Or see the help page for answers to common customer questions
Interesting read on the idea of no pain, no gain in sport:
Japanese trainers have gone so far as to enshrine this marriage of pain and athletic discipline in the concept of taibatsu, which translates roughly as ‘corporal punishment’. In his piece on Japanese baseball for The Japan Times last year, Robert Whiting traces the concept to one Suishu Tobita, head coach of the fabled Waseda University team in the 1920s. Tobita advocated ‘a baseball of savage pain and a baseball practice of savage treatment’. Players nicknamed his practice sessions ‘death training’: ‘If the players do not try so hard as to vomit blood in practice,’ he said, ‘then they cannot hope to win games. One must suffer to be good.’
Oh, Japan: you’re so kooky!
Here’s a dramatic example of athletic toughness, and a nice demonstration of how “pain is an opinion”:Shoulder dislocations are notoriously painful, but this rugby player dislocates his shoulder and just pauses to calmly, competently pop it back in place. In other words, this player’s brain seems to be more concerned about getting back in the game than worrying about a shoulder dislocation! Of course there’s more to it than that. Chances are good this guy has dislocated his shoulder quite a few times, and it’s so hypermobile that it isn’t nearly as brutal for him as it looks. Still an interesting example though!
Ig Nobel prize goes to pain science, in the masochist category. For this Ig Nobel win…
Michael Smith, of Cornell University, subjected himself to several stings a day to his face, arms and genitals to map out what section of the body was most sensitive to the barbs.
After weeks of research Smith found that although stings to his penis and testicles were uncomfortable, the worst place for a bee to attack was the nostril. Being stung on the upper lip was also one of the most painful locations for a bee sting.
But an honourable mention for stings on the shaft of the penis specifically.
Now for the fun part: trying to figure out where to cite this research here on on PainScience.com!
(Aside: I’m a fan of CBC Radio One’s As It happens, and the easiest way to explain why I’ve been so dedicated to the show is that they always cover the Ig Nobels. In fact, they never stop: most of their science stories are about the kind of science that might win an Ig Nobel.)
The management of load represents a key component of what the physiotherapist or athletic trainer does. Once the clinician establishes the need for some form of physiological adaptation, the primary clinical question becomes one of dosage.
This is a dense but excellent and polished article for professionals (for some of the same concepts pitched to patients, see Progressive Training). Nice to see Scot go straight to Dr. Dye’s patellofemoral syndrome research, which has been a major influence for me for a decade.
Researchers found that mitochondria in mouse muscles not only produce energy, but can quickly distribute it across the muscle cell through a grid-like network. The findings reveal a major mechanism for energy distribution in skeletal muscle cells, and could provide new insights into diseases linked to energy use in muscle.
What a wonderful example of how much we still have to learn about muscle tissue (and others too, I’m sure, but muscle seems to be particularly full of surprising puzzles). It seems likely that we probably can’t understand muscle pain properly if we have only just now discovered something so fundamental about muscle biology. Imagine trying to troubleshoot an electrical problem if you weren’t aware of a major feature of how power is generated and transmitted!
The application of evidence-based medicine (EBM) has always involved a mixture of evidence, experience, and the particulars of each case. For instance, a physical therapist deciding whether or not to use dry needling might consider three things:
In other words, EBM isn’t exclusively about the evidence. It’s based on it, but not limited to it. And so I got this savvy question recently:
You are obviously keen on PainScience.com being known as an EBM-friendly website, so what do you do when the evidence is contradicted by the clinical experience of your readers? Or your own?
The artful merging of evidence and experience with the unique special-flowerness of the patient in front of you is a clinical challenge…not a writing challenge. Clinicians have to make decisions based on all three, every day. That’s their job. I left that challenge behind several years ago. These days, my new challenge is to provide clinicians (and patients) with as good a picture of the evidence as I can. I’m a specialist now — I focus on just one of the pillars of EBM, the science-y pillar.
You must be very cautious not to lean too hard on your experience, because “you are the easiest person to fool” (Feynman). It’s only a third of the equation. Not two thirds. Not half. Just a third
On the other hand, I was also clinician for ten years, and I have constant and deep correspondence with many extremely experienced clinicians today. So there are hat tips to clinical experience here there and everywhere on PainScience.com. Certainly I do talk about what clinicians believe. But, mostly, I stick to what the evidence can support.
But for you clinicians: when confronted with evidence that’s a bummer, at odds with your experience, remember that your experience is a fully legit third of that EBM equation. But! You must be very cautious not to lean too hard on your experience, because “you are the easiest person to fool” (Feynman). It’s only a third of the equation. Not two thirds. Not half. Just a third, roughly, give or take (probably always less than a third for younger professionals). And it’s never a very reliable third. Just like science, experience is difficult to interpret and often wrong.
EBM-First.com is a nicely done directory of reading recommendations and references for a couple dozen topics in alternative medicine. It’s surprisingly hard to find good reading lists…but not on EBM-First. The most relevant topics for pain and manual therapy are craniosacral therapy, energy therapies and reiki, homeopathy, magnetic therapy, reflexology, therapeutic “touch.”
As you can see, there’s a strong focus on alternative medicine’s goofier side: several topics I’ve barely touched on myself, because they’re just too remote from science and reason. For instance, I will probably never bother to write about magnets. I’m happy to be able to direct readers to EBM-First for that.
I have discovered that it just does not matter how carefully I prepare content…it will get legitimately corrected, sooner or later. (With lots of unhelpful suggestions along the way!) There’s always someone who knows something I don’t. If not several someones.
(This tiny post brought to you by my good intentions to put the “micro” back into my microblog. I’ve gotten out of the habit of writing nugget-sized posts, and I think it would be nice to get back to it.)
I wouldn’t bet on it yet. “The mechanism by which bacteria may enter the lumbar spinal tissue is unclear,” wrote Urquhart et al, but it’s not unclear if it’s contamination! And there is already evidence that it is just contamination. And almost any evidence of contamination puts the whole business deep in the shadow of doubt. (This is probably why Dr. David Colquhoun tweeted at me, “‘moderate quality evidence’ — I doubt it”.)
Seems like the role of bacteria in back pain is still just a big question mark. It’s plausible and there’s smoke — much more plausible that I expected two years ago — but there could easily still be no fire here at all.
All together now: “more study needed”! As usual!
I’ve updated my low back pain book with this, because it’s the kind of odd back pain science I like to include just for kicks, even if it doesn’t amount to much.
So there’s this article I wrote for PainScience.com in 2007. It’s going to remain anonymous for the purposes of this post. Because it’s embarrassing.
The article has been bringing in a lot of readers per month for ages now, years, about 3000 of ‘em, with an average reading time of several minutes (which is very good; it means that people are actually reading it). So it’s a busy article for PainScience.com…but not so busy that it was really on my radar as a top article. Not a high priority. I have a few dozen in this league, and dozens more that get much more traffic.
So I basically haven’t thought about this particular article since I wrote it.
I found at least three cringe-inducingly obsolete key ideas in it. Nothing too horrible, but … just shabby old stuff I abandoned about five years ago, closer to when I wrote the damn thing than to the present. Words I’m really not proud to have my name on today.
Being read by a few thousand people a month.
Roughly a hundred thousand readers.
Oh, my. It’s not a bad article. But it does contain multiple strong statements that I think are misleading to readers and embarrassing to me, statements so cocky that obviously it hadn’t yet occurred to me that there was any possibility of doubt. In 2007, I just knew!
It will probably take me a few hours to fix, which I just can’t do on the spot. It’s going to have to go in the to-do list, where it will rub shoulders with dozens of other similar chores, competing for my attention for weeks or months before I finally get to it.
Fixing crap like this is the difference between “blogging” and trying to maintain a high-quality million-word educational website.
This is basically my job for the rest of time. It’s like painting a big bridge: it takes so long to paint that, by the time it’s finished, it’s already time to start repainting again at the other end!
But then I went and wrote a whole article about that particularly interesting idea: that people have often believed in “treatments” that are actually hurting them, like drinking mercury, and several other famous historical examples. If people have told a lot of success stories about dangerous treatments… well, that says a lot about just how wrong anecdotal evidence can be.