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Why is musculoskeletal medicine such a mess? 

 •  • by Paul Ingraham

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.

One of my readers wrote to me in the grips of justifiable outrage about a string of egregiously incompetent healthcare professionals he’d encountered while trying to recover from an injury. It was all routine nonsense from my perspective — I hear a lot of stories like this — but he was in a state of disbelief that so-called professionals could possibly be so amateurish. “Why is there so much ignorance in musculoskeletal medicine?” he asked.

So many factors! A sampling off the top of my head …

  • Professional pride and tribalism, ideological momentum, and screwed up incentives (certification rackets, freelancing, insurance, huge profits, etc).
  • The love of “advanced” and technological treatment methods, which has generated so much pseudo-quackery (non-obvious snake oil, superficially modern and mainstream).
  • Near universal ignorance of the history of science, critical thinking skills, and the cognitive distortions and limitations that bind us all … like emotional reasoning, Confirmation Bias, the human weakness for oversimplification and “common sense,” looking only “where the light is” (streetlight effect), and much more.
  • The obscurity and difficulty of newer and better ideas, especially the major neurological and biological factors that we’re still learning about (e.g. things like sensitization). Neglecting these was still quite understandable ten years ago, but is rapidly getting a lot less forgivable.

It was good cynical fun trying to answer that question! I rolled my answer into an update to “A Historical Perspective On Aches ‘n’ Pains.”

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