aug 1, 16Aug '16 1,400
Does Craniosacral Therapy Work?   Craniosacral therapists make big promises, but their methods have failed to pass every fair scientific test of efficacy or plausibility   Jul 31, 16Jul '16 2,400
Posture and morality     Jul 25, 16Jul '16 140
We cannot trust our eyes (or our pain)     Jul 20, 16Jul '16 120
IT Band Syndrome: Does the iliotibial band move after all?   An ultrasound study says it does, debunking my debunkery   Jul 20, 16Jul '16 1,600
A review of the science of CARTICEL® (autologous chondrocyte implantation, or ACI)   Implanting your own cartilage cells to repair knee joint surfaces   Jul 20, 16Jul '16 1,700
Medical Errors in Perspective+

Alternative medicine practitioners often point accusingly to medical error rates with the implication that their services are much safer. That’s probably true, in the sense that walking is much safer than driving. But if your profession had to treat huge numbers of people with dire injuries and illnesses, it would also have scary error rates.

Bad things do happen in hospitals, and stats about iatrogenic (doctor-generated) medical errors can seem alarming. However, to simply state that medicine kills and hurts people is unethical fear-mongering. Cars kill and hurt people too, and for pretty much the same reason: sure it’s risky, but the benefits are worth the risk, and huge numbers of people are willing to take that chance.

Medical systems deal with vastly greater numbers of much more serious cases than any chiropractor or naturopath, and many of them are no-win, rarely-win, or sometimes-lose situations with the highest stakes, terrible suffering and death. We should be cautious about criticizing that from the outside. Try working in a hospital for a while, try to be perfect, try to never have anything go wrong that matters!

  Medical error rates should not be used to spread fear, uncertainty and doubt
  Jul 20, 16Jul '16 900
Iliotibial Band & Patellofemoral Pain Defy Biomechanical Expectations   The science shows that you can’t blame runner’s knee on structural quirks that seem like “obvious” problems   Jul 20, 16Jul '16 1,500
Alternative Medicine’s Choice: Alternative to What?   Alternative to what? To cold and impersonal medicine? Or to science and reason?   Jul 20, 16Jul '16 3,750
Massage Therapy for Low Back Pain (So Low That It’s Not In the Back)   Perfect Spot No. 12, a common (almost universal) trigger point in the superolateral origin of the gluteus maximus muscle   Jul 19, 16Jul '16 2,500
Correlation-causation clarifications     Jul 12, 16Jul '16 850
Actually, correlation kinda does imply causation     Jul 8, 16Jul '16 275
The Bath Trick for Trigger Point Release   A clever way of combining self-treatment techniques to self-treat your trigger points (muscle knots)   Jul 7, 16Jul '16 550
Pain and movement recalibration     Jul 6, 16Jul '16 190
Spider bite hurts in a whole new-to-science way     Jul 1, 16Jul '16 240
“And yet it moves”: new article about the IT band     Jun 30, 16Jun '16 100
EBM hijacked     Jun 29, 16Jun '16 375
A Recipe for Chronic Neck Pain After Whiplash   Researchers discover some surprising risk factors for chronic neck pain in the aftermath of whiplash   Jun 23, 16Jun '16 900
MRI for back pain pros n cons comic     Jun 17, 16Jun '16 300
Good quality summaries of most important scientific papers about trigger points     Jun 16, 16Jun '16 275
An unusual new article about pain     Jun 16, 16Jun '16 100
Chiropractic detox     Jun 15, 16Jun '16 190
What if You Could Wipe the Chronic Pain Slate Clean?   A short, poignant thought experiment for chronic pain sufferers   Jun 15, 16Jun '16 300
Spinal Subluxation+

There can certainly be something wrong with your spinal joints — there are a few possibilities — but “subluxation” and spinal joints being “out” are not defined clearly enough to be useful, and are probably quite misleading.

“Subluxation” is mainly a chiropractic idea of some kind of spinal joint dysfunction, with many shades of meaning — too many — depending on who is talking about it. However, it is inextricably entangled with the idea of a spinal joint being “out” of place, and it is this sense of the word that needs some debunking. Some chiropractors attribute great importance to subluxation. Most believe that subluxations cause neck and back pain, and — significantly — many also believe that they cause a wide variety of other health problems and so they “use spinal manipulation to treat visceral disease” (Homola). Subluxation theory has been both popular and controversial for many decades now, and it has never achieved medical respectability. Many experts, including quite a few chiropractors, actually deny that spinal subluxations exist in any meaningful sense.

It’s problematic that spinal manipulative therapy — the umbrella term for all kinds of spinal joint “adjustment” — is so often based on such a confusing and controversial concept. Subluxation has too much baggage to be a useful term. Let’s use more modern and specific terminology, and get away from the idea of spinal joints being “out.”

  Can your spine be out of alignment? Chiropractic’s big idea has been misleading patients for more than a century
  Jun 15, 16Jun '16 1,500
Major new content about the trigger point controversy, and my official (fence) position     Jun 8, 16Jun '16 650
Imagine if your soft tissues started to harden     Jun 8, 16Jun '16 110
Trigger Points on Trial   A summary of the kerfuffle over Quintner et al., a key 2014 scientific paper criticizing the conventional wisdom about trigger points and myofascial pain syndrome   Jun 1, 16Jun '16 3,750
Painfully Odd Google Searches   Odd, amusing (and occasionally tragic) Google searches that have led people to this website   May 31, 16May '16 1,000
Chiropractor, Naturopath Training Way Less Than Doctors+

Many alternative health care practitioners, especially chiropractors, claim that they are as well trained as physicians. This is false. Doctor’s academic training is routinely longer, and — more importantly — most of their serious learning occurs during extensive on-the-job training, where they are thrust into demanding clinical environments and supervised for years as they deal with a great variety of clinical situations and many extremely sick and hurt patients. That hands-on phase of their training is where all doctors will tell you that they became professionals — and there is nothing like it in any non-medical health care training.

  Medical training is much longer and better than anything naturopaths or chiropractors normally get
  May 31, 16May '16 950
Thoracic ring theory is “the epitome of fragilistic thinking”     May 27, 16May '16 325
T’ai Chi Helps Fibromyalgia, but It’s Not “Alternative” Medicine   Despite a high profile boost from the New England Journal of Medicine, it’s still just gentle, elegant, and pleasant exercise   May 19, 16May '16 950
Into the Fire   Trigger point pain as a major injury complication, and how I finally “miraculously” healed from a serious and stubborn shoulder injury by untying the muscle knots   May 18, 16May '16 2,750
“Deep” new article     May 13, 16May '16 95
Back Pain & Trigger Points   A quick introduction to the role of trigger points in back pain   May 12, 16May '16 650
New muscle microscope     May 11, 16May '16 220
It’s about prioritizing the treatment options (not demonizing them)     May 10, 16May '16 250
New study shows bullshit     May 10, 16May '16 110
The Not-So-Humble Healer   Cocky theories about the cause of pain are waaaay too common in massage, chiropractic, and physical therapy   May 10, 16May '16 2,750
How do disc herniations change over time?     Apr 28, 16Apr '16 200
Hot Baths for Injury & Pain   Tips for getting the most benefit from a hot soak, the oldest form of therapy   Apr 23, 16Apr '16 3,250
TENS has a complicated, awesome cousin: pulsed electromagnetic field therapy     Apr 19, 16Apr '16 350
A status update on the writing of new books     Apr 18, 16Apr '16 250
Equally ineffective     Apr 12, 16Apr '16 70
You Might Just Be Weird+Strange, wonderful, and problematic anatomical variations occur in humans all the time. Over the years, I’ve collected several interesting examples relevant to musculoskeletal medicine.   The clinical significance of normal — and not so normal — anatomical variations   Apr 11, 16Apr '16 3,000
Studying massage effects with aura photography     Apr 8, 16Apr '16 400
New feature article about electrotherapy     Apr 4, 16Apr '16 190
Infinite maintenance case study     Mar 18, 16Mar '16 220
Pills or stuff or something for my headaches and stuff     Mar 15, 16Mar '16 160
Is it okay to pay for a placebo?     Mar 14, 16Mar '16 275
Keep me posted     Mar 9, 16Mar '16 130
How deep does the heat of a heating pad go?     Mar 3, 16Mar '16 230
The junky science justifying a hydration habit     Feb 29, 16Feb '16 350
Why Drink Water After Massage?+It’s just polite to offer patients a glass of water after a treatment. But therapists who make a production of it as a necessary part of the therapy are just proving their ignorance.   Massage therapy does not flush toxins into the bloodstream, and water wouldn’t help if it did   Feb 29, 16Feb '16 4,250
There there, dear: dismissing female pain     Feb 23, 16Feb '16 170
The volcano god of pain     Feb 19, 16Feb '16 275
We Are Full of Critters   The human body is a colony of ten trillion co-operating cells   Feb 17, 16Feb '16 750
Ten Trillion Cells Walked Into a Bar   A humourous and unusual perspective on how, exactly, a person is even able to stand up, let alone walk into a bar   Feb 17, 16Feb '16 2,400
Dry needling efficacy disagreement     Feb 16, 16Feb '16 160
Telescopes, not brain scanners: some musings on the relationship between pain and tissue damage     Feb 16, 16Feb '16 650
Finally doing 7-minute workout in 8 minutes     Feb 12, 16Feb '16 230
What does pain science have in common with other sensory science?     Feb 12, 16Feb '16 130
Reviving an old article about lifting and back pain     Feb 11, 16Feb '16 220
Dear Google     Feb 5, 16Feb '16 120
Too many updates to log     Feb 2, 16Feb '16 160
Anatomical jiggery–pokery: too many false ribs     Feb 1, 16Feb '16 425
Joints popping…like flashbulbs?     Jan 28, 16Jan '16 150
The worst possible causes of back pain (is a very popular topic)     Jan 11, 16Jan '16 220
Micro-ness reboot: re-dedicating this blog to its “micro” origins     Jan 6, 16Jan '16 800
My Athletic Injuries   A journal of my experiences with injuries acquired while running, cycling and hiking and playing ultimate for fifteen years   Dec 11, 15Dec '15 1,400
Toxins, Schmoxins!+

The idea of “toxins” is usually used as a tactic to scare people into buying some kind of de-toxifying snake oil. Obviously there are dangerous substances; the problem is with the kind of people who toss the idea around, the reasons they do it (fear, profit, ignorance), and because toxin claims are usually so vague that they are literally meaningless, except as a marketing message. Indeed, “detoxification” may be the single most common marketing buzzword in alternative health care.

The body deals with undesirable molecules in many ways. It eliminates some and recycles others; some are trapped in a safe place; and quite a few can’t be safely handled at all (metals). Most alleged “detox” treatments are focused on stimulating an excretion pathway, like sweating in a sauna. But it’s not like sweating is broken and the sauna is fixing it! The only truly “detoxifying” treatments help the body eliminate or disarm molecules the body cannot process on its own. A stomach pump for someone with alcohol poisoning is literally “detoxifying.” So are chelation for heavy metals, and antivenoms.

I cover the specific idea of “flushing” toxins in Why Drink Water After Massage? (Massage is wonderful for all kinds of reasons — it doesn’t need the support of the idea that it detoxifies.) For more general consumer advocacy and education about toxins, see “Detoxification” Schemes and Scams (from

  The idea of “toxins” is used to scare people into buying snake oil
  Dec 5, 15Dec '15 1,100
The “Father of Fascia” is so over it     Nov 30, 15Nov '15 425
How to Find a Good Massage Therapist   Lots of tips for finding good quality medical massage therapy in your area (especially trigger point therapy)   Nov 18, 15Nov '15 5,000
The limits of pain vocabulary     Nov 11, 15Nov '15 250
Contrast Hydrotherapy   “Exercising” tissues with quick changes in temperature, to help with pain and injury rehab (especially repetitive strain injuries)   Nov 4, 15Nov '15 2,750
Extraordinary Health Claims   A guide to critical thinking, skepticism, and smart Internet reading about health care   Nov 3, 15Nov '15 3,250
7 Reasons Older Adults Don’t Stay in Exercise Classes   And 7 reasons they should stick with it: the science and psychology of maintaining an exercise class habit   Oct 30, 15Oct '15 3,250
Therapeutic Touch is Silly+

Therapeutic touch (TT) is hands-off aura massage, actual touch not included, and it is the most common form of energy or vitalistic medicine in North America. Most practitioners are massage therapists and, oddly, nurses. Many years ago I believed in it, but eventually I decided it was based only on wishful thinking, laughably naive references to quantum physics, and wide-eyed exaggeration of ordinary social interaction effects. Auras do not exist and cannot be felt, let alone manipulated therapeutically. Just as dousers and psychics have never passed a controlled test, TT practitioners cannot not detect a person by feeling their aura, which makes them look ridiculous.

It is peculiar and pleasant to have someone wave their hands all around you with friendly intentions, but those effects are minor and fleeting and it doesn’t matter what specifically the therapist does, because it’s the interaction that is the active ingredient — a placebo, in short. And placebo is nowhere near as “powerful” as people believe, and there are all kinds of ethical and practical problems with cluttering up the interaction with magical interpretations of what’s going on.

  No touch included! Auras don’t exist and can’t be felt, let alone massaged for medical benefit
  Oct 29, 15Oct '15 1,400
Why Does Pain Hurt?+Research has shown that immune cells (neutrophils) unnecessarily “swarm” sterile injury sites, causing damage and pain with no known or likely benefit as a tradeoff. It’s just a clear error: they appear to have mistaken mitochondria for a foreign organism, a legacy of ancient evolutionary history, and a biological glitch with profound implications about why some painful problems are so severe and stubborn.   How an evolutionary wrong turn led to a biological glitch that condemned the animal kingdom — you included — to much louder, longer pain   Oct 22, 15Oct '15 5,000
Sitting is NOT the new smoking     Oct 20, 15Oct '15 200
Pain and suffering in sports     Oct 9, 15Oct '15 250
An Introduction to Health Literacy   Why everyone needs to know more about biology, medicine, and health   Oct 8, 15Oct '15 1,300
Patellofemoral Pain Diagnosis with Bone Scan   If you have anterior knee pain, should you bother x-ray, MRI, CT scan, or bone scan?   Oct 2, 15Oct '15 1,100
Do Women Get More Knee Pain?   The relationship between gender and knee pain, especially runner’s knee (IT band syndrome, patellofemoral pain)   Oct 2, 15Oct '15 1,000
Does Platelet-Rich Plasma Injection Work?+

Platelet-rich plasma (PRP) injections bathe troubled cells in a concentrated mixture of platelets from your own blood. Platelets are involved in clotting and wound healing, and so the more-is-better hope is that they’ll stimulate healing “naturally” — regenerative medicine, supposedly. Unfortunately, the hype and costs are high, there could be risks above and beyond the basic risks of any injection, and the science so far is completely discouraging — three major evidence reviews have ruled it “ineffective.” Although it’s plausible and interesting in theory, this stuff just can’t beat placebos in fair tests.

  An interesting treatment idea for arthritis, tendinopathy, muscle strain and more
  Sep 30, 15Sep '15 2,100
The Art of Rest   The finer points of resting strategy when recovering from injury and chronic pain (hint: it’s a bit trickier than you might think).   Sep 30, 15Sep '15 4,500
Palpatory Pareidolia & Diagnosis by Touch   Tactile illusions, wishful thinking, and the belief in advanced diagnostic palpation skills in massage and other touchy health care   Sep 17, 15Sep '15 2,750
EBM versus clinical experience     Sep 15, 15Sep '15 375
An Open and Closed Case   An explanation for a strange duality of muscle sensation observed in massage therapy   Sep 14, 15Sep '15 2,000
More bacterial smoke than expected in low back pain (but still no fire)     Sep 8, 15Sep '15 250
Choose Cheaper Treatments   All other things being equal, always choose the cheapest and most comfortable treatment option for your pain problem   Sep 2, 15Sep '15 900
This is why I work hard     Sep 1, 15Sep '15 325
Better citations needed: a big upgrade to the PainSci bibliography     Aug 20, 15Aug '15 1800
I have faith in sports massage…for some reason     Aug 14, 15Aug '15 500
Applied Kinesiology is Bunk+

Applied kinesiology (AK) muscle testing is a pseudoscientific method of diagnosis used by many chiropractors and naturopaths, and denounced as an absurd parlour trick by everyone else. (AK has no relationship to kinesiology, the legitimate study of human movement.) Practitioners believe that changes in muscle strength, reacting to substances placed in the aura and probing questions, reveal the sensitivities and needs of the patient. This is about as scientific as a ouija board. There is almost no real AK research, of course: no real scientist would bother.

Patients are often impressed by AK, because it exploits potent illusions based on the ideomotor and observer-expectancy or subject-expectancy (power of suggestion) effects. It fools practitioners just as readily as it fools patients: most are deluded true believers, not scam artists.

  The skeptical position on applied kinesiology, a bizarre alternative medicine method of diagnosis
  Jul 16, 15Jul '15 800
It must be good if insurance companies pay for it     Jul 9, 15Jul '15 500
Pain-causing pain-killers     Jul 7, 15Jul '15 200
A common error in alternative medicine   Amateurish speculation about the biological mechanisms of unproven treatments puts the scientific cart before the horse   Jun 30, 15Jun '15 350
Exercise works, except when it’s ineffective     Jun 24, 15Jun '15 350
Noisy knee satire     Jun 19, 15Jun '15 150
Therapy Babble   Hyperbolic, messy, pseudoscientific theories about therapy are all too common   Jun 19, 15Jun '15 4,000
Healing Usually Accelerates   The better you get, the faster you get better, a “delicious cycle” — but what if it doesn’t?   Jun 2, 15Jun '15 1,400
Stress, biology, and pain     May 27, 15May '15 230
Plantar Fasciitis Patients Have Thick Soles   There’s a connection between plantar fasciitis and a surprisingly thick tissue in the arch of the foot   May 16, 15May '15 900
The Medical Blind Spot for Aches, Pains & Injuries+

Doctors lack the skills and knowledge to treat most common aches, pains and injury problem, especially stubborn cases, and even the best are poor substitutes for physical therapists. Many doctors are well aware of this, but some are alarmingly oblivious. Dr. Jonathon Tomlinson, an instructor at St. Leonards Hospital in Hoxton, explains that “undergraduate training is focused on hospital orthopedics (broken bones and anything else that’s amenable to surgery) or rheumatology (nasty inflammatory diseases) which comprise a minority of the aches/pains/strains and injuries that people actually suffer from.”

Medical researchers have done many studies showing that most doctors do not understand aches and pains or heed expert recommendations. A good example is a paper in the Archives of Internal Medicine showing that family doctors frequently ignore guidelines for the care of low back pain — see Williams et al. In 2002, Freedman et al wrote: “It is ... reasonable to conclude that medical school preparation in musculoskeletal medicine is inadequate.” In 2005 in Journal of Bone and Joint Surgery, Matzkin et al concluded that “training in musculoskeletal medicine is inadequate in both medical school and non-orthopaedic residency training programs.” In 2006, Stockard et al found that 82% of medical graduates “failed to demonstrate basic competency in musculoskeletal medicine.”

  Most physicians are unqualified to care for many common pain and injury problems, especially the more stubborn and tricky ones
  May 15, 15May '15 700
Why Massage Makes You Tingle   The physiology of sensation when you’re being pressed and moved around   May 15, 15May '15 1,000
How to Simplify Chronic Pain Puzzles   Use Occam’s razor clean up a mess of theories about your stubborn injury or pain problem   May 13, 15May '15 1,000
Electric bath     May 9, 15May '15 150
Sad, bad news about e-books and sleep     May 8, 15May '15 300
We feel what we fear     May 5, 15May '15 200
Rheumatoid arthritis and central sensitization     May 4, 15May '15 150
The Pricing of e-Books   A candid explanation of my prices and how I present them to new visitors   Apr 20, 15Apr '15 1,200
Massage Therapy for Your Pectorals   Perfect Spot No. 9, in the pectoralis major muscle of the chest   Apr 3, 15Apr '15 750
Insider view of naturopathic training     Mar 13, 15Mar '15 160
Googling symptoms     Mar 11, 15Mar '15 150
Review of Excuse Me, Exactly How Does That Work? by Laura Allen     Mar 11, 15Mar '15 600
Sex and back pain     Mar 6, 15Mar '15 220
Choose the Therapist, Not the Therapy   When you’re in pain, you want to know “what works,” but what you should look for is an honest therapist of any kind   Mar 3, 15Mar '15 1,500
Nerve Pain Is Overdiagnosed   A story about nerve pain that wasn’t really nerve pain   Feb 28, 15Feb '15 900
IT band plungering     Feb 27, 15Feb '15 250
What’s a “Claim” in Health Care?+

A claim is any unverified assertion. But not all claims are created equal. In health care and health science, “claim” implies a more self-serving assertion. If a claim could be used as a bullet-point in a sales pitch, it’s more claim-y. If it makes you (or your profession) look better, it’s more claim-y. And the more claim-y it is, the more it needs to be backed up.

This special case of the word claim comes from the thorny ethical challenges with selling care to sick, hurt people. All claims need critical appraisal and verification, but it’s just not as ethically critical if it has no claim-stink. Sagan’s idea that “extraordinary claims require extraordinary evidence” is not just about alien abductions and lake monsters. It’s also, in spirit, about more mundane but self-serving and profitable claims — a more common ethical hazard than truly extraordinary claims.

  In health care, claims often involve a more self-serving assertion
  Feb 19, 15Feb '15 425
There are no guiltless factions     Feb 16, 15Feb '15 130
Flesh still relevant     Feb 16, 15Feb '15 170
Bought and paid for     Feb 11, 15Feb '15 120
Release me!     Feb 6, 15Feb '15 180
Make exercise as sexy as the scalpel     Feb 3, 15Feb '15 190
Overselling trigger point therapy     Jan 12, 15Jan '15 275
Progressive Training   How to take “baby steps” to recovery from an injury or pain problem   Jan 7, 15Jan '15 1,900
Review of The Trigger Point Therapy Workbook   A popular book that promises too much and ignores recent science and controversies, which alienates many physicians and sets patients up for disappointment   Jan 3, 15Jan '15 1,700
Diabolically difficult     Oct 28, 14Oct '14 210
A Systems Perspective on Chronic Pain     Oct 23, 14Oct '14 400
Not so FAST     Oct 14, 14Oct '14 350
Does Hip Strengthening Work for Runner’s Knee?   The popular “weak hips” theory is itself weak: hip weakness is not clearly a cause of problems like IT band pain or patellofemoral pain   Oct 14, 14Oct '14 4,250
FMS: Back to the drawing board?     Oct 9, 14Oct '14 475
Salamander head     Sep 24, 14Sep '14 1
Phantom scratching is like pain     Sep 22, 14Sep '14 160
Baby steps remix     Sep 17, 14Sep '14 210
Blood therapy, anyone?     Sep 11, 14Sep '14 130
Missing Serious Symptoms+

One of the most common and serious basic problems with alternative medicine is that ominous signs and symptoms of serious disease are often overlooked, misinterpreted, and minimized by many overconfident and under-trained “professionals.” Naturopaths, chiropractors, acupuncturists and massage therapists often have a haughty disdain for “mainstream” medicine.

Of course doctors often also overlook problems — nobody’s perfect (see Medical Errors in Perspective). However, the chances of a doctor missing a scary diagnosis are generally much lower, because they have vastly more experience with much sicker people (see Chiropractor, Naturopath Training Way Less Than Doctors).

  Alternative medicine often diagnoses overconfidently, overlooking or underestimating serious symptoms
  Sep 11, 14Sep '14 475
Collateral and Re-Injury Prevention   Don’t underestimate the importance of prevention … even after you’ve already been injured!   Sep 9, 14Sep '14 1,200
Phantom limb scratching     Sep 6, 14Sep '14 25
Masking Symptoms Is Under-Rated+

“Masking symptoms,” especially with medications, is often maligned because it doesn’t “aid healing” or “treat the root cause.” But masking symptoms can be a perfectly good idea, and it should not be eschewed just because it doesn’t have a real healing effect … because there are very few real healing effects! Maybe none. There are few or no known ways to actually improve on the biological process of healing. We can’t tell the body, “Hey, heal better, will ya?”

“Healing” is mainly about removing impediments to natural recovery, such as continued overuse and excessive stress. It’s not dictated by some mythical power to speed healing, but by a strong understanding of the nature of the problem and what pisses it off and slows recovery. The most idiotically simple example is that bad sprains need to be immobilized for a while, just like a fracture — and maybe that seems “obvious,” but it was actually common practice for decades to recommend excessive early mobilization.

Here’s a classic, trickier example: patellofemoral pain is often misdiagnosed and “treated” with strength training that tends to stress the knee even more, and yet it often works to simply avoid sitting with bent knees, because that position is more biomechanically “intense” than most patients realize. Removing that sneaky knee stress isn’t “healing,” per se, but it’s sure important!

Focus on facilitating natural recovery, and don’t knock a little “symptom relief” along the way.

  Masking symptoms,” especially with medications, is often maligned. But sometimes symptoms need masking!
  Sep 6, 14Sep '14 750
Simon Singh Story and British Libel Reform+

Simon Lehna Singh’s story is now the most famous example of legal bullying of a science writer for commenting on controversial health care, with important consequences for free speech, and great personal significance (I was being legally bullied for similar reasons at the same time).

Singh criticized the British Chiropractic Association for endorsing spinal adjustment for children, famously calling it “bogus.” The BCA sued, exploiting Britain’s nasty libel laws, and the case got off to a rough start for free speech. Singh persisted until the case became a public relations disaster for the BCA, and they withdrew.

A science writer should be able to comment on genuine concerns on an important public health issue (such as correct treatment for children) without the threat and expense of British High Court libel claims. The cost of an opinion about a controversial health care issue should not be ruinous. In the words of Frank Frizelle: “Let’s hear your evidence, not your legal muscle.”

  The most famous case of legal bullying science, which catalysed a campaign to reform British libel law
  Sep 6, 14Sep '14 650
Now basically rather “edited”     Aug 26, 14Aug '14 190
Why “Science”-Based Instead of “Evidence”-Based?   The rationale for making medicine more science-based   Aug 26, 14Aug '14 2,500
‘Reductionism’ Is Not an Insult+

Alternative medicine practitioners often derisively accuse their critics of being “reductionist.” This is intended to sound wise and knowing, but sneering at reductionism is a transparently convenient way to dismiss rational objections to crank theories and flaky bullshit. It insultingly insinuates a lack of vision and savvy about complex systems (like the body). It’s just an ideological gripe, not a meaningful thought, about people who allegedly can’t see the forest for the trees. (This is quite ironic, coming as it usually does from barely-trained dabblers and dilettantes, people who clearly have not exactly mastered either forest or trees.)

Certainly reductionism can go wrong, like nearly any mental mode, but it’s not an intellectual failing. It’s just one of many thinking and reasoning tools … not an all-consuming obliviousness to “the whole.”

  Reducing complex systems in nature to their components is not a bad thing
  Aug 25, 14Aug '14 900
Confirmation Bias+

Confirmation bias explains a lot about human nature. Most people know it best as “selective hearing” or “selective memory” — hearing and remembering only what you want to hear (see also “pareidolia”). Confirmation bias is a whole lot more: a dazzling array of devious and largely unconscious mental tactics and thinking glitches that lead people to confirm their beliefs and pet theories. We not only tend to ignore, deny and overlook anything that contradicts our point of view, but we also invariably notice, inflate and or even fabricate anything that supports it.

Confirmation bias is one of the main reasons that The Truth is so slippery, and both amateurs and experts alike are prone to significant thinking errors. There are people who consider it part of their job description to eliminate confirmation bias from their thinking — the best scientists and journalists, for instance — but it’s really difficult. Everyone has confirmation bias: it’s just how minds (don’t) work!

  Confirmation bias is the human habit of twisting our perceptions and thoughts to confirm what we want to believe
  Aug 23, 14Aug '14 850
Classic anatomy videos still going strong     Aug 4, 14Aug '14 325
2nd edition of patellofemoral pain e-book, co-authored with Tony Ingram     Jul 29, 14Jul '14 800
No Comment   Why I have never allowed public comments on like most blogs, and never will   Jul 25, 14Jul '14 1,000
Explaining away treatment successes     Jul 24, 14Jul '14 325
Mark my words: a new e-book feature     Jul 22, 14Jul '14 275
Why fascia matters medically (get ready to cringe)     Jul 1, 14Jul '14 400
Thumbs Up for the Scientific 7-Minute Workout     Jun 11, 14Jun '14 450
Foot strikes vary widely in elite runners     Jun 11, 14Jun '14 95
Doubting doubts     Jun 6, 14Jun '14 250
Practitioners of “placebo enhancement”     May 15, 14May '14 220
Pain without a name     May 6, 14May '14 200
The two-legged dog and biomechanics     Apr 17, 14Apr '14 160
Compression socks with tape     Apr 10, 14Apr '14 250
Vandal massage     Apr 3, 14Apr '14 300
New anecdote disclaimer     Apr 2, 14Apr '14 210
Goodbye PDF, hello lifetime access     Mar 20, 14Mar '14 250
New massage for fibromyalgia study     Mar 18, 14Mar '14 550
A brief public appearance     Jan 6, 14Jan '14 250
Proprioception, the True Sixth Sense   The vital and strange sensation of position, movement, and effort   Dec 24, 13Dec '13 700
Neck Pain, Submerged!   The story of my curious experiment with dunking severe chronic neck pain   Dec 3, 13Dec '13 3,750
Uh oh, success!     Nov 21, 13Nov '13 210
Like getting blood from a bone     Oct 21, 13Oct '13 375
Why Massage Therapy?   An attempt to explain the magic of touch therapy, and why I decided to become a Registered Massage Therapist   Aug 26, 13Aug '13 3,250
Happy traffic stats, news     Aug 20, 13Aug '13 375
Why are non-USD prices for my e-books so much higher than the going exchange rate?     Aug 15, 13Aug '13 220
I’m officially more important now     Jul 2, 13Jul '13 375
The Mind Game in Low Back Pain   How back pain is powered by fear and loathing, and greatly helped by rational confidence   Jul 1, 13Jul '13 1,000
Homo sapiens: not as wimpy you thought     Apr 8, 13Apr '13 275
What can a runner with knee pain do at the gym?   Some gym training options and considerations for runners (and others) with overuse injuries of the knee   Apr 6, 13Apr '13 2,100
Spinal infection?     Mar 26, 13Mar '13 220
Seriously, funny salt     Mar 8, 13Mar '13 75
Thixotropy is Nifty, but It’s Not Therapy+Thixotropy is the property of some gels or fluids that are normally thick (viscous), but thin when they are stressed. In the human body, the synovial fluid that lubricates most joints is thixotropic, as is the gelatinous “ground substance,” which is part of all connective tissues such as tendons and ligaments. (Fun fact: semen is also thixotropic.) Thixotropy is one of the reasons that we loosen up a little as we move around, just like engine oil warming up. However, thixotropic effect is not a therapeutic effect, and does not explain “releases” in massage or fascial therapy: it is too minor, slow, and temporary, and connective tissue is too tough.   A curious property of connective tissue is often claimed as a therapy   Feb 19, 13Feb '13 750
SSRI Antidepressants Are Not Medicine   Frightening side effects, cover-ups on the record, and no reason to believe they do what they are supposed to   Feb 14, 13Feb '13 3,250
Morgan Schmorgan     Feb 12, 13Feb '13 10
Two Audiobooks Now Available     Feb 4, 13Feb '13 250
A few thoughts on the limits of self-care     Dec 26, 12Dec '12 240
Unconventional Ergonomics   Five creative ergonomics tips you don’t hear as much about as the usual stuff   Nov 3, 12Nov '12 1,100
Massage Therapy for Shin Splints   Perfect Spot No. 3, in the tibialis anterior muscle of the shin   Oct 27, 12Oct '12 1,500
Massage Therapy for Tired Feet (and Plantar Fasciitis!)   Perfect Spot No. 10, in the arch muscles of the foot   Oct 25, 12Oct '12 1,000
Massage Therapy for Your Quads   Perfect Spot No. 8, another one for runners, the distal vastus lateralis of the quadriceps group   Oct 2, 12Oct '12 1,500
How I Cured My IT Band Pain   The story of how I got a nasty case of chronic IT band syndrome in both knees & then studied the condition in intensively so I could finally beat it   Sep 12, 12Sep '12 1,900
Electromagnetic Sensitivity Absurdity+

Electrosensitivity is an alleged allergy to electromagnetic fields and radiation. It is the basis for paranoia particularly about the health effects of Wi-Fi networks, power lines, and cell phones — fears that top the charts of human irrationality. There’s little doubt that the afflicted are suffering from something, but it is either an unrelated medical condition or psychosomatic. Electrosensitivity, like (non-celiac) gluten sensitivity, has been thoroughly debunked.

Unsurprisingly, many people who believe they can heal with life energy — reiki, acupuncture, and so on — are also active spreading fear, uncertainty, and doubt about artificial energy.

No one with an actual energy allergy would last a day anywhere in the modern world. It would be an electrosensitive holocaust. They’d vanish in a poof of oversensitive smoke, moths flying into a bonfire.

  Electrosensitivity is an imaginary, debunked energy allergy
  Jul 26, 12Jul '12 650
Typos & Nitpicking Hypocrisy+

Whenever I make criticasms of sloppy writing, I do open myself up to a charge of hypocrazy, because there are certainly scattered errrs on my website , probbly even on this veru page. But it’s a matter of dagree. I only critisize someone’s communiation skills when their writeing problem are signicifant and revelant: when the errors are thick and nasty and thick and nasty, when they arre combimed with style problems like SHOUTING IN CAPS!!!, or abusing “quotion marks”; or just horrible spellung and grammer and sentense structure, and and whn they betray ignoranse of the subjet matter,, like a chiropracor who writes the “veterbra” three times in the same short email and declares “I’m a proffesional”.

(I’m not making that last bit up. I actually got that message.)

Not everyone’s a writer, but writing with many glaring errors is much worse than just lacking a knack — and it exposes a lack of mental rigour and maturity. There is such a thing as a minimum literacy required for one’s ideas to be taken srsly.

  Jun 19, 12Jun '12 190
Massage Therapy for Tennis Elbow and Wrist Pain   Perfect Spot No. 5, in the common extensor tendon of the forearm   Jun 9, 12Jun '12 1,300
Eccentric Contraction+An eccentric or braking contraction is an interesting but routine type of muscular contraction that seems like a paradox: the muscle is contracting even as it is lengthening! Eccentric contraction is a bit physiologically mysterious, and is known to be harder on muscle, causing more soreness (quadriceps after hiking down a mountain is the classic example) — a good stimulus to adaptation, in tendon as well as muscle.   A weird bit of muscle physiology   Jun 1, 12Jun '12 700
Quackery Red Flags+When choosing treatments, please be wary of the 3 D’s: treatments that may be dangerous, dubious, and distracting (costly or time-consuming). No pain treatment is perfect, but does it at least make sense? Is it safe? Cheap? Reasonably convenient?   Beware the 3 D's of quackery: Dubious, Dangerous and Distracting treatments for aches and pains (or anything else)   May 31, 12May '12 1,800
Massage Therapy In British Columbia, Canada+Massage therapy training in British Columbia, Canada, is unusually rigorous compared to most places in the world. When I trained, the requirements included a 3000-hour training program, an internship, and some very challenging certification exams.   Training, credentials and state of the profession of massage therapy in Canada’s west coast province   Apr 30, 12Apr '12 950
Massage does not reduce inflammation and promote mitochondria   The making of a new massage myth from a high-tech study of muscle samples after intense exercise   Feb 15, 12Feb '12 4,000
Is IT Band Tendinitis Really a Tendinitis?   Recent research has clearly shown that the IT band itself is not the anatomy that gets inflamed, which has significant implications for treatment   Jan 23, 12Jan '12 950
A Stretching Experiment+What happens when you stretch your hamstrings intensely for several minutes a day in a steam room? The results of a thorough, careful personal experiment. Your mileage may vary!   What happens when you stretch your hamstrings intensely for several minutes a day in a steam room?   Dec 1, 11Dec '11 3,750
Stretching Injury   How I almost ripped my own head off! A cautionary tale about the risks of injury while stretching   Nov 2, 11Nov '11 1,100
Review of the Backnobber II & Knobble II   Plus four other massage tools from the Pressure Positive Company: the Index Knobber, Jacknobber, Orbit Massager and Tiger Tail   Nov 1, 11Nov '11 1,700
Massage Therapy Kinda, Sorta Works for Back Pain   It works, but not very well, and “advanced” techniques are no better than relaxation massage   Aug 10, 11Aug '11 4,000
Review of John Sarno’s Books about Low Back Pain   Historically important low back pain reading based on a kernel of an important truth that has been blown way out of proportion   Apr 21, 11Apr '11 1,600
An awesome ebook upgrade     Apr 20, 11Apr '11 325
Civilization Survival Tips   Coping with stress and anxiety in the modern world (without drugs)   Apr 20, 11Apr '11 2,300
Free tool calculates how fast you can run a marathon without hitting The Wall     Jan 12, 11Jan '11 275
Bad science writer, bad! A major mea culpa   A major mea culpa   Dec 14, 10Dec '10 400
Every little thing a nice therapist does is magic   Loyalty to a physical therapist is often misguided and has little or nothing to do with how well treatment is actually working   Nov 16, 10Nov '10 650
Review of Inside Chiropractic: A Patient’s Guide, a book by Samuel Homola+Homola’s book is an essential guide for anyone who likes a good spine crunch, but is concerned that the chiropractic profession might be imperfect.   Homola’s book the perfect guide if you like spinal adjustment but you’re wary of chiropractic controversies   Jan 2, 10Jan '10 1,500
Chronic Low Back Pain Is Not So Chronic   The prognosis for chronic low back pain is better than most people realize … especially for Australians in Australia!   Oct 10, 09Oct '09 650
Therapeutic Options for Pain Problems   A guide to therapies and medical professionals for injuries, chronic pain and other musculoskeletal problems   Sep 28, 09Sep '09 200
Battle of the Experts   A guide for patients caught between conflicting diagnoses and prescriptions   Jul 6, 09Jul '09 3,000
The Anatomy of Vitality   What makes life tick? A poetic romp through the substance of vitality   Jun 27, 09Jun '09 2,400
Measuring Progress in Massage Therapy   How do you know whether or not massage therapy is working for you?   Sep 22, 08Sep '08 1,200
Will Therapy Work?   The fool’s errand of trying to guess the effectiveness of a therapeutic approach to a pain problem before you’ve tried it   Jan 26, 08Jan '08 850
Endurance Training for Pain & Rehab   Why endurance training is often a wise alternative to strength training, especially when healing from an injury   Nov 30, 06Nov '06 1,200
PF-ROM Exercises   ‘Pain-free range of motion’ or early mobilization exercises can help you heal   Nov 29, 06Nov '06 1,100
A Short Story   Slow growth syndrome, oxandrolone and the pathologization of my height   Mar 28, 05Mar '05 1,900
From Atoms to Elvis   A wide-angle look at the foundations of biology   Aug 26, 04Aug '04 500
Singing, Breathing, and Scalenes   Connections between singing, breathing, neck pain, and a strange group of muscles   Jun 26, 04Jun '04 1,800