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What do I REALLY think happened with that massage success story?

 •  • by Paul Ingraham
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The sore spots commonly known as “trigger points” are quite controversial (understatement). I have a big article that explores the many doubts I have about trigger point therapy.

I perversely kick off that exploration with my very best trigger point therapy success story, the single most impressive “magic hands” anecdote from my career as a massage therapist: maximum benefit from minimal intervention. After just a few minutes of massage in the right place, my patient reported immediate, complete, and permanent relief from particularly vicious shoulder pain.

He was my uncle-in-law, so I got great long-term follow-up on that case, and that pain never bothered him again. Cool.

The point of sharing that success story to introduce my “doubts” is that I cannot trust the anecdote — and neither should you, for a bunch of reasons, which is what the whole article is about.

But the doubting begs the question:† What do I really think happened? If that was not effective trigger point therapy, what the hell was it?

Small illustration of a thumb pressing downwards on a myofascial trigger point.

What I “really think” is that I really don’t know

Obviously “I don’t know” is the only wise answer, and we should just get comfy with the uncertainty. That’s why I have never tried to explain the anecdote in my article. I think it’s important to acknowledge and even emphasize ignorance, and important not to just run with the self-serving hypothesis that I have amazing massage skillz.

But I get that my devotion to not-knowing is not terribly satisfying, and I get that readers would like to hear my best guess, despite the caveats. A reader pointedly asked me to speculate on this, and I finally caved. So here we go: my first and next best guesses about what “really” happened that day. Maybe.

My first best guess

My best guess is that it was exactly what it looked like. Trigger point therapy really did work … despite my doubts, despite the uncertainties.

I do not have high confidence in this interpretation, but it is my best guess. Some trigger points — whatever they are, however they work — do sometimes respond well to some stimulation.

But if I’m wrong about that, what’s the next best explanation? What could account for his experience that doesn’t have anything to do with a putative “trigger point”? My best guess at that

My next best guess

An expectation effect (placebo) boosted by just the right social cues and a special sauce: “persuasive” sensory guidance (more about that). My style and framing of the experience and the way that I touched his shoulder all contributed to his faith that he was getting a lucky dose of just the right medicine... producing a mind-powered, mind-blowing “healing” effect.

That is basically how faith healing “works,” but by appealing to different biases and hopes and values. If that’s what happened, then it was not “trigger point therapy,” because the active ingredient was not remotely what trigger point therapy supposedly contains.

But I also think that this placebo version of the story is a bit of a reach. I think that interpretation is actually a bit sketchier than the trigger point therapy interpretation! I am not at all sure that placebo is actually potent enough for this job. And I somewhat prefer to think that rubbing sore spots is actually just helpful sometimes.

But they both have big problems, and that’s why I avoided speculating about this: there is no explanation that isn’t seriously flawed.


Just one dorky digression today…

A little proactive defence against pedantry: “Begs the question” originally referred to a logical fallacy in which an assertion tries to support itself, often just by re-phrasing it (“God exists because God is everywhere,” which “begs the question” that has not actually been answered). Pedants are often outraged by the looser modern usage, which means more what it sounds like: a question seems obvious or needful. Neglect of the old meaning for decades has tipped the scales so far towards the new meaning that resistance is futile: I side with Merriam Webster in relegating the original meaning to a formal, secondary sense of the term. The new meaning is clearer.

“Cautionary Ghost”

xkcd #1108 © by Randall Munroe

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