Detailed guides to painful problems, treatments & more

Kooky misogynistic beliefs about gait and fibromyalgia

 •  • by Paul Ingraham
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Weekly nuggets of pain science news and insight, usually 100-300 words, with the occasional longer post. The blog is the “director’s commentary” on the core content of a library of major articles and books about common painful problems and popular treatments. See the blog archives or updates for the whole site.

Today’s post is a bit outraged and ranty, inspired by this disturbing message from a reader and bullshit spotter:

“Many physiotherapists believe that life-long wearing of high-heels is to blame for many cases of fibromyalgia. One therapist stated he could accurately identify any woman walking down the street — whether she had fibromyalgia or not — just by her gait, posture etc. He stated that he knew Lady Gaga had Fibro before she even knew it.”

This is horrifying … but believable. Candidly, just between us, that is crazy talk, the worst of the worst! But I’d like take it seriously enough to break it down for you, and explain exactly what’s so wrong with it.

No diplomacy today: healthcare professionals thinking anything like this are bad at their jobs. If you’re a paying subscriber getting scolded by this… well, then, you need the subscription more than most! 🙂

About my slow drift away from rants (before I start one)

The longer I write this blog/newsletter, the less I want to write “attack” posts like this, where I scoff at bad ideas and “punch down” at people who might be, for instance, just kids starting out in the field. I was probably even more foolish in my early twenties! So I’m mellowing with age. Having readers pay in advance for useful content will do that to you. More and more, I just want to focus on being of greater service: more positive, useful information.

But it is fun to have a good rant once in a while. And probably important, too. Plus some of you are in fact paying me for exactly this kind of content. Yesterday I got back-to-back emails, one from a massage therapist with a wounded ego angrily begging me to be gentler the way I talk about her beloved profession… and then someone urging me to tackle some massage quackery and “rip it to shreds”! 😜

I’ll do both over time. But more of the former.

A bit of context: pseudo-quackery

Once upon a time, I would not have suspected that physical therapists could indulge in such garbage. But my respect for the profession of physical therapy has been in decline for years. While of course many physical therapists are excellent, the average quality of physical therapy seems worrisomely lower than I used to believe, and the profession is very nearly as rife with bad ideas as its more obviously flaky cousins, chiropractic and massage.

Physical therapists are masters of what I call “pseudo-quackery”: ideas that are superficially more science-based and technologically sophisticated (e.g. ultrasound, laser therapy), but which are ultimately just as bad as much more obvious snake oil. See Pseudo-Quackery in Physical Therapy.

And so it is bizarre but all-too believable that “many” physiotherapists would blame fibromyalgia on high heels, of all things, and claim to be able to identify fibromyalgia patients from their gait.

Fibromyalgia isn’t one disease

The most basic overlooked fact about fibromyalgia is that it almost certainly isn’t one condition. It is a positively identifiable physiological state, but it is not a “diagnosis of exclusion.” It is not just what is leftover when everything else is eliminated. However, that does not mean that it has only one cause, and it almost certainly does not. It’s extremely likely that there are between three and many ways to get into that fragile state.

Therefore, all One True Cause theories about fibromyalgia are bullshit.

I have a guide to fibromyalgia, a book-in-progress. Head over there to learn more about the possible causes. Some of them are quite interesting.

We should stop listening every time we hear anyone acting like they can “explain” fibromyalgia in general in any way, because they are invariably doing that “visually impaired person grabbing part of the elephant” thing. But this gait-sign claim is in another league of delusional overconfidence. It’s just a dumb idea. It doesn’t even make the list of candidates. There are several actual candidates, stresses that probably do contribute to fibromyalgia … but “high heels” and “gait, posture, etc” don’t come anywhere close.

People just aren’t that fragile.

The exaggerated importance of posture

Posture does matter… but it does not matter a lot. I have written about this in detail (and that article got some substantial updating this spring).

Yes, of course some physical stresses can eventually cause trouble, but we are amazingly robust critters, and such troubles are mostly subtle, develop slowly, and are largely beyond our power to prevent in any case. If we seem to be “broken” by trivial stressors, especially while still young, I submit that biological vulnerability is a more appropriate place to lay the blame.

One reason that people can probably get the impression that fibromyalgia (or anything else) can be caused by a relatively trivial source is because any minor stressor can in principle be the straw that broke the camel’s back, and straw-piling of stressors is probably one path to fibromyalgia. But it’s not the last straw’s fault! The last straw isn’t the problem, and that’s the point of that metaphor. The problem is the accumulation of insults and/or the vulnerability to them.

The idea that postural stresses alone can wreck an otherwise healthy person is fear-mongering garbage.

Plus, it’s just a hypothesis that fibromyalgia is caused by being overwhelmed by a variety of stresses over time in the first place. No one really knows.

Identifying fibromyalgia at a glance?! This has a misogynistic stink

That claim of being able to spot fibromyalgia patients from subtle and irrelevant traits and movement patterns is delusional self-promotional boasting, and it is contemptible and laughable. If subjected to a controlled test, the people making such claims would fail, guaranteed. Even if posture and gait actually could cause fibromyalgia, they’d still fail — they wouldn’t be able to see it.

But I don’t think that’s the worst of it. The whole theory also has a misogynistic stink to it: the focus on women, the shoes they wear, they way they walk. It all feels a hair’s breadth away from “she was asking for the fibromyalgia, wearing heels like that!”

Fibromyalgia is somewhat more common in women, but they hardly have a monopoly on it! Good grief.

Women are not just dismissed as hysterical hypochondriacs by far too many healthcare professionals — their normal behaviours and biology are also pathologized and demonized far more than men’s. Burn-the-witch thinking is still tragically pervasive in our culture… and surprisingly prevalent in healthcare particularly, where there are so many opportunities to either exaggerate or ignore women’s unique health issues.

Read more on that theme: Chronic Pain and Inequality.

I’m not saying that high heels are necessarily an entirely healthy choice — that’s a whole ‘nother topic. But it’s just ridiculous to demonize them to this degree, to make them scapegoats for a very serious chronic pain challenge.


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