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This is a video of a nifty muscle rippling phenomenon. I’ve waited for an opportunity to film it in my own quadriceps, where I have seen it a few times, but it’s hard enough to induce that I haven’t had a chance yet. Hat tip to reader Chris for finding this video of it:
That’s very similar to what I’ve seen in my own muscles, but much more languid. It’s always been at least triple that speed in my flesh! Could just be natural variation in the phenomenon, or something else altogether, but this definitely looks more like it than anything else I’ve seen.
Funny how tricky it can be to find a citation to confirm something relatively obvious. In this case, I’ve been aware for many years that nerve roots have a lot of “wiggle room” where they pass through their holes in the spine. This is a useful fact for reassuring people that “nerve pinches” are unusual. It’s come up in my reading many times over the years, and I’ve seen many anatomical drawings and dissection videos and so on, but … citation needed, right? I try to check all my assumptions.
When I set to “proving” what I know with a citation to a scientific paper, I had some trouble! It was hard data to find for some reason, and the paper I finally found, Torun et al kicks off by confirming that impression: “There have been few anatomic studies on the foramina and roots of the lumbar region….” Indeed. And that’s in a 2006 paper! Hardly ancient.
However, what I knew was confirmed. The holes between the (lumbar) vertebrae that the nerve roots pass through can be more than a couple centimetres wide, while the nerve roots themselves are only about 3-4mm thick. I made a diagram:
On the left are the rough proportions of a healthy nerve root and the hole it passes through (intervertebral foramen). I also found some simple data on how the holes change shape during spinal traction and compression (Sari et al, Takasaki et al): they get a little larger or smaller, as shown on the right…but there’s still lots of nerve root room.
If it’s stuck, suck it? In this poor quality video we see a physical therapist using a cute little toilet plunger — for a hobbit loo? — to “suck” the iliotibial band off the leg. To achieve an IT band “release”, of course! (Arg, that blasted word!)
I think this is silly. Sure, it’s easy to see the suck-up-the-stuck-tissue “logic” of it, but it’s at odds with well-known IT band anatomy (the IT band is firmly anchored to the femur for most of it’s length), and it’s at odds with the nature of IT band syndrome (it doesn’t hurt because of “adherence of the IT band to the tissues beneath it”).
Even if the IT band did get stuck to underlying tissues, I’m not so sure that baby plunger would be helpful. It might lift some skin! The mechanics of it would work something like this experiment: (1) put a cookie sheet on the floor, (2) cover it with Saran Wrap, and then (3) try to pick up the cookie sheet with a toilet plunger, through the plastic. Good luck with that. (And you know what? It probably doesn’t even matter if you move that cookie sheet.)
This treatment idea is mostly just good for a chuckle. I’m sure it’s harmless to everything but your wallet … but also pointless. It boils down to a weird form of massage.
My book about iliotibial band syndrome has been updated with this vital information. (Sometimes book updates are high priority science. And sometimes they just fall in my lap and make me snicker and I can’t resist ‘em.)
Todd Hargrove on the San Diego Pain Summit:
You may have heard some of the buzz about the conference on social media. The conference definitely had a very buzzy feel to it, kind of Woodstockish, as if something important was happening, and Mr. Jones didn’t know what it was.
I’ve never felt more like I was missing an event I belonged at. But I’m a private, bookish recluse by nature and as poor a traveller as there ever was. When I travel, I do not sleep! (Some people probably scoff at that excuse. People who don’t know insomnia. And would be crushed by it if they did. Or perhaps the scoffers are just way, way more badass and resilient than me — maybe there’s some like that too.)
Rarely. The bar for “worth a try” is fairly high for invasive treatments. Even “minimally” invasive ones like injections should only be considered when at least their safety is established (and it rarely is). What you really need is clear, consistent evidence of non-trivial benefit across several good trials before anything injected is “worth a try.” Before that it’s more like “hey, it’s your knee, don’t stab it”!
Of course, what’s worth trying is always a very personal decision, because it’s as much about risk tolerance and desperation levels as it is about the treatment. But my point is that almost everyone should be wary of needles filled with mysterious meds. For an example, see Does Platelet-Rich Plasma Injection Work?
So I was doing my daily mobilizations by the seaside, enjoying a winter sunset, and an elderly Chinese man walked by me. Then he turned, and said:
Excuse me, but I’m concerned that you are hurting your neck doing that. May I show you how to do it properly?
How extraordinary! What was I doing that was so hazardous that a total stranger would offer me free safety advice?
I was rolling my head in a full circle. Pretty alarming stuff.
Many people believe that this is a problem, probably because it can be a bit crunchy (noisy). I’ve heard many warnings about it in exercise classes of all kinds over the years. The usually under-explained and vague rationale for avoiding rotation the neck is the idea that this is somehow unusually stressful for the neck joints. Supposedly it’s safer to stick to the cardinal planes of movement, or at least avoiding full extension.
I cannot think of any reason why: as long as it’s reasonably comfortable, there’s no problem. The cervical spine is generally just as well-built for compound movement as a ball-and-socket joint. I prefer to get the benefits of thoroughly moving my neck, and to avoid worrying about extremely trivial biomechanical hazards.
I politely refused the assistance. He stared at me like I was a bit nuts to refuse a safety lesson, and moved on. An odd incident.
I’ve updated my neck pain book with this little story, and a bit more detail.
There are a lot of ideological factions in health care. Even my relatively small area of interest — musculoskeletal medicine and pain science — is amazingly factionalized. Sometimes it’s really hammered home when I get email from friends trash talking each other, both trying to recruit me, even while they are being very polite to each other publicly.
The longer I do this job, and the more incidents like that I observe, the more I believe that there are no guiltless factions — everyone is getting some stuff right, and some stuff wrong, and treating some ideas fairly and giving others short shrift. It just seems to be how human minds work. Confirmation bias everywhere!
Don’t get me wrong, though: some people are still a lot more wrong than others.
Modern pain science is largely concerned with the role of the nervous system — pain is an “output of the brain,” a generated experience, and does not reside “in” the flesh. This perspective has yielded many priceless insights into how pain works (and how weird it is). But …
But it’s not the whole picture, of course, and we will never grok pain solely in terms of neurology. The nervous system is dazzling, but let’s not forget that it’s stacked on top of much older and richly functional bio “tech”: cellular biology is just as dazzling in its own way. The nervous system itself is just an extraordinary organization of cellular biology into something greater than the sum of its parts: every stitch of it is still ultimately relying on the dance of enzymes and ions and hormones. Synapses are just short range hormonal communication. It’s all just more cell tricks, spectacularly organized chemistry.
In short, the flesh and its failings are still important parts of how pain works.
So now what to believe? Who knows: the data may be perfectly good, or hopelessly corrupted. We just can’t tell without more information. We’ll simply never know what’s true without more research…which will probably be hard to get anyone but another water bottling company to pay for!
How did I not know about this? After a good solid decade of reading regularly and widely about knee pain, I am flabbergasted that I had never heard of the fabella.
How many people have this osseous oddity? Apparently it’s not clear. Driessen et al: “The presence of the fabella in humans varies widely and is reported in the literature to range from 20% to 87%.” That’s quite a range!
It may form for the same reason the patella is there (leverage, high stresses), and it can get to hurting just like the patella (fabella syndome).
Filed under “well I be danged”! And I’ve added it to the patellofemoral syndrome tutorial, of course — mainly for the novelty of it, since fabella syndrome isn’t likely to be confused with kneecap pain.