A searchable, sortable list of hundreds of articles and blog posts
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.
|title click headings to sort||date▼||words||score|
|Placebo-without-deception is deceptive||new Jun 30, 15Jun '15||190|
|A common error in alternative medicine Amateurish speculation about the biological mechanisms of unproven treatments puts the scientific cart before the horse||updated Jun 30, 15Jun '15||325|
|Voltaren® Gel+Made available in North America only quite recently, Voltaren® Gel is a particularly safe and useful medicine that many people here have still not heard about. 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. 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||updated Jun 30, 15Jun '15||2,400|
|Delayed Onset Muscle Soreness (DOMS) The biological mysteries of “muscle fever,” nature’s little tax on exercise||updated Jun 30, 15Jun '15||6,500|
|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 Jun 29, 15Jun '15||3,000|
|Save Yourself from Tension Headaches! Simple advice on healing from chronic tension headaches, also known as fibrositic headaches||updated Jun 29, 15Jun '15||2,000|
|Pain & Injury Survival Tips Dozens of ideas (and links) for evidence-based rehabilitation and self-treatment for common pain problems and injuries||updated Jun 29, 15Jun '15||9,500|
|Help for Anxiety Anxiety doesn’t respond to logic and reason, so what does it respond to?||updated Jun 27, 15Jun '15||4,500|
|Exercise works, except when it’s ineffective||new Jun 24, 15Jun '15||350|
|Noisy knee satire||new Jun 19, 15Jun '15||150|
|Therapy Babble Hyperbolic, messy, pseudoscientific theories about therapy are all too common||updated Jun 19, 15Jun '15||4,000|
|Keep it up! Neck pain reduced by long-term strengthening+ |
The evidence we have for longer term training is nothing but good news: lasting improvements in strength, pain, and disability. It still hasn’t been replicated, but it’s excellent preliminary data. For more information, see Ylinen et al, or a much more detailed new discussion in my neck pain book.
(By the way, this is yet another in a series of many updates about exercise efficacy. They just keep happening.)
|new Jun 18, 15Jun '15||1|
|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, PainScience.com’s valuable trigger point tutorial!All your treatment and self-help options for a crick in the neck explained and reviewed
|updated Jun 16, 15Jun '15||56,000|
|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 Jun 8, 15Jun '15||13,000|
|You can’t rush it, but healing speeds up on its own+ |
The good news is that the prognosis for most painful problems is good without any help. In fact, as things get better, you can usually count on getting better faster. You can’t rush it, but healing speeds up on its own. I recently rewrote and modernized my article on this topic:
|new Jun 2, 15Jun '15||95|
|Healing Usually Accelerates The better you get, the faster you get better, a “delicious cycle” — but what if it doesn’t?||updated Jun 2, 15Jun '15||1,400|
|Quite a Stretch+Stretching just doesn’t have the effects that most people hope it does. Plentiful recent stretching 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 Jun 1, 15Jun '15||12,000|
|OTC pain-killers in under 140 words or bust!||new May 30, 15May '15||250|
|Stress, biology, and pain||new May 27, 15May '15||230|
|Better citation needed+ |
So many citations are utter bollocks if you take the time to look. I encounter all the time as I work, but recently the phrase “better citation needed” popped into my head. So I doodled this up for my article Bogus Citations:
[better citation needed]
Not a big deal on a small screen, but nice and big and bold in a larger window, like an image of text but quicker to load. It’s just text styled with CSS, very simple, but with one nifty new trick I learned: it uses viewport percentage units so that the font-size scales with the size of the window it’s in. I have wanted this “simple” text-styling effect countless times over the years. Where have you been all my life, VPUs?!
|new May 26, 15May '15||120|
|The Great Ice vs. Heat Confusion Debacle A quick guide that explains when to ice, when to heat, when not to, and why||updated May 26, 15May '15||850|
|Surprising Pain Science Counterintuitive results and the fallibility of “common sense” about pain, injury, and rehab||updated May 23, 15May '15||1,300|
|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, 75 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 May 16, 15May '15||38,000|
|Plantar Fasciitis Patients Have Thick Soles There’s a connection between plantar fasciitis and a surprisingly thick tissue in the arch of the foot||updated May 16, 15May '15||950|
|The Medical Blind Spot for Aches, Pains, and 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 doctors are unqualified to care for many common pain and injury problems. Especially the stubborn ones
|updated May 15, 15May '15||700|
|Why Massage Makes You Tingle The physiology of sensation when you’re being pressed and moved around||updated May 15, 15May '15||1,000|
|Are aura atheists uncaring robots?||new May 13, 15May '15||240|
|How to Simplify Chronic Pain Puzzles Use Occam’s razor clean up a mess of theories about your stubborn injury or pain problem||updated May 13, 15May '15||1,000|
|Electric bath||new May 9, 15May '15||150|
|Sad, bad news about e-books and sleep||new May 8, 15May '15||275|
|Save Yourself from Insomnia! Serious tips from a veteran of the insomnia wars||updated May 7, 15May '15||6,500|
|Massage Therapy for Bruxism, Jaw Clenching, and TMJ Syndrome Perfect Spot No. 7, the masseter muscle of the jaw||updated May 7, 15May '15||3,250|
|We feel what we fear||new May 5, 15May '15||200|
|Rheumatoid arthritis and central sensitization||new May 4, 15May '15||150|
|The Trouble with Chairs Back pain and worse hazards of sitting in chairs way too much||updated Apr 23, 15Apr '15||6,000|
|The Pricing of PainScience.com e-Books A candid discussion about my prices and how I present them to new visitors||updated Apr 20, 15Apr '15||1,200|
|Brain stim fizzle+ |
Unfortunately, the authors of a new British Medical Journal editorial conclude that it is:
The null hypothesis strikes again! Bummer. (Null hypothesis primer: in plain English, the null hypothesis says, “Most ideas turn out to be wrong.” And therefore most weakly positive results will turn out to the product of bias and wishful thinking. Read more about the null.)
|new Apr 16, 15Apr '15||120|
|A bit of a mouthful||new Apr 14, 15Apr '15||170|
|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
|updated Apr 3, 15Apr '15||650|
|Confused about the location of Iliotibial Band Syndrome? There is no such thing as “iliotibial band pain” that is not at the knee||updated Apr 3, 15Apr '15||700|
|Massage Therapy for Your Pectorals Perfect Spot No. 9, in the pectoralis major muscle of the chest||updated Apr 3, 15Apr '15||750|
|Does Craniosacral Therapy Work? Craniosacral therapists make big promises, but their methods have failed to pass every fair scientific test of efficacy or plausibility||updated Apr 1, 15Apr '15||1,500|
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 Mar 26, 15Mar '15||1,000|
|Pain is a motivator+ |
Filed under “Pain is Weird.”
|new Mar 19, 15Mar '15||3|
|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||updated Mar 17, 15Mar '15||2,750|
|MRI and X-Ray Almost 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||updated Mar 17, 15Mar '15||950|
|Overcoming Pain with Gentle Yoga+ |
The Salt Spring Island terrain in the video is gorgeous, and in my backyard. (I’ve spent a bunch of time on that island.) You can’t beat yoga under an arbutus tree!
|new Mar 16, 15Mar '15||50|
|The Respiration Connection How dysfunctional breathing might be a root cause of a variety of common upper body pain problems and injuries||updated Mar 15, 15Mar '15||6,500|
|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||updated Mar 15, 15Mar '15||2,750|
|The Secret Anarchy of Science+ |
I’ve know some crafty, hot-tempered scientists. Hell, it seems to go with the territory!
|new Mar 14, 15Mar '15||60|
|Placebo precision||new Mar 14, 15Mar '15||250|
|Insider view of naturopathic training||new Mar 13, 15Mar '15||160|
|Does swearing reduce pain?+ |
Does swearing reduce pain? @^#@%, yeah! And so does saying “ow!” according to a new study. And of course it’s not really surprising, given what we know about pain (it’s weird and thoroughly brain-tuned). It probably doesn’t have much relevance to chronic pain. But it’s interesting, and fun.
Less measured and more forceful indeed.
|new Mar 13, 15Mar '15||110|
|Does Fascia Matter?+
Fascia is widely regarded as an exciting scientific frontier, with well-attended fascia conferences featuring “rock star” 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 Mar 13, 15Mar '15||13,000|
|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 Mar 13, 15Mar '15||2,500|
|Why Do We Get Sick? The connections between poor health and the lives we lead||updated Mar 12, 15Mar '15||2,750|
|Apt analogy+ |
Alice Sanvito, massage therapist, in a new article about the difference between nociception and pain:
|new Mar 11, 15Mar '15||55|
|Googling symptoms||new Mar 11, 15Mar '15||150|
|Review of Excuse Me, Exactly How Does That Work? by Laura Allen||new Mar 11, 15Mar '15||180|
|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
|updated Mar 11, 15Mar '15||1,300|
|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 Mar 10, 15Mar '15||66,000|
|Sex and back pain||new Mar 6, 15Mar '15||220|
|A literally stiff back||new Mar 5, 15Mar '15||150|
|Video of weirdly rippling muscle||new Mar 4, 15Mar '15||100|
|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 335 footnotes, this tutorial is the most credible and clarifying low back pain information you can find. Ships with a free copy of PainScience.com’s trigger point tutorial!Low back pain myths debunked and all your treatment options reviewed
|updated Mar 3, 15Mar '15||91,000|
|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||updated Mar 3, 15Mar '15||1,500|
|Nerve root wiggle room||new Mar 2, 15Mar '15||250|
|Fatigue-induced muscle rippling and quivering+
Muscle fibres do not normally contract all at once, as most people imagine. Instead they are organized into groups called “motor units,” one per motor nerve. Rather than firing all at once, the groups alternate their contractions, like pistons. At any given time, countless motor units are in different phases of contraction and relaxation. The units are so small and the switching system is so fast that their coordinated action seems to be completely smooth to us.
There is an interesting exception, though: if you get tired enough that a lot of motor units start failing to contract, the switching system fails because there aren’t enough motor units available for smooth contraction. This is why muscles start to ripple and quiver with very intense exertions.
This phenomenon has no official name that I know of. It is sometimes called “fasciculation,” and I used to do that myself, but it’s an error: that’s just the smartypants word for an involuntary contraction, a twitch or spasm. This rippling business happens in a resting muscle as well a contracting one.A short explanation of myokymia a fascinating muscle phenomenon
|updated Mar 2, 15Mar '15||650|
|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 143 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: PainScience.com’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 28, 15Feb '15||52,000|
|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. 193 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 28, 15Feb '15||122,500|
|Nerve Pain Is Overdiagnosed A story about nerve pain that wasn’t really nerve pain.||updated Feb 28, 15Feb '15||950|
|IT band plungering||new Feb 27, 15Feb '15||250|
|Missing the Woodstock of pain conferences+ |
Todd Hargrove on the San Diego Pain Summit:
I’ve never felt more like I was missing an event I belonged at. But I’m a private, bookish recluse by nature and as poor a traveller as there ever was. When I travel, I do not sleep! (Some people probably scoff at that excuse. People who don’t know insomnia. And would be crushed by it if they did. Or perhaps the scoffers are just way, way more badass and resilient than me — maybe there’s some like that too.)
|new Feb 26, 15Feb '15||120|
|Does Massage Therapy Work? A review of the science of massage therapy … such as it is||updated Feb 26, 15Feb '15||14,000|
|Are experimental injection treatments “worth a try”?+ |
Rarely. The bar for “worth a try” is fairly high for invasive treatments. Even “minimally” invasive ones like injections should only be considered when at least their safety is established (and it rarely is). What you really need is clear, consistent evidence of non-trivial benefit across several good trials before anything injected is “worth a try.” Before that it’s more like “hey, it’s your knee, don’t stab it”!
Of course, what’s worth trying is always a very personal decision, because it’s as much about risk tolerance and desperation levels as it is about the treatment. But my point is that almost everyone should be wary of needles filled with mysterious meds. For an example, see Does Platelet-Rich Plasma Injection Work?
|new Feb 23, 15Feb '15||110|
|Toxic Muscle Knots Research suggests myofascial trigger points may be quagmires of irritating molecules||updated Feb 22, 15Feb '15||850|
|Water Fever and the Fear of Chronic Dehydration Do we really need eight glasses of water per day?||updated Feb 20, 15Feb '15||3,000|
|Health Care Claims Are Special+
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
|updated Feb 19, 15Feb '15||425|
|Free safety lesson! Is it safe to roll your head in a full circle?||new Feb 18, 15Feb '15||240|
|There are no guiltless factions+ |
There are a lot of ideological factions in health care. Even my relatively small area of interest — musculoskeletal medicine and pain science — is amazingly factionalized. Sometimes it’s really hammered home when I get email from friends trash talking each other, both trying to recruit me, even while they are being very polite to each other publicly.
The longer I do this job, and the more incidents like that I observe, the more I believe that there are no guiltless factions — everyone is getting some stuff right, and some stuff wrong, and treating some ideas fairly and giving others short shrift. It just seems to be how human minds work. Confirmation bias everywhere!
Don’t get me wrong, though: some people are still a lot more wrong than others.
|new Feb 16, 15Feb '15||130|
|Flesh still relevant||new Feb 16, 15Feb '15||170|
|Bought and paid for+ |
So now what to believe? Who knows: the data may be perfectly good, or hopelessly corrupted. We just can’t tell without more information. We’ll simply never know what’s true without more research…which will probably be hard to get anyone but another water bottling company to pay for!
|new Feb 11, 15Feb '15||120|
|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 Feb 11, 15Feb '15||18,000|
|Flabbergasted by the fabella||new Feb 9, 15Feb '15||160|
|You Might Just Be Weird+Strange, wonderful, and problematic anatomical variations occur in humans all the time. Over the years, I’ve collected several intersting examples relevant to musculoskeletal medicine. The clinical significance of normal — and not so normal — anatomical variations||updated Feb 9, 15Feb '15||2,100|
|Release me!||new Feb 6, 15Feb '15||170|
|Acupuncture understatement+ |
Apparently “research conducted in certain countries was uniformly favorable to acupuncture” (Vickers et al). Russia and China in particular effectively do not publish any negative results about acupuncture. Incredible.
I love this ripe, juicy understatement: “Publication bias is a possible explanation.” YA THINK?!
I’ve added this reference to my acupuncture-for-pain article.
|new Feb 6, 15Feb '15||50|
|Make exercise as sexy as the scalpel||new Feb 3, 15Feb '15||190|
|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||updated Jan 30, 15Jan '15||1,700|
|Rupture: not as obvious as you’d think!+ |
Complete hamstring avulsions — that is, complete ruptures of muscles where they attach to bones — are not necessarily obvious. According to O'Laughlin et al, they “can be difficult to diagnose acutely due to swelling and patient guarding, which may mask a visibly palpable defect and lead to delays in diagnosis.” Yikes!
In this case study, the only diagnosis was “hamstring pain” for several days, before the avulsion was finally confirmed by MRI, and surgically repaired on day 13. It’s not hard to imagine cases where the diagnosis would have taken much longer — too long.
|new Jan 29, 15Jan '15||90|
|Guts are not for standing||new Jan 29, 15Jan '15||170|
|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 Jan 28, 15Jan '15||3,250|
|A Historical Perspective On Aches ‘n’ Pains We are living in a golden age of musculoskeletal health care … sorta||updated Jan 28, 15Jan '15||1,200|
|Does Therapeutic Ultrasound Work?+
Ultrasound therapy is the use of sound waves to treat musculoskeletal problems, especially inflammation (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 generally undermined or damned with faint praise by one scientific review after another for more than a decade now. Between 1995 and 2008, what little science has been done on the subject was reviewed in ten papers I considered to be worthwhile (see Gam, Windt, Brosseau, Robertson, Welch, Baker, Buchbinder, Ho, Ho, Jamtvedt). Eight of those were unambiguously negative, some of them strongly so. Authors had almost nothing good to say about ultrasound. Conclusions like this one (from 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 Jan 25, 15Jan '15||3,500|
|Does Acupuncture Work for Pain? A review of modern acupuncture evidence and myths, particularly with regards to treating low back pain and other common pain problems||updated Jan 25, 15Jan '15||6,500|
|Pressure vs shock waves: is there an (important) difference?+ |
Maybe. Probably not. Neither is revolutionizing pain treatment anyway.
There are several different types of extracorporeal shockwave therapy. One of them, radial shockwave therapy, is often called “shockwave” therapy, but probably shouldn’t be, because it uses much lower velocity waves. True shockwave therapies use waves travelling faster than the speed of sound (in flesh), about 1500 meters per second. Radial shockwave therapy is a couple orders of magnitude slower, and would be more properly described as a pressure wave therapy.
It’s probably not quite fair to lump them all in together when assessing shockwave therapy…but I’m going to do it anyway for now (in my ultrasound article). Until such time as there’s compelling evidence that one flavour has impressively different and better effects than another, it’s all just variations on a theme: stimulating tissues with different sorts of sound waves. Does that seem reasonable?
|new Jan 24, 15Jan '15||140|
|Stuck RSS+ |
Just ignore this post if you don’t know what “RSS” is (or go find out, because it’s pretty handy). If you are a subscriber…
The RSS feed for PainScience.com seems to be “stuck” on the old domain name, SaveYourself.ca, for many subscribers. It’s just a cosmetic problem. The feed works; you’re all getting new PainSci posts. But for many of you it still looks like everything is coming from SaveYourself.ca — even though SaveYourself.ca has otherwise been left completely behind.
I’ve researched this and have no idea how to fix it from my end: it appears that some feed readers just cling to whatever info it grabbed when the subscription was created, and then they never update it. (Way to go, feed readers!) But you can easily update it, if you care: just re-subscribe. The feed URL is:
|new Jan 23, 15Jan '15||140|
|Positive trend+ |
The treatment of chronic pain is something of a late bloomer in medicine. But when you look at the big picture, it’s easy to see that we’ve been rather busy making an amazing amount of progress in many, many other ways. For some amazing examples, see Visualizing the History of Improving Health around the World. So many of my worst cynical impulses are contradicted by Max Roser’s charts and data. Refreshing! As Bill Clinton said, “Follow the trendlines not the headlines.”
|new Jan 23, 15Jan '15||95|
|Written like an ad+ |
If the Wikipedia page for a treatment sports the warning “appears to be written like an advertisement,” that’s a bright red flag about its validity. Same with the “needs additional citations” warning. I’ve come across this many times over the years, but here’s the good example I noticed this morning: Extracorporeal shockwave therapy [Wikipedia].
|new Jan 22, 15Jan '15||50|
|Not just another weight loss story+ |
Particularly highly recommended reading today: it looked like a weight loss story by the headline — How Science Babe Lost (and kept off) 90 Pounds — but it turned out to be a hair-raising chronic pain story as well. And a running story! So I really have to recommend it, and probably re-read it, and cite it and quote Yvette “Science Babe” d’Entremont here on PainScience.com in seven places. (Ugh, I can never just read anymore!) Not only is it a story about weight loss, chronic pain, and running, but it’s great demonstration of how a smart, rational person grapples with extremely challenging medical mysteries.
|new Jan 22, 15Jan '15||100|
|Smoking and Pain The role of smoking in chronic pain||new Jan 14, 15Jan '15||650|
|Like storm fronts colliding||new Jan 13, 15Jan '15||170|
|Overselling trigger point therapy||new Jan 12, 15Jan '15||275|
|Metal rod embedded in arm painless for fifty years||new Jan 9, 15Jan '15||200|
|Progressive Training How to take “baby steps” to recovery from an injury or pain problem||updated 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||Jan 3, 15Jan '15||1,700|
|Boot Blooper||Dec 22, 14Dec '14||550|
|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 PainScience.com’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
|Dec 22, 14Dec '14||22,000|
|Does barefoot running prevent injuries? A dive into the science so far of barefoot or minimalist “natural” running||Dec 22, 14Dec '14||5,000|
|Orthotics Review A consumer’s guide to the science and controversies of orthotics, special shoes, and other (allegedly) corrective foot devices||Dec 22, 14Dec '14||3,500|
|Skeptical massage therapists unite||Dec 17, 14Dec '14||210|
|A Lump in My Throat+My personal story of a fierce lump in the throat, known as globus pharyngis in the absence of an actual obstruction, a common and distressing problem often provoked a combination of stress and other medical factors like an infection or heartburn. A globus hystericus story, with a side of science||Dec 16, 14Dec '14||4,250|
|Historical perspective ugprades+ |
Now with even more perspective! A few years ago I wrote a piece about this idea:
I just gave that piece a major overhaul. For a long time it was a bit of a runt, just a short post making a nice but simple point very briefly. Now it’s more of an “article,” filled out nicely as an answer to the question, “Ever wonder why there aren’t better treatments for aches and pains?”
|Dec 8, 14Dec '14||70|
|Major new article about throat lumps||Dec 8, 14Dec '14||150|
|Vitamin D Safety for Pain Patients Is it still safe and reasonable for chronic pain patients to take higher doses of Vitamin D? And just how high is safe?||Nov 29, 14Nov '14||1,400|
|How Many Muscles? A (slightly tongue-in-cheek) tally of the body’s many muscles||Nov 28, 14Nov '14||800|
|When to Worry About Low Back Pain And when not to. What’s bark and what’s bite?||Nov 28, 14Nov '14||2,300|
|The Unstretchables Eleven major muscles you can’t stretch (no matter how hard you try)||Nov 27, 14Nov '14||1,900|
|Like Shaggy from Scooby-Doo, but less scientific+ |
Ironically, Scooby-Doo was a surprisingly science-minded and skeptical show.
|Nov 26, 14Nov '14||140|
|This isn’t over: ScienceBasedMedicine.org still being sued||Nov 25, 14Nov '14||300|
|More massage better+ |
So this study showed that more massage therapy helped neck pain, suggesting that perhaps other studies showing lackluster effects on neck pain “may have not administered adequate doses.” Interesting. Pretty nice study, with good news.
But! (There’s always a but, eh?)
Among other limitations, there was this one (and kudos to them for acknowledging it, I was really hoping they would): “inability to control for nonspecific effects of attention with the use of a wait list control design.” Ayuh. In other words, it’s not exactly a shocker that just spending a lot of pleasant time with a therapist might produce better outcomes than waiting for treatment. I mean, duh. The massage itself may well not have been the mechanism. Or it may well have been. Can it tell us anything? Yes: if massage helps neck pain, more massage probably helps neck pain more.
|Nov 22, 14Nov '14||140|
|The big move+ |
SaveYourself.ca has — finally — moved to PainScience.com. For many years I’ve been both avoiding this (because it was a lot of work) and looking forward to it (because I was never comfortable with the connotations of “save”). I’ve set up a permanent page about the move that explains it in more detail — interesting reading for a few readers, I imagine.
|Nov 21, 14Nov '14||60|
|What could possibly go wrong?+ |
This probably needs a trigger warning. If you’re one of those people who can’t handle knuckle cracking, this video of extremely intense spinal adjustment will make your head explode.
|Nov 13, 14Nov '14||30|
|Three pounds in a year||Nov 5, 14Nov '14||275|
|Seven flights+ |
My new office is on the 7th floor, a just-right height: hard enough to be worthwhile, but too easy to bother making excuses for not doing it. I look forward too many micro-stair workouts! Regular light exercise — a bit less when you’re hurt, more when you’re strong — is about as close to a panacea as we’ve got in musculoskeletal health.
|Nov 5, 14Nov '14||60|
|REJOICE, fibromyalgia sufferers! Your nightmare is over!||Oct 30, 14Oct '14||300|
|The state of medicine+ |
Dr. Sandeep Juahar’s book about his bleak experience as a physician seems to be at odds with the autobiographical accounts of other doctors that I have read, most of which present a healthy mix of optimism and cynicism about their work and profession. It’s the same with the doctors I know personally, who all seem to be vigorous idealists of one sort or another. Their awareness of the failings and limitations of medicine is clear, but balanced by a strong and admirable enthusiasm to improve. If medicine is the unmitigated disaster that Juahar seems to think it is, I would expect to see a lot more doctors declaring it.
|Oct 30, 14Oct '14||100|
|Between offices+ |
I’m moving my office across town at the end of Oct, from downtown Vancouver to the quieter neighbourhood — still central Vancouver, but no longer right downtown by the ocean, where I’ve been for the last 14 years.
Moving is chaotic! Right now I’m surrounded by a forest of boxes. Customer service will continue more or less normally, but probably a little more sluggish than usual. And I probably won’t reply to non-critical messages until mid-November. Thanks for your patience.
|Oct 28, 14Oct '14||80|
|Diabolically difficult||Oct 28, 14Oct '14||210|
|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||Oct 28, 14Oct '14||3,250|
|A Systems Perspective on Chronic Pain||Oct 23, 14Oct '14||450|
|1.83 metres under||Oct 15, 14Oct '14||190|
|Not so FAST||Oct 14, 14Oct '14||350|
|197, 198, 199… 200!+ |
The Painful Quotations page now has an even 200 quotes about aches, pains, injury, therapy, and science and critical thinking. There are many more to come over time. When I realized it was close to 200, it was virtually effortless to dig through my files and boost it up to that nice round number.
|Oct 14, 14Oct '14||55|
|Being wrong is popular+ |
I have really noticed this in my publishing career: self-effacing mea culpa blog posts are always super popular... but I routinely get vilified for (correctly) calling bullshit. (This suggests an effective strategy for blogging success: be wrong a lot, admit it a lot!)
|Oct 14, 14Oct '14||45|
|Does Hip Strengthening Work for IT Band Syndrome? Despite its popularity, “weak hips” is a weak theory, and there is no compelling evidence that hip strengthening can treat or prevent running overuse injuries of leg||Oct 14, 14Oct '14||4,250|
|I’m not an expert+ |
I am often mistaken for an “expert,” but no, not in my subject matter: I am merely well-acquainted with the work of many actual experts. I’m a liaison, translator, and popularizer. I’m good at that, and it’s good work if you can get it. Many of the actual experts are also acquainted with me, and they follow and check my work. These days, I can be confident that if I get anything too far wrong, I’ll hear about it from a source I can trust. But the only thing I am truly expert at is the craft of writing and web publishing … and even in that I am humbled by the achievements of others, of course.
|Oct 10, 14Oct '14||110|
|Best mini-testimonial ever+ |
That has to be one of the best mini-testimonials I’ve ever gotten. It was regarding my muscle pain book.
But seriously kids, stay in school.
Unless school is teaching pseudoscientific bollocks. In which case, you probably should stay home and read one of my books. Or watch Cosmos or something.
|Oct 9, 14Oct '14||55|
|FMS: Back to the drawing board?||Oct 9, 14Oct '14||475|
|Still not so ancient after all||Sep 30, 14Sep '14||250|
|The smell could almost be heard+ |
“The smell could almost be heard.”
That image refers to a child’s rotting leg — rotting because of the incompetence of traditional Chinese medicine, as described in The Reality of Ancient Wisdom, by Dr. Harriet Hall.This article is essential, morbidly fascinating reading. I didn’t think I could get any more cynical about ancient folk medicine. I was wrong! Dr. Hall packages up a few excerpts from an old book by a physician working in China in the late 19th Century. His matter-of-fact reports of the actual medical habits of the Chinese at that time are chilling, and a harsh reminder that traditional Chinese medicine was not wise and profound, but rather cringe-inducingly horrible, just as brutal and bizarre as any pre-scientific European “medicine.” In particular, the stories concerning acupuncture expose a mess of superstitious and vicious excess. Bloodletting was the tip of the iceberg. Little wisdom is possible in a state of profound ignorance.
|Sep 30, 14Sep '14||35|
|Salamander head+ ||Sep 24, 14Sep '14||1|
|Recommended reading about chiropractic…and lots of it||Sep 24, 14Sep '14||190|
|Phantom scratching is like pain||Sep 22, 14Sep '14||160|
“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. There is a lot of overlap between modality empires and quackery. Classic examples of modality empires include Ida Rolf’s ROLFING®, John Barne’s myofascial release, and John Upledger’s craniosacral therapy. Sometimes a modality empire is particularly unoriginal, re-packaging old ideas for a new generation of workshop consumers.A tradition of ego-driven treatment methods in manual therapy
|Sep 20, 14Sep '14||1,500|
|The “Impress Me” Test Controversial therapies are usually fighting over scraps of “positive” evidence that damns them with faint praise||Sep 20, 14Sep '14||1,800|
|Pain is Weird+Modern pain science shows that pain is a volatile, complex sensation that is often strongly distorted by the brain, not just a symptom, and maybe worse than anything else that’s actually wrong with us. So can we think pain away? Probably not, but we do have some “neurological leverage” of great value — but it requires a good, modern understanding of how pain actually works. Pain science reveals a volatile, misleading sensation that is often more than just a symptom, and sometimes worse than whatever started it||Sep 20, 14Sep '14||7,500|
|Does Chiropractic Work? An introduction to chiropractic controversies like aggressive billing, spinal adjustment as a panacea, treating kids, neck manipulation risks, and more||Sep 20, 14Sep '14||6,000|
|Baby steps remix||Sep 17, 14Sep '14||210|
|Prism Podcast||Sep 15, 14Sep '14||160|
|Ancient wisdom+ |
So you thought “ancient” meant “good”, eh? Harriet Hall for ScienceBasedMedicine.org:
The book she’s referring to is free on archive.org.
|Sep 14, 14Sep '14||85|
|Blood therapy, anyone?+ |
New article about platelet-rich plasma (PRP) injection! And the first completely new content in a while. PRP is my most requested topic of the last year, so I’ve finally written an article about it, which I hope is now your go-to link for some sassy, referenced PRP negativity. The conclusion was more or less inevitable, but I pried my mind open on the topic for a while before letting it snap shut again.
“Cynics can stop reading here. You know this doesn’t end well.”
“There’s lots of stuff inside of me that I do not want to be extracted, concentrated, and returned!”
“You could probably talk people into drinking a platelet smoothie if you told them it would ‘regenerate' them.”
And so on. I had fun with this one.
|Sep 11, 14Sep '14||130|
|Baby steps+ |
The “secret” sauce for most training and rehab is baby steps, consistently for a long time. People get hurt when they try to do too much, too soon. People stay hurt when they try to do too much, too soon.
|Sep 11, 14Sep '14||40|
|Studying the Studies Tips and musings about how to understand (and write about) pain and musculoskeletal health science||Sep 11, 14Sep '14||2,200|
|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|
|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 10, 14Sep '14||1,900|
|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 chiropractors or naturopaths normally get.
|Sep 9, 14Sep '14||600|
|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
|Sep 9, 14Sep '14||750|
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 focussed 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 Should You 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 QuackWatch.org).The idea of “toxins” is used to scare people into buying snake oil
|Sep 9, 14Sep '14||600|
|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|
|Six Ways To Prevent Sports Injuries Get warm, co-ordinated, relaxed, smart and mobilized!||Sep 9, 14Sep '14||800|
|Phantom limb scratching+ |
Power of the central nervous system, exhibit A, three-legged cat Isaac, trying to scratch himself with his missing leg:
That has got to be super frustrating.
|Sep 6, 14Sep '14||25|
|Leaky old canoes+ |
“Science doesn’t know everything” is a classic, common non-sequitur from people defending quackery. It’s true but obvious, and irrelevant to their point…which is that their kooky treatment beliefs are so exotic that they are immune to investigation and criticism, beyond the reach of science. Nope! Not even close!
It’s like declaring a leaky old canoe to be seaworthy because we don’t yet know everything about the depths of the ocean.
|Sep 6, 14Sep '14||65|
|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|
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.”Is there any such thing?
|Sep 6, 14Sep '14||1,300|
|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|
|Audio article no. 7+ |
I’ve added another audio article to my small library of audio versions of articles, bringing the total to seven: the audio version of my stretching experiment. It was actually an old recording, rediscovered! I completely forgot that it existed. Audio articles are freely available to visually impaired readers on request, and for all boxed set customers.
|Aug 27, 14Aug '14||55|
|The fate of medicine without reductionism+ |
“Reducing” complex systems in nature to their components is just one of many thinking and reasoning tools, not an all-consuming obliviousness to “the whole” — as often insulting insinuated by alternative medicine practitioners. My previously tiny article about this has been beefed up to a few hundred words with a new section using traditional Chinese medicine as an example of “the fate of medicine without reductionism.”
|Aug 27, 14Aug '14||65|
|Now basically rather “edited”||Aug 26, 14Aug '14||190|
|“Positive”||Aug 26, 14Aug '14||275|
|Why “Science”-Based Instead of “Evidence”-Based? The rationale for making medicine more science-based||Aug 26, 14Aug '14||2,400|
|‘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||850|
|The Power of Barking||Aug 23, 14Aug '14||600|
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||800|
|Testing magic||Aug 21, 14Aug '14||180|
|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.||Aug 21, 14Aug '14||5,000|
|A Better Hot Bath Tips for getting the most out of the oldest form of therapy||Aug 21, 14Aug '14||2,750|
The PainScience.com home page has a featured content carousel: little teasers for popular articles that slide past. I’ve been meaning to do this for ages.
|Aug 20, 14Aug '14||25|
|I’m not holding my breath||Aug 20, 14Aug '14||170|
|Vibram gets vague||Aug 20, 14Aug '14||220|
|The chemistry of the burn+ |
I get a lot of my exercise science news via Alex Hutchinson of Sweat Science. For instance, this interesting item about “the burn” of intense effort — what exactly causes it? Which molecules? According to Pollak et al, it’s protons, lactate, and ATP — and only in concert. “There was essentially no response whatsoever to the individual metabolites,” explains Alex, “so the receptors apparently respond only to the synergistic combination of all three.”
Surprisingly, this fairly unsurprising result is brand new information: the paper’s authors call it “the first demonstration in humans that metabolites normally produced by exercise act in combination to activate sensory neurons that signal sensations of fatigue and muscle pain.”
|Aug 19, 14Aug '14||130|
|Peak musculoskeletal anatomy+ |
Hi, I’m back. The last couple weeks were consumed by an anatomy exam (and then some “special projects” I will remain deliberately mysterious about). The exam seemed easy except for a few questions with diagrams that looked like they’d been scribbled on the back of an envelope with a crayon and then photocopied 12 times. “Label this.” Okaaaay…
I originally intended to be an efficient underachiever, and accept much less than an A for the course, but … turns out I get sucked into anatomy. I really went for it! And I’ve now probably achieved peak musculoskeletal anatomy knowledge — I’ll never have it more down than this.
|Aug 19, 14Aug '14||100|
|The Runner’s Knee Diagnostic Stand-Off How to tell the difference between the two most common kinds of runner’s knee: IT band syndrome versus patellofemoral pain||Aug 15, 14Aug '14||1,000|
|Classic anatomy videos still going strong||Aug 4, 14Aug '14||325|
|Just exercise those thighs!||Aug 4, 14Aug '14||190|
|It doesn’t go to my head!+ |
I’ve always had trouble remembering the name of the “cephalic” vein, because the name seems wrong. What does it have to do with the head? It doesn’t go to my head! I finally went looking for an explanation and found one quickly on Wikipedia: “Ordinarily the term cephalic refers to anatomy of the head. When Persian physician Ibn Sīnā's Canon was translated into medieval Latin, cephalic was mistakenly chosen to render the Arabic term al-kífal, meaning ‘outer’.”
Phew, I feel much better knowing that! (It’s also probably to stick in my mind much more better now.) And now I wonder how many other anatomical terms are based on mistranslations…
|Aug 1, 14Aug '14||100|
|Is there hope?+ |
One of the top five questions I am asked by email, about any condition, is simply Is there hope? The answer is nearly always the same…
Yes, there is hope! There’s never a guarantee, but there’s always hope, and recovery from most kinds of severe chronic pain is not only possible but fairly common. Unless you have a known serious aggravating factor — a major trauma, for instance — there is almost never any reason to fear that recovery from any chronic pain problem is impossible. For the same reason that pain can be absurdly persistent and out of proportion to any clear cause — because it is so brain-tuned — it also never loses the potential to finally shift and evaporate.
This thought was added to my Pain is Weird article, and probably should be in several other articles as well.
|Jul 31, 14Jul '14||140|
|Free speech+||Jul 31, 14Jul '14||25|
|2nd edition of patellofemoral pain e-book, co-authored with Tony Ingram||Jul 29, 14Jul '14||850|
|No Comment Why I have never allowed public comments on PainScience.com like most blogs, and never will||Jul 25, 14Jul '14||1,100|
|Neck pain updates+ |
Several recent updates to my neck pain e-book: digital motion x-ray section, new spinal manipulative therapy evidence, comparison of “minor intervertebral derangement” to “subluxation,” and diclaimers about the weakness of trigger points science.
|Jul 24, 14Jul '14||30|
|Explaining away treatment successes||Jul 24, 14Jul '14||325|
|Ringside seats for a legal fight: ScienceBasedMedicine.org gets sued||Jul 23, 14Jul '14||350|
|Mark my words: a new e-book feature||Jul 22, 14Jul '14||275|
|Downward dog needs more dog+||Jul 22, 14Jul '14||30|
|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?||Jul 17, 14Jul '14||2,500|
|Poisoned by Massage+
Massage is not a detoxification treatment in any sense, contrary to a popular belief. Ironically, it’s the opposite: post-massage soreness and malaise (PMSM) is probably 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 well-documented cases of exertional or “white collar” rhabdo, and by the strong similarity between PMSM and ordinary exercise soreness. A rhabdo cocktail of waste metabolites and by-products of tissue damage is probably why we feel a bit cruddy after biological stresses and traumas — even massage, sometimes. And you can’t “flush” the rhabdo away with massage or by drinking a little extra water. PMSM is just an unavoidable mild side effect of strong massage.Rather than being “detoxifying,” massage may cause a modestly toxic situation in the body
|Jul 16, 14Jul '14||4,500|
|What Could Go Wrong With Massage? Rare but real adverse effects of massage therapy, especially “deep” massage||Jul 16, 14Jul '14||1,800|
|Too many choices+ |
If any treatment worked really well for any painful problem, it would be the only one to discuss. There wouldn’t be a plethora of treatments to consider. There wouldn’t be a bunch of imperfect options for me to review in my books. Which is why Chekhov wrote this:
Like most writers, I collect quotes that add colour, gravitas, or support to my own writing, and there are dozens of them around PainScience.com. So, how could I have never noticed this quotation before? Funny how even the apt-est can escape a writer’s attention for years at a time!
|Jul 15, 14Jul '14||100|
|The weirdness of pain+ |
A new blurb on the weirdness of pain, from a coming-soon update to the patellofemoral pain syndrome book (and equally applicable to most chronic pain problems).
In related news, I rebranded my main pain article yet again, and I think I’ve settled on a good title for the long haul: Pain is Weird.
|Jul 15, 14Jul '14||130|
|Save Yourself from Tennis Elbow! Not just for tennis players, straight-talking advice on healing from this common tendinitis (lateral epicondylitis)||Jul 12, 14Jul '14||3,250|
|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 completely 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?
|Jul 11, 14Jul '14||1,000|
|An epic fail for pre-run stretching+ |
This is an extremely popular warm-up ritual, performed with great faith by millions of people, that not only doesn’t help but actually dings performance. That’s an impressive disconnect between belief and reality.
My huge stretching article has been duly updated.
|Jul 9, 14Jul '14||130|
|Wonder Core!+ |
Watch this Japanese advertisement for a core strength training machine. It just keeps getting better!
Oh, and: earworm warning.
|Jul 7, 14Jul '14||15|
|Speaking of needles…+||Jul 7, 14Jul '14||30|
|What’s the point?+ |
|Jul 7, 14Jul '14||140|
|Treat the animal, not the radiograph||Jul 3, 14Jul '14||160|
|It’s about time+ |
Grant, Tjoumakaris, Maltenfort, and Freedman in the American Journal of Sports Medicine:
Fantastic news, if true. On the other hand, maybe I should be careful what I wish for: my entire career is based on making some sense out of the hopeless mess that is sports and musculoskeletal medicine…
|Jul 2, 14Jul '14||65|
|Why fascia matters medically (get ready to cringe)||Jul 1, 14Jul '14||425|
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
|Jul 1, 14Jul '14||12,000|
|More painful audio+ |
Audio articles are exclusively available as a perk for my boxed set customers (plus any visually impaired reader). I also extended the one about my trigger point doubts, keeping up with major recent updates to the written version.
|Jun 30, 14Jun '14||100|
|Shot by the witch+ |
Those Germans have a word for everything! “Hexenschuss” is a German word for back spasm or lumbago, but translated literally it means shot by the witch (hexe = witch and Schuss = shot). Hat tip to reader Richard Moison for teaching me this excellent word, now added to the introduction of my low back pain tutorial.
|Jun 30, 14Jun '14||55|
|A million page views+||Jun 29, 14Jun '14||50|
|Jun 26, 14Jun '14||100|
|My worst pain ever+ |
Not my acromioclavicular joint dislocation, not the aftermath of it for the next six months (as bad as that got), but two years later re-injuring the vulnerable area working out at the gym. Weeks of consciousness were consumed by waves of agony from ear to elbow. What a grind.
It’s impossible to say exactly how I beat it — there were a bunch of variables, I tried everything I know — but basically it seemed like a good massage was finally what did the trick.
|Jun 18, 14Jun '14||80|
|Cruciate repair non-crucial+ |
Surprisingly, Frobell et al found that it’s not clear if a torn anterior cruciate ligament should be surgically repaired. In a randomized, controlled study of 121 young adults with acute ACL injury, there was little difference between getting reconstructive surgery right away and just doing normal rehabilitation. Given the structural importance of the ACL ligament, it’s amazing that it can recover from major trauma without surgery approximately as well as it can without. This study did not show that ACL repair is never or rarely necessary, but it certainly strongly suggests that it’s less crucial than most people would expect.
|Jun 18, 14Jun '14||100|
|The DOs and DO NOTs of running your first marathon+ |
The Oatmeal: “Remember, marathon success does not come from training or perseverance, it comes from waterboarding yourself at aid stations.”
|Jun 18, 14Jun '14||20|
|True story+ |
|Jun 18, 14Jun '14||40|
|Thumbs Up for the Scientific 7-Minute Workout||Jun 11, 14Jun '14||450|
|Foot strikes vary widely in elite runners+ |
So that clears that up.
|Jun 11, 14Jun '14||95|
|Are you a narcissist?||Jun 10, 14Jun '14||150|
|Soldiers and single moms+ |
I get a lot of poignant emails asking for help and advice about some really tough painful condition, but some of the most heart-wrenching are from soldiers on active duty — a situation that usually makes the best rehab options impossible or close to it. Same with single moms. I hate trying to answer those emails, because there’s almost nothing I can do. I offer them a free book. It’s not much, but it’s something.
I officially stopped trying to answer all my e-mail a good three years ago, because the volume was already overwhelming even then, but of course I still choose to answer some, and certain kinds of message are just about impossible to ignore, no matter how busy I am. When I ignore the hate mail, it’s largely to reserve time and energy for mail like this.
|Jun 10, 14Jun '14||130|
|A vote for tolerance+ |
Does stretching increase range of motion by changing the physical characteristics of soft tissues (“plasticity”)… or our neurological tolerance for elongating it? It’s one of those surprisingly basic body mysteries. Here’s a fresh new data point in the plasticity vs. tolerance debate, from Konrad et al:
|Jun 10, 14Jun '14||75|
|My pro-science bias+ |
So I got accused of having a “pro-science” bias. Correct! As advertised. Just like it says on the tin. This is like accusing a painter of a “pro-art” bias…
|Jun 7, 14Jun '14||25|
|The back is still important in back pain+ |
However, just because we can’t seem to reliably find smoking gun causes of back pain with modern imaging technology does not mean it isn’t there. Physical therapist and researcher Tony Ingram makes this important point in a short, clear, evidence-based opinion piece, The back is still important in back pain. And I’ve added a reference to it to my back pain book, of course.
See also this academic paper from 2011: What happened to the ‘bio’ in the bio-psycho-social model of low back pain?
|Jun 7, 14Jun '14||130|
|Doubting doubts||Jun 6, 14Jun '14||250|
|Do you need a calf-stretching gadget?+ |
|May 29, 14May '14||80|
|Plasticity versus tolerance: they got more flexible, but how, dammit, HOW?!||May 28, 14May '14||180|
|For whatever it’s worth+ |
For many people, a diligent effort over a period of weeks might well increase your range of motion. In 2011, a nicely done experiment by Marshall et al showed that regular hamstring stretching substantially increased range of motion in normal university kids. Specifically, after “a 4-week stretching program consisting of 4 hamstring and hip stretches performed 5 times per week,” their range increased about 16˚ or 20%. That’s a real result. For whatever it’s worth. Regardless of what it does for flexibility, stretching remains amazingly useless for nearly any other popular or clinical goal. See Quite a Stretch. And see the next post for more discussion about the implications of this study: Plasticity versus tolerance.
|May 28, 14May '14||110|
|The Better Movement Book+ |
Just published! When I’ve read it, I’ll review it, but I predict good news: this is likely to be a fine book, and a great reading recommendation in countless places around PainScience.com. Todd Hargrove is a clear thinker and terrific writer. For years now, I’ve been reading his blog — www.BetterMovement.org, similar to this one in so many ways — and routinely kicking myself for not writing about a topic as craftily as he did, or as diplomatically, or as insightfully. He’s one of those writers that keeps me striving to refine my own skills. Buy the book from Amazon (paperback for now, Kindle coming soon).
|May 26, 14May '14||100|
|Americans Struggle to Stand Up+ |
This is so plausible it barely qualifies as satire.
|May 22, 14May '14||55|
|No real evidence that parachutes work+ |
I recently added a classic satirical citation to my bibliography, and then worked it into a revision of my article about the difference between evidence-based and science-based medicine:
|May 21, 14May '14||120|
|Society for Science-Based Medicine+ |
I recently joined the new Society for Science-Based Medicine (SFSBM.org), a society advocating for more and better science in medicine: “People should not suffer, die and lose hope, time and money due to pseudo-medicine.”
|May 21, 14May '14||30|
|The “integrated medicine” straw-man+ |
Edzard Ernst on the “integrated medicine” straw-man:
|May 21, 14May '14||80|
|Hyperaesthesia of the shins+ |
Bartonella quintana (or trench fever, or five-day fever), is a disease carried by body lice that causes, weirdly, hyperaesthesia of the shins — that is, generally heightened shin sensation, though mostly just heightened pain. However, this is unlikely to cause any diagnostic confusion with shin splints, since trench fever also causes a nasty fever and many other unpleasant symptoms, like fierce headaches and eyeball pain. Nevertheless, perfect sidebar fodder for my shin pain tutorial.
|May 15, 14May '14||95|
|Kill pain, kill performance+ |
How’s this for a counter-intuitive research result? Alex Hutchinson:
|May 15, 14May '14||55|
|Practitioners of “placebo enhancement”||May 15, 14May '14||220|
|Icing for Injuries, Tendinitis, and Inflammation Become a cryotherapy master||May 15, 14May '14||4,250|
|Vibram spanked+ |
settles a class-action lawsuit about its FiveFingers “shoes,” pays $3.75 million to customers, and agrees to remove all claims that the product “strengthens” or “reduces injury” until they can be proved. I have been pointing out for years that such claims for the powers of minimalist shoes and barefoot running were premature. Interestingly, Vibram’s claims are still online for now — I wonder how much longer? — and they are just as bold and unsubstantiated as I remember.
It’s good news, but companies will keep making premature health claims as long as the potential profits trump the risk of getting spanked for it (so, forever). Lots of discussion of this item on Facebook, and I’ve updated my barefoot/minimalist article: Does barefoot running prevent injuries?
|May 9, 14May '14||120|
|The Cassidy paper+ |
Since its publication, “the Cassidy paper” has been the defensive citation used by chiropractors to respond to accusations that neck adjustments involve a risk of stroke, and therefore should not be conducted without proven benefit and informed consent. The abstract seems to strongly exonerate chiropractors: “We found no evidence of excess risk of VBA stroke associated chiropractic care compared to primary care.”
“But abstracts are like movie trailers,” as Dr. Mark Crislip wrote. “They give a flavor of the movie, but often leave out many important plot devices and characters. … If you were to read this article in its entirety, you would not be so sanguine about the safety of chiropractic.” He goes on to explain exactly why in one of the earliest popular posts on ScienceBasedMedicine.org, Chiropractic and Stroke: Evaluation of One Paper.
|May 7, 14May '14||140|
|Pain without a name||May 6, 14May '14||200|
|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||May 5, 14May '14||2,750|
|Small study proves showers work+ |
Too often people smugly dismiss a study just because of small sample size, ignoring all other considerations, like effect size … a rookie move. For instance, you really do not need to test lots of showers to prove that they are an effective moistening procedure.
|May 1, 14May '14||45|
|Placebo Paradox 2: The Mechanism+ |
Placebo is full of paradoxes. For example, the original was: if placebo is so ding dang “powerful,” why isn’t everyone cured? And here’s a sequel, via researcher Steve Kamper:
Indeed. The whole short article is excellent.
|May 1, 14May '14||120|
|Satisfaction is not efficacy+ |
Rational chiropractor, Preston H. Long, author of a new book, Chiropractic Abuse—A Chiropractor’s Lament, knows Twenty Things Most Chiropractors Won’t Tell You. Number 16 is particularly well-phrased:
Repeat after me:
Then read the other 19. Then read the book.
|May 1, 14May '14||110|
|So much “power”!+ |
|Apr 30, 14Apr '14||110|
|Spine wrangling+ |
Fun fact: the spine is tough and strong and difficult to stabilize without surgically installing screws and rods, and even then it’s tricky: spinal fixations occasionally fall apart (my wife’s did). In fact, it’s so hard to control spinal movement that the value of external bracing in spinal fracture rehab remains controversial. Worse, one fascinating experiment (Rohlmann et al) showed that bracing may actually cause some some, dysfunctional spinal function — resulting in less support, rather than more!
|Apr 29, 14Apr '14||75|
|Inflatable back support?||Apr 29, 14Apr '14||160|
|It’s no Game of Thrones, but…+||Apr 25, 14Apr '14||25|
|Consider the source+ |
Sting operations have been proving that it’s alarmingly easy to publish bogus science. Ergo, it’s more important than ever to consider the source. Ars Technica:
|Apr 23, 14Apr '14||95|
|The two-legged dog and biomechanics||Apr 17, 14Apr '14||160|
|The Salamander’s Law of Bad Therapy+ |
|Apr 17, 14Apr '14||10|
|Stretch for torn muscles||Apr 15, 14Apr '14||180|
|No Heartbleed here+||Apr 12, 14Apr '14||35|
|New book+ |
I’m telling my story: the rather dramatic fate of my massage career, how PainScience.com became profitable, and the nail-biting transition between the two. The introduction is now available on my sleepy little personal blog, Writerly, and the first dozen chapters are queued up — they’ll be freely available while I finish writing the book.
|Apr 10, 14Apr '14||90|
|Compression socks with tape||Apr 10, 14Apr '14||250|
|Two books edited, six to go+ |
I’m pleased to announce the first complete professional editing of two of my books — about plantar fasciitis and iliotibial band syndrome. Although the difference will not be obvious to most readers, several hundred improvements and corrections were made to each, and the reading is definitely smoother.
What took me so long? Logistics and cash. Like any truly professional writer, I always knew I needed good editorial help, but that can be hard to find and pay for. Editing a book is a Big Deal. But PainScience.com has grown to the point where it finally got important and affordable, and I was lucky enough to find a skilled, reliable editor: JoAnne Dyer of Seven Madronas Communications. After working with JoAnne on many smaller projects over the last couple years, I asked her to start working on my books. Two down, six to go!
|Apr 9, 14Apr '14||140|
|So…what does work, Mister Smartypants?+ |
I am often criticized for failing to suggest alternatives when criticizing bad ideas in therapy, especially in my article about “structuralism” (overemphasizing biomechanical factors in therapy). It’s a bogus gripe: failing to suggest a wardrobe for the emperor to wear tomorrow doesn’t make him any less naked today. Structuralism is a deeply flawed basis for therapy regardless of whether anything can readily replace it. But I’ve gone ahead and made some simple suggestions anyway, in a short new conclusion to the article (link takes you directly to the conclusion).
There will be much more on this so-what-does-work theme over the next couple years. I’m just getting started on it.
|Apr 9, 14Apr '14||100|
|Vandal massage||Apr 3, 14Apr '14||300|
|Barefoot resource+ |
My barefoot running content has been revised and compiled. It’s approaching the point where it’s a fairly in-depth feature article — as opposed to a mere blog “post.” That’s what I do here: I just keep updating and improving articles until you can’t resist sharing them on Facebook!
|Apr 2, 14Apr '14||45|
|Oh, stretching! Can you do anything right?+ |
My main stretching article now includes a section on the failure to treat contracture (a scar-like shortening of soft tissues). Stretching always gets the benefit of the doubt, whether it deserves it or not. Most people and most professionals probably assume that long, intense stretches are an effective prevention/treatment for contracture. It is not an assumption held with much conviction, I imagine — it’s just that stretching always gets the benefit of the doubt, whether it deserves it or not, and it seems to “make sense” that stretching would be a cure for contracture.
Common sense fails again, I’m afraid. Continue reading (link goes directly the new section).
|Apr 2, 14Apr '14||100|
|New anecdote disclaimer||Apr 2, 14Apr '14||210|
|Neck Pain, Submerged!+ |
A “new” article about the worst pain I’ve ever personally survived, cobbled together from old blog posts, updated and tuned a bit:
|Apr 1, 14Apr '14||20|
|Financially motivated ignorance||Apr 1, 14Apr '14||150|
|Calf size variability+ |
|Mar 27, 14Mar '14||60|
|Audiobooks project cancelled||Mar 27, 14Mar '14||170|
|The marble hand+ |
Really a delightfully strange illusion.
|Mar 27, 14Mar '14||65|
|The greatest hits of back pain science||Mar 26, 14Mar '14||170|
|A lot of science is junky||Mar 26, 14Mar '14||190|
|Follow-up on the baby’s broken neck story+ |
Some follow-up from a prominent news item last year: a complete summary of the kerfuffle over the alleged fracture of a baby’s neck by an Australian chiropractor. In a nutshell: we’ll never know for sure what happened, but the chiropractic profession’s response to the allegation was predictably poor and damning, and — as always — chiropractors simply have no business treating children in the first place. See also Dr. Harriet Hall’s summary post on ScienceBasedMedicine.org, Chiropractic Reform: Myth or Reality?
|Mar 25, 14Mar '14||80|
|Love letters from librarians+ |
I get hate mail from quacks… but love letters from librarians, for the bibliography-friendly foundations of PainScience.com. New short article about the design and odd technology of this website. Because people are always asking.
|Mar 25, 14Mar '14||30|
|Goodbye PDF, hello lifetime access||Mar 20, 14Mar '14||250|
|When books don’t heal+ |
When my customers request refunds, which is unusual, by far the most common reason given is that the book didn’t solve their problem. About half of them add some kind of complaint about my legendary negativity. Here is a typical recent example:
Not many self-help books go to great lengths to stifle false hope and unrealistic expectations…but mine do. My shin splints book is not intended to “decrease shin pain,” and I warn readers about that, in several ways, in both the free introduction and in the main text. In fact, I would say it’s impossible to actually read and understand my book and still think that it should have “fixed” anything. It’s an unreasonable expectation of any book… but particularly one that goes well out of its way to caution readers against that expectation!
|Mar 20, 14Mar '14||140|
|He’s trying to shoot me, all right…+ |
|Mar 20, 14Mar '14||35|
|A good friend advances medical science+ |
My friend Dr. Rob Tarzwell is celebrating the publication of this here scientific paper with his name on it. It’s about brain injury, so it’s well off-topic for the salamander … but I’m very interested on a personal level, because my wife’s brain was so badly hurt in an accident in Laos back in 2010. Plus, the tech of it is bloody fascinating (and arcane). My congratulations to Rob on a meaningful and novel contribution to medical science: hats off and high fives!
|Mar 19, 14Mar '14||80|
|Say release again||Mar 19, 14Mar '14||180|
|The meaning of heel spurs||Mar 19, 14Mar '14||210|
|New massage for fibromyalgia study||Mar 18, 14Mar '14||600|
Thought I’d get the blogging rebooted with something easy and fun. More substance tomorrow!
|Mar 18, 14Mar '14||10|
|Back to work and blogging||Mar 18, 14Mar '14||190|
|Many (unnannounced) updates and upgrades||Feb 10, 14Feb '14||180|
|Trigger Point Doubts+
People routinely experience muscle pain and acutely sensitive spots in muscle tissue — “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 very important to keep in mind that they are not well understood.Is there really such a thing as a muscle “knot”?
|Jan 19, 14Jan '14||9,000|
|Dance of the Sarcomeres A mental picture of muscle knot physiology helps to explain four familiar features of muscle pain||Jan 16, 14Jan '14||2,750|
|Stiff, Tight Muscles and Limited Range of Motion Is your range actually limited, or do you just feel that way?||Jan 9, 14Jan '14||1,300|
|A brief public appearance||Jan 6, 14Jan '14||250|
|Morning Back Pain An uncomfortable daily mystery for many people||Jan 6, 14Jan '14||2,200|
|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.” Therapists who think they are God’s gift to therapy||Jan 1, 14Jan '14||1,200|
|Why Does Pain Hurt?+How an evolutionary wrong turn led to a biological glitch that condemned the animal kingdom — you included — to much louder, longer pain. How an evolutionary wrong turn led to a biological glitch that condemned the animal kingdom — you included — to much louder, longer pain||Dec 28, 13Dec '13||5,000|
|Proprioception, the True Sixth Sense The vital and strange sensation of position, movement, and effort||Dec 24, 13Dec '13||700|
|The Art of Rest The finer points of resting for injury & pain rehabilitation (hint: it’s a bit trickier than you might think)||Dec 14, 13Dec '13||4,250|
|Can Supplements Help Arthritis and Other Aches and Pains? Debunkery and analysis of supplements and food-like medicines (nutraceuticals), especially glucosamine, chondroitin, and creatine, mostly as they relate to pain||Dec 12, 13Dec '13||5,500|
|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 adapation & therapies like Prolotherapy & Graston Technique
|Dec 11, 13Dec '13||2,300|
|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||Dec 11, 13Dec '13||1,400|
|The View from Somewhere+
Readers often prevail upon me to be “objective,” but it’s an over-rated virtue. I am often criticized for a lack of it — always by somone who disagrees with me. And sometimes I am praised for my neutrality — always by someone who agrees with me. But I am not impartial on any of the controversial questions in my field, I’ve never met anyone who is, and I don’t aspire to it.
Objectivity and balance are highly over-rated as journalistic virtues. They are mostly a pretentious delusion, and you should actually beware of those who claim to have them. See Jay Rosen on “the view from nowhere.” And Dan Rather said it well: “I don’t like the word ‘balance’ as applied to journalistic work, because to me, that carries with it at least a connotation that, if you run 15 words about the Republican Party, then you’ve got to run 15 words about the Democratic Party. That’s balance. But I think “fairness” is the word I prefer” (interviewed by Hedrick Smith on PBS, 1996).
Instead of expecting balance, look for someone with a View from Somewhere — from someone who isn’t afraid to disclose and own a bias. That is my goal. Not only will I fail to achieve the ideal of “objectivity,” I assume that my biases are inevitable, constantly egregious, and utterly human. We are all bias machines. We can only keep a bemused eye on this frailty, do some damage control, and try to avoid being emphatic or overconfident about much of anything other than the rise of the sun, death, taxes, and the absurd fallibility of confidence itself. The ideal is not be unbiased, but to be biased with integrity.
|Dec 7, 13Dec '13||275|
|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|
|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. New materials that may achieve different and possibly superior benefits, but probably not much. It doesn’t work biomechanically, as many professionals assume. It’s more likely that the odd sensations change function and reduce pain, but that kind of effect tends to be minimal, and hard to predict and control.A quick analysis of that colourful therapy tape that was so popular at the Olympics. Does it help?
|Nov 21, 13Nov '13||1,900|
|A tale of two taping papers||Nov 20, 13Nov '13||300|
|Memoirs of a female flight surgeon||Nov 19, 13Nov '13||230|
|A tug-of-war over scraps||Nov 19, 13Nov '13||170|
|Do our bones influence our minds?+ |
Do our bones influence our minds? “Who thinks of the bone as being an endocrine organ? You think of the adrenal gland, you think of the pituitary, you don’t think of bone.” But apparently you should.
|Nov 19, 13Nov '13||35|
|Knee arthroscopy does not work+ |
The data is now overwhelmingly negative. DoctorDoubter:
And that’s why I link to him.
|Nov 13, 13Nov '13||40|
|Not so new+ |
Mea culpa: that knee ligament “discovery” I linked to yesterday? Not so much discovered as “looked at more careful like.” Studied, classified. Perfectly worthwhile research, but over-hyped by the media reporting about it. It was definitely hyperbole to describe it as a discovery. It’s been known of for at least a century, and a paper last year reported finding it in every knee they looked at. I didn’t look more carefully at the story because it was just a minor interesting thing (and anatomy really is never done), but it’s amazing what even a tiny little bit of hype will do. Hat tip to Tony Ingram of BBoy Science for raising my awareness.
|Nov 7, 13Nov '13||110|
|New ligament+ |
And perhaps iliotibial band syndrome? I don’t see any obvious relevance to ITBS — this new ligament is a little low for that — but I’ll be mulling it over. Regardless, it’s a fun discovery. Contrary to what people assume, “basic” anatomy is still a work in progress.
|Nov 6, 13Nov '13||80|
|How many sets is enough?||Nov 5, 13Nov '13||170|
|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||Nov 5, 13Nov '13||7,500|
|Microblog changes+ |
The PainScience.com “microblog” was introduced in March of 2013, a minimalistic format optimized for bite-sized posts and announcements. This week it got its first big upgrade: small as they are, posts now have their own dedicated pages (instead of just living in a big list). For instance, see the last post, “Dissing dyskinesis.” Or — random example — the very popular “Good news about running.”
There could be a little strangeness with the RSS feed at first, probably duplicates of recents posts, but it will be fine going forward.
|Nov 1, 13Nov '13||85|
|Dissing dyskinesis||Oct 22, 13Oct '13||240|
|You too can learn to feel a hair!+ |
Alert reader Michael B. sent me this example of crazy clinical arrogance about diagnosing by feel (palpation), How To Get Out Of Pain In 30 Days. There’s a million crappy miracle cure sales pitches out there, of course, but this one stands out for its emphasis on near-magical powers of palpation in particular, an entertainingly distinctive delusion of grandeur.
Yes, that’s all it takes to get “x-ray hands”: hair rubbing. And if you believe that, I’m having a bridge sale. I’ve written about this particular flavour of nonsense before…
|Oct 21, 13Oct '13||130|
|It’s not medical+ |
There is no such thing as “medical acupuncture.” The term is oxymoronic propaganda, a common way to make acupuncture seem more legitimate. But it’s all just acupuncture: defeated in one rigorous clinical trial after another for many years now.
|Oct 21, 13Oct '13||35|
|Like getting blood from a bone||Oct 21, 13Oct '13||375|
|Palpatory Pareidolia Sensory illusions, wishful thinking, and palpation pretension in massage and other touchy health care||Oct 18, 13Oct '13||2,500|
|Reflexology “science”||Oct 4, 13Oct '13||190|
|Therapy dominated by obsolete ideas+ |
In a 2011 paper, “The Modernisation of Manipulative Therapy,” Australian physiotherapist Max Zusman writes:
|Oct 3, 13Oct '13||120|
|How to run really, really far+ |
Extreme examples are educational. For instance, we know from the experience of ultra runners that it is possible to run in a way that is less hard on your body. Once again, consider the case of Philippe Fuchs, who ran from Paris to Beijing, covering ~5,100 miles in 161 days. His primary concern was his “ability to keep absorbing muscular and skeletal punishment day after week after month,” of course. By the time Fuchs finished, he had developed an endurance stride that was clearly shorter and lower: he padded along with about 6% more steps per mile, a whopping 30% less time in the air, and 11% less landing force. I’m betting he wouldn’t have made it without those adjustments. Fascinating!
|Oct 2, 13Oct '13||120|
|SaveYourself faster!+ |
20 hours per day faster. Sorta. The slowest part of downloading most web pages is the images. Although PainScience.com [formerly SaveYourself.ca, at the time of the change] pages are already fast (under one second for most visitors), a good chunk of that time is images.
From the Dept. of Long Overdue Chores: hundreds of images on PainScience.com have now been replaced with lighter, aggressively web-optimized versions that download about 20% faster on average. It doesn’t sound like a lot, but with about 18,000 page visitors per day, it definitely adds up. In fact, it will save (very roughly, lots of variables) about twenty hours of data downloading time for my visitors every single day. With more and more people on cellular data plans, that actually matters!
|Oct 1, 13Oct '13||120|
|Tight hamstrings, back pain, and movement||Sep 24, 13Sep '13||190|
|Pain’s complexity+ |
“It’s all coming from the ____, I know it!” The temptation to boil the cause of chronic pain down to a single culprit can be almost overwhelming, but you must resist. Single causes of long term pain are almost unheard of. Nearly all chronic pain is a witch’s brew of different factors, complex by nature (not just coincidence or bad luck). This makes it harder to beat overall, but some factors are more treatable or manageable than others. Find and work with those.
|Sep 24, 13Sep '13||80|
|Bad biomarkers, good knee news||Sep 20, 13Sep '13||275|
|What’s a runner gotta do?+ |
Here’s a short, fascinating ultra-running case study with a counter-intuitive outcome: Philippe Fuchs ran from Paris to Beijing, covering ~5,100 miles in 161 days. He “lost five pounds during the run, and his percent body fat dropped from 21.5% to 16.5%. You’d think this would make him more oxygen efficient. It didn’t.” Damn! Biology is wacky.
|Sep 20, 13Sep '13||55|
|Touch-testing the world+ |
new article about Kinesio Tape® and similar products, which explains that therapeutic taping is mainly just a sensation tweaker, and that’s fine as far as it goes. We humans are neurological input-output machines. We constantly, systematically, creatively tinker with how we feel … touch-testing the world. This is why I have no strong objection to therapeutic taping, but also why I will probably never be impressed by it: it’s just another method of playing with how our bodies feel, one of many. But it will never trump functional challenges as the main drivers of recovery and performance. The bottom line is always going to be that we have to push ourselves a little to get better than we are — and being taped just isn’t much of a challenge.
|Sep 19, 13Sep '13||130|
|Performance enhancement+ |
“Performance enhancement” is usually a problematic claim, because it’s commonly based on sloppy extrapolation from recovery effects (which are themselves often a bit sketchy). Even what genuinely helps people who are sick or broke is not necessarily going to do anything for fit, healthy people. Or vice versa. (Simple example: compression bandaging for swelling. Unambiguously handy in recovery … but useless if you’re not swollen!) Rehabilitation and performance enhancement are just different things. On the one hand, they are the same process with different starting points. On the other hand, how much value the body can extract from an input is generally proportionate to need. A glass of water is more important to a man dying of thirst, and novel sensation is more neurologically useful to an injured person than a healthy Olympian.
|Sep 19, 13Sep '13||130|
|The prodigy problem||Sep 17, 13Sep '13||170|
|How to dismiss science you don’t like+ |
There’s always a way! This is both deep and funny — nice work by Dylan Matthews at Wonkblog. It seems like a bit of a credibility disaster for science analysis, but don’t be too cynical: most scientific papers legitimately do not deserve an A-grade. Like any good science writer, I try hard to dismiss only the evidence that actually deserves it.
|Sep 16, 13Sep '13||60|
|Not good enough, Pilates+ |
It is a widely and passionately held belief that back and abdominal strengthening will help back pain, and Pilates is the branded exercise system dedicated to core strengthening, so Pilates must be good for back pain, right? But in a recent test by Miyamoto et al, patients who did Pilates had “small benefits” compared to those who did not. And the test had a serious flaw: it neglected to compare Pilates to other any other kind of activity (shamefully sloppy design, fairly junky science). These results only add to the pile of evidence that exercise and therapeutic attention of any kind are probably good for low back pain. It’s only worth reporting these results insofar as they damn Pilates with the faintest possible praise — evidence that Pilates has no special power over back pain. I am not even a tiny bit surprised by this.
|Sep 12, 13Sep '13||140|
|Educated guesses+ |
Ideas based only on educated guessing about biology, however reasonable and plausible they may sound, have a nasty habit of falling apart when more directly tested. This is one of the strongest patterns in the history of medicine.
A classic modern example is autologous blood injections for tendonitis: an idea that sounds promising if you just talk about the biology, but fails when tested on actual patients.
|Sep 11, 13Sep '13||60|
|What people really look like+ |
Because, of course, what we see in magazines and movies aren’t really people anymore, but skilfully lit and pixel-manipulated artwork — beautiful in their own way, of course, or why bother? But they are only distant, abstract cousins to homo sapiens. In all my years massaging, I never experienced a client as “ugly.” It just isn’t possible when you’re actually paying attention to the person.
|Sep 10, 13Sep '13||120|
|Pain vs. brain: a follow-up||Sep 5, 13Sep '13||275|
|Weights as good as a run?+ |
What if it was just as good for your aerobic fitness to lift weights as to run? Here’s a paper that says it probably is. The authors have a bias favouring this theory, and there’s no real evidence about it yet, but it’s plausible and they make several perfectly reasonable points about the basic exercise biology. At the very least, it does firmly support the idea that building strength is better for general fitness than most people realize (which is all I’m really after). More detail in the bibliography:
|Sep 5, 13Sep '13||90|
|Pain vs. 1600 pounds||Sep 4, 13Sep '13||180|
|“Just” a half hour+ |
A “half hour run” sounds so innocent. I’ll just go for a half-hour run. See? No big deal, right? But I can really kick my own ass in thirty minutes.
|Sep 3, 13Sep '13||30|
|Needless needles?||Aug 29, 13Aug '13||160|
|Because fascia||Aug 29, 13Aug '13||210|
|Biomechanicomplicated||Aug 29, 13Aug '13||200|
|Mobilizing cat+ |
Perfect little animation to whimsically “demonstrate” mobilizations (dynamic joint mobility drills). Gifs are big files, so this is a tiny version, but zoom for the full size (1.7MB!).
Also, not that it really matters, but this cat looks exactly like my cat (no longer with us, RIP) and that couch looks exactly like my couch. See?
|Aug 27, 13Aug '13||55|
|Does [favourite massage method] work?||Aug 27, 13Aug '13||230|
|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|
|Enhanced placebos||Aug 22, 13Aug '13||170|
|Never give up+ |
Never give up, because you can recover from damn near anything … if you are patient and methodical. Gene Lawrence, a 74-year-old record-setting powerlifter, tore his quadriceps. Eight months later he’s on the verge of beating his personal bests: total recovery. Bret “The Glute Guy” Contreras tells his story, and some other tales of extreme recovery, and extracts some lessons.
|Aug 22, 13Aug '13||60|
|Is science your enemy?+ |
Hint: no (certainly not when properly defined). Todd Hargrove has “noticed that some of my colleagues in the bodywork community are somewhat disapproving of using a scientific approach to understanding how the body responds to manual therapy.” Indeed! But he’s also noticed a positive trend, and I agree: it is getting better, and it has a lot to do with blogging and social media. Nice post, with a nice mention for yours truly and several more I know well. Thanks, Todd.
|Aug 22, 13Aug '13||80|
|Wonky knees||Aug 20, 13Aug '13||200|
|Happy traffic stats, ScienceBasedMedicine.org news||Aug 20, 13Aug '13||375|
|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||Aug 20, 13Aug '13||2,300|
|Hooray for thorough massage!||Aug 15, 13Aug '13||250|
|Why are non-USD prices for my e-books so much higher than the going exchange rate?||Aug 15, 13Aug '13||220|
|When to worry about back pain||Aug 14, 13Aug '13||220|
|Good screening news||Jul 31, 13Jul '13||150|
|Should I run recklessly?+ |
Real question from a runner:
Um, no … in (at least) 2 important ways:
First, of course, there’s just a real risk of making any injury much worse that way. Duh! There are exceptions, but you need to know what those are — you need a clear and specific rationale for breaking a generally excellent rule.
And second, “stuffing” with pain-killers is seriously risky and useless to boot. Pain-killers are bandaids at best, possibly not even that, and definitely not a good long term solution, because there isn't a single one that doesn't have truly serious hazards with chronic use (not the least of which is their effectiveness wanes).
|Jul 30, 13Jul '13||120|
|Critical what?+ |
Critical what? Hardly a day goes by I don’t read something smart online about critical thinking: how important it is, how to do it, why to bother. It’s everywhere. So … why is so much not-so-critical thinking still floating around out there?! It seems odd.
The answers are obvious of course: above all, good quality thinking is a skill, because it requires working around obstacles that are truly unknown to us without training (obscure logical fallacies and sneaky cognitive distortions). It’s a hard skill to learn even for people who are super motivated. There’s almost no chance if it threatens comforting beliefs… or, worse, the basis for making a living!
But it still seems mighty peculiar and ironic that there’s so much good information available about critical thinking that isn’t being used.
|Jul 30, 13Jul '13||130|
|Yoga for neck pain+ |
A small experiment (Cramer et al) optimistically concluded that Iyengar yoga helped neck pain more than a generic exercise program. But this research was too flawed to trust. Dr. Edzard Ernst was not impressed, and I entirely agree with him: “One does not need to be an expert in critical thinking to realise that… the positive outcome might be unrelated to yoga.”
|Jul 25, 13Jul '13||60|
|The placebo paradox+ |
How refreshing! A perspective on placebo that doesn’t worship the “power” of placebo, but looks instead at the paradox of placebo: if placebo is so ding dang powerful, why isn’t everyone cured? Perhaps because the placebo effect is basically a dysfunctional mistake. Here’s a video, Why does the placebo effect work? 6:01, and here’s the scientific paper it’s based on, Humphrey & Skoyles, Current Biology, 2012 — and here’s some excellent some extra reading from Seattle Rolfer Todd Hargrove, who did a nice job interpreting and explaining the scientific paper. The additional perspective is most welcome.
|Jul 25, 13Jul '13||90|
|More pain = more pain||Jul 23, 13Jul '13||170|
|Self-improvement through pain+ |
Rob Heaton, How chronic pain has made me happier:
This sentiment was perfect for my article about healing by growing up.
|Jul 23, 13Jul '13||140|
|Intelligent rabbit massage||Jul 22, 13Jul '13||150|
|Pain Relief from Personal Growth Treating tough pain problems with the pursuit of emotional intelligence, life balance, and peacefulness||Jul 20, 13Jul '13||2,000|
|Why so negative?+ |
I deal with a lot of controversial subject matter. I debunk and criticize many products, services and ideas, which many perceive as “negative” … while I perceived it as “ethical” and generally have a lot of fun taking my subject matter seriously.
I’ve been writing about my so-called negativity off and on for years. I’ve prepared a compilation of tales of outrageous hate mail, quotes and comics and quite a bit of whimsy and eye-rolling, the ethics and tactics of debunking, what’s it like to be an “enemy of massage,” and — my favourite — “advanced negativity,” a discussion of how cynicism is baked into science in the form of the null hypothesis.
|Jul 19, 13Jul '13||110|
|Noise, noise, noise!+ |
Noise, noise, noise! I am often asked about the meaning of knee noise (“crepitus”), which can often be quite spectacular — surely the loudest joint in the body. But knee noise in the absence of any other clear signs (like pain) is usually uninterpretable. It does not correlate well with problems. So you can be in trouble ... silently. And you can be fine... noisily. Rule of thumb: crepitus is only of concern if you’re also in pain, and not necessarily even then.
|Jul 18, 13Jul '13||80|
|Risk vs benefit||Jul 17, 13Jul '13||50|
|“Disc” pain+ |
In this 2003 study of 31 Olympic athletes with back pain/sciatica, only about half had signs of disc degeneration or bulging. These are elite athletes, not malingerers. If they say they hurt, they hurt! Yet MRI failed to identify a disc problem in half of them. Just one of many studies of this sort cited in my low back pain tutorial.
|Jul 16, 13Jul '13||60|
|AllTrials is going well+ |
AllTrials.net is trying make sure all pharmaceutical research results are reported — not just results that make drugs look good. The project is going better than I dared to hope. From an encouraging update on the project website: “Major organisations around the world are now taking this problem more seriously than ever before… The problem of trial results being withheld has been well documented for three decades, with poorly implemented fixes along the way, but now there is clear policy movement.” Excellent!
|Jul 16, 13Jul '13||80|
|Terrible and wonderful+ |
Odds that I would share this? 100%! Some things are just unavoidable. When one of my favourite comic artists ever (Matthew Inman of The Oatmeal) creates something detailed (six parts!) about long distance running — The Terrible & Wonderful Reasons Why I Run Long Distances — yeah, I’m definitely gonna share that. Because I’ve written three whole books about the consequences of long distance running.
|Jul 16, 13Jul '13||65|
|Good news about running+ |
|Jul 9, 13Jul '13||85|
|Dramatic acupuncture harm+ |
Egads, worst case scenario here. Eyebrow-raising pictures. Canadian Olympian’s ‘nightmare’ after acupuncture needle collapses her lung.
|Jul 5, 13Jul '13||15|
|Painful neck = weak breathing+ |
Intriguing: this test of 90 patients (half with neck pain, half without) showed that neck pain correlates pretty clearly with weak breathing. But is the weakness a cause? An effect? A bit of both, perhaps — if I had to guess (and I do have to guess), I’d guess “all of the above.” Both pain and weakness are probably both a cause of and an effect of the other.
|Jul 5, 13Jul '13||65|
|Less is more than enough||Jul 3, 13Jul '13||150|
|I’m officially more important now||Jul 2, 13Jul '13||375|
|Why is back pain still a huge problem?+ |
Why is back pain still a huge problem? Here’s an articulate explanation from a new paper by Max Zusman:
Nicely said. More simply: patients believe back pain is caused by structural fragility, and therapy careers are often built on catering to that belief.
If only I could edit it, though, I would say instead that it is difficult to alter that belief in anyone, patient or professional. The overemphasis on fragility isn’t just reinforced by the practices of manual therapists, it’s the reason for many of them.
|Jul 2, 13Jul '13||140|
|Derpish stupidity+ |
“Derp” defined as a Bayesian probability concept: the persistent refusal to update beliefs about what is likely to be true based on new evidence.
The word “derp” originally comes from pop culture, but has come to be used most earnestly in political punditry, referring to the extreme mental ruts characteristic of American right-wing extremists. But derpish stupidity is also rampant in health care, and this more technical definition of what derp has come to mean in politics is a pitch perfect description of how quacks defend their beliefs — namely, with self-serving assumptions that are impervious to contrary data, and are literally decades or even centuries behind biology and medicine.
|Jul 2, 13Jul '13||100|
|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|
|Do You Believe in Qi? How to embrace a central concept of Eastern mysticism without being a flake||Jul 1, 13Jul '13||800|
|Holy spinal adjustment, Batman!+ |
Overheard: a chiropractor speaking of an upper cervical treatment said to a patient, “Your neck is now in God’s alignment.” Not just an adjustment — it’s holy! Oddly enough, and little known to many patients, there is a strong theme of Christian fundamentalism in chiropractic that blends seamlessly with the work, as though chiropractic is a spiritual calling. It is strange and distasteful to virtually anyone but another fundamentalist Christian.
|Jun 29, 13Jun '13||70|
|Knee surgery denounced by surgeons||Jun 26, 13Jun '13||200|
An understatement from Dr. Harriet Hall writing for ScienceBasedMedicine.org: “Since knee osteoarthritis is such a ubiquitous annoyance, home remedies and CAM offerings abound.” Boy, no kidding. That’s from Dr. Hall’s short, clear summary of a major report on treatments for knee arthritis.
|Jun 25, 13Jun '13||40|
|Cat pets baby+ |
And now for a totally uncontroversial post (?) featuring a short, sweet video of a gentle cat, a tired baby, and the Awesome Power of Touch. Aaaw!Cat soothing crying baby to sleep 1:40
|Jun 25, 13Jun '13||25|
|Spinal Nerve Roots Do Not Hook Up to Organs!+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||Jun 21, 13Jun '13||2,400|
|Running still good for you||Jun 13, 13Jun '13||170|
|Science isn’t broken||Jun 8, 13Jun '13||210|
|Applied “Kinesiology”+ |
Another new sassy micro article, criticizing another off-the-wall part of alternative medicine: Applied “Kinesiology”, which has nothing to do with kinesiology, and often wastes the time and money of patients with chronic pain. They deserve and need much better. As with my therapeutic touch article earlier this week, this is another topic I have little patience for, but it’s too common to entirely ignore — so here’s my brief position statement. As usual, critics need to know before commenting that I have plenty of direct experience with every scrap of pseudoscience that I now criticize.
|Jun 7, 13Jun '13||80|
|Research tip+ |
Another new micro article, and the seed of a larger one. I’ll definitely add to this one in time: Studying the Studies: Tips and musings about how to understand (and write about) pain and musculoskeletal health science
|Jun 5, 13Jun '13||20|
|Now hear this: 5 new audio articles+ |
They aren’t free (unless you are a blind or low-vision visitor). I created these to be a nice perk for my best customers, who have bought a bundle of all my e-books, the e-boxed set.
|Jun 4, 13Jun '13||120|
|Actual touch not included+ |
I’ve never written about therapeutic touch before, or gotten involved in the many online debates about energy medicine that are more or less constantly burning somewhere on the internet (especially Facebook). I am a science writer, my plate is plenty full with that, and I just couldn’t be bothered delving into that very anti-scientific topic. On the other hand, I also want to “touch” on every therapy and pain topic, at least a little — that’s my ultimate writing goal for PainScience.com. So I finally got around to it.
|Jun 4, 13Jun '13||120|
|Good questions about orthotics||Jun 4, 13Jun '13||160|
|Failed healing+ |
Most of the time it’s hard not to heal. You couldn’t stop it if you tried — not that you’d want to. The body is going to recover from most kinds of injuries almost no matter what — it’s just a matter of time. As long as you were reasonably healthy before you were injured (and you don’t smoke or otherwise abuse your vitality), healing will usually progress inexorably.
Chronic pain is different by definition: it doesn’t stop when it’s supposed to. Either healing itself fails, or the pain continues even when the tissues are fine, or a bit of both. Overuse injuries or repetitive strain injuries (RSIs) like carpal tunnel syndrome and plantar fasciitis are slow-motion traumas that often seem immune to recovery — this is what makes them both terrible and fascinating. They are not as simple as they seem. More:
|Jun 4, 13Jun '13||140|
|Resisting postural assessment+ |
Or: How I made a newbie massage therapist cry once. An update to my main posture article:
|Jun 3, 13Jun '13||15|
|Some gold standard+ |
Probably the first ever placebo-controlled study of surgery for tennis elbow … and disappointing. The experimenter scathingly concludes:
|Jun 3, 13Jun '13||65|
Readers often prevail upon me to be “objective,” but it’s an over-rated virtue. Not only will I fail to achieve the ideal of “objectivity,” I assume that my biases are inevitable, constantly egregious, and utterly human. We are all bias machines. We can only keep a bemused eye on this frailty, do some damage control, and try to avoid being emphatic or overconfident about much of anything other than the rise of the sun, death, taxes, and the absurd fallibility of confidence itself.
|Jun 3, 13Jun '13||80|
|CRPS science “something of a mess”+ |
What works for complex regional pain syndrome? Nothing known. Neil O’Connell: “The trial evidence in CRPS is something of a mess.”
|May 31, 13May '13||20|
|Good reviews of crappy studies+ |
From a review of studies and other reviews of surgeries for back pain: “Although the quality of the reviews was quite acceptable, the quality of the included studies was poor.” So back surgeries have never really been studied properly … but the reviews are quality! Hmm. I’m pretty sure that’s terrible news.
|May 31, 13May '13||50|
|Placebo PSA+ |
Because people cannot seem to be reminded of this enough: Human beings will get great placebo from any treatment that seems impressive in any way (more invasive, novel, unpleasant, whatever suggests potency). This accounts for most treatment success stories from both patients and professionals. Everyone should know better than to trust those stories — because it’s 2013, not 1913 — but they are still prevalent, given far too much weight, and they hijack most conversations about what works and what doesn’t for stubborn painful problems. As soon as someone says, “Well, it works for me/my patients,” that’s pretty much the end of any useful debate.
|May 31, 13May '13||100|
|Good back pain science news||May 30, 13May '13||160|
|Repetitive Strain Injuries Tutorial Five surprising and important facts about repetitive strain injuries like carpal tunnel syndrome, tendinitis, or iliotibial band syndrome||May 29, 13May '13||11,000|
|Does Posture Correction Matter?+Posture matters a little, but not a lot. Most “poor posture” is just bad ergonomics, 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. 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 generally speculative and over-priced. Posture correction strategies and exercises … and some reasons not to care or bother||May 29, 13May '13||13,000|
|A taijiquan spelling bee||May 23, 13May '13||240|
|The wrong notch+ |
A nice example of anatomical variation: the size and shape of a notch in the top of the shoulder blade is quite variable, and nerve impingement is much more likely if you’ve got the wrong type of notch. More anatomical variation examples:
|May 23, 13May '13||40|
|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 23, 13May '13||850|
|The anti-placebo+ |
Placebo is belief-powered relief from symptoms, while nocebo is belief-powered symptoms, or “the placebo effect’s malevolent Mr. Hyde.” And: “The Internet has become a powerful…nocebo dosing machine.” Agreed: nocebo is a genuine hazard when writing about medical problems. Read more:
|May 21, 13May '13||40|
|Progressive mythology+ |
Progressive mythology: Dr. Harriet Hall’s review (plus some excellent reader comments) of Science Left Behind: Feel-Good Fallacies and the Rise of the Anti-Scientific Left, Berezow & Campbell. A great book idea. This quote isn’t particularly representative of the book’s message, but it’s a very important idea (which I have written about):
|May 21, 13May '13||50|
|Blood injection treatment bombs a test+ |
Utterly unsurprising: injecting your own blood doesn’t help tendinitis. Nice to have a decent new trial about this over-hyped therapy though.
Not many good treatment ideas work as well in practice as they do in theory. The null hypothesis is super reliable.
|May 21, 13May '13||70|
|No more store trouble, but sheesh+ |
Thursday and Friday’s trouble with my e-bookstore now seems to be cleared up, but it took a solid 48 hours. Fascinatingly, the slowness of the recovery may have been due to a major hacking incident several weeks ago, which affected basic internet infrastructure: that is, the “Domain Name System” (DNS) may be damaged and/or deliberately slowed down as a security measure. The theory is that corrected information about the location of my e-bookstore took much longer (2 days) to spread around the world than it would have before (2 hours). Here’s an interesting NY Times article about the hacking incident, with good diagrams:
|May 18, 13May '13||100|
|Service announcement for customers+ |
For most of Thursday and into Friday morning, my online store has been flickering on & off like an old neon sign. Geeks are slaving to restore full service, and seem to have mostly succeded at this point. •mops cold sweat from brow• Part of the problem is that the internet “lost” the correct address for the store. That’s mostly fixed now, but there are still some computers out there that don’t know the correct address. Depending on where you live, you might see a weird generic page instead of my actual store. But the correct information is steadily spreading around the world (“Domain Name System (DNS) info propagation”), and I am fairly confident the worst is over. Naturally I’m readily available for any customer having trouble.
|May 17, 13May '13||120|
|Promising new fitness blog+ |
A promising new fitness blog. The State of Evidence-Based Fitness:
|May 17, 13May '13||10|
|Replication needed+ |
“Replication needed” is the ultimate caveat in scientific criticism. It covers all the bases. Everything else is just details. At the end of the day, if promising results cannot be replicated by other researchers, it doesn’t really matter what was wrong with the original research. Either a treatment works well enough to consistently produce impressive results whenever it’s tested … or it doesn’t. Updated article:
|May 15, 13May '13||65|
|Surprise run+ |
Ever run much farther than you thought you could? I haven’t done more than 5km in ages, and I often only do 2km at a time (I’ve never been much for distance as a runner, I like sprinting) … and then suddenly a pair of big 13km runs around Stanley Park in a week! The first run was a total shock, and probably an unwise spike in pavement pounding — honestly, I’m amazed I didn’t hurt myself, prone as I am to RSIs. But I got away with it just fine.
And the 2nd run? I had to see if the 1st was a fluke! I guess it wasn’t — I did just fine again. I’ll be danged.
|May 15, 13May '13||110|
|Good pain reading for pros+ |
Superb paper about pain for professionals, with a very broad scope: it’s just called “Pain.” I love a simple title.
|May 14, 13May '13||20|
|The effects of sleep deprivation+ |
Sleep: What the Research Actually Says: A readable review of the effects of sleep deprivation, with good nugget-sized highlights throughout, from my friends at Examine.com, Sol Orwell and Kurtis Frank. One quibble! Nothing about pain. But of course I have something about insomnia and pain (Insomnia Until it Hurts).
|May 14, 13May '13||45|
|The power of barking+ |
This is basically how humans decide what to believe in (e.g. simple correlations, emotional priorities). “I have the power of barking to thank for that.”
|May 10, 13May '13||25|
|Antibiotics for back pain reality check+ |
This is great! A nicely written reality check on the antibiotics for back pain hype, from PubMed. Great stuff.
Back pain is one of the richest myth mines in all of medicine. An extremely common, often serious, and usually mysterious pain problem = absolutely maximum fertility for bullshit to grow in. There are a great many books about low back pain, and many are garbage, selling snake oil and hype and false hope instead of good information. There are also some fine myth-busting books about low back pain … and mine is one of them.
|May 10, 13May '13||90|
|I was wrong: muscle is cheap, not expensive||May 10, 13May '13||250|
|And then I read my email…+ |
Sometimes I think: manual therapy is getting progressive, more science-based, clinical reasoning is growing up. Yay!
Then I read my email.
If the contents of my inbox are any measure (and they probably are), then, alas, there is still a great deal of work to do. Crazy numbers of professionals in manual therapy have clearly not even begun to understand the need to properly test treatments. And many even fight it!
|May 10, 13May '13||65|
|Do I like “SaveYourself.ca”?+ |
People ask about this occasionally: no, I don’t actually like my domain name, “SaveYourself.ca.” It smacks of religion & too-good-to-be-true promises and I’m not comfortable with that. It’s a legacy from many years ago when I had no idea what this site would become. I plan to move to a new domain name within a year.
P.S. I may not actually like my domain name, but I do still love my salamander mascot.
UPDATE: I moved to PainScience.com in November 2014.
|May 10, 13May '13||75|
|Two tiny quotes+ |
Just finished reading a slightly trashy novel, Gone Girl, by Gillian Flynn, and mined it for a couple of nice little quotes: “Sleep is like a cat: it only comes to you if your ignore it.” Perfect quote nugget for Save Yourself from Insomnia! And: “To pretend to be calm is to be calm, in a way,” which made me think of posture/mood interdependence, discussed in Does Posture Correction Matter? (Mostly for emotional reasons!)
|May 9, 13May '13||65|
|Bad icing news?+ |
|May 7, 13May '13||90|
|Strengthening for the not-so-young+ |
A charming, well-produced video summary of why and how to build strength, pitched to the not-so-young-anymore, done by the University of BC (which is in my backyard).
|May 4, 13May '13||25|
|Incurable shitty ankle+ |
Comedian Louis CK on aging joints:
|May 2, 13May '13||60|
|Jedi pain tricks!||May 1, 13May '13||190|
|Goodbye supplement confusion+ |
Interesting, impressive new work announced today by Examine.com: a well-crafted new presentation of a huge database of scientific evidence that “clearly tells you what a supplement does (and doesn’t do). Goodbye supplement confusion.” This rabbit hole goes deep, so browse. Look at their “Human Effect Matrix” tables for key topics in particular, which beautifully summarize the science (go right to an example, for creatine). What’s remarkable here is the quality of the presentation. These are not just tables of data! They are quite artful, crafted to emphasize what matters. I would love to have evidence presented like this on PainScience.com, and I do have some of the foundations for it — but I’m a few design and technology leaps away from being able to deliver something like that.
|Apr 23, 13Apr '13||120|
|Two links, one serious, the other … not+ |
This article updated recently: What can a runner with knee pain do at the gym? That’s handy, but this link is more fun: 20 Reasons Why Going To The Gym Is A Huge Waste Of Time (actually just 20 short videos of hilarious exercise misfortune).example
|Apr 22, 13Apr '13||30|
|Affectionate or creepy?+ |
The power of touch is strong in these two: a sloth lovingly, thoroughly grooms a cat. So affectionate it’s almost creepy…
|Apr 22, 13Apr '13||20|
|Beeeep||Apr 19, 13Apr '13||160|
|We hates the DRMses, my preciousss+ |
Digital rights management (DRM): it’s used by all the big publishers to limit e-book piracy … and we all hates it. You hates it, I hates it. DRM annoys customers, prevents real ownership, makes honest lending nearly impossible, locks e-books to one kind of reader … just yuck. We hates DRM! My e-books are “low DRM.” I do protect my (preciouss) books a little — but a lot less than big publishers do. In particular, it’s easy and fine to lend my e-books!
|Apr 19, 13Apr '13||80|
|Pain changes how pain works+ |
Pain itself often changes the way the way pain works, so that patients with pain actually becomes more sensitive and gets more pain with less provocation. This awful (and surprisingly common) phenomenon is called central sensitization. Everyone should know about this: owner’s manual stuff.
Another “new” article (assembled from past posts, spiffied up, made into a permanent page)
|Apr 17, 13Apr '13||55|
|Modality empires||Apr 17, 13Apr '13||170|
|Pain Changes How Pain Works+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 (sensitization)||Apr 16, 13Apr '13||2,500|
|X-Ray video+ |
|Apr 15, 13Apr '13||75|
|Not what they seem+ |
After years of practice, I can easily find your infraspinatus muscle. In the dark, in about three seconds. Through a thick towel. However, massage and manual therapists often fool themselves into thinking they are feeling things under their hands that are not actually there, or things that might be there but cannot possibly be detected with any reliability. This is palpatory pareidolia: illusions in the sense of touch.Palpatory Pareidolia: Sensory illusions, wishful thinking, and palpation pretension in massage and other touchy health care
I’ve written about this before, but this is a topic “reboot,” with content combined from a few early drafts and whipped into shape for a permanent article:
|Apr 10, 13Apr '13||95|
|Homo sapiens: not as wimpy you thought||Apr 8, 13Apr '13||275|
|Meanwhile, backstage+ |
Meanwhile, backstage: Another audio article completed this afternoon. That’s three now! I’ll be publishing them soon, so stay tuned for that. Two more to go, I think, and then it’s back to recording several more audio books.
I’ve also been spring data cleaning! Prepping for the next several years of writing, I’ve purged roughly 10,000 lines of “cruft” (junky data) out of my bibliographic database … leaving >40,000 lines and thousands of much tidier records.
|Apr 8, 13Apr '13||75|
|I dare ya+ |
I dare ya: “Try working in a hospital for a while, try to be perfect, try to never have anything go wrong that matters!” This article freshened up a bit…
|Apr 8, 13Apr '13||30|
|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|
|Tissue pathology does not explain chronic pain+ |
Source: Dr. Lorimer Moseley, Teaching people about pain — why do we keep beating around the bush?
|Apr 5, 13Apr '13||35|
|Disc, schmisc+ |
Patients with back pain and sciatica recovered about equally well with or without disc herniations visible on MRI. Most people recovered (84%) well within a year … and there were actually 2% more good outcomes in the patients with disc herniations! This seems like a rather surprising result, but that is what the research has been showing for years. There is a chance the nearly identical stats are a fluke, but they’d have to be off by a lot to change the take-home message. Even a 20-point difference, ten times larger than this, would still show that a “slipped disc” confirmed by MRI isn’t nearly as worrisome as most people assume.
|Apr 4, 13Apr '13||110|
|Unicorn horn velvet!+||Apr 3, 13Apr '13||45|
|1-Minute fibromyalgia video+ |
Fibromyalgia is “widespread pain for three months with no other identifiable cause,” which is just as awful as it sounds. 2% of people suffer from it (that’s a lot), but in an odd and unexplained ratio of 9 female patients for every male. Here’s a good new one-minute video summary from Dr. Rob of One-Minute Medical School:
|Apr 2, 13Apr '13||55|
|Seven amusing alternatives to evidence-based medicine||Apr 1, 13Apr '13||180|
|Electric baths||Mar 28, 13Mar '13||170|
|Spinal infection?||Mar 26, 13Mar '13||220|
|Updated Tissue Provocation Therapies+ |
Updated my article about Tissue Provocation Therapies. The update was inspired by a new article by Leonard Van Gelder, a “huge proponent” of Instrument Assisted Soft Tissue Mobilization (IASTM, like Graston). It’s a decent critical review of IASTM, with some fairly harsh words, but it also rests on a foundation of classic error: certainty that a treatment really works. It doesn’t take much reading at TestingTreatments.org (see previous post) to realize that it’s actually impossible to know if a something works based on clinical observations alone. Repeat after me:
“I will not claim to know what treatments really work for pain before they are properly tested.”
“I will not claim to know what treatments really work for pain before they are properly tested.”
“I will not claim to know what treatments really work for pain before they are properly tested.”
|Mar 22, 13Mar '13||130|
|Testing Treatments+ |
Testing Treatments continues to grow & improve, and it was great to begin with. It looks like quite a few new tools and features have been added to the site over the last year. It’s a really terrific resource, maybe even the single best place for professionals to start learning about evidence-based medicine.
|Mar 22, 13Mar '13||50|
|A boast post+ |
As of Monday, PainScience.com now reaches more than 10,000 visitors every day … with great reading time statistics. People who come to PainScience.com stay and read.
|Mar 20, 13Mar '13||25|
|Clinical Decision-Making+ |
Clinical Decision-Making Part III from ScienceBasedMedicine.org: fairly heavy professional reading, but gooood. Dr. Novella is an extremely clear thinker and writer.
|Mar 20, 13Mar '13||20|
|Stretching for trigger points+ |
More about trigger points today: skeptical revision of Stretching for Trigger Points points out many problems in theory & practice (understatement).
|Mar 18, 13Mar '13||15|
|More than placebo, less than medicine+ |
|Mar 18, 13Mar '13||70|
|Topical NSAID risks much lower than oral||Mar 15, 13Mar '13||180|
|Impruvism.com podcast+ |
I was interviewed about back pain myths by Armi Legge for the Impruvism.com podcast.
|Mar 15, 13Mar '13||10|
|One of my favourite history of medicine stories+ |
It’s the 200th birthday of John Snow, the father of epidemiology, the science of diseases and how they spread. In 1854, Snow mapped cases of cholera and traced the disease to its origin, and proved with a simple test that it was coming from a polluted well: he removed the pump handle, and the cholera outbreak stopped. Naturally, this conclusion was scoffed at by those with competing theories (“bad air”), producing one of my favourite history of medicine stories: to prove that cholera was not in the water, some smartypants biologist drank a glass of the stuff … and got away with it, because he just happened to be immune. It’s a great example of why “experience” is not trustworthy, and why it takes so long to settle even relatively straightforward puzzles in medicine.
|Mar 14, 13Mar '13||130|
Why am I so “negative”? I am often asked this. There are many answers, and the most important has always been that I value truth-telling in health care for its own sake, even if it’s disappointing, and unfortunately a lot of it is. Here’s a nice quote from author Chris Brogan that gives another nice answer: “To truly know what works, you have to learn what doesn’t work first.”
|Mar 13, 13Mar '13||65|
|Revenge of the Woo+ |
Dr. Steven Novella’s entertaining report on a weird paper in which some acupuncturists “grossly mischaracterize their critics and manage to completely avoid the substance of our criticism.” See also his follow-up post the next day, Another Acupuncture Meta-Analysis — Low Back Pain, summarized thusly: “1 — Acupuncture does not work. 2 — Acupuncturists refuse to admit that acupuncture does not work.”
|Mar 13, 13Mar '13||60|
|Tissue state is just chemistry||Mar 13, 13Mar '13||150|
|Pelvic tilt+ |
Pelvic tilt is one of the great biomechanical bogeymen, one of those things that gets blamed for a lot of pain and is the justification for a lot of massage and chiropractic therapy. I was taught in school to judge pelvic tilt by measuring the pointy bits. It all seemed very technical. And yet, as I always suspected, pelvic shape is simply much too variable to diagnose pelvic tilt by feel. The shape can vary as much as the position! A new study of cadavers “found that the PSIS/ASIS angle varied from left to right (up to eleven degrees), even when the pelvis was in neutral. The asymmetrical shape of the pelvis in this respect could make it appear that one side is rotated forward compared to the other.” That’s from a superb report on the study by Todd Hargrove at BetterMovement.org:
|Mar 12, 13Mar '13||140|
|Interesting but not awfully important epiphenoma+ |
Gray matter density changes with pain are “interesting but not awfully important epiphenoma”? Neil O’Connell for Body In Mind, with his usual sassy clarity:
|Mar 11, 13Mar '13||20|
|An unfortunate trivialization+ |
“The labeling of nociceptors as pain fibers was not an admirable simplification, but an unfortunate trivialization under the guise of simplification.” — Patrick Wall, 1986 (“The relationship of perceived pain to afferent nerve impulses”). Context and more for that quote in a good, short article by Moseley, “Teaching people about pain: why do we keep beating around the bush?”
|Mar 11, 13Mar '13||50|
|Two especially nice reader comments+ |
Nice reader comment #1: “It is obvious that you are willing to go to explanatory lengths that no one else will.” That’s a great way of putting it. That is the whole idea of feature articles and ebooks for PainScience.com: deep topic diving.
Nice reader comment #2: unusually exuberant! I get a lot of “good site” and “I like the clean style,” but this fellow was really impressed:
I think he likes it. I’m not sure, but I think so. Maybe if he were slightly more enthusiastic I could tell…slug:2 nice reader comments
|Mar 11, 13Mar '13||120|
|Introducing the microblog||Mar 8, 13Mar '13||200|
|Seriously, funny salt+ |
No joke: my Epsom salts article is now funnier. Whimsy added where possible, for example the paragraph about vaginal absorption:
|Mar 8, 13Mar '13||75|
|Big fascia update+ |
|Mar 1, 13Mar '13||45|
Some nice dissection-perspective on connective tissue and stretching here. (And some kind words about PainScience.com as well—thanks, John Underdown of TailoredPT.com.)
|Feb 27, 13Feb '13||20|
|Glucosaminimal+||Feb 26, 13Feb '13||25|
|Posture is a hit!+ |
Like-new posture article has been a big viral hit last 2 weeks: more than I expected. If you missed that news, see:
|Feb 26, 13Feb '13||20|
|Sexy mental fitness+ |
Another terrific quote from Sam Kean’s very charming 2012 book about genetics, The Violinist’s Thumb. Not super on-topic for PainScience.com … but I still think a lot of you will love it.
|Feb 26, 13Feb '13||85|
|Stretching for Trigger Points Is trigger point release a good reason to stretch?||Feb 25, 13Feb '13||1,700|
Fred Wolfe on The Fibromyalgia Perplex: “It is discovered that the true meaning of fibromyalgia is not as simple as is usually believed.” Boy, no kidding. I have now read FMPerplex.com “cover to cover,” so to speak. I like Dr. Wolfe’s style, and I’ve learned a fair bit (and updated the introduction to my muscle pain tutorial). Here’s a recommended post:
|Feb 19, 13Feb '13||55|
|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|
|Stretching good for the heart+ |
A strange idea? Or maybe it’s just obvious that lots of somatic sensation is regulatory. A study finds “stretching routines may contribute to a favorable autonomic activity change…” Study:
|Feb 16, 13Feb '13||25|
|Good massage news+ |
|Feb 16, 13Feb '13||15|
|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||3,000|
|Big boner+ |
The naturalistic fallacy: “One of the biggest boners in ethical philosophy.” Another terrific quote from Sam Kean’s very charming 2012 book about genetics, The Violinist’s Thumb. This is relevant to natural/barefoot running. Full quote:
|Feb 13, 13Feb '13||130|
|Morgan Schmorgan+||Feb 12, 13Feb '13||10|
|1,001 followers+ |
1,001 followers of my Twitter account! :-) I guess I’ll keep tweetin’.
|Feb 12, 13Feb '13||10|
|Posture reactions+ |
I had 997 followers this morning. Then I started trash-tweeting the clinical importance of posture. Now I have 994. Some say I’ve been too hard on posture importance, some say not hard enough! I lean towards “not enough.” Best criticism of my posture article so far? I don’t mention potential for nocebo & unintended consequences of advice [Now corrected]. Belief in postural dysfunctional can probably drive a nocebo + spinoff beliefs about vulnerability + harmful zeal for “correction.”
|Feb 11, 13Feb '13||75|
“Posturology” is the cheesy, popular term for the mostly made-up “discipline” of studying the relationship between posture and pain, and even diseases. Posturologists (I can barely write that with a straight face) tend to assume their own conclusion: they just take it for granted that poor posture does cause pain and then look for confirmation. And so there are many, many scientific papers that seem to present evidence of a connection between posture and pain, but most of them suck (see Guimond et al for a good example) and “posturology” is mostly a slummy pseudoscientific research backwater. There may actually be something to learn, if only posturology research was better quality, but most of it has to be just chucked or at least taken with a huge grain of salt.
|Feb 11, 13Feb '13||120|
I only critisize someone’s communiation skills when their writeing problem are signicifant and revelant!
|Feb 9, 13Feb '13||10|
|New massage myth+ |
A year ago we got a new massage myth: “reduces inflammation & promotes mitochondria.” Bollocks — and I still seeing it getting passed around all the time. Here’s what I wrote:
|Feb 8, 13Feb '13||30|
|Affective massage therapy+ |
Want some good science news about massage therapy? Okay! Massage clearly reduces anxiety & depression. Great article about what massage does for “an individual’s feelings, moods and emotions”:
|Feb 8, 13Feb '13||25|
|Cleaner, sparklier+ |
PainScience.com is now routinely professionally edited — even cleaner, sparklier articles — by JoAnne Dyer of Seven Madronas Communications.
|Feb 8, 13Feb '13||15|
|Two Audiobooks Now Available||Feb 4, 13Feb '13||250|
|Unstable? Unreliable+ |
You can’t very well treat core instability if you can’t diagnose it as a problem in the first place. This test of the reliability of core strength testing was a clear failure: “6 clinical core stability tests are not reliable when a 4-point visual scoring assessment is used.” Even if core strength is important (a separate question), this evidence clearly shows that no one should be claiming to be able to detect a problem with core weakness in the first place. A bit problematic for core dogma.
Just added this citation to my article about reliability studies—it's a really good example of poor reliability. Later I will add it to a half dozen more articles.
|Feb 4, 13Feb '13||110|
|Diagnostic reliability+ |
“Gunshot wound diagnosis is reliable.” From: Is Diagnosis for Pain Problems Reliable?
|Feb 4, 13Feb '13||7|
|Comic back cracking+||Feb 4, 13Feb '13||25|
|Hope springs eternal+ |
“What’s the best solution?” I get this question constantly. There’s no “best solution” for any hard pain problem … only a few imperfect options.
|Feb 3, 13Feb '13||20|
|I don’t know if you gots it+ |
Reader question of the week: “Do i got the IT band syndrome?”
(An ESL reader, to be fair. Regardless, it’s beyond me why people think I can diagnose by email.)
|Feb 3, 13Feb '13||25|
|Kind customer feedback+ |
Kind customer feedback of the week: “Thank you for a very edifying yet witty tutorial.” Referring to my e-book:
|Feb 2, 13Feb '13||15|
|Barefoot understatement+ |
The discovery of barefoot heel-strikers adds to “lack of certainty about what makes for ideal running form.” From a NY Times article, “Is There One Right Way to Run?”
|Feb 2, 13Feb '13||25|
|A common problem+ |
“My chiropractor says this is because the top of my neck attaches to my head. Is that a common problem?” ~ Doc Grumpy
|Jan 31, 13Jan '13||20|
|Ultrasound update+ |
|Jan 28, 13Jan '13||30|
|Many people believe+ |
One thing about my job: I get a lot of email from patients everywhere…a constant, endless, informal survey of treatment practices and prevalent ideas. This allows me to write things like “many people believe” with some authority. I actually do know better than, say, the average clinician.
|Jan 28, 13Jan '13||45|
|Kinesio tape+ |
Shocker: science sez applying kinesio tape had no effect on muscle strength. Daft idea to begin with. See Vercelli et al.
Fun fact: an image Search for “kinesio taping” gets lots of SEXY shots. Huh! Ladies, many of one particularly hot male model. Yow yow!
|Jan 24, 13Jan '13||40|
|I can relate+ |
Reader finds my insomnia article Googling “when does sleep deprivation become lethal.” I can relate to that question.
|Jan 22, 13Jan '13||15|
|Creatine-induced insomnia||Jan 19, 13Jan '13||250|
|Now that’s ankle flexion+ |
“They can get their foot almost 45˚ to the shin. (Normal range of motion for a westerner is ~10-20˚).” ~ Todd Hargrove
|Jan 19, 13Jan '13||20|
|Crappy acupuncture reviews+ |
“…most systematic reviews of acupuncture published in China don’t search the literature thoroughly & don’t evaluate it properly. … There is ample reason to be suspicious of the conclusions of [Chinese] systematic reviews [of acupuncture].”
|Jan 18, 13Jan '13||35|
|Painless dislocated … neck?+ |
Case report & disturbing X-ray of a traumatic neck dislocation… mostly asymptomatic. Even very serious injuries can cause amazingly little pain. Fascinating!
|Jan 18, 13Jan '13||20|
|Exploding head syndrome+ |
I will have to look into “Exploding head syndrome.” Plus a couple others. 13 weird studies.
|Jan 18, 13Jan '13||15|
|Does Epsom Salt Work?+Epsom salt in your bath is cheap and harmless and it makes bath water feel “silkier,” so there’s no reason to ban it from your life. However, it probably doesn’t do what you hope it’s doing. Although Epsom salt probably does have some physiological effects, it is unknown if there is a therapeutic effect on aches and pains … and somewhat unlikely. Most of the theories you hear are oversimplified and meaningless — for instance, nearly everyone says it is absorbed by osmosis, but that is false and impossible — and the known effects of Epsom salt don’t have much to do with common causes of pain. The heat of a nice bath is probably more therapeutic. The case for the healing powers of Epsom salt is mostly made by people selling the stuff, or recommending it as casually and imprecisely as an old wives’ tale. The science of Epsom salt bathing for recovery from muscle pain, soreness, or injury||Jan 16, 13Jan '13||8,000|
|Change how it feels+ |
Change how it feels: “novel sensory input.” One of the new pain tips:
|Jan 14, 13Jan '13||10|
|Sensory clutter+ |
“Sensory clutter”: I don’t know how yet, but soon I will find a way to use these words. (Update: I still haven’t! But I will!)
|Jan 13, 13Jan '13||25|
|Knee lube jobs+||Jan 12, 13Jan '13||30|
|Honest fan mail+ |
Honest fan mail: “The honesty of your articles is freaking fantastic.”
I do try to avoid dishonesty!
|Jan 12, 13Jan '13||15|
|Healing speed+ |
It’s usually not possible to tell if a treatment made healing “faster.” There are few ways or none to actually improve on the biological process of healing. We can’t tell the body, “Hey, heal better, will ya?”
|Jan 12, 13Jan '13||35|
AllTrials.net is trying make sure ALL research results are reported—not just results that make drugs look good. I’ve signed the AllTrials.net petition & donated. Here’s my petition statement:
|Jan 10, 13Jan '13||90|
|Minute Medical School||Jan 8, 13Jan '13||190|
|I Ain’t Just Book Smart!+ |
I have lived & loved many of the flaky & sloppy ideas in health care that I criticize and debunk today. I’ve added more information about my background to my bio page.
|Jan 7, 13Jan '13||30|
|This will sting a little bit+ |
|Jan 6, 13Jan '13||25|
|Stretching doesn’t help contracture+ |
Thumbs down to simple #stretching as a treatment for seizing up.
|Dec 31, 12Dec '12||10|
|Blogging the process+ |
I’ve written 424 blog posts (roughly 175,000 words) since I started “blogging the process” about two years ago — that is, as I go through the process of creating very detailed articles and tutorials, I share bits and pieces of what I’m working on as I go, using a blog format. So my blog posts are all in some sense excerpts or rough drafts of larger projects. I estimate that I actually wrote more than double that much, but only blogged about 175,000 words.
|Dec 31, 12Dec '12||85|
I’d never heard “anecdata” before. Cute.
|Dec 28, 12Dec '12||6|
|Brains control pain… not minds+ |
Still working this idea, finding every angle: brains control pain… not minds. It’s a subtle but vital difference.
|Dec 26, 12Dec '12||15|
|A few thoughts on the limits of self-care||Dec 26, 12Dec '12||240|
|Popular but Weird and Dangerous Cures+
The colorful history of medicine and quackery is overflowing with people who “swore by” treatments that were bizarre and dangerous. Bloodletting was popular almost until the 20th century, despite being relentlessly harmful. Some of the most lethal “cures” in history were inspired by the discovery of radiation. People happily drank metals like mercury and silver. Even drinking urine had near fad status for a while! They tried to purge disease with sulfuric acid, and stimulate their vitality (and virility) with powerful electric shocks. Women were sold Lysol as a douche … and women actually went along with it for a while. Voluntary lobotomy may be the craziest of them all: it was a popular treatment for all kinds of psychiatric disorders, and at least fifty thousand people volunteered to have their brains lanced.
All of these terrible treatments, and many more obscure examples, had many fans and enthusiastic testimonials. People paid for them, believed in them, loved them, swore by them — that is how misleading testimonials can be. People believe what they want to believe.The most dangerous, strange, and yet popular snake oils and “treatments” in history (and why anecdotes and testimonials cannot be trusted)
|Dec 19, 12Dec '12||800|
|Should You Get A Lube Job for Your Arthritic Knee? Reviewing the science of injecting artificial synovial fluid||Dec 18, 12Dec '12||700|
|I’m sorry, Creatine, I misjudged you+ |
|Dec 10, 12Dec '12||20|
|Reston was not anaesthetized by acupuncture||Dec 8, 12Dec '12||160|
|Feel safe & good+ |
Therapists: please consider not trying to “fix” flesh. Address the nervous system. Just help patients remember what it’s like to feel safe & good.
|Dec 6, 12Dec '12||20|
|EBM appearances+ |
Now here’s a good example of how EBM gets abused, co-opted: “appearing to build up the evidence base.” Context here from @doctordoubter:
|Dec 6, 12Dec '12||20|
|Placebo surgeries+ |
You “need a placebo [surgery] trial when the outcomes are ‘soft’ (subjective: pain).” ~@doctordoubter Placebo surgeries are necessary and ethical. I’ve been arguing many years we need surgeries for pain compared to shams. More:
|Dec 5, 12Dec '12||30|
|How important is sleep?+||Dec 4, 12Dec '12||20|
|PNF stretching+ |
Static stretching vs. “fancy” PNF stretching: which works better? Hold-relax, right?
It’s common for stretching enthusiasts to dismiss my concern that stretching is not all that useful with the concession that, of course, static stretching is quite pointless, but fancier methods (their methods) are “obviously” clinically useful. By far the most common example of allegedly superior stretching is the broad category of “proprioceptive neuromuscular facilitation,” and more specifically the hold relax method. Supposedly this approach works better than mere pulling on muscle. However, this test of the immediate effects HR-PNF versus static stretch on hamstrings was a bust: they both increased flexibility equally well (for whatever that’s worth).
|Dec 3, 12Dec '12||130|
|SBM’s about page+ |
My role at ScienceBasedMedicine.org is basic…but I did write their about page. And I am proud of that. (And everything I’ve ever written about SBM is just my take on what I’ve learned from Drs. Novella, Gorski, Atwood, Crislip, Hall…)
|Dec 3, 12Dec '12||40|
|Deep Friction Massage Therapy for Tendonitis A guide to a simple self-massage technique sometimes helpful in treating common tendonitis injuries like tennis elbow or Achilles tendonitis||Nov 9, 12Nov '12||2,400|
|Unconventional Ergonomics Five creative ergonomics tips you don’t hear as much about as the usual stuff||Nov 3, 12Nov '12||1,100|
|Should You Drink Water After Massage? Only if you’re thirsty! Hydration and massage are not detoxification treatments||Nov 2, 12Nov '12||4,000|
|Natural Imperfection Evolution doesn’t care if you have back pain … just as long as you can breed||Nov 1, 12Nov '12||4,000|
|Massage Therapy for Tension Headaches Perfect Spot No. 1, in the suboccipital muscles of the neck, under the back of the skull.||Oct 28, 12Oct '12||1,500|
|Don’t Stretch Your IT Band! Despite the popularity of Iliotibial Band stretching as a treatment for IT band syndrome, there is no scientific or anatomical reason to believe that any kind of IT band stretch is even possible, let alone an effective treatment||Oct 27, 12Oct '12||2,200|
|(Almost) Never Use Ice on Low Back Pain! An important exception to conventional wisdom about icing and heating||Oct 27, 12Oct '12||3,500|
|Massage Therapy for Shin Splints Perfect Spot No. 3, in the tibialis anterior muscle of the shin||Oct 27, 12Oct '12||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 muscle pain and other kinds of chronic pain||Oct 26, 12Oct '12||2,750|
|Massage Therapy for Upper Back Pain Perfect Area No. 11, the erector spinae muscle group of the upper back||Oct 26, 12Oct '12||1,000|
|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|
|Poisoning humour+ |
entire biggish article about rhabdomyolysis.
|Oct 21, 12Oct '12||15|
|The unkillable lactic acid myth+ |
Lactic acid is not a dead-end, “bad” metabolic waste product, and it does not cause post-exercise soreness. This is a pernicious and seemingly un-killable myth. It originated with “one of the classic mistakes in the history of science,” according to George Brooks, a Berkley physiologist. See Gina Kolata’s clear overview in the New York Times, or a concise professional summary by Robergs in Experimental Phsyiology. For a deeper and geekier, but excellent read, see Dr. Goodwin’s entertaining rant about the prevalence of the lactate myth in the 2012 summer Olympics coverage.
|Oct 21, 12Oct '12||90|
|Surgeon corrects my tone||Oct 21, 12Oct '12||170|
|Radiological imagining+ |
“It is recommended that radiological imagining should continue to be used.” Indeed! That would be quite good at getting results, I imagine.
|Oct 21, 12Oct '12||20|
|Basic Self-Massage Tips for Myofascial Trigger Points Learn how to massage your own trigger points (muscle knots)||Oct 20, 12Oct '12||1,700|
|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, many cases are probably caused by minor and treatable muscle knots, respiratory dysfunction and/or weakness. Relief may be relatively easy for some patients. It’s safe and cheap to experiment with self-massage for muscular trigger points. And, although changing bad habits is always tricky, increasing your respiratory strength is definitely effective and a worthwhile fitness goal in any case. Two common, minor, and treatable causes of a scary symptom||Oct 12, 12Oct '12||3,000|
|Contrast Hydrotherapy Exercising tissues with quick temperature changes for injury recovery, especially repetitive strain injuries||Oct 8, 12Oct '12||2,500|
|Does Arnica Cream Work for Pain?+
Homeopathic (diluted) herbal ointments for inflammatory pain, like muscle pain, joint pain, sports injuries and bruising, are quite popular, but their effectiveness is fairly questioned by many. Known to most customers as “herbal” arnica cream, most contain less than 10 micrograms of arnica per dose — dramatically less that what is needed of most substances to be considered a chemically active ingredient. Homeopathy is based on an exotic interpretation of physics that involves diluting ingredients to the point of completely removing 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 mildly encouraging, but mostly old and poor quality ones. In all good quality, modern scientific trials so far, they seem to do no better than placebo. It is possible that a benefit can still be proven, but it is not likely.A detailed review of popular homeopathic (diluted) herbal creams like Traumeel, used for muscle pain, joint pain, sports injuries, bruising, and post-surgical inflammation
|Oct 2, 12Oct '12||9,000|
|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|
|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||475|
|Bad Science Watch||Jul 12, 12Jul '12||170|
|You’re Really Tight The three most common words in massage therapy are pointless||Jul 4, 12Jul '12||1,600|
|Massage Therapy for Shoulder Pain Perfect Spot No. 14, The Most Predictable Unsuspected Cause of Shoulder Pain||Jun 25, 12Jun '12||1,500|
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
|Jun 21, 12Jun '12||750|
|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 Low Back Pain (Again) Perfect Spot No. 13, The Most Classic Low Back Pain Trigger Point||Jun 9, 12Jun '12||700|
|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||Jun 9, 12Jun '12||2,100|
|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||Jun 9, 12Jun '12||1,100|
|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|
|Massage Therapy for Low Back Pain Perfect Spot No. 2, in the thoracolumbar corner||Jun 9, 12Jun '12||650|
|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 weird bit of muscle physiology||Jun 1, 12Jun '12||700|
|Spinal Fracture Bracing My wife’s terrible accident, and a whirlwind tour of the science and biomechanics of her spine brace||May 31, 12May '12||1,500|
|Quackery Red Flags+When choosing treatments, please be wary of Quackery Red Flags: 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|
|Ioannidis: Making Medical Science Look Bad Since 2005 A famous and excellent scientific paper … with an alarmingly misleading title||May 9, 12May '12||2,400|
|Water Yoga 6 unusual ways to use a swimming pool for therapeutic exercise||May 7, 12May '12||1,400|
|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|
|Mobilize! Dynamic joint mobility drills are an alternative to stretching that “massages you with movement”||Apr 30, 12Apr '12||5,500|
|Oh, a flow-induced system of mechanotransduction! Of course! A century-old mystery of bone biology was solved just a little while ago||Apr 11, 12Apr '12||475|
|Getting On Your Nerves Can you damage your nerves when self-massaging?||Apr 11, 12Apr '12||600|
|Buyer (of Therapy) Beware All other things being equal, always choose the cheapest and most comfortable therapeutic option for your pain problem||Apr 11, 12Apr '12||850|
|Bogus Citations 11 classic ways to self-servingly screw up references to science, like “the sneaky reach” or “the uncheckable”||Mar 10, 12Mar '12||1,900|
|Always Running the Same Way The trouble with running on concrete and asphalt||Mar 8, 12Mar '12||1,800|
|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|
|How smart is your right foot?+ |
Warning: you may keep trying over and over again to see if you can outsmart your foot. You probably can't. This phenomenon is pretty hard-wired into your nervous system.
And there ain’t nothing you can do about it! Naturally it works with any counter-clockwise motion of the hand — “6” is just handy way of describing that.
|Dec 22, 11Dec '11||110|
|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?||Nov 30, 11Nov '11||3,750|
|Stretch 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|
|We Are Full of Critters The human body is a colony of ten trillion co-operating cells||Oct 15, 11Oct '11||600|
|Microbreaking Prevent low back pain and neck cricks with lots of little breaks||Sep 17, 11Sep '11||1,700|
|The Pressure Question in Massage Therapy What’s the right amount of pressure to apply to your muscles in massage therapy and self-massage?||Aug 26, 11Aug '11||3,000|
|The Power of Avogadro Compels You! James Randi and Alexa Ray Joel try to poison themselves — one of them deliberately and the other accidentally making homeopathy look 10X sillier than it already did||Aug 17, 11Aug '11||1,800|
|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|
|When exactly do injuries occur in walking and running? Not when you thought. Biomechanics expert Dr. Casey Kerrigan explains her surprising research results.||Jul 29, 11Jul '11||1,000|
|The Art of Bioenergetic Breathing A potent tool for personal growth and transformation||Jun 20, 11Jun '11||2,200|
|The Not-So-Humble Healer Cocky theories about the cause of pain are common in massage, chiropractic, and physical therapy||Jun 12, 11Jun '11||2,500|
|Strength Training Surprises Why building muscle is easier, better, and more important than you thought, and its vital role in injury rehabilitation||May 6, 11May '11||4,250|
|Chronic Pain and Relationships People with chronic pain face more than just medical difficulties||Apr 26, 11Apr '11||1,200|
|Review of John Sarno’s Books about Low Back Pain Essential reading for low back pain sufferers and most health care professionals||Apr 21, 11Apr '11||1,500|
|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||2,500|
|Sciatica Tutorial A basic tutorial about buttock and leg pain||Apr 17, 11Apr '11||4,500|
|Alternative to What? “Alternative” health care professionals need to decide what they are really the alternative to||Jan 14, 11Jan '11||3,500|
|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|
|A Tour of Ideas From Recent Pain Science Pain science has advanced a great deal in the last fifty years, but most of this information has had seemingly little impact on the way pain is commonly treated||Nov 29, 10Nov '10||1,800|
|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|
|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||Oct 1, 10Oct '10||1,900|
|The Bath Trick for Trigger Point Release A clever way of combining self-treatment techniques to self-treat your trigger points (muscle knots)||Aug 2, 10Aug '10||600|
|Tennis Ball Massage for Myofascial Pain Syndrome Some creative tips on using an ordinary tennis ball and other massage tools to self-treat muscle knots and myofascial trigger points||Aug 2, 10Aug '10||1,100|
|Heat for Pain When and how to apply heat for therapy … and when not to!||Jul 12, 10Jul '10||1,700|
|The Trigger Point Symptom Checker An interview with creator Jeff Lutz about a unique online visual database of common muscular trigger points (muscle “knots”)||May 26, 10May '10||1,700|
|Wobble Cushion Technique Instructions for chair warriors on the best usage of Disc ‘O’ Sit, Balance Fit or Sissel wobble cushions||May 17, 10May '10||1,100|
|Do you know a good massage therapist in _______? Three quick ways to find decent medical massage or trigger point therapy in your own area||May 1, 10May '10||800|
|Hydrotherapy An introduction to healing with water||Mar 18, 10Mar '10||800|
|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|
|Body Types and Body Pain Some speculation about what kind of body types might hurt the most||Nov 12, 09Nov '09||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||600|
|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|
|Three Muscle Knots That Broke The Rules Three examples of myofascial trigger points that responded to therapeutic methods that don’t normally work||Sep 15, 09Sep '09||700|
|Battle of the Experts A guide for patients caught between conflicting diagnoses and prescriptions||Jul 6, 09Jul '09||2,750|
|The Anatomy of Vitality What makes life tick? A poetic romp through the substance of vitality||Jun 27, 09Jun '09||2,500|
|Alternative Medicine Doesn’t Exist Either health is cared for or it is not cared for, whether we call it “alternative” or “mainstream”||Jun 27, 09Jun '09||900|
|Trigger Points That Form Fast Sometimes muscle knots strike with alarming speed and intensity||Jun 12, 09Jun '09||450|
|Widespread Chronic Pelvic Pain In a Runner With a Surprising Cause Separation of the pubic symphysis (diastasis symphysis pubis), strangely painless at the site||May 9, 09May '09||550|
|Safe athletic training tips Getting into shape without doing damage||Apr 21, 09Apr '09||600|
|A Recipe for Chronic Neck Pain After Whiplash Researchers discover some surprising risk factors for chronic neck pain in the aftermath of whiplash||Jan 20, 09Jan '09||750|
|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||Nov 12, 08Nov '08||3,000|
|Find Good Trigger Point Therapy The tricky challenge of finding competent treatment for trigger points (muscle knots)||Sep 23, 08Sep '08||2,300|
|Measuring Progress in Massage Therapy How do you know whether or not massage therapy is working for you?||Sep 22, 08Sep '08||1,300|
|Back Pain and Trigger Points Understanding the role of trigger points in back pain||Jun 26, 08Jun '08||325|
|Knee Pain and Gender Do women get more knee pain?||Jun 23, 08Jun '08||900|
|My Very Own Athletic Injuries A journal of my experiences with injuries acquired while running, cycling and hiking and playing ultimate for fifteen years||Mar 30, 08Mar '08||1,200|
|9 Surprising Causes of Pain Trying to understand pain when there is no obvious explanation||Mar 22, 08Mar '08||1,400|
|Lifting Technique Is Not Important For Your Back Science surprises with evidence that lifting technique is not an important consideration for low back pain||Feb 6, 08Feb '08||600|
|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|
|The Cautious Art of Pain Acceptance An important concept in leveraging mind-body connections to deal with chronic pain||Nov 16, 07Nov '07||750|
|Muscle Tissue Issues Three of the most common problems that people have with their muscles||Aug 13, 07Aug '07||600|
|Give Your Muscles What They Want Resting a “freaked out shoulder” in a sling is actually a fine idea, despite possible medical objections||Jul 15, 07Jul '07||650|
|Iliotibial band syndrome and patellofemoral pain syndrome aren’t as simple as they seem Once again, evidence shows that you can’t blame overuse injuries on seemingly obvious structural problems||May 31, 07May '07||600|
|Endurance Training for Injury Rehabilitation What to do when your usual strength training workout isn’t working … or isn’t an option||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|
|An Open and Closed Case An explanation for a strange duality of muscle sensation observed in massage therapy||Jul 20, 05Jul '05||2,000|
|A Short Story Slow growth syndrome, oxandrolone and the pathologization of my height||Mar 28, 05Mar '05||1,900|
|Extraordinary Claims A guide to critical thinking, skepticism and smart reading about health care on the web||Aug 28, 04Aug '04||2,500|
|Ugly Bags of Mostly Water The chemical composition of human biology||Aug 26, 04Aug '04||1,500|
|From Atoms to Elvis A wide-angle look at the foundations of biology||Aug 26, 04Aug '04||500|
|An Introduction to Biological Literacy Why you need to know more about your body||Aug 25, 04Aug '04||1,100|
|The Still Life The trouble with a lifestyle of inactivity||Jun 26, 04Jun '04||650|
|Singing, Breathing, and Scalenes Connections between singing, breathing and a strange group of muscles||Jun 26, 04Jun '04||1,800|