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Fresh science! New review of 17 “mostly low quality“ studies of the relationship between leg injuries and movement quality shows “inconsistent evidence.” In other words, we have no idea if we can tell who’s going to get leghurt based on screening them for quality-of-movement trouble, e.g. things like Functional Movement Screen™ (FMS).
I’m always torn about how to interpret these garbage-in, garbage-out reviews: they’re officially inconclusive, because they are obviously reviewing studies that just weren’t designed well enough to answer the damn question. But realistically… they are really just totally damning, because a bunch of high-bias-risk studies can’t demonstrate the link the researchers are obviously fishing for, then it almost certainly ain’t there. Seriously, how many crappy little studies showing “not much” do we need to see before it’s safe to assume that there’s no beef?
I’m still churning out carefully crafted article summaries (as announced in a recent blog post), and still finding it crazy challenging and satisfying. It’s like taking a crash course in my own content. With each one, I feel more certain that these mini articles-within-articles are genuinely a great service to readers and to me: writing them forces me to refine my overall comprehension of a topic.
Today’s example is the topic summary for massage pressure intensity, a surprisingly large one (I think it’s one of the longest “summaries” I’ve written so far). Of course, there’s lot more detail (and citations) in the full article — that’s the whole point, of course. This is 310 words summarizing about eight thousand. 😃
There is no clear justification for painfully intense “deep tissue” massage, and it’s actually hazardous to many patients, but the pressure question is greatly complicated by the fascinating paradox of “good” pain, wildly varied patient pain tolerance and preferences (often timidly repressed), and popular faith in the “no pain, no gain” principle.
“Good pain” is at the heart of the pressure question: a strange, potent sensory paradox that many people actually seek out as the goal of therapy, consciously or unconciously. Either it isn’t literally painful (just intense), or it’s painful but desired anyway because of relief or belief: an actual biological relief or at least the belief that there is one. But it’s important to note that not all satisfying, relieving sensations are genuinely helpful (e.g. scratching a mosquito bite).
“Good pain” is at the heart of the pressure question: a strange, potent sensory paradox that many people seek out as the goal of therapy
“Bad pain” is unpleasant but manageable and probably safe — tolerate it cautiously, to a point.
“Ugly pain” is dangerous both physically and neurologically, causing a “fight or flight” reaction — always avoid it.
People do have clear pressure preferences: they often fire massage therapists who give treatments that are too painful or too fluffy. Pressure that’s fine for you may cause severe pain, emotional distress, “sensory injury” (sensitization) in others, or even physical injury, so pressure should be customized but often isn’t. Brutal massages might be appreciated or even helpful, but most people can’t tell the difference between the kind of pain that might be a necessary part of therapy, and ugly pain that is just abusive and dangerous.
Some possible justifications for painfully intense massage (these aren’t endorsements) include the destruction of motor end plates to “de-activate” trigger points; somatoemotional release (pain often strongly “resonates” with strong emotions like grief); moving tissue fluids; or just creating a strong, novel sensory experiences (which may have many subtle benefits).
You can read the whole thing here: The Pressure Question in Massage Therapy: What’s the right amount of pressure to apply to muscles in massage therapy and self-massage?
But “more study needed” in a big way! Beyond these scraps of evidence, for now there is only educated guessing and clinical experience.
Nothing’s ever simple and chronic pain least of all: it’s usually caused by a sinister stew of factors that eat away at people for many years. Trying to solve the problem by fixing one thing — if indeed vitamin D is even a problem — may be about as feasible as trying to fix a broken engine with just one tool. Vitamin D deficiency may contribute to a chronic pain disaster over time, but by the time you’re actually in trouble the problem may be much more complicated than just vitamin D deficiency.
That’s a bleak warning not to put too much hope into vitamin D. But there are still reasons for optimism! And the only thing worse than chronic pain with six causes is … seven causes. Obviously. Anything you can do to simplify the pain equation is a good idea, and you can certainly take vitamin D. (Just consult with a doctor first, please.) It’s cheap, safe, and effective, so it’s an ideal candidate for presumptive treatment: going ahead and treating based on the presumption of vitamin D deficiency even if it has not been established with blood tests. By all means do that too, of course! But if a lot of healthy people take this stuff “just in case,” it’s hardly radical for pain patients to give it a shot.
This is an excerpt from a recent major update to my vitamin D article. For more more information see:
The evidence that chronic stress ruins people is getting strong. The role of subtle systemic inflammation is particularly interesting. Dr. Robert Sapolsky, regarding a new study of nervous-wreck monkeys:
At the end of the day, being a chronically subordinate nonhuman primate and being a human mired at the bottom of the socioeconomic scale are similar in the most fundamental ways. You have remarkably little control and predictability in your life, your outlets for frustration are limited, and it’s relatively hard to access social support. That’s the prescription for chronic, stress-related maladies.