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When I encounter any reasonably well-argued, credible expert opinion in the wild, it’s less my job to agree or disagree, and more my job to report it: to do a good job of explaining who disagrees with who and why.
And yet I often do throw my opinion into the ring. Why? Because I am fond of the sound of my own opinion. :-) Obviously.
I’ve been paying more attention to the Google searches that lead people to PainScience.com: interesting ones, odd ones, funny ones. Here’s three recent examples of the “advice column” type:
Dozens of updates on the site per day lately. Just churning ‘em out. Too many to report. Way too many, in fact.
In theory, every time I update an article or a book — a tablespoon of science or ¼ cup of fresh metaphor — I’m supposed to add an item to the update log (so that readers can see what’s changed). But I’m doing that less and less, because the updating is so automatic and continuous that a lot of it just isn’t worth mentioning.
For instance, I might add a footnote that, five years ago, would have seemed like a significant change to the document…but today it’s just a tweak, automatic maintenance, one new footnote in a constant stream of new footnotes. If I had to write “added a footnote about blah blah blah” every time I added a footnote, I’d spend just as much time describing my footnote additions as I do actually adding footnotes!
I’m a freak! I have an extra pair of floating ribs! And I’ve only just realized it. Turns out my 10th ribs are “false” — that is, they don’t merge with the costal cartilage of the 8th and 9th ribs, like well-behaved 10th ribs. Their tips float free..
This anatomical jiggery–pokery is reputedly common in the Japanese, a fact mentioned without support in several sources, though I assume they are referring to this abstract-less 1974 paper, the only result of a PubMed search for “floating tenth rib”. (Mysteriously, PubMed answers that search with just one other item: “Insect succession on a decomposing piglet carcass placed in a man-made freshwater pond in Malaysia,” which chronicles the lives of insects on said floating carcass for, you guessed it, ten days. “The carcass along with the maggots sunk on day tenth, leaving an oily layer on the water surface.” Search tech is tricky.)
Most humans have a dozen ribs, with the occasional extra one at the top of bottom. Stubby little 13th ribs are almost common, about 1% of the population — so there’s enough 13th ribbers out there to populate several megacities. But floating 10th ribbers? There is exactly zero data on our prevalence. (Rule of thumb: if you can barely Google it, it’s rare.)
How could I possibly have missed this? How could literally dozens of massage therapists?
But the real marvel is that I didn’t know. That wouldn’t be so surprising for most people, but I’ve been professionally keen on anatomy, massage therapy, and self-massage for 15 years. I’ve worked on myself a lot. And it’s not like I haven’t noticed the tips of my floating ribs before: they’re pretty obvious. How could I possibly have missed this? How could literally dozens of massage therapists?
Near as I can figure, whenever I felt the tip of a floating rib, I just assumed it was the tip of one of two of them… every single time. The only way to confirm it was to carefully, slowly move from the 10th to the 11th to the 12th — and then repeat several times. And then do quite lot of carefully landmarking and rib counting to confirm that they really are the 10th, 11th, and 12th and not the 11th, 12th, and 13th. Even after that, I still wasn’t 100% sure that the anomaly was false 10th as opposed to a 13th, and could only confirm that by comparing with normal anatomy: the positions of my putative 11th and 12th are identical to what you’d expect, while the 10th tip seems to be the weirdo.
In short, it was surprisingly difficult to confirm.
Writing an article about joint popping is my oldest-ever untouched to-do list item. One of the first big articles I ever wrote about musculoskeletal medicine was about Epsom salts, and I remember thinking the night I started that one, “Well, it’s salt or cracking.” And when I finished the first edition of that one, I thought, “Time to get cracking on cracking!” This was in 2002 or something. I don’t know what happened. But I’ve been aware of it as something I’d like to write about ever since.
Because, clearly, there are some interesting mysteries in knuckle cracks. I’ve always thought there had to be more to it than the cavitation hypothesis, and now it looks like there probably is:
“What we saw was a bright flash on ultrasound, like a firework exploding in the joint,” Boutin said. “It was quite an unexpected finding.”
It’s quite a bizarre finding, is what it is.
What do you do when you’re in pain and your doctors and therapists are stumped? How do you find a pain treatment that works? This is the basic troubleshooting recipe for chronic pain:
Learn as much as you can about the treatment options, and then start experimenting, working your way from the cheaper, easier, safer, more reasonable options to the more expensive, awkward, risky, kooky options.
That’s it. That’s the basic formula for coping with one of the toughest challenges in life.
PainScience.com has a big collection of pain treatment tips to help get you started.
Beautiful slow-motion kitty pandiculation, added to my stretching article just now. Pandiculation is: “A stretching and stiffening of the trunk and extremities, as when fatigued and drowsy or on waking, often accompanied by yawning.”Strangely, despite writing about stretching for years, the word “pandiculation” has never appeared on PainScience.com before today. A million words, and not one of them is pandiculation! So there’s another item for the to-do list.
Sharing this story partly because it’s interesting and I really relate to experimenting with pain self-treatments, but also because I particularly enjoyed the way Diane introduced the post herself (on Facebook): “Lots of confirmation bias about DNM.” Because, you see, Diane is The DermoNeuroModulation Lady — DNM is her idea, her pet theory, and she’s reporting a successful self-treatment experience with it, but she knows that “the first principle is that you must not fool yourself, and you are the easiest person to fool” (Feynman). She sets a good example.
And I’m going to have to try some stretchy tape on my back. The treatment notion here (spoiler alert), is to treat pain by using stretchy medical tape (or therapy tape, like Kinesio Tape) to gently pull on the skin. Complicated theory, simple implication.
Not all science is so uncertain and unsettled, but psychology is particularly messy and difficult, and medical science is also probably more prone to this problem than physics, and even worse with musculoskeletal medicine. This is why I’m really not kidding around when I say that “one study means nothing” … especially if it’s one study produced by people who have something to prove or an ax to grind. Here’s a laughably perfect example: “proof” that a fascia-focussed treatment works, reported without a trace of critical thinking.
There’s evidence (from 2008, see Holman et al.) that some people have quite a bit too much miscellaneous body pain (a.k.a. fibromyalgia) due to intermittent compression of the spinal cord. The compression fires up the sympathetic nervous system, but has no other immediate/obvious consequences. This is clinically subtle and tricky (and expensive) to diagnose unless you know exactly what to look for.
(Note that this is not a posture problem. You’re not going to get spinal cord compression in a healthy neck. No postural habit would plausibly do that. But there are a variety of pathologies and injuries that can result in spinal cord compression. Like arthritis, most straightforwardly.)
More study needed, of course, and I haven’t yet checked to see if there’s newer research on this topic — this is just a quick look at something that really grabbed my attention. Because, if true, this would explain a lot. And illuminating sneaky mechanisms of pain is exactly what we hope will characterise the next few decades of pain science: that we will finally start reaching beyond the low-hanging fruit, and look where the light is not good, and start to figure out why pain treatment has generally been such a difficult medical challenge.
I’ll be following up on this. Hat tip to Brian James for pointing this one out to me.