Amnesiac glutes, history of pain, and rates of anxiety with pain

Three small items today:

• The amnesiac glute thing drives me nuts
• New stats on the prevalence of depression, anxiety with chronic pain
• The (Western) history of pain

The amnesiac glute thing drives me nuts

Weirdly, I’ve never written much about the idea of “forgetful” or “sleepy” or “dead” glutes that don’t “activate” — one of the most popular biomechanical scapegoats in Rehab World. So instead here’s part of a good rant about it from Adam Meakins:

Have you been told by a trainer or a physio that you’ve got weak glutes or worse “gluteal amnesia” because they noticed something in the way you squat, lunge, or walk?

Well it’s complete bollocks!

They can NOT tell how strong your glutes or any other muscle is or isn’t just by watching how you move or perform an exercise

Don’t let anyone tell you’ve got weak glutes just because they seen you squat!

This butt baloney is one of my most common reminders that physical therapy isn’t nearly as evidence-based a profession as I used to give it credit for. It blows my mind how often I hear “my physio told me my glutes aren’t activating.” It’s damned near every other time anyone reports on their last physio experience.

And if I try to correct the misinformation? “But she’s really good!” “But he works for a pro hockey team!” Or similar. Unfortunately, it’s still bollocks … even when it’s coming from most super duper elite therapists.

I’ll write an article about all of this glute gobbledygook eventually. Meanwhile, this is your occasional reminder this entire family of ideas is shallow and corrupt: people mostly don’t get hurt, or struggle to recover from being hurt, just because they are slightly wonky.

And the wonkiness they get diagnosed with is often entirely fanciful. There mostly just is no such thing as “dead butt syndrome.”

New stats on the prevalence of depression, anxiety with chronic pain

A huge new meta-analysis of data about 350,000 people in 50 countries showed that forty percent of chronic pain patients are depressed and/or anxious.

Yes, that is a lot. How much depression and anxiety do people have without pain? Just 13% and 16%!

But the only surprise to me is that the gap isn’t even worse. About 60% of people with chronic pain are somehow in a reasonably good mood? Not anxious/depressed? That’s impressive in its own way! (Not all chronic pain is equally intimidating, of course. Some of us do manage to be cheerful despite the grind.)

See the free full text for plenty of nuances, but the bottom line here is simple: chronic pain comes with about three times the depression/anxiety. As always on this topic, remember that the causality may well be bidirectional, and/or they all share underlying causes — that is, the same things that cause back pain may also cause the glitchy physiology of psychological distress.

The (Western) history of pain

From a new paper by Vincenot et al that explores the history of our ideas about what pain is, and how it works:

“The origin of the pain was probably considered esoteric for many civilizations, resulting from demons or malevolent spirits inside the body…”

Hmm, not sure we’ve evolved much past that. 😜 And I wish I were entirely kidding.

There are lot of “gap gods” in this business: essentially superstitious explanations filling in the substantial and persistent gaps in our scientific knowledge. For instance, a classic example of gap god is the completely speculative notion that body pain arises from fascial “distortions”, trouble spots of unclear nature in the web of connective tissue that shapes us and holds us together — an idea with enduring appeal, sbut scientifically bankrupt.

There are dozens of ideas like that — lots of bogeymen, many malevolent spirits! Most of them are used to sell dubious treatments that are about as credible as exorcisms. And yet they thoroughly dominate the marketplace.

So you can see why I’m only partially kidding. Our collective grasp of pain really is still quite primitive.

The main takeaway from this new history of pain is that we’ve had a lot of ideas about how pain works, but relatively few of them based on science — and even those are still hotly debated! There is still plenty of room for spicy controversy about the science of pain: see Craig, Cohen, Weisman. Or consider how it remains completely unclear whether the mind can cause or cure pain in any meaningful sense — or if that seemingly idea is just another gap god.