See the help page for answers to common customer questions!
Why do muscles often contract without permission? Can cramps be treated? Should you worry about twitches and tremors? Do backs actually “spasm”? What’s going on when we feel “tight” and “stiff”? Why doesn’t anaesthesia actually paralyze muscles? Is there such a thing as “muscle splinting”? And more!
It’s not a rough draft, but it’s hardly complete either: it just scratches the surface of this fascinating topic, and deals efficiently with a few prominent myths and controversies. I’m know I’ve completely missed some important sub-topics, and probably gotten some things wrong, and I’m sure readers will let me know.
I realized I had to write this last year while I was reading Life's Ratchet: How molecular machines extract order from chaos, from the “molecular storm” (such a cool image). I was especially motivated by the chapter about the molecules of movement and muscle:
“There is not one type of kinesin, myosin, or dynein doing one type of job. Instead, like a fleet of customizable trucks, there are superfamilies of molecular motors, with eighteen known classes of myosins, ten classes of kinesins, and two classes of dyneins.”
Muscle physiology is just bonkers. This isn’t a particular technical article, but the rabbit hole it’s built over goes deep.
For all the truly wondrous developments of modern medicine… it is distressingly ordinary for patients to get treatments that research has shown are ineffective or even dangerous. Sometimes doctors simply haven’t kept up with the science. Other times doctors know the state of play perfectly well but continue to deliver these treatments because it’s profitable — or even because they’re popular and patients demand them. Some procedures are implemented based on studies that did not prove whether they really worked in the first place. Others were initially supported by evidence but then were contradicted by better evidence, and yet these procedures have remained the standards of care for years, or decades.
He gives a great example of a doctor who prescribes epic quantities of a completely discredited drug:
When asked why he continues to prescribe atenolol so frequently in light of the randomized, controlled trials that showed its ineffectiveness, Huynh said, ‘I read a lot of medical magazines, but I didn’t see that.’ Huynh added that his ‘patients are doing fine with it’ and asked that any relevant journal articles be faxed to him.
Best practices can elude the best of us. It’s hard to keep up. Doctors are only human, after all.
There are many quotable passages from this important article. I will share it again, highlighting more.
P.S. Fun detail: as I was reading this, I kept thinking, “This is really good writing. This author is sharp.” And then I realized it’s by the same sharp author of the fantastic book I’m in the middle of: The Sports Gene.
From the ideal reader in the last post to the worst in this one: all too often I see evidence that I don’t have the kinds of readers and customers I want. There’s always been hate email, of course, but I also see signs of something even more poignantly awful: people who actually like what they find here, but for the wrong reasons. For instance, they want to buy my books because they think I’ve got secret knowledge I’m going to share, a miracle cure for their pain (and some are outraged by the “scam” when they can’t find what they were hoping for). I even see evidence that some people seem to buy my ebooks essentially because I “told” them to: because there was a button that said “Buy Now,” so they just did it, like the hapless victims of a Jedi mind trick. “This is the product you are looking for!”
Some people seem to buy my ebooks essentially because I “told” them to: because there was a button that said “Buy Now,” so they just did it, like the hapless victims of a Jedi mind trick.For a few minutes this week, I was a fly on the wall for one the worst possible kinds of potential customer: someone who didn’t know what he was buying, why he was buying it, how to buy it, or even how to call for help. So how do I know this? Because I received a five-minute accidental voice mail from him.
He called me three times, failing to communicate anything meaningful each time, and then — stumped by the advanced technology of voice mail — he just left the third call open while he continued to talk with his wife about my website and how to buy one of my e-books. He was desperately hopeful, but equally irritated because he had no idea how to get what he thought he wanted. It was shocking. It was heart-breakingly, cringe-inducingly bad. It was like satirical sketch comedy about someone profoundly ignorant, but without any jokes.
I’ve always known that such customers exist, and probably more of them than I want to know, but I’ve been sheltered from the reality of it. Eavesdropping on one of them was a bizarre, disheartening bucket of cold water.
Of course, everyone who works directly with the public sees exasperating customers every hour of every day. The only strange thing here is that I am 99.9% sheltered from it by running a virtual bookshop!
Today’s recommended reading: a practical and hopeful article by a PainScience.com reader about wrestling with fibromyalgia over the last few years, more or less successfully. But it wasn’t easy:
What do you do when all your effort backfires and makes things worse, where you feel like your body is allergic to effort? (And you tried "resting" or doing nothing for months but that clearly did not work either?) Especially if you are the type of person that thrives on effort (professional life and hobbies and ways to blow off steam?)
For several years, the pain, fatigue, isolation, anxiety and low mood cycles were hell. The harder I tried, the worse it made everything: I was used to trying harder making things better, but this was its own beast. During this time, I had trouble walking without my muscles (eventually my whole system) complaining for days. I had trouble driving. I felt trapped in my apartment.
Jared perfectly demonstrates a thoughtful, systematic approach to learning about fibromyalgia and experimenting with treatments. He’s open-minded, but — crucially — not too open-minded. His writing about that process is a great bonus, clear and interesting, and I learned a lot from it, so on top of everything else it’s a useful collaboration.
The main article is short, but some of his “Additional Notes” are actually longer and the best part: be sure to click/tap to show those.
“DOCTOR MASSEUSE: Or My Personal Pain Puzzle”
by Jared Updike
If you’re a woman smoker “of a certain age” with a history of neck & back pain in a tough job with a crappy boss, you are totally screwed. Neck pain city!
Being a woman is an especially clear risk factor for neck pain, and no one has a clue why. (And now every woman reading this is now thinking, “Fantastic: as if being a woman in this world wasn’t challenging enough, now this?” I wish it wasn’t true, but it is literally one of the only things we know for sure.)
Also, if you often “feel tense,” your risk of developing neck pain is more than 4 times higher than someone who never feels tense — the conclusion of Huysmans 2012 one of the most intriguing studies I stumbled on.
Another interesting one: Paksaichol et al found computer display position (too high, too low) is definitely not actually a risk factor for neck pain, a classic example of failed common sense. So I’ve been wrong about that for 20 years.
I’ve updated my neck pain book with a much more detailed discussion.