Detailed guides to painful problems, treatments & more

The trouble with “it worked for me” and “athletes use it”

 •  • 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 PainScience.com: a library of major articles and books about common painful problems and popular treatments. See the blog archives or updates for the whole site.

A recent note from a PainSci reader sang the praises of a treatment method (“Muscle Activation Technique” in this case, but it doesn’t matter). His satisfaction was based on:

  1. a personal anecdote about his own good results
  2. the testimonials of pro athletes

He asked for my view. Which was like inviting a vampire in. Count von Count counts two mistakes, ha-ha-ha!

“It worked for me” and “it must be good because elite athletes are using it” are among the most common kinds of “evidence” for treatment that regular folks cite when reviewing treatments. So it’s surprising that I don’t seem to have ever published anything that briefly explains the trouble with these pillars of popular thought.

I composed this for the occasion (proving once again that correspondence is a good inspiration for explanation).

Usually “it worked for me” means a relationship worked, not a technique

Whether a given treatment technique seems helpful has almost nothing to do with the technique itself. Almost every treatment method is equally unimpressive (on average, in controlled conditions). Getting “good results” for your injury or weird stubborn body pain has much more to do with how the therapeutic interaction feels to you — the “chemistry” of your relationship with the therapist, the “rightness” of the sensations, and the “fit” of the rationalization for your particular mind.

In other words, people do not finally find a therapy that works so much as they finally find a therapist they like, someone who scratches itches they didn’t even know they had (sometimes almost literally). This isn’t necessarily “placebo” — not in the sense of giving you a sugar pill, anyway — but in any case it’s never about what was actually done to your tissues with hands, machines, or substances.

People are often so impressed by the timing of their relief. It can’t possibly be a coincidence if you suffer for months and then finally recover after getting a new therapy… right? Actually, it totally can, and usually is. But “it’s complicated.” I have written about that particularly tricky nuance here: The Power of Barking: A silly metaphor for a serious point about correlation, causation, and how we decide what treatments work.

That said, “placebo” is many things & some aspects of it can be a legitimate part of therapy. Example: is it “placebo” if people do better with “good bedside manner”? That’s why I said “it’s complicated.” 😜

Please do not look to athletics for science-based medicine

Adoption of a remedy by elite athletes is not only a weak endorsement, in many cases it’s almost the opposite: a warning sign. That industry has a long and colourful history of credulity and foolishness when it comes to healthcare. Consider the Power Balance debacle, the inanity of decorative therapy tape festooning the 2012 Summer Olympics, or the flood of nonsense that Tom Brady endorses.

People tend to assume that the standards elite athletes set for themselves mean that they would only use a treatment if it was effective… but it’s actually the opposite. Their intense hopes, motives, and expectations are just a more potent power source for motivated reasoning and expectation effects (placebo again). By far the most dominant force shaping our beliefs is what we want to believe. And so they are wrong, constantly and spectacularly.