Sensible advice for aches, pains & injuries

Articles Index

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.

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 updated   May 28, 16May '16 9,000
Thoracic ring theory is “the epitome of fragilistic thinking”   new   May 27, 16May '16 325
Save Yourself from Tension Headaches!   Detailed, readable self-help for stubborn tension headaches, especially those muscle pain in the neck and shoulders updated   May 27, 16May '16 4,000
The Insomnia Guide   Serious insomnia-fighting advice from a veteran of the sleep wars updated   May 26, 16May '16 6,500
Morning Back Pain   An uncomfortable daily mystery for many people updated   May 24, 16May '16 3,000
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. 172 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   May 23, 16May '16 127,500
Frozen Shoulder Primer   An introduction to one the strangest of all common musculoskeletal problems, adhesive capsulitis new   May 21, 16May '16 1,500
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 updated   May 19, 16May '16 950
Water Fever and the Fear of Chronic Dehydration   Do we really need eight glasses of water per day? updated   May 19, 16May '16 3,500
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   May 18, 16May '16 2,750
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 updated   May 17, 16May '16 13,000
“Deep” new article   new   May 13, 16May '16 95
The Pressure Question in Massage Therapy   What’s the right amount of pressure to apply to muscles in massage therapy and self-massage? updated   May 13, 16May '16 4,500
Back Pain & Trigger Points   A quick introduction to the role of trigger points in back pain updated   May 12, 16May '16 650
New muscle microscope   new   May 11, 16May '16 220
New study shows bullshit   new   May 10, 16May '16 110
It’s about prioritizing the treatment options (not demonizing them)   new   May 10, 16May '16 250
Central Sensitization in Chronic Pain+Pain itself often modifies the way the central nervous system works, so that a patient actually becomes more sensitive and gets more pain with less provocation. This is called “central sensitization.” (And there’s peripheral sensitization too.) Sensitized patients are not only more sensitive to things that should hurt, but also to ordinary touch and pressure as well. Their pain also “echoes,” fading more slowly than in other people.   Pain itself can change how pain works, resulting in more pain with less provocation updated   May 10, 16May '16 3,500
The Not-So-Humble Healer   Cocky theories about the cause of pain are waaaay too common in massage, chiropractic, and physical therapy updated   May 10, 16May '16 2,750
Sketchy sleep increases pain sensitivity   new   May 9, 16May '16 95
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 updated   May 9, 16May '16 1,300
Healer Syndrome+“Healer syndrome” is a common delusion of grandeur in alternative medicine, especially massage therapy, naturopathy, and chiropractic, where many afflicted professionals like to be known as “healers” with allegedly unusual curative powers, vaguely defined, pseudoscientific, or based on the exaggerated importance of a single idea. Such lack of humility is tragically common. Healer syndrome has reached its most extreme in some of the founders of methods of therapy, what I call “modality empires.”   The problem with alternative health care practioners who want to be known as “healers.” updated   May 8, 16May '16 1,300
Tennis Ball Massage for Myofascial Pain   Some creative tips on using an ordinary tennis ball and other massage tools to self-treat muscle knots and myofascial trigger points updated   May 7, 16May '16 1,500
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   May 6, 16May '16 68,000
Save Yourself from Neck Pain!+

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

  All your treatment and self-help options for a crick in the neck explained and reviewed
updated   May 4, 16May '16 58,000
Insomnia Until it Hurts+Almost everyone needs to take sleep deprivation more seriously. We are used to thinking of insomnia as a symptom, but it can also be hazardous in itself in many ways. Chronic pain is probably aggravated by insomnia or even mild but chronic sleep deprivation.   The role of sleep deprivation in chronic pain, especially muscle pain updated   May 3, 16May '16 2,750
Heat for Pain   When and how to apply heat for therapy … and when not to! updated   May 3, 16May '16 3,500
Save Yourself from Low Back Pain!+

There are thousands of low back pain books — what’s special about this one? The problem is that 90% of doctors and therapists assume that back pain is structural, in spite of mountains of scientific evidence showing … exactly the opposite. Only a few medical experts understand this, and fewer still are writing for patients and therapists. Supported by 359 footnotes, this tutorial is the most credible and clarifying low back pain information you can find. Ships with a free copy of’s trigger point tutorial!

  Low back pain myths debunked and all your treatment options reviewed
updated   May 2, 16May '16 93,000
How do disc herniations change over time?   new   Apr 28, 16Apr '16 200
Smoking and Chronic Pain   We often underestimate the power of (tobacco) smoking to make things hurt more and longer updated   Apr 26, 16Apr '16 900
Icing, Heating & Tissue Temperature   How much do ice packs and heating pads change the temperature of muscle and joints? new   Apr 23, 16Apr '16 1,400
A Better Hot Bath   Tips for getting the most out of the oldest form of therapy updated   Apr 23, 16Apr '16 3,000
Is Diagnosis for Pain Problems Reliable?   Reliability science shows that health professionals can’t agree on many popular theories about why you’re in pain updated   Apr 22, 16Apr '16 1,900
Lumbar disk herniation has an uncertain natural history   new   Apr 21, 16Apr '16 70
Zapped! Does TENS work for pain?+Humans love stimulants! We have always enjoyed zapping ourselves and each other, just a little bit, or even quite a lot. In the 20th century, and still today, by far the most popular (and tame) form of electrotherapy or neuromodulation is transcutaneous electrical nerve stimulation (TENS). Other kinds of electrical stimulation are also interesting, and more promising, like deeper stimulation — zapping the brain and spinal cord. This is an overview of all forms of neuromodulation with a strong focus on TENS for pain.   The peculiar popularity of being gently zapped with electrical stimulation therapy new   Apr 20, 16Apr '16 5,000
TENS has a complicated, awesome cousin: pulsed electromagnetic field therapy   new   Apr 19, 16Apr '16 350
The emotional roller coaster of elusive cures   new   Apr 19, 16Apr '16 160
A status update on the writing of new books   new   Apr 18, 16Apr '16 250
Help for Anxiety   Anxiety doesn’t respond to logic and reason, so what does it respond to? updated   Apr 16, 16Apr '16 4,750
Save Yourself from Shin Splints!+

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

  Causes and treatment options for shin splints explained and discussed in great detail, especially shin pain caused by myofascial trigger points, compartment syndrome, medial tibial stress syndrome, and stress fracture
updated   Apr 14, 16Apr '16 23,000
Save Yourself from Plantar Fasciitis!+

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

  Plantar fasciitis explained in great detail, including every possible treatment option, and all supported by recent scientific research
updated   Apr 14, 16Apr '16 39,000
Save Yourself from IT Band Syndrome!+

ITBS is an infamously stubborn lateral knee pain common in runners. Therapy hasn’t been working? You’re not alone. This exhaustively researched tutorial shows that most medical “facts” about the condition are wrong — supported by 151 footnotes analyzing as much of the science as you can stand. Cures cannot be guaranteed, but this tutorial offers both patients and pros 25 detailed treatment options and more insights than you can find anywhere else, as well as a free bonus:’s valuable trigger point tutorial.

  All your treatment options for Iliotibial Band Syndrome reviewed in great detail, with clear explanations of recent scientific research supporting every key point
updated   Apr 14, 16Apr '16 52,000
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 14, 16Apr '16 1,800
Does barefoot running prevent injuries?   A dive into the science so far of barefoot or minimalist “natural” running updated   Apr 13, 16Apr '16 5,500
Equally ineffective   new   Apr 12, 16Apr '16 70
You Might Just Be Weird+Strange, wonderful, and problematic anatomical variations occur in humans all the time. Over the years, I’ve collected several interesting examples relevant to musculoskeletal medicine.   The clinical significance of normal — and not so normal — anatomical variations updated   Apr 11, 16Apr '16 3,000
Studying massage effects with aura photography   new   Apr 8, 16Apr '16 400
Biology knows best? Not so much   new   Apr 6, 16Apr '16 140
Icing for Injuries, Tendinitis, and Inflammation   Become a cryotherapy master updated   Apr 6, 16Apr '16 4,500
New feature article about electrotherapy   new   Apr 4, 16Apr '16 190
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 updated   Mar 22, 16Mar '16 6,000
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   Mar 22, 16Mar '16 7,000
Infinite maintenance case study   new   Mar 18, 16Mar '16 220
Why clinical trial transparency matters to patients in the US   new   Mar 18, 16Mar '16 65
Organ Health Does Not Depend on Spinal Nerves!+Are the little bundles of nerves that exit your spine the wellspring of all visceral vitality? Will your organs wilt like neglected house plants if those nerve roots are slightly impinged? No: cut a nerve root completely, and you’ll certainly paralyze something, but not an organ, because organs simply don’t depend on spinal nerve roots. And yet this is what many chiropractors believe, and would like their customers to believe, after a century of contradictory evidence.   One of the key selling points for chiropractic care is the anatomically impossible premise that your spinal nerve roots are important to your general health updated   Mar 18, 16Mar '16 2,750
Pills or stuff or something for my headaches and stuff   new   Mar 15, 16Mar '16 160
7 yoga myths   new   Mar 15, 16Mar '16 75
Is it okay to pay for a placebo?   new   Mar 14, 16Mar '16 275
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   Mar 14, 16Mar '16 3,750
9 Surprising Causes of Pain   Trying to understand pain when there is no obvious explanation updated   Mar 13, 16Mar '16 2,300
Lifting Technique Is Not Important for Your Back   Science surprises with evidence that lifting technique is not an important consideration for low back pain updated   Mar 11, 16Mar '16 1,900
Keep me posted   new   Mar 9, 16Mar '16 130
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   Mar 4, 16Mar '16 13,000
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 updated   Mar 4, 16Mar '16 9,000
How deep does the heat of a heating pad go?   new   Mar 3, 16Mar '16 230
Practical ways to turn down pain sensitisation   new   Mar 2, 16Mar '16 85
The junky science justifying a hydration habit   new   Feb 29, 16Feb '16 350
Should You Drink Water After Massage?+It’s just polite to offer patients a glass of water after a treatment. But therapists who make a production of it as a necessary part of the therapy are just proving their ignorance.   Only if you’re thirsty! Hydration and massage are not detoxification treatments updated   Feb 29, 16Feb '16 4,250
When to Worry About Low Back Pain   And when not to! What’s bark and what’s bite? updated   Feb 24, 16Feb '16 4,000
There there, dear: dismissing female pain   new   Feb 23, 16Feb '16 170
The volcano god of pain   new   Feb 19, 16Feb '16 275
Our bacterial passengers don’t outnumber us after all   new   Feb 17, 16Feb '16 150
We Are Full of Critters   The human body is a colony of ten trillion co-operating cells updated   Feb 17, 16Feb '16 750
Ten Trillion Cells Walked Into a Bar   A humourous and unusual perspective on how, exactly, a person is even able to stand up, let alone walk into a bar updated   Feb 17, 16Feb '16 2,400
Telescopes, not brain scanners: some musings on the relationship between pain and tissue damage   new   Feb 16, 16Feb '16 650
Dry needling efficacy disagreement   new   Feb 16, 16Feb '16 160
The Great Ice vs. Heat Confusion Debacle   A quick guide that explains when to ice, when to heat, when not to, and why updated   Feb 16, 16Feb '16 850
Go with love   new   Feb 15, 16Feb '16 85
Patellofemoral Pain and the Vastus Medialis Obliquus (VMO)   Can just one quarter of the quadriceps be the key to anterior knee pain? updated   Feb 13, 16Feb '16 1,200
Finally doing 7-minute workout in 8 minutes   new   Feb 12, 16Feb '16 230
What does pain science have in common with other sensory science?   new   Feb 12, 16Feb '16 130
Reviving an old article about lifting and back pain   new   Feb 11, 16Feb '16 220
Delayed Onset Muscle Soreness (DOMS)   The biological mysteries of “muscle fever,” nature’s little tax on exercise updated   Feb 11, 16Feb '16 7,500
Explaining who disagrees with who and why   new   Feb 10, 16Feb '16 65
Basic Self-Massage Tips for Myofascial Trigger Points   Learn how to massage your own trigger points (muscle knots) updated   Feb 9, 16Feb '16 2,000
Dear Google   new   Feb 5, 16Feb '16 120
Does Massage Therapy Work?   A review of the science of massage therapy … such as it is updated   Feb 5, 16Feb '16 14,000
Too many updates to log   new   Feb 2, 16Feb '16 160
Anatomical jiggery–pokery: too many false ribs   new   Feb 1, 16Feb '16 425
Joints popping…like flashbulbs?   new   Jan 28, 16Jan '16 150
Pain treatment troubleshooting formula   new   Jan 27, 16Jan '16 95
Slow-motion pandiculation   new   Jan 25, 16Jan '16 70
An interesting back pain treatment success   new   Jan 22, 16Jan '16 130
The Experiment Experiment   new   Jan 20, 16Jan '16 130
Intermittent spinal cord compression and fibromyalgia   new   Jan 18, 16Jan '16 220
Psoas, So What?+The iliopsoas muscle (“illy-oh so-ass”) is a two-in-one hip flexing pair, mostly only palpable through the guts. Its clinical importance is often curiously exaggerated, but sometimes it does need a massage.   Massage therapy for the psoas major and iliacus (iliopsoas) muscles is not that big a deal updated   Jan 17, 16Jan '16 1,900
Taping science update   new   Jan 16, 16Jan '16 100
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   Jan 16, 16Jan '16 14,000
How powerful is the placebo effect?   new   Jan 12, 16Jan '16 95
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 updated   Jan 12, 16Jan '16 5,500
The worst possible causes of back pain (is a very popular topic)   new   Jan 11, 16Jan '16 220
Most painful tweet of 2015   new   Jan 9, 16Jan '16 110
The Art of Bioenergetic Breathing   A potent tool for personal growth and transformation updated   Jan 9, 16Jan '16 2,300
Micro-ness reboot: re-dedicating this blog to its “micro” origins   new   Jan 6, 16Jan '16 800
The Functional Movement Screen (FMS)+The Functional Movement Screen (FMS) is a set of seven physical tests of coordination and strength, especially “core” strength, invented in 1997 and now in widespread use around the world. It was originally proposed as a trouble-detection system, which is baked into the name: it’s a “screen.” Its use in the wild seems to over-reach this stated purpose.   The benefits of the popular screening system for athletes might be over-sold by some professionals updated   Dec 31, 15Dec '15 3,250
The thought I’d like to leave you with   new   Dec 19, 15Dec '15 170
The pain-free future   new   Dec 14, 15Dec '15 140
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?
updated   Dec 12, 15Dec '15 2,100
My Athletic Injuries   A journal of my experiences with injuries acquired while running, cycling and hiking and playing ultimate for fifteen years updated   Dec 11, 15Dec '15 1,400
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   Dec 8, 15Dec '15 18,000
Toxins, Schmoxins!+

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

The body deals with undesirable molecules in many ways. It eliminates some and recycles others; some are trapped in a safe place; and quite a few can’t be safely handled at all (metals). Most alleged “detox” treatments are 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

  The idea of “toxins” is used to scare people into buying snake oil
updated   Dec 5, 15Dec '15 1,100
The “Father of Fascia” is so over it     Nov 30, 15Nov '15 425
How to Find a Good Massage Therapist   Lots of tips for finding good quality medical massage therapy in your area (especially trigger point therapy)   Nov 18, 15Nov '15 5,000
The limits of pain vocabulary     Nov 11, 15Nov '15 250
Save Yourself from Tennis Elbow!   Not just for tennis players, straight-talking advice on healing from this common tendinitis (lateral epicondylitis)   Nov 10, 15Nov '15 3,750
Like ripping duct tape off your skin     Nov 6, 15Nov '15 200
Massage Therapy for Bruxism, Jaw Clenching, and TMJ Syndrome   Perfect Spot No. 7, the masseter muscle of the jaw   Nov 6, 15Nov '15 3,250
Voltaren® Gel+Voltaren® Gel is a particularly safe and useful medicine. It’s a topical anti-inflammatory medication, so it can be applied only where you need it, instead of soaking your entire system with medication, avoiding or minimizing common side effects like indigestion, and some serious safety concerns associated with the oral version of the drug. In the US, it’s FDA-approved to treat osteoarthritis in “joints amenable to topical treatment, such as the knees and those of the hands,” but it probably also works for some other painful problems, such as some repetitive strain injuries and back pain. The evidence shows that it “provides clinically meaningful analgesia.” So this product actually works and it gets a pass from skeptics and critics — a rare thing indeed in the world of pain treatments!   A useful rub-on anti-inflammatory medication   Nov 4, 15Nov '15 2,500
Contrast Hydrotherapy   Exercising tissues with quick temperature changes for injury recovery, especially repetitive strain injuries   Nov 4, 15Nov '15 2,500
Extraordinary Health Claims   A guide to critical thinking, skepticism, and smart Internet reading about health care   Nov 3, 15Nov '15 3,250
Sciatica Tutorial   A basic tutorial about buttock and leg pain   Oct 31, 15Oct '15 4,250
7 Reasons Older Adults Don’t Stay in Exercise Classes   And 7 reasons they should stick with it: the science and psychology of maintaining an exercise class habit   Oct 30, 15Oct '15 3,250
The Trouble with Chairs   Back pain and worse hazards of sitting in chairs way too much   Oct 30, 15Oct '15 6,000
Therapeutic Touch is Silly+

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

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

  No touch included! Auras don’t exist and can’t be felt, let alone massaged for medical benefit
  Oct 29, 15Oct '15 1,300
The Respiration Connection   How dysfunctional breathing might be a root cause of a variety of common upper body pain problems and injuries   Oct 27, 15Oct '15 7,000
All about the science     Oct 23, 15Oct '15 120
Why Does Pain Hurt?+Research has shown that immune cells unnecessarily “swarm” sterile injury sites, causing damage and pain with no direct benefit — a biological glitch with profound implications about why some painful problems are so severe and stubborn.   How an evolutionary wrong turn led to a biological glitch that condemned the animal kingdom — you included — to much louder, longer pain   Oct 22, 15Oct '15 5,000
Sitting is NOT the new smoking     Oct 20, 15Oct '15 200
Pain and suffering in sports     Oct 9, 15Oct '15 250
An Introduction to Health Literacy   Why everyone needs to know more about biology, medicine, and health   Oct 8, 15Oct '15 1,300
Repetitive Strain Injuries Tutorial   Five surprising and important facts about repetitive strain injuries like carpal tunnel syndrome, tendinitis, or iliotibial band syndrome   Oct 7, 15Oct '15 11,000
Running on Pavement is Risky   Always running the same way — on hard, flat surfaces — is probably a huge risk factor for running injuries like patellofemoral pain and IT band syndrome   Oct 7, 15Oct '15 2,000
Patellofemoral Tracking Syndrome   The beating heart of the conventional wisdom about patellofemoral pain is mostly nonsense   Oct 2, 15Oct '15 2,500
Patellofemoral Pain Diagnosis with Bone Scan   If you have anterior knee pain, should you bother x-ray, MRI, CT scan, or bone scan?   Oct 2, 15Oct '15 1,100
Knee Pain in Women   Do women get more runner’s knee?   Oct 2, 15Oct '15 1,000
Should You Get A Lube Job for Your Arthritic Knee?   Reviewing the science of injecting artificial synovial fluid, especially for patellofemoral pain   Oct 2, 15Oct '15 850
Does Platelet-Rich Plasma Injection Work?+

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

  An interesting treatment idea for arthritis, tendinopathy, muscle strain and more
  Sep 30, 15Sep '15 2,100
The Art of Rest   The finer points of resting for injury & pain rehabilitation (hint: it’s a bit trickier than you might think)   Sep 30, 15Sep '15 4,500
Where do stings hurt worst?     Sep 23, 15Sep '15 180
Rehab is all about getting the load juuust right     Sep 23, 15Sep '15 80
Mitochondrial power grids in muscle     Sep 19, 15Sep '15 190
Palpatory Pareidolia   Sensory illusions, wishful thinking, and palpation pretension in massage and other touchy health care   Sep 17, 15Sep '15 2,500
EBM versus clinical experience     Sep 15, 15Sep '15 400     Sep 14, 15Sep '15 100
An Open and Closed Case   An explanation for a strange duality of muscle sensation observed in massage therapy   Sep 14, 15Sep '15 2,000
Inevitably incorrect     Sep 12, 15Sep '15 80
Chiropractor, Naturopath Training Way Less Than Doctors+

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

  Medical training is much longer and better than anything naturopaths or chiropractors normally get
  Sep 12, 15Sep '15 850
Pain & Injury Survival Tips   Dozens of ideas (and links) for evidence-based rehabilitation and self-treatment for common pain problems and injuries   Sep 10, 15Sep '15 9,500
More bacterial smoke than expected in low back pain (but still no fire)     Sep 8, 15Sep '15 250
Three Muscle Knots That Broke The Rules   Three examples of myofascial trigger points that responded to therapeutic methods that usually don’t work   Sep 7, 15Sep '15 1,100
Choose Cheaper Treatments   All other things being equal, always choose the cheapest and most comfortable treatment option for your pain problem   Sep 2, 15Sep '15 900
This is why I work hard     Sep 1, 15Sep '15 325
Getting On Your Nerves   Can you damage your nerves when self-massaging?   Aug 28, 15Aug '15 1,000
Trigger Points That Form Fast   Sometimes muscle knots strike with alarming speed and intensity   Aug 27, 15Aug '15 550
Deep thought of the day: anecdotes really suck     Aug 26, 15Aug '15 65
Better citations needed: a big upgrade to the PainSci bibliography     Aug 20, 15Aug '15 1800
Modality Empires+

“Modality empire” is my own term for an ego-driven proprietary method or mode of manual therapy — a sub-discipline — championed and promoted by a single charismatic entrepreneur. Most of the “emperors” have healer syndrome, lack humility, make big promises, and make their money from unusually expensive therapy, workshops and books. Professionals are sold on the opportunity to purchase credibility in the form of increasing “levels” of certification, but the quality of these certifications is completely unregulated and often dubious. A modality empire is as much a business model as a method of helping people. 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
  Aug 15, 15Aug '15 1,600
I have faith in sports massage…for some reason     Aug 14, 15Aug '15 425
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
  Jul 27, 15Jul '15 9,000
An exasperating contradiction in modern chronic pain management     Jul 17, 15Jul '15 160
Applied Kinesiology is Bunk+

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

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

  The skeptical position on applied kinesiology, a bizarre alternative medicine method of diagnosis
  Jul 16, 15Jul '15 800
Do You Believe in Qi?   How to embrace a central concept of Eastern mysticism without being a flake   Jul 16, 15Jul '15 800
It must be good if insurance companies pay for it     Jul 9, 15Jul '15 500
Pain-causing pain-killers     Jul 7, 15Jul '15 200
Protein timing doesn’t matter     Jul 4, 15Jul '15 80
Placebo-without-deception is deceptive     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   Jun 30, 15Jun '15 350
Exercise works, except when it’s ineffective     Jun 24, 15Jun '15 350
Noisy knee satire     Jun 19, 15Jun '15 150
Therapy Babble   Hyperbolic, messy, pseudoscientific theories about therapy are all too common   Jun 19, 15Jun '15 4,000
Keep it up! Neck pain reduced by long-term strengthening     Jun 18, 15Jun '15 110
You can’t rush it, but healing speeds up on its own     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?   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   Jun 1, 15Jun '15 12,000
OTC pain-killers in under 140 words or bust!     May 30, 15May '15 250
Stress, biology, and pain     May 27, 15May '15 230
Better citation needed     May 26, 15May '15 120
Surprising Pain Science   Counterintuitive results and the fallibility of “common sense” about pain, injury, and rehab   May 23, 15May '15 1,300
Plantar Fasciitis Patients Have Thick Soles   There’s a connection between plantar fasciitis and a surprisingly thick tissue in the arch of the foot   May 16, 15May '15 950
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
  May 15, 15May '15 700
Why Massage Makes You Tingle   The physiology of sensation when you’re being pressed and moved around   May 15, 15May '15 1,000
Are aura atheists uncaring robots?     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   May 13, 15May '15 1,000
Electric bath     May 9, 15May '15 150
Sad, bad news about e-books and sleep     May 8, 15May '15 300
We feel what we fear     May 5, 15May '15 200
Rheumatoid arthritis and central sensitization     May 4, 15May '15 150
The Pricing of e-Books   A candid explanation of my prices and how I present them to new visitors   Apr 20, 15Apr '15 1,200
Brain stim fizzle     Apr 16, 15Apr '15 120
A bit of a mouthful     Apr 14, 15Apr '15 170
Confused about the location of Iliotibial Band Syndrome?   There is no such thing as “iliotibial band pain” that is not at the knee   Apr 3, 15Apr '15 750
Massage Therapy for Your Pectorals   Perfect Spot No. 9, in the pectoralis major muscle of the chest   Apr 3, 15Apr '15 750
Healing Time+

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

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

  Can healing be hurried? Would we even notice if it was?
  Mar 26, 15Mar '15 1,000
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   Mar 17, 15Mar '15 950
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   Mar 15, 15Mar '15 2,750
The Secret Anarchy of Science     Mar 14, 15Mar '15 60
Placebo precision     Mar 14, 15Mar '15 250
Insider view of naturopathic training     Mar 13, 15Mar '15 160
Does swearing reduce pain?     Mar 13, 15Mar '15 110
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   Mar 13, 15Mar '15 2,750
Why Do We Get Sick?   The connections between poor health and the lives we lead   Mar 12, 15Mar '15 2,750
Apt analogy     Mar 11, 15Mar '15 55
Googling symptoms     Mar 11, 15Mar '15 150
Review of Excuse Me, Exactly How Does That Work? by Laura Allen     Mar 11, 15Mar '15 650
Sex and back pain     Mar 6, 15Mar '15 220
A literally stiff back     Mar 5, 15Mar '15 150
Video of weirdly rippling muscle     Mar 4, 15Mar '15 100
Choose the Therapist, Not the Therapy   When you’re in pain, you want to know “what works,” but what you should look for is an honest therapist of any kind   Mar 3, 15Mar '15 1,500
Nerve root wiggle room     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
  Mar 2, 15Mar '15 650
Nerve Pain Is Overdiagnosed   A story about nerve pain that wasn’t really nerve pain   Feb 28, 15Feb '15 1,000
IT band plungering     Feb 27, 15Feb '15 250
Missing the Woodstock of pain conferences     Feb 26, 15Feb '15 120
Are experimental injection treatments “worth a try”?     Feb 23, 15Feb '15 110
Toxic Muscle Knots   Research suggests myofascial trigger points may be quagmires of irritating molecules   Feb 22, 15Feb '15 850
What’s a “Claim” in Health Care?+

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

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

  In health care, claims often involve a more self-serving assertion
  Feb 19, 15Feb '15 425
Free safety lesson! Is it safe to roll your head in a full circle?     Feb 18, 15Feb '15 240
There are no guiltless factions     Feb 16, 15Feb '15 130
Flesh still relevant     Feb 16, 15Feb '15 170
Bought and paid for     Feb 11, 15Feb '15 120
Flabbergasted by the fabella     Feb 9, 15Feb '15 160
Release me!     Feb 6, 15Feb '15 180
Make exercise as sexy as the scalpel     Feb 3, 15Feb '15 190
Rupture: not as obvious as you’d think!     Jan 29, 15Jan '15 90
Guts are not for standing     Jan 29, 15Jan '15 170
A Historical Perspective On Aches ‘n’ Pains   We are living in a golden age of musculoskeletal medicine … sorta   Jan 28, 15Jan '15 1,300
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)
  Jan 25, 15Jan '15 3,500
Pressure vs shock waves: is there an (important) difference?     Jan 24, 15Jan '15 140
Stuck RSS     Jan 23, 15Jan '15 140
Positive trend     Jan 23, 15Jan '15 95
Not just another weight loss story     Jan 22, 15Jan '15 100
Like storm fronts colliding     Jan 13, 15Jan '15 170
Overselling trigger point therapy     Jan 12, 15Jan '15 275
Metal rod embedded in arm painless for fifty years     Jan 9, 15Jan '15 200
Progressive Training   How to take “baby steps” to recovery from an injury or pain problem   Jan 7, 15Jan '15 1,900
Review of The Trigger Point Therapy Workbook   A popular book that promises too much and ignores recent science and controversies, which alienates many physicians and sets patients up for disappointment   Jan 3, 15Jan '15 1,700
Boot Blooper     Dec 22, 14Dec '14 800
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
Historical perspective ugprades     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
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     Nov 26, 14Nov '14 140
More massage better     Nov 22, 14Nov '14 140
The big move     Nov 21, 14Nov '14 60
Three pounds in a year     Nov 5, 14Nov '14 275
Seven flights     Nov 5, 14Nov '14 60
REJOICE, fibromyalgia sufferers! Your nightmare is over!     Oct 30, 14Oct '14 300
The state of medicine     Oct 30, 14Oct '14 100
Between offices     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
197, 198, 199… 200!     Oct 14, 14Oct '14 55
Not so FAST     Oct 14, 14Oct '14 350
Does Hip Strengthening Work for Runner’s Knee?   The popular “weak hips” theory is itself weak: hip weakness is not clearly a cause of problems like IT band pain or patellofemoral pain   Oct 14, 14Oct '14 4,250
I’m not an expert     Oct 10, 14Oct '14 110
Best mini-testimonial ever     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
Phantom scratching is like pain     Sep 22, 14Sep '14 160
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
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     Sep 14, 14Sep '14 85
Blood therapy, anyone?     Sep 11, 14Sep '14 130
Studying the Studies   Tips and musings about how to understand (and write about) pain and musculoskeletal health science   Sep 11, 14Sep '14 3,000
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
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 '14 800
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
Leaky old canoes     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
Spinal Subluxation+

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

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

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

  Is there any such thing?
  Sep 6, 14Sep '14 1,400
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     Aug 27, 14Aug '14 55
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 '14 900
The Power of Barking   A silly metaphor for a serious point about how humans choose what to believe in   Aug 23, 14Aug '14 600
Confirmation Bias+

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

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

  Confirmation bias is the human habit of twisting our perceptions and thoughts to confirm what we want to believe
  Aug 23, 14Aug '14 850
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
I’m not holding my breath     Aug 20, 14Aug '14 170
Vibram gets vague     Aug 20, 14Aug '14 220
The chemistry of the burn     Aug 19, 14Aug '14 130
Peak musculoskeletal anatomy     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 1,100
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!     Aug 1, 14Aug '14 100
Is there hope?     Jul 31, 14Jul '14 140
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 like most blogs, and never will   Jul 25, 14Jul '14 1,000
Explaining away treatment successes     Jul 24, 14Jul '14 325
Mark my words: a new e-book feature     Jul 22, 14Jul '14 275
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 2,750
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 Possibly Go Wrong With Massage?   Rare but real adverse effects of massage therapy, especially “deep tissue” massage   Jul 16, 14Jul '14 1,800
Too many choices     Jul 15, 14Jul '14 100
The weirdness of pain     Jul 15, 14Jul '14 130
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     Jul 9, 14Jul '14 130
What’s the point?     Jul 7, 14Jul '14 140
Treat the animal, not the radiograph     Jul 3, 14Jul '14 160
It’s about time     Jul 2, 14Jul '14 65
Why fascia matters medically (get ready to cringe)     Jul 1, 14Jul '14 425
Spinal Manipulation+

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     Jun 30, 14Jun '14 100
Shot by the witch     Jun 30, 14Jun '14 55
Escape!     Jun 26, 14Jun '14 100
My worst pain ever     Jun 18, 14Jun '14 80
Cruciate repair non-crucial     Jun 18, 14Jun '14 100
Thumbs Up for the Scientific 7-Minute Workout     Jun 11, 14Jun '14 450
Foot strikes vary widely in elite runners     Jun 11, 14Jun '14 95
Are you a narcissist?     Jun 10, 14Jun '14 150
Soldiers and single moms     Jun 10, 14Jun '14 130
A vote for tolerance     Jun 10, 14Jun '14 75
The back is still important in 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     May 28, 14May '14 110
The Better Movement Book     May 26, 14May '14 100
Americans Struggle to Stand Up     May 22, 14May '14 55
No real evidence that parachutes work     May 21, 14May '14 120
The “integrated medicine” straw-man     May 21, 14May '14 80
Kill pain, kill performance     May 15, 14May '14 55
Practitioners of “placebo enhancement”     May 15, 14May '14 220
Hyperaesthesia of the shins     May 15, 14May '14 95
Vibram spanked     May 9, 14May '14 120
The Cassidy 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
Placebo Paradox 2: The Mechanism     May 1, 14May '14 120
Satisfaction is not efficacy     May 1, 14May '14 110
So much “power”!     Apr 30, 14Apr '14 110
Spine wrangling     Apr 29, 14Apr '14 75
Inflatable back support?     Apr 29, 14Apr '14 160
Consider the source     Apr 23, 14Apr '14 95
The two-legged dog and biomechanics     Apr 17, 14Apr '14 160
Stretch for torn muscles     Apr 15, 14Apr '14 180
New book     Apr 10, 14Apr '14 90
Compression socks with tape     Apr 10, 14Apr '14 250
Two books edited, six to go     Apr 9, 14Apr '14 140
So…what does work, Mister Smartypants?     Apr 9, 14Apr '14 100
Vandal massage     Apr 3, 14Apr '14 300
Oh, stretching! Can you do anything right?     Apr 2, 14Apr '14 100
New anecdote disclaimer     Apr 2, 14Apr '14 210
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     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     Mar 25, 14Mar '14 80
Goodbye PDF, hello lifetime access     Mar 20, 14Mar '14 250
When books don’t heal     Mar 20, 14Mar '14 140
A good friend advances medical science     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
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.

  Why do some experts doubt the existence of “muscle knots” and myofascial pain syndrome?
  Jan 19, 14Jan '14 9,500
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
Proprioception, the True Sixth Sense   The vital and strange sensation of position, movement, and effort   Dec 24, 13Dec '13 700
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
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
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
Not so new     Nov 7, 13Nov '13 110
New ligament     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     Nov 1, 13Nov '13 85
Dissing dyskinesis     Oct 22, 13Oct '13 240
You too can learn to feel a hair!     Oct 21, 13Oct '13 130
Like getting blood from a bone     Oct 21, 13Oct '13 375
Reflexology “science”     Oct 4, 13Oct '13 190
Therapy dominated by obsolete ideas     Oct 3, 13Oct '13 120
How to run really, really far     Oct 2, 13Oct '13 120
SaveYourself faster!     Oct 1, 13Oct '13 120
Tight hamstrings, back pain, and movement     Sep 24, 13Sep '13 190
Pain’s complexity     Sep 24, 13Sep '13 80
Bad biomarkers, good knee news     Sep 20, 13Sep '13 275
What’s a runner gotta do?     Sep 20, 13Sep '13 55
Touch-testing the world     Sep 19, 13Sep '13 130
Performance enhancement     Sep 19, 13Sep '13 130
The prodigy problem     Sep 17, 13Sep '13 170
How to dismiss science you don’t like     Sep 16, 13Sep '13 60
Not good enough, Pilates     Sep 12, 13Sep '13 140
Educated guesses     Sep 11, 13Sep '13 65
What people really look like     Sep 10, 13Sep '13 120
Pain vs. brain: a follow-up     Sep 5, 13Sep '13 275
Weights as good as a run?     Sep 5, 13Sep '13 90
Pain vs. 1600 pounds     Sep 4, 13Sep '13 180
Needless needles?     Aug 29, 13Aug '13 160
Because fascia     Aug 29, 13Aug '13 210
Biomechanicomplicated     Aug 29, 13Aug '13 200
Mobilizing cat     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     Aug 22, 13Aug '13 60
Is science your enemy?     Aug 22, 13Aug '13 80
Happy traffic stats, news     Aug 20, 13Aug '13 375
Wonky knees     Aug 20, 13Aug '13 200
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?     Jul 30, 13Jul '13 120
Critical what?     Jul 30, 13Jul '13 130
Yoga for neck pain     Jul 25, 13Jul '13 60
The placebo paradox     Jul 25, 13Jul '13 90
More pain = more pain     Jul 23, 13Jul '13 170
Self-improvement through pain     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?     Jul 19, 13Jul '13 110
Noise, noise, noise!     Jul 18, 13Jul '13 80
“Disc” pain     Jul 16, 13Jul '13 60
AllTrials is going well     Jul 16, 13Jul '13 80
Terrible and wonderful     Jul 16, 13Jul '13 65
Good news about running     Jul 9, 13Jul '13 85
Painful neck = weak breathing     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?     Jul 2, 13Jul '13 140
Derpish stupidity     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 1,100
Holy spinal adjustment, Batman!     Jun 29, 13Jun '13 70
Knee surgery denounced by surgeons     Jun 26, 13Jun '13 200
Running still good for you     Jun 13, 13Jun '13 170
Science isn’t broken     Jun 8, 13Jun '13 140
Applied “Kinesiology”     Jun 7, 13Jun '13 95
Now hear this: 5 new audio articles     Jun 4, 13Jun '13 120
Actual touch not included     Jun 4, 13Jun '13 120
Good questions about orthotics     Jun 4, 13Jun '13 160
Failed healing     Jun 4, 13Jun '13 140
Some gold standard     Jun 3, 13Jun '13 65
Objectivity     Jun 3, 13Jun '13 80
Placebo PSA     May 31, 13May '13 100
Good back pain science news     May 30, 13May '13 160
A taijiquan spelling bee     May 23, 13May '13 240
Blood injection treatment bombs a test     May 21, 13May '13 70
No more store trouble, but sheesh     May 18, 13May '13 100
Service announcement for customers     May 17, 13May '13 120
Replication needed     May 15, 13May '13 65
Surprise run     May 15, 13May '13 110
Antibiotics for back pain reality check     May 10, 13May '13 90
I was wrong: muscle is cheap, not expensive     May 10, 13May '13 250
And then I read my email…     May 10, 13May '13 65
Do I like “”?     May 10, 13May '13 75
Two tiny quotes     May 9, 13May '13 65
Bad icing news?     May 7, 13May '13 90
Incurable shitty ankle     May 2, 13May '13 60
Jedi pain tricks!     May 1, 13May '13 190
Goodbye supplement confusion     Apr 23, 13Apr '13 120
Beeeep     Apr 19, 13Apr '13 160
We hates the DRMses, my preciousss     Apr 19, 13Apr '13 80
Pain changes how pain works     Apr 17, 13Apr '13 55
Modality empires     Apr 17, 13Apr '13 170
X-Ray video     Apr 15, 13Apr '13 75
Not what they seem     Apr 10, 13Apr '13 95
Homo sapiens: not as wimpy you thought     Apr 8, 13Apr '13 275
Meanwhile, backstage     Apr 8, 13Apr '13 75
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
Disc, schmisc     Apr 4, 13Apr '13 110
1-Minute fibromyalgia video     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     Mar 22, 13Mar '13 130
More than placebo, less than medicine     Mar 18, 13Mar '13 70
Topical NSAID risks much lower than oral     Mar 15, 13Mar '13 180
One of my favourite history of medicine stories     Mar 14, 13Mar '13 130
“Negative”     Mar 13, 13Mar '13 65
Revenge of the Woo     Mar 13, 13Mar '13 60
Tissue state is just chemistry     Mar 13, 13Mar '13 150
Pelvic tilt     Mar 12, 13Mar '13 140
Two especially nice reader comments     Mar 11, 13Mar '13 120
Introducing the microblog     Mar 8, 13Mar '13 200
Seriously, funny salt     Mar 8, 13Mar '13 75
Sexy mental fitness     Feb 26, 13Feb '13 85
Stretching for Trigger Points   Is trigger point release a good reason to stretch?   Feb 25, 13Feb '13 1,700
Perplexed     Feb 19, 13Feb '13 60
Thixotropy is Nifty, but It’s Not Therapy+Thixotropy is the property of some gels or fluids that are normally thick (viscous), but thin when they are stressed. In the human body, the synovial fluid that lubricates most joints is thixotropic, as is the gelatinous “ground substance,” which is part of all connective tissues such as tendons and ligaments. (Fun fact: semen is also thixotropic.) Thixotropy is one of the reasons that we loosen up a little as we move around, just like engine oil warming up. However, thixotropic effect is not a therapeutic effect, and does not explain “releases” in massage or fascial therapy: it is too minor, slow, and temporary, and connective tissue is too tough.   A curious property of connective tissue is often claimed as a therapy   Feb 19, 13Feb '13 750
SSRI Antidepressants Are Not Medicine   Frightening side effects, cover-ups on the record, and no reason to believe they do what they are supposed to   Feb 14, 13Feb '13 3,250
Big boner     Feb 13, 13Feb '13 130
Posture reactions     Feb 11, 13Feb '13 75
Posturology     Feb 11, 13Feb '13 120
Two Audiobooks Now Available     Feb 4, 13Feb '13 250
Unstable? Unreliable     Feb 4, 13Feb '13 110
Creatine-induced insomnia     Jan 19, 13Jan '13 250     Jan 10, 13Jan '13 90
Minute Medical School     Jan 8, 13Jan '13 190
Blogging the process     Dec 31, 12Dec '12 85
A few thoughts on the limits of self-care     Dec 26, 12Dec '12 240
Reston was not anaesthetized by acupuncture     Dec 8, 12Dec '12 160
PNF stretching     Dec 3, 12Dec '12 130
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
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
IT Band Stretching Does Not Work   Stretching the iliotibial band is a popular idea, but it’s very hard to do it right, and it’s probably not worth it   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
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
The unkillable lactic acid myth     Oct 21, 12Oct '12 90
Surgeon corrects my tone     Oct 21, 12Oct '12 170
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
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 '12 650
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 Schmomeopathy+

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

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

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

  Homeopathy is not a natural or herbal remedy: it’s a magical idea with no possible basis in reality
  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 2,200
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 1,600
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
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
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?     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
Microbreaking   Prevent low back pain and neck cricks with lots of little breaks   Sep 17, 11Sep '11 1,700
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
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
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
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
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 '09 650
Therapeutic Options for Pain Problems   A guide to therapies and medical professionals for injuries, chronic pain and other musculoskeletal problems   Sep 28, 09Sep '09 200
Battle of the Experts   A guide for patients caught between conflicting diagnoses and prescriptions   Jul 6, 09Jul '09 3,000
The Anatomy of Vitality   What makes life tick? A poetic romp through the substance of vitality   Jun 27, 09Jun '09 2,500
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
Measuring Progress in Massage Therapy   How do you know whether or not massage therapy is working for you?   Sep 22, 08Sep '08 1,300
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
Muscle Tissue Issues   Three of the most common problems that people have with their muscles   Aug 13, 07Aug '07 600
Iliotibial band and patellofemoral pain syndromes defy biomechanical expectations   Once again, evidence shows that you can’t blame runner’s knee on seemingly obvious structural problems   May 31, 07May '07 700
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
A Short Story   Slow growth syndrome, oxandrolone and the pathologization of my height   Mar 28, 05Mar '05 1,900
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
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