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The Pain & Therapy Bibliography

A large, quirky database of scientific sources about musculoskeletal pain, injury & treatment, constantly updated & annotated since 1997

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3 article Negrini et al Scoliosis-Specific exercises can reduce the progression of severe curves in adult idiopathic scoliosis Scoliosis This test of exercises designed to fix scoliosis seem to produce small but positive, better-than-nothing results, but… slow. Starting out from about 56˚ Cobb angles, “patients improved 4.6 ± 5.0 °” over an average of two years. 68% of the subjects improved, and only one of 34 got any worse. Not exactly a miracle cure, and definitely not quick! But… definitely better than nothing? 2015 background scoliosis fusion surgery generally considered means stop progression adult idiopathic scoliosis adis patients refusing surgery lack evidence favour conservative treatment aim present study verify effectiveness scoliosis specific exercises facing adis progression methods designed retrospective cohort study included adis patients treatment institute males females age  ±  exclusively treated specific scoliosis specific seas exercises instrumentation seas exercises scoliosis specific exercises adult patients aimed recover postural collapse postural control vertebral stability active correction postural integration key element including neuromotor integration correct postures ergonomic education program therapy includes weekly exercise sessions lasting  min outcome measures radiographic progression main outcome analysed continuous variable statistics anova paired test applied continuous data chi square test applied categorical data alpha set results cobb angle patients included present study  ±   ° fifteen patients previous rays testifying scoliosis progression average curve progression worsening  ±   ° median range years remaining characterized severe curves exceeding  ° cobb curvature  ±  prove curves progressed cases average period  years treatment range y   patients experienced improvement scoliosis patient   scoliosis worsened  °  years progression rate reduced  °  ° year patients improved  ±   ° cobb   exercise+spine+biomechanics+posture+self-treatment+treatment+etiology+pro
3 article Mitchell et al Sulphate absorption across biological membranes Xenobiotica “Some [suplhate] absorption across…the skin may take place under appropriate circumstances.” But it’s still a “vexing question,” according to Waring and Mitchell. 2015  sulphonation unusual common phase ii condensation synthetic reactions experienced xenobiotics availability conjugating agent sulphate rate limiting factor sulphate derived body oxygenation sulphur moieties liberated numerous ingested compounds including sulphur amino acids preformed inorganic sulphate considerable contribution pool   divergence opinion inorganic sulphate readily absorbed gastrointestinal tract controversy continues quarters vexing question potential absorption inorganic sulphate lungs skin   review examines relevant diverse literature concludes sulphate ions move biological membranes means specific transporters gastrointestinal tract major portal entry absorption lungs skin place circumstances random+Epsom+toxins+controversy+debunkery+water
3 article Kuru et al The efficacy of three-dimensional Schroth exercises in adolescent idiopathic scoliosis Clinical Rehabilitation 2015 objective compare efficacy dimensional d schroth exercises patients adolescent idiopathic scoliosis design randomised controlled study setting outpatient exercise unit home setting subjects fifty patients adolescent idiopathic scoliosis interventions forty patients adolescent idiopathic scoliosis meeting inclusion criteria divided groups schroth d exercises applied group clinic home program group group control main measures scoliosis angle cobb method angle rotation scoliometer waist asymmetry waist elbow distance maximum hump height patients quality life qol srs assessed pre treatment weeks results cobb ° rotation angles ° significantly decreased improvement clinic exercise group compared groups gibbosity mm waist asymmetry improved clinic exercise group results groups worsened qol change significantly group conclusion results study schroth exercise program applied clinic physiotherapist supervision superior home exercise control groups additionally observed scoliosis progressed control group received treatment exercise+spine+biomechanics+posture+self-treatment+treatment+etiology+pro
4 article Furlan et al Massage for low-back pain Cochrane Database of Systematic Reviews 2015 background pain lbp common costly musculoskeletal problems modern society experienced adults time lives massage therapy potential minimize pain speed return normal function objectives assess effects massage therapy people specific lbp search methods searched pubmed august databases july medline embase central cinahl lilacs index chiropractic literature proquest dissertation abstracts checked reference lists language restrictions selection criteria included randomized controlled trials adults specific lbp classified acute acute chronic massage defined soft tissue manipulation hands mechanical device grouped comparison groups types inactive controls sham therapy waiting list treatment active controls manipulation mobilization tens acupuncture traction relaxation physical therapy exercises care education data collection analysis standard cochrane methodological procedures cbn guidelines independent authors performed article selection data extraction critical appraisal main results total included trials participants review update majority funded profit organizations trial included participants acute lbp remaining trials included people acute chronic lbp clbp trials massage mechanical device remaining trials hands common type bias studies performance measurement bias difficult blind participants massage therapists measuring outcomes judged quality evidence main reasons downgrading evidence risk bias imprecision suggestion publication bias acute lbp massage inactive controls pain smd ci participants studies short term function smd ci participants studies acute chronic lbp massage inactive controls pain smd ci participants studies function smd ci participants studies short term long term compared active controls massage pain short smd ci participants studies long term follow smd ci participants studies differences function short long term reports adverse events trials increased pain intensity common adverse event reported participants authors conclusions confidence massage effective treatment lbp acute acute chronic lbp improvements pain outcomes massage short term follow functional improvement observed participants acute chronic lbp compared inactive controls short term follow minor adverse effects massage massage+bad news+back pain+muscle pain+manual therapy+treatment+pain problems+spine+muscle
3 article Dibai-Filho et al Reliability of different methodologies of infrared image analysis of myofascial trigger points in the upper trapezius muscle Braz J Phys Ther Do trigger points cause hot spots on the skin overlying them? This was a reliability study of infrared thermograph for diagnosing myofascial TrPs: 24 adults with neck pain and a suspected active TrP in the trapezius were assessed by two trained examiners each, twice in a week. The examiners detected similar thermography results, suggesting that “the methods of infrared image analyses of myofascial trigger points in the upper trapezius muscle employed in the present study are suitable for clinical and research practices.” This research team also published a review of four similar studies, which had mixed results (see Dibai-Filho). 2015 background infrared thermography recognized viable method evaluation subjects myofascial pain objective aim present study assess intra inter rater reliability infrared image analysis myofascial trigger points upper trapezius muscle method reliability study conducted volunteers genders females years age ± cervical pain presence active myofascial trigger point upper trapezius muscle trained examiners performed analysis point line area infrared images periods week interval intra class correlation coefficient icc assess intra inter rater reliability results regard intra rater reliability icc values temperatures ° values standard error measurement sem ° minimal detectable change mdc inter rater reliability icc ranged temperatures ° sem ° mdc conclusion methods infrared image analyses myofascial trigger points upper trapezius muscle employed present study suitable clinical research practices muscle pain+etiology+muscle+pain problems+pro
3 article Dibai-Filho et al Evaluation of myofascial trigger points using infrared thermography Journal of Manipulative & Physiological Therapeutics Do trigger points cause hot spots on the skin overlying them? It’s unclear: this is a review of only a handful of studies of the use of infrared thermography to identify trigger points. Of 11 studies found, only four were suitable for review, and they had mixed results: “Of the few studies present, there is no agreement on skin temperature patterns in the presence of MTrPs.” The reviewer concurrently published their own trial of thermography, with positive results (see Dibai-Filho). 2015 objective aim study review studies published infrared thermography assessment myofascial trigger points mtrps methods search medline cinahl pedro scielo databases carried november january articles published english portuguese spanish year nature included studies purpose review analysis methodological quality assessed quality assessment diagnostic accuracy studies tool results search retrieved articles excluded based language german chinese duplicated databases infrared thermography diagnostic purposes infrared thermography measure skin temperature final sample observational investigations comparative studies accuracy study conclusion present studies evaluating accuracy reliability infrared thermography diagnosis assessment mtrps studies present agreement skin temperature patterns presence mtrps muscle pain+etiology+muscle+pain problems+pro
3 article Halperin et al Non-local muscle fatigue European Journal of Applied Physiology This week in weird exercise physiology: fatigue in the muscles you did not exercise (“non-local fatigue”). Wear out your glutes or pecs…feel it in your cloits n dloits! This has Interesting Implications, methinks: if non-local muscles can be fatigued, it’s plausible that they can also suffer other consequences, even likely. 2015 introduction local muscle fatigue nlmf characterized muscle performance impairments contralateral remote exercised muscle fatiguing protocol muscle group topic interest affords insights physiological determinants muscle fatigue provide practical applications order exercises training rehabilitation programs methods literature review conducted web science pubmed google scholar databases evaluate nlmf effects underlying mechanisms studies outcome measures met inclusion criteria identified results literature conflicting approximately studies reporting nlmf effects measurements closer examination outcome measures limbs reported nlmf effects measurements compared upper body measurements appears nlmf effects muscle group dependent tests involve prolonged repetitive contractions provide clearer evidence nlmf variables potentially influencing size nlmf effect include fatigued muscle groups protocols elicit fatigue gender training background participants conclusion nlmf literature conflicting variables affect nlmf responses account discrepancies nlmf effects attributed interconnected pathways neurological biochemical biomechanical psychological biology+muscle+neat+deep
3 article Urquhart et al Could low grade bacterial infection contribute to low back pain? BMC Med 2015 background immense interest controversy randomised controlled trial showed antibiotics effective treatment chronic pain disc herniation modic type change research potential result paradigm shift treatment pain questions remain unanswered systematic review aims address questions examining role bacteria pain relationship bacteria modic change methods conducted electronic searches medline embase included studies examined relationship bacteria pain modic change studies rated based methodological quality evidence synthesis summarise results bradford hill criteria assess evidence causation results eleven studies identified median range age percentage female participants years studies participants diagnosed disc herniation studies examined presence bacteria spinal disc material identified bacteria pooled estimate proportion positive samples propionibacterium acnes prevalent bacteria present studies median minimum maximum samples positive evidence synthesis moderate evidence relationship presence bacteria pain disc herniation modic type change disc herniation modest evidence effect relationship conclusions bacteria common spinal disc material people undergoing spinal surgery moderate evidence relationship presence bacteria pain disc herniation modic type change disc herniation modest evidence causation work needed determine organisms result contamination represent grade infection spine contributes chronic pain back pain+odd+etiology+treatment+medications+pain problems+spine+pro+self-treatment
3 article Dario et al Are obesity and body fat distribution associated with low back pain in women? European Spine Journal Contrary to common sense, this data shows that back pain is not caused by obesity. 2015 purpose investigate relationship measures obesity chronic pain lbp pair twin case control design adjusts genetics early shared environment methods cross sectional association lifetime prevalence chronic lbp measures obesity body mass index bmi percent body fat waist circumference waist hip ratio investigated female twins stages total sample analysis ii pair case control analysis monozygotic mz dizygotic dz twins iii pair case control analysis separated dz mz odds ratios   confidence intervals ci calculated results bmi   ci percent body fat   ci weakly lifetime prevalence chronic lbp total sample analysis absent shared environment genetic factors adjusted pair case control analysis greater waist hip ratios smaller prevalence estimates chronic lbp pair case control analysis mz dz twins   ci association remain full adjustment genetic factors mz pair case control analysis conclusions bmi percent fat mass greater depositions fat mass hips increases chronic lbp prevalence women associations small confounded effects genetics early shared environment results support causal direct relationship obesity chronic lbp etiology+counter-intuitive+back pain+random+pro+pain problems+spine
4 article Moseley et al Fifteen Years of Explaining Pain Journal of Pain A cogent formal summary and update on how this “explain pain” thing is going so far (pretty well). Moseley and Butler are always quite readable, even when writing for journals (imagine), but see also their blogging about the same thing. 2015 pain field advocating time importance teaching people live pain possibility people live pain explaining pain ep refers range educational interventions aim change understanding biological processes thought underpin pain mechanism reduce pain draws educational psychology conceptual change strategies patients understand current thought pain biology core objective ep approach treatment shift conceptualization pain marker tissue damage disease marker perceived protect body tissue describe historical context beginnings ep suggesting pragmatic application biopsychosocial model pain differentiating cognitive behavioral therapy educational components early multidisciplinary pain management programs attempt address common misconceptions ep emerged  years highlighting ep behavioral cognitive advice deny potential contribution peripheral nociceptive signals pain contend ep grounded strong theoretical frameworks targeted effects biologically plausible behavioral evidence supportive update meta analyses results systematic review contributions field propose future directions enhance effects ep part multimodal pain rehabilitation perspective ep range educational interventions ep grounded conceptual change instructional design theory increases knowledge pain related biology decreases catastrophizing imparts short term reductions pain disability presents biological information justifies biopsychosocial approach rehabilitation chronic pain+mind+pain problems
3 article Dario et al The relationship between obesity, low back pain, and lumbar disc degeneration when genetics and the environment are considered Spine J 2015 background context relationships obesity pain lbp lumbar disc degeneration ldd remain unclear familial factors including genetics early environment affect relationships purpose investigate relationship obesity related measures weight body mass index bmi lbp ldd twin studies effect genetics early environment controlled study design systematic review meta analysis methods medline cinahl scopus web science embase databases searched earliest records august cross sectional longitudinal observational twin studies identified search strategy considered inclusion investigators independently assessed eligibility conducted quality assessment extracted data metaanalyses fixed random effects pool studies estimates association results total articles met inclusion criteria studies included lbp analysis ldd analysis lbp analysis pooling studies showed risk lbp individuals highest levels bmi weight people bmi odds ratio confidence interval ci dose response relationship identified genetics effects shared early environment adjusted pair twin case control analysis pooling studies showed reduced statistically positive association obesity prevalence lbp ci association diminished significant ci pooling included studies monozygotic twin pairs studies met inclusion criteria ldd familial factors controlled body weight positively ldd cross sectional studies cross sectional studies investigated relationship obesity related measures ldd accounting familial factors results conflicting longitudinal study lbp longitudinal studies ldd increase risk obese individuals familial factors controlled conclusions findings review suggest genetics early environment mechanisms underlying relationship obesity lbp direct causal link conditions appears weak longitudinal studies twin design needed understand complex mechanisms underlying associations obesity lbp ldd etiology+counter-intuitive+back pain+random+pro+pain problems+spine
3 article Cedernaes et al Acute sleep loss induces tissue-specific epigenetic and transcriptional alterations to circadian clock genes in men J Clin Endocrinol Metab 2015 context shift workers increased risk metabolic morbidities clock genes regulate metabolic processes peripheral tissues glucose oxidation objective investigate clock genes affected epigenetic transcriptional level peripheral human tissues acute total sleep deprivation tsd mimicking shift work extended wakefulness intervention randomized period condition crossover clinical study fifteen healthy men underwent experimental sessions night sleep h overnight wakefulness subsequent morning serum cortisol measured skeletal muscle subcutaneous adipose tissue biopsies dna methylation gene expression analyses core clock genes bmal clock cry per finally baseline hr post oral glucose load plasma glucose concentrations determined main outcome measures adipose tissue acute sleep deprivation sleep increased methylation promoter cry + promoter interacting enhancer regions per + + skeletal muscle tsd sleep decreased gene expression bmal cry concentrations serum cortisol reset peripheral tissue clocks decreased ± ± nmol postprandial plasma glucose concentrations elevated tsd ± ± mmol conclusions findings demonstrate single night wakefulness alter epigenetic transcriptional profile core circadian clock genes key metabolic tissues tissue specific clock alterations explain shift work disrupt metabolic integrity observed random+sleep
3 article Goss et al Lower Extremity Biomechanics and Self-Reported Foot-Strike Patterns Among Runners in Traditional and Minimalist Shoes Journal of Athletic Training This test of running styles found that actual style — rearfoot or forefoot striking — was variable regardless of shoe type, and that runners can’t accurately report their own style, suggesting that “lots of people are fooling themselves about how they’re running” (Hutchinson). What you put on your feet does not necessarily change how you run. 2015 context injury incidence rate runners approximately individuals advocated anterior foot strike pattern reduce ground reaction forces injury rates attribute rear foot strike pattern proportion minimalist shoe wearers adopt anterior foot strike pattern remains unclear objective evaluate accuracy reported foot strike patterns compare negative ankle knee joint angular work runners foot strike patterns wearing traditional minimalist shoes describe average vertical loading rates design descriptive laboratory study setting research laboratory patients participants total healthy volunteers men women age ± years height ± mass ± kg months experience wearing traditional minimalist shoes instructed classify foot strike patterns intervention participants ran preferred shoes instrumented treadmill dimensional motion capture main outcome measure reported foot strike patterns compared dimensional video assessments runners classified groups based video assessment traditional shoe rear foot strikers tsr minimalist shoe anterior foot strikers msa minimalist shoe rear foot strikers msr ankle knee negative angular work average vertical loading rates stance phase compared groups results runners reported foot strike patterns agreed video assessment κ tsr runners demonstrated greater ankle dorsiflexion knee extension negative work msa msr runners msa msr runners demonstrated greater ankle plantar flexion negative work tsr runners msr runners demonstrated greater average vertical loading rate msa tsr runners conclusions runners report foot strike patterns accurately automatically adopt anterior foot strike pattern transitioning minimalist running shoes biomechanics+barefoot+orthotics+counter-intuitive+etiology+pro+foot+leg+limbs+pain problems+running+exercise+self-treatment+treatment+devices
3 article Hole et al Music as an aid for postoperative recovery in adults Lancet 2015 background music invasive safe inexpensive intervention delivered easily successfully systematic review meta analysis assess music improves recovery surgical procedures methods included randomised controlled trials rcts adult patients undergoing surgical procedures excluding involving central nervous system head neck published language included rcts form music initiated surgery compared standard care drug interventions searched medline embase cinahl cochrane central meta analysis revman version standardised differences smd random effects models stata version meta regression study registered prospero number crd findings identified titles abstracts included rcts systematic review size varying participants choice music timing duration varied comparators included routine care headphones music white noise undisturbed bed rest music reduced postoperative pain smd ci anxiety analgesia increased patient satisfaction length stay differ smd subgroup analyses showed choice music timing delivery difference outcomes meta regression identified heterogeneity variables assessed music effective patients general anaesthetic interpretation music offered patients reduce pain anxiety postoperative period timing delivery adapted individual clinical settings medical teams funding treatment+good news+surgery+fun+tips+self-treatment
4 article Machado et al Efficacy and safety of paracetamol for spinal pain and osteoarthritis British Medical Journal 2015 objective investigate efficacy safety paracetamol acetaminophen management spinal pain osteoarthritis hip knee design systematic review meta analysis data sources medline embase amed cinahl web science lilacs international pharmaceutical abstracts cochrane central register controlled trials inception december eligibility criteria selecting studies randomised controlled trials comparing efficacy safety paracetamol placebo spinal pain neck pain osteoarthritis hip knee data extraction independent reviewers extracted data pain disability quality life secondary outcomes adverse effects patient adherence rescue medication pain disability scores converted scale pain disability worst pain disability calculated weighted differences risk ratios confidence intervals random effects model cochrane collaboration tool assessing risk bias grade approach evaluate quality evidence summarise conclusions results reports randomised trials included high quality evidence paracetamol ineffective reducing pain intensity weighted difference confidence interval disability improving quality life short term people pain hip knee osteoarthritis high quality evidence paracetamol significant clinically important effect pain disability short term number patients reporting adverse event risk ratio confidence interval adverse event withdrawn study adverse events similar paracetamol placebo groups patient adherence treatment rescue medication similar groups high quality evidence showed patients paracetamol times abnormal results liver function tests clinical importance effect uncertain conclusions paracetamol ineffective treatment pain minimal short term benefit people osteoarthritis results support reconsideration recommendations paracetamol patients pain osteoarthritis hip knee clinical practice guidelines medications+bad news+self-treatment+treatment
2 article Kraus et al Piriformis Syndrome with Variant Sciatic Nerve Anatomy PM & R: The Journal of Injury, Function, and Rehabilitation 2015 year male long distance runner presented left buttock pain eventually progressed severe debilitating pain intermittently radiating posterior thigh foot comprehensive workup ruled spine hip etiologies symptoms pelvic mri neurogram complex oblique planes piriformis demonstrated variant anatomy left sciatic nerve consistent clinical diagnosis piriformis syndrome patient ultimately underwent neurolysis release sciatic nerve partial resection piriformis muscle post operatively patient reported significant pain reduction resumed running months piriformis syndrome uncommon considered differential diagnosis buttock pain advanced imaging essential guide management anatomy+sciatica+neurology+case+back pain+pain problems+spine+butt+hip
3 article Ware et al Cannabis for the Management of Pain Journal of Pain Ars Technica (which I read more and more of these days): “Almost every news story one reads about the use of cannabis as a medical therapy contains some variation of disclaimer saying ‘more research is needed’ into the longterm safety of medical cannabis use. Now a tiny bit of that ‘more research’ has been published in the Journal of Pain. The headline result was that there was NO INCREASE IN THE NUMBER OF SERIOUS ADVERSE EVENTS in a group that used cannabis for chronic pain when compared to a group that did not. ” Hard to overstate how significant that kind of safety level is for any medication that helps with pain. Also: This science comes from Canada. (Which is where I come from.) You’re welcome. 2015 cannabis widely management strategy patients wide range symptoms diseases including chronic noncancer pain safety cannabis medical purposes systematically evaluated conducted prospective cohort study describe safety issues subjects chronic noncancer pain standardized herbal cannabis product thc dispensed eligible subjects year period controls subjects chronic pain clinics cannabis users primary outcome consisted adverse events saes adverse events aes secondary safety outcomes included pulmonary neurocognitive function standard hematology biochemistry renal liver endocrine function secondary efficacy parameters included pain symptoms mood quality life sixteen individuals chronic pain recruited cannabis group current users users controls chronic pain current cannabis clinics canada median daily cannabis dose g difference risk saes adjusted irr ci groups medical cannabis users increased risk aes adjusted irr ci mild moderate differences secondary safety assessments quality controlled herbal cannabis cannabis experienced patients part monitored treatment program year appears reasonable safety profile longer term monitoring functional outcomes needed perspective study evaluated safety cannabis patients chronic pain year study higher rate adverse events cannabis users compared controls adverse events average dose g herbal cannabis day chronic pain+medications+pain problems+self-treatment+treatment
3 article Derry et al Ibuprofen for acute treatment of episodic tension-type headache in adults Cochrane Database of Systematic Reviews 2015 background tension type headache tth affects person worldwide divided infrequent episodic tth headache month frequent episodic tth headaches month chronic tth headaches month ibuprofen number analgesics suggested acute treatment headaches frequent episodic tth objectives assess efficacy safety oral ibuprofen treatment acute episodic tth adults search methods searched central cochrane library medline embase house database january sought unpublished studies personal contacts searching line clinical trial registers manufacturers websites selection criteria included randomised placebo controlled studies parallel group cross oral ibuprofen symptomatic relief acute episode tth studies prospective include participants treatment arm data collection analysis review authors independently assessed studies inclusion extracted data numbers participants achieving outcome calculate risk ratio rr number needed treat additional beneficial outcome nnt number needed treat additional harmful outcome nnh oral ibuprofen compared placebo range outcomes predominantly recommended international headache society ihs main results included studies enrolled adult participants frequent episodic tth ihs diagnostic criteria older classification ad hoc committee describe diagnostic criteria excluded participants migraines people tth participated studies numbers form analysis placebo standard ibuprofen mg standard ibuprofen mg fast acting ibuprofen mg participants moderate severe pain start treatment participants studies reporting outcomes analyse active comparators single studies ihs preferred outcome pain free hours nnt ibuprofen mg formulations compared placebo confidence interval ci studies significant difference placebo hour moderate quality evidence nnt global evaluation good excellent studies moderate quality evidence study reported number participants experiencing worse mild pain hours rescue medication ibuprofen mg placebo number needed treat prevent event nntp studies quality evidence adverse events ibuprofen mg placebo rr high quality evidence adverse events reported authors conclusions ibuprofen mg important benefit terms pain free hours small number people frequent episodic tension type headache acute headache moderate severe initial pain information lesser benefit worse mild pain hours headache+medications+head+head/neck+pain problems+self-treatment+treatment
4 article Derry et al Topical NSAIDs for acute musculoskeletal pain in adults Cochrane Database of Systematic Reviews 2015 background topical nsaids treat acute musculoskeletal conditions widely accepted provide pain relief systemic adverse events review update topical nsaids acute pain adults originally published issue objectives determine efficacy safety topically applied nsaids acute musculoskeletal pain adults search methods searched cochrane register studies online medline embase february sought unpublished studies personal contacts searching online clinical trial registers manufacturers websites earlier review searched house database contacted manufacturers selection criteria included randomised double blind active placebo inert carrier controlled trials treatments administered adults acute pain resulting strains sprains sports overuse type injuries twisted ankle instance participants treatment arm application treatment daily data collection analysis review authors independently assessed studies inclusion extracted data numbers participants achieving outcome calculate risk ratio numbers needed treat additional beneficial outcome nnt additional harmful outcome nnh compared placebo active treatment reported confidence intervals ci interested compare formulations gel cream plaster individual nsaids main results update added included studies participants excluded studies identified additional reports completed ongoing studies published full earlier review included studies update included studies compared topical nsaids form gel spray cream similar topical placebo participants treated topical nsaid placebo oral nsaid increase number included participants previous version review identified number studies clinical trial registries unavailable results amounting participants efficacy adverse events formulations topical diclofenac ibuprofen ketoprofen piroxicam indomethacin demonstrated significantly higher rates clinical success participants pain relief matching topical placebo moderate high quality data benzydamine drug formulation combinations nnts clinical success diclofenac emulgel® formulation lowest nnt ci studies pain intensity reduction outcome diclofenac plasters flector® nnt based good excellent responses studies ketoprofen gel nnt studies s defined outcomes ibuprofen gel nnt studies outcomes marked improvement complete remission drug formulation combinations nnt values indicating lesser efficacy insufficient data compare reliably individual topical nsaids oral nsaid local skin reactions generally mild transient differ placebo high quality data systemic adverse events high quality data withdrawals due adverse events quality data authors conclusions topical nsaids good levels pain relief acute conditions sprains strains overuse injuries similar oral nsaids gel formulations diclofenac emugel® ibuprofen ketoprofen diclofenac patches effects adverse events minimal version review included studies additional information information topical diclofenac greatly expanded present review supports previous review concluding topical nsaids effective providing pain relief demonstrate formulations gel formulations diclofenac ibuprofen ketoprofen provide results large amounts unpublished data identified influence results updates review medications+self-treatment+treatment
3 webpage Gavura How risky are NSAIDS? Science Based Pharmacy A good general discussion of painkiller risks and side effects, but the relative safety of topical treatments is of particular interest:
The main advantage of topical NSAIDs is the reduced exposure of the rest of the body to the product, which reduces the side effect profile. Given the toxicity of NSAIDs is related in part to the dose, it follows that topical treatments should have a better toxicity profile. Consequently, the cardiovascular risks of topical diclofenac, even in those with a high baseline risk of disease, should be negligible with the topical forms.
2015 medications+inflammation+harms+self-treatment+treatment+pain problems
3 article Campos et al Hemodynamic Effects Induced by Transcutaneous Electrical Nerve Stimulation in Apparently Healthy Subjects Archives of Physical Medicine & Rehabilitation TENS seems to be ever so slightly relaxing: this review actually confirmed that it can reduce blood pressure and heart rate. However, the effects were really small, right on the edge of detectability. 2015 objective determine effects transcutaneous electrical nerve stimulation tens heart rate hr systolic sbp diastolic blood pressure dbp apparently healthy adults aged years data sources cochrane library pubmed embase lilacs electronic databases searched study selection randomized clinical trials rcts included tens administered noninvasively surface electrodes rest effect compared control group placebo tens sensitive search strategy identifying rcts employed independent reviewers initial search led identification studies articles met eligibility criteria data extraction independent reviewers extracted data selected studies quality evaluated pedro scale differences standardized differences outcomes calculated data synthesis eligible articles involved total apparently healthy subjects studies high frequency hf tens frequency lf tens evaluated effect sbp studies hf lf tens evaluated effect dbp studies hf study lf tens evaluated effect hr statistically significant reduction sbp mm hg ci lf tens statistically significant reduction dbp mm hg ci i hr bpm ci i frequencies median pedro scale conclusion tens promote discrete reduction sbp dbp hr apparently healthy subjects TENS+devices+treatment
3 article Yoo Effects of the slow speed-targeting squat exercise on the vastus medialis oblique/vastus lateralis muscle ratio J Phys Ther Sci 2015 purpose study investigated effects slow speed targeting squat exercise vastus medialis oblique vastus lateralis ratio subjects ten asymptomatic men recruited methods emg activities vastus medialis oblique vastus lateralis muscles recorded surface electrodes subject performed squat exercise conditions results vastus medialis oblique vastus lateralis ratio condition ± significantly higher conditions ± ± conclusion effectively slow movement speed recommended selective strengthening vastus medialis oblique slow speed targeting device biofeedback patellar pain+strength+exercise+muscle+counter-intuitive+arthritis+aging+pain problems+knee+leg+limbs+overuse injury+injury+running+self-treatment+treatment
3 article Malanga et al Mechanisms and efficacy of heat and cold therapies for musculoskeletal injury Postgrad Med Although it’s 2015, “most recommendations for the use of heat and cold therapy are based on empirical experience,” not evidence, because the only evidence we have is still “limited.” Malinga, Yang, and Stark review the alleged benefits of heat and cold: pain relief for both, of course, plus ice reduces “blood flow, edema, inflammation, muscle spasm, and metabolic demand,” while heating increases “blood flow, metabolism, and elasticity of connective tissues.” Even these aren’t well-tested, and there are other possibilities that haven’t been tested at all. Based on a handful of relevant trials, they concluded that “heat-wrap therapy provides short-term reductions in pain and disability in patients with acute low back pain and provides significantly greater pain relief of DOMS than does cold therapy.” But the main take-home message from this paper is just “much more study needed.” 2015 nonpharmacological treatment strategies acute musculoskeletal injury revolve pain reduction promotion healing order facilitate return normal function activity heat cold therapy modalities facilitate outcome prevalent confusion modality heat cold recommendations heat cold therapy based empirical experience limited evidence support efficacy specific modalities literature review information practitioners heat cold therapies based mechanisms action physiological effects medical evidence support clinical physiological effects cold therapy include reductions pain blood flow edema inflammation muscle spasm metabolic demand limited evidence randomized clinical trials rcts supporting cold therapy acute musculoskeletal injury delayed onset muscle soreness doms physiological effects heat therapy include pain relief increases blood flow metabolism elasticity connective tissues limited evidence support topical heat general rcts shown heat wrap therapy short term reductions pain disability patients acute pain significantly greater pain relief doms cold therapy remains ongoing sufficiently powered high quality rcts effects cold heat therapy recovery acute musculoskeletal injury doms ice heat+injury+DOMS+rehab+pain problems+self-treatment+treatment+exercise+inflammation+muscle
3 article Chen et al Transcutaneous Electrical Nerve Stimulation in Patients with Knee Osteoarthritis The Clinical Journal of Pain An analysis of 18 trials showed only TENS “might” relieve knee pain caused by osteoarthritis. The average effect size was undoubtedly small. 2015 objectives transcutaneous electrical nerve stimulation tens reported relieve pain improve function patients knee osteoarthritis purpose systematic review meta analysis evaluate efficacy tens management knee osteoarthritis methods searched embase pubmed central sigle pedro clinicaltrials gov june literature related tens treatment knee osteoarthritis authors independently screened searched records based title abstract information including authors study design age sex study population stimulation frequency tens outcome measures follow periods extracted authors results eighteen trials included qualitative systematic review included meta analysis tens significantly decreased pain smd ci knee+TENS+arthritis+leg+limbs+pain problems+devices+treatment+aging
3 article Glancy et al Mitochondrial reticulum for cellular energy distribution in muscle Nature For decades, mitochondria have been described as the “power plants” of cells, and they are already fascinating and complex. (I’m particularly amazed by their role in unnecessary inflammation.) But we may need to update the simile: turns out mitochondria don’t just produce energy “like a power plant,” they also deliver it like a network of power lines. This phenomenon was identified in mouse muscles:

Researchers found that mitochondria in mouse muscles not only produce energy, but can quickly distribute it across the muscle cell through a grid-like network. The findings reveal a major mechanism for energy distribution in skeletal muscle cells, and could provide new insights into diseases linked to energy use in muscle.

What a wonderful example of how much we still have to learn about muscle tissue (and others too, I’m sure, but muscle seems to be particularly full of surprising puzzles). It seems likely that we probably can’t understand muscle pain properly if we have only just now discovered something so fundamental about muscle biology. Imagine trying to troubleshoot an electrical problem if you weren’t aware of a major feature of how power is generated and transmitted!
2015 intracellular energy distribution attracted interest proposed occur skeletal muscle metabolite facilitated diffusion genetic evidence suggests facilitated diffusion critical normal function hypothesized mitochondrial structure minimizes metabolite diffusion distances skeletal muscle demonstrate mitochondrial reticulum providing conductive pathway energy distribution form proton motive force mouse skeletal muscle cell reticulum find proteins mitochondrial proton motive force production preferentially cell periphery proteins proton motive force atp production cell interior contractile transport atpases show rapid coordinated depolarization membrane potential component proton motive force cell response spatially controlled uncoupling cell interior propose membrane potential conduction mitochondrial reticulum dominant pathway skeletal muscle energy distribution biology+muscle+neat
3 article Aboodarda et al Pain pressure threshold of a muscle tender spot increases following local and non-local rolling massage BMC Musculoskeletal Disorders 2015 background aim present study determine acute effect rolling massage pressure pain threshold ppt individuals tender spots plantar flexor muscles methods randomized control trial single blinded study tender spots identified participants plantar flexor muscles gastrocnemius soleus participants randomly assigned intervention groups     heavy rolling massage calf exhibited higher tenderness ipsi heavy rolling massage contralateral calf contra light stroking skin roller massager calf exhibited higher tenderness sham manual massage calf exhibited higher tenderness ipsi intervention control ppt measured    min post intervention pressure algometer results   post intervention ipsi   contra   demonstrated higher   muscle pain+muscle+pain problems
3 article Toepfer et al Bilateral diaphyseal bone cysts of the tibia mimicking shin splints in a young professional athlete-a case report and depiction of a less-invasive surgical technique BMC Musculoskeletal Disorders This is a case report of a fantastically rare (“never been reported before”) cause of shin pain: bone cysts in both shins of a 17-year old pro athlete. Bone cysts are not particularly rare, but a matched set of painful ones in the tibiae sure is. Such lesions are tricky to distinguish from overuse injuries like medial tibial stress syndrome (shin splints). I discuss bone cysts in a little more detail in my shin splints tutorial. 2015 background medial tibial stress syndrome common exertional leg pain runners musculoskeletal tumors tumor lesions rare encounters orthopedic sports medicine practice unicameral simple bone cyst tumor lesions bone typically affecting children adolescents bilateral occurrence rare reported tibiae failing accurately diagnose tumorous lesion entail reaching consequences patients physicians case presentation report case large bilateral unicameral bone cysts diaphyseal tibiae mimicking medial tibial stress syndrome year professional athlete report symmetric tibial unicameral bone cysts literature patient complained persisting shin splint symptoms months comprehensive conservative treatment mri revealed extensive osteolytic bone lesions diaphyseal tibiae patient tailored invasive surgical procedure allowing patient return competitive sports level symptom free months surgery eventually qualify years biathlon junior world championships outlined briefly pathogenesis treatment options entity discussed conclusion report raise awareness musculoskeletal tumors differential diagnosis therapy refractory symptoms young athletes encourage medical staff involved sports medicine athlete support perform early high quality imaging initiate sufficient surgical treatment similar cases invasive surgical procedure aiming fast return sports optimal compromise traditional open curettage risk recurrence soft tissue saving bone sparing minimal invasive technique shin pain+etiology+diagnosis+leg+limbs+pain problems+overuse injury+injury+running+exercise+self-treatment+treatment+pro
3 article Walker et al Interrater Reliability of Motion Palpation in the Thoracic Spine Evid Based Complement Alternat Med 2015 introduction manual therapists commonly assessments intervertebral motion determine spinal manipulation reliability procedures demonstrates conflicting results objectives study investigate interrater reliability thoracic spine motion palpation perceived joint restriction pain methods twenty participants ages mid pain enrolled raters motion palpated marked t t levels methods standardised pragmatic noted restricted painful segments calculated agreement raters generating raw agreement percentages kappa coefficients confidence intervals results poor level agreement raters joint stiffness pain localization pragmatic standardized approaches results improve significantly conducted post hoc analysis spinal levels collapsed left sides combined conclusions results interrater reliability poor motion restriction pain findings unfavourable implications manual therapists motion palpation select patients spinal manipulation diagnosis+bad news+spinal adjustment+back pain+neck+spine+treatment+pain problems+head/neck
article Romero et al Long-term follow-up in sacroiliac joint pain patients treated with radiofrequency ablative therapy Arq Neuropsiquiatr 2015 sacroiliac joint sij pain responsible cases lumbar pain objective report long term efficacy radiofrequency denervation sacroiliac joint pain twelve eighteen months method adults patients sacroiliac join pain diagnosis included prospective study primary outcome measure pain intensity numeric rating scale nrs secondary outcome measure patient global impression change scale pgic results short term pain relief observed nrs pain score decreasing ± baseline ± month ± months post procedure long term pain relief sustained twelve eighteen months post procedure nrs pain remaining ± ± conclusion radiofrequency denervation sij significantly reduce pain selected patients sacroiliac syndrome back pain+denervation+pain problems+spine+neurology+treatment
4 article Berthelot et al Strong opioids for noncancer pain due to musculoskeletal diseases Joint Bone Spine 2015 classification morphine step iii analgesic based pharmacological data creates strong bias belief efficacy drug double blind emergency room trials showed similar levels pain relief intravenous acetaminophen intravenous morphine patients renal colic pain acute limb pain patients chronic noncancer pain morphine strong opioids dosages mg day slightly effective placebos effective acetaminophen effective nonsteroidal anti inflammatory drugs nsaids patients osteoarthritis strong opioids effective nsaids studies placebos randomized controlled trial patients sciatica difference placebo chronic strong opioids induce hyperalgesia patients hyperpathia increased sensitivity cold leading patient request higher dosages suggest opioid induced hyperalgesia pain specialists issued petition strong opioids dosages higher mg day morphine equivalent effort decrease high rate mortality due misuse abuse strong opioids deaths year healthcare providers overestimate efficacy step iii analgesics pain score decreases points back pain+sciatica+arthritis+bad news+medications+harms+pain problems+spine+butt+hip+aging+self-treatment+treatment
3 article Geller et al Emergency Department Visits for Adverse Events Related to Dietary Supplements New England Journal of Medicine 2015 harms+nutrition+controversy+medicine+random+bad news+pain problems+self-treatment+treatment+debunkery
4 article Pulsford et al Associations of sitting behaviours with all-cause mortality over a 16-year follow-up Int J Epidemiol This study is a nice FUD-fighter: its results directly contradict the overhyped notion that a lot of sitting is just as dangerous as smoking, an idea that’s been around for a few years now and it reeks of premature, fear-mongering speculation. There was never any good evidence that “sitting is the new smoking,” but this is good evidence that “sitting time was not associated with all-cause mortality risk” in over 5,000 subjects. This doesn’t remotely get us off the exercise hook. It doesn’t mean that a sedentary lifestyle is safe or healthy, but it does strongly suggest that we aren’t doomed by it (that is, you likely can compensate for a lot of time in a chair by being as active as possible otherwise). And it’s still possible that sedentariness is unhealthy independently of other exercise, and I’m sure we’re going to see more research about it. Regardless, the scary headlines over the last few years were not defensible, and this new evidence is definitely reassuring. 2015 background sitting behaviours linked increased risk mortality independent moderate vigorous physical activity mvpa previous studies tended examine single indicators sitting sitting behaviours combined study aims enhance evidence base examining type specific prospective associations sitting behaviours total sitting risk mortality methods participants men women whitehall ii cohort study free cardiovascular disease information weekly sitting time work leisure time watching tv leisure time excluding tv work leisure time combined covariates proportional hazards models investigate prospective associations sitting time week mortality risk follow date measurement earliest death date censor july   results   person years follow follow time  ±  years total deaths recorded associations observed sitting indicators mortality risk unadjusted models models adjusted covariates including mvpa conclusions sitting time mortality risk results study suggest policy makers clinicians cautious placing emphasis sitting behaviour risk factor mortality distinct effect physical activity sedentariness
3 article Snowdon et al Physiotherapy commenced within the first four weeks post spinal surgery is safe and effective Archives of Physical Medicine & Rehabilitation 2015 objectives determine physiotherapy commenced weeks post spinal surgery safe effective data sources electronic databases cinahl medline amed pubmed embase pedro searched earliest date additional trial identified reference list scanning study selection controlled trials evaluating comprehensive physiotherapy rehabilitation commenced weeks post operatively compared control group receiving physiotherapy standard post operative care rest active physiotherapy sham physiotherapy spinal surgery musculoskeletal eitiology reviewers independently applied inclusion exclusion criteria disagreements discussed consensus reached searching identified potentially relevant articles trials participants met inclusion criteria data extraction data extracted predefined data extraction form methodological quality trials assessed independently reviewers downs black checklist pooled analyses performed random effects model inverse variance methods calculate risk differences confidence intervals ci dichotomous outcomes standardised differences smds cis continuous outcomes data synthesis compared sham physiotherapy early comprehensive physiotherapy increase risk adverse events risk difference ci addition moderate quality evidence demonstrating reduction pain moderate significant amount weeks smd ci + months smd ci conclusions early comprehensive physiotherapy commenced weeks post spinal surgery increase potential adverse event leads moderate statistically significant reduction pain compared control group back pain+physical therapy+surgery+rehab+pain problems+spine+manual therapy+treatment+injury
3 article Rathleff et al High-load strength training improves outcome in patients with plantar fasciitis Scandinavian Journal of Medicine & Science in Sports 2015 aim study investigate effectiveness shoe inserts plantar fascia specific stretching shoe inserts high load strength training patients plantar fasciitis forty patients ultrasonography verified plantar fasciitis randomized shoe inserts daily plantar specific stretching stretch group shoe inserts high load progressive strength training strength group performed day high load strength training consisted unilateral heel raises towel inserted toes primary outcome foot function index ffi months additional follow ups performed months primary endpoint months strength group ffi points confidence interval ci     compared stretch group months differences groups     months ffi points ci strength group points ci stretch group differences secondary outcomes simple progressive exercise protocol performed day resulted superior reported outcome months compared plantar specific stretching high load strength training aid quicker reduction pain improvements function plantar fasciitis+strength+treatment+good news+foot+leg+limbs+pain problems+overuse injury+injury+tendinosis+exercise+self-treatment
2 webpage Meakins Soft tissue sore spots of an unknown origin 2015 muscle pain+trigger points doubts+muscle+pain problems
3 webpage Wachter How Medical Tech Gave a Patient a Massive Overdose Every time your computer glitches or your smart phone acts stupid for the next while, remember that software also controls medical systems. You’ll have a hard time forgetting it after reading this… 2015 medications+medicine+random+deep+self-treatment+treatment
webpage O’Connell et al Transcranial direct current brain stimulation for chronic pain British Medical Journal 2015 treatment+bad news+chronic pain+devices+pain problems
article Chae et al Psychophysical and neurophysiological responses to acupuncture stimulation to incorporated rubber hand Neurosci Lett 2015 neuroscientific perspective sensations induced acupuncture product bottom modulation simple needling somatosensory receptors reciprocal interaction top modulation brain present study investigated acupuncture stimulation incorporated body parts produces brain responses similar responses observed acupuncture stimulation real hand present study included participants watched rubber hand synchronously stroked unseen left hand induce incorporation rubber hand body experimental modification body ownership acupuncture needle stimulation applied li acupoint incorporated rubber hand brain activity measured functional magnetic resonance imaging fmri rubber hand fully incorporated real body acupuncture stimulation rubber hand resulted experience deqi sensation brain activations dorsolateral prefrontal cortex dlpfc insula secondary somatosensory cortex sii medial temporal mt visual area insular activation deqi sensation rubber hand psychophysical neurophysiological responses acupuncture stimulation incorporated rubber hand influenced enhanced bodily awareness hand due top modulation interoceptive system brain acupuncture+sensation & touch+mind+controversy+debunkery+energy work
3 webpage Brissonnet Placebo, Are You There? Harriet Hall translated this French article on placebo for, calling it “the best explanation of placebo that I had ever read.” (I was quite involved editorially, and in particular spent a bunch of time on producing shinier, translated diagrams.) I’m not quite sure it’s the best placebo explanation I’ve ever read, but on the other hand I can’t point to a better one, and it is certainly chock-a-block with historical context, effectively cited science, and little gems of clarity on this tricky topic. The gist of the article is that “placebo” is an umbrella term for many phenomena, most which are relevant only to research methodology, not treating patients. 2015 pro+mind+deep
article Nakashima et al Abnormal Findings on Magnetic Resonance Images of the Cervical Spines in 1,211 Asymptomatic Subjects Spine (Phila Pa 1976) 2015 study design cross sectional study objective purpose study determine prevalence distribution abnormal findings cervical spine magnetic resonance image mri summary background data neurological symptoms abnormal findings images keys diagnose spinal diseases determine significance mri abnormalities account frequency spectrum structural abnormalities asymptomatic large scale study documented abnormal findings cervical spine image asymptomatic subjects methods images analyzed anteroposterior spinal cord diameter disc bulging diameter axial cross sectional area spinal cord healthy volunteers age healthy volunteers prospectively enrolled study ranged years approximately individuals decade sex data determine spectrum degree disc bulging spinal cord compression scc increased signal intensity spinal cord results subjects presented disc bulging significantly increased age terms frequency severity number levels subjects s bulging discs males females contrast asymptomatic subjects diagnosed scc increased signal intensity numbers increased age age years scc involved level levels predominantly occurred c c c c conclusion disc bulging frequently observed asymptomatic subjects including s number patients minor disc bulging increased age years contrast frequency scc increased signal intensity increased age years accompanied increased severity disc bulging neck+imaging+biomechanics+head/neck+spine+diagnosis+etiology+pro
webpage Hermes ND Confession, Part 1 2015
3 webpage Coe It's the effect size, stupid Too often people smugly dismiss a study just because of small sample size, ignoring all other considerations, especially effect size … a rookie move. (For instance, you really do not need to test lots of showers to prove that they are an effective moistening procedure.) This article delves into the significance of effect size, as opposed to statistical significance. 2015 effect size simple quantifying difference groups advantages tests statistical significance effect size emphasises size difference confounding sample size primary reports rarely mention effect sizes textbooks research methods courses computer packages address concept paper explication effect size calculated interpreted relationship effect size statistical significance discussed confidence intervals outlined advantages dangers effect sizes meta analysis discussed problems effect sizes raised number alternative measures effect size finally advice effect sizes summarised random+stats+scientific medicine
3 article Gliedt et al Chiropractic identity, role and future Chiropr Man Therap This survey of more than 7000 chiropractic students showed that traditional chiropractic subluxation theory is alive and well. 61% agreed that the “emphasis of chiropractic intervention is to eliminate vertebral subluxations/vertebral subluxation complexes…while a larger percent found it is important to learn about evidence-based practice. These two key points may seem contradictory, suggesting cognitive dissonance.” Or perhaps it just suggests a woeful ignorance of what evidence-based medicine actually is. A lot of CAM practitioners happily pay lip service to EBM. It’s easy to sound science-y while cherry-picking junk science that confirms biases. 2015 background literature pertaining chiropractic students opinions respect desired future status chiropractic physician limited topic worthy study previous pilot study performed single chiropractic college current study expansion pilot project collect data chiropractic students enrolled colleges north america objective purpose study investigate north american chiropractic students opinions professional identity role future methods item cross sectional electronic questionnaire developed total chiropractic students north american english speaking chiropractic colleges invited complete survey survey items encompassed demographics evidence based practice chiropractic identity setting scope practice data collected descriptive statistical analysis performed results total response rate questionnaires electronically submitted respondents agreed strongly agreed important chiropractors educated evidence based practice majority agreed strongly agreed emphasis chiropractic intervention eliminate vertebral subluxations vertebral subluxation complexes large number respondents favor expanding scope chiropractic profession include prescribing medications advanced training respondents estimated chiropractors considered mainstream health care practitioners respondents chiropractic research focus physiological mechanisms chiropractic adjustments conclusion chiropractic students study showed preference participating mainstream health care report exposure evidence based practice desire hold traditional chiropractic theories practices majority students emphasis correction vertebral subluxation larger percent important learn evidence based practice key points contradictory suggesting cognitive dissonance   students hold traditional theory subluxation centered practice recognizing research fully explore theories research topic needed chiropractic+politics+spinal adjustment+manual therapy+treatment+controversy+debunkery+spine
3 article Chang et al Evening use of light-emitting eReaders negatively affects sleep, circadian timing, and next-morning alertness Proceedings of the National Academy of Sciences of the United States of America 2015 years decline average sleep duration quality adverse consequences general health representative survey american adults revealed americans type electronics nights week bedtime mounting evidence countries world shows negative impact technology sleep negative impact sleep due short wavelength enriched light emitted electronic devices artificial light exposure shown experimentally produce alerting effects suppress melatonin phase shift biological clock reports shown devices suppress melatonin levels effects circadian phase sleep episode exposing substantial gap knowledge increasingly popular technology affects sleep compare biological effects reading electronic book light emitting device le ebook reading printed book hours bedtime participants reading le ebook longer fall asleep reduced evening sleepiness reduced melatonin secretion timing circadian clock reduced morning alertness reading printed book results demonstrate evening exposure le ebook phase delays circadian clock acutely suppresses melatonin important implications understanding impact technologies sleep performance health safety sleep+bad news
3 article Beliard et al Compression garments and exercise J Sports Sci Med Maybe if I squeeeeeze my limbs, that’ll help? Science says: “There are conflicting results regarding the effects of wearing compression garments during exercise.” There’s a few studies with slightly encouraging results, of course. But nothing remotely exciting: a classic example of being damned with faint praise. Results this tepid can be safely regarded as negative. 2015 compression garments limbs increasingly popular athletes improve performance reduce exercise induced discomfort reduce risk injury beneficial effects compression garments established performed review literature prospective randomized controlled studies quantified limb compression order describe beneficial effects identified compression garments conditions investigate relation pressure applied reported effects pressure delivered measured laboratory conditions garments identical studies derived publication data twenty original articles selected inclusion review effects wearing compression garments exercise controversial studies failed demonstrate beneficial effect performance recovery delayed onset muscle soreness trend beneficial effect compression garments worn recovery performance recovery improved studies investigated delayed onset muscle soreness reportedly reduced studies apparent relation effects compression garments worn exercise pressures applied beneficial effects obtained high pressures wearing compression garments recovery exercise beneficial performance recovery delayed onset muscle soreness factors explaining efficacy remain elucidated key points observed relationship effects compression pressures applied pressure applied level limb compression garments destined athletes varies widely products conflict results effects wearing compression garments exercise trend beneficial effect compression garments worn recovery devices+prevention+movement+DOMS+treatment+exercise+self-treatment+inflammation+pain problems+muscle
3 article Cheng et al Long-term effects of therapeutic exercise on nonspecific chronic neck pain J Phys Ther Sci “The studies reviewed in this study were medium- or high-quality RCTs with high evidence reliability. The reviewed results show that short-term neck exercise training yields immediate therapeutic relief for patients with chronic nonspecific neck pain. However, their effectiveness was not sustained for long. When the patients developed long-term exercise habits at home, the body structure and function of the patients improved with concomitant long-term benefits. More high-level evidence is needed to verify the efficacy of long-term exercise interventions on patients’ activity and social participation.” 2015 purpose nonspecific neck pain common musculoskeletal disease therapeutic exercise shown improve pain disability short term midterm follow ups study performed literature review long term effects therapeutic exercise subjects nonspecific chronic neck pain subjects methods databases cinahl medline pedro pubmed randomized controlled trials rct published january january explicitly including year follow identified results articles included review scores points pedro scale level evidence grade study results show main exercises cervical strengthening endurance training exercise short term exercises weeks helped improve body function structure activity participation immediately intervention long term follow hand long term interventions  year resulted improvements body function structure  year follow conclusion results high quality studies suggest long term exercise long term benefits patients nonspecific neck pain terms body function structure treatment+strength+exercise+neck+self-treatment+head/neck+spine
3 webpage Jevne The sexy scalpel An excellent short opinion piece by Jørgen Jevne in the British Medical Journal about unnecessary shoulder surgeries, with broad applicability to other orthopedic surgeries. 2015 surgery+ethics+shoulder+mind+pro+treatment+head/neck
3 article Ruivo et al The effects of training and detraining after an 8 month resistance and stretching training program on forward head and protracted shoulder postures in adolescents Manual Therapy This experiment compared show small temporary improvements in the head-forward posture of a few dozen Portugese teens who went through a postural training program. They were back to their usual slouching selves several weeks later, but continued training might have made a more lasting difference (see Ylinen). 2015 purpose study aimed evaluate effects week resistance stretching training program applied physical education classes head posture protracted shoulder posture portuguese adolescents years detraining effects week period measured methods prospective randomized controlled study conducted secondary schools portugal adolescents head protracted shoulder posture randomly assigned control experimental group sagittal head cervical shoulder angle measured week time intervention period control group     physical education classes exercise group     received posture corrective exercise programme addition physical education classes week detraining period week results significant increase observed cervical shoulder angle experimental group week intervention period week detraining period significant differences observed postural angles intervention group conclusions exercise intervention successful decreasing head protracted shoulder adolescents detraining period sufficient reduce training effects study supports postural training rehabilitation performed physical education classes aim preventing managing upper quadrant musculoskeletal pain self-treatment+strength+exercise+neck+stretch+treatment+head/neck+spine+muscle
3 article Wu et al Curcumin boosts DHA in the brain Biochim Biophys Acta Curcumin has a larger evidence base than most other supplements. This study of rats found that curcumin increases the synthesis of docosahexaenoic acid (DHA), which “is linked to the neuropathology of several cognitive disorders, including anxiety.” The increases in DHA were accompanied by decreased anxiety. One human trial concluded that “curcumin has a potential anti-anxiety effect” (Esmaily 2015). This evidence is promising but preliminary and probably not sufficient for most patients to justify the cost and hassle of supplementation. However, curcumin probably does have other benefits (most notably, see Nicol 2015). Note that curcumin is poorly absorbed without other agents such as black pepper extract (piperine). 2015 dietary deficiency docosahexaenoic acid c dha linked neuropathology cognitive disorders including anxiety dha essential brain development protection primarily obtained diet synthesized dietary precursors conversion efficiency curcumin diferuloylmethane principal component spice turmeric complements action dha brain study performed determine molecular mechanisms involved report curcumin enhances synthesis dha precursor α linolenic acid c ala elevates levels enzymes involved synthesis dha fads elongase liver brain tissues vivo treatment curcumin ala reduced anxiety behavior rodents data suggest curcumin enhances dha synthesis resulting elevated brain dha content findings important implications human health prevention cognitive disease populations eating plant based diet consume fish primary source dha dha essential brain function deficiency implicated types neurological disorders random+nutrition+mind+self-treatment+treatment
4 webpage Spudd “I just know” replaces systematic reviews at top of evidence pyramid 2015 fun+snark+scientific medicine
5 article Dear et al The Pain Course Pain Researchers tested a series of web-based pain management tutorials on a group of adults who had been suffering symptoms for more than six months. Regardless of how much contact the patients had with clinicians, they all experienced significant reductions in disability, anxiety, and average pain levels at the end of the eight week experiment as well as three months down the line. It’s hard to imagine study results any more in harmony with my business model. :-) “While face-to-face pain management programs are important, many adults with chronic pain can benefit from programs delivered via the internet, and many of them do not need a lot of contact with a clinician in order to benefit.” 2015 present study evaluated internet delivered pain management program pain levels clinician support participants randomised groups regular contact optional contact contact treatment usual waitlist control group treatment program based principles cognitive behaviour therapy cbt comprised internet delivered lessons weeks treatment groups reported significant improvements groups cohen avg reduction disability ds avg reduction anxiety ds avg reduction depression ds avg reduction average pain ds avg reduction immediately post treatment sustained improved month follow high treatment completion rates levels satisfaction reported marked consistent differences observed treatment groups clinician time participant minutes sd minutes sd minutes sd receiving regular contact option contact clinical contact results highlight significant public health potential carefully designed administered internet delivered pain management programs programs successfully administered levels clinical support open access article distributed terms creative commons attribution noncommercial derivatives license permits downloading sharing work properly cited work changed commercially neck+IT band pain+back pain+patellar pain+shin pain+plantar fasciitis+site news+head/neck+spine+knee+leg+limbs+pain problems+overuse injury+injury+running+exercise+self-treatment+treatment+tendinosis+arthritis+aging+foot
3 article Esmaily et al An investigation of the effects of curcumin on anxiety and depression in obese individuals Chin J Integr Med See Wu et al. 2015 objective investigate effectiveness curcumin natural polyphenolic compound antioxidant anti inflammatory activities frequency symptoms anxiety depression obese individuals methods double blind cross trial obese subjects randomized receive curcumin day placebo period days wash interval weeks subject crossed alternative regimen days severity anxiety depression assessed baseline weeks trial beck anxiety inventory bai beck depression inventory bdi scales results bai score significantly reduced curcumin therapy curcumin supplementation exert significant impact bdi scores conclusion curcumin potential anti anxiety effect individuals obesity random+nutrition+mind+self-treatment+treatment
3 article Beedie et al Death by effectiveness British Journal of Sports Medicine “Efficacy” is how well a treatment works in ideal circumstances, such as in a carefully contrived scientic test. Unfortunately, real life is rarely ideal: “effectiveness” is how well the same thing works in typical clinical settings and patients’ lives. Exercise is well-known to be efficacious, but is often not effective. That is, it works well when tested in the lab, but not for real patients. Effectiveness is what matters to patients! 2015 exercise+deep+debunkery+sci+self-treatment+treatment
3 article Schmidt et al Prebiotic intake reduces the waking cortisol response and alters emotional bias in healthy volunteers Psychopharmacology (Berl) Prebiotics are basically food for the bacteria in your guts, which have a strange-but-true relationship with your nervous system (the gut-brain axis). This is the first human test of prebiotics for anxiety and stress, with promising but only preliminary results. In this test, the prebiotic product Bimuno®-galactooligosaccharides (B-GOS) appeared to be effective (while another product did not). Specifically, “The salivary cortisol awakening response was significantly lower after B-GOS intake compared with placebo. Participants also showed decreased attentional vigilance to negative versus positive information in a dot-probe task after B-GOS compared to placebo intake.” There are many caveats, of course. A detailed analysis of the paper by (ERD #6, April 2015) explains that it’s not clear that the observed effects are clinically relevant, “especially since only one out of the many emotion-related variables tested was affected by a prebiotic. Assuming that prebiotic fibers could be used to ‘treat’ anxiety or depression is a premature conclusion.” The page on pro/pre-biotics notes the “bewildering array” of products available and concludes “there is much work to be done before specific clinical guidelines and recommendations can be made.” 2015 rationale compelling evidence link enteric microbiota brain function ingestion probiotics modulates processing information strongly linked anxiety depression influences neuroendocrine stress response demonstrated prebiotics soluble fibres augment growth indigenous microbiota significant neurobiological effects rats action humans reported objectives present study explored effects prebiotics secretion stress hormone cortisol emotional processing healthy volunteers methods forty healthy volunteers received prebiotics fructooligosaccharides fos bimuno® galactooligosaccharides gos placebo maltodextrin daily  weeks salivary cortisol awakening response sampled prebiotic placebo administration final day treatment participants completed computerised task battery assessing processing emotionally salient information results salivary cortisol awakening response significantly gos intake compared placebo participants showed decreased attentional vigilance negative positive information dot probe task gos compared placebo intake effects administration fos conclusion suppression neuroendocrine stress response increase processing positive negative attentional vigilance subjects supplemented gos consistent previous findings endocrine anxiolytic effects microbiota proliferation studies needed test utility gos supplementation treatment stress related disorders random+mind+nutrition+self-treatment+treatment
3 article Luedtke et al Effectiveness of transcranial direct current stimulation preceding cognitive behavioural management for chronic low back pain British Medical Journal 2015 objective evaluate effectiveness transcranial direct current stimulation combination cognitive behavioural management patients specific chronic pain design double blind parallel group randomised controlled trial months follow conducted march participants physiotherapists assessors analyses blinded group allocation setting interdisciplinary chronic pain centre participants participants specific chronic pain weeks recruited patients assessed eligibility intervention participants randomised receive anodal minutes motor cortex ma sham transcranial direct current stimulation identical electrode position stimulator switched seconds consecutive days immediately cognitive behavioural management week multidisciplinary programme hours main outcomes measures primary outcome measures pain intensity visual analogue scale disability oswestry disability index evaluated primary endpoints stimulation cognitive behavioural management results analyses covariance baseline values pain disability covariates showed transcranial direct current stimulation ineffective reduction pain difference groups visual analogue scale mm confidence interval mm mm disability difference groups point influence outcome cognitive behavioural management difference group mm mm mm difference groups oswestry disability index point stimulation tolerated minimal transitory side effects conclusions results trial effectiveness transcranial direct current stimulation reduction pain disability support clinical managing specific chronic pain treatment+bad news+chronic pain+devices+pain problems
4 article Johnsen et al The Effects of Cognitive Behavioral Therapy as an Anti-Depressive Treatment is Falling Psychological Bulletin The evidence of the benefit of cognitive behavioural therapy for depression may be declining: “modern CBT clinical trials seemingly provided less relief from depressive symptoms as compared with the seminal trials.” (Or it may not be: the importance of the “decline effect” has probably been exaggerated.) 2015 meta analysis examining temporal time trends effects cognitive behavioral therapy cbt treatment unipolar depression conducted comprehensive search psychotherapy trials yielded eligible studies effect sizes es quantified hedge based beck depression inventory bdi hamilton rating scale depression hrsd rates remission registered publication year study examined linear metaregression predictor es part interaction moderators year × moderator average es bdi ci hrsd ci subgroup analyses revealed women profited therapy men experienced psychologists achieved results experienced student therapists metaregressions examining temporal trends effects cbt declined linearly steadily introduction measured patients reports bdi clinicians ratings hrsd rates remission subgroup analyses confirmed declining trend present group pre post designs controlled trial designs modern cbt clinical trials seemingly relief depressive symptoms compared seminal trials potential implications future studies discussed random+mind
3 article Rio et al Isometric exercise induces analgesia and reduces inhibition in patellar tendinopathy British Journal of Sports Medicine This good news study (of only six athletes, so grain of salt) found that isometric muscle contractions (tensing without moving) “may be used to reduce pain in people with patellar tendinopathy without a reduction in muscle strength.” The pain reduction was substantial and lasted for at least 45 minutes. If this is true of patellar tendinopathy, it’s probably true of others as well. 2015 background interventions reduce patellar tendinopathy pt pain short term eccentric exercises painful limited effectiveness competitive season isometric isotonic muscle contractions effect pt pain methods single blinded randomised cross study compared  min effects bout isometric isotonic muscle contractions outcome measures pt pain single leg decline squat slds quadriceps strength maximal voluntary isometric contraction mvic measures corticospinal excitability inhibition data analysed split plot time repeated measures analysis variance anova results volleyball players pt participated condition effects detected greater pain relief immediately isometric contractions isometric contractions reduced slds ±sd ± ± isotonic contractions reduced slds ±sd ± ± treatment+sports+exercise+rehab+chronic pain+self-treatment+injury+pain problems
3 article Generaal et al Biological stress systems, adverse life events and the onset of chronic multisite musculoskeletal pain Annals of the Rheumatic Diseases An eyebrow-raiser of a study: it’s a common assumption that stress has biological consequences which drive up the risk of pain later in life. If these results are reproducible, they suggest that there’s another mechanism — because there’s still a connection between adverse life events and pain, but independently of any obvious biological effects of stress. For instance, adverse life events may dial up the sensitivity of the brain’s threat-o-meter. Or the study might have gotten it wrong. :-) 2015 objectives dysregulated biological stress systems adverse life events independently interaction hypothesised initiate chronic pain examine function biological stress systems adverse life events combination predict onset chronic multisite musculoskeletal pain methods subjects netherlands study depression anxiety free chronic multisite musculoskeletal pain baseline identified chronic pain grade questionnaire onset chronic multisite musculoskeletal pain  years baseline assessment biological stress systems comprised function hypothalamic pituitary adrenal axis cortisol awakening response evening levels postdexamethasone levels immune system basal lipopolysaccharide stimulated inflammation autonomic nervous system heart rate pre ejection period sd normal normal interval respiratory sinus arrhythmia number adverse life events assessed baseline list threatening events questionnaire results hypothalamic pituitary adrenal axis immune system autonomic nervous system functioning onset chronic multisite musculoskeletal pain interaction adverse life events adverse life events predict onset chronic multisite musculoskeletal pain hr event ci conclusions longitudinal study confirm dysregulated biological stress systems increase risk developing chronic multisite musculoskeletal pain adverse life events risk factor onset chronic multisite musculoskeletal pain suggesting psychosocial factors play role triggering development condition etiology+counter-intuitive+chronic pain+mind+pro+pain problems
3 article Nicol et al Curcumin supplementation likely attenuates delayed onset muscle soreness (DOMS) European Journal of Applied Physiology Curcumin “exerts potent anti-inflammatory effects.” In this study, “curcumin caused moderate to large reductions in pain” in 17 men with very sore leg muscles. It also helped some aspects of strength loss. The effect size here passes the “impress me” test. These results constitute the only really good science news about any kind of treatment for delayed-onset muscle soreness. Now it just needs to be replicated. Note that curcumin is poorly absorbed without other agents such as black pepper extract (piperine). 2015 introduction oral curcumin decreases inflammatory cytokines increases muscle regeneration mice purpose determine effects curcumin muscle damage inflammation delayed onset muscle soreness doms humans method seventeen men completed double blind randomized controlled crossover trial estimate effects oral curcumin supplementation   daily placebo single leg jump performance doms unaccustomed heavy eccentric exercise curcumin placebo eccentric single leg press exercise separated washout measurements baseline post exercise comprising limb pain  cm visual analogue scale vas muscle swelling single leg jump height serum markers muscle damage inflammation standardized magnitude based inference define outcomes results post exercise curcumin caused moderate large reductions pain single leg squat vas scale   cl ± gluteal stretch ± squat jump  ±  small reductions creatine kinase activity   ±   pain reduction small increase single leg jump performance     cl ±    curcumin increased interleukin concentrations   ±     ±   relative baseline decreased il relative post exercise   ±   conclusions oral curcumin reduces pain doms evidence enhanced recovery muscle performance study required mechanisms translational effects sport vocational performance nutrition+DOMS+good news+self-treatment+treatment+exercise+inflammation+pain problems+muscle
2 article Pamuk et al MRI analyses show that kinesio taping affects much more than just the targeted superficial tissues and causes heterogeneous deformations within the whole limb J Biomech Having read (only) the abstract, they seem to have gone to great effort to prove the obvious, which is that “everything is connected.” I don’t particularly object to proving it in this context, but it does not surprise me, or interest me much. Of course taping “affects” and “deforms” non-local tissue to some degree. So does pulling your finger and pinching your cheek. But it also means almost nothing in and of itself. Does deforming non-local tissue have any clinical relevance? Probably these researchers believe it does, and that’s why they did the research. But their findings don’t actually establish anything except that, yeah, tape pulls on stuff, which pulls on other stuff — with completely unknown but likely very trivial biological significance. *slow clap* 2015 kinesio taping kt widely treatment sports injuries neuro musculoskeletal disorders considered selectively effective targeted tissues mechanical effects quantified objectively ascribed continuity muscular connective tissues mechanical loading imposed widespread heterogeneous effects aim characterize mechanical effects kt objectively test hypotheses kt acutely local deformations necessarily agreement tape adhering direction ii limited targeted tissues high resolution d magnetic resonance image sets acquired healthy human subjects prior acutely kt application skin tibialis anterior ta hip knee ankle angles constant demons image registration algorithm calculate local tissue deformations leg vivo peak tissue strains significantly higher strain artifacts kt ta region part shows local deformations agreement tape adhering direction superficial skin rest kt ta ta regions show deformations length change directions targeted tissues show sizable heterogeneous deformations smaller amplitudes inter subject variability notable magnetic resonance imaging analyses detailed assessment local tissue deformation occurring acutely kt application findings confirm hypotheses characterize kt affects underlying tissues immediately targeted distant revealing mechanisms affect clinical outcomes kt objectively treatment+devices
3 article Müller et al Two-dimensional ultrasound and ultrasound elastography imaging of trigger points in women with myofascial pain syndrome treated by acupuncture and electroacupuncture Ultrason Imaging These reseachers tested trigger point treatment in 24 women who’d had shoulder pain for at least six months, presumed to be caused by trigger points in the trapezius muscles. They compared acupuncture and electroacupuncture to a sham treatment, and measured the size of the trigger points with ultrasonography and ultrasound elastography before and after. (Acupunture disclaimer: acupuncture does not work, and the use of acupuncture and electroacupuncture in this test casts doubt on its value. However, whether the authors saw it this way or not, it’s also just a test of the effect of inserting fine needles in or near trigger points — a popular non-acupuncture treatment, used by very large numbers of physiotherapists. In this study, the authors noted that some of the points they picked corresponded with suspected trigger points — “Ashi” points, the acupuncture term for a tender point or trigger point.) A standard set of acupuncture points was treated, plus up to two relevant Ashi points in both trapezius muscles. For the sham, needles were inserted one centimetre from the real point. Pain reduced and the trigger points decreased in size in all groups, but significantly more so in the treatment groups. The size of the effect on pain was clinically significant: pain dropped by about 2-3 points (on a 10-scale). Trigger points got about 30 to 50% smaller. 2015 chronic pain myofascial pain syndrome mps determined myofascial trigger points mtrp features tested mtrp diagnosis aim study evaluate dimensional ultrasonography d ultrasound elastography ue images elastograms upper trapezius mtrp electroacupuncture ea acupuncture ac treatment women participated aged years ± sd ± body mass index ranging kg m ± regular menstrual cycle active mtrp rtpz left trapezius ltpz local referred pain months subjects randomized ea ac treatment groups control sham ac sham group intensity pain assessed visual analogue scale mtrp area strain ratio sr d ue significant decrease intensity general rtpz ltpz pain observed ea group general pain ac group decreased mtrp area rtpz ltpz observed ac ea groups rtpz ltpz post treatment sr rtpz ltpz pre treatment treatment groups d ue effectively characterized mtrp surrounding tissue pointing possibility objective confirmation subjective ea ac treatment effects muscle pain+trigger points doubts+muscle+pain problems
4 article Brinjikji et al Systematic Literature Review of Imaging Features of Spinal Degeneration in Asymptomatic Populations AJNR Am J Neuroradiol 2015 background purpose degenerative commonly spine imaging occur pain free individuals pain sought estimate prevalence age common degenerative spine conditions performing systematic review studying prevalence spine degeneration imaging asymptomatic individuals materials methods performed systematic review articles reporting prevalence imaging findings ct imaging asymptomatic individuals published english literature april reviewers evaluated manuscript selected age groupings decade years determining age specific prevalence estimates imaging finding fit generalized linear mixed effects model age specific prevalence estimate clustering study adjusting midpoint reported age interval results articles reporting imaging findings asymptomatic individuals met study inclusion criteria prevalence disk degeneration asymptomatic individuals increased year individuals year individuals disk bulge prevalence increased years age years age disk protrusion prevalence increased years age years age prevalence annular fissure increased years age years age conclusions imaging findings spine degeneration present high proportions asymptomatic individuals increasing age imaging based degenerative features part normal aging unassociated pain imaging findings interpreted context patient clinical condition back pain+spine+arthritis+aging+neck+etiology+biomechanics+pain problems+head/neck+pro
article Dommerholt et al A Critical Evaluation of Quintner et al Journal of Bodywork & Movement Therapies 2015 muscle pain+trigger points doubts+muscle+pain problems
3 article Quintner et al A critical evaluation of the trigger point phenomenon Rheumatology (Oxford) Quintner, Cohen, and Bove argue that the common picture of trigger points as lesions in muscle and soft tissue, spelled out most formally in Gerwin 2004, is “flawed both in reasoning and in science,” and that treatments (e.g. massage, needling) based on that idea produces results “indistinguishable from the placebo effect.” They believe that all of the biological evidence put forward over the years (like Shah 2008) is critically flawed in one way or another, while other evidence leads elsewhere, and so the old picture of trigger points “remains conjecture in the face of conflicting data.” They also point out that the theory is inappropriately treated like an established fact by a great many people. Not even these fierce critics of trigger points deny that people have pain that seems to come from their muscles. But if it’s not coming from the muscle, where is it coming from? They briefly discuss two other ideas of their own: inflamed nerve fibres, and referred pain and tenderness from deeper structures. They do not thoroughly explore or defend either idea. Neuritis is undoubtedly worth investigating, but it requires us to believe that nerve axons are routinely inflamed for no apparent reason, which doesn’t seem much different than the theory it is supposed to replace. The evidence cited to support it is just as limited as the evidence for trigger points, if not more so (just a few papers, all from the authors themselves, or their research colleagues). The proposal of “referred pain and tenderness” from deeper tissues with unspecified troubles and/or “altered central nociceptive mechanisms” is imprecise. We know that these mechanisms probably exist, but there is not a jot of evidence that they have anything to do with the subjective experience of “muscle pain.” This is just a proposal to look somewhere other than the integrated hypothesis. 2015 theory myofascial pain syndrome mps caused trigger points trps seeks explain phenomena muscle pain tenderness absence evidence local nociception lacks external validity practitioners uncritically accepted diagnosis mps system treatment rheumatologists implicated trps pathogenesis chronic widespread pain fm syndrome critically examined evidence existence myofascial trps putative pathological entities vicious cycles maintain find inventions scientific basis experimental approaches interrogate suspect tissue empirical approaches assess outcome treatments predicated presumed pathology theory mps caused trps refuted deny existence clinical phenomena scientifically sound logically plausible explanations based neurophysiological phenomena advanced muscle pain+trigger points doubts+injections+classics+deep+bad news+muscle+pain problems+medicine+treatment
3 article Fu Medical missionaries to China and the reformation of anatomy Journal of Medical Biography According to some, cultural and religious (Confucian) taboos made anatomical and physiological reduction difficult by making autopsy taboo. I’ve seen the no-dissection-in-China claim made in many contexts, but disputed in others, and I have no way of readily resolving it. However, this paper makes it fairly clear that dissection probably was mostly avoided in China for centuries, whether it was impeded by a taboo or something else. 2014 earliest record human anatomy chapters yellow emperor classic based proper dissections incident human dissection medical purpose documented history han dynasty occurred ad sung dynasty physician prepared illustrations internal organs executed criminals published images truth successive chinese medical treatises plagiarized preserved anatomical diagrams improvements modifications china wait mid th century anglo american protestant medical missionaries bring complete permanent reformation anatomical science acupuncture+random+mind+controversy+debunkery+energy work
4 article Zhou et al An update on botulinum toxin A injections of trigger points for myofascial pain Curr Pain Headache Rep Previous reviews of Botox injection (Jackson, Ho) for myofascial pain have been disappointing. This review (in a much more obscure journal) is a little more optimistic…but only a little bit. Zhou and Wang believe that “there are well-designed clinical trials to support the efficacy of trigger-point injections with BTX-A for MPS.” But they emphasize that it’s not conclusive, and that we need more studies “minimizing placebo effect,” among other improvements. Indeed — and that is just how promising effects tend to evaporate in follow-up studies. 2014 myofascial pain syndrome mps common chronic pain condition characterized distinct trigger points current treatments physical therapy analgesics anti depressants trigger point injections myofascial pain remains challenging chronic pain condition clinical practice botulinum toxin btx prolonged muscle relaxation inhibition acetylcholine release offer advantages current treatments mps providing longer sustained period pain relief numerous clinical trials efficacy btx alleviating mps established due mixed results clinical trials active trigger points referred pain greatly impact aspects activities daily living mood health status review designed analyze clinical trials efficacy btx injection active trigger points treatment mps literature referenced obtained computer search google scholar pubmed medline embase search terms included botulinum toxin myofascial pain trigger points myofascial trigger points chronic pain additional references retrieved reference list reports search studies considered eligible inclusion double blinded randomized controlled trials evaluating efficacy btx injections trigger points pain reduction trigger point selection trial included referred pain local twitch response open label studies case reports randomized studies excluded trials criteria summarized table  designed clinical trials support efficacy trigger point injections btx mps clinical trials considerations minimizing placebo effect repeated dosing adequate coverage trigger points ultrasound confirmation guidance required provide conclusive evidence btx treatment myofascial pain muscle pain+injections+medications+muscle+pain problems+medicine+treatment+self-treatment
4 article Li et al Massage therapy for fibromyalgia PLoS ONE 2014 background studies evaluated effectiveness massage therapy fibromyalgia fm role massage therapy management fm remained controversial objective purpose systematic review evaluate evidence massage therapy patients fm methods electronic databases june searched identify relevant studies main outcome measures pain anxiety depression sleep disturbance reviewers independently abstracted data appraised risk bias risk bias eligible studies assessed based cochrane tools standardised difference smd confidence intervals ci calculated conservative random effects model heterogeneity assessed based statistic results randomized controlled trials involving patients met inclusion criteria meta analyses showed massage therapy duration weeks significantly improved pain smd ci anxiety smd ci depression smd ci patients fm sleep disturbance smd ci conclusion massage therapy duration weeks beneficial effects improving pain anxiety depression patients fm massage therapy viable complementary alternative treatments fm eligible studies subgroup meta analyses evidence follow effects large scale randomized controlled trials long follow warrant confirm current findings treatment+massage+chronic pain+muscle pain+manual therapy+pain problems+muscle
4 article Nuzzo Scientific method Nature 2014 pro+good reads+scientific medicine+stats+deep
2 article Arooj et al Piriformis syndrome--a rare cause of extraspinal sciatica J Pak Med Assoc 2014 piriformis syndrome rare entity resulting severe unilateral isolated buttock pain shooting nature discogenic origin imaging pelvis plays important role patients normal anatomy piriformis muscle relationship sciatic nerve year woman presented year history radiating leg pain normal lumbosacral spine mri pelvis showed abnormal orientation left sciatic nerve cleaved fibers piriformis muscle patient symptoms relieved surgical decompression purpose case report show role importance imaging tracing sciatic nerve relationship piriformis muscle imaging pelvis sciatic nerve plays important role symptomatic patients isolated buttock pain normal mri lumbosacral spine anatomy+sciatica+neurology+case+back pain+pain problems+spine+butt+hip
4 article Natsis et al Anatomical variations between the sciatic nerve and the piriformis muscle Surg Radiol Anat This dissection study of 275 dead buttocks found that 6.4% of them had variations of sciatic nerve and piriformis muscle anatomy, with considerable variety in the variation. They found several different arrangements, and concluded: “Some rare, unclassified variations of the sciatic nerve should be expected during surgical intervention of the region.” Prepare to be surprised, surgeons! All of these differences are potentially clinically significant, probably especially in the cases where the nerve (or part of it) passes right through the muscle. For a couple case studies, see Arooj 2014 and Kraus 2015. 2014 purpose detect variable relationship sciatic nerve piriformis muscle surgeons aware anatomical features variation surgical treatment piriformis syndrome methods gluteal region caucasian cadavers limbs dissected anatomical relationship sciatic nerve piriformis muscle recorded classified beaton anson classification literature reviewed summarize incidence variation results sciatic nerve piriformis muscle relationship typical anatomical pattern limbs limbs common peroneal nerve passed tibial nerve double piriformis limb common peroneal nerve coursed superior tibial nerve piriformis limb nerves penetrated piriformis limb nerves passed piriformis limbs presented classified anatomical variations double piriformis muscle present arrangements heads observed conclusions anatomical variations sciatic nerve piriformis muscle present limbs examined dissection entire piriformis adequate sciatic nerve decompression surgeon explore existence tendon inferior deep rare unclassified variations sciatic nerve expected surgical intervention region anatomy+sciatica+neat+back pain+pain problems+spine+butt+hip
4 article Whiteside et al Grading the Functional Movement Screen™ Journal of Strength & Conditioning Research Is the Functional Movement Screen accurate? Who knows: “virtually no investigations have probed the accuracy of FMS grades assigned by a manual tester.” So Whiteside et al probed it! They compared “the FMS scores assigned by a certified FMS tester to those measured by an objective inertial-based motion capture system.” Alas for FMS, the results were “poor”:
Manual grading may not provide a valid measurement instrument. The levels of agreement between the two grading methods were poor in all six FMS exercises. It appears that manual grading of the FMS is confounded by vague grading criteria.
The discussion section of the article is detailed, readable, and full of ominous understatement. “Dubious grading presents a concern for FMS clientele,” they write. They graciously allow that, with better objective criteria, FMS grading might “improve to acceptable levels.” Meanwhile, FMS testers are officially encouraged to aim for lower scores when in doubt, but in this test, even under scrutiny, apparently they didn’t have much self-doubt, consistently scoring “0.54 points higher than the IMU system.” (I’m shocked, simply shocked, to learn that FMS practitioners might be a tad overconfident!) The authors also point out that FMS has not only failed to reliably forecast injuries, but all FMS predictions may be “a product of specious grading.” Which is hardly surprising, since FMS fails to take into account “several factors that contribute to musculoskeletal injury.” These concerns must be addressed “before the FMS can be considered a reliable injury screening tool.” Clearly more research is needed — of course! Naturally! But it’s worse than that:
The high potential for subjective and/or inaccurate grading implies that standard procedures must be developed before FMS performance and injury rates can be conclusively studied.
Before it can be studied. They seem to be saying that not only is the cart is still in front of the FMS horse, the horse may now be falling well behind. FMS research so far may be a bit of a write-off, because it can’t inform us without better criteria, and everyone should probably just go back to the drawing board and try again. Which suggests that this article is still reasonably sound after three years without an update.
2014 inter intra tester reliability common theme functional movement screen fms research criterion validity manual grading comprehensively examined study aimed compare fms scores assigned certified fms tester measured objective inertial based motion capture system imu eleven female division collegiate athletes performed fms exercises manually graded tester explicit kinematic thresholds formulated correspond grading criteria fms exercise grade athletes objectively imu data levels agreement grading methods poor fms exercises appears manual grading fms confounded vague grading criteria explicit grading guidelines improve uniformity accuracy manual fms grading facilitate objective measurement systems grading process contrary approach employed previous studies potential subjective inaccurate fms grading insinuates inappropriate assume manual fms grading valid measurement tool development criterion validation uniform grading procedures precede research attempting link fms performance injury rates manual grading methods seemingly susceptible error fms cautiously direct strength conditioning programs diagnosis+bad science+etiology+exercise+debunkery+scientific medicine+pro+self-treatment+treatment
4 article Smith et al An update of stabilisation exercises for low back pain BMC Musculoskeletal Disorders According to Smith, Littlewood, and May, there is “strong evidence stabilisation exercises are not more effective than any other form of active exercise in the long term” and “further research is unlikely to considerably alter this conclusion.” It’s all sewn up: there is no difference between core stability exercises for back pain and any other kind of exercise (e.g. walking). In fact, core stability exercise may even be problematic (probably because the belief in the need for it refeinforces a harmful fear of being weak or fragile). 2014 background specific pain nslbp large costly problem lifetime prevalence results high levels healthcare cost major long term sickness workforce high levels fear avoidance kinesiophobia stabilisation core stability exercises suggested reduce symptoms pain disability form effective treatment commonly form physiotherapy treatment uk lack positive evidence support aims systematic review update investigate effectiveness stabilisation exercises treatment nslbp compare effectiveness forms exercise methods systematic review published updated search pubmed cinahl amed pedro cochrane library october october authors independently selected studies authors independently extracted data methodological quality evaluated pedro scale meta analysis carried results studies included studies     post treatment effect pain studies     post treatment effect disability pain disability scores transformed scale meta analysis showed significant benefit stabilisation exercises alternative treatment control long term pain disability difference ci ci difference groups clinically insignificant compared alternative forms exercise statistical clinically significant difference difference pain ci disability ci conclusion strong evidence stabilisation exercises effective form active exercise long term levels heterogeneity large number high methodological quality studies long term follow strengthen current findings research considerably alter conclusion back pain+abdominals+pain problems+spine+movement+strength+exercise+self-treatment+treatment
3 article Pandolfi et al The faulty statistics of complementary alternative medicine (CAM) Eur J Intern Med 2014 authors illustrate difficulties involved obtaining valid statistical significance clinical studies prior probability hypothesis scrutiny prior probability research hypothesis related scientific plausibility commonly frequentist statistics account probability unsuitable studies exploring matters degree disconnected science complementary alternative medicine cam interventions statistical significance obtained field considered great caution applied plausible hypotheses placebo effect examined specific efficacy intervention achieving meaningful statistical significance essential step validation medical interventions cam practices producing outcomes inherently resistant statistical validation belong modern evidence based medicine scientific medicine+stats+deep
webpage Lyons Repetitive Strain Injury Specialist Paul Ingraham is Now a Successful Published Author 2014 personal
3 article Vos et al Clinical findings just after return to play predict hamstring re-injury, but baseline MRI findings do not British Journal of Sports Medicine 2014 background acute hamstring injuries common hard predict aim study investigate association clinical imaging findings occurrence hamstring injuries methods obtained baseline data clinical mri findings athletes sustained acute hamstring injury  days initial injury collected data standardised clinical tests  days return play rtp number injuries recorded  months analysed association predictive variables injuries multivariate proportional hazards regression model results patients included baseline patients included final analysis data rtp cases injuries baseline mri findings univariately injury higher number previous hamstring injuries adjusted aor ci degrees active knee extension deficit rtp aor ci isometric knee flexion force deficit ° rtp aor ci presence localised discomfort hamstring palpation rtp aor ci significant independent predictors injury athletes localised discomfort hamstring palpation rtp times sustain injury conclusions number previous hamstring injuries active knee extension deficit isometric knee flexion force deficit ° presence localised discomfort palpation rtp higher hamstring injury rate baseline mri parameters predictor hamstring injury strain+injury+pain problems+muscle
article Kim et al Autologous platelet-rich plasma versus dextrose prolotherapy for the treatment of chronic recalcitrant plantar fasciitis PM & R: The Journal of Injury, Function, and Rehabilitation 2014 objective determine efficacy autologous platelet rich plasma prp compared dextrose prolotherapy dp patients chronic recalcitrant plantar fasciitis pf design single blinded randomized controlled study setting department physical medicine rehabilitation university hospital participants twenty patients clinical diagnosis chronic pf confirmed diagnostic ultrasound plantar fascia thickness mm randomly assigned prp group dp group interventions patient received injections plantar fascia peppering technique ultrasound guidance interval weeks ml autologous prp ml dextrose lidocaine solution main outcome measurements outcome measures included pain disability activity limitation subscales measured means foot functional index data collected injection weeks injection month follow ups results patients completed follow ups exception patient prp group foot functional index total subcategory score improvements greater prp group compared dp group improvement prp dp total pain disability activity limitation statistically significant difference noted follow pain disability subcategories groups showed significant improvements evaluation prp group showed significant improvements disability activity limitation subscales evaluation conclusions treatment effective chronic recalcitrant pf expanding treatment options patients conservative care failed prp treatment lead initial improvement function compared dp treatment injections+tendinosis+plantar fasciitis+medicine+treatment+pain problems+overuse injury+injury+foot+leg+limbs
3 webpage Hall The Reality of Ancient Wisdom This article is essential, morbidly fascinating reading. I didn’t think I could get any more cynical about ancient folk medicine. I was wrong! Dr. Hall packages up a few excerpts from an old book by a physician working in China in the late 19th Century. His matter-of-fact reports of the actual medical habits of the Chinese at that time are chilling, and a harsh reminder that traditional Chinese medicine was not wise and profound, but rather cringe-inducingly horrible, just as brutal and bizarre as any pre-scientific European “medicine.” In particular, the stories concerning acupuncture expose a mess of superstitious and vicious excess. Bloodletting was the tip of the iceberg. Little wisdom is possible in a state of profound ignorance. 2014 acupuncture+good reads+energy work+facepalm+history+odd+mind+controversy+debunkery
4 article Mohseni-Bandpei et al Application of ultrasound in the assessment of plantar fascia in patients with plantar fasciitis Ultrasound in Medicine & Biology 2014 plantar fasciitis pfs common heel pain estimated affect general population lifetime ultrasound imaging technique increasingly assess plantar fascia pf thickness monitor effect interventions guide therapeutic interventions patients pfs purpose present study systematically review previously published studies application assessment pf patients pfs literature search performed period science direct scopus pubmed cinahl medline embase springer databases key words ultrasound sonography imaging techniques ultrasonography interventional ultrasonography plantar fascia plantar fasciitis literature search yielded relevant studies sixteen studies evaluated effect interventions pf thickness patients pfs studies compared pf thickness patients pfs studies investigated application guide therapeutic intervention patients pfs variations studies terms methodology results considered reliable imaging technique assessing pf thickness monitoring effect interventions guiding therapeutic interventions patients pfs diagnosis+devices+plantar fasciitis+treatment+foot+leg+limbs+pain problems+overuse injury+injury+tendinosis
3 article Petre et al Smoking increases risk of pain chronification through shared corticostriatal circuitry Human brain mapping The science here is a bit more complex than I usually deal with, but the punchline is simple enough: “We conclude that smoking increases risk of transitioning to chronic back pain.” 2014 smoking increased incidence chronic pain evidence cross sectional nature underlying mechanisms remain unclear longitudinal observational study examined relationship smoking transition chronic pain brain physiology subjects subacute pain sbp pain lasting weeks prior pain bp year pain characteristics smoking status brain functional properties measured repeatedly year sixty completed study subdivided recovering sbpr     persisting sbpp     based decrease bp year chronic pain cbp duration    years healthy controls similarly monitored smoking prevalence higher sbp cbp related intensity bp sbp smoking status baseline predictive persistence bp year symptom onset differentiating sbpp sbpr accuracy smoking status combined affective properties pain medication improved prediction accuracy mediation analysis prediction bp persistence smoking largely due synchrony fmri activity brain areas nucleus accumbens medial prefrontal cortex nac mpfc sbp cbp ceased smoking strength nac mpfc decreased precessation postcessation smoking conclude smoking increases risk transitioning cbp effect mediated corticostriatal circuitry involved addictive behavior motivated learning back pain+random+pain problems+spine
3 article Tam et al Barefoot running British Journal of Sports Medicine 2014 barefoot running popular research topic driven increasing prescription barefoot running means reducing injury risk proponents barefoot running cite evolutionary theories long distance running ability crucial human survival proof benefits natural running subsequently runners advised run barefoot treatment mode injuries strength conditioning body literature examining mechanical structural clinical performance implications barefoot running infancy research significant differences barefoot running relative shod running differences factors thought contribute injury performance crucially long term prospective studies conducted link barefoot running injury performance remains tenuous speculative injury prevention potential barefoot running complicated complexity injury aetiology single factor identified causative common running injuries aim present review critically evaluate theory evidence barefoot running drawing collected evidence literature argue favour barefoot running describe factors driving prescription barefoot running examine factors merit collected evidence suggests suitability barefoot running purported describe future research confirm refute barefoot running hypotheses running+barefoot+overuse injury+exercise+biomechanics+self-treatment+treatment+foot+leg+limbs+pain problems+injury+etiology+pro
3 article Gorski et al Clinical trials of integrative medicine Trends in Molecular Medicine A lot of dead horses are getting beaten in alternative medicine: pointlessly studying silly treatments like homeopathy and reiki over and over again, as if it’s going to tell us something we don’t already know. This point has been made ad infinitum on since its founding in 2009, but here Drs. Novella and Gorski make the case against testing “whether magic works” in a high-impact journal, Trends in Molecular Medicine. 2014 decades complementary alternative medicine treatments relying dubious science embraced medical academia nonexistent prior probability testing treatments randomized clinical trials rcts successful rcts modalities proliferated consistent principles evidence based medicine underemphasize prior plausibility rooted science examine phenomenon argue needed science based medicine evidence based medicine scientific medicine
3 webpage Hargrove A Systems Perspective on Chronic Pain 2014 chronic pain+deep+biology+good news+random+pain problems
3 article Wepner et al Effects of vitamin D on patients with fibromyalgia syndrome Pain 2014 role calcifediol perception chronic pain widely discussed subject serum levels calcifediol common patients severe pain fibromyalgia syndrome fms lack evidence role vitamin supplementation patients knowledge randomized controlled trial published subject women fms american college rheumatology criteria serum calcifediol levels nutrition+vitamin D+muscle pain+etiology+self-treatment+treatment+muscle+pain problems+pro
5 webpage Long Twenty Things Most Chiropractors Won’t Tell You An excerpt from a book by rational chiropractor, Preston H. Long, Chiropractic Fraud and Abuse. 2014 chiropractic+controversy+manual therapy+treatment+debunkery+spine
4 article Steffens et al Does magnetic resonance imaging predict future low back pain? European Journal of Pain 2014 background objective magnetic resonance imaging mri potential identify pathology responsible pain lbp importance findings mri remains controversial aimed systematically review mri findings lumbar spine predict future lbp samples lbp databases data treatment medline cinahl embase databases searched included prospective cohort studies investigating relationship baseline mri abnormalities lumbar spine clinically important lbp outcome follow excluded cohorts specific diseases lbp associations mri findings lbp pain outcomes extracted eligible studies results total studies met inclusion criteria studies presented data participants current lbp included sample current lbp included sample history lbp included mixed samples due small sample size poor quality heterogeneity studies terms participants mri findings clinical outcomes investigated pool findings consistent associations mri findings outcomes identified single studies reported significant associations modic type pain disc degeneration disability samples current lbp disc herniation pain mixed sample conclusions limited number heterogeneity quality studies permit definite conclusions association mri findings lumbar spine future lbp back pain+imaging+biomechanics+pain problems+spine+diagnosis+etiology+pro
3 webpage Reynolds The Scientific 7-Minute Workout 2014 exercise+self-treatment+research+treatment+pro
4 webpage Ingram The back is still important in back pain A short evidence-based opinion piece with an important point: just because we can’t seem to reliably find any cause of most back pain with modern imaging technology does not mean it isn’t there. 2014 etiology+back pain+pro+pain problems+spine
3 webpage Crislip That’s so Chiropractic A terrific read covering a lot of chiropractic ground: fantastical autopsy results, frightening autistic children, chiropractic vaccinations, and stroke and patient safety. 2014 chiropractic+spinal adjustment+controversy+random+scientific medicine+manual therapy+treatment+debunkery+spine
3 webpage Yeager Sitting is the New Smoking — Even for Runners 2014 running+sedentariness+random+exercise+self-treatment+treatment
3 webpage O'Brien “Just a Flesh Wound” Journalist Miles O’Brien tells his harrowing tale of amputation, made necessary by the complications of acute compartment syndrome in is forearm. A cautionary tale for anyone with steadily worsening pain and swelling in a forearm or calf — never, ever ignore that. 2014 fascia+controversy+debunkery+etiology+pro+massage+manual therapy+treatment
4 webpage Kamper The placebo effect Researcher Steve Kamper:
“…there exists a logical paradox at the very heart of the way placebo effects are conceptualised. We have an intervention that is, by definition, inert (a placebo intervention) which produces an effect which is real (a placebo effect). Now maybe this reflects my own lack of imagination, but I just can’t get my head around an effect that has no mechanism. Surely there must either be no effect (i.e. there is no placebo effect), or the intervention must have a mechanism (i.e. placebos are not inert, but real treatments).”
Indeed. The whole short article is excellent.
2014 mind
article Schmid et al Television viewing and time spent sedentary in relation to cancer risk J Natl Cancer Inst 2014 background sedentary behavior emerging independent risk factor chronic disease mortality evidence relating television tv viewing sedentary behaviors cancer risk quantitatively summarized methods performed comprehensive electronic literature search cochrane embase medline scisearch databases february published articles investigating sedentary behavior relation cancer incidence randomized controlled trials difficult perform topic focused observational studies met uniform inclusion criteria data extracted independently authors summarized random effects meta analysis meta regression statistical tests sided results data observational studies including total cancer cases analyzed comparing highest lowest levels sedentary time relative risks rrs colon cancer confidence interval ci tv viewing time ci occupational sitting time ci total sitting time endometrial cancer relative risks ci tv viewing time ci total sitting time positive association sedentary behavior noted lung cancer rr ci sedentary behavior unrelated cancers breast rectum ovaries prostate stomach esophagus testes renal cell hodgkin lymphoma conclusions prolonged tv viewing time spent sedentary pursuits increased risks types cancer sedentariness
3 article Franklin et al Massage therapy restores peripheral vascular function after exertion Archives of Physical Medicine & Rehabilitation 2014 objective determine extremity exercise induced muscle injury reduces vascular endothelial function upper extremity massage therapy mt improves peripheral vascular function exertion induced muscle injury design randomized blinded trial evaluations minutes hours hours hours setting clinical research center participants sedentary young adults randomly assigned groups exertion induced muscle injury mt age ± se ± exertion induced muscle injury age ± se ± mt age ± se ± intervention participants assigned exertion induced muscle injury single bout bilateral eccentric leg press exercise mt min extremity massage swedish technique exertion induced muscle injury mt main outcome measures brachial artery flow mediated dilation fmd determined ultrasound time point nitroglycerin ntg induced dilation assessed mg results brachial fmd increased baseline exertion induced muscle injury mt group mt group ± ± massage+movement+exercise+DOMS+manual therapy+treatment+self-treatment+inflammation+pain problems+muscle
3 article Killer et al No evidence of dehydration with moderate daily coffee intake PLoS ONE 2014 suggested coffee dehydration consumption avoided significantly reduced maintain fluid balance aim study compare effects coffee consumption water ingestion range validated hydration assessment techniques counterbalanced cross design male coffee drinkers habitually consuming cups day participated trials lasting consecutive days addition controlled physical activity food fluid intake participants consumed × ml coffee mg kg caffeine water total body water tbw calculated pre post trial ingestion deuterium oxide urinary haematological hydration markers recorded daily addition nude body mass measurement bm plasma analysed caffeine confirm compliance significant tbw beginning trial differences trials ± ± kg differences observed trials haematological markers urine volume ± ± ml usg osmolality creatinine urinary na + excretion higher     significant differences bm conditions small progressive daily fall observed trials ± kg random
3 article Sherman et al Five-week outcomes from a dosing trial of therapeutic massage for chronic neck pain Ann Fam Med This study compared different doses of massage therapy for 228 patients with chronic neck pain with no obvious cause. It showed that more massage therapy helped neck pain, and suggested that perhaps other studies showing lackluster effects on neck pain “may have not administered adequate doses.” Interesting. It’s a pretty nice study, with actual good news. But! (There’s always a but, eh?) Among other limitations, there was this one (and kudos to them for acknowledging it, I was really hoping they would): “inability to control for nonspecific effects of attention with the use of a wait list control design.” Ayuh. In other words, it’s not exactly a shocker that just spending a lot of pleasant time with a therapist might produce better outcomes than waiting for treatment. I mean, duh! The massage itself may well not have been the mechanism. Or it may well have been. The problem is that this study can’t really tell us. Can it tell us anything? Yes: if massage helps neck pain, more massage probably helps neck pain more. 2014 purpose trial designed evaluate optimal dose massage individuals chronic neck pain methods recruited individuals chronic nonspecific neck pain integrated health care system general population randomized groups receiving doses massage week consisting minute visits times weekly minute visits times weekly single control group week period wait list assessed neck related dysfunction neck disability index range points pain intensity numerical rating scale range points baseline weeks log linear regression assess likelihood clinically meaningful improvement neck related dysfunction points neck disability index pain intensity improvement treatment group results adjustment baseline age outcome measures imbalanced covariates minute treatments significantly wait list control condition terms achieving clinically meaningful improvement neck dysfunction pain frequency treatments contrast minute treatments times weekly significantly increased likelihood improvement compared control condition terms neck dysfunction relative risk pain intensity relative risk conclusions weeks treatment multiple minute massages week effective shorter sessions individuals chronic neck pain clinicians recommending massage researchers studying therapy ensure patients receive effective dose treatment neck+good news+head/neck+spine
article Monto Platelet-rich plasma efficacy versus corticosteroid injection treatment for chronic severe plantar fasciitis Foot & Ankle International 2014 background chronic plantar fasciitis common orthopedic condition prove difficult successfully treat study autologous platelet rich plasma prp concentrated bioactive blood component rich cytokines growth factors compared traditional cortisone injection treatment chronic cases plantar fasciitis resistant traditional nonoperative management methods forty patients females males unilateral chronic plantar fasciitis respond minimum months standardized traditional nonoperative treatment modalities prospectively randomized treated single ultrasound guided injection cc prp mg depomedrol cortisone american orthopedic foot ankle society aofas hindfoot scoring completed patients immediately prior prp cortisone injection pretreatment time months injection treatment baseline pretreatment radiographs mri studies obtained cases confirm diagnosis plantar fasciitis results cortisone group pretreatment average aofas score initially improved months posttreatment decreased months dropped baseline levels months continued decline final score months contrast prp group started average pretreatment aofas score increased months remained elevated months final score months conclusions prp effective durable cortisone injection treatment chronic recalcitrant cases plantar fasciitis level evidence level prospective randomized comparative series injections+tendinosis+plantar fasciitis+medicine+treatment+pain problems+overuse injury+injury+foot+leg+limbs
3 article Yin et al Adverse events of massage therapy in pain-related conditions Evidence-Based Complementary and Alternative Medicine At first glance, this paper makes it seem like massage might be rather dangerous! The main complications of “massage” reported here were mostly spinal injuries. Really? Massage harms spines? I agree with their general conclusion — “massage therapies are not totally devoid of risks” — but it turns out that the majority of serious adverse events reported were actually the result of spinal manipulation practiced within the context of massage therapy, and not actually massage per se. Also, the great majority of adverse events were reported in Asia, where aggressive and incompetent spinal manipulation may be more common. And yet even with these major mitigating considerations, “the incidence of such events is low.” For people receiving massage outside of Asia with minimal and cautious spinal manipulation, the risks reported here are of little concern. This citation is more useful as evidence that spinal manipulation is a little hazardous. 2014 pain related massage important traditional eastern medicine increasingly western world widening acceptance demands continual safety assessment review evaluation frequency severity adverse events aes reported pain related massage relevant languages reports databases identified assessed coauthors year period reports aes massage author year publication country occurrence participant related age sex number patients affected details manual therapy clinician type extracted disc herniation soft tissue trauma neurologic compromise spinal cord injury dissection vertebral arteries main complications massage spinal manipulation massage repeatedly aes massage therapies totally devoid risks incidence events harms+bad news+spinal adjustment+chiropractic+massage+pain problems+spine+treatment+manual therapy+controversy+debunkery
3 article Moroney et al The Conundrum of Calcaneal Spurs Foot & Ankle Specialist Moroney et al. looked at about a thousand heel x-rays, found spurs in about 12%, and then compared them to some spurless patients. Spurred patients were heavier and had more diabetes, arthritis, and (non-plantar-fasciitis) pain, leading the authors to a rather grand-sounding CONCLUSION: “We have demonstrated the relevance of a radiographic finding once considered irrelevant.” In other, humbler words: smoking gun evidence that heel spurs are, shocker, not entirely innocuous and are more common in people whose lower limb tissues are under siege from age and weight. It’s mildly interesting data, but I’m not sure it matters much, and we can probably do without the grandiosity and just file this one under No Shit, Sherlock. 2014 background chronic plantar heel pain common potentially debilitating condition caused plantar fasciitis plantar calcaneal spurs originally considered plantar fasciitis regarded incidental finding authors aimed test hypothesis investigate predisposing factors development spurs methods reviewed lateral ankle rays institution month period identified rays demonstrating calcaneal spurs identified similar number age sex matched controls spurs contacted groups telephone compared symptoms heel pain plantar fasciitis comorbidities foot ankle outcome scores faoss results reviewed rays consecutive patients spur prevalence common women older patients questioning spur group control group higher body mass index spur group patients spurs times diabetes mellitus times limb osteoarthritis patients spurs foot pain poorer faos control group patients plantar fasciitis excluded conclusion results demonstrate presence plantar calcaneal spur indicator foot pain independent plantar fasciitis spurs foot pain indication conditions clinical relevance demonstrated relevance radiographic finding considered irrelevant plantar fasciitis+diagnosis+etiology+foot+leg+limbs+pain problems+overuse injury+injury+tendinosis+pro
3 article Loew et al Deep transverse friction massage for treating lateral elbow or lateral knee tendinitis Cochrane Database of Systematic Reviews 2014
3 webpage Hargrove Does Bad Posture Cause Back Pain? 2014 back pain+posture+biomechanics+pain problems+spine+etiology+pro
3 article Broatch et al Postexercise Cold-Water Immersion Benefits Are Not Greater than the Placebo Effect Medicine & Science in Sports & Exercise 2014 purpose general lack understanding underlying mechanisms cold water immersion cwi widely athletes recovery study examined physiological merit cwi recovery high intensity exercise investigating placebo effect responsible acute performance psychological benefits methods males ± sd age ± combining dot o peak ± ml kg min performed acute high intensity interval training hit session comprised sprints immediately min recovery conditions cwi ± ° thermo neutral water immersion placebo twp ± ° thermo neutral water immersion control twi ± ° intramuscular thermistor inserted exercise recovery record muscle temperature swelling thigh girth pain threshold tolerance interleukin concentration total leukocyte neutrophil lymphocyte count recorded baseline post exercise post recovery post exercise maximal voluntary isometric contraction mvc quadriceps performed time points exception post exercise assessments readiness exercise fatigue vigour sleepiness pain belief recovery effectiveness completed results leg strength mvc ratings readiness exercise pain vigour significantly impaired twi compared cwi twp similar conclusion recovery placebo administered acute hit session superior recovery muscle strength compared twi effective cwi attributed improved ratings readiness exercise pain vigour suggesting commonly hypothesised physiological benefits surrounding cwi partly placebo related treatment+inflammation+ice heat+devices+pain problems+rehab+injury+self-treatment
article Wartolowska et al Use of placebo controls in the evaluation of surgery British Medical Journal 2014 objective investigate placebo controls evaluation surgical interventions design systematic review data sources searched medline embase cochrane controlled trials register inception november study selection randomised clinical trials comparing surgical intervention placebo surgery defined procedure anatomy requires skin incision endoscopic techniques data extraction reviewers kw bjfd ir independently identified relevant trials extracted data study details outcomes harms included studies results trials improvement placebo arm trials effect placebo differ surgery trials surgery superior placebo magnitude effect surgical intervention placebo generally small adverse events reported placebo arm trials surgical arm trials trials authors arm events occurred studies adverse events unrelated intervention severity condition existing placebo controlled trials investigated invasive procedures involve laparotomy thoracotomy craniotomy extensive tissue dissection conclusions placebo controlled trial powerful feasible showing efficacy surgical procedures risks adverse effects placebo small studies results provide evidence continued investigated surgical procedures designed placebo controlled trials surgery ineffective treatment continue unchallenged surgery+mind+scientific medicine+pro+treatment
4 article Rathleff et al High-load strength training improves outcome in patients with plantar fasciitis Scandinavian Journal of Medicine & Science in Sports 2014 aim study investigate effectiveness shoe inserts plantar fascia specific stretching shoe inserts high load strength training patients plantar fasciitis forty patients ultrasonography verified plantar fasciitis randomized shoe inserts daily plantar specific stretching stretch group shoe inserts high load progressive strength training strength group performed day high load strength training consisted unilateral heel raises towel inserted toes primary outcome foot function index ffi months additional follow ups performed months primary endpoint months strength group ffi points confidence interval ci     compared stretch group months differences groups     months ffi points ci strength group points ci stretch group differences secondary outcomes simple progressive exercise protocol performed day resulted superior reported outcome months compared plantar specific stretching high load strength training aid quicker reduction pain improvements function plantar fasciitis+strength+treatment+foot+leg+limbs+pain problems+overuse injury+injury+tendinosis+exercise+self-treatment
3 article Lowery et al Effects of static stretching on 1-mile uphill run performance Journal of Strength & Conditioning Research There’s more to say about this one, and Alex Hutchinson did, but here’s the nasty nugget: pre-run stretching caused an eight percent drop in performance in a one-mile uphill run. Yikes! 2014 previously demonstrated static stretching decrease running economy distance run minute time trial trained runners detrimental effects static stretching economy limited minutes endurance bout economy remains studied direct effects performance shorter endurance events aim study investigate effects static stretching mile uphill run performance electromyography emg ground contact time gct flexibility ten trained male distance runners aged ± years average vo max ± ml kg min recruited subjects reported laboratory separate days interspersed hours day anthropometrics combining dot o max determined motor driven treadmill days subjects performed minute treadmill warm performed series body stretches repetitions sat minutes time complete mile run stretching nonstretching conditions place randomized order performance run subjects instructed run fast set incline distance mile completed flexibility sit reach test emg gct performance determined time complete mile run recorded condition time complete run significantly ± minutes nonstretching condition compared stretching condition ± minutes significant condition time interaction muscle activation existed change nonstretching condition pre ± mv post ± mv increased stretching condition pre ± mv post ± mv significant condition time interaction gct present nonstretching condition pre ± ms post ± ms increased stretching trial pre ± ms post ± ms significant condition time interaction flexibility increased stretching condition pre ± post ± unchanged nonstretching condition pre ± post ± study findings static stretching decreases performance short endurance bouts ∼ increasing gct muscle activation coaches athletes risk decreased performance static stretching bout static stretching avoided short endurance bout stretch+running+harms+exercise+self-treatment+treatment+muscle+pain problems
3 article Goodall et al Vitamin D3 and gargling for the prevention of upper respiratory tract infections BMC Infectious Diseases 2014 background undertook x factorial randomized controlled trial rct assess vitamin d supplementation international units week placebo gargling gargling prevent viral clinical upper respiratory tract infection urti university students methods randomized students treatment arms vitamin d gargling placebo gargling vitamin d gargling placebo gargling students completed weekly electronic surveys submitted collected mid turbinate nasal flocked swabs september october symptomatic students completed electronic symptom diary primary secondary outcomes occurrence symptomatic clinical urti laboratory confirmed urti results participants completed surveys completed reported clinical urti seventy participants randomized vitamin d reported clinical urti compared randomized placebo rr ci     participants randomized gargling reported clinical urti compared participants randomized gargling arm rr ci     laboratory testing identified infections urtis vitamin d treatment significantly risk laboratory confirmed urti rr ci     significantly viral load measured log viral copies ml difference ci     students assigned gargling experienced laboratory confirmed urti statistically significant rr ci     conclusions results suggest vitamin d promising intervention prevention urti vitamin d significantly reduced risk laboratory confirmed urti reduce risk clinical infections trial registration clinical trials registration nct random+water+vitamin D+controversy+debunkery+nutrition+self-treatment+treatment
book Allen Excuse me, exactly how does that work? self-published Laura Allen’s book is unique. As far as I know, she is the first massage therapist to ever write one like it: a scathing and sassy denunciation of her profession’s love affair with crystals, chakras, and fringe science. Addressing her colleagues throughout, she tells them, “Our profession has turned into the snake oil medicine show.” The book takes the reader on a tour of most of the weird practices that seem to cling to massage therapy like parasites, and asks again and again, “Excuse me, exactly how does that work?” In most cases, of course, the point is that they don’t. Read the rest of my full review. 2014 controversy+scientific medicine+massage+debunkery+manual therapy+treatment
3 article Damasceno et al Static Stretching Alters Neuromuscular Function and Pacing Strategy, but Not Performance during a 3-Km Running Time-Trial PLoS ONE This test found that a nice pre-run stretch causes “a reduced capacity of the skeletal muscle to produce explosive force,” a conclusion that reproduces and builds on similar evidence. As Alex Hutchinson put it for Runner’s World, “I can’t see anything good about something that makes me go slower but feel like I’m trying harder.” Yeah, I’m with Alex: this wasn’t a huge negative effect, but absolutely in the wrong direction. I note with amazement the devotion to a popular warm-up exercise that not only doesn’t help, but actually dings performance. 2014 purpose previous studies report static stretching ss impairs running economy assuming pacing strategy relies rate energy study aimed determine ss modify pacing strategy performance km running time trial methods eleven recreational distance runners performed constant speed running test previous ss maximal incremental treadmill test anthropometric assessment constant speed running test previous ss km time trial familiarization outdoor track km time trials ss experimental situation control situation previous static stretching order sessions randomized counterbalanced fashion sit reach drop jump tests performed km running time trial control situation stretching exercises ss running economy stride parameters electromyographic activity emg vastus medialis vm biceps femoris bf gastrocnemius medialis ga measured constant speed tests results running time change condition ss ± control ±     completed significantly velocity ss surprisingly ss modify running economy iemg bf +     stride duration +     range motion +     significantly modified drop jump height decreased ss     conclusion static stretch impaired neuromuscular function resulting slow start km running time trial demonstrating fundamental role neuromuscular system selected speed initial phase race stretch+running+exercise+self-treatment+treatment+muscle
article O'Laughlin et al Diagnosis and expedited surgical intervention of a complete hamstring avulsion in a military combatives athlete International Journal of Sports Physical Therapy Complete hamstring avulsions — that is, complete ruptures of muscles where they attach to bones — are not necessarily obvious. They aren’t all as painful initially as they sound. And according to this study, they “can be difficult to diagnose acutely due to swelling and patient guarding, which may mask a visibly palpable defect and lead to delays in diagnosis.” Yikes! 2014 background purpose hamstring injuries frequent injuries athletes common strains musculotendinous junction muscle belly conversely hamstring avulsions rare misdiagnosed leading delay surgical interventions purpose case report describe history physical examination findings led diagnostic imaging subsequent diagnosis expedited surgical intervention complete avulsion hamstring muscle group ischium military combatives athlete case description patient year male sustained hyperflexion injury hip knee extension participating military combatives presenting acute posterior thigh buttock pain history physical examination findings physical therapy evaluation prompted urgent magnetic resonance imaging mri study led diagnosis complete avulsion hamstring muscle group ischium outcome expedited surgical intervention occurred days injury potentially limiting comorbidities delayed diagnosis conclusion recognition avulsion led prompt surgical evaluation intervention literature shown diagnosis hamstring avulsions frequently missed delayed results myriad complications level evidence level strain+diagnosis+injury+pain problems+muscle
3 article Fioravanti et al Short- and long-term effects of mud-bath treatment on hand osteoarthritis Int J Biometeorol 2014 aim study evaluate short term long term effectiveness spa therapy patients primary hand osteoarthritis oa prospective randomized single blind controlled trial sixty outpatients primary bilateral hand oa included study randomized groups group     treated daily local mud packs generalized thermal baths sulfate calcium magnesium fluorides mineral water added usual treatment control group     continued regular outpatient care routine exercise nsaids analgesics patient examined baseline  weeks  months primary outcome measures global spontaneous hand pain visual analogue scale vas functional index hand osteoarthritis fihoa score secondary outcomes health assessment questionnaire haq duration morning stiffness medical outcomes study item short form sf symptomatic drugs consumption results demonstrated efficacy spa therapy significant assessed parameters therapy  months values fihoa haq drugs consumption continued significantly  months comparison baseline significant modifications parameters follow control group differences groups significant parameters th day  months follow fihoa haq symptomatic drugs consumption difference groups persisted significant month follow tolerability spa therapy good conclusion results confirm beneficial effects spa therapy patients hand oa time Epsom+toxins+controversy+debunkery+water
4 article Sekharappa et al Lumbosacral transition vertebra Asian Spine Journal Sometimes the sacrum is fused to the lowest lumbar vertebra: a lumbosacral transition vertebra. “LSTV is the most common congenital anomaly of the lumbosacral spine.” In about a thousand patients studied, it was about twice as common in patients who had sought spinal surgery as it was in patients with no spinal complaint (about 14-16% of patients, instead of 8%). The study also identified a “definite causal relationship” with degeneration of the disc above the LSTV. 2014 study design retrospective analysis radiological images purpose determine prevalence lumbosacral transition vertebra lstv study significance respect clinically significant spinal symptoms disc degeneration herniation overview literature lstv common congenital anomaly lumbosacral spine prevalence debated vary relationship pain disc degeneration herniation established methods study involved examining radiological images groups patients group consisted kidney urinary bladder kub rays patients attending urology outpatient clinic group consisted rays magnetic resonance images mris patients tending spine outpatient clinic group consisted rays mri patients undergone surgery lumbar disc herniation thousand patients meeting inclusion criteria selected group lstv classified castellvi classification disc degeneration assessed pfirrmann grading mri scans results prevalence lstv urology outpatients spine outpatients discectomy patients lstv patients showed higher pfirrmann grade degeneration mobile disc results significant statistically conclusions prevalence lstv spinal outpatients discectomy patients significantly higher compared attending urology outpatient clinic definite causal relationship transitional vertebra degeneration disc immediately cephalad etiology+back pain+neurology+anatomy+pro+pain problems+spine
3 article Porter et al Prevalence of extraforaminal nerve root compression below lumbosacral transitional vertebrae Skeletal Radiology 2014 objective pathology mobile segment lumbosacral transitional vertebra lstv source spinal symptoms nerve root compression lstv sporadically reported objective assess prevalence nerve root entrapment lstv review entrapment correlate presenting symptoms materials methods retrospective review ct examinations lumbar spine performed year period words transitional vertebra mentioned report nerve root compression lstv assessed subtype transitional vertebra correlation clinical symptoms referral ct examinations reviewed exclude symptoms lstv results seventy patients included study neural compression bone formation lstv demonstrated patients patients pseudarthrosis present side compression due partial sacralization incomplete fusion patients symptomatic correlation radiculopathy demonstrated patients correlating symptoms part attributable compression lstv conclusions nerve root compression lstv occurs prevalence symptomatic patients region carefully assessed symptomatic patients lstv back pain+neurology+pain problems+spine
article Kulinski et al Association Between Cardiorespiratory Fitness and Accelerometer-Derived Physical Activity and Sedentary Time in the General Population Mayo Clinic Proceedings 2014 objective determine association cardiorespiratory fitness sedentary behavior independent exercise activity patients methods included participants aged years females heart disease cardiovascular fitness testing day accelerometer data national health nutrition examination survey accelerometer data quantified bouts exercise minutes day participant sedentary time defined counts minute minutes day cardiorespiratory fitness derived submaximal exercise treadmill test multivariable adjusted linear regression analyses performed fitness dependent variable models stratified sex adjusted age body mass index wear time included sedentary exercise time results additional hour daily exercise activity time exercise+sedentariness+self-treatment+treatment
4 article Rathleff et al Is hip strength a risk factor for patellofemoral pain? British Journal of Sports Medicine This review of 24 of the highest quality studies available found that patellofemoral pain and hip weakness are certainly associated, but weakness is not the cause of the pain — indeed, it’s probably the other way around. Correlations are easy to find, but causality can be tricky to nail down: you have to study runners before they develop pain (a prospective study design), and then wait and see who develops it. Experiments of that kind have shown that hip strength was the same in runners regardless of whether or not they eventually ended up in pain. 2014 objective evaluate synthesise literature hip strength patients patellofemoral pain pfp address differentiate hip strength risk factor deficit pfp describe hip strength men women pfp age ranges investigate effects hip strengthening biomechanical knee variables pfp development methods medline cinahl web science sportdiscus google scholar searched november studies investigating hip strength patients pfp reviewers independently assessed papers inclusion quality means sds extracted included study effect size calculations comparisons results results moderate strong evidence prospective studies association isometric hip strength risk developing pfp moderate evidence cross sectional studies men women pfp isometric hip musculature strength compared pain free individuals limited evidence adolescents pfp strength deficits adults pfp conclusions review highlights discrepancy prospective cross sectional research cross sectional studies adult men women pfp hip strength compared pain free individuals contrary limited number prospective studies association isometric hip strength risk developing pfp reduced hip strength result pfp patellar pain+etiology+arthritis+aging+pain problems+knee+leg+limbs+overuse injury+injury+running+exercise+self-treatment+treatment+pro
4 article Kooiker et al Effects of physical therapist-guided quadriceps-strengthening exercises for the treatment of patellofemoral pain syndrome Journal of Orthopaedic & Sports Physical Therapy Do quadriceps strengthening exercises help with patellofemoral pain? This 2014 systematic literature review set out to summarize the evidence, sorting through the junk to find 7 of the highest quality studies published at the time. The conclusion was strongly in favor of quadriceps strengthening being effective for decreasing pain and improving function in patients with patellofemoral pain syndrome. Effects sizes were mostly "large" — clinically significant as well as statistically significant. Considering the decent methodological quality of the studies included, it seems the total evidence suggests quad strengthening works for patellofemoral pain. Of course, this doesn't mean it will work for everyone — but it should for most! Note that this study also found that pretty much any form of quadricep strengthing is effective, with no superiority found in weight bearing vs non-weight bearing or VMO specific training. Just exercise those thighs! 2014 study design systematic literature review objective summarize evidence physical therapist guided quadriceps strengthening exercises treatment patellofemoral pain syndrome background quadriceps strengthening included plan care patellofemoral pain syndrome systematic review published limited evidence exercise effective exercise common condition methods pubmed embase medline cochrane central register controlled trials databases inception january searched randomized controlled trials comparing quadriceps strengthening exercises interventions consisting advice information placebo outcomes interest pain measures function measured report questionnaires methodological quality randomized controlled trials assessed physiotherapy evidence database scale results summarized evidence synthesis graphically illustrated forest plots meta analysis results studies included literature review studies reported strong evidence isolated quadriceps strengthening effective reducing pain improving function advice information addition compared advice information placebo strong evidence quadriceps strengthening exercises combined interventions effective reducing pain immediately postintervention months improving function conclusion literature strong evidence quadriceps strengthening exercises interventions treatment patellofemoral pain syndrome patellar pain+physical therapy+exercise+arthritis+aging+pain problems+knee+leg+limbs+overuse injury+injury+running+self-treatment+treatment+manual therapy
3 article Portillo-Soto et al Comparison of blood flow changes with soft tissue mobilization and massage therapy Journal of Alternative and Complementary Medicine 2014 objectives instrument assisted soft tissue mobilization massage therapy manual techniques claim increase blood flow treated areas data techniques study sought compare effects graston technique ® gt massage therapy calf blood flow skin temperature measures leg design single blinded prospective longitudinal controlled repeated measures design setting research laboratory participants twenty participants age ± years men women calf girth ±  cm calf skinfold thickness ±  cm interventions participant received minute treatments massage gt separate sessions untreated leg control outcome measures baseline skin temperature calf measured treatment minutes treatment total minutes differences treatment conditions gt gt control massage massage control performed times evaluated repeated measures analysis variance significance set priori massage+manual therapy+treatment
3 article Pollak et al Exogenously applied muscle metabolites synergistically evoke sensations of muscle fatigue and pain in human subjects Exp Physiol What specifically causes “the burn” in intense effort? Which molecules? Protons, lactate, and ATP — and only in concert. Individually, none of them really have that much effect. Surprisingly, this fairly unsurprising result is brand new information: “the first demonstration in humans that metabolites normally produced by exercise act in combination to activate sensory neurons that signal sensations of fatigue and muscle pain.” 2014 findings central question study physiological concentrations metabolite combinations evoke sensations fatigue pain injected skeletal muscle sensations evoked main finding importance concentrations protons lactate atp evoked sensations related fatigue higher concentrations metabolites evoked pain single metabolites evoked sensations suggests combination asic receptor purinergic p x receptor required signalling fatigue pain results suggest types sensory neurons encode metabolites detects concentrations metabolites signals sensations fatigue detects higher levels metabolites signals ache hot perception fatigue common disease states mechanisms sensory muscle fatigue understood mice rats cats muscle afferents signal metabolite production skeletal muscle complex asic p x trpv receptors endogenous muscle agonists receptors combinations protons lactate atp applied physiological concentrations agonists muscle interstitium human subjects determine combination activate sensations determine subjects sensations ten volunteers received infusions ml protons lactate atp fascia thumb muscle abductor pollicis brevis infusion individual metabolites maximal amounts evoked fatigue pain metabolite combinations resting muscles ph + nm atp + mm lactate evoked sensation infusion metabolite combination muscle moderate endurance exercise ph + nm atp + mm lactate produced significant fatigue sensations infusion metabolite combination vigorous exercise ph + nm atp + mm lactate produced stronger sensations fatigue ache higher levels metabolites ischaemic exercise caused ache additional fatigue sensation dose dependent manner intramuscular infusion combinations protons lactate atp leads fatigue sensation eventually pain activation asic p x trpv receptors demonstration humans metabolites produced exercise act combination activate sensory neurons signal sensations fatigue muscle pain biology+DOMS+exercise+neat+self-treatment+treatment+inflammation+pain problems+muscle
article Aspenberg Mythbusting in Orthopedics challenges our desire for meaning Acta Orthop 2014 myth medicine false concepts based akin story good story meniscal tears pain removed pain showing pain relief due placebo effects means destroying good story unpopular depriving colleagues good business scientific medicine+deep+mind
3 article Staiano et al Sitting time and cardiometabolic risk in US adults British Journal of Sports Medicine “Self-reported sitting time was associated with adverse cardiometabolic risk factors consistently across sex and race groups in a representative US sample, independent of other risk factors. Excessive sitting warrants a public health concern.” 2014 background sitting time adverse health outcomes including chronic disease premature mortality association sitting time cardiometabolic risk factors varies sociodemographic health factors methods sample included adults years participated cross sectional national health nutrition examination survey participants reported typical daily sitting time weight height blood pressure fasting triglycerides high density lipoprotein cholesterol hdl glucose insulin measured homeostatic model assessment insulin resistance homa ir β cell function homa calculated subsample participants underwent oral glucose tolerance test obtain postload glucose levels population weighted linear regression analysis examine association sitting time cardiometabolic risk factor stratified sex race socioeconomic status activity level analyses controlled demographics socioeconomic status survey cycle personal family medical history diet physical activity results sitting time significantly adverse levels waist circumference body mass index triglycerides hdl insulin homa ir homa postload glucose blood pressure glucose level stratified analyses sitting time consistently related cardiometabolic risk factors middle socioeconomic groups reported weekly physical activity differences sex race groups conclusions reported sitting time adverse cardiometabolic risk factors consistently sex race groups representative sample independent risk factors excessive sitting warrants public health concern exercise+self-treatment+random+treatment
3 article Zhang et al Effect of whole-body vibration exercise on mobility, balance ability and general health status in frail elderly patients Clinical Rehabilitation 2014 objective study effects body vibration exercises mobility function balance general health status feasibility intervention frail elderly patients design pilot randomized controlled trial subjects forty frail older persons ± years meeting fried frailty criteria interventions eligible subjects randomly assigned experimental group received body vibration exercise vibration amplitude mm frequency hz bouts × seconds times weekly control group received usual care exercises weeks main measures timed test chair stand test extremities muscle strength balance function balance confidence general health status assessed beginning study weeks weeks intervention results body vibration exercise reduced time timed test ± ± improved bilateral knees extensor strength ± kg ± kg posture stability surface area ellipse ± ± general health status short form health survey score ± ± ± ± repeated measures anova showed significant differences timed test chair stand test bilateral knees extensor strength activities specific balance confidence score general health status groups side effects observed training conclusions body vibration exercise safe effective method improve mobility knee extensor strength balance general health status frail elderly exercise+odd+devices+aging+self-treatment+treatment
3 article Denning et al Piezoelectric properties of aligned collagen membranes J Biomed Mater Res B Appl Biomater This paper (and Harnagea and Rivard) definitely qualifies as research showing that there is piezoelectric effect in fascia.  But there’s a huge “but.”  Context is everything! It doesn’t mean much.  It’s about as basic as basic biology gets, a biologically trivial finding: a teensy little microscopic spark of PE when you would need a bonfire to get any biological significance out of it (never mind clinical significance).  They found PE effect at molecular scales, but the thing is that nearly everything at that scale has a mess of interesting electromagnetic properties, and PE is all over the place.  For instance, hair, some plastics, lots of minerals…nearly any molecularly regular structure, really. For PE effect to be leveraged biologically for anything, it would have to be happening on a much larger scale, electrons would have to actually *go* somewhere, further than a few nanometers. Anything PE effect at that scale is just a little molecular noise. Their imaging technology and methodology is more interesting than what they found with it.  Really quite impressive tools they were using! 2014 electromechanical coupling phenomenon present collagenous materials influence cell extracellular matrix interactions electromechanical coupling investigated piezoresponse force microscopy transparent opaque membranes consisting helical arrays aligned type collagen fibrils assembled acidic solution atomic force microscopy transparent membrane determined fibrils average diameter ± nm opaque membrane comprised fibrils average diameter ± nm acidity membranes neutralized serve cell culture substrates structure piezoelectric properties membranes measured ambient conditions neutralization process crimp structure ± µ width perpendicular fibril alignment apparent transparent membrane ph adjusted acidic ph neutral ph conditions addition fold increase observed amplitude shear piezoelectricity transparent membrane structure piezoelectric properties opaque membrane significantly affected neutralization process results highlight presence additional translational order transparent membrane direction perpendicular fibril alignment piezoelectric response membrane types order magnitude collagen fibrils rat tail tendon reduced response attributed ordered molecular assembly present periodic collagen fibrils evidenced absence periodicity membranes random+fascia+controversy+debunkery+etiology+pro+massage+manual therapy+treatment
4 article Martin et al Heel pain-plantar fasciitis Journal of Orthopaedic & Sports Physical Therapy 2014 orthopaedic section american physical therapy association apta ongoing effort create evidence based practice guidelines orthopaedic physical therapy management patients musculoskeletal impairments world health organization international classification functioning disability health icf purpose revised clinical practice guidelines review peer reviewed literature recommendations related nonarthritic heel pain plantar fasciitis+foot+leg+limbs+pain problems+overuse injury+injury+tendinosis
3 article Grabiner et al Exercise-based fall prevention Exercise & Sport Sciences Reviews 2014 trip specific perturbation training reduces trip related falls laboratory induced trips prospectively community based emerging body evidence hypothesize task specific perturbation training stand approach conjunction conventional exercise based approaches improve effectiveness fall prevention interventions significantly exercise+injury+prevention+self-treatment+treatment+pain problems
3 article Wicke et al A comparison of self-administered proprioceptive neuromuscular facilitation to static stretching on range of motion and flexibility Journal of Strength & Conditioning Research 2014 stretching effective method increasing range motion proprioceptive neuromuscular facilitation pnf stretching technique partner goal study examine hip range motion rom hip shoulder flexibility hbsf intervention administered pnf traditional static stretching nineteen healthy college aged individuals ages years completed study participants tested preintervention postintervention hip rom hbsf goniometer sit reach test interventions included static pnf hamstring stretching × seconds leg weeks participants randomly group completion intervention week rest period repeated process intervention statistical analysis revealed significant difference change hip rom hbsf static stretch pnf group sd hip rom ± ° ± ° pnf static groups negative increase rom ± cm ± cm hsbf addition significant improvements confidence intervals measures pnf intervention hbsf static stretching intervention results suggest pnf place static stretching require partner control stretching individual stretch+exercise+self-treatment+treatment+muscle
article Moraes et al Platelet-rich therapies for musculoskeletal soft tissue injuries Cochrane Database of Systematic Reviews 2014 background platelet rich therapies increasingly treatment musculoskeletal soft tissue injuries ligament muscle tendon tears tendinopathies therapies principal treatment augmentation procedure application surgical repair reconstruction platelet rich therapies produced centrifuging quantity patient blood extracting active platelet rich fraction platelet rich fraction applied injured tissue injection platelets ability produce growth factors therapies enhance tissue healing assess translates clinical benefit objectives assess effects benefits harms platelet rich therapies treating musculoskeletal soft tissue injuries search methods searched cochrane bone joint muscle trauma group specialised register march cochrane central register controlled trials central issue medline march embase week lilacs march searched trial registers week conference abstracts march language publication restrictions applied selection criteria included randomised quasi randomised controlled trials compared platelet rich therapy placebo autologous blood dry needling platelet rich therapy people acute chronic musculoskeletal soft tissue injuries primary outcomes functional status pain adverse effects data collection analysis review authors independently extracted data assessed study risk bias disagreement resolved discussion arbitration author contacted trial authors clarification methods missing data treatment effects assessed risk ratios dichotomous data differences md standardised differences smd continuous data confidence intervals data pooled fixed effect model rr md random effects model smd quality evidence outcome assessed grade criteria main results included data small single centre trials randomised quasi randomised participants compared platelet rich therapy placebo autologous blood dry needling platelet rich therapy trials covered clinical conditions rotator cuff tears arthroscopic repair trials shoulder impingement syndrome surgery trial elbow epicondylitis trials anterior cruciate ligament acl reconstruction trials acl reconstruction donor graft site application trials patellar tendinopathy trial achilles tendinopathy trial acute achilles rupture surgical repair trial grouped trials tendinopathies platelet rich therapy prt injections main treatment trials surgical augmentation procedures prt applied surgery trials trial participants male trials including rotator cuff tears elbow achilles tendinopathies trials judged risk bias high unclear risk bias relating selection detection attrition selective reporting combinations methods preparing platelet rich plasma prp varied lacked standardisation quantification prp applied patient pool data primary outcomes function pain adverse events maximum trials participants evidence primary outcomes judged quality data assessing function short term months pooled trials assessed prt clinical conditions measures showed significant difference prt control smd confidence interval ci ² participants positive values favour prt medium term function data months pooled trials assessed prt clinical conditions measures showed difference groups smd ci ² participants long term function data year pooled trials assessed prt clinical conditions measures showed difference groups smd ci ² participants confidence intervals possibility poorer outcome prt group moderate difference favour prt short long term follow translate clinically relevant differences data pooled trials assessed prt clinical conditions showed small reduction short term pain favour prt point scale md ci ² participants clinical significance result marginal trials reported adverse events trials reported absence adverse events difference treatment groups numbers participants adverse effects rr ci ² participants terms individual conditions pooled heterogeneous data long term function trials prt application rotator cuff tear surgery showed statistically clinically significant differences groups participants evidence insufficient effects prt differ importantly individual clinical conditions authors conclusions individual clinical conditions insufficient evidence support prt treating musculoskeletal soft tissue injuries researchers contemplating rcts coverage ongoing trials assessing future rcts specific conditions standardisation prp preparation methods injections+tendinosis+strain+medicine+treatment+pain problems+overuse injury+injury+muscle
3 article Grant et al Levels of Evidence in the Clinical Sports Medicine Literature American Journal of Sports Medicine Things may be getting better: “The emphasis on increasing levels of evidence to guide treatment decisions for sports medicine patients may be taking effect.” Fantastic news, if true! On the other hand, maybe I should be careful what I wish for, since my entire career is based on making some sense out of the hopeless mess that is sports and musculoskeletal medicine… 2014 background increased emphasis improving level evidence basis clinical treatment decisions journals require statement level evidence basic gauge study strength purpose review levels evidence published articles clinical sports medicine literature determine improvement levels evidence published years study design systematic review methods articles years american journal sports medicine ajsm arthroscopy sports medicine related articles journal bone joint surgery american jbjs analyzed articles categorized type ranked level evidence guidelines centre evidence based medicine excluded animal cadaveric basic science articles editorials surveys special topics letters editor correspondence statistical analysis performed chi square results total articles periods met inclusion criteria percentage level studies increased level studies decreased jbjs significant increase level studies ajsm arthroscopy showed significant change time diagnostic therapeutic prognostic studies showed significant increases level studies time conclusion statistically significant increase percentage level studies published sports medicine literature years jbjs ajsm largest increase diagnostic studies therapeutic prognostic studies demonstrated modest improvement emphasis increasing levels evidence guide treatment decisions sports medicine patients effect scientific medicine+good news+fun
4 article Konrad et al Increased range of motion after static stretching is not due to changes in muscle and tendon structures Clin Biomech (Bristol, Avon) Another data point in the plasticity vs. tolerance debate: “The increased range of motion could not be explained by the structural changes in the muscle-tendon unit, and was likely due to increased stretch tolerance possibly due to adaptations of nociceptive nerve endings.” 2014 background static stretching means increasing range motion information literature mechanical adaptation muscle tendon unit scarce purpose study investigate influence week static stretching training program structural functional parameters human gastrocnemius medialis muscle achilles tendon methods total volunteers randomly assigned static stretching control groups stretching intervention determined maximum dorsiflexion range motion fascicle length pennation angle passive resistive torque maximum voluntary contraction measured dynamometer muscle tendon junction displacement allowed determine length tendon muscle calculate stiffness fascicle length pennation angle muscle tendon junction displacement measured ultrasound findings range motion increased significantly intervention group functional passive resistive torque maximum voluntary contraction structural fascicle length pennation angle muscle stiffness tendon stiffness parameters unaltered interpretation increased range motion explained structural muscle tendon unit due increased stretch tolerance possibly due adaptations nociceptive nerve endings stretch+exercise+self-treatment+treatment+muscle
article Hamid et al Platelet-Rich Plasma Injections for the Treatment of Hamstring Injuries American Journal of Sports Medicine 2014 background hamstring injury common types injury affecting athletes optimal management hamstring muscle injuries defined effect autologous platelet rich plasma prp therapy recovery hamstring injuries unclear purpose investigate effect single prp injection treatment grade hamstring muscle injuries study design randomized controlled trial level evidence methods twenty patients diagnosed acute hamstring injury randomly allocated autologous prp therapy combined rehabilitation program rehabilitation program primary outcome study time return play addition pain severity pain interference scores time examined results patients prp group achieved full recovery significantly earlier controls time return play ± days control group ± days prp group significantly pain severity scores observed prp group study significant difference pain interference score groups conclusion single autologous prp injection combined rehabilitation program significantly effective treating hamstring injuries rehabilitation program injections+strain+medicine+treatment+injury+pain problems+muscle
article Vos et al Strong evidence against platelet-rich plasma injections for chronic lateral epicondylar tendinopathy British Journal of Sports Medicine 2014 background chronic lateral epicondylar tendinopathy frequent athletes platelet rich plasma prp increasingly treatment objective systematically review literature efficacy prp injections chronic lateral epicondylar tendinopathy methods databases pubmed embase cinahl medline ovidsp scopus google scholar web science cochrane library searched october inclusion criteria clinical diagnosis chronic lateral epicondylar tendinopathy randomised controlled trial intervention prp injection outcome measures terms pain function author screened search results authors independently assessed study quality physiotherapy evidence database pedro score study considered high quality pedro score evidence synthesis identify level evidence results studies included considered high quality high quality studies quality studies showed significant benefit final follow measurement predefined primary outcome score compared control group high quality study showed beneficial effect prp injection compared corticosteroid injection corticosteroid injections harmful tendinopathy based evidence synthesis strong evidence prp injections efficacious chronic lateral epicondylar tendinopathy conclusions strong evidence prp injections efficacious management chronic lateral elbow tendinopathy injections+tendinosis+medicine+treatment+pain problems+overuse injury+injury
3 article Johnson Transcutaneous electrical nerve stimulation Nurs Stand 2014 effectiveness transcutaneous electrical nerve stimulation tens pain relief challenged article evaluates systematic review findings demonstrates studies tens technique dosage demonstrate clinical efficacy reasonable continue tens pain management intervention chronic pain+TENS+pain problems+devices+treatment
4 article Gage et al Benzodiazepine use and risk of Alzheimer's disease British Medical Journal 2014 objectives investigate relation risk alzheimer disease exposure benzodiazepines started years dose response relation prodromes anxiety depression insomnia possibly linked treatment design case control study setting quebec health insurance program database ramq participants people diagnosis alzheimer disease years matched controls sex age group duration follow groups randomly sampled older people age living community main outcome measure association alzheimer disease benzodiazepine started years diagnosis assessed multivariable conditional logistic regression exposure benzodiazepines considered categorised cumulative dose expressed prescribed daily doses drug elimination life results benzodiazepine increased risk alzheimer disease adjusted odds ratio confidence interval adjustment anxiety depression insomnia markedly alter result association cumulative dose prescribed daily doses drug life short acting drugs long acting conclusion benzodiazepine increased risk alzheimer disease stronger association observed long term exposures reinforces suspicion direct association benzodiazepine early marker condition increased risk dementia unwarranted long term drugs considered public health concern random+aging
2 article Li et al Massage therapy for fibromyalgia PLoS ONE This is a review of massage therapy for fibromyalgia that epitomizes the “garbage in, garbage out” problem with meta-analysis: there was virtually no research on this topic worth analyzing to begin with, and trying to pool the results of several weak studies is meaningless. To the extent that the study results are generally inconclusive and ambiguous, the conclusions of any review are going to have more to do with the authors’ opinions and biases than hard data. In this case, they report “significant” positive results without mentioning that they only mean “statistically significant,” and the effect size is barely-there — clinically insignificant. They also boast about traditional Chinese massage in the abstract, which is odd. And they fail to note that a much of the data did not even measure the effect on pain, just mood. So here’s my conclusion: whoopty-do. There’s really nothing here, except maybe massage for fibromyalgia being damned by faint, ambiguous praise. I’ve written several more paragraphs about this paper in Does Massage Therapy Work? 2014 background studies evaluated effectiveness massage therapy fibromyalgia fm role massage therapy management fm remained controversial objective purpose systematic review evaluate evidence massage therapy patients fm methods electronic databases june searched identify relevant studies main outcome measures pain anxiety depression sleep disturbance reviewers independently abstracted data appraised risk bias risk bias eligible studies assessed based cochrane tools standardised difference smd confidence intervals ci calculated conservative random effects model heterogeneity assessed based statistic results randomized controlled trials involving patients met inclusion criteria meta analyses showed massage therapy duration weeks significantly improved pain smd ci     anxiety smd ci     depression smd ci     patients fm sleep disturbance smd ci     conclusion massage therapy duration weeks beneficial effects improving pain anxiety depression patients fm massage therapy viable complementary alternative treatments fm eligible studies subgroup meta analyses evidence follow effects large scale randomized controlled trials long follow warrant confirm current findings treatment+massage+chronic pain+muscle pain+manual therapy+pain problems+muscle
3 article Vance et al Using TENS for pain control Pain Manag 2014 transcutaneous electrical nerve stimulation tens nonpharmacological intervention activates complex neuronal network reduce pain activating descending inhibitory systems central nervous system reduce hyperalgesia evidence tens efficacy conflicting requires description critique population specific systemic reviews meta analyses emerging indicating hf lf tens shown provide analgesia specifically applied strong nonpainful intensity purpose article provide critical review latest basic science clinical evidence tens additional research determine tens effects specific mechanical stimuli reduction pain improve activity levels function quality life chronic pain+TENS+pain problems+devices+treatment
article Sandrey Autologous growth factor injections in chronic tendinopathy Journal of Athletic Training 2014 clinical question authors systematic review evaluated literature critically effects growth factors delivered autologous blood platelet rich plasma prp injections managing wrist flexor extensor tendinopathies plantar fasciopathy patellar tendinopathy primary question published literature sufficient evidence support growth factors delivered autologous blood prp injections chronic tendinopathy data sources authors performed comprehensive systematic literature search october pubmed medline embase cinahl cochrane library time limits key words combinations tendinopathy tendinosis tendinitis tendons tennis elbow plantar fasciitis platelet rich plasma platelet transfusion autologous blood injection search limited human studies english bibliographies initial literature search viewed identify additional relevant studies study selection studies eligible based criteria articles suitable inclusion criteria participants clinically diagnosed chronic tendinopathy design prospective clinical study randomized controlled trial nonrandomized clinical trial prospective case series intervention form growth factor injection prp autologous blood outcome reported terms pain function data extraction titles abstracts assessed researchers relevant articles obtained researchers independently read full text article determine met inclusion criteria opinions differed suitability reviewer consulted reach consensus data extracted included number participants study design inclusion criteria intervention control group primary outcome measures pain visual analog ordinal scale function time follow outcomes intervention control group percentage improvement standardized data extraction form function evaluated studies nirschl scale elbow function modified mayo score wrist flexors extensors victorian institute sports assessment patella score validated outcome measure patellar tendinopathy tegner score patellar tendinopathy rearfoot score american orthopaedic foot ankle scale plantar fasciopathy physiotherapy evidence database pedro scale items items receive point response reliability sufficient pedro scale assess physiotherapy trials score higher pedro scale considered high quality study considered quality study pedro score results determined quality randomized controlled trial rct nonrandomized clinical trial prospective case series injections+tendinosis+plantar fasciitis+medicine+treatment+pain problems+overuse injury+injury+foot+leg+limbs
3 article Balcarek et al Vastus medialis obliquus muscle morphology in primary and recurrent lateral patellar instability Biomed Res Int 2014 morphology vastus medialis obliquus vmo muscle anatomical setting unstable patella purpose study investigate morphological parameters vmo muscle delineate importance maintenance patellofemoral joint stability consecutive subjects prospectively enrolled study groups composed patients acute primary patellar dislocation patients recurrent patellar dislocation twenty controls groups adjusted sex age body mass index physical activity magnetic resonance imaging measure vmo cross sectional area muscle fiber angulation craniocaudal extent muscle relation patella significant difference respect measured vmo parameters primary dislocation recurrent dislocation control subjects trend noted vmo cross sectional area vmo muscle fiber angulation finding notable atrophy vmo suggested play important role pathophysiology unstable patellofemoral joint patellar pain+anatomy+arthritis+aging+pain problems+knee+leg+limbs+overuse injury+injury+running+exercise+self-treatment+treatment
3 article Reurink et al Myotoxicity of injections for acute muscle injuries Sports Medicine Injecting medications into muscles might not be harmless. (No one’s surprised by that, right? Good.) This data shows that anaesthetics and NSAIDs are myotoxic, and there’s “conflicting evidence” about PRP (which is generally still understudied). Corticosteroids get an all clear … unless you use it with anaesthetics, which isn’t uncommon. 2014 background injection therapies widely muscle injuries limited evidence efficacy physicians aware potential harmful effects injected preparations objectives purpose review systematically review literature myotoxic effects intramuscular injection preparations commonly acute muscle injuries data sources databases pubmed embase web science cochrane library cinahl sportdiscus searched march study eligibility criteria studies reporting histological evaluation creatine kinase activity intramuscular injection local anaesthetics corticosteroids steroidal anti inflammatory drugs nsaids platelet rich plasma prp traumeel ® actovegin ® combination preparations eligible inclusion data analysis authors independently screened search results assessed risk bias evidence synthesis identify level evidence results forty studies included systematic review strong moderate evidence intramuscularly injected local anaesthetics nsaids myotoxic conflicting evidence myotoxicity prp limited evidence single corticosteroid injections myotoxic synergistic myotoxic effect local anaesthetics information assess actovegin ® traumeel ® myotoxic conclusion local anaesthetics nsaid injections recommended treatment muscle injuries athletes myotoxic myotoxic effects corticosteroids prp traumeel ® actovegin ® assessed future research injections+strain+harms+medicine+treatment+injury+pain problems+muscle
article Hamid et al Platelet-rich plasma (PRP) for acute muscle injury PLoS ONE 2014 introduction acute muscle injury commonest injuries result loss training competition time management muscle injury identified sports medicine practitioners approaches attempt accelerate time recovery muscle injury growing interest focussed autologous blood product injection methods literature search conducted systematically ovidmedline pubmed embase sportdiscus cinahl databases retrieve articles published december controlled trials controlled laboratory studies comparing strategies promote early recovery muscle injury included methodological quality studies assessed results limited studies effects prp therapy muscle injury vivo laboratory studies pilot human study reviewed laboratory studies reported histological evidence significant acceleration muscle healing animals treated autologous conditioned serum acs platelet rich plasma prp platelet rich fibrin matrix prfm pilot human study athletes treated repeated acs injection recovers significantly faster retrospective controls conclusion vivo laboratory studies suggest beneficial effects acs prp prfm accelerating muscle recovery evidence suggest similar effects humans limited valuable information robust human controlled trials moment studies satisfactory methodological quality platelet rich plasma interventions muscle injury justified injections+strain+medicine+treatment+injury+pain problems+muscle
article Tietze et al The effects of platelet-rich plasma in the treatment of large-joint osteoarthritis Phys Sportsmed 2014 context osteoarthritis oa common costly condition operative nonoperative treatments platelet rich plasma prp emerging treatment option variety musculoskeletal pathologies including oa objective evaluate effectiveness intra articular prp injection treatment large joint oa data sources pubmed web knowledge scopus cochrane database searched references articles met inclusion criteria manually searched additional articles study selection english studies enrolled human participants included level evidence iv results thirteen articles met inclusion criteria focused knee oa hip oa studies showed statistically significant improvement patient outcome scores prp platelet rich plasma statistically significant benefit knee oa compared hyaluronic acid benefit prp appears months conclusion platelet rich plasma effective treatment knee oa level evidence small sample sizes wide variability treatment definitive recommendations time injections+medicine+treatment
article Shetty et al A study to compare the efficacy of corticosteroid therapy with platelet-rich plasma therapy in recalcitrant plantar fasciitis Foot Ankle Surg 2014 background plantar fasciitis commonest frustrating foot ailments regular orthopaedic clinic number modalities treat condition corticosteroid injection popular years increased interest platelet rich plasma prp injections clinical situations plantar fasciitis methods undertook prospective randomized study compare efficacy traditional corticosteroid injection steroid group prp injection prp group cohort patients results studied groups patients injections visual analogue score vas foot amp ankle disability index fadi american foot ankle score afas study confirms significant clinical improvement prp group months injection conclusion prp injection attractive alternative treatment disabling recalcitrant plantar fasciitis study design cohort study level clinical evidence level injections+tendinosis+plantar fasciitis+medicine+treatment+pain problems+overuse injury+injury+foot+leg+limbs
4 article Freedman et al Re-evaluating the functional implications of the Q-angle and its relationship to in-vivo patellofemoral kinematics Clin Biomech (Bristol, Avon) Does the Q-angle actually provide a measure of how the quadriceps is pulling on the kneecap? And can adding different angles or levels of quadriceps contraction improve the tests reliability? No, and No. Not according to this study, which compared several measures of Q-angle with magnetic resonance imaging and their relationship with kneecap movement (patellofemoral kinematics). Their findings? “Q-angle did not represent the line of action of the quadriceps.” There were up to 8° differences in angle between measurement techniques, which varied even more across subjects: -25.8° to 3.9°! That's quite the range considering a "painful knee" apparently has a 3° difference from a non-painful knee. What's more, adding quadriceps contraction or changing the knee flexion angle didn't improve the reliability — so the whole “you're doing it wrong” argument doesn't work here. Interestingly, there was a correlation between Q-angle and medial kneecap position in people with knee pain. Still, the authors conclude with: “Clinicians are cautioned against using the Q-angle to infer patellofemoral kinematics.” 2014 background angle widely clinically evaluate individuals anterior knee pain studies questioned utility measure suggested large angle lateral patellofemoral translation assumed objective study determine accurately angle represents line action quadriceps adding active quadriceps contraction bent knee position measurement angle improves reliability accuracy association patellofemoral kinematics methods study included individuals diagnosed chronic idiopathic patellofemoral pain control subjects knees measures clinical angle straight bent knee relaxed quadriceps straight knee maximum isometric quadriceps contraction obtained goniometer compared fourth based measure angle patellofemoral kinematics derived dynamic cine phase contrast images acquired subjects extended flexed knee approximately ° ° findings angle represent line action quadriceps average difference clinical based angle ranged ° ° differences varied greatly subjects range ° ° adding active quadriceps contraction bent knee position improve reliability angle increased angle correlated medial patellar displacement tilt patellar pain+etiology+biomechanics+arthritis+aging+pain problems+knee+leg+limbs+overuse injury+injury+running+exercise+self-treatment+treatment+pro
article Kumar et al The treatment of intractable plantar fasciitis with platelet-rich plasma injection Foot (Edinb) 2013 background cases plantar fasciitis settled existing conservative treatment intractable cases difficult resolve biologic treatments proposed variety soft tissue problems objective evaluate effectiveness platelet rich plasma prp chronic cases plantar fasciitis patients methods patients plantar fasciitis responded minimum year standard conservative management offered prp therapy injections performed theatre day case roles maudsley rm scores visual analogue scores vas aofas scores injection collated pre operatively months results prospective data collected heels patients month review rm score improved injections+tendinosis+plantar fasciitis+medicine+treatment+pain problems+overuse injury+injury+foot+leg+limbs
4 article Nunes et al Clinical test for diagnosis of patellofemoral pain syndrome Physical Therapy in Sport 2013 high incidence diversity factors attributed etiology patellofemoral pain syndrome pfps diagnosis problem complex susceptible misinterpretation defined set procedures considered ideal diagnose pfps investigate diagnostic accuracy clinical functional tests diagnose pfps systematic review searched relevant studies databases medline cinahl sportdiscus embase quadas score assess methodological quality eligible studies analyzed data diagnostic properties tests sensibility specificity positive lr+ negative lr likelihood ratio predictive values search identified potential studies studies met eligibility criteria studies analyzed tests intending accurately diagnose pfps tests analyzed studies perform meta analysis studies included study high methodological quality studies good methodological quality studies methodological quality tests patellar tilt lr+    lr     squatting lr+    lr     values show trend diagnosis pfps lr+ lr lr patellar pain+diagnosis+etiology+arthritis+aging+pain problems+knee+leg+limbs+overuse injury+injury+running+exercise+self-treatment+treatment+pro
3 article Isner-Horobeti et al Intramuscular pressure before and after botulinum toxin in chronic exertional compartment syndrome of the leg American Journal of Sports Medicine A promising preliminary test of an unusual treatment for extertional compartment syndrome: reducing pressure in the compartment by paralyzing the muscle with Botulinum toxin. 2013 background botulinum toxin bont treatment muscle hypertrophy chronic exertional compartment syndrome cecs objective diagnostic criterion condition abnormally elevated intramuscular pressure imp compartment study imp measured minute p minutes p exercise stopped bont injection hypothesis botulinum toxin reduces imp p p eliminates pain cecs study design case series level evidence methods botulinum toxin injected muscles moderately trained patients anterior anterolateral exertional compartment syndrome leg bont dose ± sd ranged ± ± muscle depending muscles compartments injected primary point imp p p secondary points exertional pain muscle strength safety follow conducted months results total anterior compartments lateral compartments injected patients time interval ± sd bont injection bont injection imp measurement ± months range months anterior compartment p p fell ± ± lateral compartment p p fell ± ± exertional pain muscle strength monitored based medical research council score exertional pain completely eliminated patients patients strength injected muscles remained normal patients strength decreased functional consequences conditions study bont showed good safety profile patients cecs conclusion case series bont reduced imp eliminated exertional pain anterior anterolateral cecs leg months intervention mode action bont unclear randomized controlled study carried determine bont medical alternative surgical treatment treatment+odd+shin pain+good news+leg+limbs+pain problems+overuse injury+injury+running+exercise+self-treatment
4 article Giles et al Does quadriceps atrophy exist in individuals with patellofemoral pain? Journal of Orthopaedic & Sports Physical Therapy This review complied data from 10 studies to find that quadriceps muscle atrophy is indeed present in people with patellofemoral pain syndrome (PFPS). This atrophy was only really visible with imaging technology (like MRIs), not by simply measuring the girth of the thigh with measuring tape. Interestingly, there was no significant difference between the vastus medialis obliquus (VMO) and the vastus lateralis (VL)! So while this supports the use of quadriceps strengthening for rehabilitation of PFPS, it does not support the special status of the VMO when treating PFPS. 2013 study design systematic literature review objectives investigate quadriceps atrophy present affected limb individuals patellofemoral pain pfp background pfp common condition atrophy quadriceps femoris vastus medialis obliquus assumed present clinicians resolution underpin reported effectiveness quadriceps strengthening intervention pfp rehabilitation methods systematic search literature conducted identify studies measured size quadriceps individuals pfp meta analyses performed determine quadriceps size limbs pfp differed comparison limbs separate meta analyses performed quadriceps size measured girth quadriceps size measured imaging thickness cross sectional area volume results ten studies included review meta analysis girth measurements studies atrophy limbs pfp meta analyses imaging techniques thickness cross sectional area volume measurements showed atrophy limb pfp compared asymptomatic limb studies limbs comparison group studies single study compared vastus medialis obliquus vastus lateralis individuals pfp atrophy vastus medialis obliquus vastus lateralis significant difference amount atrophy conclusion quadriceps muscle atrophy shown present pfp analyzed imaging girth measures insufficient data determine greater atrophy vastus medialis obliquus vastus lateralis findings support rationale quadriceps strengthening part rehabilitation program pfp patellar pain+etiology+arthritis+aging+pain problems+knee+leg+limbs+overuse injury+injury+running+exercise+self-treatment+treatment+pro
3 article Kakiashvili et al The medical perspective on burnout Int J Occup Med Environ Health 2013 objective aim study review medical findings related burnout diagnosis treatment characteristic pathophysiological features preventive measures materials methods systematic review scientific literature pubmed medline performed important findings reported results burnout risk factor myocardial infarction coronary heart disease related reduced fibrinolytic capacity decreased capacity cope stress hypothalamic pituitary adrenal hpa axis hypoactivity severe burnout symptoms level smaller increase cortisol awakening response car higher dehydroepiandrosterone sulphate dheas levels cortisol dheas ratios stronger suppression measured dexamethasone suppression test dst literature works suggest evaluation hpa axis brought attention primary care physicians universal agreement specific treatment diagnostic measures evaluate wide range hpa axis disorders cost effective evaluation adrenal hormones saliva samples primary care physician significantly alter therapy numerous chronic disease patients psychiatric disorders similar symptoms distinctive hormonal profiles burnout recognized medical condition differentiating burnout similar clinical syndromes depression anxiety provide treatment burnout patients proper treatment essential fast full recovery conclusion chronic stress related disorders fall category true disease treated depression treated evaluation adrenal hormones saliva samples helps predict burnout burnout screening techniques dietary nutritional guidelines lifestyle supporting hpa function developed presented material includes hormonal dietary pharmaceutical perspectives random+mind
book Long Chiropractic fraud and abuse American Council on Science & Health SBM’s review by Dr. Hall calls A Chiropractor’s Lament a “valuable addition to the literature on chiropractic, combining Long’s personal story with everything you never wanted to know about chiropractic. It’s fun to read and packed with information. Even if you think you’ve heard it all before, there are revelations here that will be new to you, that will elicit surprise, indignation, and laughter.” 2013 chiropractic+controversy+manual therapy+treatment+debunkery+spine
4 article Bertozzi et al Effect of therapeutic exercise on pain and disability in the management of chronic nonspecific neck pain Physical Therapy 2013 background prevalence chronic nonspecific neck pain cnsnp internationally attention increasingly paid years evaluating efficacy therapeutic exercise te management condition purpose purpose study conduct current review randomized controlled trials effect te pain disability people cnsnp perform meta analysis summarize current understanding data sources data obtained medline cumulative index nursing allied health literature cinahl embase physiotherapy evidence database pedro cochrane central register controlled trials central databases inception august reference lists relevant literature reviews tracked study selection published randomized trials restriction time publication language considered inclusion study participants symptomatic adults cnsnp data extraction reviewers independently selected studies conducted quality assessment extracted results data pooled meta analysis random effects model data synthesis studies met inclusion criteria therapeutic exercise proved medium significant short term intermediate term effects pain confidence interval ci ci medium significant short term intermediate term effects disability ci ci limitations study investigated effect te pain disability follow longer months intervention conclusions consistent reviews results support te management cnsnp significant effect size supporting te effect pain short intermediate terms self-treatment+strength+exercise+neck+stretch+treatment+head/neck+spine+muscle
4 article Ismail et al Closed kinetic chain exercises with or without additional hip strengthening exercises in management of patellofemoral pain syndrome Eur J Phys Rehabil Med This study compared exercise programs for patellofemoral pain syndrome with and without additional hip strengthening. Improvements in function were similar for both groups, but those who did additional hip strengthening got some more pain relief for their trouble. 2013 background patellofemoral pain syndrome pfps common musculoskeletal pain condition females decreased hip muscle strength implicated contributing factor isolated open kinetic chain hip abductors lateral rotators exercises added authors rehabilitation program closed kinetic chain ckc exercises focusing hip knee muscles investigated produce similar effect hip strengthening decreasing pain isolated exercises hip musculature aim aim present study determine effect ckc exercises program additional hip strengthening exercises pain hip abductors lateral rotators peak torque design prospective randomized clinical trial setting patients patellofemoral pain syndrome referred outpatient physical therapy clinic faculty physical therapy cairo university population patients patellofemoral pain syndrome age ranged eighteen years methods patients randomly assigned groups ckc group ckc hip muscles strengthening exercises control group treatment times week weeks patients evaluated pre post treatment pain severity vas function knee joint kujala questionnaire hip abductors external rotators concentric eccentric peak torque results significant improvements pain function hip muscles peak torque groups patellar pain+exercise+treatment+arthritis+aging+pain problems+knee+leg+limbs+overuse injury+injury+running+self-treatment
4 article Boling et al Relationship between hip strength and trunk, hip, and knee kinematics during a jump-landing task in individuals with patellofemoral pain International Journal of Sports Physical Therapy This study aimed to investigate the possible relationship between hip muscle strength and various lower limb and trunk mechanics during a jump landing task in people with patellofemoral pain syndrome. The results did show that as hip strength decreased, hip and trunk motion increased during the landings — more less strength led to wonkier landings. Interesting, but the study didn't compare these people to others without knee pain. It's possible that weaker hips lead to more wobbly landings in anyone — not just people with knee pain! 2013 background purpose decreased strength hip musculature altered mechanics extremity identified individuals patellofemoral pain pfp aim study determine relationship exists hip muscle strength transverse frontal plane motion hip knee ipsilateral trunk flexion jump landing task individuals pfp methods fifteen individuals females males pfp participated investigation dimensional motion analysis system utilized assess trunk hip knee kinematics jump landing task isokinetic dynamometer utilized assess concentric eccentric strength hip musculature simple correlation analyses performed determine relationships hip muscle strength peak frontal transverse plane hip knee kinematics ipsilateral trunk flexion results decreased eccentric strength hip external rotators abductors significantly correlated increased frontal plane motion hip trunk patellar pain+biomechanics+arthritis+aging+pain problems+knee+leg+limbs+overuse injury+injury+running+exercise+self-treatment+treatment+etiology+pro
3 article Leaver et al People seeking treatment for a new episode of neck pain typically have rapid improvement in symptoms J Physiother This good-and-bad-news study showed that about half of 180 patients who sought treatment for a new case of neck pain “recovered completely within three months” … and the other half didn’t. Which is actually quite a high number. The authors believe that “physiotherapists should reassure people with a new episode of neck pain that rapid improvement in symptoms is common, modifying this advice where applicable based on risk factors.” 2013 question clinical episode specific neck pain people treated multimodal physical therapies primary care setting design observational study month follow run conjunction randomised trial participants adults consulted physiotherapist chiropractor episode nonspecific neck pain outcome measures time recover episode neck pain time recover normal activity pain neck related disability months clinical demographic characteristics investigated potential predictors recovery results months participants reported complete recovery episode neck pain scale worst pain improved sd baseline sd weeks sd months scale worst disability improved sd baseline sd months faster recovery independently rated general health shorter duration symptoms smoker absence concomitant upper pain headache higher disability months independently higher disability baseline concomitant upper pain older age previous sick leave neck pain conclusion people seek physical treatments episode neck pain primary care setting typically high pain scores improve rapidly commencing treatment seek treatment recover completely months residual pain disability group physiotherapists reassure people episode neck pain rapid improvement symptoms common modifying advice applicable based risk factors neck+stats+good news+bad news+head/neck+spine+scientific medicine
book Goldacre Bad pharma Faber and Faber British science journalist Ben Goldacre is fascinating and awesome. Read this book, or at least watch this TED talk about it. [munches popcorn] 2013 medications+bad science+self-treatment+treatment+scientific medicine
2 article Stefanov et al The primo vascular system as a new anatomical system J Acupunct Meridian Stud New to me. Smells like fringe science. My first impression is that no one writing about it seems to be credible. Lots of touting it as a major discovery, plenty of claims and hand waving, many leaps of logic about the clinical implications. Everybody just goes straight to “and therefore acupuncture works”! (Which is particularly problematic because we already know acupuncture doesn’t actually beat placebo.) All of this seems to be based on what appears to be a single study of rats…with a process so complicated that it contains a thousand opportunities for self-deception on the part of the researchers. And researchers have agendas. So…needs replication it ain’t going to get. I can easily believe there are still undiscovered marvels and subtleties in biology. But I don’t believe they’ll be found by researchers on a fishing expedition for an explanation for how acupuncture works — because it doesn’t. 2013 traditional eastern medicine successful existence long time functional paths curing disease scientists accept acupuncture primarily meridian system lacks physical anatomical basis date scientific theories explain functional paths traditional eastern medicine cure disease western medicine anatomical foundation exists meridians unknown nervous circulatory endocrine immune mechanisms mediate effects acupuncture early s hypothesis proposed explain anatomical basis meridians experimental approaches years number scientific papers report discovery anatomical physiological evidence confirming existence anatomical basis meridian system increased morphological science greatly challenged offer biomedical theory explains existence bodily systems primo vascular system pvs pvs previously unknown system integrates features cardiovascular nervous immune hormonal systems physical substrate acupuncture points meridians announcements morphological architectonics function pvs fundamentally changed basic understanding biology medicine pvs involved development functions living organisms propose vision anatomical basis pvs vital energy called qi electromagnetic wave involved closely dna pvs dna genetic information functions store information obtained electromagnetic fields environment pvs communication system living organisms environment lies lowest level life theory pvs good basis forming point view darwin evolutionary theory discoveries morphological theory discoveries respect pvs th century reason pvs attention acupuncture+mind+controversy+debunkery+energy work
3 article Posadzki et al The safety of massage therapy Focus on Alternative and Complementary Therapies 2013 objective update systematic review evaluating safety massage therapy methods literature search carried electronic databases period december articles reporting adverse effects massage therapy retrieved adverse effects relating atypical massage aromatherapeutic massage oil ice excluded language restrictions applied data extracted evaluated predefined criteria results seventeen case reports case series published previous review reported adverse effects comprised acute paraplegia abdominal distension bladder rupture bilateral cerebellar infarction cervical lymphocele cervical cord injury cervical internal carotid vertebral dissection chylothorax haematuria interosseous nerve palsy myopathy perinephric haemorrhage rhabdomyolysis severe headache blurred vision paraesthesia focal motor seizures majority reports effect relationship adverse effects commonly massage techniques applied neck area conclusion evidence suggests massage occasionally lead moderately severe adverse effects massage+harms+manual therapy+treatment+pain problems
article Gawaz et al Platelets in tissue repair Blood 2013 mediating primary hemostasis thrombosis platelets play critical role tissue repair regeneration regulate fundamental mechanisms involved healing process including cellular migration proliferation angiogenesis control apoptosis cell survival interaction progenitor cells clinically relevant poorly understood aspects platelets tissue repair highlighted review gaining deeper insight characterized molecular mechanisms develop therapeutic platelet based options injections+medicine+treatment
article Hashmi et al Shape shifting pain Brain 2013 chronic pain conditions abnormalities brain structure function studies brain activity related subjective perception chronic pain distinct activity acute pain based observations cross sectional studies brain activity reorganizes transition acute chronic pain remained unexplored study transition examining brain activity rating fluctuations pain magnitude compared pain related brain activity subjects condition ∼ months prior history pain year early acute subacute pain group subjects lived pain years chronic pain group subset subacute pain patients brain activity pain longitudinally year period compared brain activity recover recovered acute acute pain group pain persists persistent acute acute pain group based decrease intensity pain year report results relation meta analytic probabilistic maps related terms pain emotion reward map based brain imaging studies derived neurosynth org observed brain activity pain early acute subacute pain group limited regions involved acute pain chronic pain group activity confined emotion related circuitry reward circuitry equally represented groups recovered acute subacute pain group brain activity diminished time persistent acute subacute pain group activity diminished acute pain regions increased emotion related circuitry remained unchanged reward circuitry results demonstrate brain representation constant percept pain undergo large scale shifts brain activity transition chronic pain observations challenge long standing theoretical concepts brain mind relationships provide important insights definitions mechanisms chronic pain etiology+mind+chronic pain+back pain+pro+pain problems+spine
article Mautner et al Outcomes after ultrasound-guided platelet-rich plasma injections for chronic tendinopathy PM & R: The Journal of Injury, Function, and Rehabilitation 2013 objective determine ultrasound guided platelet rich plasma prp injections effective treatment chronic tendinopathies design retrospective cross sectional survey setting academic sports medicine centers united states patients total men women ages years received ultrasound guided prp injections tendinopathy refractory conventional treatments interventions survey satisfaction functional outcome main outcome measurements perceived improvement symptoms months treatment perceived change visual analog scale score assessment functional pain satisfaction results average patients years symptoms median months treatment answered survey average months treatment patients moderate complete improvement symptoms common injection sites lateral epicondyle achilles patellar tendons sites treated included rotator cuff hamstring gluteus medius medial epicondyle patients received injection received injections received injections patients perceived decrease visual analog scale score ± ± sd confidence interval addition follow patients reported pain rest disrupted activities daily living reported pain activities total patients satisfied procedure conclusions retrospective study evaluated administration prp chronic tendinopathy majority patients reported moderate improvement pain symptoms injections+tendinosis+medicine+treatment+pain problems+overuse injury+injury
3 article Sihvonen et al Arthroscopic partial meniscectomy versus sham surgery for a degenerative meniscal tear New England Journal of Medicine 2013 background arthroscopic partial meniscectomy common orthopedic procedures rigorous evidence efficacy lacking methods conducted multicenter randomized double blind sham controlled trial patients years age knee symptoms consistent degenerative medial meniscus tear knee osteoarthritis patients randomly assigned arthroscopic partial meniscectomy sham surgery primary outcomes lysholm western ontario meniscal evaluation tool womet scores ranging scores indicating severe symptoms knee pain exercise rated scale denoting pain months procedure results intention treat analysis significant group differences change baseline months primary outcome improvements primary outcome measures lysholm score points partial meniscectomy group compared points sham surgery group group difference points confidence interval ci womet score points group difference points ci score knee pain exercise points group difference ci significant differences groups number patients required subsequent knee surgery partial meniscectomy group sham surgery group adverse events conclusions trial involving patients knee osteoarthritis symptoms degenerative medial meniscus tear outcomes arthroscopic partial meniscectomy sham surgical procedure funded sigrid juselius foundation clinicaltrials gov number nct knee+surgery+mind+leg+limbs+pain problems+treatment
2 webpage Sanvito If We Cannot Stretch Fascia, What Are We Doing? Massage therapist Alice Sanvito’s clear summary of Dr. Robert Schleip’s theory that fascial “release” may be attributable to changes in muscle tone stimulated by mechanoreceptors in fascia and other soft tissues, and not by plastic deformation of fascia. 2013 debunkery+fascia+controversy+etiology+pro+massage+manual therapy+treatment
3 webpage Wolfe Travell, Simons and Cargo Cult Science An informal survey of the poor state of trigger point science from an articulate expert, Fred Wolfe, a rheumatologist. Dr. Wolfe gives his first-hand account of the first trigger point diagnosis reliability study in 1992 (see Wolfe), and he tells the story of meeting Dr. Janet Travell and observing her unscientific conduct with a patient. 2013 muscle pain+trigger points doubts+manual therapy+chronic pain+scientific medicine+etiology+muscle+pain problems+treatment+pro
3 article Sluka et al Regular physical activity prevents development of chronic pain and activation of central neurons Journal of Applied Physiology This elaborate test of mice showed that they were less sensitive to certain kinds of pain if they had gotten more exercise. Specifically, regular exercise protected them from pain caused by exercise (no surprise there), but also — a little more interesting — pain caused by injecting carageenan (which causes inflammation). So exercise probably protects mice from the pain of carageenan injections — does that mean it will protect humans from other kinds of pain? We can’t quite go that far based on the this research. Nevertheless, it’s suggestive, and I’m inclined to agree with the authors: “physical inactivity is a risk factor for development of chronic pain and may set the nervous system to respond in an exaggerated way to low-intensity muscle insults.” 2013 chronic musculoskeletal pain significant health problem increases pain acute physical activity regular physical activity protective chronic diseases unknown plays role development chronic pain current study induced physical activity placing running wheels home cages mice days wk compared sedentary mice running wheels home cages chronic muscle pain induced repeated intramuscular injection ph saline exercise enhanced pain induced combining fatiguing exercise task dose muscle inflammation carrageenan acute muscle inflammation induced carrageenan tested responses paw response frequency muscle withdrawal threshold nociceptive stimuli rostral ventromedial medulla rvm involved exercise induced analgesia chronic muscle pain tested phosphorylation nr subunit methyl aspartate nmda receptor rvm demonstrate regular physical activity prevents development chronic muscle pain exercise induced muscle pain reducing phosphorylation nr subunit nmda receptor central nervous system regular physical activity effect development acute pain physical inactivity risk factor development chronic pain set nervous system respond exaggerated intensity muscle insults treatment+sedentariness+exercise+good news+chronic pain+muscle pain+self-treatment+pain problems+muscle
3 article Couto et al Paraspinal Stimulation Combined With Trigger Point Needling and Needle Rotation for the Treatment of Myofascial Pain The Clinical Journal of Pain This study found “significantly” better results from dry needling of trigger points. (That’s a method of lancing painful spots in muscle with acupuncture needles. To make them feel better. No, really, that is the idea.) But that “significant” was the statistical sense of the word, meaning “real” not “large.” The abstract actually neglects to mention how much better the results were, which often means that the number wasn’t worth advertising. Sure enough, looking at the data, the decrease is just 2 points on a 10-point scale. That’s not nothing, but for someone who starts at a 6 or an 8, it’s not exactly a cure, is it? If it actually does work that “well” — assuming that these pro-IMS researchers (unconfirmed, but very likely) didn’t make any mistakes or do anything that might have skewed the data towards their bias a little — is a 2-point drop actually worth the high cost and discomfort of this treatment? An open question … 2013 background types parameters dry needling dn affect efficacy treatment pain assessed properly objective test hypothesis multiple deep intramuscular stimulation therapy mdimst trp lidocaine injection ltrp effective placebo sham treatment myofascial pain syndrome mps mdimst effective ltrp improving pain relief sleep quality physical mental state patient methods seventy females aged limited ability perform active routine activities due mps previous months recruited participants randomized groups placebo sham ltrp mdimst treatments weekly weeks standardized mdimst ltrp protocols results significant interaction time group main outcomes compared sham treated group mdimst ltrp administration improved pain scores based visual analog scale pain pressure threshold treatment+muscle pain+acupuncture+injections+muscle+pain problems+mind+controversy+debunkery+energy work+medicine
3 webpage Reynolds Is There an Ideal Running Form? This article is an excellent summary and discussion of the findings of Hatala et al. 2013 finding adds growing lack certainty ideal running form provocative wide ranging implication kenyan study natural human runners hunts activities conducted sedate pace closer daasanach ancestors heel strikers case wearing shoes striking heel necessarily represent warped running form running+foot+biomechanics+exercise+self-treatment+treatment+leg+limbs+pain problems+etiology+pro
3 webpage Hargrove Barefoot Running, Squatting Like a Baby, and Pygmy Feet An excellent short overview, with interesting video examples, of human biomechanical plasticity. We change! But it’s not easy, either. 2013 fun+barefoot+biomechanics+stretch+running+foot+leg+limbs+pain problems+exercise+self-treatment+treatment+etiology+pro+muscle
3 article Tseng et al Topical cooling (icing) delays recovery from eccentric exercise-induced muscle damage Journal of Strength & Conditioning Research Bad icing news: a small study of icing for severe muscle soreness with “unexpected” results, according to the researchers. It seemed to do more harm than good. The icing victims had higher blood levels of molecules associated with muscle injury, and they felt more fatigued. Icing had no effect on recovery of strength, or any biochemical sign of inflammation. A small study, to be sure, but how good can icing be if it can generate this kind of data? 2013 generally thought topical cooling interfere blood perfusion positive effects recovery traumatic challenge study examined influence topical cooling muscle damage markers hemodynamic recovery eccentric exercise eleven male subjects age ± years performed sets elbow extension maximum voluntary load randomly assigned topical cooling sham groups recovery randomized crossover fashion cold packs applied exercised muscle minutes hours exercise exercise significantly elevated circulating creatine kinase mb isoform ck mb myoglobin levels unexpectedly greater elevations circulating ck mb myoglobin control level noted cooling trial hours post exercise recovery period subjective fatigue feeling greater hours topical cooling compared controls removal cold pack led protracted rebound muscle hemoglobin concentration compared controls measures interleukin il il il β muscle strength recovery influenced cooling peak shift il p noted recovery topical cooling data suggest topical cooling commonly clinical intervention improve delay recovery eccentric exercise induced muscle damage treatment+counter-intuitive+ice heat+overuse injury+rehab+injury+pain problems+self-treatment
3 article Hosseinzadeh et al Pain sensitivity is normalized after a repeated bout of eccentric exercise European Journal of Applied Physiology 2013 purpose purpose study investigate effect repeated bouts eccentric exercise nociceptive withdrawal reflex nwr threshold measure sensitivity spinal nociceptive system methods sixteen healthy students age  ±   years bmi  ±   kg participated randomized controlled crossover study identical bouts high intensity eccentric exercises performed tibialis anterior muscle  days control sessions involving exercise performed  weeks exercise sessions pressure pain thresholds ppt nwr threshold recorded immediately  day bouts exercise results pressure pain thresholds decreased significantly muscle belly sites day initial bout compared baseline nwr threshold decreased  ±    immediately initial bout  ±    day   etiology+chronic pain+pro+pain problems
3 article Barzouhi et al Magnetic resonance imaging in follow-up assessment of sciatica New England Journal of Medicine Disc, schmisc: patients with back pain and sciatica recovered about equally well with or without disc herniations visible on MRI. Most people recovered (84%) well within a year … and there were actually 2% more good outcomes in the patients with disc herniations! This seems like a rather surprising result, but that is what the research has been showing for years. There is a chance the nearly identical stats are a fluke, but they’d have to be off by a lot to change the take-home message. Even a 20-point difference, ten times larger than this, would still show that a “slipped disc” confirmed by MRI isn’t nearly as worrisome as most people assume. 2013 background magnetic resonance imaging mri frequently performed follow patients lumbar disk herniation persistent symptoms sciatica association findings mri clinical outcome controversial methods studied patients randomized trial comparing surgery prolonged conservative care sciatica lumbar disk herniation patients underwent mri baseline year point scale assess disk herniation mri ranging present absent favorable clinical outcome defined complete complete disappearance symptoms year compared proportions patients favorable outcome definite absence disk herniation definite probable presence disk herniation year area receiver operating characteristic roc curve assess prognostic accuracy point scores favorable unfavorable outcome indicating perfect discriminatory indicating discriminatory results year patients reported favorable outcome disk herniation visible favorable outcome unfavorable outcome favorable outcome reported patients disk herniation disk herniation mri assessment disk herniation distinguish patients favorable outcome unfavorable outcome area roc curve conclusions mri performed year follow patients treated sciatica lumbar disk herniation distinguish favorable outcome unfavorable outcome etiology+diagnosis+biomechanics+back pain+pro+pain problems+spine
4 article Kumar et al The effectiveness of massage therapy for the treatment of nonspecific low back pain International Journal of General Medicine 2013 introduction decade growth utilization complementary alternative medicine therapies popular sought complementary alternative medicine therapies nonspecific pain massage massage perceived safe therapeutic modality significant risks side effects popularity continues ongoing debate effectiveness massage treating nonspecific pain rapidly evolving research evidence base access innovative means synthesizing evidence time reinvestigate issue methods systematic step step approach underpinned practice reviewing literature utilized part methodology umbrella review systematic search conducted databases embase medline amed iconda academic search premier australia zealand reference centre cinahl healthsource sportdiscus pubmed cochrane library scopus web knowledge web science psycinfo proquest nursing allied health source investigating systematic reviews meta analyses january december restricted english language documents methodological quality included reviews undertaken centre evidence based medicine critical appraisal tool results systematic reviews methodological quality systematic reviews varied poor excellent primary research informing systematic reviews generally considered weak quality findings massage effective treatment option compared placebo active treatment options relaxation short term conflicting contradictory findings effectiveness massage therapy treatment nonspecific pain compared manual therapies mobilization standard medical care acupuncture conclusion emerging body evidence albeit small supports effectiveness massage therapy treatment specific pain short term due common methodological flaws primary research informed systematic reviews recommendations arising evidence base interpreted caution treatment+massage+back pain+manual therapy+pain problems+spine
2 article Miyamoto et al Efficacy of the Addition of Modified Pilates Exercises to a Minimal Intervention in Patients With Chronic Low Back Pain Physical Therapy In this test of Pilates for back pain, patients who did Pilates had “small benefits” compared to those who did not, and six months later even those small benefits were gone. The test had a serious flaw: it neglected to compare Pilates to other any other kind of activity, shamefully sloppy design, fairly junky science. These results only add to the pile of evidence that exercise and therapeutic attention of any kind are probably good for low back pain. It’s only worth reporting these results insofar as they damn Pilates with the faintest possible praise — evidence that Pilates has no special power over back pain. 2013 background pilates method improve function reduce pain patients chronic nonspecific pain scientific evidence describes efficacy objective purpose study investigate effectiveness addition modified pilates exercises minimal intervention patients chronic pain design randomized controlled trial conducted setting study outpatient physical therapy department brazil patients patients chronic nonspecific pain participated study intervention participants received education booklet information pain randomly allocated receive sessions weeks exercises based pilates principles education measurements primary outcomes pain intensity disability measured weeks months secondary outcomes patient specific functional disability global impression recovery kinesiophobia measured weeks months outcomes measured blinded assessor time points results loss follow time points improvements observed pain difference points confidence interval ci disability difference points ci global impression recovery difference points ci favor pilates group intervention differences longer statistically significant months limitations treatment provider participants blinded interventions conclusions addition modified pilates exercises educational booklet small benefits compared education patients chronic nonspecific pain effects sustained time treatment+exercise+biomechanics+back pain+self-treatment+etiology+pro+pain problems+spine
3 article Pal et al Patellar maltracking is prevalent among patellofemoral pain subjects with patella alta Journal of Orthopaedic Research This study reports that people with patellofemoral (kneecap) pain tend to have higher kneecaps, and in turn those with high kneecaps are less likely to slide evenly on the knee. This contradicts my bias and I’m a bit skeptical. The researchers were probably biased in the other direction, and expected to find abnormalities correlating with pain. They title and abstract seem crafted to show that the study proves that tracking is a factor in patellofemoral pain, and yet I think the data shows exactly the opposite. Strangely, they didn’t measure all that many knees, just 52, and it’s easy to find what you expect in small batches of data. They don’t report just how much higher kneecaps were in the abstract, which would be natural to do if it were an impressive number, so I suspect it’s not an impressive number. Similarly, the prevalence of maltracking was allegedly a little higher in patients with pain (32% in vs. 27%), but the statistical significance of the difference was not reported — so it probably wasn’t significant. Furthermore, the presence of maltracking or patella alta in people with pain did not increase pain level. Even if the correlation is real, it doesn’t tell us anything about cause (maybe misbehaving kneecaps cause pain, or maybe knee pain causes kneecaps to misbehave). Almost half their subject had no abnormalities at all, which is consistent with other studies (Herrington et al) showing that you can find a roughly even mix of abnormalities in everyone, whether they have pain or not. 2013 purpose study determine patellar maltracking prevalent patellofemoral pf pain subjects patella alta compared subjects normal patella height imaged pf pain pain free subjects open configuration magnetic resonance imaging scanner stood weightbearing posture measured patella height caton deschamps blackburne peel insall salvati modified insall salvati patellotrochlear indices classified subjects patella alta normal patella height groups measured patella tilt bisect offset oblique axial plane images classified subjects maltracking normal tracking groups patellar maltracking prevalent pf pain subjects patella alta compared pf pain subjects normal patella height tailed fisher exact test   patellar pain+knee+biomechanics+etiology+arthritis+aging+pain problems+leg+limbs+overuse injury+injury+running+exercise+self-treatment+treatment+pro
5 webpage O'Connell Clean teeth, bad back? The first somewhat skeptical analysis of one of the weirder back pain studies in memory, Albert et al’s test of antiobotic treatment for low back pain, which had weirdly good results but was quickly tainted by controversy and probably cannot be trusted. 2013 treatment+etiology+fun+back pain+pro+pain problems+spine
3 article Minetto et al Origin and Development of Muscle Cramps Exercise & Sport Sciences Reviews 2013 cramps sudden involuntary painful muscle contractions pathophysiology remains poorly understood hypothesis cramps result motor neuron excitability central origin hypothesis result spontaneous discharges motor nerves peripheral origin central origin hypothesis supported experimental findings implications understanding cramp contractions discussed medications+back pain+biology+etiology+self-treatment+treatment+pain problems+spine+pro
3 article McAlindon et al Effect of vitamin D supplementation on progression of knee pain and cartilage volume loss in patients with symptomatic osteoarthritis Journal of the American Medical Association Vitamin D supplementation for two years “did not reduce knee pain or cartilage volume loss in patients with symptomatic knee ostoarthritis.” 2013 importance knee osteoarthritis oa disorder cartilage periarticular bone public health problem effective medical treatments studies suggested vitamin protect structural progression objective determine vitamin supplementation reduces symptom structural progression knee oa design setting patients year randomized placebo controlled double blind clinical trial involving participants symptomatic knee oa age years sd women white race patients enrolled tufts medical center boston march june intervention participants randomized receive placebo oral cholecalciferol iu dose escalation elevate serum levels ng ml main outcome measures primary outcomes knee pain severity western ontario mcmaster universities womac pain scale pain extreme pain cartilage volume loss measured magnetic resonance imaging secondary points included physical function knee function womac function scale difficulty extreme difficulty cartilage thickness bone marrow lesions radiographic joint space width results percent participants completed study serum hydroxyvitamin levels increased ng ml ci treatment group mg ml ci placebo group baseline knee pain slightly worse treatment group ci placebo group ci baseline knee function significantly worse treatment group ci placebo group ci knee pain decreased groups ci treatment group ci placebo group significant differences time percentage cartilage volume decreased extent groups ci ci differences secondary clinical points conclusion relevance vitamin supplementation years dose sufficient elevate hydroxyvitamin plasma levels higher ng ml compared placebo reduce knee pain cartilage volume loss patients symptomatic knee oa treatment+vitamin D+arthritis+nutrition+knee+self-treatment+aging+pain problems+leg+limbs
3 article Albert et al Antibiotic treatment in patients with chronic low back pain and vertebral bone edema (Modic type 1 changes) European Spine Journal This study shows weirdly good, strong results treating low back pain with antibiotics, but was mired in controversy soon after publication when it came to light that the authors may have had serious, undeclared commercial conflict of interest. In the unlikely event that the COI had no effect on the study, there are still some significant caveats. In particular, the study focussed on a specific sort of back pain in rather carefully chosen subjects — so it’s probably not going to work on the average frustrated back pain patient. Also: there was a suspicious lack of response in the placebo group, a possible red flag that something was wrong with the methodology; the connection to the mouth is basically speculative (they didn’t culture the painful sites); and there are other ways to explain the effect (perhaps an immunomodulation effect of antibiotics). 2013 purpose modic type bone edema vertebrae present   general population   pain population strongly pain aim test efficacy antibiotic treatment patients chronic pain  months modic type bone edema methods study double blind rct patients illness chronic lbp greater  months duration occurring previous disc herniation bone edema demonstrated modic type vertebrae adjacent previous herniation patients randomized  days antibiotic treatment bioclavid placebo blindly evaluated baseline treatment year follow outcome measures primary outcome disease specific disability lumbar pain secondary outcome leg pain number hours pain  weeks global perceived health eq d thermometer days sick leave bothersomeness constant pain magnetic resonance image mri results original patients evaluated year follow groups similar baseline antibiotic group improved highly statistically significantly outcome measures improvement continued  days follow year follow baseline  days follow year follow disease specific disability rmdq changed antibiotic placebo leg pain antibiotics placebo lumbar pain antibiotics placebo outcome measures clinically important effect size defined improvements exceeded thresholds trend dose response relationship double dose antibiotics efficacious conclusions antibiotic protocol study significantly effective group patients clbp modic placebo primary secondary outcomes treatment+etiology+fun+back pain+pro+pain problems+spine
3 webpage Gelder What IASTM is, is not, and might be A decent critical review of Instrument Assisted Soft Tissue Mobilization (IASTM) by a “huge advocate,” but note that the article also rests on a foundation of classic clinical overconfidence: the certainty that the technique works. 2013 massage+devices+manual therapy+treatment
4 article McGettigan et al Use of non-steroidal anti-inflammatory drugs that elevate cardiovascular risk PLoS Med Diclofenac is an extremely popular painkiller associated with serious cardiovascular risks, as with other NSAIDs: “There is increasing regulatory concern about diclofenac. … Diclofenac has no advantage in terms of gastrointestinal safety and it has a clear cardiovascular disadvantage.” 2013 background steroidal anti inflammatory drugs nsaids rofecoxib vioxx increase risk heart attack stroke avoided patients high risk cardiovascular events rates cardiovascular disease high rising middle income countries studied extent evidence cardiovascular risk nsaids translated guidance sales countries methods findings data relative risk rr cardiovascular events individual nsaids derived meta analyses randomised trials controlled observational studies listing individual nsaids essential medicines lists emls obtained world health organization nsaid sales prescription data middle high income countries obtained intercontinental medical statistics health ims health national prescription pricing audit case england canada drugs rofecoxib diclofenac etoricoxib ranked consistently highest terms cardiovascular risk compared nonuse naproxen risk diclofenac listed national emls naproxen rofecoxib documented country diclofenac etoricoxib accounted total nsaid usage countries median range proportion vary high income countries diclofenac commonly nsaid market share close popular drugs combined naproxen average market share conclusions listing nsaids national emls account cardiovascular risk preference risk drugs diclofenac risk similar rofecoxib withdrawn worldwide markets owing cardiovascular toxicity diclofenac removed emls article editors summary medications+harms+inflammation+self-treatment+treatment+pain problems
5 article Melzack et al Pain Wiley Interdisciplinary Reviews: Cognitive Science 2013 pain valuable functions signals injury disease generates wide range adaptive behaviors promotes healing rest beneficial aspects pain negative features challenge understanding puzzle pain including persistent phantom limb pain amputation total spinal cord transection pain personal subjective experience influenced cultural learning meaning situation attention psychological variables pain processes stimulation receptors injury disease produces neural signals enter active nervous system adult organism substrate experience culture host environmental personal factors brain processes actively participate selection abstraction synthesis information total sensory input pain simply product linear sensory transmission system dynamic process involves continuous interactions complex ascending descending systems neuromatrix theory guides cartesian concept pain sensation produced injury inflammation tissue pathology concept pain multidimensional experience produced multiple influences influences range existing synaptic architecture neuromatrix determined genetic sensory factors influences body areas brain genetic influences synaptic architecture determine predispose development chronic pain syndromes wires cogn sci doi wcs for resources related article visit wires website chronic pain+classics+pain problems
3 article Hyong et al Activities of the Vastus Lateralis and Vastus Medialis Oblique Muscles during Squats on Different Surfaces J Phys Ther Sci 2013 purpose purpose present study examine effects squat exercises performed surfaces activity quadriceps femoris muscle order provide information support surfaces effective squat exercises subjects method fourteen healthy subjects performed squat exercises seconds support surfaces hard plates foam rubber air discs performance measured electromyography subjects performed squat exercises surface data activity vastus medialis oblique vastus lateralis vastus medials oblique vastus lateralis ratio collected results activity vastus medialis oblique vastus medialis oblique vastus lateralis ratio statistically significantly higher rubber air discs squats performed hard plates foam conclusion activate vastus medialis obilique enhance vastus medialis oblique vastus lateralis ratio unstable surfaces highly unstable selected patellar pain+strength+exercise+muscle+counter-intuitive+arthritis+aging+pain problems+knee+leg+limbs+overuse injury+injury+running+self-treatment+treatment
3 article Wood Back pain study failed to disclose COI Rheumatology Update An allegation of a serious conflict of interest that may explain strangely good results in a study of antibiotic therapy for back pain (Albert et al). 2013 treatment+etiology+fun+back pain+pro+pain problems+spine
4 article Cameron et al Topical herbal therapies for treating osteoarthritis Cochrane Database of Systematic Reviews Among many other findings, this review of osteoarthritis treatments reports that Arnica for osteoarthritis is as effective and risky as NSAIDS, or even riskier. 2013 background extraction synthetic chemistry invented musculoskeletal complaints treated preparations medicinal plants administered orally topically contrast oral medicinal plant products topicals act part counterirritants toxic orally objectives update previous cochrane review herbal therapy osteoarthritis evaluating evidence effectiveness topical medicinal plant products search methods databases mainstream complementary medicine searched terms include forms arthritis combined medicinal plant products searched electronic databases cochrane central register controlled trials central medline embase amed cinahl isi web science world health organization clinical trials registry platform february unrestricted language searched reference lists retrieved trials selection criteria randomised controlled trials herbal interventions topically compared inert placebo active controls people osteoarthritis included data collection analysis review authors independently selected trials inclusion assessed risk bias included studies extracted data main results studies medicinal plant interventions participants included single studies studies comparable studies studies precluded pooling results moderate evidence single study people hand osteoarthritis treatment arnica extract gel results similar benefits treatment ibuprofen steroidal anti inflammatory drug similar number adverse events pain ibuprofen group points point scale treatment arnica gel reduced pain points weeks difference md points confidence intervals ci absolute reduction reduction increase hand function points point scale ibuprofen treated group treatment arnica gel reduced function points md ci absolute improvement improvement decline total adverse events higher arnica gel group compared ibuprofen group relative risk rr ci moderate quality evidence single trial people knee osteoarthritis compared placebo capsicum extract gel improve pain knee function commonly treatment related adverse events including skin irritation burning sensation weeks follow pain placebo group points point scale treatment capsicum extract reduced pain point md ci absolute reduction reduction increase knee function placebo group points point scale weeks treatment capsicum extract improved function points md ci absolute improvement improvement decline adverse event rates greater capsicum extract group compared placebo group rate ratio ci number needed treat result adverse events ci moderate evidence single trial people knee osteoarthritis suggested comfrey extract gel improves pain increasing adverse events weeks pain placebo group points point scale treatment comfrey reduced pain points md ci absolute reduction reduction function reported adverse events similar reported adverse events comfrey group compared placebo group rr ci evidence single trial adhesive patches chinese herbal mixtures fnzg sjg improve pain function clinical applicability findings uncertain participants treated days uncertain topical herbal products marhame mafasel compress stinging nettle leaf improve osteoarthritis symptoms due quality evidence single trials side effects reported authors conclusions mechanism action topical medicinal plant products rationale basis treatment osteoarthritis quality quantity current research studies effectiveness insufficient arnica gel improves symptoms effectively gel steroidal anti inflammatory drug possibly worse adverse event profile comfrey extract gel improves pain capsicum extract gel improve pain function doses examined review high quality fully powered studies required confirm trends effectiveness identifed studies treatment+adhesive capsulitis+self-treatment+arthritis+medications+shoulder+head/neck+aging+pain problems
3 article Zusman Belief reinforcement J Multidiscip Healthc Why is back pain still a huge problem? Maybe this: “It is extremely difficult to alter the potentially disabling belief among the lay public that low back pain has a structural mechanical cause. An important reason for this is that this belief continues to be regularly reinforced by the conditions of care of a range of ‘hands-on’ providers, for whom idiosyncratic variations of that view are fundamental to their professional existence.” Well said. If only I could edit it, though, I would say that it is difficult to alter that belief in anyone, patient or professional. The belief isn’t just reinforced by the practices of manual therapists, it’s the reason for them. 2013 figures show change upward trend direct indirect costs largely benign symptom pain western societies greater understanding recommendation conservative independent approach management years large scale education programs aim bring knowledge public including general practitioners line evidence based practice carried countries hope information imparted change beliefs dysfunctional patient behavior biomedical practice part clinicians programs influence behavior costs countries implemented argued reason lack success extremely difficult alter potentially disabling belief lay public pain structural mechanical important reason belief continues regularly reinforced conditions care range hands providers idiosyncratic variations view fundamental professional existence mind+biomechanics+back pain+etiology+pro+pain problems+spine
3 article McCartney Antibiotics for back pain British Medical Journal Margaret McCartney investigates an alleged conflict of interest that may explain strangely good results in a study of antibiotic therapy for back pain (Albert et al). 2013 treatment+etiology+fun+back pain+pro+pain problems+spine
3 article Tjønna Low- and High-Volume of Intensive Endurance Training Significantly Improves Maximal Oxygen Uptake after 10-Weeks of Training in Healthy Men PLoS ONE More evidence that surprisingly brief bouts of intense exercise can do a body good: “Our data suggest that a single bout of aerobic interval training performed three times per week may be a time-efficient strategy to improve VO2max and reduce blood pressure and fasting glucose in previously inactive but otherwise healthy middle-aged individuals.” 2013 regular exercise training improves maximal oxygen uptake vo max optimal intensity volume obtain maximal benefit remains defined growing body evidence suggests exercise training volume high intensity time efficient means achieve health benefits present study measured vo max traditional cardiovascular risk factors wk training protocol involved weekly high intensity interval sessions group protocol consisted × min maximal heart rate hrmax interspersed min active recovery hrmax ait group performed single bout protocol consisted × min hrmax ait twenty inactive healthy overweight men bmi age randomized ait ait training vo max increased ~ ml⋅kg− ⋅min− ~ ml⋅kg− ⋅min− ait ait group difference oxygen cost running maximal workload reduced ait ait systolic blood pressure decreased mmhg ait ait diastolic pressure decreased mmhg group difference groups similar ~ decrease fasting glucose body fat total cholesterol ldl cholesterol ox ldl cholesterol significantly reduced ait data suggest single bout ait performed times week time efficient strategy improve vo max reduce blood pressure fasting glucose previously inactive healthy middle aged individuals ait type exercise training readily implemented part activities daily living easily translated programs designed improve public health exercise+running+self-treatment+treatment
4 article O'Connell et al Interventions for treating pain and disability in adults with complex regional pain syndrome Cochrane Database of Systematic Reviews What works for complex regional pain syndrome? Certainly nothing confirmed yet. Study author Neil O’Connell, describing the results for
“The trial evidence in CRPS is something of a mess. … To summarise our findings, using the GRADE system for assessing the quality of a body of evidence we concluded that there was high quality evidence for … nothing. Zip. … At the very best this evidence could be considered exploratory, but for making any confident judgement on effectiveness it is really better described as ‘no credible evidence.’ … The old cliché rings true: we need bigger better trials, and in CRPS we need them desperately.”
2013 background strong consensus optimal management complex regional pain syndrome multitude interventions commonly objectives summarise evidence cochrane cochrane systematic reviews effectiveness therapeutic intervention reduce pain disability adults complex regional pain syndrome crps methods identified cochrane reviews cochrane reviews systematic search databases cochrane database systematic reviews database abstracts reviews effects ovid medline ovid embase cinahl lilacs pedro included cochrane systematic reviews contained evidence covered identified cochrane reviews methodological quality reviews assessed amstar tool extracted data primary outcomes pain disability adverse events secondary outcomes quality life emotional participants ratings satisfaction improvement evidence arising randomised controlled trials considered grade system assess quality evidence main results included cochrane reviews cochrane systematic reviews cochrane reviews demonstrated methodological quality cochrane reviews trials typically small quality variable moderate quality evidence intravenous regional blockade guanethidine effective crps procedure appears risk significant adverse events quality evidence bisphosphonates calcitonin daily intravenous ketamine effective pain compared placebo graded motor imagery effective pain function compared usual care mirror therapy effective pain post stroke crps compared covered mirror control evidence interpreted caution quality evidence local anaesthetic sympathetic blockade effective quality evidence suggests physiotherapy occupational therapy small positive effects clinically important year follow compared social work passive attention control wide range interventions evidence quality evidence conclusions drawn authors conclusions critical lack high quality evidence effectiveness therapies crps larger trials undertaken formulating evidence based approach managing crps remain difficult chronic pain+random+pain problems
4 article Vibe-Fersum et al Efficacy of classification-based cognitive functional therapy in patients with non-specific chronic low back pain European Journal of Pain Statistically and clinically significant results for a back pain treatment? Pinch me! Classification-based cognitive functional therapy (CB-CFT or just CFT) for low back pain is a “body/mind approach to understanding and managing this complex problem” that “targets the beliefs, fears and associated behaviours” of patients — what I have called the “confidence cure” for many years. The big idea of CFT is that back pain does not necessarily have anything to do with a damaged or degenerated back, and the cycle of pain and disability can be broken by easing patient fears and anxieties. CFT was tested on 62 patients with moderate back pain, and compared to 59 who were treated with manual therapy and exercise. Three months and a year later, the CFT group was much better off: a 13-point boost on a 100-point disability scale, and 3 points on a 10-point pain scale. Those are not amazing results, but enough to be considered clinically significant, and they beat manual therapy and exercise handily (those patients improved by only 5.5 and 1.5 points on the same scales). CFT was “more effective at reducing pain, disability, fear beliefs, mood and sick leave at long-term follow-up than MT-EX.” As the authors put it for, “Disabling back pain can change for the better with a different narrative and coping strategies.” There were some blemishes on the study methods, but nothing dire; its results can be safely regarded as “promising” while we wait for replication from bigger studies. 2013 background specific chronic pain disorders proven resistant change lack clear evidence specific treatment intervention superior methods randomized controlled trial aimed investigate efficacy behavioural approach management classification based cognitive functional therapy compared traditional manual therapy exercise linear mixed models estimate group differences treatment effects primary outcomes month follow oswestry disability index pain intensity measured numeric rating scale inclusion criteria age years diagnosed specific chronic pain months localized pain t gluteal folds provoked postures movement activities oswestry disability index pain intensity days total patients randomized classification based cognitive functional therapy group     manual therapy exercise group       results classification based cognitive functional therapy group displayed significantly superior outcomes manual therapy exercise group statistically   treatment+mind+neck+back pain+head/neck+spine+pain problems
3 article Jacobs et al The evidence on surgical interventions for low back disorders, an overview of systematic reviews European Spine Journal From the conclusion to this review of studies (and other reviews) of surgeries for back pain: “Although the quality of the reviews was quite acceptable, the quality of the included studies was poor.” So back surgeries have never really been studied properly … but the reviews are quality! Hmm. I’m pretty sure that’s terrible news. 2013 purpose systematic reviews published surgical interventions disorders objective overview evaluate evidence systematic reviews effectiveness surgical interventions disc herniation spondylolisthesis stenosis degenerative disc disease ddd earlier version review published quality reviews published methods comprehensive search performed cochrane database systematic reviews cdsr database reviews effectiveness pubmed reviewers independently performed selection studies risk bias assessment data extraction included cochrane reviews cochrane systematic reviews published peer reviewed journals conditions included disc herniation spondylolisthesis ddd spinal stenosis comparisons evaluated surgery conservative care surgical techniques compared methodological quality systematic reviews evaluated amstar report pooled analyses individual reviews results thirteen systematic reviews surgical interventions disorders included disc herniation     spondylolisthesis     spinal stenosis     ddd       high quality reviews meta analysis showed significant difference treatment spinal stenosis intervertebral process devices showed favorable results compared conservative treatment zurich claudication questionnaire difference md   ci degenerative spondylolisthesis fusion showed favorable results compared decompression mixed aggregation clinical outcome measures rr   ci fusion rate favored instrumented fusion instrumented fusion rr   ci conclusions comparisons included reviews significant clinically relevant differences interventions identified quality reviews acceptable quality included studies poor future studies influence assessment interventions treatment+mind+surgery+back pain+pain problems+spine
4 article American Academy of Orthopaedic Surgeons Treatment of Osteoarthritis of the Knee – 2nd Edition A major, comprehensive report on treatments for knee arthritis. Exercise, weight loss, and regular painkillers are praised as effective. Particularly ineffective treatments include acupuncture, glucosamine, chondroitin, “lube jobs” (injection of joint lubricant), and surgical lavage and debirdement. Homeopathy is left out (presumably considered beneath contempt). The report is notable for its integrity: written by an association of surgeons, it nevertheless denounces a profitable, common surgical treatment for osteoarthritis (athroscopic lavage and debridement, basically polishing joint surfaces). They tipped over their own cash cow! Dr. Harriet Hall:
Critics who claim doctors are just out to make money, take note: if they were the evil money-grubbers some make them out to be, wouldn’t these surgeons want to promote income-generating arthroscopic lavage and debridement? Wouldn’t they want to suppress information about conservative treatments and keep patients in pain until they were desperate enough to consent to expensive joint replacement surgery? Gee, do you suppose maybe they really are just trying to do what’s best for their patients?
2013 treatment+arthritis+knee+running+patellar pain+scientific medicine+aging+pain problems+leg+limbs+exercise+self-treatment+overuse injury+injury
4 article Williams Effects of running and walking on osteoarthritis and hip replacement risk Medicine & Science in Sports & Exercise This analysis of many tens of thousands of runners versus walkers found that “running significantly reduced arthritis and hip replacement risk,” but due in large part to the fact that runners were typically skinnier. Weight was a trump factor. Nevertheless, this data flies in the face of the common assumption that running is much harder on the joints. Instead, what it clearly shows is that running is either neutral or helpful, and weight is a much more important factor regardless of whether you walk or run. 2013 purpose running strenuous sports activities purported increase osteoarthritis oa risk walking strenuous activities analyses performed test running walking exercise affect oa hip replacement risk assess role body mass index bmi mediating relationships methods article studied proportional hazards analyses patients report physician diagnosed oa hip replacement exercise energy expenditure mets results runners reported oa reported hip replacements yr follow walkers reported oa reported hip replacements yr follow compared running exercise+running+arthritis+etiology+patellar pain+self-treatment+treatment+aging+pain problems+pro+knee+leg+limbs+overuse injury+injury
1 article Kassolik et al Comparison of Massage Based on the Tensegrity Principle and Classic Massage in Treating Chronic Shoulder Pain Journal of Manipulative & Physiological Therapeutics Here’s a study that compares two kinds of massage for shoulder pain: regular Swedish versus “tensegrity-based” massage, which I have literally never heard of in 15 years of studying massage (although I can easily guess what they think they mean.) I smell a pet theory. “Tensegrity-based” massage is not actually a thing. There is no TBM® or standard definition. It means about as much as “anatomy-based.” Tensegrity refers to a principle of biomechanical organization (see Ten Trillion Cells Walked Into a Bar). Massage “based on the tensegrity principle” is wide open to interpretation to the point of absurdity. And yet the defining characteristic of tensegrity-based treatment offered in the abstract of this paper is merely where massage was applied (not how): “directing treatment to the painful area and the tissues … that structurally support the painful area.” As opposed to foot massage, perhaps? Meanwhile, the control group massaged “tissues surrounding the glenohumeral joint.” So, shoulder massage compared to … shoulder massage. This comparison may be about as meaningful as a taste-test of tomatoes and tomahtoes. Giving these researchers a little benefit of the doubt, perhaps they were trying to describe the size of the treated area, also known as “less thorough” and “more thorough.” That would be a somewhat interesting comparison, though not really useful for validating a treatment idea as vague as “tensegrity-based massage.” I can think of a few (about 17) non-tensegrity-based reasons why more thorough massage might work well. “Be thorough” is pretty much the first lesson in massage school. And the shocking conclusion? They found that “more thorough” worked much better. 2013 objective purpose study compare clinical outcomes classic massage massage based tensegrity principle patients chronic idiopathic shoulder pain methods subjects chronic shoulder pain symptoms divided groups subjects received classic swedish massage tissues surrounding glenohumeral joint subjects received massage techniques based tensegrity principle tensegrity principle based directing treatment painful area tissues muscles fascia ligaments structurally support painful area treating tissues direct indirect influence motion segment treatment groups received sessions weeks session lasted minutes mcgill pain questionnaire glenohumeral ranges motion measured immediately massage session day therapy ended weeks therapy started month massage results subjects receiving massage based tensegrity principle demonstrated statistically significance improvement passive active ranges flexion abduction glenohumeral joint pain decreased massage groups conclusions study showed increases passive active ranges motion flexion abduction patients massage based tensegrity principle pain outcomes classic tensegrity massage groups demonstrated improvement controversy+fascia+biomechanics+debunkery+etiology+pro+massage+manual therapy+treatment
2 article Littlewood et al The central nervous system--an additional consideration in 'rotator cuff tendinopathy' and a potential basis for understanding response to loaded therapeutic exercise Manual Therapy Explanations for pain based on “peripherally driven nociceptive mechanisms secondary to structural abnormality, or failed healing, appear inadequate” — at least in the context of rotator cuff tendinopathy (and probably much else). 2013 tendinopathy term describe painful tendon disorder recognised clinical presentation definitive understanding pathoaetiology rotator cuff tendinopathy remains elusive current explanatory models relate peripherally driven nocioceptive mechanisms secondary structural abnormality failed healing inadequate context current literature light limitations paper presents extension current models incorporates integral role central nervous system pain experience role central nervous system cns justified potential rationale explain favourable response loaded therapeutic exercises demonstrated previous studies additional consideration potential offer explain pain patients clinicians prescribe therapeutic management strategies researchers advance knowledge relation clinically challenging problem shoulder+neurology+tendinosis+chronic pain+head/neck+pain problems+overuse injury+injury
3 article Bell et al Impact of autologous blood injections in treatment of mid-portion Achilles tendinopathy British Medical Journal Utterly unsurprising: injecting your own blood doesn’t help tendinitis. Nice to have a decent new trial about this over-hyped therapy though: “The administration of two unguided peritendinous autologous blood injections one month apart, in addition to a standardised eccentric training programme, provides no additional benefit in the treatment of mid-portion Achilles tendinopathy. 2013 objective assess effectiveness peritendinous autologous blood injections addition standardised eccentric calf strengthening programme improving pain function patients mid portion achilles tendinopathy design single centre participant single assessor blinded parallel group randomised controlled trial setting single sports medicine clinic zealand participants adults age men symptoms unilateral mid portion achilles tendinopathy months participants excluded history previous achilles tendon rupture surgery undergone previous adjuvant treatments injectable therapies glyceryl trinitrate patches extracorporeal shockwave therapy interventions participants underwent unguided peritendinous injections month standardised protocol treatment group ml blood injected control group substance injected needling participants groups carried standardised monitored week eccentric calf training programme follow months main outcome measures primary outcome measure change symptoms function baseline months victorian institute sport assessment achilles visa score secondary outcomes participant perceived rehabilitation ability return sport results participants randomly assigned treatment group control group total completed month study group clear clinically worthwhile improvements visa score evident months treatment change score confidence interval control groups effect treatment significant confidence intervals points precluded clinically meaningful benefit harm significant difference groups secondary outcomes levels compliance eccentric calf strengthening programme adverse events reported conclusion administration unguided peritendinous autologous blood injections month addition standardised eccentric training programme additional benefit treatment mid portion achilles tendinopathy treatment+tendinosis+injections+pain problems+overuse injury+injury+medicine
1 webpage Feinberg Ted Kaptchuk of Harvard Medical School studies placebos A terrible article in a fancy publication, more of a love letter to Ted Kaptchuk than anything else. Kaptchuk is the patron saint of the trend of aggrandizing placebo as a rationale for treatments that are “as good as placebo” (read: can’t beat a placebo), which is a big pet peeve of mine. It was a bit hard to keep my lunch down reading this: it irritatingly declares an inspiring Kaptchukian victory over … straw men, false dilemmas, and puzzles that weren’t all that puzzling. Basically it portrays scientific medicine as being much more clueless about placebo than it really is, which just happens to make Kaptchuk’s placebo research look much more profound than it really is. 2013 mind+scientific medicine
2 article Cramer et al Randomized-controlled trial comparing yoga and home-based exercise for chronic neck pain The Clinical Journal of Pain A small, low-quality experiment that optimistically concludes “yoga was more effective in relieving chronic nonspecific neck pain than a home-based exercise program.” Unfortunately, better research will be required to confirm this. I entirely agree with Dr. Edzard Ernst about this study: “One does not need to be an expert in critical thinking to realise that… the positive outcome might be unrelated to yoga.” 2013 objectives chronic neck pain significant public health problem evidence based treatment options growing evidence effectiveness yoga relieving musculoskeletal disorders aim study evaluate effect iyengar yoga compared exercise chronic nonspecific neck pain methods patients randomly assigned yoga exercise yoga group attended week yoga exercise group received care manual home based exercises neck pain relief main outcome measure present neck pain intensity mm visual analog scale secondary outcome measures included functional disability neck disability index pain motion visual analog scale health related quality life short form questionnaire cervical range motion proprioceptive acuity pressure pain threshold results fifty patients age female randomized yoga exercise intervention study period patients yoga group reported significantly neck pain intensity compared exercise group difference mm ci yoga group reported disability mental quality life range motion proprioceptive acuity improved pressure pain threshold elevated yoga group discussion yoga effective relieving chronic nonspecific neck pain home based exercise program yoga reduced neck pain intensity disability improved health related quality life yoga influence functional status neck muscles improvement physiological measures neck pain self-treatment+stretch+neck+exercise+treatment+muscle+head/neck+spine
5 book Davies et al The trigger point therapy workbook New Harbinger Publications The Workbook is a significant book: it offers hope and many practical self-treatment tips to countless people suffering from pain that doctors struggle to diagnose or treat. Unfortunately, despite the publication of a third edition in 2013, it has fallen behind the times and much of the hope it offers is false hope — it has been making trigger point therapy sound much more effective than it really is since the first edition in 2001. The third edition adds a few ideas of questionable value, while failing to explain (or even acknowledge) many important new findings and controversies in pain science. So it’s a significant book, but not good one. 2013 trigger point therapy fastest growing effective pain therapies world medical doctors chiropractors physical therapists massage therapists beginning technique relieve patients undiagnosable muscle joint pain conditions studies shown percent doctor visits book addresses problem myofascial trigger points tiny contraction knots develop muscle injured overworked restricted circulation lack oxygen points referred pain massage trigger safest natural effective form pain therapy trigger points create pain body predictable patterns characteristic muscle producing discomfort ranging mild severe trigger point massage increases circulation oxygenation area produces instant relief trigger point therapy workbook edition huge impact health professionals public alike overnight classic field pain relief edition includes chapter deceased author clair davies daughter amber davies passionate continuing father legacy edition includes postural assessments muscle tests illustrated index symptoms clinical technique drawings descriptions assist practitioners regular readers assessing treating trigger points suffered treated suffers myofascial trigger point pain book edition bestselling trigger point therapy workbook outlines user friendly updated methods massage relieve pain edition techniques drawings tips readers find treat trigger points chronic pain+massage+biology+muscle pain+pain problems+manual therapy+treatment+muscle
3 article Dimitriadis et al Respiratory weakness in patients with chronic neck pain Manual Therapy A test of 90 people showed that 45 with neck pain had weaker respiration: “This weakness seems to be a result of the impaired global and local muscle system of neck pain patients, and psychological states also appear to have an additional contribution. Clinicians are advised to consider the respiratory system of patients with chronic neck pain during their usual assessment and appropriately address their treatment.” 2013 respiratory muscle strength parameter proposed affected patients chronic neck pain study aimed examining patients chronic neck pain reduced respiratory strength neck pain problems respiratory strength controlled cross sectional study patients chronic neck pain healthy matched controls recruited respiratory muscle strength assessed maximal mouth pressures subjects additionally assessed pain intensity disability neck muscle strength endurance deep neck flexors neck range movement head posture psychological states paired tests showed patients chronic neck pain reduced maximal inspiratory mip maximal expiratory pressures mep neck muscle strength kinesiophobia catastrophizing significantly maximal mouth pressures mep additionally negatively correlated neck pain disability neck muscle strength predictor remained significant prediction models mip mep concluded patients chronic neck pain present weakness respiratory muscles weakness result impaired global local muscle system neck pain patients psychological states additional contribution clinicians advised respiratory system patients chronic neck pain usual assessment appropriately address treatment etiology+mind+random+biomechanics+neck+pro+head/neck+spine
3 article Lehr et al Field-expedient screening and injury risk algorithm categories as predictors of noncontact lower extremity injury Scandinavian Journal of Medicine & Science in Sports This looks like some positive evidence for the power of the FMS screen to predict injury. My money is still on the null, and I don’t think any of the other evidence to date is all that persuasive yet. But if, in the end, good evidence says the screen works, then bully for FMS! Almost all my gripes with FMS concern over-reaching its stated purpose as a screen and using it as a diagnostic/prescriptive tool. If it does actually work as a screen, I will be the first in line to say, “Congratulations, FMS!” 2013 positive evidence power functional movement screen fms screen predict injury test importantly study test screen balance generally good news screening tests money null hypothesis ultimately evidence date persuasive good evidence fms screening predict injury bully fms gripes fms concern egregious reaching stated purpose screen diagnostic prescriptive tool work screen line congratulations fms hard data exercise+patellar pain+IT band pain+strain+shin pain+self-treatment+treatment+arthritis+aging+pain problems+knee+leg+limbs+overuse injury+injury+running+tendinosis+muscle
3 article Ridge et al Foot bone marrow edema after a 10-wk transition to minimalist running shoes Medicine & Science in Sports & Exercise 2013 purpose minimalist running shoes popular choice runners years conclusive evidence advantages disadvantages running shoes performance benefits exist injury occur added stress running benefit cushioning foot bone marrow edema manifestation added stress foot study measured bone marrow edema runners feet wk period transitioning traditional minimalist running shoes methods experienced recreational runners underwent magnetic resonance imaging mri wk period seventeen subjects control group ran traditional shoes wk experimental group gradually transitioned vibram fivefinger running shoes wk severity bone marrow edema scored range bone marrow edema edema length bone score represented stress fracture results pretraining mri scores statistically groups posttraining mri scores showed subjects vibram group showed increases bone marrow edema bone wk running control group conclusion runners interested transitioning minimalist running shoes vibram fivefingers transition slowly gradually avoid potential stress injury foot running+barefoot+foot+exercise+self-treatment+treatment+leg+limbs+pain problems
4 article Dizon et al Effectiveness of extracorporeal shock wave therapy in chronic plantar fasciitis Am J Phys Med Rehabil 2013 objective study evaluate effectiveness extracorporeal shock wave therapy eswt treating chronic plantar fasciitis online database search conducted studies eswt managing chronic plantar fasciitis eleven high quality randomized controlled trials included meta analysis showed eswt effective reducing morning pain weighted difference confidence interval ci odds ratio ci moderate intensity eswt effective decreasing activity pain weighted difference ci weighted difference ci moderate high intensity eswt effective improving functional outcome odds ratios ci ci adverse effects eswt pain calcaneal area calcaneal erythema study concludes moderate high intensity eswt effective treatment chronic plantar fasciitis plantar fasciitis+devices+foot+leg+limbs+pain problems+overuse injury+injury+tendinosis+treatment
3 webpage Heaton How chronic pain has made me happier 2013 problem superficially physical real challenges faced chronic pain mental mental state biggest modulator physical pain hurt stressed sad increased pain stressed sad vicious circle wholesale change perceive fear suffering setbacks biology+etiology+chronic pain+mind+self-treatment+back pain+pro+pain problems+treatment+spine
3 article Toye et al Patients' experiences of chronic non-malignant musculoskeletal pain The British Journal of General Practice People who suffer with chronic musculoskeletal pain face a daily struggle with their sense of self and find it difficult to prove the legitimacy of their condition. A new study, funded by the National Institute for Health Research Health Services and Delivery Research (HS&DR) Programme, systematically searches for, and makes sense of, the growing body of qualitative research on musculoskeletal pain to help understand the experiences of patients suffering from chronic pain. A number of concerning themes arose from the study, published today in the Health Services and Delivery Research journal, which highlighted: Patients struggling with the fundamental relationship with their body, and a sense that it is no longer ‘the real me’. A loss of certainty for the future, and being constantly aware of the restrictions of their body. Feeling lost in the health care system; feeling as though there is no answer to their pain. Finding it impossible to ‘prove’ their pain; “if I appear ‘too sick’ or ‘not sick enough’ then no one will believe m 2013 background musculoskeletal msk pain predominant types pain accounts large portion primary care workload aim systematically review integrate findings qualitative research increase understanding patients experiences chronic malignant msk pain design setting synthesis qualitative research meta ethnography electronic databases february medline embase cinahl psychinfo amed hmic method databases searched inception february supplemented hand searching contents lists specific journals citation tracking full published reports qualitative studies exploring adults experience chronic malignant msk pain eligible inclusion results titles abstracts full texts screened papers reporting individual studies included concept pain adversarial struggle emerged adversarial struggle affirm reconstruct time construct explanation suffering negotiate healthcare system prove legitimacy struggle sense patients moving pain conclusions review theoretical underpinning improving patient experience facilitating therapeutic collaborative partnership conceptual model presented offers opportunities improvement involving patients showing pain understood forming basis patients move pain chronic pain+mind+pain problems
3 webpage Coyne Questioning Whether Psychotherapy and Support Groups Extend the Lives of Cancer Patients 2013 simply evidence psychological interventions slow progression cancer extend life claims contrary serve burden cancer patients unrealistic responsibility outcome medical condition mind+random
3 webpage Moseley Pain really is in the mind, but not in the way you think In this not-too-technical article, the endlessly quotable Lorimer Moseley summarizes the role of the mind in chronic pain, especially low back pain. 2013 biology+etiology+chronic pain+mind+self-treatment+back pain+pro+pain problems+treatment+spine
3 webpage Blackwell Canadian Olympian’s ‘nightmare’ after acupuncture needle collapses her lung National Post 2013 acupuncture+controversy+harms+mind+debunkery+energy work+pain problems
4 article Rixe et al A review of the management of patellofemoral pain syndrome The Physician and Sportsmedicine This is a review of recent research on treating patellofemoral pain syndrome (PFPS), including only well designed studies. Their CONCLUSIONS: hip and quadriceps strengthening appears to be the best treatment for both reducing pain and increasing function. Other methods such as balance training, orthotics, and taping may be helpful but usually not by themselves. Finally, they point out that recent research confirms that surgical and pharmacologic (medications) are not effective. 2013 objective patellofemoral pain syndrome pfps frequently diagnosed knee conditions primary care orthopedic sports medicine settings strength training stretching programs traditionally mainstay patient treatment consensus recovery protocols runners experiencing pfps purpose review examine literature efficacy treatment modalities management patients pfps methods review included articles pubmed literature search search term pfps treatment search limited randomized controlled trials crossover case controlled studies cohort studies participants trial data published years results strength training stretching exercises continue strongly supported research effective treatment options runners pfps studies confirmed quadriceps hip strengthening combined stretching structured physiotherapy program comprise effective treatment reducing knee pain symptoms improving functionality patients pfps previous studies shown therapies proprioceptive training orthotics taping offer benefits adjunctive therapies show significant benefit patients pfps additionally research confirmed surgical pharmacologic therapies effective management patients pfps conclusion large number athletes impacted pfps year young runners sports medicine researchers investigated therapies patients pfps clear guidelines emerged management syndrome review analyzes literature pfps identifies specific treatment recommendations effective strongly supported treatment modality patients pfps combined physiotherapy program including strength training quadriceps hip abductors stretching quadriceps muscle group adjunctive therapies including taping biofeedback devices prefabricated orthotic inserts provide limited additive benefits select populations surgery avoided patients pfps treatment+orthotics+surgery+patellar pain+exercise+medications+stretch+devices+foot+leg+limbs+pain problems+self-treatment+arthritis+aging+knee+overuse injury+injury+running+muscle
3 article Aguilar-Ferrándiz et al A randomized controlled trial of a mixed Kinesio taping-compression technique on venous symptoms, pain, peripheral venous flow, clinical severity and overall health status in postmenopausal women with chronic venous insufficiency Clinical Rehabilitation “Compression socks with tape,” quipped @exuberantdoc, and that’s probably all the commentary on this paper that’s really called for. I would only be surprised by a measurable circulatory effect on fit people, and downright shocked if it was a robust enough effect to affect performance, let alone elite performance. 2013 objectives investigate effect mixed kinesio taping treatment women chronic venous insufficiency design double blinded randomized clinical trial setting clinical setting participants twenty postmenopausal women mild moderate chronic venous insufficiency randomly assigned experimental group receiving standardized kinesio taping treatment gastrocnemius muscle enhancement ankle functional correction placebo control group simulated kinesio taping main outcomes variables venous symptoms pain photoplethysmographic measurements bioelectrical impedance temperature severity health recorded baseline weeks treatment results × mixed model ancova repeated measurements showed statistically significant group time interaction heaviness claudication swelling muscle cramps venous refill time left venous pump function left extracellular water left severity physical function body pain groups reported significant reduction pain conclusion mixed kinesio taping compression therapy improves symptoms peripheral venous flow severity slightly increases health status females mild chronic venous insufficiency kinesio taping placebo effect pain devices+random+treatment
3 webpage Langevin The Science of Stretch This popular article about how acupuncture works “because fascia” is riddled with problems. Alt-med celebrity Helene Langevin makes a mountain out of a biology molehill: the mildly interesting fact that tissue is a bit “grabby” and hangs onto acupuncture needles. This may or may not have anything to do with fascia, but so what if it does? Does it matter? Can such tiny fascial stretches relieve pain? In fact, we know that they don’t, because we know that acupuncture doesn’t relieve pain, and therefore doesn’t need any explaining in terms of fascia or anything else. Nevertheless, this is the purpose of the article, and Langevin lobs out a major bonus, bogus premise to clinch her case that acupuncture is probably all about fascia: according to her own research, acupuncture meridians correspond to fascial structures. But the “mysterious” meridians are “nothing more than a rudimentary and prescientific model of blood vessels and nerves,” because until about a hundred years ago, acupuncture was pretty much the Eastern version of bloodletting, and its needles were more like little knives (see Kavoussi). There is no meaningful connection between fascia and acupuncture meridians. This article is a classic example — one of the best — of trying to make fascia (and acupuncture) sound much more medically important than the evidence can justify. 2013 acupuncture+fascia+controversy+mind+debunkery+energy work+etiology+pro+massage+manual therapy+treatment
3 article Carlesso et al A survey of patient's perceptions of what is "adverse" in manual physiotherapy and predicting who is likely to say so J Clin Epidemiol In this Canadian survey, low back pain patients were generally much more likely (51%) to report some kind of unpleasant reaction to therapy than patients with a problem anywhere else in the body, generally suggesting that back pain makes people nervous, or actual harm from therapy is more common, or both. Patient expectations, for better or worse, are a major factor in what is considered a “bad reaction” to therapy. For instance, back pain patients who expected to be “sore” after therapy were somewhat less likely (8.5%) to report a serious reaction. In 2010 Carlesso et al reported that “harms have either been neglected or poorly defined in much of the available studies on the efficacy of orthopaedic physical therapy.” This paper focusses on the patient perspective, which is totally neglected in the study of adverse events and, of course, “important to consider.” See Carlesso. 2013 objectives primary objective describe patient perspective identification occurrence adverse responses related manual therapy secondary objective evaluated predictors incidence rate adverse responses identified patients receiving manual physiotherapy study design setting cross sectional survey patients receiving manual physiotherapy recruited physiotherapists canada conducted survey included questions symptoms patients identified adverse causal associations treatment impact contextual factors descriptive statistics reported poisson modeling predicted factors identification adverse responses results response rate obtained lumbar spine dysfunction significant predictor adverse responses incidence rate ratio irr confidence interval ci         greater identification adverse responses compared extremity disorder expectation soreness protective identifying major adverse responses irr ci         rate identifying major adverse responses relative expectation conclusions patient perspective important comprehensive framework defining adverse responses manual therapies developed treatment+physical therapy+manual therapy+harms+back pain+chiropractic+pain problems+spine+controversy+debunkery
0 article Hartmann et al Analysis of the load on the knee joint and vertebral column with changes in squatting depth and weight load Sports Medicine 2013 suggested deep squats increased injury risk lumbar spine knee joints avoiding deep flexion recommended minimize magnitude knee joint forces suggestion influence wrapping effect functional adaptations soft tissue contact thigh calf account aim literature review assess squats knee flexion quarter squats safer musculoskeletal system deep squats search relevant scientific publications conducted march january pubmed articles included review realistic estimations knee joint forces knee flexion angles ° deep squat based biomechanical calculations measurements cadaver knee joints highest retropatellar compressive forces stresses ° increasing flexion wrapping effect contributes enhanced load distribution enhanced force transfer retropatellar compressive forces additionally flexion knee joint cranial displacement facet contact areas continuous enlargement retropatellar articulating surface occurs lead retropatellar compressive stresses menisci cartilage ligaments bones susceptible anabolic metabolic processes functional structural adaptations response increased activity mechanical influences concerns degenerative tendofemoral complex apparent higher risk chondromalacia osteoarthritis osteochondritis deep squats unfounded load configuration deep squat quarter squat training comparatively supra maximal loads favour degenerative knee joints spinal joints long term technique learned accurately expert supervision progressive training loads deep squat presents effective training exercise protection injuries strengthening extremity contrary commonly voiced concern deep squats contribute increased risk injury passive tissues knee+patellar pain+biology+biomechanics+overuse injury+etiology+leg+limbs+pain problems+arthritis+aging+injury+running+exercise+self-treatment+treatment+pro
3 article Sangam et al A study on the morphology of the suprascapular notch and its distance from the glenoid cavity Journal of Clinical and Diagnostic Research A nice example of anatomical variation: the size and shape of a notch in the top of the shoulder blade is quite variable, and nerve impingement is much more likely if you’ve got the wrong type of notch. 2013 introduction suprascapular nerve entrapment occur suprascapular notch spinoglenoid notch size shape suprascapular notch suprascapular entrapment neuropathy injury suprascapular nerve arthroscopic procedures knowledge variations nerve important understanding source entrapment syndrome material methods present study carried scapulae obtained department anatomy nri medical college nearby medical colleges suprascapular notches scapulae classified based descriptions rengachary al ticker al distance suprascapular notch supraglenoid tubercle distance posterior rim glenoid cavity medial wall spinoglenoid notch base scapular spine determined data analyzed statistically results based rengachary classification type iii notch common suprascapular foramen observed scapulae scapulae superior transverse diameter greater maximum depth shaped notch common scapulae fell short mentioned respective safe zone distances margin glenoid cavity conclusion studies understanding role notch causing nerve entrapment prevent iatrogenic nerve injuries posterior approaches shoulder joint anatomy+neurology
3 webpage Vagg The chiropractic war with reality rages on… A complete summary of the kerfuffle over the alleged fracture of a baby’s neck by an Australian chiropractor. In a nutshell: we’ll never know for sure what happened, but the chiropractic profession’s response to the allegation was predictably poor and damning, and — as always — chiropractors have no business treating children in the first place. See also Dr. Harriet Hall’s summary post on, Chiropractic Reform: Myth or Reality? 2013 chiropractic+harms+neck+controversy+manual therapy+treatment+debunkery+spine+pain problems+head/neck
article Turo et al Ultrasonic characterization of the upper trapezius muscle in patients with chronic neck pain Ultrason Imaging 2013 myofascial trigger points mtrps palpable tender nodules taut bands skeletal muscle painful compression mtrps characteristic findings myofascial pain syndrome mps role mtrps pathophysiology mps unknown localization diagnosis clinical outcome measures painful mtrps improved objectively characterizing quantitatively measuring properties goal study evaluate ultrasound imaging elastography differentiate symptomatic active mtrps normal muscle patients chronic months neck pain spontaneously painful palpable active mtrps healthy volunteers spontaneous pain palpably normal muscle tissue recruited study upper trapezius muscles subjects imaged echotexture analyzed entropy filtering mode images vibration elastography performed vibrating muscle externally hz color doppler variance imaging quantify regions color deficit exhibiting vibration amplitude imaging measures compared clinical findings standardized physical exam sites active mtrps significantly entropy significantly larger nonvibrating regions vibration elastography compared normal uninvolved muscle combination entropy analysis vibration elastography yielded sensitivity specificity discriminating active mtrps normal muscle results suggest active mtrps homogeneous texture heterogeneous stiffness compared normal unaffected muscle methods enabled improve imaging contrast suspected mtrps surrounding muscle results subjects chronic neck pain active mtrps abnormalities confined discrete isolated nodules affect milieu muscle surrounding palpable mtrps refinement ultrasound imaging promising objective method characterizing soft tissue abnormalities active mtrps elucidating role mtrps pathophysiology mps muscle pain+etiology+muscle+pain problems+pro
3 webpage Burfoot Could Usain Bolt Run from Paris to Beijing? A short article about Philippe Fuchs’s run from Paris to Beijing, covering ~5,100 miles in 161 days. His primary concern was his “ability to keep absorbing muscular and skeletal punishment day after week after month,” of course. By the time Fuchs finished, he had developed an endurance stride that was clearly shorter and lower: he padded along with about 6% more steps per mile, a whopping 30% less time in the air, and 11% less landing force. 2013 running+neat+overuse injury+fun+exercise+self-treatment+treatment+injury+pain problems
3 webpage unknown Antibiotics may help ease chronic back pain PubMed Health An anti-hype analysis of Albert et al, which showed that back pain might be treatable with antibiotics. It’s good, but it was written prior to the discovery that the authors may have failed to report a serious conflict of interest. 2013 treatment+etiology+fun+back pain+pro+pain problems+spine
3 webpage Bouma et al Sorry, but Science Says Running is Good for You, Not Bad A thoughtful evisceration of Kiefer’s popular anti-running anti-running article, Why Women Should Not Run, a case study in bad science writing that represents a trend of “anti-running claims making the rounds of the blogosphere lately.” According to Bouma and Orwell, Kiefer’s article is littered with unsupported claims, leaps of logic, and classic bogus citations (particularly clean misses and backfires, see Bogus Citations). 2013 exercise+running+random+scientific medicine+self-treatment+treatment
3 article Klika et al High-Intensity Circuit Training Using Body Weight ACSM's Health & Fitness Journal 2013 exercise+good news+self-treatment+research+treatment+pro
1 article Miura et al Activity in the primary somatosensory cortex induced by reflexological stimulation is unaffected by pseudo-information BMC complementary and alternative medicine Reflexology will probably get a big PR boost from this bogus science. It’s already “highly accessed,” which creates the appearance of validity where there is probably is none. It has a shiny, hard protective shell of superficial legitimacy. That is, it sounds good and fancy, and there’s nothing obviously wrong with the paper. And yet fMRI studies are notoriously prone to producing research artifacts, and the results just happen — coincidence, I’m sure — to give a lot of comfort and aid to one of the most implausible and scientifically bankrupt treatment claims in all of alternative medicine. Dr. Christopher Moyer: “There is no good theory for reflexology. In the absence of a good theory, a single study that connects a twitch of the toe to the blink of an eye is as close to worthless as it gets.” Without high quality replication, this gets no more than a Spock eyebrow raise from me. 2013 background reflexology alternative medical practice produces beneficial effects applying pressure specific reflex areas previous study suggested reflexological stimulation induced cortical activation somatosensory cortex stimulated reflex area rule possibility placebo effect resulting instructions experimental task functional magnetic resonance imaging fmri investigate reflexological stimulation reflex area processed primary somatosensory cortex correct pseudo information reflex area laterality activation reflexological stimulation investigated methods healthy japanese volunteers participated experiment double blind design subjects received correct information base toe eye reflex area pseudo information base toe shoulder reflex area subjects received information fmri time series data acquired reflexological stimulation feet experimenter stimulated reflex area accordance auditory cue fmri data analyzed conventional stage approach hemodynamic responses produced stimulation reflex area assessed general linear model intra subject basis repeated measures analysis variance performed intersubject basis determine effect reflex area laterality information accuracy results results stimulation eye reflex area foot induced activity left middle postcentral gyrus area tactile sensation face projects postcentral gyrus contralateral foot representation area activity affected pseudo information results relationship reflex area projection primary somatosensory cortex lateral pattern differs actual somatotopical representation body conclusion findings suggest robust relationship exists neural processing somatosensory percepts reflexological stimulation tactile sensation specific reflex area controversy+massage+acupuncture+debunkery+manual therapy+treatment+mind+energy work
article Rose et al Denervation of the lateral humeral epicondyle for treatment of chronic lateral epicondylitis J Hand Surg Am 2013 purpose chronic lateral epicondylitis remains treatment challenge traditional surgical treatments lateral epicondylitis involve variations classic nirschl lateral release anatomic studies reveal posterior branch branches posterior cutaneous nerve forearm consistently innervate lateral humeral epicondyle undertook present study determine effectiveness denervation lateral humeral epicondyle treating chronic lateral epicondylitis methods institutional review board approved prospective study included elbows patients inclusion criteria included failure respond nonoperative treatment months improvement grip strength visual analog pain scale diagnostic nerve block posterior branches posterior cutaneous nerve forearm proximal lateral humeral epicondyle excluded patients undergone previous surgery lateral epicondylitis outcome measures included visual analog pain scale grip strength testing denervation surgery involved identification transection posterior cutaneous nerve forearm branches implantation triceps presence radial tunnel syndrome noted affect inclusion criteria present correct surgically postoperative splinting permitted return activities daily living results months follow average visual analog scale score decreased average grip strength elbow extended improved kg total patients good excellent results defined improvement points visual analog scale pain conclusions denervation lateral epicondyle effective relieving pain patients chronic lateral epicondylitis positive response local anesthetic block posterior branches posterior cutaneous nerve forearm radial nerve compression syndromes evaluated confounding source symptoms require additional treatment patients fail improve denervation type study level evidence therapeutic iv tendinosis+denervation+elbow+pain problems+overuse injury+injury+neurology+treatment+arm+limbs
4 article Kietrys et al Effectiveness of Dry Needling for Upper Quarter Myofascial Pain Journal of Orthopaedic & Sports Physical Therapy Body In Mind evaluated this review of dry needling for myofascial pain and concluded that the evidence does not make the grade: “Dry needling is not convincingly superior to sham/control conditions and possibly worse than comparative interventions…” Bummer. The reviewers themselves came to a different conclusion based on their data: they “recommend (Grade A) dry needling, compared to sham or placebo, for decreasing pain (immediately after treatment and at 4 weeks).” But digging into the actual results, it doesn’t take me long to start rolling my eyes and sympathizing with BIM’s opinion: there’s not much here. 2013 study design systematic review meta analysis background myofascial pain syndrome mps hyperalgesic zones muscle called myofascial trigger points mtrps palpated active mtrps local referred symptoms including pain dry needling involves inserting acupuncture needle mtrp goal reducing pain restoring range motion objective explore evidence effectiveness dn reducing pain patients mps upper quarter methods electronic literature search performed keyword dry needling articles identified search screened inclusion criteria human subjects randomized controlled trials rcts dry needling intervention group mps involving upper quarter rcts met criteria assessed scored internal validity macdermid quality checklist separate meta analyses performed dry needling compared sham control effects dry needling compared sham control weeks dry needling compared treatments effects dry needling compared treatments weeks results initial search yielded articles twelve rcts ultimately selected methodological quality scores ranged points points scale range score findings studies compared dry needling sham placebo treatment provide evidence dry needling immediately decrease pain patients upper quarter mps effect favoring dry needling findings studies compared dry needling sham placebo treatment provide evidence dry needling decrease pain weeks patients upper quarter mps wide confidence interval effect limits impact effect findings studies compared dry needling treatments highly heterogeneous due variance comparison treatments evidence studies lidocaine injection effective reducing pain dry needling weeks conclusions based current evidence recommend grade dry needling compared sham placebo decreasing pain immediately treatment weeks patients upper quarter mps due small number high quality rcts published date additional designed studies needed inform future evolution recommendation level evidence therapy level a orthop sports phys ther epub june doi jospt treatment+injections+acupuncture+muscle pain+medicine+mind+controversy+debunkery+energy work+muscle+pain problems
4 article Hatala et al Variation in Foot Strike Patterns during Running among Habitually Barefoot Populations PLoS ONE This new study found some lifelong barefoot runners habitually heel striking. Gasp! The paper is very competently described by Gretchen Reynolds for the NY Times: “This finding adds to a growing lack of certainty about what makes for ideal running form.” (Brought do you by the Department of YA THINK?!) 2013 endurance running long evolutionary history hominin clade humans ran wearing shoes research modern habitually unshod runners suggested utilize biomechanical strategy runners wear shoes barefoot runners typically forefoot strike order avoid generating high impact forces experienced strike ground heels finding suggests habitually unshod ancestors run similar research conducted single population variation running form habitually barefoot people including effects running speed shown affect strike patterns shod runners present results investigation selection running foot strike patterns modern habitually unshod group daasanach northern kenya data collected consenting adults ran trackway plantar pressure pad midway length subjects ran selected endurance running sprinting speeds data support hypothesis forefoot strike reduces magnitude impact loading majority subjects rearfoot strike endurance running speeds percentages midfoot forefoot strikes increased significantly speed results habitually barefoot people prefer running forefoot strike suggest factors running speed training level substrate mechanical properties running distance running frequency influence selection foot strike patterns running+biomechanics+foot+exercise+self-treatment+treatment+etiology+pro+leg+limbs+pain problems
5 article Wright et al Diagnostic accuracy of scapular physical examination tests for shoulder disorders British Journal of Sports Medicine From the abstract: “no physical examination test of the scapula was found to be useful in differentially diagnosing pathologies of the shoulder.” 2013 objective systematically review critique evidence diagnostic accuracy physical examination tests scapula patients shoulder disorders methods systematic computerised literature search pubmed embase cinahl cochrane library databases database inception january keywords related diagnostic accuracy physical examination tests scapula quality assessment diagnostic accuracy studies tool critique quality paper results articles met inclusion criteria considered high quality high quality studies reference diagnosis shoulder pain high quality article referenced specific shoulder pathology acromioclavicular dislocation reported sensitivity scapular dyskinesis sick scapula test conclusions physical examination test scapula differentially diagnosing pathologies shoulder diagnosis+etiology+shoulder+biomechanics+chiropractic+pro+head/neck+manual therapy+treatment+controversy+debunkery+spine
3 webpage Reynolds Barefoot Running Can Cause Injuries, Too 2013 running+overuse injury+exercise+self-treatment+treatment+injury+pain problems
5 article Peters et al Proximal exercises are effective in treating patellofemoral pain syndrome International Journal of Sports Physical Therapy Patellofemoral pain syndrome (PFPS) is a common knee pain disorder of multifactoral origin which is often difficult to resolve. This review of the existing research looked for any particular type of exercise that stood out — namely, proximal exercises targeting muscles closer to the center of your body, like hip and trunk muscles; or knee exercises targeting muscles of the thigh (quadriceps and hamstrings). The authors evaluated only better quality studies studies that precisely defined what type of exercise they did. They found that proximal exercises consistently outperform knee exercises — in both the short and long term — for reducing pain and improving function in people with PFPS. The results were impressive: on average, knee strengthening programs led to a 37% decrease in pain, and 21% increase in function, while proximal (hip) strengthening programs led to a 65% decrease in pain, and a 38% increase in function! None of the studies included in the review were perfect, but such large effects are very encouraging. Not surprisingly, the authors of this review concluded: “physical therapists should consider using proximal interventions for treatment of patellofemoral pain.” 2013 background patellofemoral pain syndrome common disorder knee multifactorial aetiology multimodal treatment including exercise therapy shown effective treatment patellofemoral pain patients continue experience pain dysfunction treatment address research started investigate lumbo pelvic hip girdle patellofemoral pain purpose aim systematic review investigate effectiveness proximal exercises compared knee exercises patients patellofemoral pain improving pain function methods computer based search population patients patellofemoral pain intervention proximal hip lumbo pelvic exercises comparator knee exercises outcome reported pain functional questionnaire undertaken medline embase cinahl sportsdiscus cochrane library pedro searched studies published january january included studies appraised independently mcmaster critical review form quantitative studies data extracted exercise prescription applicable outcome measures descriptive analysis undertaken results studies randomized controlled trials clinical controlled trial cohort studies case series moderate high methodological quality met inclusion criteria proximal exercise programs showed consistent reduction pain function treatment patellofemoral pain knee exercise programs variable outcomes conclusion proximal interventions provide relief pain improved function short long term physical therapists proximal interventions treatment patellofemoral pain level evidence a patellar pain+exercise+treatment+arthritis+aging+pain problems+knee+leg+limbs+overuse injury+injury+running+self-treatment
4 article Kamper et al Kinesio taping for sports injuries British Journal of Sports Medicine This short paper is formal response to a meta-analysis of taping for sports injuries (Williams). It’s harshly critical:
Despite the title of the review, the authors do not report a meta-analysis of the included studies. … The review has several flaws, the most serious of which is selective reporting of outcomes. As only positive (significant) results are reported it is not possible to assess the entirety of the evidence for effectiveness of kinesio taping. In addition, while the authors report to have followed the methodological guidelines of the Cochrane Collaboration this does not appear to be the case. … Clinicians should look to other sources of information…
2013 kinesio taping beneficial effect pain compared sham treatment based studies healthy populations inconsistent results outcome measures rom strength muscle activity proprioception systematic review methodological limitations compromise reliability conclusions clinicians sources information determining apply intervention present appears high quality evidence assess effectiveness kinesio taping hoped future research clarify situation treatment+devices+running+exercise+self-treatment
3 article Rathleff et al Lower mechanical pressure pain thresholds in female adolescents with patellofemoral pain syndrome Journal of Orthopaedic & Sports Physical Therapy This study demonstrates that young women with patellofemoral pain syndrome have lowered mechanical (pressure) pain thresholds at the knee. Pain thesholds were also lower at a location slightly distant from the knee (lower on the shin). This supports the (quite novel) idea that altered pain processing — both at the site, as well as in the central nervous system — may be a driving factor in chronic patellofemoral pain. 2013 study design cross sectional study objectives compare pressure pain thresholds ppts adolescent females diagnosed patellofemoral pain syndrome pfps gender age matched controls musculoskeletal pain background pfps prevalent adolescents reduced ppt locally remotely site reported pain altered central processing nociceptive information investigated adolescents pfps methods adolescents pfps comparison group musculoskeletal pain recruited population based cohort students upper secondary schools aged years students age range invited answer online questionnaire musculoskeletal pain students reported knee pain contacted telephone offered clinical examination experienced rheumatologist diagnosis ppts measured sites knee site tibialis anterior female adolescents diagnosed pfps female adolescents musculoskeletal pain results adolescents pfps compared controls significantly ppts kpa sites knee suggesting localized hyperalgesia tibialis anterior adolescents pfps kpa ppt distal hyperalgesia compared controls conclusion findings suggest adolescent females pfps localized distal hyperalgesia findings implications treating pfps peripheral central mechanisms driving pain registered clinicaltrials gov nct patellar pain+etiology+neurology+chronic pain+arthritis+aging+pain problems+knee+leg+limbs+overuse injury+injury+running+exercise+self-treatment+treatment+pro
3 article Roush et al Prevalence of anterior knee pain in 18-35 year-old females International Journal of Sports Physical Therapy 2012 purpose background anterior knee pain akp patellofemoral pain syndrome pfps believed common young active females prevalence rate commonly cited literature rate anecdotal empirical purpose study estimate prevalence akp females years age methods cohorts females totaling participants years age participated study age participants years sd height cm sd weight kg sd bmi kg m sd participants completed anterior knee pain questionnaire akpq functional outcome tool developed document symptoms akp progress patients rehabilitation results score akpq left extremity sd sd extremity cutoff score akpq subjects classified akp left extremity prevalence ci subjects classified akp extremity prevalence ci conclusion estimated prevalence akp sample year females commonly cited results provide representation subjects akp level evidence patellar pain+etiology+arthritis+aging+pain problems+knee+leg+limbs+overuse injury+injury+running+exercise+self-treatment+treatment+pro
4 article Lankhorst et al Risk factors for patellofemoral pain syndrome Journal of Orthopaedic & Sports Physical Therapy The authors only included prospective studies in their review, which are studies that follow people over time — starting before they develop pain. This is a much better way of observing risk factors than the typical cross-sectional study design that could never say “which came first.” Out of 13 possible risk factors commonly studied, including numerous popularly blamed biomechanical factors, only knee extension (quadriceps) weakness stood out as a significant predictor of developing PFPS. 2012 study design systematic review objectives systematically outline risk factors patellofemoral pain syndrome pfps background pfps commonly diagnosed condition young individuals knee complaints high incidence athletes suggests possibility prevention step prevention identification risk factors methods prospective studies included patients pfps examined risk factor pfps included assessment list applied evaluate quality studies meta analysis conducted random effects model significant differences based calculated differences matching confidence intervals cis dichotomous data odds ratios relative risks calculated results potentially relevant articles included review studies examined total variables pooling potential risk factors pooled data showed knee extension peak torques significantly pfps group controls differences torque negative differences reflecting means pfps group standardized relative body weight ° nm ci standardized relative body weight ° nm ci standardized relative body mass index ° nm ci standardized relative body mass index ° nm ci nonstandardized concentric mode ° nm ci nonstandardized concentric mode ° nm ci conclusion weaker knee extension strength expressed peak torque appears risk factor pfps based meta analyses pooled results multiple studies risk factors pfps single studies additional risk factors conflicting evidence confirmed future studies level evidence prognosis level a etiology+biomechanics+patellar pain+pro+arthritis+aging+pain problems+knee+leg+limbs+overuse injury+injury+running+exercise+self-treatment+treatment
4 article Pappas et al Prospective Predictors of Patellofemoral Pain Syndrome Sports Health Many biomechanical causes for chronic anterior knee pain have been blamed, but usually only in cross-sectional studies that look at people who already have pain. This study reviewed only prospective research: studies of people don’t have pain at the start, and are followed over time to see who develops the condition. This way you can measure a bunch of things at the beginning and actually see what might matter in the long run! In this review, out of seven common scapegoats for PFPS — things like Q-angle, poor knee biomecanics when landing a jump, and obesity — the only one that seemed to definitely increase one’s risk of developing pain was weak knee extensor muscles (the quadriceps). 2012 context patellofemoral pain syndrome pfps common overuse injuries objective assess collective evidence predisposing factors pfps data sources medline june embase june cinahl june study selection studies included patients asymptomatic baseline testing free pfps prospectively development disorder studies assessed variable measured typical clinic included duplicates removed studies assessed titles abstracts full text met inclusion criteria data extraction data extracted age weight height sample size patient type military civilian follow periods diagnostic methods diagnostic criteria means standard deviations extracted outcome variables results meta analyses performed height weight leanness angle number sit ups knee extension strength peak knee valgus angle landing knee extension strength variable predictive pfps variables identified predictive pfps single studies vertical jump push ups knee flexion hip abduction strength thumb forearm flexibility quadriceps gastrocnemius flexibility genu varum navicular drop knee valgus moment initial contact landing social support palliative reaction conclusions appears anthropometric variables pfps knee extension strength deficits predictors pfps etiology+biomechanics+patellar pain+pro+arthritis+aging+pain problems+knee+leg+limbs+overuse injury+injury+running+exercise+self-treatment+treatment
3 article Steinberg et al Joint range of motion and patellofemoral pain in dancers Int J Sports Med 2012 aim present study determine association joint range motion rom patellofemoral pain syndrome pfps young female dancers study population included female dancers aged years dancers clinically examined current pfps joint rom measured lumbar spine extremities dancers experienced pfps prevalence syndrome increased dancer age patellar pain+etiology+arthritis+aging+pain problems+knee+leg+limbs+overuse injury+injury+running+exercise+self-treatment+treatment+pro
4 article Frye et al The effects of exercise on decreasing pain and increasing function in patients with patellofemoral pain syndrome Sports Health A review of studies of rest versus exercise for patellofemoral pain concluded that “exercise is the more effective treatment for immediate decrease in pain and increase in function….” which is great! They go on to say that “these differences appear to be less distinguishable over time,” but that’s probably not such bad news: it probably doesn’t mean the exercise effect fades away so much as people tend to eventually get better anyway. Thus, longer term studies can miss the beneficial effects of exercise. It appears exercise helps people recover a bit earlier. 2012 context exercise rest commonly prescribed treatment patellofemoral pain syndrome study selection study based level ii research studies examining effects exercise rest decreasing pain visual analog scale increasing function kujala scoring questionnaire human participants articles limited printed english pubmed september cinahl september sportdiscus september data extraction weighted aggregate effect sizes confidence intervals calculated means standard deviations extracted studies resulting analysis patients results large effect exercise patient reported functional outcomes perceived pain treated patients larger functional outcomes pain controls short term follow patients data sets studies revealed large effect functional outcomes pain patients performed exercise intervention study reported moderate effect sizes functional outcomes pain months postintervention conclusions exercise effective treatment decrease pain increase function differences distinguishable time treatment+exercise+patellar pain+self-treatment+arthritis+aging+pain problems+knee+leg+limbs+overuse injury+injury+running
4 article Pence et al Exercise speeds cutaneous wound healing in high-fat diet-induced obese mice Medicine & Science in Sports & Exercise 2012 purpose obesity shown impair cutaneous wound healing increased wound inflammation exercise decrease obesity inflammation shown speed cutaneous wound healing aged mice investigated treadmill exercise speed cutaneous wound healing obese high fat diet fed mice methods fed female c bl j mice high fat diet calories fat wk induce state obesity insulin resistance mice ran treadmill excisional wounding day mice wounded exercise mice exercised wounding healing assessed photoplanimetry results previously obesity impaired wound healing significantly larger wound sizes measured days day wounding exercise improve healing lean mice fed normal chow diet wound size significantly smaller exercised obese mice compared lean counterparts day day day wound surprisingly unable detect differences gene protein expression proinflammatory cytokines interleukin β tumor necrosis factor α anti inflammatory cytokine interleukin wounds differences gene expression chemokines monocyte chemoattractant protein keratinocyte chemoattractant growth factor platelet derived growth factor wounds exercise sedentary mice conclusion suggests effect exercise independent alterations inflammation future work focus early events wounding including exercise effects hemostasis myofibroblast function biology+exercise+inflammation+self-treatment+treatment+pain problems
4 article Fukuda et al Hip posterolateral musculature strengthening in sedentary women with patellofemoral pain syndrome Journal of Orthopaedic & Sports Physical Therapy This fairly good quality study of exercise for anterior knee pain was focussed on long term results. Fifty-four sedentary patients were tested. They that found knee stretching and strengthening exercises plus hip muscle strengthening was more effective than knee exercises alone for improving function and reducing pain…with the advantage sustained for at least a year. 2012 study design randomized controlled trial objectives determine adding hip strengthening exercises conventional knee exercise program produces long term outcomes conventional knee exercises women patellofemoral pain syndrome pfps background studies shown hip strengthening program reduces pain improves function individuals pfps clinical trials evaluating long term outcomes type program compared conventional knee strengthening stretching exercises methods fifty sedentary women years age diagnosis unilateral pfps randomly assigned knee exercise ke knee hip exercise khe women ke group age years performed week conventional knee stretching strengthening program women khe group age years performed exercises ke group strengthening exercises hip abductors lateral rotators extensors point numeric pain rating scale extremity functional scale anterior knee pain scale single hop test outcome measures baseline pretreatment months posttreatment results baseline demographic pain functional assessment data similar groups khe group higher level function pain months compared baseline patellar pain+exercise+treatment+arthritis+aging+pain problems+knee+leg+limbs+overuse injury+injury+running+self-treatment
3 article Nakagawa et al Frontal plane biomechanics in males and females with and without patellofemoral pain Medicine & Science in Sports & Exercise Research on the biomechanics of patellofemoral pain syndrome (PFPS), and almost any knee issue, has focus on movement in the "saggital plane" (looking at someone from the side). This study decided to investigate the "frontal plane" (looking at someone from the front) movements and how they may change in someone with PFPS during a stepping task. People with PFPS tended to have increased knee abduction (knock knees) throughout the motion, and greater trunk, pelvis and hip motion during the step down. Females were also a little weaker in the hips than males. Interestingly, this study seemed to show that PFPS indeed alters frontal plane biomechanics. No effect sizes were reported, however, so "how much different" remains a question, but the differences certainly exist. It's not surprising — if your knee hurts, you move differently! 2012 purpose study purpose compare trunk pelvis hip knee frontal plane biomechanics males females patellofemoral pain syndrome pfps stepping methods recreational athletes equally divided groups female pfps female controls male pfps male controls trunk pelvis hip knee frontal plane kinematics activation gluteus medius evaluated ° ° ° ° knee flexion downward upward phases stepping task isometric hip abductor torque evaluated results females showed increased hip adduction knee abduction knee flexion angles greater ipsilateral trunk lean contralateral pelvic drop ° knee flexion stepping task diminished hip abductor torque increased gluteus medius activation males pfps subjects presented increased knee abduction angles evaluated greater trunk pelvis hip motion ° knee flexion downward phase maneuver diminished gluteus medius activation ° knee flexion compared controls females pfps showed hip abductor torque compared groups conclusions females presented altered frontal plane biomechanics predispose knee injury pfps subjects showed frontal plane biomechanics increase lateral patellofemoral joint stress angles evaluated increase ° knee flexion downward phase maneuver hip abductor strengthening motor control training considered treating females pfps patellar pain+biomechanics+arthritis+aging+pain problems+knee+leg+limbs+overuse injury+injury+running+exercise+self-treatment+treatment+etiology+pro
3 article Iliadis et al The operative management of patella malalignment Open Orthop J This article surveyed the existing research on surgery for PFPS as of 2012. The authors conclude that the evidence of efficacy is generally poor for most surgical techniques techniques. This may be due to the research being poorly designed and populations studied being poorly described, but other evidence (e.g. Kettunen 2007 and Kettunen 2012) has shown that common surgeries doesn’t work. Some techniques might be promising in very specific situations, but a good rationale needs to be developed to justify going ahead with surgery, and better research needs to be produced to support it. 2012 management patellofemoral joint pathology challenging result unique complex organization static forces dynamic factors contributing functional capacity anterior knee pain common musculoskeletal complaint daily practices primary care physicians rheumatologists orthopedic surgeons key successful treatment lies correct diagnosis chondral defect importantly accurate identification pathomechanical factors appreciating pathoanatomic basis disease addressing imbalances anatomical abnormalities guide treatment complexity interplay components essential attempt describe patellar malalignement clinical entity order proceed surgical management successful outcomes goals patellofemoral alignment surgery create stable environment optimal extensor mechanism performance load transmission optimal cartilage wear joint loading context article review operative management patellofemoral malalignment indications surgery techniques evidence effectiveness large number procedures employed undergone modifications years majority publications retrospective series poorly defined population groups significant methodological inconsistencies result lack strong evidence base majority procedures surgery+patellar pain+treatment+arthritis+aging+pain problems+knee+leg+limbs+overuse injury+injury+running+exercise+self-treatment
3 article Chiu et al The effects of quadriceps strengthening on pain, function, and patellofemoral joint contact area in persons with patellofemoral pain Am J Phys Med Rehabil A small study of strength training for the knee showed that it improved pain and function in people with PFPS. Interestingly, they also noticed improvements in the biomechanics of the knee cap, and speculated that strength training somehow reduces the mechanical stress on the knee for the rest of the day. The study was too small to conclude anything about that, but it’s interesting. 2012 objective patellar malalignment major patellofemoral pain syndrome pfps relationship clinical symptoms patellar position knee muscle strength confirmed study examined effect weight training hip knee muscle strength patellofemoral joint contact area patellar tilt subjects pfps hoping develop optimal rehabilitation protocol subjects pfps design study prospective independent group comparison fifteen subjects pfps assessed knee strength patellofemoral joint contact area patellar tilt angle magnetic resonance imaging subjects pfps examined numeric pain rating score kujala patellofemoral score subjects performed limb weight training times wk wks outcomes assessed training results subjects pfps increased patellofemoral joint contact area weight training statistical significant change patellar tilt angle isometric isokinetic knee strength subjects pfps increased weight training increased numeric pain rating kujala patellofemoral score pfps group improved training conclusions weight training exercise increased knee muscle strength patellofemoral joint contact area reduce mechanical stress joint improving pain function subjects pfps patellar pain+exercise+treatment+arthritis+aging+pain problems+knee+leg+limbs+overuse injury+injury+running+self-treatment
3 article Jessee et al Bracing and taping techniques and patellofemoral pain syndrome Journal of Athletic Training This is a review of the results of five studies of bracing and taping for patellofemoral pain. All of them provided low quality but positive evidence: taping seemed to work at least a little, and better in combination with exercise. More evidence is certainly needed to confirm the benefit. No magic bullet here, but a cheap, easy and safe option to consider. 2012 partial abstract systematic review hondt al strength retrieved research based evidence effectiveness orthotic devices treatment patellofemoral pain syndrome graded grade trials quality methodologic evidence support reject effectiveness orthotics taping techniques reducing pain scientific evidence orthotics taping techniques hondt al identified trends orthotics taping techniques considered clinical practice comprehensive exercise stretching program tape application effective decreasing worst pain usual pain increasing functional improvement finding patellofemoral pain syndrome treated intervention addition difference apparent pain outcomes mcconnell taping technique couman bandage technique resolved pain protonics orthosis actively affected patellar tracking reducing internal rotation femur compression lateral aspect patella result protonics orthosis reduced pain compared treatment contrast couman bandage guide patellar tracking pattern massage structures patella motion home exercise program addition stretching program mcconnell taping decreased pain increased function suggest combination treatment approaches needed effectively treat condition previous studies patellar pain+treatment+self-treatment+devices+arthritis+aging+pain problems+knee+leg+limbs+overuse injury+injury+running+exercise
4 article Kettunen et al Knee arthroscopy and exercise versus exercise only for chronic patellofemoral pain syndrome British Journal of Sports Medicine This paper is a 5-year followup to Kettunen 2007, a study that compared the effects of surgery (arthoscopy) plus exercise (an 8 week home program) with exercise alone (same program), to see if surgery added any benefit. At the end of the that study, both groups improved significantly… but surgery did no better! Five years later, the groups were still the same: surgery didn’t help at all, short term or long. 2012 objective study long term outcome arthroscopy patients chronic patellofemoral pain syndrome pfps authors conducted randomised controlled trial authors investigated factors predicting outcome patients pfps methods fifty patients pfps randomised groups arthroscopy group treated knee arthroscopy week home exercise programme control group treated similar week home exercise programme primary outcome kujala score pain function year secondary outcomes visual analogue scales vass assess activity related symptoms results kujala score groups showed marked improvement year follow improvement ci arthroscopy group ci controls differences groups improvement kujala score group difference ci vas scores investigated factors predicted long term outcome cases treatment result immediately exercise programme remained similar year follow conclusion rct kind year outcome patients chronic pfps treated knee arthroscopy home exercise programme home exercise programme equally good groups patients groups long term symptoms treatment+surgery+patellar pain+arthritis+aging+pain problems+knee+leg+limbs+overuse injury+injury+running+exercise+self-treatment
2 article Opar et al Hamstring strain injuries Sports Medicine 2012 hamstring strain injuries hsis common number sports incidence rates declined times additionally high rate recurrent injuries suggests current understanding hsi injury risk incomplete multifactoral nature hsis agreed individual risk factors injury examined isolation review aims bring risk factors interventions hsis understand hsis prevalent running identified primary activity type hsis high eccentric forces moderate muscle strain hamstrings running factors considered part aetiology hsis exact hsis remain unknown eccentric contraction muscle strain purportedly play role accumulated muscle damage single injurious event contribute potentially factors interact varying degrees depending injurious activity type running kicking anatomical factors biarticular organization dual innervations biceps femoris bf fibre type distribution muscle architecture degree anterior pelvic tilt implicated variables impact hsi risk number mechanisms include increasing hamstring muscle strain altering susceptibility hamstrings muscle damage reported risk factors hsis include age previous injury ethnicity strength imbalances flexibility fatigue definitively previous injury increases risk future hsis interventions put place reduce incidence hsis addressing modifiable risk factors focused primarily increasing eccentric strength correcting strength imbalances improving flexibility response intervention programmes mixed varied levels success reported conceptual framework presented suggesting neuromuscular inhibition hsis impede rehabilitation process subsequently lead maladaptation hamstring muscle structure function including preferentially eccentric weakness atrophy previously injured muscles alterations angle peak knee flexor torque remains area future research practitioners remain aware multifactoral nature hsis injury rates decline strain+injury+pain problems+muscle
3 article Parr et al Pain-related fear and catastrophizing predict pain intensity and disability independently using an induced muscle injury model Journal of Pain The fear of pain was assessed in 126 brave volunteers with a questionnaire before — yikes — “inducing muscle injury to the shoulder.” (Don’t worry, nothing too awful for the subjects: they just did a workout with a lot of eccentric contraction that made them super sore.) The results were not what the researchers expected. This study is interesting because it found evidence that fear of pain before injury can predict recovery time. In other words: how well you respond to injury and recover is affected enough by fear that it can actually be predicted by measuring fear before hand. That’s profound. 2012 timing assessment psychological construct controversial results differ based model pain induction previous studies exercise induced injury model investigate timing psychological assessment exercise induced injury models investigations approximate clinical pain conditions experimental stimuli study examined psychological constructs time determined timing assessment affected construct association reports pain intensity disability twenty healthy volunteers completed fear pain questionnaire fpq iii pain catastrophizing scale pcs tampa scale kinesiophobia tsk prior inducing muscle injury shoulder pcs tsk measured hours postinjury induction pain intensity disability collected hours served dependent variables separate regression models results fpq iii strongest prediction pain intensity baseline hours baseline pcs tsk stronger predictors pain intensity disability data provide support psychological constructs predicting outcomes shoulder pain deviate current theoretical model indicating fear pain consequence injury suggests fear pain injury influence reports pain intensity perspective current study evidence fear pain assessed prior injury supports injury pain catastrophizing kinesiophobia independently pain disability data suggest timing psychological assessment important consideration clinical environments chronic pain+mind+neat+pain problems
4 article Jackson et al Botulinum toxin A for prophylactic treatment of migraine and tension headaches in adults Journal of the American Medical Association This review of many scientific studies found that having Botox injections for chronic daily headaches or migraines was only slightly more beneficial than using a placebo. Not dramatic results at all. Disappointing, in fact, after years of believing that Botox was “probably” a good evidence-based option for migraine. Sigh. 2012 context botulinum toxin food drug administration approved prophylactic treatment chronic migraines objective assess botulinum toxin prophylactic treatment headaches adults data sources search medline embase bibliographies published systematic reviews cochrane trial registries march inclusion exclusion criteria study reviewed headaches categorized episodic treatment+headache+medications+injections+head+head/neck+pain problems+self-treatment+medicine
3 article Cohen et al Epidural steroids, etanercept, or saline in subacute sciatica Annals of Internal Medicine This small, six-month study attempted to find out if injections of epidural steroids would help those who suffered from low back pain, specifically from sciatica. Researchers concluded that steroid injections “may provide modest short-term pain relief for some adults” but more follow-up studies are necessary to confirm this. 2012 background perineural inhibitors tumor necrosis factor generated intense interest alternative epidural steroid injections lumbosacral radiculopathy objective evaluate epidural steroids etanercept saline improves pain function adults lumbosacral radiculopathy design multicenter group randomized placebo controlled trial conducted randomization computer generated stratified site pharmacists prepared syringes patients treating physicians nurses assessing outcomes blinded treatment assignment clinicaltrials gov registration number nct setting military civilian treatment centers patients adults lumbosacral radiculopathy months duration intervention epidural injections steroids etanercept saline mixed bupivacaine separated weeks measurements primary outcome measure leg pain month injection patients month follow visits patients condition improved remained blinded month study period results group received epidural steroids greater reductions primary outcome measure received saline difference ci etanercept difference ci pain smaller differences favoring steroids compared saline difference ci etanercept difference ci observed largest differences noted functional capacity etanercept fared worse treatments steroids etanercept difference ci steroids saline difference ci etanercept saline difference ci patients treated epidural steroids reported greater leg pain relief positive global perceived effect month received saline etanercept limitation short term follow small sample size possibly subtherapeutic dose etanercept conclusion epidural steroid injections provide modest short term pain relief adults lumbosacral radiculopathy larger studies longer follow needed confirm benefits treatment+medications+injections+back pain+self-treatment+medicine+pain problems+spine
3 article Jansson et al Sickness absence because of musculoskeletal diagnoses and risk of all-cause and cause-specific mortality Pain Can pain shorten your life? A large Swedish study of four million Swedes looked for a correlation between increased mortality and work absenteeism due to painful musculoskeletal conditions. They found the first ever evidence that people who have musculoskeletal pain may have “an increased risk of premature death.” The researchers adjusted their data for “several potential confounders.” It’s a plausible and disturbing conclusion. The costs of pain are often expressed in terms of hair-raising stats on the economics of work absenteeism — but they may be much greater still. 2012 knowledge mortality potential consequence sickness absent musculoskeletal diagnoses nonexistent association sickness absence musculoskeletal diagnoses risk premature death examined prospective nationwide population based cohort study based swedish registers included individuals living sweden december aged years disability age pension sickness absent musculoskeletal diagnoses compared sickness absent musculoskeletal diagnoses sickness absence musculoskeletal diagnoses categorized artropathies systemic connective tissue disorders dorsopathies soft tissue disorders osteopathies chondropathies musculoskeletal disorders mortality specific mortality hazard ratios hrs confidence intervals cis estimated regression models adjusted socio demographic factors morbidity sickness absence categories musculoskeletal diagnoses fold increased risks mortality adjusted model category diagnoses hr ci similar associations observed women men increased mortality risks due tumors hr circulatory diseases hr mental disorders hr suicide hr observed persons sickness absent musculoskeletal diagnoses nationwide cohort study reveals time increased risk premature death women men sickness absent musculoskeletal diagnoses adjustment potential confounders fun+chronic pain+neck+back pain+pain problems+head/neck+spine
3 article Trost et al Pain-related fear predicts reduced spinal motion following experimental back injury Pain The findings of this study suggest that individuals will avoid spinal motions during a simple reaching activity if there is reason to believe it will cause pain. Thus, fearing pain may be a risk factor for future pain and disability. 2012 current study examined prospective relationship pain related fear altered motor behavior perceived interference healthy participants induction delayed onset muscle soreness doms trunk extensor muscles healthy participants history pain completed standardized reaches high targets paced rapid speeds induction acute pain doms paradigm pain related fear assessed prior doms induction dimensional joint motions thoracic spine lumbar spine hip recorded electromagnetic tracking device doms induced differences high fear participants observed lumbar spine flexion thoracic hip flexion pain related fear scores predictive lumbar flexion baseline predicted reduced lumbar flexion fast paced trials target locations doms induced pain related fear predictive perceived interference life activities doms induction findings suggest initially pain free individuals high pain related fear adopt avoidant spinal strategies common reaching movements shortly injury sustained comprise risk factor future pain disability etiology+mind+chronic pain+back pain+pro+pain problems+spine
3 article Johnson et al Spinal motor control differences between the sexes European Journal of Applied Physiology Why is knee trouble more common in women than men? Researchers measured neurological control of the soleus muscle in 17 males and 17 females. They found that “recurrent inhibition, a post-synaptic regulator of force output, was greater in males.” In other words, men’s muscle usage is more explosive, like a sprinter, while women use their calves more like an endurance-trained athlete. 2012 activity related knee joint dysfunction prevalent females males explanation discrepancy differences movement patterns sexes underlying mechanisms responsible differences remain unidentified study tested spinal motor control mechanisms influencing motor neuron pool output subsequent muscle activation males females variables assessed soleus gain unconditioned reflex gain intrinsic pre synaptic inhibition ipi extrinsic pre synaptic inhibition epi level recurrent inhibition ri level supraspinal drive determined ratio max max wave electromechanical delay emd rate force development rfd wilks lambda multivariate test differences groups significant     univariate subjects tests revealed males greater ri     sexes differ variables tested conclusion sexes differ modulation spinal motor control specifically ri post synaptic regulator force output greater males etiology+exercise+biomechanics+knee+patellar pain+pro+self-treatment+treatment+leg+limbs+pain problems+arthritis+aging+overuse injury+injury+running
3 article Lyby et al Induced fear reduces the effectiveness of a placebo intervention on pain Pain Pain and fear, it seems, go together, and even a placebo will not change that. Thirty-three subjects who were already in pain were told that they were going to receive electric shock, but they were then given a placebo analgesic to see if the pain would be reduced. The placebo did not help, and the most fearful subjects felt the most pain. 2012 fear induced anticipation electric shock order investigate fear reduced effectiveness placebo intervention reported pain acoustic startle reflex subjects participated condition natural history nh placebo placebo+fear pf × test pretest posttest posttest subject design tested separate days measures fear fear pain fop measured fear pain questionnaire fpq iii fear potentiated startle report measure assessed effectiveness fear induction procedure pain intensity data trend placebo effect trend abolished induced fear pronounced subjects highest measures fear placebo manipulation caused reduction startle reflex amplitude effect abolished induced fear strongest high fop subjects conclusion induced fear abolished placebo analgesia effect strongest subjects high scores measures fear mind+chronic pain+etiology+pain problems+pro
3 article Höfle et al Viewing a needle pricking a hand that you perceive as yours enhances unpleasantness of pain Pain From childhood, we believe that anything sharp that penetrates the skin will hurt. This study tried to find out if that perception could be changed. Does it matter what the doctor says before giving you an injection? Participants watched a video clip of either a needle prick or a Q-tip touch on what they thought was their own hand. At the same time, painful or nonpainful electrical stimuli was applied. Pupil dilation responses were monitored, as well as asking participants how painful it felt. “Intensity ratings of electrical stimuli were higher when a clip was associated with expectation of painful compared to nonpainful stimuli, suggesting that situational expectations about forthcoming pain bias perceived intensity.” In other words, information given prior to an injection will effect how much pain the person feels. 2012 hurt commonly heard advice receiving injection implies observing needle pricks enhances pain perception lives repeatedly learn sharp objects pain penetrating skin situational expectations information clinician prior injection influence viewing needle pricks affects forthcoming pain previous experiences acute situational expectations related viewing needle pricks modulate pain perception unknown presented participants video clips hand perceived pricked needle touched tip concurrently applying painful nonpainful electrical stimuli intensity unpleasantness ratings pupil dilation responses monitored effects situational expectations strength electrical stimuli investigated manipulating contingency clips electrical stimuli experimental blocks participants explicitly informed contingency intensity ratings electrical stimuli higher clip expectation painful compared nonpainful stimuli suggesting situational expectations forthcoming pain bias perceived intensity unpleasantness ratings pupil dilation responses higher participants viewed needle prick compared viewed tip touch suggesting previous experiences viewing needle pricks primarily act perceived unpleasantness remote painful experiences viewing needle pricks information prior injection differentially shape impact viewing needle prick pain perception etiology+mind+chronic pain+pro+pain problems
3 article Maigne et al Lower back pain and neck pain Ann Phys Rehabil Med Researchers tested two (presumably expert) examiners to see if they could detect the painful side of the neck or back by touch alone, feeling for tension in the spinal muscles. In almost two hundred patients, they identified the correct side of 65% of lower back pain and 59% of neck pain — only slightly better than chance. An odd anomaly occurred in the difference between the left and right side: the examiners were more accurate on the right side with back pain, but better on the left side with neck pain. The results are underwhelming. Although they did a little better than just guessing, the results suggest that it’s difficult even for expert examiners to detect the location of neck and back pain by feel. As well, they were only attempting to detect the side of pain. Imagine how much worse their performance would have been if they had had to identify the location more precisely, or if the pain could have been anywhere or nowhere. So they barely passed the easiest possible test, and probably would have failed a harder one and done no better than guessing. An obvious weakness of the study is that only two examiners (of unknown skill) were tested, and so the results are inconclusive. One would still hope for a better detection, though, even from professionals with only average examination skills. 2012 objectives pain attributed increased tension muscles tension primary related disc facet pathology hypothesized pain neck pain unilateral muscle tension pronounced painful side detected palpation apply pain triggering manoeuvres methods patients unilateral neck pain enrolled study participants scoliosis obesity history spinal surgery pain radiating knee elbow excluded patients examined comparative muscle palpation examiner unaware body side painful patient told remain silent spinal muscles examined bilaterally superficial deep palpation examiner determine side tension greater patients age body mass index time onset symptoms rolland morris pain indic neck pain functional disability questionnaire scores recorded results patients unilateral pain males females ±sd age ± yrs patients unilateral neck pain males females ± yrs enrolled study pain neck pain sided cases examiners correctly identified painful side cases pain significantly percentage chance cases neck pain pain patients results side pain left side pain correct answers ns neck pain patients results left side pain side pain ns significant differences examiners respective performance levels patients clinical parameters influence successful detection painful side conclusion findings suggest palpation detect increased muscle tension limited proportion cases neck+massage+fun+back pain+head/neck+spine+manual therapy+treatment+pain problems
3 article Macdonald et al An Acute Bout of Self Myofascial Release Increases Range of Motion Without a Subsequent Decrease in Muscle Activation or Force Journal of Strength & Conditioning Research In this study, foam rolling was put the test… barely. Foam rolling is a popular form of self-massage using a firm foam tube. This relatively straightforward experiment is more a test of massage (“self-myofascial release”) than “foam rolling” per se. However, because foam rolling is often used in a sports massage context, the study focussed on muscle function and joint range of motion. A small group of healthy, active men used a foam roller application on their quadriceps to see of their knee range of motion would increase. It seemed to do so by as much as 8%, ten minutes after the activity. The researchers concluded that “an acute bout of SMR of the quadriceps was an effective treatment to acutely enhance knee joint range of motion” — but measuring only 10 minutes after the activity, these results seem less than exciting. And it was hardly a perfect study. Greg Lehman points out several key flaws: (1) the control group was not a true therapeutic control group, (2) the warm up was not consistent with standard practice, (3) the experimenters were not blind to the interventions, (4) the ROM testing was too subjective. The significance of this paper was so well summarized by Jason Silvernail, PT, that it’s worth quoting him in full:

Here’s a small study about foam rolling in typical exercise science style: done on a very small number of healthy people. It’s an important first step, but the size of the study and it’s design limits what we conclusions we can draw. My prediction is that those who love foam rolling will talk about this like this is a big deal. It’s not.

Anyone who says “foam rolling works and this study supports it” is demonstrating their inability to appraise research well. Anyone who says “foam rolling doesn’t work and this study shows it’s useless” is also demonstrating that inability as well as their bias against this tool. The only rational response is a shrug and an acknowledgement that this is only a first step and that the core clinical claims for rolling remain unlikely from a mechanism standpoint and untested/unproven fom a clinical research standpoint.

2012 foam rolling thought improve muscular function performance overuse joint range motion rom empirical evidence demonstrating objective study determine effect myofascial release smr foam roller application knee extensor force activation knee joint range motion eleven healthy male height ± cm mass ± kg age ± years subjects physically active participated subjects quadriceps maximum voluntary contraction force evoked force activation knee joint rom measured prior minutes minutes conditions minute trials smr quadriceps foam roller smr control anova condition time repeated measures performed dependent variables recorded pre post condition tests significant differences conditions neuromuscular dependent variables foam rolling subjects rom significantly ρ increased minutes significant ρ negative correlation subjects force rom prior foam rolling longer existed foam rolling conclusion acute bout smr quadriceps effective treatment acutely enhance knee joint range motion concomitant deficit muscle performance treatment+massage+knee+devices+biomechanics+IT band pain+patellar pain+manual therapy+leg+limbs+pain problems+etiology+pro+overuse injury+injury+running+exercise+self-treatment+tendinosis+arthritis+aging
4 article Mathieu et al Misleading abstract conclusions in randomized controlled trials in rheumatology Joint Bone Spine Researchers determined that almost 25% of abstracts have misleading conclusions … and even more so if you look only at studies with negative results, where the rate of misleading conclusions jumps to an alarming 45%. That is, study abstracts clearly tend to make the evidence sound more positive than it is. And of course that’s all that most people ever read. None of this is really surprising — if anything, I’m surprised it isn’t worse — but it is useful to have some hard data about it. See also some entertaining commentary by Neil O’Connell for 2012 introduction readers scientific articles read abstract conclusions lack time access full length articles objectives assess prevalence misleading conclusions abstracts randomized controlled trials rcts rheumatology determine trials registered abstract conclusions based primary outcome po identify predictors misleading abstract conclusions methods searched medline embase cochrane collaboration reports rcts assessing rheumatoid arthritis osteoarthritis spondylarthropathies published january  april  abstract conclusions misleading po reported conclusion conclusions based secondary outcome subgroup results results conclusions disagreement negative results suggested equivalent discussion benefits risks cases adverse events results  reports selected focused  articles clear po twenty reports contained misleading conclusions lack po reporting conclusions disagreeing article results frequent reasons nineteen declared study registration clear similar registered published pos misleading abstract conclusions reports negative results showed higher frequency misleading conclusions assessing osteoarthritis multivariable analysis negative results predicted misleading abstract conclusions conclusions quarter rct rheumatology misleading conclusions abstract negative results biology+bad science+scientific medicine+research+pro
3 article Lieberman What we can learn about running from barefoot running Exercise & Sport Sciences Reviews Lieberman summarizes his thoughts about barefoot running in this paper. “Barefoot running raises more questions about injury than we have answers at the moment … We simply do not yet know if experienced barefoot runners have fewer injuries than habitually shod runners.” 2012 barefoot running people ran millions years opportunity study natural selection adapted human body run humans evolved run barefoot barefoot running style minimizes impact peaks increased proprioception foot strength hypothesized avoid injury wearing shoes exercise+orthotics+running+barefoot+biomechanics+self-treatment+treatment+foot+leg+limbs+pain problems+devices+etiology+pro
1 article Guimond et al Intricate correlation between body posture, personality trait and incidence of body pain PLoS ONE The researchers looked for correlations between personality traits, postures and pain. They claim that “overall, our studies establish a novel correlative relationship between personality, posture, and pain,” but the paper is sloppy to the point of being useless. There are many red flags here. For instance, words like “overall” in that context are usually code for “we know it could be easily questioned, but in our opinion our data confirms our beliefs.” The main text kicks off with a clearly stated assumption that posture is a factor in pain. Two footnotes provided for this premise are vivid examples of particularly Bogus Citations (specifically “the curve ball” and “the backfire”). This kind of quality is generally typical of “posturology” papers. 2012 objective occupational pain disorder commonly affects working population resulting disability health care utilization heavy socioeconomic burden etiology occupational pain remains largely unsolved anecdotal evidence exists contribution personality posture long term pain management pointing direct contribution mind body axis current study conducted extensive evaluation relationships posture personality method sampled random population subjects men women age range years based personality biomechanical profiles subjects french canadian living canada québec sorel tracy areas biotonix analyses report subjects tested order distinguish postural deviations personality determined myers briggs type indicator questionnaire results establish correlation ideal kyphosis lordosis postures extraverted personalities conversely studies establish correlative relationship flat sway postures introverted personalities conclusion studies establish correlative relationship personality posture pain treatment+mind+biomechanics+back pain+etiology+pro+pain problems+spine
3 article Vance et al Effects of transcutaneous electrical nerve stimulation on pain, pain sensitivity, and function in people with knee osteoarthritis Physical Therapy Researchers tested transcutaneous electrical nerve stimulation (TENS) on 75 arthritic knee patients. They were given a high or low frequency stimulation or a placebo. Several different measurements of pain were taken before and after, such as resting pain and pressure tolerance. Pressure tolerance and an activity test improved a bit, but the effects were nil or trivial by all other measures. The researchers concluded that there is “a strong placebo component” to the effect of this type of treatment. (Ya think?) 2012 background transcutaneous electrical nerve stimulation tens commonly management pain effects pain function measures unclear objective purpose study determine effects high frequency tens hf tens frequency tens lf tens outcome measures pain rest movement evoked pain pain sensitivity people knee osteoarthritis design study double blind randomized clinical trial setting setting tertiary care center participants seventy participants knee osteoarthritis men women years age assessed intervention participants randomly assigned receive hf tens hz lf tens hz placebo tens pulse duration microseconds intensity motor threshold measurements measures assessed single tens treatment cutaneous mechanical pain threshold pressure pain threshold ppt heat pain threshold heat temporal summation timed amp test tug pain intensity rest tug linear mixed model analysis variance compare differences tens groups hf tens lf tens placebo tens results compared placebo tens hf tens lf tens increased ppt knee hf tens increased ppt tibialis anterior muscle effect cutaneous mechanical pain threshold heat pain threshold heat temporal summation pain rest tug significantly reduced hf tens lf tens placebo tens limitations study tested single tens treatment conclusions hf tens lf tens increased ppt people knee osteoarthritis placebo tens significant effect ppt cutaneous pain measures unaffected tens subjective pain ratings rest movement similarly reduced active tens placebo tens suggesting strong placebo component effect tens knee+TENS+arthritis+leg+limbs+pain problems+devices+treatment+aging
3 article Landau et al Exertional rhabdomyolysis Journal of Clinical Neuromuscular Disease 2012 review clinical laboratory features exertional rhabdomyolysis er discussed detail emphasizing full clinical spectrum physiological elevations serum creatine kinase exertion life threatening rhabdomyolysis acute kidney injury systemic complications laboratory markers diagnose er rhabdomyolysis sensitive specific imperfectly distinguish subclinical asymptomatic severe life threatening illness genetic factors recognized discovered influence diverse clinical spectrum disease response exercise genetic mutations causative mcardle disease carnitine palmitoyl transferase deficiency myoadenylate deaminase deficiency malignant hyperthermia er polymorphic variations myosin light chain kinase α actin creatine kinase muscle isoform angiotensin converting enzyme heat shock protein interleukin genes er exercise induced serum creatine kinase elevations typical er prognosis er significantly etiologies rhabdomyolysis risk recurrence initial episode unknown guidelines management etiology+pro
3 article Telfer et al Computer-aided design of customized foot orthoses Archives of Physical Medicine & Rehabilitation Foot orthotics are made from basic measurements and captured images of the foot (plaster casting, foam box impressions, or three-dimensional computer images). None of these techniques is very accurate (<80%), especially with measuring the peak arch height. Skilled 3D computer imaging may be the most accurate. Basic measurement is particularly inaccurate. 2012 objective determine number techniques obtain foot shape based plaster casting foam box impressions dimensional scanning effect technique reproducibility custom foot orthoses fos terms inter intracaster reliability reproducibility fo design computer aided design cad software terms inter intra cad operator reliability techniques design cross sectional study setting university laboratory participants convenience sample individuals noncavus foot types interventions applicable main outcome measures parameters fo design length width forefoot width rearfoot peak medial arch height forefoot rearfoot angle foot shape volume match device designs results intra intercaster reliability methods obtaining foot shape methods fell reproducibility quality threshold medial arch height device volume matching variables exception forefoot rearfoot angle volume matches devices conclusions techniques obtaining foot shape met criteria excellent reproducibility peak arch height variable additional variability added cad stage fo design process adequate operator experience good excellent reproducibility achieved stage basic linear angular measurement parameters device fail fully capture variability fo design treatment+orthotics+devices+biomechanics+foot+leg+limbs+pain problems+self-treatment+etiology+pro
3 article McMillan et al Ultrasound guided corticosteroid injection for plantar fasciitis British Medical Journal This test of 82 cases of plantar fasciitis treatment showed that a single ultrasound-guided corticosteroid injection will probably give temporary pain relief … but the relief is unlikely to last beyond four weeks. In other words, this is good evidence that steroids are an effective temporary treatment, but they definitely do not actually solve the problem. 2012 objective investigate effectiveness ultrasound guided corticosteroid injection treatment plantar fasciitis design randomised investigator participant blinded placebo controlled trial setting university clinic melbourne australia participants people clinical ultrasound diagnosis plantar fasciitis unrelated systemic inflammatory disease interventions participants randomly allocated ultrasound guided injection plantar fascia ml mg ml dexamethasone sodium phosphate experimental group ml normal saline placebo injection participants ultrasound guided posterior tibial nerve block lidocaine lignocaine main outcome measures primary outcomes pain measured foot health status questionnaire point scale plantar fascia thickness measured ultrasound weeks results reduction pain weeks favoured dexamethasone group points confidence interval group differences pain scores weeks statistically significant plantar fascia thickness measured weeks favoured dexamethasone group mm confidence interval weeks group differences plantar fascia thickness favoured dexamethasone mm mm number needed treat dexamethasone successful outcome pain weeks confidence interval reported adverse events intervention conclusion single ultrasound guided dexamethasone injection safe effective short term treatment plantar fasciitis greater pain relief placebo weeks reduces abnormal swelling plantar fascia months clinicians offering treatment note significant pain relief continue weeks treatment+plantar fasciitis+inflammation+injections+foot+leg+limbs+pain problems+overuse injury+injury+tendinosis+medicine
3 article Abbassian et al Proximal medial gastrocnemius release in the treatment of recalcitrant plantar fasciitis Foot & Ankle International 2012 background isolated gastrocnemius contracture implicated number foot ankle conditions plantar fasciitis pf condition secondary altered foot biomechanics result gastrocnemius contracture paper report results isolated release proximal medial head gastrocnemius recalcitrant pf methods prospectively consecutive series heels patients proximal medial gastrocnemius release pmgr pf diagnosed clinically confirmed radiologically cases included ~year conservative treatment isolated gastrocnemius contracture confirmed clinically silfverskiold test preoperatively outcome measures included point likert scale subjective objective calf weakness assessments final followup average range months surgery results seventeen heels reported total significant pain relief surgery reported worsening symptoms majority subjective objective evidence calf weakness `major complications case suffered `minor complication conclusion pmgr simple treating patient pf failed respond conservative management series results favorable recovery fast morbidity treatment+surgery+plantar fasciitis+foot+running+overuse injury+leg+limbs+pain problems+injury+tendinosis+exercise+self-treatment
3 article Castrillon et al Comparison of glutamate-evoked pain between the temporalis and masseter muscles in men and women Pain Pain-inducing injections into two different chewing muscles showed two key results: women found it much more painful than men, and the temporalis muscle causes a lot more pain referral than the masseter. 2012 pain myofascial temporomandibular disorder tmd affect masseter temporalis muscles glutamate injection masseter muscle evokes pain greater men women pain attenuated injection methyl aspartate nmda receptor antagonist ketamine mmol men animal studies suggested pain induced peripheral nmda receptor activation differ temporalis masseter muscles men women study aims investigate differences glutamate evoked pain muscles effectiveness ketamine attenuate glutamate evoked pain genders pain mechanical sensitivity induced sessions experiment women men repeated injections glutamate mol ketamine mmol masseter temporalis muscles injections applied masseter muscle injections anterior temporalis muscle session visual analogue scale vas pain intensities pain drawing areas assessed glutamate evoked pain pain drawing area significantly greater temporalis muscle masseter muscle treatment+head+chronic pain+injections+head/neck+pain problems+medicine
4 article Crane et al Massage therapy attenuates inflammatory signaling after exercise-induced muscle damage Science Translational Medicine This study is the source of a new massage myth that massage reduces inflammation. Inspired by the doubtful notion that “massage may relieve pain in injured muscle” after intense exercise, researchers looked for changes in the proteins that cells constantly make (“gene expression”). They compared muscle tissue samples with and without massage and concluded that “massage therapy appears to be clinically beneficial by reducing inflammation and promoting mitochondrial biogenesis.” Massaged muscle was found to be producing different amounts of five protein related to inflammation and promoting the growth of mitochondria (cell power plants). It was an interesting, technically demanding, and worthwhile experiment, and it’s nifty that there was any difference in gene expression in massaged muscle. Unfortunately, the results of this study were actually negative: the data showed that massage has no significant effect on gene expression in muscle cells. There are several major problems with the study: the sample size was extremely small; the number of changes they found was trivial (and dwarfed by what exercise causes); the size of the differences was barely statistically significant—and short-lived, too; they measured genetic “signals” and not actual results, and guessed about their meaning; and we already know from clinical trials that massage doesn’t work any miracles for soreness after exercise, so what is there for the data to “explain”? Despite all of these problems, the results were spun as an explanation for how massage works in general — in the paper itself, the abstract, the journal’s summary, the press release, and interviews. Consequently, the results have been widely reported and discussed as if it is now a scientific fact that massage actually does reduce pain and promote recovery, and the only question was “how?” It’s a debacle. For a much more detailed analysis, see Massage does not reduce inflammation and promote mitochondria, or a more technical analysis by Dr. David Gorski at, Does massage therapy decrease inflammation and stimulate mitochondrial growth?. 2012 massage therapy commonly physical rehabilitation skeletal muscle ameliorate pain promote recovery injury evidence massage relieve pain injured muscle massage affects cellular function remains unknown assess effects massage administered massage therapy treatment separate quadriceps young male participants exercise induced muscle damage muscle biopsies acquired quadriceps vastus lateralis baseline immediately min massage treatment hour period recovery massage activated mechanotransduction signaling pathways focal adhesion kinase fak extracellular signal regulated kinase erk potentiated mitochondrial biogenesis signaling nuclear peroxisome proliferator activated receptor γ coactivator α pgc α mitigated rise nuclear factor κ nfκ p nuclear accumulation caused exercise induced muscle trauma effect muscle metabolites glycogen lactate massage attenuated production inflammatory cytokines tumor necrosis factor α tnf α interleukin il reduced heat shock protein hsp phosphorylation mitigating cellular stress resulting myofiber injury summary administered skeletal muscle acutely damaged exercise massage therapy appears clinically beneficial reducing inflammation promoting mitochondrial biogenesis treatment+movement+self-treatment+exercise+chronic pain+massage+pain problems+manual therapy
3 article Cook et al Is compressive load a factor in the development of tendinopathy? British Journal of Sports Medicine “This paper examines the potential role of compressive loads in the onset and perpetuation of tendinopathy, and reviews the anatomical, epidemiological and clinical evidence that supports consideration of compressive loads in overuse tendinopathy.” 2012 tendons designed tensile load excessive load overuse tendinopathy overuse tendinopathy results extensive cells extracellular matrix resulting activated cells increase large proteoglycans breakdown collagen structure pathological areas fibrocartilaginous metaplasia mechanotransduction models suggest response due compressive load load management cornerstone treating overuse tendinopathy defining effect tensile compressive loads important optimising clinical management tendinopathy paper examines potential role compressive loads onset perpetuation tendinopathy reviews anatomical epidemiological clinical evidence supports consideration compressive loads overuse tendinopathy etiology+treatment+tendinosis+pro+pain problems+overuse injury+injury
3 article Callaghan et al Effects of Patellar Taping on Brain Activity During Knee Joint Proprioception Tests Using Functional Magnetic Resonance Imaging Physical Therapy This simple study of brain activity is small and un-powerful, but it also isn’t trying to prove much: just that “patellar taping modulates brain activity in several areas of the brain during a proprioception knee movement task.” This tends to support the notion that taping changes how the knee feels, at least temporarily, which may in turn have an effect on pain. 2012 background patella taping common treatment modality physical therapists treating patellofemoral pain mechanisms action remain unclear debate efficacy due change patellar alignment alteration sensory input objective investigate sensory input hypothesis functional magnetic resonance imaging fmri taping applied knee joint proprioception task design observational study patellar taping intervention participants methods healthy leg dominant male volunteers participated motor block design study performed knee extension repetitive movement tasks simple proprioceptive tasks performed patellar taping auditorally paced beats min hz results proprioception task patellar tape caused positive blood oxygenation level dependant bold response bilaterally medial supplementary motor area sma cingulate motor area cma basal ganglion bg thalamus medial primary sensory motor cortex sm proprioception task patellar tape decreased bold response regions lateral primary sensory cortex s negative bold response activity proprioception task tape limitations study limited small sample size learning effect due random order tasks single joint knee extension task conclusion study demonstrated patellar taping modulates brain activity areas brain proprioception knee movement task patellar pain+treatment+devices+etiology+biology+arthritis+aging+pain problems+knee+leg+limbs+overuse injury+injury+running+exercise+self-treatment+pro
3 article Büssing et al Effects of yoga interventions on pain and pain-associated disability Journal of Pain The bottom line: “This meta-analysis suggests that yoga is a useful supplementary approach with moderate effect sizes on pain and associated disability.” 2012 searched databases controlled clinical studies performed meta analysis effectiveness yoga interventions pain disability randomized studies reported single blinding higher methodological quality studies randomized blinded moderate quality nonrandomized studies quality studies yoga treat patients pain studies treat rheumatoid arthritis studies treat patients headache migraine studies enrolled individuals indications studies reported positive effects favor yoga interventions respect pain random effect meta analysis estimated treatment effect smd ci treatment effect smd ci pain related disability limitations evidence yoga pain disorders hints short term interventions effective large scale studies identify patients benefit respective interventions perspective meta analysis suggests yoga supplementary approach moderate effect sizes pain disability chronic pain+treatment+self-treatment+stretch+exercise+pain problems+muscle
3 article Drdla-Schutting et al Erasure of a spinal memory trace of pain by a brief, high-dose opioid administration Science According to this study, “Opioids thus not only temporarily dampen pain but may also erase a spinal memory trace of pain.” This could imply a protective effect against central sensitization (pain oversensitivity). Hardly proof of anything, but certainly intriguing, and a nice rare bit of optimistic news about opioids. 2012 painful stimuli activate nociceptive fibers induce synaptic long term potentiation ltp spinal terminals ltp fiber synapses represents cellular model pain amplification hyperalgesia memory trace pain μ opioid receptor agonists exert powerful reversible depression fiber synapses renders continuous application opioid doses gold standard pain therapy discovered application high opioid dose reversed forms activity dependent ltp fiber synapses depotentiation involved ca + dependent signaling normalization phosphorylation state α amino hydroxy methyl isoxazolepropionic acid receptors reversed hyperalgesia behaving animals opioids temporarily dampen pain erase spinal memory trace pain etiology+back pain+chronic pain+treatment+medications+pro+pain problems+spine+self-treatment
4 article Bronfort et al Spinal manipulation, medication, or home exercise with advice for acute and subacute neck pain Annals of Internal Medicine This reasonably well-designed, big, 12-week NCCAM trial of spinal manipulative therapy (SMT) for neck pain concludes with an important disclaimer: although SMT “won” and chiropractors cite this study as evidence that adjustment works, the authors acknowledge that just “a few instructional sessions of home exercise with advice resulted in similar outcomes at most time points.” And so SMT is damned, damned, damned with (extremely) faint praise yet again, as it always is, every time it gets studied: it costs vastly more and performs barely better than sending someone home to do a few simple exercises! Now that hurts. 2012 background mechanical neck pain common condition affects estimated persons point lives research exists guide choice therapy acute subacute neck pain objective determine relative efficacy spinal manipulation therapy smt medication home exercise advice hea acute subacute neck pain short long term design randomized controlled trial clinicaltrials gov registration number nct setting university research center pain management clinic minnesota participants persons aged years nonspecific neck pain weeks intervention weeks smt medication hea measurements primary outcome participant rated pain measured weeks randomization secondary measures reported disability global improvement medication satisfaction general health status short form health survey physical mental health scales adverse events blinded evaluation neck motion performed weeks results pain smt statistically significant advantage medication weeks   hea superior medication weeks   important differences pain smt hea time point results secondary outcomes similar primary outcome limitations participants providers blinded specific criteria defining clinically important group differences prespecified literature conclusion participants acute subacute neck pain smt effective medication short long term instructional sessions hea resulted similar outcomes time points primary funding source national center complementary alternative medicine national institutes health spinal adjustment+chiropractic+treatment+neck+inflammation+spine+manual therapy+controversy+debunkery+head/neck+pain problems
4 article Zourdos et al Effects of dynamic stretching on energy cost and running endurance performance in trained male runners Journal of Strength & Conditioning Research Some good commentary on this study by Alex Hutchinson at Sweat Science. Punchline: “if you’re an endurance athlete, you may have many reasons for why and how you stretch, but “going faster” shouldn’t be one of them.” 2012 purpose study examine effects dynamic stretching running energy cost endurance performance trained male runners fourteen male runners performed minute preload run ov o max minute time trial assess running energy cost performance subjects repeated trials minutes dynamic stretching experimental condition quiet sitting control condition order balanced subjects avoid order effect total calories expended determined minute preload run distance covered measured time trial average resting ov o increased significantly dynamic stretching prestretch ± poststretch ± ml kg min quiet sitting condition caloric expenditure significantly higher minute preload run stretching ± kcal compared quiet sitting ± kcal difference distance covered quiet sitting ± km compared stretching condition ± km findings suggest dynamic stretching affect running endurance performance trained male runners running+stretch+exercise+self-treatment+treatment+muscle
1 article Simmonds et al A theoretical framework for the role of fascia in manual therapy Journal of Bodywork & Movement Therapies This is a terrible modern article that perfectly expresses the intellectual bankruptcy and absence of a intelligible rational for targetting fascia in manual therapy. Consider how the authors express this exquisitely simplistic clinical goal: “All therapies aim to break up adhesions and speed up a return to normal function. The intended outcome is a permanent alteration to the tissue structure and this may occur through collagen fibres sliding past each other (slowly) in response to stretch, a phenomenon known as creep, a loosening of the cross-links between the collagen fibres or the desired outcome may be microfailure of the collagen fibrils (Threlkeld, 1992) as their tensile strength is exceeded. Either way, the character of the tissue is changed and is softened. When microfailure of collagen is induced through instrument assisted fascia release (e.g. Graston) there is deliberate damage and the release of inflammatory mediators in an attempt to speed healing.” 2012 theoretical framework role fascia play apparently diverse passive manual therapies presented relevant anatomy fascia briefly reviewed therapies divided myofascial soft tissue manipulative joint based comparisons qualitative basis measures pain function autonomic activation outcomes evaluated therapies observed comparable quality quantity measures viewed patients perspective therapeutic benefits hard distinguish proposed biologically plausible mechanism generate significant component observed effects manual therapies descriptions therapeutic stimulation fascia forms body considerations explain diverse therapies apparently give comparable results fascia+controversy+debunkery+etiology+pro+massage+manual therapy+treatment
4 article Bleakley et al Cold-water immersion (cryotherapy) for preventing and treating muscle soreness after exercise Cochrane Database of Systematic Reviews This review of the evidence for ice bathing to deal with muscle soreness was mostly inconclusive. Either it has been studied well enough, or there’s just not that much of an effect to find. 2012 background strategies intention preventing minimising delayed onset muscle soreness fatigue exercise cold water immersion water temperatures ° popular interventional strategies exercise objectives determine effects cold water immersion management muscle soreness exercise search methods february searched cochrane bone joint muscle trauma group specialised register cochrane central register controlled trials cochrane library issue medline embase cumulative index nursing allied health cinahl british nursing index archive bni physiotherapy evidence database pedro searched reference lists articles handsearched journals conference proceedings contacted experts november updated searches central issue medline november week embase week cinahl november check publications selection criteria randomised quasi randomised trials comparing effect cold water immersion exercise passive intervention rest intervention contrast immersion warm water immersion active recovery compression duration dosage cold water immersion primary outcomes pain muscle soreness tenderness pain palpation subjective recovery return previous activities signs symptoms data collection analysis authors independently evaluated study quality extracted data data obtained author correspondence extracted graphs trial reports data pooled fixed effect model main results seventeen small trials included involving total participants study quality temperature duration frequency cold water immersion varied trials exercises settings majority studies failed report active surveillance pre defined adverse events fourteen studies compared cold water immersion passive intervention pooled results muscle soreness showed statistically significant effects favour cold water immersion exercise hour standardised difference smd ci trials hour smd ci trials hour smd ci trials hour smd ci trials follow ups results heterogeneous exploratory subgroup analyses showed studies cross designs running based exercises showed significantly larger effects favour cold water immersion pooled results studies cold water immersion groups significantly ratings fatigue md ci units scale worst potentially improved ratings physical recovery md ci units scale worst immediately cold water immersion studies compared cold water contrast immersion pooled data pain showed evidence differences groups follow times immediately hours treatment similar findings pooled analyses hour follow ups applied studies comparing cold water warm water immersion single trials compared cold water immersion active recovery compression dose cold water immersion hours authors conclusions evidence cold water immersion reduces delayed onset muscle soreness exercise compared passive interventions involving rest intervention insufficient evidence conclude outcomes comparisons majority trials undertake active surveillance pre defined adverse events high quality reported research area required treatment+self-treatment+ice heat+exercise+rehab+injury+pain problems
2 article Plas et al A 5-year follow-up study of Alfredson's heel-drop exercise programme in chronic midportion Achilles tendinopathy British Journal of Sports Medicine This follow-up study showed that patients were doing pretty well five years after a program of eccentric training (heel drop) exercises for Achilles tendinitis. However, the results are of questionable value due to the fact that many patients had received other treatments in the interim. What we really need to know is not how well these patients did, but how well they did compared to patients who did no heel drop exercises. 2012 background eccentric exercises evidence conservative treatment midportion achilles tendinopathy short term studies show significant improvement long term years results aim evaluate year outcome patients chronic midportion achilles tendinopathy treated classical alfredson heel drop exercise programme study design part year follow previously conducted randomised controlled trial methods patients tendons approached years start heel drop exercise programme alfredson baseline year follow validated victorian institute sports assessment achilles visa questionnaire score pain status alternative treatments received ultrasonographic neovascularisation score recorded results patients tendons visa score significantly increased baseline years treatment+tendinosis+pain problems+overuse injury+injury
3 article Ajimsha et al Effectiveness of myofascial release in the management of lateral epicondylitis in computer professionals Archives of Physical Medicine & Rehabilitation 68 patients suffering from lateral epicondylitis (tennis elbow), divided into two groups, some receiving myofascial release, the others receiving a “sham ultrasound therapy.” The results were statistically significant and strongly positive: “The simple main effects analysis showed that the MFR group performed better than the control group in weeks 4 and 12 (P<.005). Patients in the MFR and control groups reported a 78.7% and 6.8% reduction, respectively, in their pain and functional disability in week 4 compared with that in week 1, which persisted as 63.1% in the follow-up at week 12 in the MFR group.” 2012 objective investigate myofascial release mfr reduces pain functional disability lateral epicondylitis le comparison control group receiving sham ultrasound therapy computer professionals design randomized controlled single blinded trial setting nonprofit research foundation clinic kerala india participants computer professionals le interventions mfr group control group techniques administered certified mfr practitioners consisted sessions client weeks main outcome measure patient rated tennis elbow evaluation prtee scale assess pain severity functional disability primary outcome measure difference prtee scale scores week pretest score week posttest score follow week randomization results simple main effects analysis showed mfr group performed control group weeks treatment+tendinosis+massage+pain problems+overuse injury+injury+manual therapy
3 article Suri et al Recurrence of radicular pain or back pain after nonsurgical treatment of symptomatic lumbar disk herniation Archives of Physical Medicine & Rehabilitation This study attempted to determine if pain to the lumbar region will return after non-surgical treatments. These treatments are not discussed in detail and were “tailored to the patient.” Pain recurred in about 40% of patient within a year, though there might be a greater distance between pain episodes. Recurrence was less likely in older patients. 2012 objectives determine recurrence rates extremity radicular pain nonsurgical treatment acute symptomatic lumbar disk herniation ldh identify predictors recurrence design prospective inception cohort setting outpatient spine clinic participants patients reporting resolution radicular pain magnetic resonance imaging confirmation ldh interventions individualized nonsurgical treatment tailored patient patients received education treatments varied depending individual main outcome measures resolution radicular pain defined pain free period month patients reported resolution radicular pain year seeking care acute ldh asked pain recurred year seeking care reassessed year time resolution radicular pain years seeking care patients reported recurrence date recurrence evaluated year incidence recurrence kaplan meier survival plots examined predictors recurrence bivariate multivariate proportional hazards models examined secondary outcome pain recurrence identical methods results twenty percent confidence interval ci individuals resolution radicular pain month reported subsequent recurrence pain year resolution factor independently radicular pain recurrence number months prior resolution pain hazard ratio month ci treatment+sciatica+manual therapy+back pain+pain problems+spine+butt+hip
3 article Hooten et al Effects of strength vs aerobic exercise on pain severity in adults with fibromyalgia Pain People with fibromyalgia, and many other forms of chronic pain, often benefit from exercise. But what works better: strength training or aerobics? In these fibromyalgia patients, both types of exercise were effective: “This study found that strength and aerobic exercise had equivalent effects on reducing pain severity among patients with fibromyalgia.” 2012 strength training aerobic exercise beneficial effects pain adults fibromyalgia equivalence strengthening aerobic exercise reported primary aim randomized equivalence trial involving patients fibromyalgia admitted interdisciplinary pain treatment program test hypothesis strengthening aerobic exercise equivalent effects confidence interval equivalence margin ± pain measured pain severity subscale multidimensional pain inventory secondary aims included determining effects strengthening aerobic exercise peak vo uptake leg strength pressure pain thresholds intent treat analysis ± standard deviation pain severity scores strength aerobic groups study completion ± ± group difference confidence interval equivalence margin Δ significant improvements pain severity treatment+self-treatment+exercise+chronic pain+pain problems
1 article Bohns et al It hurts when I do this (or you do that) Journal of Experimental Social Psychology Here’s an easy science-powered pain relief tip: Stand tall! Assume a bold, confident posture. Or, as a mentor of mine liked to put it, “Tits up!” This research showed that “power poses” actually reduce pain sensitivity. It was inspired by other research (Carney et al) showing that “power poses” make people feel and act more powerfully, complete with hormonal changes. 2012 research carney cuddy amp yap shown adopting powerful pose people hormonal levels increases propensity risks ways possessing actual power current research explore adopting physical postures power simply interacting adopt postures similarly influence sensitivity pain conducted experiments experiment participants adopted dominant poses displayed higher pain thresholds adopted submissive neutral poses findings explained semantic priming experiment manipulated power poses interpersonal interaction power posing engendered complementary tiedens amp fragale embodied power experience interaction partners participants interacted submissive confederate displayed higher pain thresholds greater handgrip strength participants interacted dominant confederate biomechanics+fun+self-treatment+chronic pain+etiology+pro+treatment+pain problems
2 article Diebal et al Forefoot Running Improves Pain and Disability Associated With Chronic Exertional Compartment Syndrome American Journal of Sports Medicine Although a small case series of only ten, the conclusions were somewhat positive: “a 6-week forefoot strike running intervention led to decreased postrunning lower leg intracompartmental pressures.” 2012 background anterior compartment pressures leg kinematic kinetic measures significantly influenced running technique unknown adopting forefoot strike technique decrease pain disability chronic exertional compartment syndrome cecs hindfoot strike runners hypothesis people cecs adopting forefoot strike running technique lead decreased pain disability condition study design case series level evidence methods ten patients cecs surgical release prospectively enrolled resting postrunning compartment pressures kinematic kinetic measurements report questionnaires patients baseline weeks forefoot strike running intervention run distance reported pain levels recorded point global rating change groc scale measure perceived change intervention results weeks forefoot run training postrun anterior compartment pressures significantly decreased ± mm hg ± mm hg vertical ground reaction force impulse values significantly reduced running distance significantly increased ± km intervention ± km weeks intervention reported pain running significantly decreased single assessment numeric evaluation sane significantly increased ± ± leg outcome survey llos significantly increased ± ± groc scores weeks intervention patients year intervention sane llos scores greater reported week follow mile run times significantly faster preintervention values patient required surgery conclusion consecutive patients cecs week forefoot strike running intervention led decreased postrunning leg intracompartmental pressures pain disability typically cecs greatly reduced year intervention surgical intervention avoided patients treatment+shin pain+running+leg+limbs+pain problems+overuse injury+injury+exercise+self-treatment
2 article Li et al Acupuncture for migraine prophylaxis Canadian Medical Association Journal This is a disturbing and typical example of sloppy modern acupuncture research, methologically flawed in several ways with clearly negative results, despite the fact that it was clearly built to give acupuncture an unfair advantage, by researchers who wanted to prove that acupuncture works. They concluded that acupuncture has only “a clinically minor effect on migraine,” damning with (very) faint praise, but even that is a biased exaggeration — cherry-picking the best results, and ignoring the more important negative ones. As summarized by Dr. Steven Novella for “Despite all of these shortcomings, all of which would bias the study in the direction of being positive, the study was negative. For the primary outcome measure there was no statistically significant difference between any of the acupuncture groups and the sham acupuncture group.” 2012 background acupuncture commonly treat migraine assessed efficacy acupuncture migraine specific acupuncture points compared acupuncture points sham acupuncture methods performed multicentre single blind randomized controlled trial total patients migraine randomly assigned groups shaoyang specific acupuncture shaoyang nonspecific acupuncture yangming specific acupuncture sham acupuncture control groups received treatments included electrical stimulation period weeks primary outcome number days migraine experienced weeks randomization secondary outcomes included frequency migraine attack migraine intensity migraine specific quality life results compared patients control group patients acupuncture groups reported days migraine weeks differences treatments significant significant reduction number days migraine weeks acupuncture groups compared control shaoyang specific acupuncture control difference confidence interval ci shaoyang nonspecific acupuncture control difference ci yangming specific acupuncture control difference ci significant clinically relevant benefit secondary outcomes acupuncture groups compared control group relevant differences acupuncture groups interpretation acupuncture tested appeared clinically minor effect migraine prophylaxis compared sham acupuncture treatment+acupuncture+scientific medicine+mind+controversy+debunkery+energy work
2 article Baliki et al Corticostriatal functional connectivity predicts transition to chronic back pain Nat Neurosci Dramatic quote from lead researcher Vania Apkarian: “We can predict who will become a chronic pain patient versus who will not.” By brain scanning! That’s a grandiose claim. 100% accuracy seems unlikely, so … how accurate exactly? Any qualifiers on that statement? It’s interesting research, but that synopsis is much too boldly stated. Either it’s a misquote, or it was a bit of a rash thing to say. This science is not done. See Blaming the Brain for Chronic Back Pain. 2012 mechanism brain reorganization pain chronification unknown longitudinal brain imaging study subacute pain sbp patients year pain persisted sbpp contrast recovering sbp healthy controls brain gray matter density decreased initially greater functional connectivity nucleus accumbens prefrontal cortex predicted pain persistence implying corticostriatal circuitry causally involved transition acute chronic pain chronic pain+back pain+pain problems+spine
3 article Dunstan et al Breaking up prolonged sitting reduces postprandial glucose and insulin responses Diabetes Care In this small study, it was shown that very overweight adults who get up and walk every 20 minutes can improve their glucose and insulin levels. This, in turn, “may improve glucose metabolism and potentially be an important public health and clinical intervention strategy for reducing cardiovascular risk.” 2012 objective observational studies show breaking prolonged sitting beneficial associations cardiometabolic risk markers intervention studies required investigate causality examined acute effects postprandial glucose insulin levels uninterrupted sitting compared sitting interrupted bouts light moderate intensity walking research design methods overweight obese adults aged years recruited randomized period treatment acute crossover trial uninterrupted sitting seated min bouts light intensity walking min seated min bouts moderate intensity walking min standardized test drink initial period uninterrupted sitting positive incremental area curves iauc glucose insulin ci test drink glucose fat calculated respective treatments results glucose iauc mmol activity break conditions reduced light moderate compared uninterrupted sitting insulin iauc pmol reduced activity break conditions light moderate compared uninterrupted sitting conclusions interrupting sitting time short bouts light moderate intensity walking lowers postprandial glucose insulin levels overweight obese adults improve glucose metabolism potentially important public health clinical intervention strategy reducing cardiovascular risk exercise+self-treatment+treatment
3 article Venkataraman et al Tree climbing and human evolution Proceedings of the National Academy of Sciences of the United States of America The Twa people of Africa and you will earn amazingly limber calves that allow your ankles to bend half way (45˚) to the shin — two to four times greater than the average urban person! See: Twa man climbs a tree 0:48. 2012 paleoanthropologists long argued contentiously climbing abilities early hominins foot adapted terrestrial bipedalism constrained regular access trees modern humans climb tall trees routinely pursuit honey fruit game aid tools support systems mortality morbidity facultative arboreality expected favor behaviors anatomies facilitate safe efficient climbing show twa hunter gatherers extraordinary ankle dorsiflexion ° climbing similar degree observed wild chimpanzees detect skeletal signature dorsiflexion museum specimens climbing hunter gatherers ituri forest find climbing twa longer fibers gastrocnemius muscle relative neighboring nonclimbing agriculturalists result suggests excursive calf muscle facilitates climbing bipedally adapted ankle foot positioning climber closer tree mechanisms hunter gatherers access canopy safely find skeletal correlate observed behavior results imply derived aspects hominin ankle bipedalism remain compatible vertical climbing arboreal resource acquisition findings challenge persistent arboreal terrestrial dichotomy informed behavioral reconstructions fossil hominins highlight modern humans models inferring limits hominin arboreality fun+biomechanics+stretch+plantar fasciitis+etiology+pro+exercise+self-treatment+treatment+muscle+foot+leg+limbs+pain problems+overuse injury+injury+tendinosis
3 article Moseley Teaching people about pain — why do we keep beating around the bush? Pain Management 2012 chronic pain+mind+pain problems
3 article Torres et al Evidence of the physiotherapeutic interventions used currently after exercise-induced muscle damage Physical Therapy in Sport This review of 35 tests of treatments for delayed onset muscle soreness (DOMS) is strongly consistent with my own past interpretations of the research: basically, nothing works. Massage is “slightly effective” but “its mean effect was too small to be of clinical relevance.” The evidence for cryotherapy, stretching, and low-intensity exercise is not promising, but technically still inconclusive: more study needed. 2012 introduction exhaustive unaccustomed exercise involving eccentric muscle actions induces temporary muscle damage evidenced delayed onset muscle soreness doms decreased muscle function strategies recover signs symptoms studied result significant number articles issue published objective assess modalities physiotherapy massage cryotherapy stretching intensity exercise effective treating signs symptoms exercise induced muscle damage methods randomized controlled trials rcts written english portuguese included physiotherapeutic interventions massage cryotherapy stretching intensity exercise adult human subjects years gender searched electronic databases including medline cinhal embase pedro sportdiscus main outcome measures muscle soreness muscle strength outcome measures included meta analysis results studies included analysed effects massage examined effects cryotherapy investigated effects stretching focused intensity exercise intervention massage intervention positive effects reducing soreness   average  cm visual analog scale percent ci     increasing muscle recovery percent percent ci additionally inconclusive evidence support cryotherapy evidence prove efficacy stretching intensity exercise conclusion massage proved slightly effective relief symptoms signs exercise induced muscle damage effect small clinical relevance lack evidence support cryotherapy stretching intensity exercise exercise+physical therapy+treatment+self-treatment+massage+ice heat+inflammation+stretch+manual therapy+rehab+injury+pain problems+muscle
3 article Bechard et al Toe-out, lateral trunk lean, and pelvic obliquity during prolonged walking in patients with medial compartment knee osteoarthritis and healthy controls Arthritis Care & Research This 2012 study of knee arthritis showed that people who already have arthritic knees are bigger leaners, and their gait is “consistently different” than people with healthy knees, and they probably weren’t walking different because of pain. (Causality is a major problem with studies like this: it lacks the scientific power to actually demonstrate causality. Neverthless, I like that the authors actually considered the problem, and I do agree with their conclusion: “over 30 minutes of walking, these gait characteristics remain quite stable, suggesting they are not acute compensatory mechanisms in response to repetitive loading with subtle increases in pain.” That’s good thinking, I think.) 2012 objective compare time varying behavior maximum toe angle lateral trunk lean stance leg pelvic obliquity rise drop swing leg prolonged walking participants medial compartment knee osteoarthritis oa explore correlations gait characteristics pain methods twenty patients knee oa healthy controls completed minutes treadmill walking toe trunk lean pelvic obliquity pain measured minute intervals results ± sd toe angle significantly smaller patients knee oa ± degrees controls ± degrees toe changed significantly time systematic interaction group time ± sd trunk lean higher patients knee oa ± degrees controls ± degrees trunk lean change time interaction group time differences pelvic drop ± sd pelvic rise higher patients knee oa ± degrees controls ± degrees change time interaction patients experienced small increase pain trunk lean pelvic drop correlated pain conclusion toe trunk lean consistently individuals medial compartment knee oa prolonged walking patients greater pain greater trunk lean minutes walking gait characteristics remain stable suggesting acute compensatory mechanisms response repetitive loading subtle increases pain biomechanics+knee+arthritis+etiology+pro+leg+limbs+pain problems+aging
3 article Vercelli et al Immediate effects of kinesiotaping on quadriceps muscle strength Clinical Journal of Sports Medicine Shocker: this experiment found that applying kinesio taping (KT) had no effect on muscle strength (as claimed by some KT propopents, probably too many of them). “These results do not support the use of KT applied in this way to change maximal muscle strength in healthy people.” It was a ridiculous idea to begin with — obviously. It is conceivable, but rather unlikely and wild speculation without the slightest confirmation (and now this evidence against it). Advocates of KT protest that a study of healthy subjects is irrelevant, but it’s clear that KT is routinely, fashionably used on/by many serious and elite athletes who are fighting fit and not “injured” enough for it to be likely to make a meaningful difference to this research. In other words, if KT can’t enhance the strength of an average healthy athlete, it probably can’t do it for a slightly injured elite one either. 2012 objective investigate effects maximal muscle strength kinesiotaping kt applied dominant quadriceps healthy subjects design single blind placebo controlled crossover trial setting salvatore maugeri foundation participants ethical approval informed consent convenience sample healthy volunteers recruited subjects complete sessions excluded analysis interventions subjects tested sessions randomly receiving experimental kt conditions applied aim enhancing inhibiting muscle strength sham kt application main outcome measures quadriceps muscle strength measured means isokinetic maximal test performed degrees secondary outcome measures performed single leg triple hop distance measure limb performance global rating change scale grcs calculate agreement kt application subjective perception strength results compared baseline taping conditions showed significant change muscle strength performance effect size conditions subjects showed individual change greater minimal detectable change global rating change scale scores demonstrated moderate agreement type kt applied placebo effects reported independently condition conclusions findings significant effect maximal quadriceps strength immediately application inhibition facilitation sham kt results support kt applied change maximal muscle strength healthy people devices+exercise+controversy+treatment+self-treatment+debunkery
3 article Muyor et al Effect of stretching program in an industrial workplace on hamstring flexibility and sagittal spinal posture of adult women workers J Back Musculoskelet Rehabil This experiment found that a typical stretching routine for the hamstrings did make them more extensible, and did change spinal behaviour during deep flexion (toe touching), but did not affect normal posture: “no significant changes were found in standing posture for any group.” 2012 objectives determine effect stretching program performed workplace hamstring muscle extensibility sagittal spinal posture adult women material methods fifty adult women volunteers age ± years private fruit vegetable company randomly assigned experimental control groups experimental group performed exercises hamstrings stretching seconds exercise sessions week period weeks control group participate hamstring stretching program hamstring flexibility evaluated passive straight leg raise test toe touch test performed stretching program thoracic lumbar curvatures pelvic inclination measured relaxed standing toe touch test spinal mouse results significant increases toe touch score straight leg raise angle legs experimental group post test control group showed significant decrease toe touch score straight leg raise test significant decrease thoracic curve significant increase pelvic inclination toe touch test experimental group biomechanics+stretch+self-treatment+back pain+etiology+pro+exercise+treatment+muscle+pain problems+spine
4 article Goss et al A review of mechanics and injury trends among various running styles U.S. Army Medical Department journal Can any running style or shoe type prevent running injuries? This is one of those reviews of a virtually non-existent literature. The authors speculate, as many others have, that styles and shoes probably involve risk trade-offs: less risk of one kind of injury, but more of another. But mostly the paper inevitably confirms that, as of 2012, there really is no hard data about this. 2012 context running related overuse injuries significant problem runners sustaining injury annually medical providers coaches question advise running clients prevent injuries alternative running styles anterior footstrike barefoot running pose running chi running popular information published comparing mechanics injury trends running styles objective original purpose paper examine evidence biomechanics injury trends running styles injury data separated running style existed discuss biomechanics running styles present biomechanical findings running injuries data sources english language articles published peer reviewed journals identified searching pubmed cinahl sportdiscus databases studies identified search observational studies results anterior initial foot contact present barefoot alternative running styles decrease eliminate initial vertical ground reaction peak impact transient possibly reducing knee joint loads injuries anterior foot strike increase mechanical work ankle tensile stress plantarflexors wearing minimal footwear increase contact pressure imposed metatarsals conclusion research needed determine individuals morphological mechanical gait characteristics benefit alternative running styles incorporate anterior initial foot contact shoes running+orthotics+overuse injury+IT band pain+patellar pain+plantar fasciitis+shin pain+exercise+self-treatment+treatment+foot+leg+limbs+pain problems+devices+injury+knee+tendinosis+arthritis+aging
3 article Behrend et al Smoking Cessation Related to Improved Patient-Reported Pain Scores Following Spinal Care Journal of Bone & Joint Surgery This study added to the pile of evidence that smoking is “associated with low back pain, intervertebral disc disease” along with many other medical complications. Their conclusion, after studying the records of more than 5000 patients with “axial or radicular pain from a spinal disorder,” was that there is a “need for smoking cessation programs for patients with a painful spinal disorder.” (And not just for the back pain!) 2012 background smoking pain intervertebral disc disease inferior patient outcomes surgical interventions increased rates postoperative complications purpose present study examine effect smoking smoking cessation pain disability patients painful spinal disorders methods examined prospectively maintained database records patients axial radicular pain spinal disorder regard smoking history patient assessment pain visual analog scales care confounding factors including secondary gain sex age body mass index examined duration follow months multivariate statistical analysis performed variables including smoking status secondary gain status sex depression age predictors pain disability results compared patients smoked patients current smokers reported significantly greater pain visual analog scale pain ratings lt improvement reported pain care significantly nonsmokers current smokers lt compared patients continued smoke quit smoking care reported significantly greater improvement pain visual analog scale pain ratings worst current lt average weekly pain improvement visual analog scale pain ratings clinically important patients groups nonsmokers group continued smoking treatment clinically important improvement reported pain conclusions strong association improved patient reported pain smoking cessation study supports smoking cessation programs patients painful spinal disorder level evidence prognostic level ii instructions authors complete description levels evidence treatment+back pain+pain problems+spine
3 article Schreuder et al Vitamin D supplementation for nonspecific musculoskeletal pain in non-Western immigrants Ann Fam Med This test of the effect of Vitamin D supplementation on nonspecific chronic musculoskeletal pain showed that pain modestly improved within 6 weeks. Musculoskeletal strength (stair climbing ability) also improved somewhat. See a thorough analysis of this study by Dr. Steven Leavitt for “a most remarkable aspect of this study is that, even though patients probably received fundamentally inadequate vitamin D supplementation and for a relatively brief period of time, there were still strongly beneficial outcomes … significant enough to realize meaningful differences in everyday clinical practice.” 2012 purpose western immigrants report musculoskeletal pains hard treat studied effect high dose vitamin nonspecific persistent musculoskeletal complaints vitamin deficient western immigrants assessed correlation pain patterns benefit methods conducted semi crossover randomized controlled trial february february primary care western immigrants visiting general practitioner nonspecific musculoskeletal pain baseline patients randomized placebo vitamin iu vitamin orally week patients original vitamin group randomized time receive vitamin switch placebo patients original placebo group switched vitamin main outcome assessed change pain weeks results patients vitamin group significantly counterparts placebo group report pain relief weeks treatment report improved ability walk stairs pain pattern correlated success treatment nonsignificant trend patients receiving vitamin weeks improvement patients receiving weeks conclusions small positive effect weeks high dose vitamin persistent nonspecific musculoskeletal pain future research focus longer follow higher supplementation doses mental health treatment+vitamin D+muscle pain+nutrition+chronic pain+exercise+self-treatment+muscle+pain problems
3 article Kroslak Surgical treatment of lateral epicondylitis Unpublished Past studies have reported good results from surgery (eg: see Garden, Solheim), but this is probably the first ever placebo-controlled study of surgery for tennis elbow (lateral epicondylitis), and it had disappointing results. Eleven patients were treated with the Nirschl technique (surgical excision of the macroscopically degenerated portion of ECRB), and 11 received a sham operation: a skin incision, exposing the tendon. Both groups improved equally: “The only difference observed between the groups was that patients who underwent the Nirschl procedure for tennis elbow had significantly more pain with activity at 2 weeks.” The author rather scathingly concludes: “There is no benefit to be gained from the gold standard tennis elbow surgery over placebo surgery in the management of chronic lateral epicondylitis. In fact, the Nirschl procedure may increase the morbidity of the condition in the immediate post-operative period.” 2012 background tennis elbow lateral epicondylitis common condition community prevalence resulting pain elbow weakness extending wrist overuse progresses chronic stage tennis elbow shows macroscopic microscopic degeneration origin extensor carpi radialis brevis ecrb universally effective management chronic tennis elbow common surgical technique nirschl amp pettrone bone joint surg a involves cutting degenerated portion ecrb results technique reported excellent surgical procedure tennis elbow compared placebo surgery methods study prospective randomised double blinded placebo controlled clinical trial investigating nirschl technique surgical excision macroscopically degenerated portion ecrb compared sham operation skin incision exposure ecrb treat chronic tennis elbow primary outcome measure defined patient rated elbow pain activity months post surgery secondary outcome measures included patient rated pain functional outcomes elbow stiffness range motion epicondyle tenderness strength measurements results groups matched age gender duration symptoms nirschl sham procedures improved patient rated pain frequency severity elbow stiffness difficulty picking objects twisting motions grip strength months treatment+surgery+tendinosis+pain problems+overuse injury+injury
3 article Raftry et al Does a 'tight' hamstring predict low back pain reporting during prolonged standing? Journal of Electromyography and Kinesiology 2012 purpose study investigate relationship hamstring passive stiffness extensibility asymptomatic individuals reporting pain prolonged standing twenty healthy participants history pain ±sd age ± years height ± weight ± kg pain vas score mm continuously monitored prolonged standing hamstring extensibility passive stiffness stretch tolerance measured prolonged standing instrumented straight leg raise islr ten participants reported clinically relevant increase Δ vas mm pain prolonged standing hamstring extensiblity leg° max passive stiffness nm ° stretch tolerance vas mm pain developers pain developers hamstring measures observed prolonged standing relationship observed study measures hamstring extensibility reporting pain prolonged standing evidence recommend hamstring extensibility interventions passive stretching means reducing pain reporting occupations requiring prolonged standing treatment+self-treatment+stretch+biomechanics+etiology+back pain+exercise+muscle+pro+pain problems+spine
2 article Williams et al Kinesio taping in treatment and prevention of sports injuries Sports Medicine This meta-analysis of kineso taping for sports injuries in New Zealand’s Sports Medicine journal doesn’t really have much good news to report, but it comes off as pro-taping and cautiously optimistic:
In conclusion, there was little quality evidence to support the use of KT over other types of elastic taping in the management or prevention of sports injuries. KT may have a small beneficial role in improving strength, range of motion…. The amount of case study and anecdotal support for KT warrants well designed experimental research, particularly pertaining to sporting injuries, so that practitioners can be confident that KT is beneficial for their athletes.
And yet even that tepid report may be over-enthusiastic. This formal response in the British Journal of Sports Medicine (Kamper) just seethes with irritation:
Despite the title of the review, the authors do not report a meta-analysis of the included studies. … The review has several flaws, the most serious of which is selective reporting of outcomes. As only positive (significant) results are reported it is not possible to assess the entirety of the evidence for effectiveness of kinesio taping. In addition, while the authors report to have followed the methodological guidelines of the Cochrane Collaboration this does not appear to be the case. … Clinicians should look to other sources of information…
2012 kinesio tape kt elastic therapeutic tape treating sports injuries variety disorders chiropractor dr kenso kase developed kt taping techniques s claimed kt supports injured muscles joints helps relieve pain lifting skin allowing improved blood lymph flow profile kt rose tape donated countries olympic games high profile athletes practitioners kt elastic adhesive tapes aim review evaluate meta analysis effectiveness kt treatment prevention sports injuries electronic databases including sportdiscus scopus medline sciencedirect sports medicine websites searched keywords kinesio taping tape articles ten met inclusion criteria article reported data effect kt musculoskeletal outcome control group retained meta analyses magnitude based inferences assess clinical worth positive outcomes reported studies studies investigated sports related injuries shoulder impingement involved injured athletes studies attending musculoskeletal outcomes healthy participants included basis outcomes implications prevention sporting injuries efficacy kt pain relief trivial clinically important results inconsistent range motion outcome results small beneficial results studies trivial results studies numerous joint measurements beneficial effect proprioception grip force sense error positive outcome ankle proprioception outcomes relating strength beneficial numerous trivial findings quadriceps hamstrings peak torque grip strength measures kt substantial effects muscle activity unclear beneficial harmful conclusion quality evidence support kt types elastic taping management prevention sports injuries kt small beneficial role improving strength range motion injured cohorts force sense error compared tapes studies needed confirm findings amount case study anecdotal support kt warrants designed experimental research pertaining sporting injuries practitioners confident kt beneficial athletes devices+treatment+running+exercise+self-treatment
4 article Visser et al Risk factors of recurrent hamstring injuries British Journal of Sports Medicine 2012 background recurrent hamstring injury frequent problem significant impact athletes data factors determining risk recurrent hamstring injury scarce objective systematically review literature provide overview risk factors injury acute hamstring muscle injuries study design prospective studies risk factors injury acute hamstring injuries systematically reviewed medical databases reference lists included articles searched reviewers independently selected potential studies assessed methodological quality reviewer extracted data evidence synthesis studied risk factors performed results articles identified prospective follow studies fulfilled inclusion criteria studies reported recurrence incidence playing season years initial injury limited evidence risk factors protective factor recurrent hamstring injury patients recurrent hamstring injury initial injury larger volume size measured mri cm grade initial trauma grade grade grade previous ipsilateral anterior cruciate ligament acl reconstruction independent graft selection athletes rehabilitation programme agility stabilisation exercises strength stretching exercises risk injury significant relationship injury related determinants conflicting evidence larger cross sectional area risk factor recurrent hamstring injury conclusions limited evidence athletes larger volume size initial trauma grade hamstring injury previous ipsilateral acl reconstruction increased risk recurrent hamstring injury athletes risk injury agility stabilisation exercises strain+injury+pain problems+muscle
3 article Steele et al Resistance Training to Momentary Muscular Failure Improves Cardiovascular Fitness in Humans Journal of Exercise Physiology This paper makes the case that relatively brief, intense doses of muscular training may be able to build cardiovascular fitness about as well as steady-state aerobic exercise (like, say, running). This conclusion is mostly supported by comparing what is known about physiological responses to these types of exercise (it’s not a report on the results of a controlled experiment directly comparing the two). It’s a controversial idea that many exercise physiologists denigrate as a pet theory. Who’s pet? Why, the authors of this paper! Steele and McGuff are particularly well-known for their association with a strength training method, high-intensity training (HIT). Their conclusion here, if true, would obviously be great news for HIT — because it suggests that HIT is good for general fitness, not just bodybuilding. So the risk of bias is high. But biased opinions can be valid, and there’s nothing obviously wrong with this paper. This is probably their boldest statement: “Identifying a particular modality of exercise as being ‘aerobic’ or ‘CV’ constitutes a misnomer. The extent that any modality of exercise produces CV fitness adaptations appears to be dependent primarily upon the intensity of the exercise.” That could be true, but perhaps a bit overconfident, because (as they acknowledge) there just isn’t much experimental data about this yet — and it does seem a little far-fetched that athletes who did only resistance training would stand a chance competing in an endurance event. But it is possible they would do much better than we think. The biology does seem to support the claim, at least well enough to make it plausible and worth testing. 2012 research demonstrates resistance training produces significant improvement cardiovascular fitness vo max economy movement date review article considered underlying physiological mechanisms support improvements article comprehensive systematic narrative review literature surrounding area resistance training cardiovascular fitness acute responses chronic adaptations produces primary concern existing research lack clarity inappropriate quantification resistance training intensity important consideration review effect intensity acute metabolic molecular responses resistance training momentary muscular failure differ traditional endurance training myocardial function appears maintained enhanced acute response high intensity resistance training contraction intensity appears mediate acute vascular response resistance training results chronic physiological adaptations demonstrate resistance training momentary muscular failure produces number physiological adaptations facilitate observed improvements cardiovascular fitness adaptations include increase mitochondrial enzymes mitochondrial proliferation phenotypic conversion type iix type iia muscle fibers vascular remodeling including capillarization resistance training momentary muscular failure sufficient acute stimuli produce chronic physiological adaptations enhance cardiovascular fitness review appears present conclusion stimulate changing paradigm addressing misnomer cardiovascular exercise determined modality exercise+self-treatment+treatment
3 article Humphrey et al The evolutionary psychology of healing Curr Biol Humphrey and Skoyles proposes an evolutionary explanation for the placebo paradox: even though it might be possible in theory, in practice our brains dare not routinely invoke powerful recovery mechanisms because they have costs that often outweigh the benefits. Here’s some excellent some extra reading from Todd Hargrove, who did a nice job interpreting and explaining this idea. The additional perspective is most welcome. 2012 mind
3 article Kim et al Is early passive motion exercise necessary after arthroscopic rotator cuff repair? American Journal of Sports Medicine This was a test of two rehab strategies in 105 patients with surgically repaired rotator cuff tears (small to medium-sized tears of the shoulder muscles). Half were fully braced after surgery, while others performed mobilization exercises. Range of motion, pain, and function were the same across the board for both groups. “Early passive motion exercise after arthroscopic cuff repair did not guarantee early gain of ROM or pain relief but also did not negatively affect cuff healing.” 2012 background early passive motion exercise standard rehabilitation protocol rotator cuff repair preventing postoperative stiffness approaches show longer immobilization enhance tendon healing quality purpose elucidate early passive motion exercise affects functional outcome tendon healing arthroscopic rotator cuff repair study design randomized controlled trial level evidence methods consecutive patients underwent arthroscopic repair small medium sized full thickness rotator cuff tears included patients large massive tears concomitant stiffness labral lesions excluded patients instructed wear abduction brace weeks surgery start active assisted shoulder exercise brace weaning fifty patients randomly allocated group early passive motion exercises conducted times day abduction brace wearing period forty patients allocated group passive motion allowed period range motion rom visual analog scale vas pain measured preoperatively months postoperatively functional evaluations including constant score simple shoulder test sst american shoulder elbow surgeons ases score evaluated months postoperatively ultrasonography magnetic resonance imaging computed tomography arthrography utilized evaluate postoperative cuff healing results statistical differences groups rom vas pain time point functional evaluations statistically groups final functional scores assessed months groups constant score ± ± sst ± ± ases score ± ± detachment repaired cuff identified group group conclusion early passive motion exercise arthroscopic cuff repair guarantee early gain rom pain relief negatively affect cuff healing suggest early passive motion exercise mandatory arthroscopic repair small medium sized full thickness rotator cuff tears postoperative rehabilitation modified ensure patient compliance self-treatment+exercise+treatment
3 article Hou et al [Promoting effect of massage on quadriceps femoris repair of rabbit in vivo] Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi Animal studies don’t come up all that often in my work days, and I find them rather macabre. In this study, rabbits were injured, and then some of them received a lot of daily automated massage during recovery, from — I love this bit — an “intelligent massage device.” Their tissues were put under a microscope before and after, and apparently “histomorphology and cytoskeletal structure can be significantly improved after massage, which may help to repair muscle injury by up-regulation of Desmin and alpha-Actin expressions.” Sounds good. Any study of tissue involves substantial complexities of observation and interpretation, and so it’s basically impossible to know whether the experiment was actually conducted competently and its results are trustworthy, unless other researchers do the same thing and get similar results. But it’s interesting, and promising, and consistent with the fairly sensible notion that moderate stimulation helps tissues recover from damage. 2012 objective investigate effect massage quadriceps femoris repair expressions desmin alpha actin rabbits explore molecular mechanisms massage repair muscle injury methods twenty zealand white rabbits weighing + kg randomly divided groups groups group rabbits treated controls groups rabbit models quadriceps femoris injury prepared beater group massage therapy nature recovery controls group rt n intelligent massage device massage therapy days injury min minutes day days days quadriceps femoris specimens rabbits groups days days staining employed detect histomorphological change immunohistochemistry staining western blot detect desmin alpha actin expressions massage therapy effect evaluated histomorphological change desmin alpha actin expressions results rabbits survived experiment groups histological change regular order muscle fibers connective tissue group obvious tissue necrosis broken muscular fibers muscle atrophy irregular order group group skeletal muscle morphology musle atrophy improved regenerated muscle fibers compared group immunohistochemistry staining showed desmin alpha actin expressions reduced groups significantly weaker group desmin alpha actin expressions significantly stronger group group days days group western blot results showed desmin alpha actin expressions significantly higher group groups expressions lowest days group conclusion histomorphology cytoskeletal structure significantly improved massage repair muscle injury regulation desmin alpha actin expressions massage+strain+manual therapy+treatment+injury+pain problems+muscle
4 article Pereira et al Empirical evaluation of very large treatment effects of medical interventions Journal of the American Medical Association A “very large effect” in medical research is probably exaggerated, according to Stanford researchers. Small trials of medical treatments often produce results that seem impressive. However, when more and better trials are performed, the results are usually much less promising. In fact, “most medical interventions have modest effects” and “well-validated large effects are uncommon.” 2012 context medical interventions modest effects occasionally clinical trials find large effects benefits harms objective evaluate frequency features large effects medicine data sources cochrane database systematic reviews cdsr issue study selection separated binary outcome cdsr forest plots comparisons interventions published trial subsequent trial trial nominally statistically significant large effect odds ratio sampled randomly topics group depth evaluation data extraction assessed types treatments outcomes trials large effects examined large effect trials trials topic effects compared effects respective meta analyses results forest plots reviews significant large effect published trial published trial trials significant large effects nominally significant large effects typically appeared small trials median number events trials subsequent trials topics large effects topics address mortality trials subsequent trials trials significant large effects address laboratory defined efficacy trials subsequent trials significant large effects trials large effects trials large effects subsequent published trials percent large effects observed subsequently published trials smaller meta analyses included trials median odds ratio decreased trials subsequent trials selected topics subsequent trials large effect trial meta analysis maintained large effects additional trials included pertained mortality related outcomes cdsr intervention large beneficial effects mortality major concerns quality evidence trial extracorporeal oxygenation severe respiratory failure newborns conclusions large treatment effects emerge small studies additional trials performed effect sizes typically smaller validated large effects uncommon pertain nonfatal outcomes treatment+bad science+scientific medicine+research+pro
3 article Hamilton Hamstring muscle strain injuries British Journal of Sports Medicine Hamstring muscle strain injuries remain one of the most challenging issues facing sports medicine. Over the past 100 years, there has been a gradual evolution in our understanding and management of hamstring injuries, but the challenge of optimising the management of the acutely injured hamstring remains. In recent years, increasingly high-quality studies have addressed the aetiology, risk factors and management of hamstring strains. Paradoxically, many popular treatment options have little evidence and remain controversial. The history of hamstring injury management is characterised as a longstanding dissociation between popular clinical techniques and a limited evidence base. Taking a historical perspective on the management of hamstring muscle strains, this study aims to place the current management strategies in a temporal perspective. 2012 running+exercise+treatment+strain+self-treatment+injury+pain problems+muscle
4 article Yavchitz et al Misrepresentation of randomized controlled trials in press releases and news coverage PLoS Med Even when looking at scientific published findings, this study concluded that “"Spin" was identified in about half of press releases and media coverage. In multivariable analysis, the main factor associated with ‘spin’ in press releases was the presence of ‘spin’ in the article abstract conclusion.” 2012 background previous studies published reports trial results distorted spin specific reporting strategies intentional unintentional emphasizing beneficial effect experimental treatment aimed evaluate presence spin press releases media coverage evaluate findings randomized controlled trials rcts based press releases media coverage misinterpreted methods findings systematically searched press releases indexed eurekalert database december march press releases retrieved screened included press releases arm parallel group rcts     obtained copy scientific article press release related systematically searched related news items lexis nexis spin defined specific reporting strategies intentional unintentional emphasizing beneficial effect experimental treatment identified scientific article abstract conclusions press releases bivariate multivariable analysis assessing journal type funding source sample size type treatment drug results primary outcomes nonstatistically significant author press release presence spin abstract conclusion factor spin press release spin article abstract conclusions relative risk rr ci biology+bad science+scientific medicine+research+pro
1 article Vickers et al Acupuncture for Chronic Pain Archives of Internal Medicine The conclusion of this acupuncture meta-analysis sure sounds positive, but it’s the usual hard-spun, garbage-in-garbage-out, damned-with-faint-praise-anyway nonsense. The conclusion indicates that “acupuncture is more than a placebo” but the differences are too minimal to care, or to attribute to anything more than a sloppy, biased meta-analysis. An editorial for the Huffington Post confidently, absurdly declares of this study, “It turns out acupuncture works. It's not a placebo, and it's not a scam. It's a technique with documented efficacy,” but the author’s next statement is “I have little to say about the evidence involved.” Clearly! What do actual experts say? Dr. Edzard Ernst: “In my view, this meta-analysis is the most compelling evidence yet to demonstrate the ineffectiveness of acupuncture for chronic pain.” Dr. Steven Novella: “The Vickers acupuncture meta-analysis, despite the authors’ claims, does not reveal anything new about the acupuncture literature, and does not provide support for use of acupuncture as a legitimate medical intervention.” 2012 background acupuncture widely chronic pain remains considerable controversy aimed determine effect size acupuncture chronic pain conditions neck pain osteoarthritis chronic headache shoulder pain methods conducted systematic review identify randomized controlled trials rcts acupuncture chronic pain allocation concealment determined unambiguously adequate individual patient data meta analyses conducted data eligible rcts total   patients analyzed results primary analysis including eligible rcts acupuncture superior sham acupuncture control pain condition   lt   comparisons exclusion outlying set rcts strongly favored acupuncture effect sizes similar pain conditions patients receiving acupuncture pain scores ci ci ci sds sham controls neck pain osteoarthritis chronic headache effect sizes comparison acupuncture controls ci ci ci sds results robust variety sensitivity analyses including related publication bias conclusions acupuncture effective treatment chronic pain reasonable referral option significant differences true sham acupuncture acupuncture placebo differences modest suggesting factors addition specific effects needling important contributors therapeutic effects acupuncture treatment+acupuncture+chronic pain+neck+back pain+arthritis+head+mind+controversy+debunkery+energy work+pain problems+head/neck+spine+aging
3 article Schneiders et al The Ability of Clinical Tests to Diagnose Stress Fractures Journal of Orthopaedic & Sports Physical Therapy This science attacks something I care deeply about: tuning fork diagnosis of stress fractures. Yeah, you read that right. Supposedly a humming tuning fork applied to a stress fracture will make it ache. This analysis of studies since the 1950’s tried to determine if either ultrasound or tuning forks are actually useful in finding lower-limb stress fractures. Neither technique was found to be accurate; “it is recommended that radiological imaging should continue to be used” instead. Fortunately (for the sake of the elegant quirkiness of the tuning fork idea), they aren’t saying that a tuning fork actually can’t work … just that’s it not reliable for confirmation, which kind of a “well, duh” conclusion. I don’t suppose I ever thought it was a slam dunk diagnosis, just an easy and quirky clue generator. 2012 study design systematic literature review meta analysis objectives evaluate diagnostic accuracy clinical tests identify stress fractures limb background stress fractures bone related overuse injury primarily occurring limb commonly affecting running athletes military personnel physical examination procedures clinical tests suggested diagnosing stress fractures data diagnostic accuracy tests investigated systematic review literature methods systematic review conducted electronic databases identify diagnostic accuracy studies published january june evaluated clinical tests radiological diagnosis limb stress fracture retrieved articles evaluated quality assessment diagnostic accuracy studies tool meta analysis performed results articles investigating clinical procedures therapeutic ultrasound tuning fork testing met study inclusion criteria meta analysis statistically analyze data extracted ultrasound articles demonstrated pooled sensitivity confidence interval ci specificity ci positive likelihood ratio ci negative likelihood ratio ci tuning fork test data pooled sensitivity specificity positive likelihood ratio negative likelihood ratio ranged conclusion results systematic review support specific ultrasound tuning forks standalone diagnostic tests limb stress fractures diagnostic accuracy tests investigated strong based calculated likelihood ratios recommended radiological imaging continue confirmation diagnosis stress fractures limb treatment+diagnosis+devices+shin pain+fun+leg+limbs+pain problems+overuse injury+injury+running+exercise+self-treatment
2 article Begley et al Drug development Nature See: Preclinical trials: Keep 'reproducibility' in context. Picha B, Thompson M, Vondriska TM. Nature. 2012 May 2; 485(7396):41. Epub 2012 May 2. 2012 treatment+scientific medicine+medications+self-treatment
3 article Durup et al A Reverse J-Shaped Association of All-Cause Mortality with Serum 25-Hydroxyvitamin D in General Practice J Clin Endocrinol Metab “I think the message is pretty clear: think twice before you megadose.” — Alex Hutchinson (Sweat Science). Amen. The low to nil risks of “high“ doses of D may be justified by the evidence for the specific case of patients with chronic pain. But “mega” doses? Not sure that was ever a good idea for anyone. 2012 context optimal levels vitamin topic heavy debate correlation hydroxyvitamin levels mortality remains established objective aim study determine association mortality serum levels calcium pth design setting conducted retrospective observational cohort study copd study single laboratory center copenhagen denmark participants serum analyzed subjects copenhagen general practice sector addition serum levels calcium albumin adjusted calcium pth creatinine measured subjects main outcome measures multivariate regression analysis compute hazard ratios mortality results follow median yr subjects died reverse shaped association serum level mortality observed serum level nmol liter lowest mortality risk compared nmol liter hazard ratios confidence intervals mortality nmol liter high nmol liter serum levels similarly high levels albumin adjusted serum calcium serum pth increased mortality secondary hyperparathyroidism higher mortality conclusion study general practice sector reverse shaped relation serum level mortality observed indicating limit upper limit lowest mortality risk nmol liter study inference causality studies needed elucidate causal relationship levels higher levels mortality treatment+vitamin D+self-treatment+nutrition+chronic pain+pain problems
4 article Vas et al Acupuncture in patients with acute low back pain Pain Yet another study of acupuncture with predictably disappointing results. This part sounds good: “all 3 modalities of acupuncture were better than conventional treatment alone.” But that means only that people find the ritual of acupuncture gives good placebo. The real story is told by this: “there was no difference among the 3 acupuncture modalities [true/sham/placebo], which implies that true acupuncture is not better than sham or placebo acupuncture.” In other words, it doesn’t matter if acupuncture is real, just that it seems to the patient, like an impressive ancient Chinese healing ritual with needles. 2012 reviews efficacy acupuncture treatment acute pain concluded insufficient evidence efficacy research needed evaluate multicentre randomized controlled trial conducted primary care centres spain evaluate effects acupuncture patients acute nonspecific pain context primary care total patients nonspecific acute pain diagnosed general practitioner recruited assigned randomly groups conventional treatment complemented sessions week period true acupuncture sham acupuncture placebo acupuncture patient patients treated february january primary outcome reduction roland morris disability questionnaire scores weeks treatment patients types acupuncture groups blinded treatments received conventional treatment analysis adjusted total sample true acupuncture relative risk confidence interval sham acupuncture relative risk confidence interval placebo acupuncture relative risk confidence interval subsample occupationally active patients modalities acupuncture conventional treatment difference acupuncture modalities implies true acupuncture sham placebo acupuncture treatment+acupuncture+controversy+mind+debunkery+energy work
3 article Wand et al Should we abandon cervical spine manipulation for mechanical neck pain? British Medical Journal Extremely well-written position paper this tired old controversy. 2012 cervical spine manipulation high velocity amplitude range thrust manoeuvre common treatment option mechanical neck pain carry potential neurovascular complications specifically vertebral artery dissection subsequent vertebrobasilar stroke superiority manipulation alternative treatments coupled concerns safety renders cervical spine manipulation unnecessary inadvisable treatment+chiropractic+spinal adjustment+neck+manual therapy+controversy+debunkery+spine+head/neck
4 article Rutjes et al Viscosupplementation for Osteoarthritis of the Knee Annals of Internal Medicine Should you get a knee lube job? Just say no! This treatment for osteoarthritis is so busted by a new review of the research so far. The injection of hyaluronic acid — slippery stuff — into the knee to decrease the symptoms of osteoarthritis has been in use for several years (in Canada since 1992). Nearly 90 trials were reviewed and it was determined that this treatment is associated “with a small and clinically irrelevant benefit and an increased risk for serious adverse events.” Take home message? Combining injections and wishful thinking is bad news. 2012 background viscosupplementation intra articular injection hyaluronic acid widely symptomatic knee osteoarthritis purpose assess benefits risks viscosupplementation adults symptomatic knee osteoarthritis data sources medline january embase january cochrane central register controlled trials january sources study selection randomized trials language compared viscosupplementation sham nonintervention control adults knee osteoarthritis data extraction primary outcomes pain intensity flare ups secondary outcomes included function adverse events reviewers duplicate abstractions assessed study quality pooled data random effects model examined funnel plots explored heterogeneity meta regression data synthesis trials involving   adults met inclusion criteria sixty sham control follow duration greater months cross linked forms hyaluronic acid trials patients showed viscosupplementation moderately reduced pain effect size ci important trial heterogeneity asymmetrical funnel plot trial size blinded outcome assessment publication status effect size unpublished trials patients showed effect size ci eighteen large trials blinded outcome assessment patients showed clinically irrelevant effect size ci trials patients showed viscosupplementation increased statistically significantly risk flare ups relative risk ci fourteen trials patients showed viscosupplementation increased risk adverse events relative risk ci limitations trial quality generally safety data reported conclusion patients knee osteoarthritis viscosupplementation small clinically irrelevant benefit increased risk adverse events treatment+knee+arthritis+injections+leg+limbs+pain problems+aging+medicine
3 article Robergs Nothing ‘evil' and no ‘conundrum' about muscle lactate production Experimental Physiology Concise, clear summary of the lactic acid myth, by a physiologist, in a journal. This is the single best professional source citation I know of on this topic. 2012 evil muscle lactate production clear evidence lactate direct negative effect muscle contraction conundrum muscle lactate muscle lactate production essential sustained repeated intense muscle contraction post training increases mct mct support greater rates total capacities muscle lactate efflux intense exercise performance allowing greater capacity muscle lactate production related glycolytic atp turnover long overdue based aspects scientific method recognize muscle lactate production benefit intense exercise performance muscle biochemistry encourage researchers educators alike present interpretation muscle lactate production evidence based view benefits lactate production espoused traditional blame fatigue acidosis simply biology+muscle+debunkery+DOMS+exercise+self-treatment+treatment+inflammation+pain problems
4 article Newman et al Two simple clinical tests for predicting onset of medial tibial stress syndrome British Journal of Sports Medicine Both clinical tests — shin palpatation and shin edema — used in this study were found to be a “significant predictor” of shin splints. 2012 objective examine relationship clinical test results future diagnosis medial tibial stress syndrome mtss personnel military trainee establishment design data preparticipation musculoskeletal screening test performed australian defence force academy officer cadets compared injuries reported officer cadets months data held injury surveillance database analysed χ fisher exact tests receiver operating characteristic curve analysis main outcome measure diagnosis mtss confirmed independent blinded health practitioner results palpation oedema clinical tests significant predictors onset mtss specifically shin palpation test ci positive likelihood ratio negative likelihood ratio pearson χ exercise+diagnosis+shin pain+self-treatment+treatment+leg+limbs+pain problems+overuse injury+injury+running
3 article Rixe et al The barefoot debate Curr Sports Med Rep A summary of the state of barefoot-minimalist running science, much shorter than Lieberman’s early 2012 summary, with the same conclusion: on the one hand, “A growing body of biomechanics research has emerged to support the advantages of ‘barefoot’ running,” but unfortunately, “No clinical studies have been published to substantiate the claims of injury reduction using a ‘minimalist’ style.” 2012 running evolved history form locomotion athletic recreational pursuit transition barefoot ancestors developed footwear late s running popularity surged footwear manufacturers developed running shoe shoe technology expert advice runners face high injury rates decline minimalist running marked soft forefoot strike shorter quicker strides increasingly popular running community biomechanical studies suggested features barefoot style running lead reduction injury rates conducting outcomes based research minimalist footwear gait retraining serve methods reduce injuries running population barefoot+foot+leg+limbs+pain problems+running+exercise+self-treatment+treatment
4 article Joseph et al Deep friction massage to treat tendinopathy Journal of Sport Rehabilitation This review of the “efficacy of deep friction massage (DFM) in the treatment of tendinopathy” concludes that there’s basically still no hard data, and “its isolated efficacy has not been established.” However, they offer a firm opinion that technique still makes some good sense despite the important “paradigm shift away from an active inflammatory model since the popularization of the DFM technique by Cyriax.” 2012 study design systematic literature review objective assess efficacy deep friction massage dfm treatment tendinopathy context anecdotal evidence supports efficacy dfm treatment tendinopathy advanced understanding etiopathogenesis tendinopathy resultant paradigm shift active inflammatory model place popularization dfm technique cyriax treatment tendinitis increasing mechanical load tendinopathic tissue reducing molecular cross linking healing process transverse massage offers plausible explanation observed responses light contemporary understanding tendinopathy evidence acquisition authors surveyed research articles languages searching pubmed scopus pedro cinahl psycinfo cochrane library terms deep friction massage deep tissue massage deep transverse massage cyriax soft tissue mobilization soft tissue mobilisation cross friction massage transverse friction massage included randomized comparison trials extensor carpi radialis brevis ecrb supraspinatus outlet tendinopathy nonrandomized comparison trials receiving dfm ecrb prospective noncomparison trials supraspinatus ecrb achilles tendons articles meeting inclusion criteria assessed based pedro centre evidence based medicine rating scales results studies met inclusion criteria evidence synthesis heterogeneity dependent measures meta analysis conclusion varied locations study designs etiopathogenesis outcome tools examine efficacy dfm unified conclusion tenuous evidence benefit elbow combination mills manipulation supraspinatus tendinopathy presence outlet impingement joint mobilization examination dfm single modality treatment comparison methods control undertaken isolated efficacy established excellent anecdotal evidence remains rationale fits current understanding tendinopathy treatment+manual therapy+massage+overuse injury+tendinosis+etiology+injury+pain problems+pro
5 article Rubinstein et al Spinal manipulative therapy for acute low-back pain Cochrane Database of Systematic Reviews If it were possible to report good news about spinal manipulation, it would be in this large Cochrane review of the science. Unfortunately, the good news is not here to report. Historically, spinal manipulative therapy (SMT, a.k.a. chiropractic adjustment) for acute low back pain has been regarded as the best example of evidence-based care routinely offered (primarily) by the chiropractic profession. Even many fierce critics of chiropractic have supported this claim (or at least left it alone while focusing on other issues, e.g. the risks of cervical manipulation). Nevertheless, critics have pointed out that even this “best” use of SMT has been damned with faint praise by the research. This meta-analysis supports the most critical view: the authors concluded that “SMT is no more effective in participants with acute low-back pain” than shams and placebos. Despite this, the rest of their conclusions seem crafted to prolong the controversy. They explain to clinicians why they should still refer patients for SMT (“preferences” and “costs”); they say that more research is needed to “examine specific subgroups.” (This is based on the rather faint hope that SMT might work so well for an unknown subcategory of patients that they can pull up the average.) And they say there’s a need for “an economic evaluation,” but a treatment cannot be “cost effective” if it is not effective. 2012 background therapies exist treatment pain including spinal manipulative therapy smt worldwide extensively practised intervention report update earlier cochrane review published january search studies january objectives examine effects smt acute pain defined pain weeks duration search methods comprehensive search conducted march cochrane central register controlled trials central medline embase cinahl pedro index chiropractic literature search strategies employed completeness limitations language publication status selection criteria randomized controlled trials rcts examined effectiveness spinal manipulation mobilization adults acute pain included addition studies included pain predominantly study allowed mixed populations including participants radiation pain buttocks legs studies exclusively evaluated sciatica excluded restrictions setting type pain primary outcomes pain pain specific functional status perceived recovery secondary outcomes return work quality life smt defined hands therapy directed spine includes manipulation mobilization includes studies chiropractors manual therapists osteopaths data collection analysis review authors independently conducted study selection risk bias rob assessment data extraction checked review author effects examined comparisons smt inert interventions sham smt interventions smt additional therapy addition examined effects smt techniques compared grade assess quality evidence authors contacted missing unclear data outcomes evaluated time intervals short term week month intermediate months long term months longer clinical relevance defined small difference md scale standardized difference smd medium md scale smd large md scale smd main results identified rcts total number participants included previous review sample sizes ranged median iqr total trials included studies rob rcts identified comparison outcome time interval amount data considered robust general primary outcomes quality evidence suggesting difference effect smt compared inert interventions sham smt added intervention varying quality evidence moderate suggesting difference effect smt compared interventions exception quality evidence trial demonstrating significant moderately clinically relevant short term effect smt pain relief compared inert interventions quality evidence demonstrating significant short term moderately clinically relevant effect smt functional status added intervention general side lying supine thrust smt techniques demonstrate short term significant difference compared thrust smt techniques outcomes pain functional status recovery authors conclusions smt effective participants acute pain inert interventions sham smt added intervention smt appears recommended therapies evaluation limited small number studies comparison outcome time interval future research important impact estimates decision refer patients smt based costs preferences patients providers relative safety smt compared treatment options future rcts examine specific subgroups include economic evaluation treatment+classics+manual therapy+spinal adjustment+chiropractic+controversy+back pain+spine+debunkery+pain problems
3 article Daoud et al Foot strike and injury rates in endurance runners Medicine & Science in Sports & Exercise This important retrospective study of Harvard runners found that forefoot (barefoot or minimally shod) runners had half the repetitive strain injuries — emotionally compelling evidence that this style of running is useful. If true, as author Dr. Dan Lieberman pointed out, “it's the biggest effect ever shown on running injury.” However, the abstract of the paper declares that it “does not test the causal basis” for these results — and indeed it cannot. This is retrospective research — examining old data, gathered without controlled conditions. Restrospective studies, especially small ones, cannot in principle reveal causation, and are notoriously prone to pollution with confounding factors. Nevertheless, Lieberman seems to believe the data is persuasive — he presents these new results enthusiastically and uncritically in a generally fascinating talk for, Brains Plus Brawn. I agree it is emotionally compelling evidence. However, I am also uncomfortably aware of how shockingly, seductively easy it is to be fooled by an appealing correlation like this. There are other possible reasons why forefoot striking Harvard runners might have lower injury rates. It is not necessarily running in bare feet or barely-there running shoes. Many alleged causal relationships in the history of science, just as “persuasive” as this one, turned out to be wrong. So, I note these results with interest, and I admit for the first time that maybe — just maybe — this barefoot running fad is going to turn out to be important. But I must still reserve judgement until cause is confirmed by good quality research. 2012 purpose retrospective study tests runners habitually forefoot strike rates injury runners habitually rearfoot strike methods measured strike characteristics middle long distance runners collegiate cross country team quantified history injury including incidence rate specific injuries severity injury rate mild moderate severe injuries mile run results runners studied primarily rearfoot strike primarily forefoot strike approximately runners experienced moderate severe injury year habitually rearfoot strike approximately rate repetitive stress injuries individuals habitually forefoot strike traumatic injury rates significantly groups generalized linear model showed strike type sex race distance average miles week correlate significantly repetitive injury rates conclusions competitive cross country runners college team incur high injury rates runners habitually rearfoot strike significantly higher rates repetitive stress injury forefoot strike study test causal bases general difference hypothesis requires research absence marked impact peak ground reaction force forefoot strike compared rearfoot strike contribute rates injuries habitual forefoot strikers barefoot+counter-intuitive+classics+foot+leg+limbs+pain problems+running+exercise+self-treatment+treatment
2 article Ramos-González et al Comparative study on the effectiveness of myofascial release manual therapy and physical therapy for venous insufficiency in postmenopausal women Complementary Therapies in Medicine This study compared the effects of massage and minimal exercise therapy on poor circulation (venous insufficiency) in post-menopausal women. Superficially it looks like a good news story for massage, and in some ways it is. Massage did have a statistically significant positive effect and seems to have “increased circulation” in one sense (something I have often called a myth). But there’s a lot to consider here. Only the statistical significance of the results is touted in the abstract, not their size. This almost always means a real effect that was too small to emphasize. So I read the full paper and, sure enough, the effects of massage were positive but modest at best (and in many cases trivial). There were a lot of measures of success, and none changed all that much. The phrase “damned with faint praise” comes to mind, as it so often does in massage science. Also, some of the measures also seemed barely useful. If I got that much massage, I’d probably feel like my quality of life had improved too — but I’m not sure that would have much to do with improving my mild venous insufficiency. And it was really a lot of massage (expensive in the real world). And the pure “kinesiotherapy” treatment was super basic — this control group barely did more than wiggle their toes and clench their thighs, so it’s hardly surprising that they didn’t improve much. I wish the study had included a third group doing more exercise, perhaps a half hour of brisk walking per day. I think there’s an excellent chance walkers would have performed as well or even far better than massage. And walking is notably a lot cheaper than massage. 2012 objectives venous insufficiency present large number postmenopausal women increasing risk disability objective study determine effects myofascial release therapy conventional kinesiotherapy venous blood circulation pain quality life postmenopausal patients venous insufficiency methods randomised controlled trial undertaken enrolled postmenopausal women stage ii venous insufficiency clinical aetiological anatomical physiopathological ceap scale venous disorders randomly assigning control experimental group control experimental group patients underwent physical venous return therapy kinesiotherapy week period experimental group patients received sessions myofascial release therapy main outcome measures determined pre post intervention blood pressure cell mass intracellular water basal metabolism venous velocity skin temperature pain quality life results basal metabolism treatment+massage+manual therapy
3 article Cheng et al Reproducibility of sonographic measurement of thickness and echogenicity of the plantar fascia Journal of Clinical Ultrasound Based on 56 feet, 20 with inferior heel pain, researchers concluded that “the reliability of sonographic examination of the thickness of the plantar fascia is high,” with no advantage to a transverse scan. 2012 background evaluate intra interrater reliability ultrasonographic measurements thickness echogenicity plantar fascia methods eleven patients feet complained inferior heel pain volunteers feet enrolled sonographers independently imaged plantar fascia longitudinal transverse planes volunteers assessed evaluate intrarater reliability quantitative evaluation echogenicity plantar fascia performed measuring gray level region interest digital imaging communications medicine viewer software results sonographic evaluation thickness plantar fascia showed high reliability sonographic evaluations presence absence hypoechoic change plantar fascia showed surprisingly agreement reliability gray scale evaluations appears subjective judgments evaluation echogenicity transverse scanning show advantage sonographic evaluation plantar fascia conclusions reliability sonographic examination thickness plantar fascia high gray level analysis quantitative sonography evaluation echogenicity reduce discrepancies interpretation echogenicity sonographers longitudinal transverse scanning recommended imaging plantar fascia treatment+plantar fasciitis+devices+foot+leg+limbs+pain problems+overuse injury+injury+tendinosis
3 article Finan et al Quantitative sensory tests of central sensitization are associated with discordance between pain and radiographic severity in knee osteoarthritis Arthritis and Rheumatism Many lines of evidence suggest that pain is not tightly linked to tissue damage. If so, there should be people with knees that look bad on a scan, but feel fine, and vice versa. This study of 113 people found exactly that: as Tony Ingram summarized it, people “who had a little arthritis and high pain & people with severe arthritis but low pain.” And why did the hurters hurt? High sensitivity to pain in general: “central sensitization” (see Woolf). Their knees weren’t the problem — their nervous systems were. 2012 objective radiographic measures knee osteoarthritis oa pathology modest associations clinical pain sought evaluate differences quantitative sensory testing qst psychosocial distress profiles oa patients discordant congruent clinical pain reports relative radiographic severity measures patients methods participants women age ± oa participated study radiographic joint pathology graded kellgren lawrence scale central sensitization indexed quantitative sensory testing including heat pressure pain threshold tonic suprathreshold pain cold pressor test repeated phasic suprathreshold mechanical thermal pain subgroups constructed dichotomizing clinical knee pain scores median split knee grade scores resulting groups pain knee grade high pain knee grade pain high knee grade high pain high knee grade results multivariate analyses revealed significantly heightened pain sensitivity high pain knee grade group pain high knee grade group pain sensitive group differences remained significant adjusting differences psychosocial measures age sex race conclusion results suggest central sensitization oa apparent patients high clinical pain reports absence moderate severe radiographic evidence oa pathology etiology+patellar pain+chronic pain+arthritis+biomechanics+pro+aging+pain problems+knee+leg+limbs+overuse injury+injury+running+exercise+self-treatment+treatment
2 article Proske et al The proprioceptive senses Physiol Rev 2012 review proprioceptive senses generated result actions include senses position movement limbs trunk sense effort sense force sense heaviness receptors involved proprioception located skin muscles joints information limb position movement generated individual receptors populations afferents afferent signals generated movement processed code endpoint position limb afferent input referred central body map determine location limbs space experimental phantom limbs produced blocking peripheral nerves shown motor areas brain generate conscious sensations limb displacement movement absence sensory input normal limb tendon organs possibly muscle spindles contribute senses force heaviness exercise disturb proprioception implications musculoskeletal injuries proprioceptive senses limb position movement deteriorate age increased risk falls elderly information proprioception understanding mechanisms underlying senses providing insight range clinical conditions strain+injury+pain problems+muscle
4 article Cook et al Best tests/clinical findings for screening and diagnosis of patellofemoral pain syndrome Physiotherapy 2012 background diagnosis patellofemoral pain syndrome pfps commonly performed myriad clinical imaging based criteria objectives objective systematic literature review summarize research accuracy individual clinical tests findings pfps data sources medline proquest nursing allied health cochrane trials pedro cinahl study selection eligibility criteria prisma guidelines review considered review study required description clinical test tests diagnosing pfps including test combined finding patient history report diagnostic accuracy measures sensitivity specificity acceptable reference standard comparison study appraisal synthesis methods quality assessment studies diagnostic accuracy quadas scores completed selected article sensitivity specificity negative positive likelihood ratios lr lr+ calculated diagnostic test results systematic search strategy hand search revealed potential articles met criteria review analysing total pfps clinical tests assessment quadas score articles high quality tests highest reported diagnostic studies lowest quadas values conclusion majority studies investigated diagnostic accuracy clinical tests pfps demonstrate notable design reporting biases stage determining tests diagnosis pfps difficult patellar pain+diagnosis+etiology+arthritis+aging+pain problems+knee+leg+limbs+overuse injury+injury+running+exercise+self-treatment+treatment+pro
inbook Kean The violinist’s thumb Little, Brown and Co. 2012 remember genetic predilections behavior shaped african savanna thousands millions years natural sense predilections necessarily serve today live radically environment nature poor guide making decisions biggest boners ethical philosophy naturalistic fallacy equates nature natural justify excuse prejudice human beings humane part biology biology+random+scientific medicine
inbook Kean The violinist’s thumb Little, Brown and Co. 2012 playing clarinet wound fingers awkward braids constantly felt crack knuckles throb blue moon thumb stuck place frozen extension work joint free hand learned story violinist niccolò paganini man gifted shake rumors life sold soul satan talent hometown church refused bury body decades death turns paganini pact subtler master dna paganini genetic disorder gave freakishly flexible fingers connective tissues rubbery pull pinky sideways form angle rest hand stretch hands abnormally wide incomparable advantage playing violin investigating paganini syndrome caused health problems joint pain poor vision weakness breath fatigue dogged violinist life biology+random
3 webpage Nirenberg Biomechanics of Sport Shoes A podiatrist’s review of a new textbook — apparently still to be distributed? I’m afraid I can’t actually find the book — with some excellent observations. Both review and book generally strongly debunk the utility of a structural perspective on feet. 2012 biomechanics+orthotics+foot+etiology+plantar fasciitis+patellar pain+devices+pro+leg+limbs+pain problems+self-treatment+treatment+overuse injury+injury+tendinosis+arthritis+aging+knee+running+exercise
inbook Kean The violinist’s thumb Little, Brown and Co. 2012 entire system dna chemistry accidental frozen cells billions years ingrained replace qwerty keyboard biology rna employees fancy anagrams error correcting algorithms strive maximize storage space code choking wasteful redundancy biology+random
1 article Armstrong et al Mild dehydration affects mood in healthy young women J Nutr This research, funded in part by a giant corporation that sells bottled water, shows that surprising mild dehydration can make you a bit pissy. The level of dehydration studied here is similar to what it takes to provoke thirst, and the effects on mood are presumably milder at the lower end of the range. So if the effect on mood is significant, we are probably also thirsty ... and if we’re not actually thirsty, the effect is probably pretty minor. That said, I might agree with the author’s conclusion that “increased emphasis on optimal hydration is warranted,” but I’m also guessing it’s not that big a deal, and I’m inclined to be rather cynical about it, because the conclusion is just so pitch-perfect for a study funded by a water bottling company. Mood effects are not to be ignored, for sure, but they are also a lot less serious than the health effects that people tend to believe (mostly based on very successful fear-mongering by people selling ‘water cures’). 2012 limited information effects mild dehydration cognitive function mild dehydration produced intermittent moderate exercise hyperthermia effects cognitive function women investigated twenty females age ± participated placebo controlled experiments involving hydration state day exercise induced dehydration diuretic dn exercise induced dehydration diuretic dd furosemide mg euhydration eu cognitive performance mood symptoms dehydration assessed experiment times rest exercise sessions dn dd trials volunteer attained level dehydration pooled compared volunteer equivalent eu trials dehydration achieved dn dd trials ± body mass significant adverse effects dehydration present rest exercise vigor activity fatigue inertia total mood disturbance scores profile mood states task difficulty concentration headache assessed questionnaire aspects cognitive performance affected dehydration serum osmolality marker hydration greater dehydrated trials level dehydration achieved compared eu conclusion degraded mood increased perception task difficulty concentration headache symptoms resulted dehydration females increased emphasis optimal hydration warranted moderate exercise water+bad science+controversy+debunkery+scientific medicine
webpage Lieberman Brains Plus Brawn Fascinating video (with complete transcript) of a talk by Dr. David Lieberman, a Harvard biologist, about how humans evolved a remarkable capacity for athletic endurance much earlier than we got large brains. He concludes with a summary of the first persuasive research (Lieberman) that modern running shoes probably injure runners more by encouraging a high impact style: Harvard track athletes who have adopted a toe-running style have almost half as many injuries as their heel-striking peers. Lieberman is a terrific speaker, and this presentation will carry great weight with runners everywhere. However, it’s important to understand that it is still premature to conclude that running barefoot or minimally-shod prevents injuries. It may. But a lot of similarly safe-seeming “conclusions” in science history have turned out to be wrong! Early adopters beware. 2012 etiology+orthotics+overuse injury+barefoot+running+plantar fasciitis+patellar pain+IT band pain+foot+knee+pro+leg+limbs+pain problems+self-treatment+treatment+devices+injury+exercise+tendinosis+arthritis+aging
3 webpage Goodwin From Time Magazine to NBC Commentators A deeper, geekier lactate rant, about the prevalence of the lactate myth in the 2012 summer Olympics coverage. This is a terrific read for anyone really interested in the subject. For more digestible summaries, be sure to see Lactic Acid Is Not Muscles' Foe, It's Fuel in the New York Times, and Robergs in Experimental Physiology. 2012 summer olympics finally glued televisions watching world athletes compete painfully obvious weeks reporting olympic trials olympics announcers magazines time continue confuse viewers readers understand basic physiology world athletes correct incorrect statement hope address big gaffes continually reported lactate soreness nonsense widely read publications focus areas expertise oxidative metabolism lactate metabolism mangled recognition reporting biology+exercise+pro+self-treatment+treatment
3 webpage Homola Chiropractic gimmickry An good overview of dubious practices in chiropractic care other the standard chiropractic treatment. 2012 chiropractic+spinal adjustment+controversy+manual therapy+treatment+debunkery+spine
2 webpage Grimes Three men make a tiger One of the best one-stop-shop summaries I’ve found of why homeopathy’s central claims are scientifically untenable. (A shame about the eye-watering color scheme! But the writing is good.) 2012 homeopathy+scientific medicine+controversy+debunkery
3 webpage Griffiths Overpronation 2012 biomechanics+foot+etiology+pro+leg+limbs+pain problems
2 webpage Grant Flushing Out Myths 2012 massage+biology+manual therapy+treatment
2 webpage Moseley The therapy might work, but does it work in the manner you think it does? We know that “explaining pain” seems to reduce it, but how? Do we really know what’s going on? “The theory behind explaining pain is that it decreases pain by changing the underlying schema about what pain actually is.” Dr. Moseley methodically applies a validity test to that theory, which it passes with flying colours, meaning that it is a reasonable, working theory about how pain education works (not proof that is does work — a technical but important difference). For contrast, note that in a follow-up article, he concludes that graded motor imagery does not satisfy the burns test — a nice demonstration of the integrity of his reasoning. 2012 mind+chronic pain+treatment+scientific medicine+pain problems
5 book Chabris et al The invisible gorilla MJF Books Christopher Chabris and Daniel Simons created of one of psychology’s most famous experiments, The Invisible Gorilla experiment. In this book, they describe the weird implication of several more years of related research, using story and surprising science to demonstrate that our minds and senses don’t work the way we think they do. In particular, they should that do not notice far more than we realize — even the seemingly obvious. 2012 fun+random+scientific medicine
webpage Ingraham Lecture A $6.95, 1-hour dose of me talking about the clinical relevance of fascia science, and how it’s probably pretty limited. I have some experience in radio, and have a pretty agreeable style. Give it a try. 2012 controversy+fascia+personal+fun+debunkery+etiology+pro+massage+manual therapy+treatment
webpage Schleip Fascia Contractility FAQ 2012
3 webpage Birch The 10 Most Insane Medical Practices in History 2012 controversy+fun+random+debunkery
4 article Meeus et al Central sensitization in patients with rheumatoid arthritis Seminars in Arthritis and Rheumatism Sometimes the central nervous system changes so that we feel more pain with less provocation (central sensitization). How much does this phenomenon complicate chronic pain problems? For instance, rheumatoid arthritis (RA) is a nasty source of chronic pain, but could some of the pain be caused by central sensitization instead of the disease itself? Meeus et al. concluded that there are signs of this, from analyzing 24 scientific papers (although “more research is needed,” of course). RA mainly attacks joints, but patients often experience pain elsewhere, and in response to a variety of stimuli, and symmetrically — all of which are a good fit for central sensitization. Also, as with many other chronic pain conditions, in RA there’s often more (or less) pain than detectable tissue trouble (e.g. see Younes), indicating that the progress of the disease is probably not the only driver of pain. Sensitization may be the best way to explain this. 2012 objective goal present study systematically review scientific literature addressing central sensitization central nociceptive processing patients rheumatoid arthritis ra methods identify relevant articles searched pubmed web science search strategy combination terms groups rheumatoid arthritis inflammatory joint pain arthritis central sensitization central hypersensitivity central hyperexcitability pain modulation pain processing neural inhibition pain physiopathology pain nociception hyperalgesia pain threshold algometry articles fulfilling inclusion criteria screened methodologic quality specific checklists evaluate study designs independent raters results twenty full text articles included majority case control studies nonsystematic reviews cross sectional studies case reports methodologic quality heterogeneous preliminary evidence generalized hyperalgesia ra addition mechanism impaired central nociceptive processing remains obscure role cytokines neuropeptides remains elucidated windup appears develop easily ra evidence support impaired nociceptive inhibition cognitive emotional sensitization sensitization due cognitive bias scarce conclusions symmetrical manifestation disease poor relation disease activity symptoms generalized hyperalgesia articular nonarticular sites kinds stimuli indicative presence central sensitization ra patients research required provide firm evidence support aspects central sensitization humans ra chronic pain+sensitization+arthritis+pain problems+neurology+aging
5 article Kay et al Exercises for mechanical neck disorders Cochrane Database of Systematic Reviews “Low to moderate quality evidence supports the use of specific cervical and scapular stretching and strengthening exercise for chronic neck pain… and headaches.” This is promising, but not based on any high quality evidence, only six of the 21 experiments they looked at were of decent quality, and they were spread thin over different kinds of exercise, many ways of measuring success, a lot of apples to oranges comparisons. So overall the results were mostly mixed, confusing, unimpressive and highly subject to interpretation … and therefore also subject to the huge bias in favour of therapeutic exercise. And there’s been no real improvement since the first version of this review in 2005. I don’t trust any conclusions here. 2012 background neck disorders common disabling costly effectiveness exercise physiotherapy intervention remains unclear objectives improve pain disability function patient satisfaction quality life global perceived effect adults neck pain search methods computerized searches conducted february selection criteria included single therapeutic exercise randomized controlled trials adults neck pain cervicogenic headache radiculopathy data collection analysis review authors independently conducted selection data extraction risk bias assessment clinical relevance quality body evidence assessed grade relative risk standardized differences smd calculated   judging clinical statistical heterogeneity performed meta analyses main results selected trials risk bias moderate quality evidence shows combined cervical scapulothoracic stretching strengthening beneficial pain relief post treatment pooled smd confidence interval ci intermediate follow pooled smd ci improved function short term intermediate term pooled smd ci chronic neck pain moderate quality evidence demonstrates patients satisfied care treated therapeutic exercise quality evidence shows exercise benefit pain short term function long term follow chronic neck pain   moderate quality evidence shows chronic neck pain respond upper extremity stretching strengthening general exercise program moderate quality evidence supports mobilization craniocervical endurance load cervical scapular endurance exercises reducing pain improving function global perceived effect long term subacute chronic cervicogenic headache quality evidence supports neck strengthening exercise acute cervical radiculopathy pain relief short term authors conclusions moderate quality evidence supports specific cervical scapular stretching strengthening exercise chronic neck pain immediately post treatment intermediate term cervicogenic headaches long term moderate evidence suggests benefit upper extremity stretching strengthening exercises general exercise program   future trials exercise classification system establish similarity protocols adequate sample sizes factorial trials determine active treatment agent treatment regimen standardized representation dosage essential standardized reporting adverse events needed balancing likelihood treatment benefits potential harms self-treatment+strength+exercise+neck+stretch+treatment+head/neck+spine+muscle
3 article West et al Cognitive sophistication does not attenuate the bias blind spot J Pers Soc Psychol This paper is the scientific version of the classic Richard Feynman quote: “The first principle is that you must not fool yourself & you are the easiest person to fool.” It presents evidence that intelligence makes you better at fooling yourself: “none of these bias blind spots were attenuated by measures of cognitive sophistication such as cognitive ability or thinking dispositions related to bias. If anything, a larger bias blind spot was associated with higher cognitive ability.” 2012 called bias blind spot arises people report thinking biases prevalent bias turns easy recognize behaviors difficult detect judgments previous research bias blind spot focused bias social domain studies replicable bias blind spots respect classic cognitive biases studied heuristics biases literature tversky amp kahneman bias blind spots attenuated measures cognitive sophistication cognitive ability thinking dispositions related bias larger bias blind spot higher cognitive ability additional analyses free bias blind spot person avoid actual classic cognitive biases discuss findings terms generic dual process theory cognition random+critical thinking+mind
3 webpage Burkeman This column will change your life The Guardian 2012 biomechanics+exercise+etiology+pro+self-treatment+treatment
3 webpage Skeptic Doctor Skeptic Placebo surgery: necessary, ethical? Yes! Here’s a fine short post on this topic from Doctor Skeptic ( You “need a placebo [surgery] trial when the outcomes are ‘soft’ (subjective: pain).” I’ve been arguing this for many, many years. We really need to compare surgeries for pain problems to shams, because, by golly, that method sure does reveal some useless surgeries. One of the best examples of why is Moseley’s fascinating 2002 knee trial. 2012 surgery+mind+scientific medicine+back pain+treatment+pain problems+spine
3 article Kim et al Effect of Intradiscal Methylene Blue Injection for the Chronic Discogenic Low Back Pain Ann Rehabil Med This study provides some encouraging replication of Peng 2010, which had almost shockingly good news for a high quality test of a back pain treatment. Predictably, however, the results here are not quite as thrilling — merely “good” — and the long term results were definitely less promising: “The intradiscal MB injection is a short-term effective minimally invasive treatment indicated for discogenic back pain but it may lose its effectiveness long-term.” Still good news though. 2012 objective evaluate efficacy intradiscal methylene blue mb injection patients chronic discogenic pain method twenty patients discogenic pain males females age years refractory conservative management recruited subjects underwent mb injection target lumbar intervertebral discs confirmed provocative discography clinical outcome assessed visual analog scale vas oswestry disability index odi baseline months treatment successful outcome minimum points reduction pain intensity compared baseline results vas odi significantly decreased injection average vas odi reduced significantly baseline months injection back pain+injections+pain problems+spine+medicine+treatment
3 article Hurlow et al Transcutaneous electric nerve stimulation (TENS) for cancer pain in adults Cochrane Database of Systematic Reviews 2012 background cancer related pain complex multi dimensional mainstay cancer pain management predominantly biomedical approach pharmacological innovative approaches transcutaneous electric nerve stimulation tens role pain management effectiveness tens unknown update original review published issue objectives aim systematic review determine effectiveness tens cancer related pain adults search methods initial review searched cochrane library medline embase cinahl psychinfo amed pedro databases april performed updated search central medline embase cinahl pedro databases november selection criteria included randomised controlled trials rcts investigating tens management cancer related pain adults data collection analysis search strategy identified studies inclusion review authors screened abstract study eligibility tool eligibility determined author assessed full paper author standardised data extraction sheet collect information studies independently assess quality studies validated point oxford quality scale small sample sizes differences patient study populations included studies original review included update prevented meta analysis original review search strategy identified published studies divided pairs review authors decided study selection review authors discussed agreed final scores main results additional rct met eligibility criteria participants updated review feasibility study designed investigate intervention effect suggested tens improve bone pain movement cancer population initial review identified rcts participants review includes total rcts participants studies heterogenous respect study population sample size study design methodological quality mode tens treatment duration method administration outcome measures rct significant differences tens placebo women chronic pain secondary breast cancer treatment rct significant differences acupuncture type tens sham palliative care patients study underpowered authors conclusions additional rct results updated systematic review remain inconclusive due lack suitable rcts large multi centre rcts required assess tens management cancer related pain adults chronic pain+TENS+pain problems+devices+treatment
3 article Thielke et al Aging J Fam Pract 2012 pain natural part aging toughing pain tolerable read evidence common misconceptions pain aging chronic pain+aging+pain problems
article Ge et al Accelerated muscle fatigability of latent myofascial trigger points in humans Pain Med 2012 objective muscle fatigue prevalent acute chronic musculoskeletal pain conditions myofascial trigger points mtps involved aim study investigate association latent mtps muscle fatigue design intramuscular electromyographic emg recordings obtained latent mtps mtps surface emg recordings upper trapezius muscles sustained isometric muscle contractions healthy subjects outcome measures normalized root square rms emg amplitude power frequency mnf analyzed rate perceived exertion pain intensity mtp side mtp side recorded results pain intensity mtp side significantly higher mtp side intramuscular emg latent mtps showed early onset decrease mnf significant decrease fatiguing contraction compared mtps   muscle pain+exercise+etiology+muscle+pain problems+self-treatment+treatment+pro
article González-Izal et al Electromyographic models to assess muscle fatigue Journal of Electromyography & Kinesiology 2012 muscle fatigue common experience daily life authors defined incapacity maintain required expected force force power torque recordings direct measurements muscle fatigue addition measurement variables combined measurement surface electromyography semg recordings measured types movements exercise assess understand muscle fatigue develop muscle fatigue models relate semg variables muscle fatigue main issue conventional semg variables quantify fatigue poor association direct measures fatigue techniques authors combined sets semg parameters assess muscle fatigue aim paper serve state art summary semg models assess muscle fatigue paper overview linear linear semg models estimating muscle fatigue ability assess power loss limitations due neuromuscular training period exercise+etiology+self-treatment+treatment+pro
5 webpage Burfoot Do Running Shoes Cause Running Injuries? 2012 love amby burfoot tone running injury post humble fun amp informed manages lot reserving judgement effectively interesting debatable conclusion put feet potential harm good raise platform increasing instabilities ideal compromise running+orthotics+overuse injury+IT band pain+plantar fasciitis+patellar pain+shin pain+etiology+exercise+self-treatment+treatment+foot+leg+limbs+pain problems+devices+injury+knee+tendinosis+arthritis+aging+pro
2 article Bron et al Etiology of myofascial trigger points Curr Pain Headache Rep 2012 myofascial pain syndrome mps sensory motor autonomic symptoms caused myofascial trigger points trps knowing potential trps important prevent development recurrence inactivate eliminate existing trps general agreement muscle overuse direct trauma muscle lead development trps muscle overload hypothesized result sustained repetitive level muscle contractions eccentric muscle contractions maximal submaximal concentric muscle contractions trps develop occupational recreational sports activities muscle exceeds muscle capacity normal recovery disturbed muscle pain+etiology+muscle+pain problems+pro
3 webpage Bradley From ‘trust us, we’re doctors’ to the rise of evidence-based medicine A mostly excellent article on the rise of evidence-based medicine for The Conversation. Bradley concludes with a flourish of naive optimism, however: “With the widespread adoption of evidence-based medicine, the older clinical style has finally withered away.” Oh, if only! Not only has that old style not “withered” away, EBM is actively resisted and rejected, even by many physicians, and of course most everyone involved in complementary and alternative medicine, which exists and thrive entirely outside of EBM by definition. In particular, in the world of manual and manipulative therapy, there’s still a strong demand for and huge supply of “therapist’s intuition.” That trade has thrived over the entire 20-year history of EBM, and for the most part therapists and practitioners of every description still regard EBM with deep suspicion, as a faddish and new-fangled thing. 2012 scientific medicine
4 article Patel et al Massage for mechanical neck disorders Cochrane Database of Systematic Reviews 2012 background prevalence mechanical neck disorders mnd hindrance individuals costly society massage widely form treatment mnd objectives assess effects massage pain function patient satisfaction global perceived effect adverse effects cost care adults neck pain comparison post treatment long term follow search methods searched cochrane library central medline embase mantis cinahl icl databases date inception feburary selection criteria studies random assignment included data collection analysis review authors independently conducted citation identification study selection data abstraction methodological quality assessment random effects model calculated risk ratio standardised difference main results fifteen trials met inclusion criteria methodology trials assessed grade level trials strong moderate grade level results showed level evidence massage techniques traditional chinese massage classical modified strain counter strain technique effective control placebo treatment improving function tenderness level evidence massage beneficial education short term pain bothersomeness level evidence ischaemic compression passive stretch effective combination individually pain reduction clinical applicability assessment showed trials adequately massage technique majority trials assessed outcomes post treatment adequate time assess clinical change due limitations quality existing studies unable firm statement guide clinical practice noted studies reported side effects studies reported post treatment pain side effect study irnich showed participants experienced blood pressure treatment authors conclusions recommendations practice time effectiveness massage neck pain remains uncertain stand treatment massage mnd provide short term effectiveness pain tenderness additionally future research needed order assess long term effects treatment treatments occasion neck+massage+head/neck+spine+manual therapy+treatment
3 article Seifert et al Skin shedding and tissue regeneration in African spiny mice (Acomys) Nature This neat 2012 science story is promising for regeneration science: “Biologist discovers mammal with salamander-like regenerative abilities.” The African spiny mouse does a far better job at regenerating any part of itself than any other known mammal to date. (Salamanders are much better at regeneration, in every way, but at least we know mammals aren’t completely left out of the regeneration game.) 2012 evolutionary modification produced spectrum animal defence traits escape predation including ability autotomize body parts elude capture autotomy missing part replaced regeneration urodeles lizards arthropods crustaceans permanently lost mammals autotomy involves loss appendages legs chelipeds antennae tails skin autotomy occur taxa scincid gekkonid lizards report demonstration skin autotomy mammalia african spiny mice acomys mechanical testing showed propensity skin tear tension absence fracture plane skin loss rapid wound contraction hair follicle regeneration dorsal skin wounds notably regenerative capacity acomys extended ear holes mice exhibited complete regeneration hair follicles sebaceous glands dermis cartilage salamanders capable limb regeneration form blastema mass lineage restricted progenitor cells limb loss findings suggest ear tissue regeneration acomys proceed assembly similar structure study underscores importance investigating regenerative phenomena conventional model organisms suggests mammals retain higher capacity regeneration previously believed emergent interest regenerative medicine seeks isolate molecular pathways controlling tissue regeneration mammals acomys prove identifying mechanisms promote regeneration lieu fibrosis scarring neat
3 webpage Ernst The “integrated medicine” straw-man 2012 notion preach gospel integrated medicine perform art medicine ridiculous insulting healthcare meet patients assumption unproven disproven treatments acceptable simply administered kind caring fashion simply true controversy+debunkery
book Kean The violinist’s thumb Little, Brown and Co. 2012 biology+random
3 webpage Griffiths Choosing Running Shoes Ian Griffiths debunks 4 rusty links in the chain of reasoning from “shoe choice” to “injury prevention.” I really enjoyed the way he structured his argument here. This is one of those “wish I’d written it” articles! Some nice quotes that stand out: “…functioning in a pronated position does not mean that you will necessarily get injured.” “All decisions could and should be based on one main factor in my opinion: comfort. Believe it or not comfort has been linked to injury frequency reduction41 and is thought to be the most important variable for sports shoes, and a focal point for any future sports shoe development.” “…the current model upon which running shoes are recommended/chosen is erroneous.” “So ‘anti-pronatory’ shoes with stiffer midsoles are actually doing what they promise to. The problem is we don’t know whether we need them to do it for us or not.” “The word ‘normal’ is probably an inappropriate word to apply to the human body.” 2012 running+orthotics+foot+exercise+self-treatment+treatment+leg+limbs+pain problems+devices
book Dryden et al Massage therapy Human Kinetics 2012 massage+scientific medicine+manual therapy+treatment
webpage no author What FX? 2012 controversy+random+debunkery
article Ford et al Sedentary behaviour and cardiovascular disease Int J Epidemiol 2012 background current estimates objective accelerometer data suggest american adults sedentary ∼ day historically sedentary behaviour conceptualized physical activity spectrum increasingly viewed behaviour distinct physical activity methods prospective studies examining associations screen time watching television watching videos computer sitting time fatal fatal cardiovascular disease cvd identified prospective studies relied reported sedentary behaviour results majority prospective studies screen time sitting time shown greater sedentary time increased risk fatal fatal cvd compared lowest levels sedentary time risk estimates ranged highest level sitting time highest level screen time adjustment series covariates including measures physical activity studies screen time cvd summary hazard ratio increase ci studies sitting time summary hazard ratio increase ci conclusions future prospective studies objective measures sedentary behaviour prove helpful quantifying risk sedentary behaviour cvd morbidity mortality budding science shape future guideline development clinical public health interventions reduce amount sedentary behaviour modern societies sedentariness
3 webpage Gorski Does massage therapy decrease inflammation and stimulate mitochondrial growth? An excellent technical analysis of an interesting high-tech study of massage (Crane et al). Spoiler: the study didn’t really show much. 2012 treatment+self-treatment+exercise+chronic pain+massage+pain problems+manual therapy
3 webpage Reynolds Phys Ed “How little exercise do we need?” Great question! 2012
5 webpage Gawande Scratching an itch through the scalp to the brain This is a particularly wonderful article, which uses a fascinating and awful medical story — about a woman who scratched through her skull — to make an important and interesting point about how pain works. This is a point that a lot of us are making in a lot of different ways, and more all the time, but this is the best I’ve seen yet: great storytelling and superb reasoning, from one of the best medical writers alive today. 2012 chronic pain+fun+random+pain problems
2 webpage Broad How Yoga Can Wreck Your Body This “yoga bashing” piece was the New York Times most-shared article for a while in early 2011. It’s an excerpt from a forthcoming book, and describes potentially serious yoga hazards, such as stroke. Broad raises a legitimate concern about a gap between a popular belief (“most yoga is safe and beneficial”) and the more likely reality: some fairly common postures and practices are almost certainly at least somewhat dangerous, and there may well not be enough yoga-specific benefits to justify even small risks. Plus, the rationale for some extreme yoga is just total bollocks, and certainly deserves to be challenged. I’m looking forward to the book, it makes me I wish I’d been meaner to yoga in the past, and I don’t think Broad’s piece is particularly “sensationalistic” (as many yoga apologists have asserted, of course). It’s a given that any athletic activity has both rewards and risks. (Look no further than head injuries in football for a prime example.) The problem is that risks are a really rotten price to pay for many of the the more ridiculous motives for bothering with yoga in the first place. It’s not a perfect article by a long shot. After a too-positive initial review on Facebook, many of my readers pointed out valid science-based criticisms, primarily that Broad relies quite heavily on anecdotes, and in particular concludes the piece with a doozy based on pure speculation: that decades of yoga was the direct cause of a severe case of spinal stenosis, which is really not a safe assumption at all (stenosis happens, with or without yoga). The worst case scenario is that the the article is fear mongering based mostly on a handful of nasty anecdotes without citing much in the way of real risk/benefit data. For instance, for all we know, average yoga injuries per hour may be less than soccer, or even showering ... and we can't do a real risk-benefit analysis without that information. 2012 exercise+controversy+harms+stretch+self-treatment+back pain+neck+treatment+debunkery+pain problems+muscle+spine+head/neck
3 article Zderic et al Identification of hemostatic genes expressed in human and rat leg muscles and a novel gene (LPP1/PAP2A) suppressed during prolonged physical inactivity (sitting) Lipids In Health and Disease 2012 background partly functional genomics major paradigm shift solely thinking skeletal muscle contractile machinery understanding roles paracrine endocrine functions physical inactivity established risk factor blood clotting disorders effects inactivity sitting alarming person develops enigmatic condition legs called deep venous thrombosis dvt coach syndrome caused part muscular inactivity goal study determine skeletal muscle expresses genes roles hemostasis expression level responsive muscular inactivity occurs prolonged sitting methods microarray analyses performed skeletal muscle samples rats humans identify genes hemostatic function significantly expressed background based multiple probe sets perfect mismatch sequences determined genes responsive models physical inactivity multiple criteria determine differential expression including significant expression background fold change parametric statistical tests results studies demonstrate skeletal muscle tissue expresses genes involved hemostasis include fibrinolytic factors tetranectin annexin a tpa anti coagulant factors tfpi protein receptor paf acetylhydrolase coagulation factors genes posttranslational modification coagulation factors vitamin epoxide reductase special interest lipid phosphate phosphatase lpp pap a key gene degrading prothrombotic proinflammatory lysophospholipids suppressed locally muscle tissue hours sitting humans observed acute chronic physical inactivity conditions rats exercise ineffective counteracting effect species conclusions findings suggest skeletal muscle play important role hemostasis muscular inactivity contribute hemostatic disorders slowing blood flow se potentially contribution genes expressed locally muscles lpp biology+sedentariness+muscle
2 webpage Reynolds Does Foot Form Explain Running Injuries? This is a good level-headed summary of recent science about running form. The article summarizes Lieberman’s recent research showing that forefoot strikers get injured less, and concludes with some cautious advice that it might be worthwhile for injured runners to change to that style. I am even more cautious than Lieberman and Daoud, though: I am not yet ready to endorse tinkering with running style as an evidence-based reason for optimism or hope. As an option to cautiously mess around with, keeping expectations nice and low … sure. But I think (a) we still need (much) more evidence about this in general, and in particular (b) there’s no data on changing form … which could easily be a completely different thing than the running form you naturally settled into many years ago. In other words, if indeed forefoot runners suffer fewer injuries, it may well be because they have some other natural advantage that just happens to correlate with forefoot striking … and not something that other runners can imitate. 2012 running+orthotics+etiology+barefoot+patellar pain+shin pain+IT band pain+plantar fasciitis+foot+exercise+self-treatment+treatment+leg+limbs+pain problems+devices+pro+arthritis+aging+knee+overuse injury+injury+tendinosis
3 webpage Ornstein et al The Champion of Painkillers Pro Publica For years I assumed that narcotic pain killers are effective, and I took at face value the American Pain Foundation’s position that the risks of addiction are overblown, and the drugs are stigmatized and underused, resulting in a tragic lack of relief for many patients. This article casts reasonable doubt on all of that, and on the credibility of the APF, who may be serving the interests of pharmaceutical companies better than patients. In the spirit of Dr. Harriet Hall’s skeptical rule of thumb — “Who disagrees and why?” — it is clear that there is a problem here. Politics aside, I am most perturbed by the idea that opiates may not be all that effective in the first place. There is little doubt that these powerful drugs are valuable for some kinds of pain — just try passing a kidney stone without them! — but they may be surprisingly powerless against other kinds. 2012 medications+chronic pain+scientific medicine+random+self-treatment+treatment+pain problems
3 webpage Barrett How the Dietary Supplement Health and Education Act (DSHEA) of 1994 Weakened the FDA 2012 controversy+nutrition+random+debunkery+self-treatment+treatment
4 webpage Parkes The Limits of Breath Holding An excellent, interesting review of the science of breath-holding with some good surprises and examples of harrowing historical experiments. 2012 determines long hold breath people gasp air long brain body runs oxygen obvious limitation investigating limits control breath holding difficult decades research suggest diaphragm contracts inflate lungs plays key role hypothesis diaphragm sends signals brain long contracted biochemically reacting depleted levels oxygen rising levels carbon dioxide initially signals mere discomfort eventually brain finds intolerable forces breathing start fun+random
3 webpage Robbins Homeopaths on homeopathy In this brilliant compilation, science writer Martin Robbins lets homeopaths hoist themselves on their own petards. It’s a hair-raising parade of bad thinking and warped medical ethics. 2012 homeopathy+controversy+fun+debunkery
3 webpage Nicholl et al Plantar fasciitis Podiatry Now 2012 treatment+surgery+plantar fasciitis+foot+running+overuse injury+leg+limbs+pain problems+injury+tendinosis+exercise+self-treatment
book Loxton et al Abominable science! Columbia University Press 2012 random+critical thinking+fun
3 article Azevedo et al Uninvolved versus target muscle contraction during contract Physical Therapy in Sport This well-planned experiment tested whether or not the contraction component of a contract-relax stretch actually makes a difference, and clearly found that it does not. The researchers compared a normal CR stretch of the hamstring to a modified one without any hamstring contraction (instead, some other “uninvolved, distant” muscle was contracted). The effect of both stretches was the same — “a significant moderate increase in range of motion.” In other words, it didn’t matter if the hamstring was contracted or not — with or without a contraction, the result was the same. This strongly undermines the central claim of CR-PNF stretching. 2011 objective purpose study compare acute effect contract relax cr stretching technique knee active range motion rom target muscle contraction uninvolved muscle contraction design pre test post test control experimental design setting clinical research laboratory participants sixty healthy men randomly assigned groups interventions contract relax group cr performed traditional hamstring cr stretch modified contract relax group mcr performed hamstring cr stretching contraction uninvolved muscle distant target muscle control group cg stretch main outcome measures active knee extension test performed stretching procedure results analysis variance anova results showed significant interaction group pre test post test   treatment+muscle+stretch+exercise+self-treatment
webpage Goldacre The statistical error that just keeps on coming Ben Goldacre explains a “stark statistical error so widespread it appears in about half of all the published papers surveyed from the academic neuroscience research literature.” I explain the same error, along with other common problems with “significant” research results, in Statistical Significance Abuse. 2011
3 webpage Johnson Homeopathy Superb investigative journalism from Canada’s CBC television, from a consumer advocacy point of view. A massive homeopathy overdose demonstration; a homeopath is recorded promising to cure stage 1 breast cancer in (such a claim would be condemned by homeopathic professional associations); a chemistry lab proves that active ingredients cannot be identified in homeopathic preparations; and a mom who vaccinates her kids with homeopathy admits that she is a surprised by the lack of active ingredients. 2011 homeopathy+controversy+debunkery
3 article Puentedura et al Immediate effects of quantified hamstring stretching Physical Therapy in Sport It’s common for stretching enthusiasts to dismiss my concern that stretching is not all that useful with the concession that, of course, static stretching is quite pointless, but fancier methods (their methods) are “obviously” clinically useful. By far the most common example of allegedly superior stretching is the broad category of “proprioceptive neuromuscular facilitation,” and more specifically the hold relax method. Supposedly this approach works better than mere pulling on muscle. However, this test of the immediate effects HR-PNF versus static stretch on hamstrings was a bust: they both increased flexibility equally well (for whatever that’s worth). “No significant differences were found when comparing the effectiveness of HR-PNF and SS techniques. Both stretching methods resulted in significant immediate increases in hamstring length.” 2011 purpose compare effects hold relax proprioceptive neuromuscular facilitation stretching hr pnf static stretch ss hamstring flexibility healthy asymptomatic subjects subjects subjects female age  ±  range excessive hamstring muscle flexibility randomly assigned stretch groups hr pnf ss methods left leg treated control receive intervention leg measured rom pre post stretch interventions subjects receiving randomly assigned interventions week data analyzed intervention hr pnf ss control  ×  time pre post factorial anova repeated measures post hoc analyses results significant interaction observed intervention time hamstring extensibility       treatment+stretch+knee+exercise+self-treatment+muscle+leg+limbs+pain problems
article Jacobs et al Therapist as operator or interactor? Journal of Manual & Manipulative Therapy 2011 random+deep
3 webpage Bar My Standing Desk Experiment 2011 self-treatment+fun+back pain+biomechanics+treatment+pain problems+spine+etiology+pro
3 webpage Beames NOI Notes An excellent little 2010 summary of the clinical significance of central sensitization for professionals, with a clear call to get “bums into gear” and “get CS evidence based management strategies … out there and heard. Central sensitisation is so liberating in the clinic — the relentless and often disappointing searches for sources of nociception in the clinic becomes less important and it supports the critical notion that functional restoration can be processed even in the presence of pain.” In particular, they really encourage therapists to study and read “Central sensitization: Implications for the diagnosis and treatment of pain”, by Woolf. 2011 chronic pain+etiology+scientific medicine+pain problems+pro
3 article Meria et al Influence of the Hip on Patients With Patellofemoral Pain Syndrome Sports Health “There is a link between the strength and position of the hip and PFPS.” The evidence in this paper shows this fairly clear. However, the authors then reach beyond the evidence to this conclusion: “a coordination program may be useful in a conservative treatment plan for PFPS.” It’s not unreasonable speculation, but I want to be clear that it is speculation, and that no evidence published to date has yet established that knee pain is caused by hip weakness or can be treated by it. 2011 context patellofemoral pain syndrome pfps common conditions limiting athletes growing body evidence suggesting dysfunction hip contributing factor pfps data sources medline september cinahl september sportdiscus september searched identify relevant research report study selection studies included assessing hip strength extremity kinematics relation pfps included data extraction studies included randomized controlled trials quasi experimental designs prospective epidemiology case control epidemiology cross sectional descriptive epidemiology scientific peer reviewed journal results pfps decreased hip strength specifically abductors external rotators correlation pfps faulty hip mechanics adduction internal rotation conclusions link strength position hip pfps patients common deficit symptomatic hip strengthening coordination program conservative treatment plan pfps knee+patellar pain+treatment+etiology+leg+limbs+pain problems+arthritis+aging+overuse injury+injury+running+exercise+self-treatment+pro
4 article Mizuno et al Viscoelasticity of the muscle-tendon unit is returned more rapidly than range of motion after stretching Scandinavian Journal of Medicine & Science in Sports Participants stretched their calf muscle; at intervals following the stretch, the stiffness of the muscle and the range of motion of the ankle were tested. Although the stiffness of the muscle improved considerably at first, it decreased quickly; however, the range of motion of the ankle significantly increased and was retained for up to 90 minutes. That is, range of motion was retained even after a brief reduction in stiffness subsided, strongly suggesting that ROM is not limited by the viscoelasticity of the tissue. This study, although small, is consistent with other evidence and the general trend that the impact of stretch is sensory and neurological, not mechanical — i.e. a mild warm-up, basically. 2011 purpose study clarify time viscoelasticity gastrocnemius medialis muscle tendon stretching male participants displacement myotendinous junction gastrocnemius medialis muscle measured ultrasonographically passive dorsiflexion test ankle passively dorsiflexed speed ° range motion rom passive torque representing resistance stretch measured isokinetic dynamometer days passive dorsiflexion tests performed  min stretching consisted dorsiflexion rom holding position  min times result rom significantly increased  min stretch+exercise+self-treatment+treatment+muscle
3 webpage Grant Flushing Out Myths 2011 massage+controversy+manual therapy+treatment+debunkery
2 webpage Thompson Dead bodies can’t feel pain, or why biomechanics and ergonomics haven’t reduced back pain 2011 back pain+biomechanics+treatment+etiology+self-treatment+pain problems+spine+pro
webpage Arndt Interview with Paul Ingraham Matrix Fitness Education & Counselling 2011 personal
3 webpage Ingraham Science-Based Medicine » Acupuncture Does Not Work for Back Pain 2011
3 webpage Freedman Lies, Damned Lies, and Medical Science For most readers, this is a fine translation of the key ideas of John Ioannidis for a general readership. Unfortunately, author David Freedman mildly sensationalizes and emphasizes the incorrect “science is wrong” aspect of Ioannidis’ work … but on a much larger scale than ever before. Like the original Ioannidis paper, Freedman’s article is now widely cited by cranks and quacks to advance an anti-scientific agenda — and it’s quite tragic, considering that Ioannidis is actually a great champion of science. 2011 scientific medicine+bad science
2 webpage Hargrove The Monday Effect, or Why Your Massage Lasted Only Two Days « Better Movement 2011 chronic pain+massage+biomechanics+pain problems+manual therapy+treatment+etiology+pro
3 article Ryan et al The effect of three different levels of footwear stability on pain outcomes in women runners British Journal of Sports Medicine Fancy running shoes are “overly simplistic and potentially injurious,” according to the authors of this paper. They randomly assigned 81 female runners to different types of running shoes and observed the relationship between shoe type, foot type, and pain. The results ranged from neutral and inconclusive to poor (painful). This evidence shows that conventional running shoe designs not only failed to help, but may even have caused harm. 2011 background present study examines injury status women runners randomised receive neutral stability motion control running shoe methods female runners categorised foot posture types neutral pronated highly pronated randomly assigned neutral stability motion control running shoe runners underwent baseline testing record training history leg alignment commencing week marathon training programme outcome measures included number missed training days due pain visual analogue scale vas items pain rest activities daily living running results missed training days reported running population stability shoe reporting fewest missed days motion control shoe significant main effect running+orthotics+barefoot+overuse injury+patellar pain+plantar fasciitis+IT band pain+shin pain+exercise+self-treatment+treatment+foot+leg+limbs+pain problems+devices+injury+arthritis+aging+knee+tendinosis
3 webpage Kavoussi The Acupuncture and Fasciae Fallacy Ben Kavoussi, a doctor and acupuncturist himself by training (and therefore an unusually credible critic) explains the dubious history and provenance of some of acupuncture’s key concepts. For instance, Kavoussi describes how the supposedly “ancient” and mystical meridians of acupuncture are actually based on rather modern and arbitrary interpretation, prior to which the meridians corresponded mainly with the big, obvious blood vessels and were basically all about bloodletting: an idea common to many primitive medical philosophies, and not related to any proposed magic forces. Such historical perspective is extremely useful in understanding how naively over-rated acupuncture has become in the world today. 2011 acupuncture+controversy+mind+debunkery+energy work
5 webpage Leavitt New IOM Report Snubs Vitamin D Research When the Institute of Medicine published new guidelines in 2010 which generally slammed high dosages, Dr. Stewart Leavitt responded with this clear, readable review, which should be a useful survey of the topic for some time to come. Much as I concluded (see Vitamin D Safety for Pain Patients), the IoM report actually “neither confirms nor refutes our prior research and advocacy for vitamin D supplementation as benefitting pain relief, particularly relating to musculoskeletal disorders” and “we do not believe it is necessary or appropriate at this time to recant our prior positions regarding vitamin D for pain.” 2011 chronic pain+vitamin D+muscle pain+etiology+treatment+nutrition+self-treatment+harms+pain problems+muscle+pro
3 webpage O'Connell Location location location! Neil O’Connell presents a major criticism of a study (Molsberger et al) that certainly seems to show that acupuncture works at first glance. 2011 treatment+acupuncture+controversy+scientific medicine+mind+debunkery+energy work
3 webpage McKenzie How popular is acupuncture? 2011 treatment+acupuncture+controversy+mind+debunkery+energy work
3 webpage Gavura Topical NSAIDs Pharmacist Scott Gavura started out skeptical about topical NSAIDs. To my relief, he changed his mind and gave them a stamp of approval, backing up my own opinion, in this post on He provides some great information about these products along the way. 2011 medications+self-treatment+treatment
4 webpage Aschwanden Convincing the Public to Accept New Medical Guidelines An excellent article about how hard it is to get people to accept new evidence. In particular (and most relevant to, Aschwanden makes an example of research showing that ibuprofen does not prevent athletes from getting sore muscles (see Nieman 2006). 2011 scientific medicine+controversy+medications+random+debunkery+self-treatment+treatment
3 webpage British Broadcasting Corporation The Secret World of Pain 2011 chronic pain+fun+pain problems
4 webpage Johnson Stretching the Truth? Absolutely top notch consumer advocacy reporting! Well worth a look — both the show and the show page are probably now the best source of information about spinal decompression machines. I doubt that there will be a better debunking for a long time. 2011 back pain+controversy+biomechanics+chiropractic+pain problems+spine+debunkery+etiology+pro+manual therapy+treatment
2 webpage Thompson Fear/Anxiety/Avoidance – treatments review! 2011 treatment+chronic pain+mind+pain problems
3 webpage Hall Acupuncture Revisited A readable summary of Ernst et al. Dr. Hall makes many excellent points, but here’s the one I want to emphasize:

More studies are not the answer. No matter how many studies showed negative results, they would not persuade true believers to give up their beliefs. There will always be “one more study” to try, but there should be a common-sense point at which researchers can agree to stop and divert research time and funds to areas more likely to produce useful results.

2011 treatment+acupuncture+controversy+mind+debunkery+energy work
3 webpage Kolata Orthotic Shoe Inserts May Work, but It’s Not Clear Why 2011 devices+biomechanics+treatment+etiology+pro
3 article Tilbrook et al Yoga for chronic low back pain Annals of Internal Medicine This study of more than 300 people found that using yoga to treat chronic low back pain help only very slightly: somewhat improved function (reduced RMDQ score) and no effect on pain. The researchers concluded that “a 12-week yoga program … led to greater improvements in back function than did usual care,” but that’s not saying much, of course (“usual care” generally being really lame for back pain). It’s also worth noting that yoga went badly for 12 of 156 people, “mostly increased pain.” Almost 10% = not good. 2011 background previous studies yoga effective treatment chronic recurrent pain objective compare effectiveness yoga usual care chronic recurrent pain design parallel group randomized controlled trial computer generated randomization conducted april march outcomes assessed postal questionnaire international standard randomised controlled trial number register isrctn setting national health service premises united kingdom patients adults chronic recurrent pain intervention yoga usual care participants received pain education booklet intervention group offered class gradually progressing yoga program delivered teachers months measurements scores roland morris disability questionnaire rmdq primary outcome secondary outcomes months pain pain efficacy general health measures months secondary outcomes results patients offered yoga attended sessions sessions yoga group function months usual care group adjusted rmdq score points ci points yoga group months points ci points months points ci points months yoga usual care groups similar pain general health scores months yoga group higher pain efficacy scores months months usual care participants yoga participants reported adverse events increased pain limitation missing data primary outcome yoga group usual care group differential missing data yoga group secondary outcomes conclusion offering week yoga program adults chronic recurrent pain led greater improvements function usual care treatment+stretch+exercise+back pain+self-treatment+muscle+pain problems+spine
3 webpage Grumpy Dr. Grumpy and Dr. Google Dr. Grumpy writes with his customary articulate grumpiness, about patients seeking health care information online. (From websites like this one.) Much has been written about the phenomenon of online health care information. This is the funniest. 2011 random+fun
4 article Bialosky et al Placebo response to manual therapy Journal of Manual & Manipulative Therapy Manual therapy probably “works” to reduce pain for many reasons: the patient, the practitioners, and the environment. Pain research suggests, however, that placebo response plays a role in all manual therapy. Manual therapists need to be aware of this and recognize its potential in treating patients without using sham or ineffective interventions. 2011 mechanisms manual therapy inhibits musculoskeletal pain multifaceted related interaction intervention patient practitioner environment placebo traditionally considered inert intervention pain research literature suggests placebo active hypoalgesic agent placebo response plays role interventions pain suggest true treatment effects manual therapy magnitude placebo response influenced negative mood expectation conditioning suggest manual therapists conceptualize placebo comparative intervention potential active mechanism partially account treatment effects manual therapy suggesting manual therapists include sham ineffective interventions clinical practice steps maximize placebo responses reduce pain mind+treatment+massage+manual therapy
3 webpage Burfoot Veteran Biomechanics Expert Benno Nigg Doubts That Barefootin', Forefootin' Or Pronation-Control Will Change Injury Rates Terrific short myth-busting interview with a running, shoe and biomechanics expert — who is (delightfully) a bit cranky about “so many wrong ideas out there.” It’s all too rare to see this kind of sanity-inducing, hype-reducing talk on this topic. 2011 devices+running+IT band pain+patellar pain+plantar fasciitis+shin pain+fun+biomechanics+foot+treatment+exercise+self-treatment+knee+leg+limbs+pain problems+overuse injury+injury+tendinosis+arthritis+aging+etiology+pro
3 article Thijs et al Is hip muscle weakness a predisposing factor for patellofemoral pain in female novice runners? American Journal of Sports Medicine Contrary to a trendy theory, this study specifically looked for and could not find a causal connection between hip strength and runner’s knee: “there was no significant difference in strength of any of the assessed hip muscle groups between the runners who did and did not develop patellofemoral dysfunction syndrome.” There are other considerations, but the study is of good quality (for a cohort) study, and I have confidence in at least one clear implications of the results: based on this data, hip weakness is not predictive of anterior knee pain in middle aged female runners. Incidentally, they also eliminated several other causal contenders: according to their data, Q-angles, age, and weight/BMI were all irrelevant to developing pain. 2011 background hip muscle weakness proposed contribute patellofemoral malalignment development patellofemoral dysfunction syndrome pfds retrospective studies addressed issue unclear hip muscle weakness consequence pfds purpose study undertaken investigate hip muscle weakness predisposing factor development pfds study design cohort study prognosis level evidence methods start week start run program isometric strength hip flexor extensor abductor adductor external internal rotator muscles measured healthy female novice runners week training period patellofemoral pain diagnosed registered orthopaedic surgeon results statistical analysis revealed significant difference strength assessed hip muscle groups runners develop pfds logistic regression analysis identify deviation strength assessed hip muscle groups risk factor pfds conclusion findings study suggest isometric hip muscle strength predisposing factor development pfds patellar pain+running+etiology+arthritis+aging+pain problems+knee+leg+limbs+overuse injury+injury+exercise+self-treatment+treatment+pro
3 article Mahowald et al The correlation between plantar fascia thickness and symptoms of plantar fasciitis Journal of the American Podiatric Medical Association In 39 feet, both increasing and decreasing pain correlated well with changes in plantar fascia thickness, assessed with ultrasonography. The authors conclude that their study “provides evidence that changing thickness of the plantar fascia is a valid objective.” 2011 background purpose study determine plantar fascia thickness reliable gauge efficacy treatment protocols plantar fasciitis methods feet patients plantar fasciitis received ultrasound examination measure thickness medial band plantar fascia patient assessed pain visual analogue scale treatments ultrasound examination performed thickness plantar fascia measured subjective pain level assessed results twenty feet showed decrease plantar fascia thickness decrease pain foot experienced increase fascia thickness reported increase pain feet increase thickness plantar fascia reported change pain level feet minor increases fascia thickness reported decrease pain foot change fascia thickness decrease pain foot decrease plantar fascia change pain level average reduction fascia thickness mm ± mm correlating average improvement pain ± conclusions study evidence changing thickness plantar fascia valid objective measurement assess effectiveness existing treatment protocols treatment+plantar fasciitis+devices+foot+leg+limbs+pain problems+overuse injury+injury+tendinosis
2 webpage York Medical/knuckle cracking 2011 fun+biology
3 webpage Novella Acupuncture Does Not Work for Back Pain (Part I) An extremely clear interpretation of a large study of acupuncture for back pain in 2009 (Cherkin). Dr. Novella also includes an excellent summary how such research works. This article has second part. 2011 treatment+back pain+acupuncture+controversy+mind+scientific medicine+pain problems+spine+debunkery+energy work
3 article Shrier et al Psychological predictors of injuries in circus artists British Journal of Sports Medicine This small study was done with a group of Cirque du Soleil artists involved in a training programme. Circus artists have just about the same risk factors for injury as athletes — interest, injury, emotional exhaustion, self-efficacy and fatigue — but “conflict/pressure” is less of a factor for them. 2011 objectives explore relationship potential psychological risk factors injury risk circus artists design historical cohort study setting cirque du soleil training programme participants forty circus artists training cirque du soleil artists assessment risk factors artists completed validated rest questionnaire domains weeks training main outcome injury risk ratio results priori exposures interest injury emotional exhaustion efficacy fatigue increase injury risk risk ratios conflicts pressure risk ratio specific psychological aspects considered risk factors injury efficacy strongest relationship conclusions strong psychological risk factors injuries previously identified athletes risk factors circus artists fun+mind
4 article Syu et al Differential Effects of Acute and Chronic Exercise on Human Neutrophil Functions Medicine & Science in Sports & Exercise As nicely summarized by Alex Hutchinson, this research shows that, “Regular, moderate exercise boosts the ability of the neutrophils to get to infection sites quickly (chemotaxis) and attack the bad guys (phagocytosis),” as they live longer too. Busier, longer-lasting neutrophils: sounds great! But a “boost” to immune function isn’t as simple as it sounds or all good news, and the counterintuitive price of better infection-fighting could be vulnerability to repetitive strain injury, slower healing, and pain chronicity. We know from McDonald et al that neutrophils are active even when they shouldn’t be, responding overprotectively to aseptic (internal) cell trauma even when there is no possibility of pathogens. They go nuts anyway, attracted to exposed mitochondria (because mitochondria are technically, biologically “foreign,” a legacy of evolution and symbiosis). And this inappropriate immune response is a likely explanation for one of the great catch-22s of the human condition: exercise is good for you, but it often hurts. For more about this, see my detailed article: Why Does Pain Hurt? (section: “It gets worse! Exercise makes neutrophils more feisty.”) 2011 exercise effects immunity highly dependent exercise intensity duration frequency purpose neutrophils play essential role innate immunity investigated acute severe exercise ase chronic moderate exercise cme differentially regulate human neutrophil functions methods thirteen sedentary young males underwent initial ase pedaling bicycle ergometer increasing loads exhaustion subsequently divided exercise control groups exercise group underwent months cme pedaling ergometer moderate intensity min day months detraining control group abstained regular exercise months additional ase paradigms performed month exercise group months control group neutrophils isolated blood specimens drawn rest immediately ase assaying chemotaxis phagocytosis citrate synthase activity mitochondria membrane potential ΔΨ additional blood specimens drawn exercise group immediately bout cme determine acute moderate exercise ame effects neutrophil functions results initial ase enhanced chemotaxis induced ΔΨ depolarization ame influence measured parameter neutrophils cme increased chemotaxis phagocytosis citrate synthase activity ΔΨ cme effects remained detraining phagocytosis ase effects disappeared cme partially restored detraining conclusions ase cme differentially affected neutrophil functions ame ineffective fact cme improves neutrophil functions partially explain physically active subjects risk infection exercise+chronic pain+inflammation+etiology+biology+fun+self-treatment+treatment+pain problems+pro
3 article Sefton et al Physiological and clinical changes after therapeutic massage of the neck and shoulders Manual Therapy This is a small science experiment comparing the effects of three short “therapeutic massages” of the neck to light touching and a neutral control group in just sixteen healthy adults. The purpose was not to find out if massage is an effective therapy — these were not neck pain patients — but whether or not it has some measurable physiological effects. Both massage and light touch reduced muscle activity a little more than 10%, which is a good number for such brief treatments. Massage alone reduced reflex sensitivity and increased range of motion. It’s unknown if these effects would occur in people with neck pain, but it’s certainly plausible. 2011 physiological clinical effects therapeutic massage tm prescribed musculoskeletal complaints chronic neck pain study investigated influence standardized clinical neck shoulder tm intervention physiological measures assessing α motoneurone pool excitability muscle activity clinical measure range motion rom compared light touch control intervention flexor carpi radialis fcr α motoneurone pool excitability hoffmann reflex electromyography emg signal amplitude upper trapezius maximal muscle activity cervical rom assess physiological clinical effects tm sixteen healthy adults participated  min interventions control light touch lt therapeutic massage tm analysis covariance decrease fcr α motoneurone pool excitability tm compared lt         interventions emg signal amplitude decreased tm \   treatment+massage+neck+manual therapy+head/neck+spine
3 article Keenan et al Lower limb joint kinetics in walking Gait & Posture Do running shoes have positive or negative impacts on joints? Researchers analyzed peak joint forces in barefoot walking versus three different types of shoes: stability, motion control, and cushion. Results showed an increase in knee and hip flexion forces in all shod conditions during the early stance phase, mostly due to increased step length. This is not clear evidence that “shoes are bad” — more forces are not necessarily bad — but it is an interesting addition to the debate about the biomechanics of shoes versus going barefoot. 2011 effects current athletic footwear extremity biomechanics unknown aim study examine occur peak extremity net joint moments walking industry recommended athletic footwear sixty healthy young adults underwent kinetic evaluation extremity extrinsic joint moments walking barefoot walking current standard athletic footwear matched foot mechanics subject controlling speed secondary analysis performed comparing peak knee joint extrinsic moments barefoot walking walking standard footwear types stability motion control cushion motion capture data collected synchrony ground reaction force data collected instrumented treadmill shod condition increase peak knee varus moment increases hip flexion extension moments increases largely related increase stride length shoes increases ground reaction forces axes barefoot walking observed peak knee joint moments similar subjects walked footwear types unclear extent increased joint moments clinically relevant potentially adverse differences considered recommendation design footwear future orthotics+biomechanics+barefoot+etiology+arthritis+running+shin pain+patellar pain+plantar fasciitis+foot+leg+limbs+pain problems+self-treatment+treatment+devices+pro+exercise+aging+overuse injury+injury+knee+tendinosis
3 article Gabay et al Symptomatic effects of chondroitin 4 and chondroitin 6 sulfate on hand osteoarthritis Arthritis and Rheumatism It was a bit hard to believe my eyes when I first read this abstract. On a 100mm VAS (pain scale), the treatment group was just “8.77mm happier” with their hands. With a p=.02. And then the conclusion is that chondroitin sulfate “improves hand pain”? My my, that is a lovely demonstration of the abuse of statistical significance! (See Statistical Significance Abuse.) Basically what the researchers found is a chance that chondroitin makes a small difference in arthritis pain. It’s not nothing, but it is an unimpressive result. The authors’ interpretation is like taking the dog to the end of the driveway and saying you took him for a walk. Technically true … 2011 objective evaluate symptomatic effect highly purified chondroitin sulfate cs patients hand osteoarthritis oa methods investigator initiated single center randomized placebo controlled double blind clinical trial included symptomatic patients radiographic hand oa acr criteria inclusion criteria included global spontaneous hand pain mm visual analogue scale vas mm level functional impairment functional index hand oa fihoa scale symptomatic hand patients received mg cs patients placebo patients daily months analyzed intent treat approach primary outcomes change baseline month global spontaneous hand pain hand function secondary outcomes improvement grip strength duration morning stiffness acetaminophen consumption global impression efficacy results decrease global hand pain significantly pronounced cs placebo group vas mm hand function improved significantly cs placebo group fihoa statistically significant difference groups favour cs duration morning stiffness global impression treatment efficacy evolution grip strength acetaminophen consumption safety endpoints significantly groups conclusion study demonstrates cs improves hand pain function symptomatic hand oa good safety profile treatment+arthritis+nutrition+controversy+aging+pain problems+self-treatment+debunkery
3 article Wolfe et al TIme Course of The Effects of Static Stretching on Cycling Economy Journal of Strength & Conditioning Research Worse than failing to enhance athletic performance, a stretching habit may actually reduce it: “Recent research has concluded that static stretching prior to many exercises inhibits acute power, strength and sprinting performance. … Coaches and highly trained endurance cyclists should exclude static stretching immediately prior to moderate intensity cycling as it reduces acute cycling economy.” See Alex Hutchinson’s analysis on Sweat 2011 stretching implemented part warm physical events widely thought promote increased sport performance decreased injury risk research concluded static stretching prior exercises inhibits acute power strength sprinting performance research examining time effects moderate intensity cycling purpose study examine time static stretching cycling economy subjects consisted men women highly trained endurance cyclists visits baseline testing cycling vo max visits stretching stretching prior minute stationary ride \ vo max stretching condition consisted repetitions stretches average total stretching time minutes vo demonstrated significant condition time interaction minute time point significantly stretching condition ± ml kg min stretching ± ml kg min time points results demonstrate static stretching yielded acute increase submaximal vo coaches highly trained endurance cyclists exclude static stretching immediately prior moderate intensity cycling reduces acute cycling economy treatment+self-treatment+exercise+stretch+controversy+muscle+debunkery
3 article Foley et al Effectiveness of once-weekly gym-based exercise programmes for older adults post discharge from day rehabilitation British Journal of Sports Medicine Three groups of study subjects did the same intense workout either one or twice per week, with no difference in results, suggesting that more may not be better. “The overall finding of no significant differences between the two intervention groups for all outcomes measured gives support to the effectiveness of once-a-week exercise in maintaining outcomes at 3 months post rehabilitation. Further research is warranted given the once-a-week exercise intervention should cost less, had higher compliance and was nominated as the preferred exercise frequency by most of the participants.” 2011 objective determine high intensity progressive gym based exercise performed week effective weekly maintaining subjective objective outcomes older adults post discharge metropolitan day rehabilitation centre drc design randomised controlled trial setting community based exercise centre older adults located metropolitan adelaide south australia participants men women completed drc programme assessed randomly allocated study group intervention experimental interventions gym based exercise programmes including resistance aerobic flexibility balance training varying frequency delivery week compared usual care control main outcome measures limb strength repetition maximum balance berg balance scale physical function gait speed chair stand test timed test primary outcome min walk test reported pain glasgow pain questionnaire activities daily living barthel index older americans resources services multidimensional functional assessment questionnaire perceived benefits barriers exercise exercise benefits barriers scale quality life assessment quality life questionnaire exercise frequency preference results outcomes maintained intervention period significant group effects detected intervention groups compared control group physical activity levels recorded control group showed significant proportion participants actively exercising weekly protocol analysis undertaken potential contamination effect account showed control group participants exercise maintain outcomes extent intervention groups significant group time effects detected intervention groups control group participants nominated week preferred exercise frequency conclusions finding significant differences intervention groups outcomes measured support effectiveness week exercise maintaining outcomes months post rehabilitation research warranted week exercise intervention cost higher compliance nominated preferred exercise frequency participants exercise+self-treatment+treatment
4 article Michels et al The iliotibial band syndrome treated with an arthroscopic technique in 40 patients ScienceMED This is an update of a 2009 report (Michels) on a new surgical procedure for IT band syndrome: treating it by cleaning out irritated tissue from a small area under the IT band on the side of the knee, instead of cutting the IT band to loosen it. “Thirty-six patients (38 knees) had good or excellent results. All patients went back to sports after 3 months.” This compares extremely favorably with the conventional open surgery (i.e. Drogset et al). Not only are these promising results, but they have fascinating implications about the causes of IT band syndrome. For detailed analysis, see Save Yourself from IT Band Syndrome! 2011 iliotibial band syndrome itbs overuse injury affecting runners initial treatment conservative recalcitrant cases surgery open techniques newer studies question pathogenesis itbs based findings technique developed forty athletes knees resistant itbs treated standardized arthroscopic technique limited resection lateral synovial recess patients knees good excellent results patients sports months results show arthroscopic treatment resistant itbs valid option consistently good outcome addition arthroscopic approach excluding treating intra articular pathology surgery+classics+knee+IT band pain+running+etiology+treatment+leg+limbs+pain problems+overuse injury+injury+exercise+self-treatment+tendinosis+pro
4 article Quinn et al Aging and factors related to running economy Journal of Strength & Conditioning Research This study showed that runner’s do not get less efficient as they age, which is a bit surprising. Performance degrades with age because reduced cardiovascular fitness and strength, not due to reduced running economy. Phrased more technically by the researchers, “The results from this cross-sectional analysis suggest that age-related declines in running performance are associated with declines in maximal and submaximal cardiorespiratory variables and declines in strength and power, not because of declines in running economy.” See analysis in the New York Times. 2011 purpose study investigate relationship age factors affecting running economy competitive distance runners fifty male female subelite distance runners young years master years older older measured step rate lactate threshold lt vo max muscle strength endurance flexibility power body composition test conducted velocities min subjects running minutes velocity steady state vo max minute stage recorded plotted speed regression equation formulated × analysis variance revealed differences slopes regression lines age groups x r x r x + r vo max significantly group compared groups ± ± ± mlo kg min maximal heart rate velocity @ lt significantly age groups ± ± ± min ± ± ± min vo max @ lt significantly group compared groups ± ± ± mlo kg min group significantly groups flexibility power upper body strength multiple regression analyses showed strength power significantly related running velocity results cross sectional analysis suggest age related declines running performance declines maximal submaximal cardiorespiratory variables declines strength power declines running economy running+biology+etiology+exercise+self-treatment+treatment+pro
4 article Doherty et al A randomised controlled trial of ibuprofen, paracetamol or a combination tablet of ibuprofen/paracetamol in community-derived people with knee pain Annals of the Rheumatic Diseases Conclusion: “Ibuprofen/paracetamol combination analgesia, at non-prescription doses, confers modest short-term benefits for knee pain/osteoarthritis. However, in this population, paracetamol 3 g/day may cause similar degrees of blood loss as ibuprofen 1200 mg/day, and the combination of the two appears to be additive.” See this useful analysis, which introduces the paper rather glowingly: “this cautious and excellent long-term study reveals many new and important findings which should be the basis for reconsideration of the treatment of musculoskeletal conditions with over-the-counter (OTC) analgesics. It may turn out that many of our widely-held beliefs and assumptions are wrong and that the recommendation for our patients needs to be changed.” 2011 objectives compare efficacy safety single combination prescription oral analgesics community derived people aged years older chronic knee pain methods randomised double blind arm parallel group active controlled trial investigating short term day long term week benefits side effects regimens times day ibuprofen mg paracetamol mg fixed dose combination tablet ibuprofen mg paracetamol mg fixed dose combination tablets ibuprofen mg paracetamol mg results participants age range years radiographic knee osteoarthritis fulfilled american college rheumatology criteria osteoarthritis day combination tablets superior paracetamol treatment+medications+arthritis+inflammation+self-treatment+aging+pain problems
5 article Kay et al Effect of Acute Static Stretch on Maximal Muscle Performance Medicine & Science in Sports & Exercise Are there benefits to pre-exercise muscle stretching? In this huge review of the scientific literature, researchers looked at more than 4500 studies before choosing about 100 to look at more carefully. It’s no surprise in 2011 that they showed a pattern of “overwhelming evidence that stretch durations of 30-45 seconds … imparted no significant effect.” A little more surprising was that they also found some evidence that more thorough stretching reduces muscle strength. I wouldn’t take this too seriously, but it certainly emphasizes the lack of benefit: if anything, it swings the other way. “The detrimental effects of static stretch are mainly limited to longer durations (≥60 s) which may not be typically used during pre-exercise routines in clinical, healthy or athletic populations. Shorter durations of stretch (<60 s) can be performed in a pre-exercise routine without compromising maximal muscle performance.” 2011 introduction benefits pre exercise muscle stretching questioned reports significant post stretch reductions force power production methodological issues equivocal findings prevented clear consensus reached detailed systematic review exists literature describing responses acute static muscle stretch comprehensively examined methods medline sciencedirect sportdiscus zetoc searched recursive reference checking selection criteria included randomized quasi randomized controlled trials intervention based trials published peer reviewed scientific journals examining effect acute static stretch intervention maximal muscular performance results searches revealed articles met inclusion criteria study design poor studies failed provide reliability statistics clear evidence exists indicating short duration acute static stretch limited evidence effect eccentric strength conclusion detrimental effects static stretch limited longer durations typically pre exercise routines clinical healthy athletic populations shorter durations stretch stretch+exercise+running+controversy+harms+self-treatment+treatment+muscle+debunkery+pain problems
2 article Marchi et al Low-level laser therapy (LLLT) in human progressive-intensity running Lasers Med Sci Can low-level laser therapy affect “exercise performance, oxidative stress, and muscle status in humans”? That’s what this randomized double-blind pacebo-controlled study tried to determine in 22 male volunteers. “The use of LLLT before progressive-intensity running exercise increases exercise performance, decreases exercise-induced oxidative stress and muscle damage, suggesting that the modulation of the redox system by LLLT could be related to the delay in skeletal muscle fatigue observed after the use of LLLT.” Those results do seem promising, but they are from a tiny study published in a journal that is actually dedicated to laser therapy. Hmmm. Risk of bias could be high! 2011 aim work evaluate effects level laser therapy lllt exercise performance oxidative stress muscle status humans randomized double blind placebo controlled crossover trial performed untrained male volunteers lllt  nm  mw   site irradiation site multi diode cluster spots   spot sites limb quadriceps hamstrings gastrocnemius performed min standardized progressive intensity running protocol motor drive treadmill exhaustion analyzed exercise performance vo max time exhaustion aerobic threshold anaerobic threshold levels oxidative damage lipids proteins activities antioxidant enzymes superoxide dismutase sod catalase cat markers muscle damage creatine kinase ck lactate dehydrogenase ldh compared placebo active lllt significantly increased exercise performance vo max     time exhaustion     changing aerobic anaerobic thresholds lllt decreased post exercise lipid     protein     damages activities sod     ck     ldh     enzymes lllt application modulate cat activity lllt progressive intensity running exercise increases exercise performance decreases exercise induced oxidative stress muscle damage suggesting modulation redox system lllt related delay skeletal muscle fatigue observed lllt exercise+treatment+devices+self-treatment
3 article Hirata et al Experimental muscle pain challenges the postural stability during quiet stance and unexpected posture perturbation Journal of Pain Pain probably impairs a person’s ability to control their posture and stability. This small study (only 9 subjects) attempted to determine how much postural sway might occur when in pain, and found evidence that pain may be the cause of problems with posture and core stability … and not the result of it (which is a classic assumption about chronic pain). “This article presents the acute responses to leg muscle pain on the postural control. This measure could potentially help clinicians who seek to assess how pain responses may contribute to patient's postural control and stability during quiet standing and after recovering from unexpected perturbations.” The study suggests that “people suffering from leg muscle pain are more vulnerable to falls.” 2011 musculoskeletal pain impairs postural control stability subjects stood quietly moveable force platform experimental pain leg muscles moveable force platform measure center pressure unexpected perturbations limb muscle activity joint angles foot pressure distributions measured hypertonic saline induce pain vastus lateralis vastus medialis biceps femoris muscle leg compared baseline control sessions pain knee extensor muscles quiet standing evoked larger sway area greater medial lateral center pressure displacement higher speed increased sway displacement anterior posterior direction increased electromyography emg activity left tibialis anterior left erector spinae muscles pain provoked longer time return equilibrium posture emg activity pain vastus medialis muscle decreased time maximum hip flexion perturbation results show muscle pain impairs postural stability quiet standing unexpected perturbation suggest people suffering leg muscle pain vulnerable falls perspective article presents acute responses leg muscle pain postural control measure potentially clinicians seek assess pain responses contribute patient postural control stability quiet standing recovering unexpected perturbations chronic pain+back pain+biomechanics+pain problems+spine+etiology+pro
3 article Power et al Exposing the evidence gap for complementary and alternative medicine to be integrated into science-based medicine J R Soc Med This paper is particularly interesting for its explanation of the “frustrebo” effect: “Negative true placebo effects (‘frustrebo effects’) in the comparison group, and cognitive measurement biases in the comparison group and the experimental group make the non-specific effect look like a benefit for the intervention group.” (A particularly excellent example of the frustrebo effect can be seen in Cherkin et al.) 2011 people advocate integrating conventional science based medicine complementary alternative medicine cam confronted lack evidence support cam counter calling research diverting attention package care specific effects recommending unblinded pragmatic trials explain responses close evidence gap focus risk biased results open unblinded pragmatic trials clinical trials compare treatment usual care additional care risk bias overlooked components outcome measurements account components outcome measure specific effect intervention specific effects true placebo effects cognitive measurement biases effects tend cancel similar groups compared negative true placebo effects frustrebo effects comparison group cognitive measurement biases comparison group experimental group specific effect benefit intervention group clinical importance effects dismissed justification bottom line results open pragmatic trials trusted research required measure clinical importance true placebo effects cognitive bias effects specific effects treatments mind+scientific medicine+controversy+debunkery
3 article et al The neurophysiological effects of a single session of spinal joint mobilization Journal of Manual & Manipulative Therapy “Results of this review showed that the neurophysiological effects of a single session of spinal mobilization are mostly 5 minutes or less.” 2011 studies detailing neurophysiological effects spinal manual therapy fueled paradigm shift strict biomechanical model systematic review temporal nature single session spinal thrust manipulation neurophysiological effects temporary objective review examine temporal nature neurophysiological effects session spinal mobilization studies eligible review report temporal component neurophysiological effects single session joint mobilization spine human subjects order temporal nature effects captured studies monitor neurophysiological effects time post treatment period systematic review methodology preferred reporting items systematic reviews meta analyses order assess quality strength importance included studies grading recommendations assessment development evaluation system results review showed neurophysiological effects single session spinal mobilization minutes exception findings hypoalgesia hours based study continued research small samples healthy subjects irrelevant outcomes salivary rate skin conductance skin temperature give randomized controlled trials subjects pain decreased function treatment+chiropractic+spinal adjustment+controversy+manual therapy+debunkery+spine
4 article Pal et al Patellar maltracking correlates with vastus medialis activation delay in patellofemoral pain patients American Journal of Sports Medicine This is a study of thigh muscle reflexes in 40 patients with anterior knee pain, compared to 15 healthy people. There was no difference. The researchers did find a correlation between slow muscle activation and poor kneecap movement was detected only in the patients with the “worst” biomechanics: “maltrackers with both abnormal tilt and abnormal bisect offset.” It’s quite possible that having abnormal anatomy changes muscle behaviour, and not the other way around, and none of it necessarily has the slightest thing to do with PFPS — this study does not even try to answer that question. Nevertheless, the paper opines that “VM retraining may be effective” in that subgroup. Yes, it might. And it might not have anything to do with it at all. 2011 background delayed onset vastus medialis vm activity compared vastus lateralis activity reported patellofemoral pain delayed onset vm activity patellofemoral pain patients imbalance muscle forces lateral maltracking patella evidence relating vm activation delay patellar maltracking sparse aim study investigate relationship vm activation delay patellar maltracking measures pain free controls patellofemoral pain patients hypothesis patellar tilt bisect offset measures patellar tracking correlate vm activation delay patellofemoral pain patients classified maltrackers study design case control study level evidence methods vasti muscle activations recorded pain free patellofemoral pain participants walking jogging participants scanned open configuration magnetic resonance scanner upright weightbearing position acquire position patella respect femur patellar tilt bisect offset measured patellofemoral pain participants classified normal tracking maltracking groups results correlations vm activation delay patellar maltracking measures statistically significant patellofemoral pain participants classified maltrackers abnormal tilt abnormal bisect offset patellar tilt walking bisect offset jogging differences means activation delays pain free patellofemoral pain participants walking jogging conclusion relationship vm activation delay patellar maltracking subgroup patellofemoral pain participants classified maltrackers abnormal tilt abnormal bisect offset clinical relevance clinical intervention vm retraining effective subset patellofemoral pain participants excessive tilt excessive bisect offset measures results highlight importance classification patellofemoral pain patients selection clinical intervention etiology+knee+patellar pain+running+biomechanics+pro+leg+limbs+pain problems+arthritis+aging+overuse injury+injury+exercise+self-treatment+treatment
4 article Jane et al Effects of massage on pain, mood status, relaxation, and sleep in Taiwanese patients with metastatic bone pain Pain Does massage therapy help patients with the grinding, deep pain of bone cancer? This Korean study in the journal Pain — nicely randomized, controlled, and a little bigger than small with 72 patients involved — compared the efficacy of massage therapy to “social attention.” That’s a good comparison, because it is likely that being cared for and attended to is one of the most important factors in the perceived (and actual) value of massage therapy. To know if massage itself is the “active ingredient” in massaging cancer patients, it’s got to do better than that. This comparison is rarely done in massage studies, and it should be done more often. Researchers looked for effects on “pain, mood, muscle relaxation, and sleep quality,” and the results were encouraging across the board. Compared to people who were “just” given social attention, “the reduction in pain with massage was both statistically and clinically significant, and the massage-related effects on relaxation were sustained for at least 16–18 hours post intervention.” It’s unlikely that the effects were sustained for long after that. Short-lived relief is a common problem with massage, and it is not all that impressive with problems like chronic low back pain, where treatment results need to last to be meaningful. With the severe pain of a serious and possibly fatal disease, however, any real relief is a genuinely big deal to the patient. As an example, such a massage could literally give a patient one of the only and most pleasant moments of their treatment process — or even of the remaining days of life. Another interesting note here is that the benefits were both “statistically and clinically significant.” As I’ve explained here before, it’s unfortunate how often we see positive experimental results reported as “significant” statistically, but not clinically — meaning the experiment showed a real but trivially minor effect. (See: Trivial but statistically significant: A lot of research makes evidence seem more “significant” than it is.) In this case, the benefits were probably both real and worth writing about it. 2011 date patients bony metastases small fraction samples studied excluded patients metastatic cancers bone metastases report pain compared patients metastatic cancer cancer pain results substantial morbidity disrupted quality life cancer patients massage therapy mt appears positive effects patients cancer benefits mt specifically patients metastatic bone pain remains unknown purpose randomized clinical trial compare efficacy mt social attention control condition pain intensity mood status muscle relaxation sleep quality sample taiwanese cancer patients bone metastases investigation mt shown beneficial subjects effects pain mood muscle relaxation sleep quality results repeated measures analysis covariance demonstrated massage resulted linear trend improvements mood relaxation time importantly reduction pain massage statistically clinically significant massage related effects relaxation sustained hours postintervention massage related effects sleep subjects effects future studies suggested increased sample sizes longer interventional period duration objective sensitive measure sleep results study support employing mt adjuvant therapies improving bone pain management treatment+massage+mind+chronic pain+random+manual therapy+pain problems
3 article Williams How important is the ‘minimal clinically important change’? International Musculoskeletal Medicine There are various ways of measuring improvement in scientific tests of treatments. As this paper points out, “when an outcome measure improves by, say, five points it is not immediately apparent what this means.” How much improvement matters? It is extremely common for experimenters to confirm real, statistically significant treatment effects that are nevertheless trivial. This paper discusses how much benefit is needed to be taken seriously, and cites the damning example of spinal manipulation. Chiropractors routinely claim that the benefits of spinal adjustment are “proven,” but the authors point out that trials have “shown an effect size for manipulation that is less than the threshold for what is clinically worthwhile.” I think it’s particularly noteworthy that these authors have no particular axe to grind about chiropractic treatment — this is not a paper about that. They simply needed a good example to make their point, and it’s telling that they picked spinal manipulative therapy. 2011 patient based outcome measures developed measure health status patients suffering conditions musculoskeletal medicine types developed generic measures broad spectrum illness compare health affected group general population condition specific instruments hand measure effect single condition health compared generic measures narrower focus sensitive small clinically significant health status short periods examples include roland morris questionnaire pain western ontario mcmaster universities arthritis index womac osteoarthritis scientific medicine+spinal adjustment+spine+treatment
4 article Akhtar et al Severe back pain - risk factors British Journal of Sports Medicine This study attempted to compare risk factors in younger and older back pain patients. The researchers considered occupation, BMI, smoking habits, alcohol consumption, and psychological history. There were both male and female, employed and unemployed. Younger patients with severe back pain were overweight, and had more history with pscyhological issues, compared to older patients. “There was no difference in the occupation status, smoking and alcohol consumption in both groups.” 2011 pain common problem age groups risk factors identified including high bmi smoking alcohol psychological history aim study identify difference incidence risk factors age groups collected data prospectively consecutive patients admitted january march severe pain needed mri scan rule cauda equina syndrome nerve root compression district general hospital demographic details recorded occupation bmi smoking status alcohol intake psychological history group younger group patients age range female male employed unemployed housewives bmi range patients smokers alcohol users smoker alcohol users patients psychological history group older group patients age years range female male employed retired house wives bmi range patients smoker enjoyed alcohol patients psychological history younger patients severe pain overweight bmi higher incidence psychological history compared older patients difference occupation status smoking alcohol consumption groups younger patients severe pain routinely assessed psychological history advice weight management back pain+etiology+pain problems+spine+pro
3 article Henschke et al Stretching before or after exercise does not reduce delayed-onset muscle soreness British Journal of Sports Medicine 2011 stretch+controversy+exercise+self-treatment+treatment+muscle+debunkery
2 article Balachandar et al The efficacy of patellar taping in individuals with patellofemoral pain syndrome British Journal of Sports Medicine Garbage in, garbage out: another study that looks a little bit into something, doesn’t find much, and recommends more study. Does taping do any good in treatment of patellar pain syndrome? This study looked at many studies that have already been done. “Additionally, further high quality randomised trials with long term follow-up evaluating the efficacy of patellar taping as an adjunct or alternative treatment to other evidence based interventions is needed. Possible neuromuscular mechanisms behind patellar taping efficacy may be reduced levels and earlier onsets of VMO activity. There is a paucity of research evaluating the effects of patellar taping on PFJ kinematics.” 2011 pain reduction patella taping hypothesised achieved neuromuscular control patellofemoral joint pfj kinematics high number publications systematic review meta analysis evaluating effects patellar taping pain neuromuscular control pfj kinematics warranted medline cinahl sportdiscus google scholar web science embase databases searched inception february randomised studies evaluating effects patellar taping pain neuromuscular control pfj kinematics individuals pfps potential publications assessed independent reviewers inclusion quality downs black quality index ten studies included final review studies investigated medium longer term effects taping pain weeks studies investigated effects taping pain neuromuscular control pfj kinematics effect size calculations showed perceived pain reduced weeks medially directed taping combination exercise term medially directed patellar taping reduced pain functional tasks patellar taping reduce vastus medialis vmo vastus lateralis vl ratio produce earlier vastus medialis oblique vmo activation patellar taping effective means pain relief pfps term additionally high quality randomised trials long term follow evaluating efficacy patellar taping adjunct alternative treatment evidence based interventions needed neuromuscular mechanisms patellar taping efficacy reduced levels earlier onsets vmo activity paucity research evaluating effects patellar taping pfj kinematics patellar pain+treatment+devices+running+arthritis+aging+pain problems+knee+leg+limbs+overuse injury+injury+exercise+self-treatment
3 article Morris et al Corset hypothesis rebutted - Transversus abdominis does not co-contract in unison prior to rapid arm movements Clin Biomech (Bristol, Avon) “These findings indicate that training bilateral pre-activation of the transversus abdominis prior to rapid movement is not justified and may potentially be problematic for the production of normal movement patterns.” This significantly undermines a classic theory (see Hodges et al) used to justify an “advanced” approach to core strength training. 2011 background aim paper test corset model spinal stability specifically hypothesis feed transversus abdominis activity bilaterally symmetrical independent direction perturbation posture due arm study assess transversus abdominis electromyographical activity bilaterally methods feed intramuscular transversus abdominis electromyographical data reaction forces thorax due arm movement collected processed healthy subjects trials types arm movements randomised order reciprocal transversus abdominis indices calculated difference normalised integrated feed transversus abdominis electromyographical data side trunk findings main finding study reciprocal transversus abdominis index significantly related axial rotational forces thorax due arm movement self-treatment+sciatica+back pain+anatomy+etiology+exercise+treatment+pain problems+spine+butt+hip+pro
3 article Willoughby et al Effects of 7 days of arginine-alpha-ketoglutarate supplementation on blood flow, plasma L-arginine, nitric oxide metabolites, and asymmetric dimethyl arginine after resistance exercise Int J Sport Nutr Exerc Metab A small study showing that arginine supplementation increased the amount of arginine in the blood, but changes in circulatory function were simply due to exercise — that is, they also occurred in people who took only a placebo. 2011 background arginine alpha ketoglutarate aakg supplements alleged increase nitric oxide production resulting vasodilation resistance exercise study sought determine effects aakg supplementation hemodynamics brachial artery blood flow circulating levels arginine nitric oxide metabolites nox nitrate nitrite asymmetric dimethyl arginine adma arginine adma ratio resistance exercise methods twenty physically active men underwent days aakg supplementation day platinum placebo plc supplementation resistance exercise session involving elbow flexors performed involving sets repetitions repetition maximum data collected immediately immediately pst min pst exercise session data analyzed factorial anova results heart rate blood pressure blood flow increased groups pst groups plasma arginine increased group nox shown increase groups pst pst groups adma affected tests time points arginine adma ratio increased group conclusion platinum increased plasma arginine levels effects observed hemodynamics brachial artery blood flow nox attributed resistance exercise treatment+self-treatment+medications+exercise+nutrition
2 article Chaitow Is a postural-structural-biomechanical model, within manual therapies, viable? Journal of Bodywork & Movement Therapies A series of rebuttals to Eyal Lederman’s well-known article criticizing the validity and clinical utility of the postural-structural-biomechanical model of pain (see Lederman), and therefore it is also a rebuttal to my own article on this topic (see Your Back Is Not Out of Alignment). I am not impressed: most of what is good in these rebuttals is consistent with what I've already conceded (namely that, yes, duh, structure is sometimes clinically relevant), while the rest generally fails to address the concerns that both Dr. Lederman and I have raised. 2011 massage+chiropractic+biomechanics+manual therapy+treatment+controversy+debunkery+spine+etiology+pro
3 article Orchard et al The management of tennis elbow British Medical Journal 2011 tennis elbow tendinopathy common extensor origin lateral elbow cortisone injections harmful longer term longer recommended cases rehabilitation exercise based treatment helpful effective patients remove tendon overload research needed newer minimally invasive treatments platelet rich plasma injections hyaluronan gel injections nitrate patches reserve surgery botulinum toxin injections worst cases patients months return full function cases tennis elbow cases naturally resolve months tendinosis+treatment+injections+medications+strain+pain problems+overuse injury+injury+medicine+self-treatment+muscle
3 article Hilty et al Fatigue-induced increase in intracortical communication between mid/anterior insular and motor cortex during cycling exercise Eur J Neurosci “To the best of our knowledge, this is the first study to empirically demonstrate that muscle fatigue leads to changes in interaction between structures of a brain’s neural network.” 2011 present study intracortical communication mid anterior insular motor cortex investigated fatiguing cycling exercise healthy male subjects performing constant load test peak oxygen consumption vo peak volitional exhaustion electroencephalography data analysed repetitive artefact free periods min duration quantify fatigue induced intracortical communication intra hemispheric lagged phase synchronization mid anterior insular motor cortex calculated beginning cycling ii cycling iii recovery cycling results revealed significantly increased lagged phase synchronization cycling returned baseline recovery cycling subjects cessation exercise previous imaging studies reporting mid anterior insular cortex essential instance processing variety sensory stimuli signalling forthcoming physiological threat results provide evidence fatiguing exercise structure integrate evaluate sensory information periphery act communication motor cortex knowledge study empirically demonstrate muscle fatigue leads interaction structures brain neural network mind+exercise+running+self-treatment+treatment
3 article Steiger et al Is a positive clinical outcome after exercise therapy for chronic non-specific low back pain contingent upon a corresponding improvement in the targeted aspect(s) of performance? European Spine Journal Does spinal function improve in low back pain patients who exercise? Does it improve in the way that it should? It ought to — that’s certainly one of the core assumptions of core training. This 2011 analysis of trials looked for correlations between clinical outcomes and spinal functional performance, but found little or none. Even when patients felt better, their backs didn’t work better… not even in terms of spinal functions that were allegedly specifically related to the type of back pain they had. If well-designed exercise plans for the right kind of patients actually improved spinal function as “advertised” by advocates, there should have been much clearer signs of that here. As back pain researcher Neil O’Connell put it, this data “suggests that if there are specific subgroups for whom exercise therapies have benefits, then the improvement in those subgroups was not likely due to the suggested ‘active ingredient’ of the exercises given.” 2011 introduction effect size exercise therapy treatment chronic specific pain clbp modest review aims analyse specificity effect examining relationship clinical outcome pain disability targeted aspects physical function muscle strength mobility muscular endurance exercise therapy methods searched exercise therapy trials clbp published april medline embase cochrane library cinahl pedro independent reviewers selected studies inclusion criteria data extraction author extracted data articles results studies total participants met inclusion criteria evidence supporting relationship pain physical function performance measures mobility correlation studies weak correlation study trunk extension strength trunk flexion strength muscle endurance disability showed correlation mobility studies weak correlation strength numbers correlation weak correlation conclusions findings support notion treatment effects exercise therapy clbp attributable musculoskeletal system future research aimed increasing effectiveness exercise therapy clbp explore coincidental factors influencing symptom improvement treatment+self-treatment+back pain+exercise+pain problems+spine
4 article Nieuwenhuis et al Erroneous analyses of interactions in neuroscience Nat Neurosci This research identified a major common problem in scientific papers. It was described by Ben Goldacre for The Guardian as “a stark statistical error so widespread it appears in about half of all the published papers surveyed from the academic neuroscience research literature.” Dr. Steven Novella also wrote about it for recently, adding that “there is no reason to believe that it is unique to neuroscience research or more common in neuroscience than in other areas of research.” 2011 theory comparison experimental effects requires statistical test difference practice comparison based incorrect procedure involving separate tests researchers conclude effects differ effect significant reviewed behavioral systems cognitive neuroscience articles top ranking journals science nature nature neuroscience neuron journal neuroscience correct procedure incorrect procedure additional analysis suggests incorrect analyses interactions common cellular molecular neuroscience discuss scenarios erroneous procedure beguiling scientific medicine+bad science+random
2 article Hróbjartsson et al Placebo effect studies are susceptible to response bias and to other types of biases J Clin Epidemiol It’s still unclear whether or not the effect of placebo is “real.” This study analyzes placebo science so far and explains how existing research methods may produce the appearance of a real physiological effect — a “powerful” placebo — when in fact it is just an illusion, based primarily on research artifacts like reporting bias. 2011 objective investigations effect placebo challenging conduct interpret history placebo shows assessment clinical significance real potential biased analyze discuss typical types bias studies placebo study design setting methodological analysis discussion results inherent nonblinded comparison placebo treatment research design estimating effects placebo clinical experimental setting difference placebo treatment remains approximate crude reflection true effect placebo interventions main problem response bias trials outcomes based patients reports biases involve differential intervention patient dropouts publication bias outcome reporting bias extrapolation results clinical settings challenging lack clear identification causal factors clinical trials nonclinical setting short duration laboratory experiments conclusions creative experimental efforts needed assess rigorously clinical significance placebo interventions investigate component elements contribute therapeutic benefit biology+mind+treatment+fun
3 article Apazidis et al The prevalence of transitional vertebrae in the lumbar spine Spine J There is a fairly common spinal deformity, a “transitional vertebra,” in which the lowest vertebrae of the spine is partially merged with the sacrum. It is not quite a vertebra, and not quite sacrum — thus, “transitional.” This study looked at how common transitional vertebrae are, and if they correlate with low back pain. Not that we needed it, but the results give us yet more evidence that structure is nowhere near the most important factor in pain. Simply put, this study found that this common spinal deformity is not much more common in people with pain (maybe no more common at all): “Although LSTV's role in low back pain remains controversial, our study has shown that, when the same criteria are used for classification, prevalence among the general population and symptomatic patients may be similar.” As always, this kind of finding is strongly at odds with an entire industry of therapy based on trying to fix subtle alleged biomechanical problems because they are supposedly painful. And yet here we have a vertebral birth defect that is found in pain-free people about as often as it is found in cases of back pain. Something is wrong with this picture. 2011 background context lumbosacral transitional vertebrae lstvs congenital vertebral anomaly l s junction spine alteration contribute incorrect identification vertebral segment leading wrong level spine surgery poor correlation clinical symptoms studies describe occurrence anomaly pain populations investigation prevalence american general population lacking purpose establish prevalence rates lstvs general population study design retrospective review patient sample consecutive kidney urinary bladder kub radiographs subjects years outcome measures clinical demographics number lumbar vertebrae l s transverse process tp height rib length methods consecutive adult kub studies adult subjects queried clear visibility rib vertebral body articulation lumbar tps complete sacral wings exclusion criteria consisted radiologic evidence previous lumbosacral surgery obstruct measurements total abdominal films reviewed identified adequate measurement desired parameters results eleven subjects identified eligible study classified positive transitional lumbosacral vertebra common anatomical variant castellvi type ia average age time kub study years years subjects presented lumbar nonribbed vertebrae lumbar vertebrae conclusions significance lumbosacral transitional level establishment pain degenerative stenosis disc disease documented symptomatic patients lstv role pain remains controversial study shown criteria classification prevalence general population symptomatic patients similar back pain+etiology+biology+surgery+biomechanics+pain problems+spine+pro+treatment
4 article Herbert et al Stretching to prevent or reduce muscle soreness after exercise Cochrane Database of Systematic Reviews Does stretching help either before or after exercise to reduce soreness? Nope. This large review of many scientific studies concluded with a clear thumbs down: “The evidence from randomised studies suggests that muscle stretching, whether conducted before, after, or before and after exercise, does not produce clinically important reductions in delayed-onset muscle soreness in healthy adults.” 2011 background people stretch engaging athletic activity purpose reduce risk injury reduce soreness exercise enhance athletic performance update cochrane review published objectives aim review determine effects stretching exercise development delayed onset muscle soreness search strategy searched cochrane bone joint muscle trauma group specialised register august cochrane central register controlled trials issue medline th february embase th february cinahl rd february sportdiscus th february pedro th february reference lists articles selection criteria eligible studies randomised quasi randomised studies pre exercise post exercise stretching technique designed prevent treat delayed onset muscle soreness doms studies included stretching conducted exercise muscle soreness assessed data collection analysis risk bias assessed cochrane collaboration risk bias tool quality evidence assessed grade estimates effects stretching converted common point scale outcomes pooled fixed effect meta analyses main results twelve studies included review update incorporated studies trials large field based trial included participants allocated stretching studies small participants receiving stretch condition ten studies laboratory based field based studies exposed moderate high risk bias quality evidence moderate high degree consistency results studies pooled estimate showed pre exercise stretching reduced soreness day exercise average point point scale difference ci studies post exercise stretching reduced soreness day exercise average point point scale difference ci studies similar effects evident day days exercise large study showed stretching exercise reduced peak soreness week period average points point scale difference ci effect statistically significant small authors conclusions evidence randomised studies suggests muscle stretching conducted exercise produce clinically important reductions delayed onset muscle soreness healthy adults stretch+exercise+running+self-treatment+treatment+muscle
3 article Nijs et al How to explain central sensitization to patients with 'unexplained' chronic musculoskeletal pain Manual Therapy This is an opinion piece echoing some of the tenets of the “explain pain” movement (see Moseley). Better yet, see my pain explainer, Pain is Weird. 2011 central sensitization evidence based explanation cases unexplained chronic musculoskeletal pain prior commencing rehabilitation cases crucial change maladaptive illness perceptions alter maladaptive pain cognitions reconceptualise pain accomplished patient education central sensitization role chronic pain strategy pain physiology education pain physiology education clinical picture characterized dominated central sensitization maladaptive illness perceptions present prerequisites commencing pain physiology education face face sessions pain physiology education conjunction written educational material effective changing pain cognitions improving health status patients chronic musculoskeletal pain disorders include patients chronic pain chronic whiplash fibromyalgia chronic fatigue syndrome biopsychosocial assessment pain physiology education comprises face face session explaining basic pain physiology contrasting acute nociception chronic pain session written information pain physiology homework session session correct misunderstandings facilitate transition knowledge adaptive pain coping daily life pain physiology education continuous process initiated educational sessions continued active treatment longer term rehabilitation program treatment+self-treatment+biology+chronic pain+etiology+mind+back pain+pain problems+pro+spine
3 article Janet et al Backward Walking Journal of Exercise Physiologyonline Backward walking, eh? Huh. Didn’t see that one coming. “Results suggest that backward walking may reduce LBP and enhance function for athletes. Further investigation is warranted.” Of course, this study also takes “small sample size” about as far as it can go. 2011 specific pathologies associate pain lbp challenge athletic trainers healthcare professionals techniques treat stricken athletes primary purpose study investigate effectiveness walking exercise program alleviating lbp enhancing function athletes secondary purpose identify aspects walking performance beneficial alleviation lbp subjects included ncaa division athletes experiencing lbp healthy active individuals experiencing lbp performed pre test week intervention walking post test range motion stride parameters shock attenuation pain scores measured recorded test session group results group time anovas identified significant differences groups time stride parameters lbp group exhibited significantly greater sagittal plane motion lesser coronal plane motion healthy group single subject analyses identified unique participant responses reducing shock attenuation ± increasing sagittal ± deg coronal ± deg plane range motion intervention participant elicted responses results suggest walking reduce lbp enhance function athletes investigation warranted back pain+treatment+self-treatment+exercise+fun+pain problems+spine
3 article Hill et al Effects of High-Intensity Inspiratory Muscle Training Following a Near-Fatal Gunshot Wound Physical Therapy After a gunshot wound, a “high-intensity, interval-based threshold inspiratory muscle training (IMT) was undertaken” for the 38-year-old man. The treatment was found to be “safe and well tolerated. It was associated with improvements in maximum forced inspiratory flow and changed the locus of symptom limitation during high-intensity exercise from dyspnea to leg fatigue.” 2011 background purpose severe injuries sustained combat classify individuals undeployable active service imperative effort optimize physical function injuries case description year man sustained gunshot wound armed combat bullet entered left axilla exited side abdomen resulting severe thoracic abdominal injuries months continued describe severe dyspnea exertion cardiopulmonary exercise test cycle ergometer achieved maximum rate oxygen uptake ml min predicted maximum power predicted maximum forced inspiratory flow inspiratory reserve volume test ∼ ml test terminated patient due dyspnea severe tolerate video fluoroscopy demonstrated impaired hemidiaphragm function main goals therapy reduce dyspnea exertion enable return full work duties program high intensity interval based threshold inspiratory muscle training imt undertaken outcomes average sessions imt completed week weeks repeat cardiopulmonary exercise test patient achieved similar power maximum rate oxygen uptake maximum forced inspiratory flow increased \ limited leg fatigue discussion high intensity imt safe tolerated improvements maximum forced inspiratory flow changed locus symptom limitation high intensity exercise dyspnea leg fatigue exercise+case+treatment+random+self-treatment
4 article Schwellnus et al Increased running speed and previous cramps rather than dehydration or serum sodium changes predict exercise-associated muscle cramping British Journal of Sports Medicine Blood samples from 210 Ironman triathletes were checked for electrolytes and other signs of hydration status. 43 had suffered cramps. There was no significant differences between the crampers and the non-crampers in any of the pre-testing or post-testing. The shocking conclusion? Dehydration and electrolyte shortage don’t cause cramps — intense effort does. “The results from this study add to the evidence that dehydration and altered serum electrolyte balance are not causes for EAMC.” A nice myth-mangler of a study! 2011 background high prevalence exercise muscle cramping eamc endurance athletes aetiology risk factors condition fully understood aim aim prospective cohort study identify risk factors eamc endurance triathletes methods triathletes competing ironman triathlon recruited prior race subjects completed detailed validated questionnaire blood samples serum electrolytes immediately race pre race body weight obtained body weight blood samples serum electrolyte concentrations obtained immediately race clinical data eamc experienced immediately race collected results triathletes reported eamc cramping group compared report eamc cramping group significant differences groups pre race post race serum electrolyte concentrations body weight development eamc faster predicted race times faster actual race times similarly matched preparation performance histories subjects groups regression analysis identified faster race time cycling time history cramping races independent risk factors eamc conclusion results study add evidence dehydration altered serum electrolyte balance eamc endurance runners competing fast pace suggests exercise high intensity risk eamc exercise+running+biology+etiology+fun+strain+self-treatment+treatment+pro+injury+pain problems+muscle
3 article Hunter et al Tendon length and joint flexibility are related to running economy Medicine & Science in Sports & Exercise This study’s results fly in the face of conventional wisdom and expectations of stretching. It showed that that “longer lower limb tendons (especially Achilles tendon) and less flexible lower limb joints are associated with improved running econmy.” Similar results were obtained by Trehearn et al. Todd Hargrove described this research in an article about stretching and running economy. 2011 purpose purpose study determine quadriceps patella achilles tendon length flexibility knee extensors plantar flexors related walking running economy methods twenty male distance runners subjects quadriceps patella achilles tendon length measured magnetic resonance imaging body composition dxa oxygen uptake rest seated walking mph running mph indirect calorimetry knee ankle joint flexibility goniometry leg lengths anthropometry seated correlations identify relationships variables interest results net vo exercise vo rest vo walking nvowk running mph nvo nvo significantly related achilles tendon length varying achilles tendon cross section related walking running economy quadriceps patella tendon length significantly related nvo approached significance nvo flexibility plantar flexors related nvo + multiple regression showed achilles tendon length independently related nvo nvo partial varying self-treatment+running+stretch+controversy+exercise+treatment+muscle+debunkery
4 article Morikawa et al Physical fitness and indices of lifestyle-related diseases before and after interval walking training in middle-aged and older males and females British Journal of Sports Medicine This study seems to prove that increasing aerobic capacity for walking through interval training can lower the chances of getting one of several lifestyle-related diseases in middle age and older. 2011 hypothesis increasing peak aerobic capacity walking peak interval walking training iwt closely linked decreasing indices lifestyle related diseases lsds middle aged older people examined methods months april september males females ∼ years performed iwt consisting sets fast walking peak min slow walking peak min days week iwt measured peak body mass index bmi body fat arterial blood pressure thigh muscle strength blood parameters analysed males females undergone measurements iwt examine hypothesis divided subjects equally groups pretraining peak middle high groups sex results training thigh muscle strength blood high density lipoprotein cholesterol concentration body weight bmi body fat arterial blood pressure blood glucose higher group high group exercise+random+self-treatment+treatment
3 article Elliott et al Hamstring Muscle Strains in Professional Football Players American Journal of Sports Medicine Hamstring injuries are common in football, rugby and soccer. This study looked at injuries in the National Football League and found that injuries are more common during the preseason and also the particular position the person plays. Knowing this might make it more possible to avoid injury. 2011 background investigations hamstring strain injuries elite level exist sports australian rules football rugby soccer large scale study exists incidence circumstances surrounding injuries national football league nfl hypothesis injury rates vary player positions times season playing situations study design descriptive epidemiology study methods injury data prospectively collected athletic trainers nfl team recorded nfl injury surveillance system data collected included team date injury activity player engaged time injury injury severity position played mechanism injury history previous injury injury rates reported injuries athlete exposure athlete exposure defined athlete participating practice game results year study period hamstring strains reported injury rate ir hamstring strains occurred week preseason preseason practice ir significantly elevated compared regular season practice ir commonly injured positions defensive secondary accounting injuries wide receivers accounting special teams constituting injuries study conclusion hamstring strains considerable disability football majority injuries occurring short preseason speed position players wide receivers defensive secondary players special teams units elevated risk injury positions situations higher risk injury provide foci preventative interventions strain+injury+pain problems+muscle
3 article Wang et al Identification of a central role for complement in osteoarthritis Nat Med This is a complex genetic study of mice, with the conclusion that “dysregulation of complement in synovial joints has a key role in the pathogenesis of osteoarthritis,” meaning that arthritis may not just be caused by “wear and tear” but by an inflammation malfunction. 2011 osteoarthritis characterized breakdown articular cartilage synovial joints long viewed result wear tear grade inflammation detected osteoarthritis role unclear identify central role inflammatory complement system pathogenesis osteoarthritis proteomic transcriptomic analyses synovial fluids membranes individuals osteoarthritis find expression activation complement abnormally high human osteoarthritic joints mice genetically deficient complement component c c complement regulatory protein cd a show complement specifically membrane attack complex mac mediated arm complement crucial development arthritis mouse models osteoarthritis pharmacological modulation complement wild type mice confirmed results obtained genetically deficient mice expression inflammatory degradative molecules chondrocytes destabilized joints c deficient mice c sufficient mice mac induced production molecules cultured chondrocytes mac colocalized matrix metalloprotease mmp activated extracellular signal regulated kinase erk chondrocytes human osteoarthritic cartilage findings dysregulation complement synovial joints key role pathogenesis osteoarthritis etiology+mind+arthritis+inflammation+knee+chronic pain+pro+aging+pain problems+leg+limbs
3 article Andersson et al Tenocyte hypercellularity and vascular proliferation in a rabbit model of tendinopathy British Journal of Sports Medicine This is a study of how rabbit tendons responded to exercise over a period of weeks. The “exercise” was electrically stimulated contraction of the triceps surae muscle, as well as a bunch of passive movement (basically, grabbing a rabbits foot and moving it over and over again). Three groups of rabbits were subjected to variations on this theme, and a fourth group was unmolested. There was no difference after just a week, but the exercised rabbits showed more tendon cells and blood vessels after three weeks, and signs of damage after six. And there was one particularly fascinating discovery: “There were bilateral tendinosis-like changes in the Achilles tendons of rabbits in the current model after 3 weeks of training, suggesting that central neuronal mechanisms may be involved.” 2011 objective determine objective findings tendinosis rabbit tendinopathy model exercised contralateral exercised achilles tendons design groups zealand white rabbits group animals control group subjected exercise stimulation interventions animals subjected protocol electrical stimulation passive flexion extension triceps surae muscle day weeks main outcome measures tenocyte number vascular density calculated morphological evaluations performed situ hybridisation vascular endothelial growth factor vegf messenger rna results significant increase tenocyte number weeks exercise week comparison control group achilles tendons legs experimental animals including unexercised limb pattern vascularity showed increase number tendon blood vessels rabbits exercised weeks compared exercised week vegf mrna detected investigated tissue reactions detected tendon tissue tendinosis week rabbits normal tendon tissue control rabbits conclusions bilateral tendinosis achilles tendons rabbits current model weeks training suggesting central neuronal mechanisms involved contralateral side control tendinosis+counter-intuitive+etiology+neurology+chronic pain+pain problems+overuse injury+injury+pro
3 article Barton et al The immediate effects of foot orthoses on functional performance in individuals with patellofemoral pain syndrome British Journal of Sports Medicine Attempting to find out if patellofemoral pain syndrome could be helped by foot orthoses, 52 individuals were prescribed prefabricated foot orthoses. Conclusions were “Prefabricated foot orthoses provide immediate improvements in functional performance, and these improvements are associated with a more pronated foot type and poorer footwear motion control properties.” 2011 objective patellofemoral pain syndrome pfps results reduced functional performance growing evidence foot orthoses treat multifactorial condition study effects foot orthoses functional performance association foot posture footwear improvements function evaluated methods fifty individuals pfps years prescribed prefabricated foot orthoses vasyli pro vasyli international labrador australia functional outcome measures evaluated included change pain ease single leg squat point likert scale change number pain free step downs single leg rises sitting association foot posture foot posture index navicular drop calcaneal angle relative subtalar joint neutral footwear motion control properties scale score improved function evaluated spearman ρ statistics results prefabricated foot orthoses produced significant improvements treatment+patellar pain+devices+biomechanics+arthritis+aging+pain problems+knee+leg+limbs+overuse injury+injury+running+exercise+self-treatment+etiology+pro
3 article O'Sullivan et al Association of Biopsychosocial Factors With Degree of Slump in Sitting Posture and Self-Report of Back Pain in Adolescents Physical Therapy Does the way we sit affect back pain? Teens slouch a lot, and they do get back pain (though much less than adults). If posture is an important factor in back pain, it shouldn’t be too hard to find a connection… but this big study did not. Researchers looked for a correlation between sitting posture and back pain and the results were (predictable) rather unexciting. “This study demonstrated that a greater degree of slump in sitting was only weakly associated with adolescent back pain made worse by sitting after adjustment for other physical and psychosocial factors.” Hardly a smoking gun there… 2011 background conflicting evidence exists relationships sitting posture factors influence sitting posture pain conflicting evidence partially due presence multiple overlapping factors sitting posture pain objective purpose study determine degree slump sitting sex physical lifestyle psychosocial factors additionally relationship report pain worse sitting degree slump sitting physical lifestyle psychosocial factors investigated design cross sectional study methods adolescents completed questionnaires determine lifestyle psychosocial profiles experience pain sagittal sitting posture body mass index bmi muscle endurance bme recorded standing posture subgroup categorization determined results multivariate analysis revealed significant factor degree slump sitting male sex neutral standing postures perceived efficacy bme greater television higher bmi multivariable analysis poorer child behaviour checklist scores strongest correlate report pain worse sitting degree slump sitting female sex bme weakly related limitations causality determined cross sectional study sitting posture variation explained measured variables conclusions slump sitting physical correlates sex lifestyle psychosocial factors highlighting complex multidimensional nature usual sitting posture adolescents additionally study demonstrated greater degree slump sitting weakly adolescent pain worse sitting adjustment physical psychosocial factors back pain+biomechanics+fun+pain problems+spine+etiology+pro
5 webpage Beyerstein Why Bogus Therapies Seem to Work A classic article that explains many common illusions of treatment benefit. Required reading for all health care professionals. 2011 ten kinds errors biases convince intelligent honest people cures achieved sell therapies kind obligation prove treatments safe effective difficult task subtle ways honest intelligent people patients therapists led treatment cured true assessing treatments scientific medicine nostrums folk medicine fringe treatments alternative medicine frankly magical panaceas faith healers controversy+classics+scientific medicine+chiropractic+homeopathy+debunkery+manual therapy+treatment+spine
3 article Ayles et al Vibration-induced afferent activity augments delayed onset muscle allodynia Journal of Pain For this study, young men exercised one leg hard enough to make it good and sore. Pressure pain thresholds and sensitivities were measured a day later in the sore muscles, but also in other muscles that send their sensory information to the same part of the spinal cord — that’s unexercised and non-sore muscles on the sore side, that just happen to be connected to the same area of the spinal cord. Not surprisingly, pain thresholds were lower in the sore, exercised muscles. But — and this is cool — vibrating the sore muscles caused soreness in other muscles that should not have been sore! So soreness effectively “spread” to other muscle groups, via the central nervous system. This raises interesting questions about how people with brain-regulated pain dysfunction might react to exercise soreness: could the pain spread to unaffected areas by the same mechanism? It seems likely. 2011 evidence suggests large diameter afferents response centrally mediated augment mechanical allodynia hyperalgesia delayed onset muscle soreness doms conditions healthy males aged performed eccentric exercise eliciting doms tibialis anterior muscle randomly assigned exercised leg contralateral leg served control mechanosensitivity assessed exercised control legs prior hours postexercise pressure pain thresholds ppts ppts assessed muscle site distant segmentally related site vibration vibration concurrently applied distant muscle segmentally related control extra segmentally related site participants completed point likert scale providing subjective measure doms days postexercise baseline mechanosensitivity significantly site exercised  control legs prior exercise soreness ratings higher hours postexercise   baseline ppts exercised legs muscle site decreased postexercise day exercise segmentally related site ppts reduced significantly vibration applied concurrently doms affected tibialis anterior muscle compared baseline mechanosensitivity extrasegmental control vibration perspective evidence presented article indicating large diameter afferents centrally mediated mechanisms augment mechanical hyperalgesia doms conditions future research examining eccentric activity individuals centrally sensitized conditions warranted etiology+chronic pain+exercise+pro+pain problems+self-treatment+treatment
4 article Katz et al Efficacy and safety of tanezumab in the treatment of chronic low back pain Pain Patients with chronic low back pain received injections of tanezumab, a drug that inhibits nerve growth. Those who received tanezumab showed more improvement than the groups that received naproxen or a placebo. Tanezumab, however, was associated with abnormal peripheral sensations "that were generally mild and resolved" before the study was completed. Four patients discontinued the study because of these side effects, and the clinical development of Tanezumab is on hold due to these adverse side effects in osteoarthritis patients. 2011 increased nerve growth factor levels chronic pain conditions including chronic pain lbp study examined safety analgesic efficacy tanezumab humanized anti nerve growth factor antibody adults chronic lbp patients received intravenous tanezumab μ kg oral placebo intravenous placebo oral naproxen mg day intravenous placebo oral placebo primary outcome average lbp intensity albpi week secondary outcomes proportion patients reduction albpi roland morris disability questionnaire pain inventory short form scores patients global assessment lbp patients global evaluation study medication rescue medication albpi change baseline week greater tanezumab naproxen placebo treatment+medications+injections+back pain+self-treatment+medicine+pain problems+spine
3 article Howe et al Exercise for improving balance in older people Cochrane Database of Systematic Reviews There is “weak evidence that some types of exercise” — more challenging types, for the most part — are “moderately effective, immediately post intervention, in improving clinical balance outcomes in older people.” A very common sense conclusion! So far there is really no evidence about the balance effects of more typical exercises like walking or cycling. 2011 background older adults diminished balance reduced physical functioning increased risk falling update cochrane review published authors conclusions weak evidence types exercise gait balance ordination functional tasks strengthening exercise d exercise multiple exercise types moderately effective immediately post intervention improving clinical balance outcomes older people interventions safe insufficient evidence draw conclusions general physical activity walking cycling exercise involving computerised balance programmes vibration plates high methodological quality research core outcome measures adequate surveillance required random
2 article Yelland et al Prolotherapy injections and eccentric loading exercises for painful Achilles tendinosis British Journal of Sports Medicine This is a trial of 40 patients, comparing eccentric loading exercises and prolotherapy, or a combination of the two. It looks like a win, and the evidence is worth noting, particularly about prolotherapy, but there are several caveats and the results must be taken with a grain of salt: it’s a small study with no control group, the short-term effect size is modest, and the long-term results were scarcely distinguishable. With a control group, for all we know, untreated individuals would have done just as well, or even better. 2011 objective compare effectiveness cost effectiveness eccentric loading exercises ele prolotherapy injections singly combination painful achilles tendinosis design single blinded randomised clinical trial primary outcome measure visa questionnaire minimum clinically important change mcic points setting australian primary care centres participants patients painful mid portion achilles tendinosis commenced completed treatment protocols interventions participants randomised week program ele prolotherapy injections hypertonic glucose lignocaine affected tendon combined treatment main outcome measurements visa pain stiffness limitation activity scores treatment costs results months proportions achieving mcic visa \ ele \ prolotherapy combined treatment ci increases visa scores months ele prolotherapy combined treatment weeks months increases significantly ele combined treatment compared ele reductions stiffness limitation activity occurred earlier prolotherapy reductions pain stiffness limitation activity occurred earlier combined treatment combined treatment lowest incremental cost additional responder $a compared ele conclusions achilles tendinosis prolotherapy ele combined prolotherapy give rapid improvements symptoms ele long term visa scores similar tendinosis+treatment+exercise+injections+pain problems+overuse injury+injury+self-treatment+medicine
article Liang et al Deformation and stress distribution of the human foot after plantar ligaments release Sci China Life Sci “Plantar fascia release decreased arch height, but did not cause total collapse of the foot arch,” and the arch was lost completely only “when all the four major plantar ligaments were sectioned simultaneously” (i.e. a total fasciotomy). 2011 majority foot deformities related arch collapse instability longitudinal arch relationship plantar fascia arch height previously investigated stress distribution remains unclear aim study explore role plantar ligaments foot arch biomechanics constructed geometrical detailed dimensional finite element fe model human foot ankle computer tomography images model comprised majority joints foot bone segments major ligaments plantar soft tissue release plantar fascia ligaments simulated evaluate biomechanical effects load distribution bony ligamentous structures intrinsic ligaments foot arch sectioned simulate pathologic situations injury plantar ligaments explore bone segment displacement stress distribution validity fe model verified comparing results experimentally measured data displacement von mise stress bone segment plantar fascia release decreased arch height total collapse foot arch longitudinal foot arch lost major plantar ligaments sectioned simultaneously plantar fascia release compromised increased strain applied plantar ligaments intensified stress midfoot metatarsal bones load redistribution centralized metatarsal bones focal stress relief calcaneal insertion predicted fe model plantar fascia release provide relief focal stress heel pain operative procedures pose risk arch stability clinically produce dorsolateral midfoot pain initial strategy treating plantar fasciitis operative treatment+surgery+plantar fasciitis+foot+running+overuse injury+leg+limbs+pain problems+injury+tendinosis+exercise+self-treatment
book Hutchinson Which comes first, cardio or weights? HarperCollins 2011 presents latest research commonly held beliefs topics fitness routines weight management aerobic exercise strength training injuries aging exercise+scientific medicine+self-treatment+treatment
4 article Elliott et al The temporal development of fatty infiltrates in the neck muscles following whiplash injury PLoS ONE A most intriguing paper, presenting evidence of muscle changes in people with chronic “whiplash associated disorders,” specifically extra fat (of all things). They looked at 44 people over several months who had had whiplash injury and found that “muscle fatty infiltrates in the cervical extensors occur soon following whiplash injury and suggest the possibility for the occurrence of a more severe injury with subsequent PTSD in patients with persistent symptoms.” The paper is nicely summarized and discussed on on Body In Mind. 2011 background radiological findings poor recovery whiplash injury remain elusive muscle fatty infiltrates mfi cervical extensors magnetic resonance imaging mri patients chronic pain observed association specific aspects pain psychological factors explored longitudinally materials findings subjects whiplash injury enrolled weeks post injury classified months scores neck disability index recovered mild moderate severe measure mfi patient report pain loss cervical range movement posttraumatic stress disorder ptsd collected weeks months months post injury effects time group interaction time group mfi determined assessed mediating effect posttraumatic stress cervical range movement longitudinal relationship initial pain intensity mfi difference mfi groups enrollment mfi values increased moderate severe group significantly higher comparison recovered mild groups months differences mfi values mild recovered groups initial severity ptsd symptoms mediated relationship pain intensity mfi months initial rom loss conclusions mfi cervical extensors occur whiplash injury suggest possibility occurrence severe injury subsequent ptsd patients persistent symptoms etiology+neck+chronic pain+pro+head/neck+spine+pain problems
4 article Mayer et al The intensity and effects of strength training in the elderly Dtsch Arztebl Int All studies seem to indicate that the elderly (over 60) need strength training more and more as they grow older. This allows them to stay mobile for everyday activities. How much training is still uncertain. 2011 elderly strength training grow older stay mobile everyday activities goal training reduce loss muscle mass resulting loss motor function dose response relationship training intensity training effect fully elucidated exercise+self-treatment+treatment
book Kean The disappearing spoon Back Bay Books 2011 random
3 article Schneiders et al Functional movement screen normative values in a young, active population International Journal of Sports Physical Therapy According to the authors of this study, the Functional Movement Screen™ (FMS) is “based on the assumption that identifiable biomechanical deficits in fundamental movement patterns have the potential to limit performance and render the athlete susceptible to injury.” However, this small, high-quality experiment could not even detect a difference in test results in people who had actually been injured recently: the results “demonstrated no significant differences on the composite score between individuals who had an injury during the 6 last months and for those who had not.” On the bright side, this study did confirm that the FMS testing is reliable (inter-rater reliability): different professionals get almost exactly the same results. It also produced good baseline test results for average active people, which is an important first step in helping professionals (and future researchers) start to understand the meaning of FMS results — if any. For more detailed analysis of this paper, see The Functional Movement Screen (FMS). 2011 functional movement screen tm fms tm screening instrument evaluates selective fundamental movement patterns determine potential injury risk global normative values fms tm exercise+biomechanics+self-treatment+treatment+etiology+pro
2 article Wand et al Managing chronic nonspecific low back pain with a sensorimotor retraining approach Physical Therapy This is a tiny study: only three people! They were assessed weekly during a no-treatment period and then during a 10-week retraining program. Data was collected for at least a month after the end of the formal treatment. While “pain intensity, pain interference, and disability all were reduced, and the improvements were maintained throughout the follow-up period,” 2011 background current approaches management chronic nonspecific pain cnslbp shown limited effectiveness appears disruption cortical structure function feature cnslbp contribute current treatment failures sensorimotor retraining approaches shown effective management long standing pain problems characterized cortical dysfunction similar treatments option people cnslbp objective objectives study describe effects participation graded sensorimotor retraining program pain intensity interference pain daily life pain interference reported disability evaluate safety program design multiple baseline replicated single case design study methods people disabling cnslbp assessed weekly treatment baseline period person participated graded sensorimotor retraining program minimum weeks clinical status assessed weekly data collection continued weekly month formal treatment results pain intensity pain interference disability reduced improvements maintained follow period adverse reactions treatment reported limitations findings preliminary based single case design observed improvements clinical status attributable effects factors treatment effect time nonspecific effects conclusions positive outcomes reported participants cnslbp completion graded sensorimotor retraining program findings preliminary require replication robust study designs back pain+treatment+chronic pain+exercise+mind+pain problems+spine+self-treatment
4 article Cherkin et al A comparison of the effects of 2 types of massage and usual care on chronic low back pain Annals of Internal Medicine This is one of the only large, long duration studies of massage that has ever been done. Four hundred patients with chronic low back pain were split into three groups: one group got weekly hour-long relaxation massages, another got more advanced therapeutic massage, and patients in a third group got nothing. Unfortunately, the unmassaged patients knew that they were missing out — a serious flaw in the study that the authors believe made massage “seem more superior than it really is” in comparison, and so they found it “difficult to determine the true magnitude of the benefits of massage observed in this trial.” Nevertheless, 60% of massage patients seemed to improve about 30% — about a 2-point drop on a 10-point pain scale, compared to a 1-point drop for patients who did nothing — which is just barely a large enough improvement to be clinically significant with a wee bit of wiggle room. Their gains were lost steadily after the last massage, and there were only small differences between groups after six months, and none after a year. The most useful result from this study is that there was “no clinically meaningful difference between relaxation and structural massage” whatsoever. This was a serious blow to many supposedly “advanced” massage techniques. For an extremely detailed analysis of this research, see: Massage Therapy Kinda, Sorta Works for Back Pain: It works, but not very well, and “advanced” techniques are no better than relaxation massage. 2011 background studies evaluated effectiveness massage chronic pain objective compare effectiveness types massage usual care chronic pain design parallel group randomized controlled trial randomization computer generated centralized allocation concealment participants blinded massage type assignment massage usual care massage therapists unblinded study personnel assessed outcomes blinded treatment assignment clinicaltrials gov registration number nct setting integrated health care delivery system seattle area patients persons years age nonspecific chronic pain intervention structural massage   relaxation massage   usual care   measurements roland disability questionnaire rdq symptom bothersomeness scores weeks primary outcome weeks secondary outcomes group differences points rdq points symptom bothersomeness scale considered clinically meaningful results massage groups similar functional outcomes weeks adjusted rdq score points ci points relaxation group points ci points structural massage group usual care group adjusted symptom bothersomeness scores points ci points relaxation massage points ci points structural massage beneficial effects relaxation massage function symptom reduction persisted weeks small limitation participants blinded treatment conclusion massage therapy effective treatment chronic pain benefits lasting months clinically meaningful difference relaxation structural massage observed terms relieving disability symptoms primary funding source national center complementary alternative medicine treatment+self-treatment+back pain+massage+biomechanics+pain problems+spine+manual therapy+etiology+pro
3 article Starbuck et al Exercise-induced muscle damage and the repeated bout effect European Journal of Applied Physiology If one exercises one arm, will the other arm benefit? Researchers tried this with 15 males (a small group). Divided into two groups, eccentric exercises were done in either one arm or both arms. Strength, muscle soreness, and resting arm angle were measured at the beginning and at 1, 24 and 48 hours after exercise. The researchers concluded, based on the data, that “the repeated bout effect transfers to the opposite (untrained) limb. The similar reduction in MF between bouts for the two groups provides evidence for a centrally mediated, neural adaptation.” 2011 examined prior bout eccentric exercise elbow flexors protection exercise induced muscle damage contralateral arm fifteen males age  ±   years height  ±   cm mass  ±   kg randomly assigned groups performed bouts eccentric contractions ° separated  weeks ipsilateral     bouts performed arm contralateral     bout performed arm strength muscle soreness resting arm angle raa measured baseline   post exercise surface electromyography recorded bouts exercise degree strength loss attenuated   fun+mind+chronic pain+exercise+biology+pain problems+self-treatment+treatment
4 article Bulley et al Against All Reason — Effects of Acupuncture and Tens Delivered to an Artificial Hand Physiotherapy Fascinating, head-trippy study — I have not considered all of its implications yet! 2011 purpose determine specific treatment effects imparted treatment cognitively implausible perceptual cues credible relevance patient believes treatment work thought critical determinant treatment placebo effects treatment patient clinician futile induce treatment effects widely accepted position tested visual illusions definition induce perceptual effects absence reason raises possibility illusions domains participants experiments involved healthy volunteers recruited advertisement methods experiment extant literature perceptual effects acupuncture reviewed key perceptual descriptive terms collectively deqi identified experiment synchronous stimulation participant hand held view artificial hand view induces sense ownership artificial hand participants rubber hand called rubber hand illusion induced established method participants asked report perceptual effects acupuncture delivered rubber hand participants naïve acupuncture frequency key perceptual descriptive terms compared database terms reported illusion experiment conditioning session tens delivered real hand participants randomly allocated real sham tens delivered rubber hand rubber hand illusion perceptual effects reported primary outcome measure pressure pain threshold ppt actual hand real sham tens rubber hand analysis experiment frequency acupuncture specific terms compared existing data fischer exact test experiment time condition anova compared ppt real sham tens results experiment twelve participants reported perceptual effects characteristic deqi acupuncture rubber hand effects seldom reported association illusion fischer chronic pain+controversy+acupuncture+pain problems+debunkery+mind+energy work
4 article George et al Brief psychosocial education, not core stabilization, reduced incidence of low back pain BMC Med Despite good general fitness, soldiers get back pain: do they get less if they train their “core” muscles more in basic training? They should! As the authors note, “Core stabilization has been advocated as preventative.” However, core training “offered no such benefit when compared to traditional lumbar exercise in this trial” — none at all. Although the results might be better with civilians, a good prevention method for us shouldn’t fail completely with soldiers. And although a different, more perfect training program might have worked, even a suboptimal one should have worked at least a little. The null result is therefore significant. Headlines about the study have focussed on the fact that soldiers who got a little extra back pain education reported less back pain over the next two years. (They measured the number of medical follow-ups.) However, it was a minor effect (17% relative risk reduction), and might be due to a fairly obvious (and acknowledged) limitation of the study — the education was “designed to reduce…threat and fear” and may have persuaded soldiers to seek less medical care. Of course, that is a win-win situation, good news either way, whether it was actually preventing back pain, or merely reassuring people and reducing the load on the health care system. 2011 background effective strategies primary prevention pain lbp remain elusive large scale clinical trials investigating exercise education approaches purpose trial determine core stabilization combination psychosocial education prevented incidence pain comparison traditional lumbar exercise methods prevention pain military study cluster randomized clinical study intervention arms year follow participants recruited military training setting soldiers consecutive companies considered eligibility ineligible eligible refused participation soldiers enrolled previous history lbp average age years sd males companies randomly assigned receive traditional lumbar exercise traditional lumbar exercise psychosocial education core stabilization exercise core stabilization psychosocial education psychosocial education session occurred session exercise programs daily minutes weeks primary outcome trial incidence pain resulting seeking health care results adverse events reported evaluable patient analysis data differences incidence resulting seeking health care receiving traditional exercise core stabilization exercise programs psychosocial education prevented pain episodes assigned exercise approach resulting ci decrease years numbers needed treat nnt ci conclusions core stabilization advocated preventative offered benefit compared traditional lumbar exercise trial psychosocial education program reduced fear threat pain decreased incidence pain resulting seeking health care trial conducted military setting future studies determine findings translated civilian populations etiology+treatment+exercise+mind+biomechanics+back pain+pro+self-treatment+pain problems+spine
4 book Evans et al Testing treatments Pinter & Martin This excellent book is currently available for free from It’s a superb exploration why research matters, and how it’s done. 2011 treatment+scientific medicine
3 article Ahn et al Variability of neural activation during walking in humans Biol Lett Why does calf muscle size in humans vary so much? (It really does.) The bulkiness of the calf is an amplified sign of what kind of heel bone you have. Specifically, Ahn et al. showed that calf size is probably driven by how far the heel bone projects backwards. They studied ten people of similar overall height and weight, lower limb length, and foot length and found that they were divided evenly: half were short-heeled with big-calves, and half had longer calcaneuses and more slender calves. They also looked at the neurology of the muscle recruitment. Folks with short heels and big calves were also using their medial gastrocnemius more than the lateral. So not only were their calves big, but they were pulling harder with the inside half of their gastrocs. By contrast, long-heeled humans appear to have more evenly distributed calf contractions. 2011 people shapes sizes calf muscle size humans varies considerably shapes calf muscles inherent difference neural signals muscles walking sedentary adults variability neural control calf muscles examined muscle size walking kinematics limb morphometrics subjects walked activating medial gastrocnemius mg muscles strongly lateral gastrocnemius lg muscles walking speeds mg biased subjects walked activating mg lg muscles equally unbiased walked mg biased recruitment pattern thicker mg muscles shorter heel lengths mg muscle moment arms unbiased walkers similar height weight limb length foot length exhibited similar walking kinematics plastic skeletal system drive calf muscle size motor recruitment patterns walking humans biology+barefoot+anatomy+biomechanics+running+foot+leg+limbs+pain problems+exercise+self-treatment+treatment+etiology+pro
4 article Chaléat-Valayer et al Sagittal spino-pelvic alignment in chronic low back pain European Spine Journal 2011 introduction differences sagittal spino pelvic alignment adults chronic pain lbp normal population poorly understood unknown patterns sagittal spino pelvic alignment prevalent chronic lbp current study helps understand relationship sagittal alignment pain materials methods compare sagittal spino pelvic alignment patients chronic lbp cohort asymptomatic adults sagittal spino pelvic alignment evaluated prospective cohorts patients chronic lbp normal subjects cohorts compared respect sacral slope ss pelvic tilt pt pelvic incidence pi lumbar lordosis ll lumbar tilt lt lordotic levels thoracic kyphosis tk thoracic tilt tt kyphotic levels lumbosacral joint angle lsa correlations parameters assessed results sagittal spino pelvic alignment significantly chronic lbp respect ss pi lt lordotic levels tk tt lsa pt ll kyphotic levels correlations parameters similar cohorts compared normal adults greater proportion patients lbp presented ss ll small pi greater proportion normal subjects presented normal high ss normal high pi conclusion sagittal spino pelvic alignment patients chronic lbp controls greater proportion chronic lbp patients ss ll small pi suggesting relationship specific pattern presence chronic lbp etiology+back pain+biomechanics+pro+pain problems+spine
3 article Singer et al Treatment of refractory anterior knee pain using botulinum toxin type A (Dysport) injection to the distal vastus lateralis muscle British Journal of Sports Medicine This was a RCT to see if the injection of botulinum toxin Type A (BoNT-A)m, plus exercise, would help those suffering from chronic anterior knee pain. 24 individuals were involved; 14 got the “real thing” and 10 received the placebo. “BoNT-A injection produced a greater reduction in pain and disability than placebo injection in carefully selected patients with chronic AKP related to quadriceps muscle imbalance.” 2011 objectives randomised controlled crossover trial examined efficacy botulinum toxin type bont injection exercise programme remediate chronic anterior knee pain akp quadriceps muscle imbalance methods individuals refractory akp received bont dysport volume saline injection vastus lateralis vl muscle performed home exercises focusing training vastus medialis vm muscle subjects offered open label injection weeks knee related disability anterior knee pain scale akps activity induced pain cm visual analogue scale weeks primary outcomes peak isometric extensor force recorded normalised vl vm ratios derived simultaneous surface electromyography selfreported pain disability measures collected time points ± months results subjects received bont placebo injection improvement weeks significantly greater bont compared placebo injected subjects akps patellar pain+knee+running+treatment+injections+arthritis+muscle pain+biomechanics+aging+pain problems+leg+limbs+overuse injury+injury+exercise+self-treatment+medicine+muscle+etiology+pro
4 article Pereles et al A Large, Randomized, Prospective Study of the Impact of a Pre-Run Stretch on the Risk of Injury in Teenage and Older Runners As the title promises, this is an unusually large study of pre-run stretching, with more than 2700 participants, and decisively finding “no statistically significant difference in injury risk between the pre-run stretching and non-stretching groups.” Injury rates for all kinds of injuries were the same, with or without stretching. It’s almost as though stretching made no difference at all. But make up your own mind! 2011 self-treatment+running+stretch+controversy+treatment+exercise+muscle+debunkery
3 article Katalinic et al Effectiveness of stretch for the treatment and prevention of contractures in people with neurological conditions Physical Therapy Twenty-five tests of stretching for complications of neurological conditions showed that it does not clinically improve “joint mobility, pain, spasticity, or activity limitation.” Typically useful treatments and therapies are more clearly valuable to those who need them more (i.e. the effect of acetominophen is more obvious to someone with a headache than someone without). If stretching has any real benefit for these problems, it should be most obvious in the cases where it is most needed. This evidence shows that stretch does not meaningfully help even in cases where the need is great, for problems that seem like natural targets for stretch. 2011 background contractures disabling complication neurological conditions commonly managed stretch objective purpose systematic review determine effectiveness stretch treatment prevention contractures review part detailed cochrane review results studies including patients neurological conditions reported data sources electronic searches conducted june computerized databases cochrane central register controlled trials database abstracts reviews effects health technology assessment database hta medline cumulative index nursing allied health literature cinahl embase sci expanded physiotherapy evidence database pedro study eligibility criteria review included randomized controlled trials controlled clinical trials stretch applied purposes treating preventing contractures people neurological conditions study appraisal synthesis methods reviewers independently selected studies extracted data assessed risk bias primary outcome measures joint mobility range motion quality life secondary outcome measures pain spasticity activity limitation participation restriction meta analyses conducted random effects models results twenty studies met inclusion criteria studies provide moderate quality evidence stretch small effect joint mobility difference ° confidence interval ci ° ° high quality evidence stretch short term long term effects joint mobility difference ° ° ci ° ° ° ° effect stretch pain spasticity activity limitation limitations studies retrieved investigated effects stretch longer months conclusion regular stretch produce clinically important joint mobility pain spasticity activity limitation people neurological conditions treatment+stretch+exercise+self-treatment+muscle
2 webpage Hall Pursued by Protandim Proselytizers Dr. Harriet Hall once again summarizes the (lack) of evidence that Protandim helps people. There’s still only one human trial of this stuff … and still none that have anything to do with pain.
Note that there have been no human clinical studies since the one in 2006. The newer studies are just more animal and laboratory studies, so they do nothing to change my previous conclusion. If I were a mouse being artificially induced to develop skin cancer in a lab study, I might seriously consider taking Protandim. But so far, the only study in humans measured increased antioxidant levels by a blood test but did not even attempt to assess whether those increases corresponded to any measurable clinical benefit, for cancer or for anything else.
Dr. Hall also shares some of her contents of her mail bag about this stuff. It’s illuminating, and good for a chuckle. Note that Dr. Hall also has a concurrent article about antioxidants in the print issue (Volume 16 Number 4) of Skeptic Magazine, “Complexities of Antioxidants.”
2011 nutrition+random+self-treatment+treatment
4 article Marshall et al A randomized controlled trial for the effect of passive stretching on measures of hamstring extensibility, passive stiffness, strength, and stretch tolerance Journal of Science & Medicine in Sport A nicely done experiment showing that regular hamstring stretching substantially increased range of motion in normal university kids. Specifically, after “a 4-week stretching program consisting of 4 hamstring and hip stretches performed 5 times per week,” their range increased about 16˚ or 20%. That is, when stretched with the same force (torque) applied, to the same level of discomfort, they could go 20% farther. The take-home message is that stretching can definitely increase range of motion — for whatever that’s worth. The authors followed this data into an overinterpretation about how range increased, perhaps trying to score points for Team Plasticity — that is, for the idea that the body adapts physically to stretch, rather than neurologically. Because range increased, but pain at the end of the range did not, they unwisely concluded that, although they “cannot completely rule out volitional stretch tolerance as a possible explanation for changes in extensibility, it does seem that hamstring pain elicited during a passive stretch has little involvement in explaining training related improvements.” But an increase in range with no change in pain does constitute an increase in tolerance! Although it wasn’t measured, it’s safe to assume the subjects’ pain would have been less if stretched only to the end of their original range. But the study is actually agnostic about mechanism. The authors place their bet on tissue plasticity, while I put mine on tolerance, but this experiment cannot actually settle the bet — it demonstrated only greater range and reduced stiff, and not whether it was due to neural or structural adaptations. 2011 measure hamstring extensibility stiffness stretch tolerance strength week passive stretching program randomized controlled trial twenty healthy participants randomly assigned week stretching program consisting hamstring hip stretches performed times week stretching control group hamstring extensibility stiffness measured training instrumented straight leg raise test islr stretch tolerance measured pain intensity visual analog scale vas elicited maximal stretch hamstring strength measured isokinetic dynamometry ° hamstring extensibility increased intervention group weeks training treatment+self-treatment+stretch+biomechanics+etiology+back pain+exercise+muscle+pro+pain problems+spine
4 article Nguyen et al Long-term Outcomes of Lumbar Fusion Among Workers' Compensation Subjects Spine (Phila Pa 1976) This study provides good evidence of extremely poor results from surgery (spinal fusion). Patients suffered “significant increases” in nearly every possible negative outcome in the two years after surgery — significantly increased disability, opiate use, prolonged work loss, prolonged work loss, and poor return-to-work status. 2011 study design historical cohort study objective determine objective outcomes return work rtw permanent disability postsurgical complications opiate utilization reoperation status chronic pain subjects lumbar fusion similarly rtw status permanent disability opiate utili zation measured nonsurgical controls summary background data historical cohort study workers compensation wc subjects lumbar arthrodesis randomly selected controls evaluate multiple objective outcomes previously published methods total lumbar fusion cases compared controls randomly selected pool wc subjects chronic pain diagnoses dates injury january december study ended january main outcomes reported rtw status years date injury controls years date surgery cases disability reoperations complications opioid usage deaths determined results years fusion surgery fusion cases rtw nonsur gical controls rtw years date injury reoperation rate surgical patients lumbar fusion subjects complications permanent disability rates cases nonoperative controls seventeen surgical patients controls died study lumbar fusion subjects daily opioid increased \ surgery \ cases continuing opioid surgery total number days work prolonged cases compared controls days final multi variate logistic regression analysis number days surgery odds ratio \ confidence interval ci legal representation ci daily morphine usage ci reoperation ci complications ci significant predictors rtw lumbar fusion patients conclusion lumbar fusion diagnoses disc degeneration disc herniation radiculopathy wc setting significant increase disability opiate prolonged work loss poor rtw status treatment+sciatica+back pain+surgery+biomechanics+etiology+harms+pain problems+spine+butt+hip+pro
3 article Huang et al Topical application of compound Ibuprofen suppresses pain by inhibiting sensory neuron hyperexcitability and neuroinflammation in a rat model of intervertebral foramen inflammation Journal of Pain It may seem surprising, but these scientists found evidence that an anti-inflammatory cream on the skin (such as Voltaren®) might be able to treat pain coming from deep inside the spine — right in the centre — which means it could be a “convenient and safe clinical intervention” for a few types of back pain. So convenient and safe, in fact, that it lands in the clinical “why not?” sweet spot. An anti-inflammatory gel will probably fail with many kinds of back pain, but there’s also virtually no down-side. Fascinatingly, these results also demonstrate the importance of some principles of pain science, namely that interactions with the skin can be surprisingly profound for the body. And from that one can also say some nice, reasonable things about why massage therapy might be effective. There’s really quite a lot of scientific innuendo packed into this little study. 2011 lack evidence topical application anti inflammatory reagent reduce pain due intervertebral foramen ivf inflammation ivfi investigated analgesic effects underlying mechanisms topical application compound ibuprofen cream cic surface skin covering inflamed ivf rat model repetitive cic treatment ∼ treatment daily consecutive days significantly reduces severity duration ivfi induced thermal hyperalgesia mechanical allodynia \ \ electrophysiological studies western blot analysis demonstrated cic treatment significantly inhibited hyperexcitability inflamed dorsal root ganglion drg neurons upregulation nav nav protein pathological manifestations inflamed drg markedly improved cic treatment inflamed drgs phosphorylation expression transcription factor nf κ pro inflammatory enzyme cyclooxygenase significantly increased cytokine il β level increased ivfi induced upregulation molecules significantly inhibited cic treatment study evidence anti inflammatory reagent topically suppress pain due ivfi drg inflammation inhibition sensory neuron hyperexcitability immune inflammatory responses perspective study suggests convenient safe clinical intervention treating pain due intervertebral foramen inflammation similar syndromes treatment+back pain+chronic pain+medications+neck+etiology+pain problems+spine+self-treatment+head/neck+pro
article Berry et al Epicondylectomy versus denervation for lateral humeral epicondylitis Hand (N Y) 2011 background traditional management lateral humeral epicondylitis tennis elbow relies antiinflammatory medication rehabilitation steroid injection counterforce splinting finally surgery common extensor origin diversity surgical approaches lateral humeral epicondylitis lhe suggests ideal technique determined denervation lateral humeral epicondyle concept interrupting neural pathway transmits pain message epicondylectomy accomplish relief lhe denervating epicondyle methods posterior branch posterior cutaneous nerve forearm innervates lateral humeral epicondyle patients treated surgically refractory lhe retrospectively evaluated group consisted patients treated epicondylectomy group ii consisted patients treated lateral epicondylectomy neurectomy group iii consisted patients treated lateral denervation results denervation gave statistically significantly greater improvement pain relief   tendinosis+denervation+elbow+pain problems+overuse injury+injury+neurology+treatment+arm+limbs
article Storey et al Wrist denervation in isolation Hand Surg 2011 surgical wrist denervation involves division anterior posterior interosseous nerves articular branches superficial radial nerve outcome study patients individually assessed deemed suitable denervation surgery due appreciable symptom resolution local anesthetic wrist block months denervation surgery median activity pain scores decreased initial assessment levels quarters patients reported continued improvement activity pain thirds patients satisfaction vas greater postoperative resting pain greater reduction postoperative activity pain important predictors patient satisfaction patients represented department revision wrist surgery years follow procedure ameliorating symptoms patients conventionally required partial total wrist fusions greater residual functional limitation hand & wrist+denervation+arm+limbs+neurology+treatment
5 article Zusman The Modernisation of Manipulative Therapy International Journal of Clinical Medicine An articulate endictment of the obsolete and persistent “structuralist” paradigm in physical therapy. 2011 research physiotherapists comprehensive training basic sciences manipulative therapy dominated clinical setting original obsolete structure based bio medical model inexplicable light evidence underlying philosophy fundamental requirements clinical process structural mechanical model basis shown flawed irrelevant apparent inability profession fully abandon outmoded concepts embrace acknowledged science based practice biopsychosocial model potentially undesirable consequences patients therapists engaged management chronic musculoskeletal pain disability biomechanics+back pain+etiology+pro+pain problems+spine
4 article Ernst et al Acupuncture Pain A dozen of the best scientific studies of acupuncture treatments for pain were carefully analyzed in this review. The acupuncture treatments were for conditions like osteoarthritis, headache and migraine, low back pain, fibromyalgia, and more. The authors found a statistically significant but “small difference between acupuncture and placebo acupuncture.” They concluded that “the apparent analgesic effect of acupuncture seems to be below a clinically relevant pain improvement.” They also note that “serious adverse effects continue to be reported.” Pain invited a well-known voice of reason in medicine, Dr. Harriet Hall, to write an editorial about this paper. Dr. Hall’s editorial is an easy-reading summary for both patients and professionals. It is reproduced in full on see Acupuncture Revisited. 2011 acupuncture commonly pain control doubts effectiveness safety remain review aimed critically evaluating systematic reviews acupuncture treatment pain summarizing reports adverse effects published literature searches carried databases language restrictions systematic reviews considered evaluation effectiveness case series case reports summarizing adverse events data extracted predefined criteria fifty systematic reviews met inclusion criteria excellent methodological quality numerous contradictions caveats emerged unanimously positive conclusions high quality systematic review existed neck pain cases severe adverse effects including fatalities included pneumothorax infections frequently reported adverse effects conclusion numerous systematic reviews generated convincing evidence acupuncture effective reducing pain adverse effects continue reported numerous reviews produced convincing evidence acupuncture effective reducing pain adverse events including deaths continue reported treatment+acupuncture+controversy+mind+debunkery+energy work
2 article Migliorini et al The hamstring syndrome in endurance athletes British Journal of Sports Medicine 2011 hamstring syndrome gluteal sciatic pain posttraumatic congenital hard fibrotic bands irritate sciatic nerve insertion site hamstring muscles ischial tuberosity traction mechanical compression impingement sciatic nerve occur anatomopathological situations origin hamstrings ischial tuberosity symptoms include local pain ischial tuberosity irradiating posterior thigh appears cyclic stress running physical exercise typically sitting hamstring syndrome diagnosis basically typical symptoms finding differential diagnosis required piriformis syndrome ischiogluteal bursitis posterior femoral muscle compartment pain scars hamstring muscles originated symptoms mri examination detect abnormality ischial tuberosity area majority athletes hamstring syndrome respond positively conservative therapy refractory cases hamstring syndrome treated surgically dividing compressing band performing sciatic neurolysis paper describes results surgical treatment years personal series endurance athletes middle long distance running marathon triathlon cycling refractory operative treatments period years bilateral operation time cases operation performed failed piriformis surgery cases practised miotomy hypertrofic quadratus femoris good results months surgery subjects returned practice competitive sports patient chronic lumbar problems final healing years chronic cases hamstring syndrome misunderstood confused sciatica frequent occurrence sports etiology+sciatica+neurology+pro+back pain+pain problems+spine+butt+hip
3 article Hsieh et al Spinal cord mechanism involving the remote effects of dry needling on the irritability of myofascial trigger spots in rabbit skeletal muscle Archives of Physical Medicine & Rehabilitation According to Dommerholt et al.: “They measured the concentrations of a variety of biochemicals, including b- endorphine, substance P, tumor necrosis factor-a, cyclo- oxygenase-2, hypoxia-inducible factor 1-alpha, inducible nitric oxide synthase, and vascular endothelial growth factor and noted that dry needling of TrPs can modulate these concentrations in a dosage dependent manner.” 2011 objective elucidate neural mechanisms underlying remote effects produced dry needling rabbit skeletal muscle myofascial trigger spots mtrss analyses endplate noise epn recordings design experimental animal controlled trial setting animal laboratory university animals male zealand rabbits body weight kg age wk intervention animals received intervention neural interruption group transection tibial nerve group ii transection l l spinal cord group iii transection t t spinal cord group iv group divided subgroups animals received ipsilateral dry needling contralateral dry needling ipsilateral sham needling contralateral sham needling gastrocnemius mtrss main outcome measures epn amplitudes biceps femoris bf mtrss results bf mtrs epn amplitudes significantly increased muscle pain+muscle+pain problems
3 webpage Ingraham About Science-Based Medicine I am proudly the author of the about page for I can earnestly take credit for the carefully crafted wording of this summary, but I also took several key concepts straight out of articles written by Drs. Novella, Atwood, and Gorski. 2011 personal+scientific medicine
3 article Bray et al Disrupted working body schema of the trunk in people with back pain British Journal of Sports Medicine If someone is suffering from low back pain, is it possible that they are less accurate in making left/right trunk rotation judgements? Apparently so. The researchers concluded: “Chronic back pain is associated with disruption of the working body schema [mental picture] of the trunk. This might be an important contributor to motor control abnormalities seen in this population.” But it’s very important to note that the arrow of causation could swing back and forth like a compass in an MRI machine. Is poor coordination causing low back pain? Or is low back causing poor coordination? Or do they just happen to go well together, like peanut butter and chocolate? 2011 background test working body schema trunk disrupted people pain motor imagery task decides pictured model trunk rotated left authors hypothesised chronic pain reduced accuracy left trunk rotation judgements methods patients pain controls completed tasks involving trials images left hand judgement task control task left trunk rotation judgement task task × group bilateral pain unilateral pain control analyses variance undertaken response time accuracy results response time similar participants tasks ns accuracy patients bilateral pain mistakes left trunk rotation task patients unilateral pain turn mistakes task controls body part × group interaction etiology+sciatica+back pain+mind+exercise+pro+pain problems+spine+butt+hip+self-treatment+treatment
3 article Blanchette et al Augmented soft tissue mobilization vs natural history in the treatment of lateral epicondylitis Journal of Manipulative & Physiological Therapeutics A small clinical trial comparing treatment of tennis elbow with augmented soft tissue mobilization (tool massage) to “advice on the natural evolution of lateral epicondylitis, computer ergonomics, and stretching exercise.” Both helped a bit, and tools were no better. 2011 objective purpose study evaluate effect augmented soft tissue mobilization astm treatment lateral epicondylitis methods randomized clinical study assessed subjects men women lateral epicondylitis divided randomly groups experimental group received astm week weeks subjects control group received advice natural evolution lateral epicondylitis computer ergonomics stretching exercises patient rated outcome assessed baseline weeks months visual analog scale patient rated tennis elbow evaluation function assessed pain free grip strength baseline weeks results groups showed improvements pain free grip strength visual analog scale patient rated tennis elbow evaluation sample size larger future randomized clinical trial participants conclusion larger study investigating hypothesis warranted detect difference effects treatments strategies study design feasible minor improvements minimize potential bias massage+devices+manual therapy+treatment
4 article Pattyn et al Vastus Medialis Obliquus Atrophy American Journal of Sports Medicine It is an article of faith for many professionals that the inner portion of the quadriceps muscle group (VMO) is weak and atrophied in patients with patellofemoral pain, “despite very little objective evidence” according to this paper. For the first time, researchers used MRI to measure the size of the vastus medialis obliquus muscle in patients with and without patellofemoral pain syndrome, and found that it was 9% smaller in PFPS patients. There was a 4% chance that the results are coincidental — a statistically significant result, but only just — and of course it is “not clear whether this atrophy is a result or a cause of PFPS.” However, that wise disclaimer is contradicted by the following statement that VMO is a “contributing factor in PFPS” — a troubling inconsistency in the paper’s abstract. 2011 background quadriceps atrophy atrophy vastus medialis obliquus vmo muscle frequently related patellofemoral pain syndrome pfps objective evidence hypothesis patients pfps exhibit atrophy vmo comparison healthy controls study design case control study level evidence methods forty patients pfps healthy control persons similar age gender body mass index activity index distributions underwent magnetic resonance imaging mri quadriceps muscle size determined calculating cross sectional area total quadriceps components results cross sectional area csa vmo significantly smaller pfps group control group ± cm ± cm tendency noted smaller total quadriceps csa pfps patients midthigh level ± cm ± cm conclusion study examine vmo size pfps patients mri patients patellofemoral problems exhibited atrophy vmo clear atrophy result pfps results study show atrophy vmo contributing factor pfps longitudinal prospective studies needed establish effect relation vmo atrophy pfps etiology+biomechanics+patellar pain+running+anatomy+pro+arthritis+aging+pain problems+knee+leg+limbs+overuse injury+injury+exercise+self-treatment+treatment
4 article Warensjö et al Dietary calcium intake and risk of fracture and osteoporosis British Medical Journal Does long-term supplementation with calcium reduce the risk of fractures? The answer, based on this study, appears to be no: "Gradual increases in dietary calcium intake above the first quintile in our female population were not associated with further reductions in fracture risk or osteoporosis." My interest in this evidence is mainly because it’s a good example of how supplements continue to turn out to be less useful than we all hoped in the 20th Century. 2011 objective investigate associations long term dietary intake calcium risk fracture type hip fractures osteoporosis design longitudinal prospective cohort study based swedish mammography cohort including subcohort swedish mammography cohort clinical setting population based cohort sweden established participants   women born years women participated subcohort main outcome measures primary outcome measures incident fractures type hip fractures identified registry data secondary outcome osteoporosis diagnosed dual energy ray absorptiometry subcohort diet assessed repeated food frequency questionnaires results   women experienced fracture type hip fracture women subcohort measured osteoporotic risk patterns dietary calcium linear crude rate fracture type person years risk lowest quintile calcium intake person years risk quintile multivariable adjusted hazard ratio confidence interval hazard ratio hip fracture odds ratio osteoporosis vitamin intake rate fracture calcium quintile pronounced highest quintile calcium intake reduce risk fractures type osteoporosis higher rate hip fracture hazard ratio conclusion gradual increases dietary calcium intake quintile female population reductions fracture risk osteoporosis nutrition+vitamin D+random+self-treatment+treatment
3 article Luomajoki et al Tactile acuity and lumbopelvic motor control in patients with back pain and healthy controls British Journal of Sports Medicine This study showed that patients with back pain have decreased tactile acuity and coordination — that is, their sense of touch goes on the blink, and their movement precision is a bit wonky. Touch accuracy is determined by the minimum distance apart that two points of contact can be distinguished: 10mm for a healthy person, but 13mm for those with low back pain. The worse the touch accuracy in a patient, the worse the coordination as well. The authors speculated that “training tactile acuity may aid recovery and assist in achieving normal motor performance after back injury.” That’s quite a leap, but it’s not an unreasonable question to ask (and it could be an example of the potential value of touch therapy for assisting with normalizing a patient’s sense of self). 2011 background voluntary lumbopelvic control compromised patients pain loss proprioceptive acuity contributor decreased control reasons decreased proprioceptive acuity proposed integrity cortical body maps overlooked investigated tactile acuity clear clinical signature primary sensory cortex organisation relates lumbopelvic control people pain methods forty patients pain age sex matched healthy controls participated cross sectional study tactile acuity assessed point discrimination tpd threshold vertical horizontal directions voluntary motor control assessed established battery clinical tests results patients performed worse voluntary lumbopelvic tasks healthy controls etiology+back pain+mind+exercise+massage+pro+pain problems+spine+self-treatment+treatment+manual therapy
2 article Solheim et al Extensor tendon release in tennis elbow Knee Surgery, Sports Traumatology, Arthroscopy An uncontrolled surgical study of surgery for tennis elbow, concluding that “open lateral extensor release performed as outpatient surgery results in improved clinical outcome at both short- and medium-term follow-ups with few complications.” I cite this paper mainly for contrast with Kroslak. 2011 purpose objectives study evaluate results outpatient treatment recalcitrant lateral epicondylitis release common extensor origin hohmann determine prognostic factors methods tennis elbows patients characteristic history activity related pain lateral epicondyle interfering activities daily living refractory conservative care months confirmatory physical examination included clinical outcome evaluated quickdash score system data collected operation medians months range months short term years range years medium term postoperatively results quickdash improved short medium term follow ups change significantly follow ups final follow quickdash improved elbows rated excellent good quickdash treatment+surgery+tendinosis+pain problems+overuse injury+injury
3 book Dommerholt et al Myofascial trigger points Jones and Bartlett 2011 myofascial trigger points pathophysiology evidence informed diagnosis management emphasis etiology trigger points critical overview current concepts contributing authors respected myofascial pain research practice experts authors address etiology trigger points epidemiology myofascial pain clinical management patients specific treatment issues role trigger points pain syndromes book accessible introduction myofascial trigger points physicians therapists chiropractors osteopaths acupuncturists massage therapists harms+muscle pain+pain problems+muscle
3 article Rios et al Bone marrow edema patterns in the ankle and hindfoot American Journal of Roentgenology 2011 objective disorders produce similar overlapping patterns bone marrow edema ankle bone marrow edema present hindfoot bones simultaneously single bone purpose pictorial essay provide guidelines based clinical history specific mri patterns locations accurately identify ankle bone marrow edema focus bone marrow edema general disease categories involving multiple bones reactive processes trauma neuroarthropathy arthritides discussion bone marrow edema individual bones ankle hindfoot including tibia fibula talus calcaneus follow helpful hints arriving correct diagnosis section conclusion review article radiologists knowledge clinical history specific mri patterns locations accurately distinguish bone marrow edema ankle hindfoot diagnosis+etiology+plantar fasciitis+patellar pain+pro+foot+leg+limbs+pain problems+overuse injury+injury+tendinosis+arthritis+aging+knee+running+exercise+self-treatment+treatment
3 article Maurer et al Spine abnormalities depicted by magnetic resonance imaging in adolescent rowers American Journal of Sports Medicine Rowers often experience abnormalities of the lumbar spine as a result of their sport, but those abnormalities are not strongly associated with symptoms. 2011 background lesions spine athletes detected incidentally important symptoms athletes discontinue physical activities understand significance lesions imaging studies conducted asymptomatic athletes sports aiming detect potentially deleterious disabling abnormalities purpose compare magnetic resonance imaging mri lumbar spine findings group asymptomatic adolescent rowers control group adolescents matched age sex practice regular physical activity study design cohort study prevalence level evidence methods study evaluated asymptomatic adolescent boys distributed groups rowers control subjects examinations performed open field mri unit evaluated experienced radiologists blinded study groups mri scan analyzed presence disc degeneration desiccation herniated bulging disc pars interarticularis stress reaction spondylolysis student test fisher exact test statistical analyses results rowers abnormality detected mri lumbar spine participants control group mri abnormality disc pars abnormalities group elite rowers control group disc pars abnormalities scans comparison groups showed statistically significant differences stress reaction pars articularis conclusion disc disease pars interarticularis stress reaction prevalent abnormalities lumbar spine high performance rowers diagnosis+sciatica+etiology+back pain+biomechanics+pain problems+spine+butt+hip+pro
3 article Chou et al Diagnostic Imaging for Low Back Pain Annals of Internal Medicine From the abstract: “…evidence indicates that routine imaging is not associated with clinically meaningful benefits but can lead to harms. … In this area, more testing does not equate to better care.” Emphasis emphatically mine. 2011 diagnostic imaging patients pain severe progressive neurologic deficits signs symptoms suggest specific underlying condition patients evidence routine imaging clinically meaningful benefits lead harms addressing inefficiencies diagnostic testing minimize potential harms patients large effect resources reducing direct downstream costs area testing equate care implementing selective approach imaging suggested american college physicians american pain society guideline pain provide care patients improve outcomes reduce costs diagnosis+sciatica+back pain+biomechanics+harms+pain problems+spine+butt+hip+etiology+pro
4 article Annaswamy et al Emerging concepts in the treatment of myofascial pain PM & R: The Journal of Injury, Function, and Rehabilitation 2011 significant developments interventions treatments management myofascial pain syndrome occurred years emerging concepts changed approach clinicians manage pain disorders wide variations practice patterns prevail clear consensus exists interventions addition awareness evidence basis limited review examines advances treatment myofascial pain syndromes specifically evidence basis emerging interventions reviewed recommendations routine clinical practice rationale purpose review provide clinician understanding emerging concepts interventions myofascial pain syndromes muscle pain+muscle+pain problems
5 article Lake et al Effect of therapeutic modalities on patients with patellofemoral pain syndrome Sports Health A review of classic treatments for patellofemoral pain syndrome (PFPS): specifically, the modalities studied were ultrasound, cold therapy, iontophoresis, phonophoresis, neuromuscular electrical stimulation, electromyographic feedback, electrical stimulation and laser therapy. None of the modalities had “sound scientific justification… when used alone.” 2011 context patellofemoral pain syndrome pfps common orthopaedic condition operative nonoperative treatments therapeutic modalities recommended treatment patients pfps including cold ultrasound phonophoresis iontophoresis neuromuscular electrical stimulation electrical stimulation pain control electromyographic biofeedback laser objective determine effectiveness therapeutic modalities treatment patients pfps data sources august medline searched databases pubmed cinahl web science citation index science direct proquest nursing amp allied health journals@ovid study selection selected studies randomized controlled trials therapeutic modality treat patients pfps review included articles outcome measures relevant pfps patient knee extension flexion strength isokinetic isometric patellofemoral pain assessment activities daily life functional tests squats kujala patellofemoral score electromyographic recording knee flexors extensors quadriceps femoris cross sectional areas data extraction authors conducted independent quality appraisals studies pedro scale system designed analysis studies interventions patellofemoral pain results twelve studies met criteria effects cold ultrasound ice iontophoresis phonophoresis neuromuscular electrical stimulation electromyographic biofeedback electrical stimulation control pain laser discussion studies moderate quality reported therapeutic modalities combined treatments benefit pain management symptoms consistent evidence beneficial effect therapeutic modality studies consistently provide added benefit conventional physical therapy treatment pfps conclusions therapeutic modalities reviewed sound scientific justification treatment pfps patellar pain+treatment+devices+arthritis+aging+pain problems+knee+leg+limbs+overuse injury+injury+running+exercise+self-treatment
4 inbook Sands Flexibility John Wiley and Sons 2011 flexible athletes necessarily successful stretch+exercise+self-treatment+treatment+muscle
3 article Garber et al American College of Sports Medicine position stand. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults Medicine & Science in Sports & Exercise We all should be doing more exercise than most of us will ever do, according to the American College of Sports Medicine. In these official exercise dosing recommendations, they suggest: about a 30 minutes of daily walking, plus 20 minutes of running every other day, plus about an hour at the gym a couple times per week, and about an hour of stretching each week. These recommendations are out of touch with economic reality for huge numbers of people who can barely get their kids fed properly. But it’s nice to have clear goals to aim for, I suppose — even if they are out of reach. 2011 purpose position stand provide guidance professionals counsel prescribe individualized exercise apparently healthy adults ages recommendations apply adults chronic diseases disabilities appropriately evaluated advised health professional document supersedes american college sports medicine acsm position stand recommended quantity quality exercise developing maintaining cardiorespiratory muscular fitness flexibility healthy adults scientific evidence demonstrating beneficial effects exercise indisputable benefits exercise outweigh risks adults program regular exercise includes cardiorespiratory resistance flexibility neuromotor exercise training activities daily living improve maintain physical fitness health essential adults acsm recommends adults engage moderate intensity cardiorespiratory exercise training min wk total min wk vigorous intensity cardiorespiratory exercise training min wk min wk combination moderate vigorous intensity exercise achieve total energy expenditure met min wk wk adults perform resistance exercises major muscle groups neuromotor exercise involving balance agility coordination crucial maintaining joint range movement completing series flexibility exercises major muscle tendon groups total exercise wk recommended exercise program modified individual habitual physical activity physical function health status exercise responses stated goals adults unable unwilling meet exercise targets outlined benefit engaging amounts exercise recommended addition exercising regularly health benefits concurrently reducing total time engaged sedentary pursuits interspersing frequent short bouts standing physical activity periods sedentary activity physically active adults behaviorally based exercise interventions behavior change strategies supervision experienced fitness instructor exercise pleasant enjoyable improve adoption adherence prescribed exercise programs educating adults screening signs symptoms chd gradual progression exercise intensity volume reduce risks exercise consultations medical professional diagnostic exercise testing chd clinically recommended universal screening enhance safety exercise exercise+sedentariness+self-treatment+treatment
4 article Coppack et al The effects of exercise for the prevention of overuse anterior knee pain American Journal of Sports Medicine The authors of this study thought perhaps preventive exercises will reduce the chances of developing anterior knee pain (patellofemoral pain included). Young army recruits undergoing training were given either a specific warm up designed to prevent knee injuries or a control program. There were 1502 particpants in the study! The knee injury prevention program consisted of exercises for the legs, particularly the hips (including isometric hip abduction, forward lunges, single leg squats, step downs, and stretches of the quads, IT band, hamstrings and calves). Those in the control group were given a typical warm up used by the military already (slow running, general upper and lower body stretching, abdominal curls and pushups). Participants performed their warm-ups for 14 weeks, and the amount of knee injuries were measured at the end of the study. The group performing the knee prevention program had a 75% reduction in anterior knee pain risk compared to the controls! Impressive results from a well designed study. 2011 background anterior knee pain akp common activity related injury knee authors investigated effect exercise intervention incidence akp uk army recruits undergoing week physically arduous training program hypothesis modifying military training include targeted preventative exercises reduce incidence akp young recruit population study design randomized controlled trial level evidence methods single blind cluster randomized controlled trial performed male female training groups median age years interquartile range undergoing phase army recruit training group randomly assigned intervention control protocol intervention consisted strengthening stretching exercises completed supervised physical training lessons week control group existing training syllabus warm exercises primary outcome diagnosis akp week training program results forty participants confidence interval ci diagnosed akp ci cases akp control group intervention group reduction akp risk intervention group unadjusted hazard ratio ci participants intervention group discharged military medical reasons compared control group conclusion simple set limb stretching strengthening exercises resulted substantial safe reduction incidence akp young military population undertaking physical conditioning program exercises beneficial preventing common injury nonmilitary participants recreational physical activity patellar pain+etiology+biomechanics+exercise+treatment+arthritis+aging+pain problems+knee+leg+limbs+overuse injury+injury+running+self-treatment+pro
article Andia et al Platelet rich plasma therapies for sports muscle injuries Expert Opin Biol Ther 2011 introduction present drugs hasten restoration muscle function injury platelet rich plasma prp therapies athletes promoting muscle regeneration areas covered systematic review assessing evidence base prp therapies management muscle injuries computerized literature search citation tracking hand searching original studies assessing effect prp therapies skeletal muscle cell biology skeletal muscle repair regeneration animals humans performed randomized trials studied merits prp injections muscle healing clinical studies prp therapies enhance muscle repair strain contusion laboratory data enhance diverse aspects myogenesis muscle injuries present complicated picture includes components muscle cells blood vessels connective tissue neural components expert opinion field relevant researched prp formulation displayed proven solid evidence stimulation healing recovery sports muscle injuries major issues including standardization formulations application procedures addressed inform clinical studies recommending practice guidelines injections+muscle+strain+medicine+treatment+injury+pain problems
3 article Sherman et al A Randomized Trial Comparing Yoga, Stretching, and a Self-care Book for Chronic Low Back Pain Archives of Internal Medicine This experiment compared the effects of yoga, a normal stretching class, and an educational booklet on chronic low back pain. The primary findings were that both yoga and stretching seemed to be modestly effective, but neither was better than the other. Back in 2005, the same authors got similar results comparing yoga to conventional therapeutic exercise. The research has been widely reported as “stretching and yoga work,” with a few writers emphasizing that yoga was no better. However, I haven’t seen anyone report that both stretching and yoga are equally damned here with faint praise, and quite possibly illusory praise: the effect size was modest, just 2.5 points on a scale of 11, and some or all that effect may well be attributable to bias an frustrebo (frustrated placebo) caused by a lack of blinding. Subjects deprived of either a lovely stretching or yoga experience may have reported a more negative experience. I analyze this study in greater detail in my advanced tutorial, Save Yourself from Low Back Pain! 2011 background chronic pain common problem lacking highly effective treatment options small trials suggest yoga benefits condition trial designed determine yoga effective conventional stretching exercises care book primary care patients chronic pain methods total adults chronic pain randomized weekly classes yoga patients conventional stretching exercises patients care book patients related functional status modified roland disability questionnaire point scale bothersomeness pain point numerical scale weeks primary outcomes outcomes assessed baseline weeks interviewers unaware treatment group results adjustment baseline values week outcomes yoga group superior care group difference function ci   treatment+self-treatment+back pain+stretch+pain problems+spine+exercise+muscle
3 article Gulick et al Effect of ischemic pressure using a Backnobber II device on discomfort associated with myofascial trigger points Journal of Bodywork and Movement Therapies This experiment has the simple elegance of a good science-fair project. Dr. Dawn Gulick of the Widener University Physical Therapy Department simply compared the sensitivity of trigger points both with and without a simple treatment of pressure — squishing them, that is. Dr. Gulick et al. tested a specific method of squishing: pressing a trigger point firmly and long enough to starve it of some oxygen (ischemic pressure), repeatedly, for several days. They measured trigger point sensitivity before and after treatment in 28 people with two trigger points in the upper back. Their conclusion: “There was a significant difference between the pre- and post-test sensitivities of the treated and non-treated trigger points … ischemic compression … was effective in reducing trigger point irritability.” Excellent! This is small-scale science, but the results are encouraging and certainly consistent with my professional experience. 2011 objective purpose study assess effectiveness ischemic pressure myofascial trigger point mtrp sensitivity design randomized controlled study researcher assessing mtrp sensitivity blinded intervention participants twenty people mtrps upper musculature intervention sensitivity mtrps upper assessed jtech algometer mtrps randomly selected treatment backnobber ii served control outcome measures pre post test pressure pain thresholds mtrps results significant difference pre post test sensitivities treated treated mtrps conclusions results study confirm protocol repetitions ischemic compression backnobber ii rendered day week effective reducing mtrp irritability muscle pain+muscle+pain problems
4 inbook Sands Flexibility John Wiley and Sons 2011 commonly accepted idea increased rom stretching prior activity prevents injuries challenged shakiest scientific foundations paucity data reasonable conclusions drawn stretch+exercise+self-treatment+treatment+muscle
4 inbook Sands Flexibility John Wiley and Sons 2011 beliefs flexibility optimal means stretching proceeded assumptions tested religious zeal perceived benefits stretching stretch+exercise+self-treatment+treatment+muscle
webpage Ingraham Do something! 2011 personal+exercise+self-treatment+treatment
article Ballyns et al Objective sonographic measures for characterizing myofascial trigger points associated with cervical pain J Ultrasound Med 2011 objectives purpose study determine physical properties vascular environment active myofascial trigger points acute spontaneous cervical pain asymptomatic latent trigger points palpably normal muscle differ terms trigger point area pulsatility index resistivity index measured sonoelastography doppler imaging methods sonoelastography performed external hz vibration upper trapezius muscles patients acute cervical pain palpable trigger point area reduced vibration amplitude measured estimate size stiff myofascial trigger points patients underwent triplex doppler imaging region analyze blood flow waveforms calculate pulsatility index blood flow vessels trigger points results sonoelastography active sites spontaneously painful palpable myofascial trigger points larger trigger points ± sd ± cm compared latent sites palpable trigger points painful palpation ± cm palpably normal sites ± cm analysis receiver operating characteristic curves showed area measurements robustly distinguish active latent normal sites areas curve active latent active normal latent normal doppler spectral waveform data showed vessels active sites significantly higher pulsatility index median compared normal sites median conclusions results presented study show myofascial trigger points classified area sonoelastography monitoring trigger point area pulsatility index evaluating natural history myofascial pain syndrome muscle pain+etiology+muscle+pain problems+pro
3 article Ernst et al An independent review of NCCAM-funded studies of chiropractic Clin Rheumatol Dr. Edzard Ernst is a highly qualified critic of sloppy researchers in alternative medicine. In this review of The National Center for Complementary and Alternative Medicine (NCCAM) studies of chiropractic therapy, he finds that “their quality was frequently questionable. Several randomized controlled trials failed to report adverse effects and the majority was not described in sufficient detail to allow replication.” But if NCCAM cannot produce the best quality studies of alternative medicine, who can? No organization has ever been better funded (or motivated) to validate alternative therapies. Ernst concludes: “It seems questionable whether such research is worthwhile.” 2011 promote independent critical evaluation randomised clinical trials rcts chiropractic funded national centre complementary alternative medicine nccam electronic searches conducted identify relevant rcts key data extracted risk bias study determined ten rcts included related chiropractic spinal manipulation musculoskeletal problems quality frequently questionable rcts failed report adverse effects majority sufficient detail replication criticism repeatedly aimed nccam justified rcts chiropractic concerned questionable research worthwhile treatment+chiropractic+spinal adjustment+manual therapy+controversy+debunkery+spine
3 article Carlesso et al Defining adverse events in manual therapy Manual Therapy In 2010