Sensible advice for aches, pains & injuries

Painful Quotations

More than two hundred selected quotations about aches, pains, injury, therapy, recovery, and critical thinking

Most writers love quotes. The temptation to season our own writing with someone else’s grander, wiser, or funnier words is usually irresistible. I’ve been writing about musculoskeletal health for many years, and it never ceases to amaze me how there’s always more apt quotations I’ve never come across before, and no thought is entirely original. No matter how obscure the topic, it seems, someone has said something clever or hilarious about it before. And so I’ve been harvesting quotes for many years now, and the collection has finally reached an impressive, share-worthy size: it’s worth putting all 231 of them in one place. All of these are stored in a database, tagged and filed with love, so that I can unleash them wherever they are needed around You will see them here, there, and everywhere — and right here.

And this is only the tip of the iceberg. There are many more quotes I haven’t gotten around to putting in the database … and many more new ones to find. publisher
Vancouver, Canada

Let’s hear your evidence, not your legal muscle.

Frank Frizelle

When a lot of remedies are suggested for a disease, that means it can’t be cured.

Anton Chekhov, The Cherry Orchard

The effectiveness or ineffectiveness of therapists bears little relationship to either the type or duration of their training.

The efficacy of treatment, by Peter Watkins, 309–310

Dr. Zang has unbelievably gifted hands. What he is doing looks to you and me like massage, but he’s worked on my body for months, and his hands are like radar. They can find spots you didn’t know were sore. The first time he taught me, he brought in a bag of millet and threw it on the floor and said, ‘When you can use your hand to crush this to dust, then you have the beginning movements. But until you learn to crush it with your finger, you are not ready.’ It takes a lot of energy and skill to use your hand to crush millet into dust. That’s the amount of force he can use, if he wants, on a single spot. He has to know many different manipulations — but more important, he has to know when and where to use them.

Another Way of Seeing, by David Eisenberg, p. 305

Many years before when I had serious back pain from a sports injury, the surgeons said they would explore my spine and “figure it out.” Out of frustration I had impulsively opted for the procedure. They ended up fusing the vertebrae. It left me debilitated. In hindsight, I blamed myself more than the surgeons. I had pressed them for a solution when in fact none was apparent because the cause of the pain was obscure.

How doctors think, by Jerome Groopman

I think all of the best nonfiction that has ever been made comes from the result of someone who can’t stop thinking about a certain topic — a very specific aspect of a certain topic in some cases. And second, they got really good at figuring out what they had to say about it.

Merlin Mann (, from his talk with John Gruber (, 149 Surprising Ways to Turbocharge Your Blog With Credibility!

It’s easy to win forgiveness for being wrong; being right is what gets you into real trouble.

Bjarne Stroustrup

New scientific understanding of perception has emerged in the past few decades, and it has overturned classical, centuries-long beliefs about how our brains work—though it has apparently not penetrated the medical world yet. The old understanding of perception is what neuroscientists call “the naïve view,” and it is the view that most people, in or out of medicine, still have. We’re inclined to think that people normally perceive things in the world directly. We believe that the hardness of a rock, the coldness of an ice cube, the itchiness of a sweater are picked up by our nerve endings, transmitted through the spinal cord like a message through a wire, and decoded by the brain.

Scratching an itch through the scalp to the brain, by Atul Gawande

The work of a science blogger is largely comprised of correcting and criticizing bad science news reporting.

Dr. Steven Novella, Who’s To Blame for Bad Science News Reporting

Science is not a major or a career. It is a commitment to a systematic way of thinking, an allegiance to a way of building knowledge and explaining the universe through testing and factual observation. The thing is, that isn’t a normal way of thinking. It is unnatural and counterintuitive. It has to be learned.

Atul Gawande MD, MPH

… many of the flaws in our ‘design’ have a common theme: They arise primarily from evolutionary compromises that came about when our ancestors stood upright — the first step in the long path to becoming human.

Downside of Upright, by Jennifer Ackerman, 126–145

Not everyone in medicine can be constantly making calculations about the value of the information. You’d go crazy. But if you are in a subspeciality field … you not only need to know what people know but how they know it. You have to regularly question everything and everyone.

James Lock, MD, Chairman, Dept of Cardiology, Boston Children’s Hospital

I enjoy “pathologizing” posture. It gives me a sense of purpose.

Les Glennie, Registered Massage Therapist (yes, tongue-in-cheek)

Truthiness is what you want the facts to be, as opposed to what the facts are. It is the truth that is felt deep down, in the gut.

Stephen Colbert, The Colbert Report

See, when it starts to fall apart,
man it really falls apart
Like boots or hearts oh when they start,
they really fall apart.

“Boots Or Hearts,” The Tragically Hip

Sleep isn’t an escape, it’s an act of rest.

Jock McKeen & Bennet Wong, founders of Haven

It is my impression that ‘pain-killing’ drugs improve the patient’s mood rather than take away the pain.

Mind over back pain, by John Sarno, p. 97

The biology of pain is never really straightforward, even when it appears to be.

“Reconceptualising pain according to modern pain science”, Lorimer Moseley

Notably, CSMTA Sport Massage Therapists are trained not to use deep tissue massage in an immediate post event environment. Years of sport massage practice have demonstrated that it does not improve recovery and generally leads to soreness. In fact, this study confirms this position as results showed exactly that response.

Response to Queen’s Study, by Burchat, Paula and {Canadian Sport Massage Therapists Association}

The labeling of nociceptors as pain fibers was not an admirable simplification, but an unfortunate trivialization under the guise of simplification.

The relationship of perceived pain to afferent nerve impulses, by Patrick Wall and SB McMahon, 254–255

Sleep is like a cat: it only comes to you if you ignore it.

Gillian Flynn, Gone Girl

In fact, on one occasion, a rather pedantic experimental psychologist was telling him about a long, complicated experiment he had done, incorporating all the proper controls and using considerable technical virtuosity. When he saw Crick’s exasperated expression he said, “but Dr. Crick, we have got it right — we know it’s right,” Crick’s response was, “The point is not whether it’s right. The point is: does it even matter whether its right or wrong?

V.S. Ramachandran, telling a story about Francis Crick

In neuroscience, the homunculus has big gorilla hands, a giant toe, looming genitals, and huge lips and tongue; these brain-areas lie close together, or even overlap. Anything that happens to the mouth might as well be happening to the genitals, too, which is why kissing is integral to sex. By this logic, and according to the homunculus, dentistry could be considered the antikiss. If there is incest or other dark sexual trauma in someone’s past, dental work can stir up those memories, too.

Pain, by Marni Jackson, p. 241

That danger message arrives at the brain and the brain has to decide: What does this mean? What should be done here?

Lorimer Moseley, from his surprisingly funny TED talk, Why Things Hurt 14:33

We apply fight-or-flight reflexes not only to predators, but to data itself.

Chris Mooney, The Science of Why We Don’t Believe Science

Knowledge is in every country the surest basis of public happiness.

George Washington, 1790

The brain cells that produce pain get better and better at producing pain. They become more and more sensitive…

Lorimer Moseley, from his surprisingly funny TED talk, Why Things Hurt 14:33

Proper research is rarely undertaken and typically comes late, often 10 to 20 years after the first invention of the procedure. This is opposite to the way scientists behave in other disciplines, where if the results are negative, that should lead to cessation of the procedure. This never happens. Once it’s established, despite the evidence, invasive procedures keep being perpetuated.

Dr. Nikolai Bogduk, at the 2003 American Pain Society AGM

Scientific results that aren’t reported might as well not exist. They’re like the sound of one hand clapping. For scientists, communication isn’t only a responsibility, it’s our chief pleasure.

The body electric, by Robert O Becker and Gary Selden, p. 102

A lasting guru culture exists in physical therapy, promulgating an ugly self righteousness: “follow me first and then maybe the science.”

Dr. David Butler, “What is the difference between cancer & whiplash?”

Many [chiropractic] schools are magnets for New Agers, theosophists, magical and mystical thinkers, and those attracted y the low admissions standards and the lure of a lucractive private practice .... Moreover, since the largest chiropractic colleges tend to have the strongest commitment to dogma, fuzzy thinkers are likely to fill the chiropractic ranks for decades to come.

Chiropractic Science and Antiscience and Pseudoscience Side by Side, by Joseph Keating, 37–43

The odds are lousy that I actually said something attributed to me.

Morgan Freeman

Yes, well of course, and that’s all fine and good, but don’t throw the baby out with the bathwater.

most of the world’s manual therapists, before getting back to biomechanical business as usual

Whilst the problem is superficially a physical one, the real challenges faced by someone with chronic pain are mental. Mental state is the biggest modulator of physical pain. Things hurt more when you’re stressed or sad, and the increased pain makes you both stressed and sad. The way out of this vicious circle is a wholesale change to how you perceive fear, suffering and setbacks.

How chronic pain has made me happier, by Rob Heaton

Surgery is not the answer for back pain, and it doesn’t work. So I’m now going to jump out of this hot-air balloon and leave the other two hot-air experts to battle it out. But the trouble is, it’s very easy for back specialists to set themselves up as experts. Beware of amateur experts who step out with their own speciality. Beware of high-tech experts who blind you with science or pseudoscience. And beware most of all of the bullshit artist who can sell the idea to you and convince you that their treatment is better than everyone else’s — odds are, they’re wrong. So throw out the experts and fill up the balloon with malt whisky, which will probably do your back more good than the experts.

Pain, by Marni Jackson, p. 121

I’ve never enjoyed having massages. I don’t like being naked in front of strangers, and I can never relax if I think someone might play Norah Jones.

Roy, The IT Crowd, “Something Happened” (Season 4 Episode 3)

House: Give him a whole body scan.

Cameron: You hate whole body scans.

House: Because they’re useless. You could probably scan every one of us and find five different doodads that look like cancer.

House, Season 1, Episode 17, Role Model, written by Matt Whitten

Never stand when you can sit, never sit when you can lay down, never stay awake when you can be asleep.

an old army aphorism

We should listen less to the opinions of those who either overtly promote or stubbornly reject complementary and alternative medicine without acceptable evidence. The many patients who use complementary and alternative medicine deserve better. Patients and healthcare providers need to know which forms are safe and effective. Its future should (and hopefully will) be determined by unbiased scientific evaluation.

The role of complementary and alternative medicine, by E Ernst, 1133–5

We’re told to strengthen this muscle or stretch that one, or inject this substance into an injury, or zap it with heat or electricity or ultrasound…and sometimes it really works, even though placebo-controlled trials fail to validate the treatment. I’m a big advocate of better science to really understand what causes injuries and how to treat them — but in practice, I also believe that sometimes it’s worth trying something, anything, just in case it successfully ‘reboots’ your injury.

Alex Hutchinson, Sweat Science

A positive attitude does not cure cancer, any more than a negative one causes it.

Siddhartha Mukherjee, The Emperor of All Maladies: A Biography of Cancer, 2011

Muscle is an orphan organ. No medical speciality claims it. As a consequence, no medical specialty is concerned with promoting funded research into the muscular causes of pain, and medical students and physical therapists rarely receive adequate primary training in how to recognize and treat myofascial trigger points. Fortunately, massage therapists, although rarely well-trained medically [BC being one of the obvious exceptions, see Massage Therapy In British Columbia, Canada — PI], are trained in how to find myofascial trigger points and frequently become skilled in their treatment.

Foreword of The Trigger Point Therapy Workbook, by David Simons

When 99% of experts agree on something, and 1% of experts believe something else, it’s not a controversy: the 1% are usually just a few kooks.


… surgery is a powerful placebo, perhaps the ultimate placebo. The effectiveness of a placebo is directly proportional to the impression it makes on the patient’s subconscious mind.

Mind over back pain, by John Sarno, p. 35

… the more we learn about the placebo effect, the more ammunition it gives to the pharmaceutical companies. They now have evidence that round white pills are less effective than a colored tablet with corners, and that certain colors have more powerful associations. Red suggests power, green and blue are associated with calm, and the most promising pill is a capsule with lots of colored beads inside. (With doctors with feather anklets may have the right idea.) Also, a patient is more likely to respond to an injected placebo than to a pill, because we have learned that injections are serious medicine. And an intravenous placebo, with a nice little hanging bag attached, is the best of all.

Pain, by Marni Jackson, p. 278

Every drug out there in the world, every single one, even the ones that you see on TV, are, in a sense, inside our heads. The only reason those drugs work is because our brain has receptors for them. And why would it have those receptors? Because it can already make them in house. Every pharmacological agent that there is, there is a chemical produced by your own brain that essentially does that thing. It’s like an internal pharmacy in there, just stocked full of drugs …

Radiolab episode, “Placebo”

No plan survives contact with the enemy.

Helmuth von Moltke the Elder

Even the clearest localization of pain in one area may, in fact, be originating from a distant area …. The reference of pain implies the existence of convergence of inputs within the spinal cord. This leads to the necessary involvement in central neural circuits in the simplest of peripheral disorders. It also leads to the possibility that the basic disorder is entirely central …

Professor Patrick D. Wall, FRS, DM, FRCP, in the Foreword to Muscle Pain: Understanding its nature, diagnosis and treatment

In all the years that they have been talking about them, chiropractors have never been able to furnish proof of these mysterious subluxations which they alone are able to see. They may convince their clients, but never have they provided proof of their pretensions to men of science.

The scientific brief against chiropractic, by {College of Physicians and Surgeons of the Province of Quebec}

Why do we persist in this distinction between mental and physical pain when pain is always an emotional experience? What explains the fact that something as universal as pain is so poorly understood, especially in a century of self-scrutiny? Has nobody noticed the embarrassing fact that science is about to clone a human being, but it still can’t cure the pain of a bad back? Americans consumer four tons of aspirin a year, while chronic pain is on the rise. It’s almost as if pain flourishes on our diet of analgesics.

Many medical students receive no more than one hour of instruction in pain management. Some schools don’t even have pain on curriculum, even though pain is the number one reason that sends people to their GPs ... It’s not the fault of physicians — this is how we teach them.

Why are we, the most medicalized of societies, a culture in pain?

Pain, by Marni Jackson, p. 5

We love comfort. We have this idea that things that are comfortable must be good for us. So people buy shoes that are comfortable. Well, since when was there a relationship between comfort and health? I would argue that a lot of shoes actually cause people to become injured because they’re comfortable. An arch support in a shoe is comfortable because that arch support means that the muscles in your foot no longer have to work anymore to support your arch. It’s like taking the elevator all day long. Those muscles then atrophy, or they never even develop properly if you give kids arch supports. Their arches don’t even develop properly, or they collapse pretty quickly. Twenty-five percent of Americans have fallen arches, which is an amazing statistic.

In the Kenyan villages where I work, where people don’t wear shoes, I have yet to find a single person with a fallen arch. They just don’t exist. Maybe we’ll find one eventually, like a black swan. But they’re obviously extremely rare, those kinds of foot problems. They may have all kinds of crud in their feet and they have other shoe problems and foot problems, but collapsed arches don’t seem to exist in barefoot populations.

Brains Plus Brawn, by Daniel E Lieberman

The greatest enemy of knowledge is not ignorance, it is the illusion of knowledge.

Stephen Hawking

Massage therapists, and others in the holistic arts … seem to be a particularly gullible bunch. And there are a lot of people who have seized upon that, and marketed their products, their classes, their modalities, and their wild claims to us … and many of us have fallen for it, hook, line and sinker … and unfortunately, gone on to convince our clients to buy into it, as well. … Our profession has turned into the snake oil medicine show.

Excuse me, exactly how does that work?, by Laura Allen

It is difficult to get a man to understand something when his job depends on not understanding it.

Upton Sinclair

The behaviours that make us human are not professional. Honesty, frankness, humour, emotionality, embracing the moment, speaking up for what you believe, affection, sincerity. Quoting extremely offensive trolls. These are all things that will make some people love you and others hate you. When you get more attention, these aspects of your personality fuel the inevitable backlash. As your audience grows, the chance of any given action triggering criticism asymptotically approaches 100%.

Allen Pike, “Unprofessionalism

The conventional wisdom is often wrong. Crime didn’t keep soaring in the 1990s, money alone doesn’t win elections, and — surprise — drinking eight glasses of water a day has never actually been shown to do a thing for your health. Conventional wisdom is often shoddily formed and devilishly difficult to see through, but it can be done.

Malcolm Gladwell, Freakonomics, 2005

It’s so deep it’s meaningless.

The Tragically Hip, “So Hard Done By” (Day for Night)

The art of medicine consists of amusing the patient, while nature cures the disease.


More studies are not the answer. No matter how many studies showed negative results, they would not persuade true believers to give up their beliefs. There will always be “one more study” to try, but there should be a common-sense point at which researchers can agree to stop and divert research time and funds to areas more likely to produce useful results.

Harriet Hall, Acupuncture Revisited

It seems to me that placebo treatments ought to be paid with a placebo payment.


Facts do not cease to exist because they are ignored …

Aldous Huxley

The function and integrity of all innervated structures are contingent on the flow of nerve impulses in the intact nerve to provide a regulatory or ‘trophic’ effect. When this flow (probably a combination of axoplasmic flow and electrical input) is blocked, innervated structures are deprived of the trophic factor which is necessary for the control and maintenance of cellular function. ‘A-trophic’ structures become highly irritable and develop abnormal sensitivity or supersensitivity according to Cannon and Rosenblueth’s Law of Denervation ... The importance of disuse supersensitivity cannot be overemphasized. When a nerve malfunctions, the structures it supplies become supersensitive and will behave abnormally. These structures over-react to many forms of input, not only chemical, but physical inputs as well, including stretch and pressure.

Neuropathic Myofascial Pain Syndromes, by C Chan Gunn

Saddling a perfectly good naturalistic practice like massage with repeatedly debunked supernatural faith in energy medicine is the single fastest path professional massage therapy could take to total irrelevance.

Ravensara Travillian, MT

If you walk in a shoe store and their sole basis for choosing a shoe for you is how much your pronate and what your arch looks like, turn around and walk out the door. The science simply does not support this protocol.


I believe that the corporatisation of healthcare is dehumanising. By this I mean that real, whole people living with their hopes and worries, ideas and expectations, are broken down by the process of corporatisation into biological parts not for diagnosis and treatment but so that they can be measured and converted into profits. We are far more than the sum of our biological parts; we also have relationships with our past and future, our family and friends, our work and environment, our country and our home. We are irrational and passionate as well as calculating and objective; we need kindness, affection and understanding as well as diagnoses and treatments. And healthcare is far more effective when this is taken into account.

Patients not Profits; the NHS and Corporate Healthcare, by Jonathon Tomlinson

There is a crack in everything
That’s how the light gets in.

Leonard Cohen, Anthem

Most bloggers have no institutional credibility, and so they must build it, by linking transparently, and allowing you to easily double check their work. But more than anything, because linking sources is such an easy thing to do, and the motivations for avoiding links are so dubious, I’ve detected myself using a new rule of thumb: if you don’t link to primary sources, I just don’t trust you.

Dr. Ben Goldacre, science journalist

Friction on the skin, pressure on the deeper tissues, distortion of the tissues surrounding the joints — these are the media through which the organism perceives itself and through which it organizes its internal and external muscular responses. As we develop and mature, most of us build up and reinforce a reliably consistent sense of our selves by carefully selecting and maintaining a specific repertoire of movement habits — which generate a specific repetoire of sensations — and by surrounding ourselves with a stable environment with which to interact. This careful process of selection is largely unconscious, and so as long as we are comforable we are rarely aware of any limitations or potential dangers our cultivated habits may entail. And even if a disturbing symptom appears, we generally do not suspect that our well-worn, tried-and-true behaviour might be its cause. In fact, the very consistency of our normal patterns frequently prevents us from changing our ways long enough to obtain such an insight.

It is exactly this circular relationship between our habitual behaviours and the chronic conditions of our tissues that skillful touching can so usefully penetrate. New frictions, new pressures, and new movements of the limbs necessarily create new sensations, volumes of new data which the mind can scan in search of clues for new habits, new modifications, more constructive conditions. And here we are close to putting our finger on the possible reason why the touch therapies can sometimes produce positive results so quickly, almost “miraculously.” No matter how much I move myself around, my strongest tendency is to move in the same ways that I have always moved, guided by the same deeply seated postural habits, sensory cues, and mental images of my body; but if I can succeed in surrendering to the movements that another person imposes on my body, without my own system of cues and responses interfering, it is possible to treat my mind to a flood of sensations that are novel in important ways, sensations that may well be able to indicate what things I have been doing that have produced my aches and pains at the same time as they have reinforced my normal sense of self.

And even more important, this moment of surrender and new sensation can demonstrate to me that I am not permanently obliged to continue acting out a habitual compulsion. I can see that the habit is a habit, that I am something else, and that for the moment at any rate I can choose to repeat it or now. And if I can drop a compulsive behaviour or attitude for a moment without causing a crisis, then perhaps I can dispense with it altogether. As every physician knows, this kind of insight can often be worth more than any number of drugs or procedures for the reversal of a chronic condition.

Job’s body, by Deane Juhan, p. xxvi

If you torture data for long enough, it will confess to anything.

Ronald Harry Coase

Fine, dash my hopes with all your crazy logic and science. Be that way.

funny reader

Never in the history of calming down has anyone ever calmed down by being told to calm down.

~ unknown

Encoded in the large, highly evolved sensory and motor portions of the human brain is a billion years of experience about the nature of the world and how to survive in it. The deliberate process we call reasoning is, I believe, the thinnest veneer of human thought, effective only because it is supported by this much older and much powerful, though usually unconscious, sensorimotor knowledge. We are all prodigious olympians in perceptual and motor areas, so good that we make the difficult look easy. Abstract thought, though, is a new trick, perhaps less than 100 thousand years old. We have not yet mastered it.

Hans Moravec, roboticist, Sensor Fusion in Certainty Grids for Mobile Robots

While there are many taxonomies of alternative medicines, one thing almost all alternative therapies have in common is they are originally the de novo “discovery” of one lone individual.

Dr. Mark Crislip, “The Marshall Protocol” on Science-Based Medicine

To many biologists and physicians, bones are pretty dull. They seem like a bunch of scarecrow sticks in which nothing much happens, plain props for a subtler architecture. Many of my patients were in sad shape because doctors had failed to realize that bone is a living tissue that has to be treated with respect. It’s a common misconception that orthopedic surgery is like carpentry. All you have to do is put a recalcitrant fracture together with screws, plates or nails; if the pieces are firmly fixed after surgery, you’re done. Nothing could be further from the truth. No matter how firmly you hold them together, the pieces will come loose and the limb can’t be used if the bone doesn’t heal.

The body electric, by Robert O Becker and Gary Selden, p. 118

Don’t see a masseuse. They’re the biggest con of the 20th Century.

Doug, The IT Crowd, “Something Happened” (Season 4 Episode 3)

I do not like the principle of using magic machines to treat.

“Nari,” physical therapist, in an internet forum discussion

“Objective” means that, in a confrontation with the evidence, you would be willing to change your own mind.

Christopher Hitchens

I do worry there is a combination of side effects and unnecessary treatments and labeling people as being fragile when they’re really not. The combination of those kinds of things may actually be in some cases doing more harm than good.

Richard Deyo, quoted by the New York Times in Back Pain Spending Surge Shows No Benefit regarding Martin

Chiropractic, which celebrated its centennial in 1995, is a curious mixture of science and pseudoscience, sense and nonsense. Much of it is based on the theory that misaligned spinal bones produce nerve interference that causes disease. Many chiropractors claim that correcting these misalignments (“subluxations”) can restore health and that regular spinal adjustments are essential to maintain it.

Neither logic nor scientific evidence supports such a belief. Although spinal manipulation can relieve certain types of back pain, neck pain, and other musculoskeletal symptoms, there is no scientific evidence that it can restore or maintain health. As a result of expressing my opinion on this subject, I have been called a chiropractic heretic.

The chiropractic profession has little tolerance for dissension. Its nonsense remains unchallenged by its leaders and has not been denounced in its journals. In fact, many chiropractic journals continue to publish articles that attempt to justify subluxation theory. Although progress has been made, the profession still has one foot lightly planted in science and the other firmly rooted in cultism. Without appropriate criticism, the good in chiropractic will never be sifted out, and competent chiropractors will not receive the recognition they deserve.

This book denounces the cultism in chiropractic but supports the appropriate use of spinal manipulation and the research efforts required to solidify its scientific basis. If you are contemplating or receiving chiropractic care, it might help protect both your pocketbook and your health.

Inside chiropractic, by Samuel Homola, p. vii

[If all your own flesh and cells were magically removed] what would remain would be a ghostly image, the skin outlined by a shimmer of bacteria, fungi, round worms, pin worms and various other microbial inhabitants. The gut would appear as a densely packed tube of anaerobic and aerobic bacetira, yeasts, and other microorganisms. Could one look in more detail, viruses of hundreds of kinds would be apparent throughout all tissues.

Microbes, by Clair Folsome

Well, it’s practically over, thank God — I’m 83, there won’t be that much more of it to put up with I don’t think!

Kurt Vonnegut, novelist, 2008, when asked by an interviewer "How's life?"

It is the natural tendency of the ignorant to believe what is not true. In order to overcome that tendency it is not sufficient to exhibit the true; it is also necessary to expose and announce the false.

HL Mencken

There are those who suffer and grow strong; there are those who suffer and grow weak. This mystery of pain is still for me the saddest of earth’s disabilities.

Doctor and Patient, by Silas Weir Mitchell

The worst diseases known to science pale in comparison to the chronic and untreatable nature of somatoform disorders.

Mark Reid, MD, Twitter, @MedicalAxioms, Apr 16, 2015

... an appallingly high percentage of doctors and other practitioners are still pretty much out of the loop regarding trigger points, despite their having been written about in medical journals for over sixty years.

The trigger point therapy workbook, by Clair Davies, p. 2

Most drugs work on only about a third of the population, they do no damage to another third, and the final third can have negative consequences.

Craig Venter, extremely famous and spooky smart geneticist (public lecture, Vancouver, May 3, 2011)

Hasn’t anyone thought to look at outcomes as a logical way to figure out what really works? Not until recently. That tells you how far out of the picture the patient has been.

Pain, by Marni Jackson, p. 122

Dr. House: You sir, will, research all the causes in the universe of neck pain.

Dr. Chase: The list is like two miles long

Dr. House: Start with the letter A.

Dr. Greg House & Dr. Robert Chase, House, American TV series

Noble deeds and hot baths are the best cures for depression.

Dodie Smith, I Capture the Castle

I think about the meaning of pain. Pain is personal. It really belongs to the one feeling it. Probably the only thing that is your own. I like mine.

Henry Rollins, musician, writer, and much more

Given the … multidisciplinary philosophy [of The Ninth World Congress of the International Association for the Study of Pain], I was surprised by the absence of alternative pain approaches — the whole spectrum of cranial-sacral massage [sic], healing-touch therapy, and other hands-on skills that are a lifeline to many people with chronic pain. Alternative therapie are hard to evaluate, but that’s no reason not to explore them.

Pain, by Marni Jackson, p. 130

Why are pain and movement linked? In the presence of acute injury and/or pain, if the nervous system concludes there is a threat to the tissues, then movement is the primary mechanism by which the nervous system can react to that threat.

Grieve's Modern Musculoskeletal Physiotherapy

Only massage therapists seemed to be informed about trigger points and referred pain, and only exceptional individuals among them (in my own experience at least) were treating trigger points effectively. What’s more, the burgeoning variety of unproven modalities offered by massage therpaists gave the profession such an aura of flakiness that the elegant science of myofascial pain got unfairly confused with treatments whose results could easily be attributed to the placebo effect.

The trigger point therapy workbook, by Clair Davies, p. 10

Much more of the brain is devoted to movement than to language. Language is only a little thing sitting on top of this huge ocean of movement.

Oliver Sacks, “The Man Who Took His Life as a Dance

The evidence that tissue pathology does not explain chronic pain is overwhelming (e.g., in back pain, neck pain, and knee osteoarthritis).

Teaching people about pain — why do we keep beating around the bush?, by Lorimer Moseley, 2–3

Among the many, many benefits I feel I've derived from training over the years, the ability to tolerate temporary discomfort without getting too worked up about it has got to be right up there among the most useful.

Alex Hutchinson, science journalist

I don’t want to believe. I want to know.

Carl Sagan

Most doctors are uncomfortable with medical conditions that have a psychological basis.

Mind over back pain, by John Sarno, p. 12

It’s a bit like smoking. Smoking is bad for you even if you get lots of exercise. So is sitting too much.

Travis Saunders, quoted in Sitting is the New Smoking — Even for Runners

What were the bodies like on the beach? Ugly and white and ruined by offices.

Leonard Cohen, The Favourite Game

The first principle is that you must not fool yourself & you are the easiest person to fool.

Richard Feynman

I was the first to adjust the cause of disease .... The man who had the intellectual capacity to comprehend the displacement of the vertebrae; the mental ability to grasp the significance of nerve impingement; the power to conceive and discriminate between normal and abnormal positions; the foresight and wisdom to discern the outcome; the genius of originality to create such a unique science; the judgement needed for the occasion; the brain caliber of reasoning on this heretofore perplexing question — the cause of disease; the sense of touch required to discover a racked vertebra and the skill and tact to replace it, was the one destined to discover and develop the science which he named chiropractic.

Shall Chiropractic Survive?, by BJ Palmer

You know me to be a very smart man. Don’t you think that if I were wrong, I’d know it?

Sheldon Cooper, theoretical physicist, in “The Jiminy Conjecture” (an episode of The Big Bang Theory)

When you tear out a man’s tongue, you are not proving him a liar, you’re only telling the world that you fear what he might say.

Tyrion Lannister

There is a groan that unites men and women, rich and poor, in any nation. These [muscle] pains are “explained” in every culture, but the universal fact of this persistence must mean that no adequate therapy exists.

Professor Patrick D. Wall, FRS, DM, FRCP, in the Foreword to Muscle Pain: Understanding its nature, diagnosis and treatment

The first thing one wants to know about any treatment — alternative or otherwise — is whether it works. Until that is decided, all talk of qualifications, regulation, and so on is just vacuous bureaucratese.

Dr. David Colquhoun, “Doctor Who? Deception by chiropractors”

For a long time it had seemed to me that life was about to begin - real life. But there was always some obstacle in the way, something to be gotten through first, some unfinished business, time still to be served, or a debt to be paid. Then life would begin. At last it dawned on me that these obstacles were my life.

Alfred Souza

The Force is what gives a Jedi his power. It's an energy field created by all living things. It surrounds us and penetrates us. It binds the galaxy together.

Obi-Wan Kenobi

Calling nutrition, exercise, and sleep ‘integrative medicine’ is like calling keeping your eyes on the road and your hands on the wheel ‘integrative driving.’


Medical thinking usually sees stress as highly disturbing but isolated events such as, for example, sudden unemployment, a marriage breakup, or the death of a loved one. These major events are potent sources of stress for many, but there are chronic daily stresses in people’s lives that are more insidious and more harmful in their long-term biological consequences. Internally generated stresses take their toll without in any way seeming out of the ordinary.

… While nervous tension may be a component of stress, one can be stressed without feeling tension.

When the body says no, by Gabor Maté, p. 28–9

It is a capital mistake to theorize before one has data. Insensibly one begins to twist facts to suit theories, instead of theories to suit facts.

Sherlock Holmes, in Doyle’s A Scandal in Bohemia, 1892, p163

You won't like me when I'm angry, because I always back up my rage with facts and documented resources.

The Credible Hulk

Some patients do seem to have some kind of post-infection meltdown. They don’t still have an infection any more in any sense that we understand infection. But someone is going to have to explain these patients to me someday.

Mark Crislip, MD, at the 2009 Science-Based Medicine Conference in Las Vegas, in his presentation on chronic lyme disease, in reference to patients who continue to suffer seriously long after an infection has resolved

Now my suspicion is that the universe is not only queerer than we suppose, but queerer than we can suppose … I suspect that there are more things in heaven and earth than are dreamed of in any philosophy.

JBS Haldane

Life is pain. I wake up every morning, I’m in pain. You know how many times I wanted to just give up? How many times I thought about ending it?

House, MD

Those who don’t stay current with the literature think my perspective is contrarian.

Christopher Johnson, PT,

If I woke up in the morning and nothing hurt, I would think I was dead.


Statistics are like bikinis: what they reveal is suggestive, but what they conceal is vital.

Aaron Levenstein

… the major complaint [Dr. Travell] encountered among her patients was pain. A patient might be dying of a serious illness, but when asked, “How are you?” would answer, “Well, ok, except I have this terrible pain in my shoulder. I can’t sleep. I can’t lie on that side.”

Myofascial Pain and Dysfunction, by Janet Travell, David Simons, and Lois Simons, p. ix

Daniel watched Isaac gain a couple of inches in height as he remembered the erect posture that Puritans used to set a better example.

a fictionalized Isaac Newton and his Cambridge roommate, Daniel, in Quicksilver, by Neal Stephenson

What can be asserted without evidence can be dismissed without evidence.

Christopher Hitchens, paraphrasing the Latin proverb “Quod gratis asseritur, gratis negatur” (What is freely asserted is freely deserted), in a 2003 Slate article

Yesterday I saw a guy who repeatedly mentioned that he’s a nurse. When he called he said he was having “carpal tunnel problems.” That’s fine, I can handle that. But when he came in, all he wanted to talk about was his neck pain. I can handle that, too. But I asked him why he’d said he was having carpal tunnel problems when he called. He said “because the carpal tunnel is in the neck.” When I tried to correct him, he argued with me, then walked out. Said he was going to “find a doctor who knows his damn anatomy.”

Dr. Grumpy, Anatomy 101

Before you diagnose yourself with depression or low self esteem, first make sure you are not, in fact, just surrounded by assholes.

not Freud or Gibson, but Notorious d.e.b. (@debihope), Jan 24, 2010 (see

I still am amazed that people would never buy a car if they were told it gets 75 miles to the gallon — they're absolutely clear on what's a scam. But when it comes to their health they will immediately fall for somebody telling them, “Take this pill and you'll live to be a hundred years old.” There's something about medicine that allows us to fall for stupid sales pitches more easily.

Dr. Dean Edell, “America’s Doctor”

We are, each of us, a multitude. Within us is a little universe.

Carl Sagan

I must have physical exercise, or my temper’ll certainly be ruined.

Tolstoy, Anna Karenina

100% of the time, pain is a construct of the brain.

Lorimer Moseley, from his surprisingly funny TED talk, Why Things Hurt 14:33

The manner in which our commander was freed from a rheumatic complaint, that consisted of pain extending from the head to foot, deserves to be recorded. Otoo’s mother, his three sisters, and eight other women went on board, for the express purpose of undertaking the cure of his disorder. He accepted of their friendly offer, had a bed spread for them on the cabin floor, and submitted himself to their directions. Being desired to lay himself down amongst them, then, as many of them ask could get round him began to squeeze him with both hands, from head to foot, but more particularly in the part where the pain was lodged, till they made his bones crack, and his flesh become a perfect mummy. After undergoing this discipline about a quarter of an hour, he was glad to be released from the women. The operation, however, gave him immediate relief; so that he was encouraged to submit to another rubbing down before he went to bed; the consequence of which was that he was tolerably easy all the succeeding night. His female physicians repeated their prescription the next morning, and again in the evening; after which his pains were entirely removed and the cure was perfected. This operation, which is called romee, is universally practiced among these Islanders; being sometimes performed by then, but more generally by the women.

regarding Captain James Cook, from A Narrative of the Voyages Around the World, by A Kippis

To pretend to be calm is to be calm, in a way.

Gillian Flynn, Gone Girl

“There are psychic factors involved in every patient’s complaint of pain,” [Bill Livingston] wrote. He tells a story of one midnight emergency to illustrate his point.

A woman called him to report that her husband had just had a “massive bowl hemorrhage and was in a state of collapse.” Just before bed, he had felt some cramping pains and hurried to the bathroom. Then she heard him calling her name, followed by the thud of him falling to the floor. She found him unconscious, white-faced, and covered in sweat. And in the toilet there was a quantity of bright red blood.

Livingston told her not to flush the toilet and rushed over. He found the man lying on the bed, conscious, but in pain. Where does it hurt the worst, Livingston asked. “All over,” the man whispered. He went on groaning as his wife said that he had been in fine spirits and food health, until he had gone to the bathroom.

Livingston examined him, to no avail. Then he went into the bathroom and inspected the alarm-looking contents of the toilet. Beets. Lots of beet fragments. It turned out that her husband had eaten beets for lunch, and little else. Livingston decided that this accounted for the “hemorrhage” and that the man’s state — the pallor, the sweating, and the “all over” pain — had been entirely caused by fright.

The two of them walked back into the bedroom with smiles on their faces, which annoyed the husband, who was languishing on the bed. But when Livingston gave him his diagnosis, the man’s condition improved rapidly. “Within half an hour he was moving about in his usual energetic fashion and offering to pour me a drink if I would stay and chat.”

Pain, by Marni Jackson, p. 213

A great many people think they are thinking when they are merely rearranging their prejudices.

source unknown, by William James

Paper after paper, study after study, have shown that chairs give us back problems because they shorten our hip flexors, give us weak backs, of course it make us sedentary. We take years off our lives probably by sitting in chairs, but we like them because they’re comfortable. You go to an African village, you find me a chair with a back. That’s a rare thing out there.

Brains Plus Brawn, by Daniel E Lieberman

Rocket science isn’t all that difficult. It’s not brain surgery.

a rocket scientist

Any piece of credible evidence that they are in danger should change their pain … And they are all walking into a hospital department with models like this on the desk: what does your brain say when it sees a disc that’s slipped so far out it’s sitting on it’s own? If you’ve ever seen a disc in a cadaver, you can’t slip the suckers — they’re immobile, you can’t slip a disc — but that’s our language, and it messes with your brain. It cannot not mess with your brain.

Lorimer Moseley, from his surprisingly funny TED talk, Why Things Hurt 14:33

If Jeff Mogil and Ron Melzack are right [about genetics and pain], fifty years from now, generic Tylenol tablets will seem as quaint to us as a bottle of sarsaparilla tonic. Instead, we’ll take our genotype ID bracely to the local genopharmacologist to order some bespoke pharmaceuticals. Or we may rise at four A.M. to meditate on the part of our nature that is painful and feel better for it. Along with social insurance, we’ll carry geno-cards that list our predispositions: photosensitivity, osteoporosis, and poor response to codeine.

Addiction might be redefined not as a character flaw but as a “biochemical deficit management.” Our emotional habits will become an accepted factor of good health, along with slogans like “Heartache can be harmful to your unborn children.”

Pain, by Marni Jackson, p. 348

The method of science, as stodgy and grumpy as it may seem, is far more important than the findings of science.

Carl Sagan

Constable Moore had reached the age when men can subject their bodies to the worst irritations — whisky, cigars, woolen clothes, bagpipes — without feeling a thing or, at least, without letting on.

Diamond Age, Neil Stephenson

There is simply no evidence that psychological interventions can slow progression of cancer or extend life. Claims to the contrary serve to burden cancer patients with an unrealistic responsibility for the outcome of their medical condition.

Questioning Whether Psychotherapy and Support Groups Extend the Lives of Cancer Patients, by James Coyne

Interestingly, almost all the people who came to me had some kind of back pain along with whatever other pain complaint they had. Their previous treatments for back pain had always focused on the spine. I heard about injections of papaya or cortisone. People had usually been told they had arthritis or bad disks, or that their cartilage had been worn away. They’d been shown X-rays [or MRIs! — PI] that purported to prove it. Some had already had surgery, and frequently had as much pain after surgery as before. Typically, the surgeon’s last word was always that he was sorry but he’d done all he could. Then he’d renew their prescription for painkillers and dump them off on a physical therapist. I heard these stories over and over again. And over and over, I found that trigger point therapy gave them the relief they’d been seeking for so long. Had trigger points been the problem in the first place? Arthritis? Bad disks? In Travell and Simons’ Myofascial Pain and Dysfunction, I had read that you can have herniated disks and arthritis of the spine and still find that myofascial trigger points are the primary cause of your back pain.

The trigger point therapy workbook, by Clair Davies, p. 13

Finding the occasional straw of truth awash in a great ocean of confusion and bamboozle requires vigilance, dedication, and courage. But if we don’t practice these tough habits of thought, we cannot hope to solve the truly serious problems that face us — and we risk becoming a nation of suckers, a world of suckers, up for grabs by the next charlatan who saunters along.

Carl Sagan, The Demon-Haunted World: Science as a Candle in the Dark

If you think the world is too complicated for reductionism to be useful, then you don’t really know what reductionism is or how it works.

Dr. Christopher A. Moyer

… our diagnosis and treatment of of tension myositis syndrome [same or similar to myofascial pain syndrome — Paul] represent yet another instance of what is possible when the power of the mind is mobilized for healing the body. It’s not magic; it is as scientific as the appropriate use of antibiotics, for science encompasses everything that is true in nature.

We must learn to recognize nature’s truths even though we don’t understand them, for some of those truths may still be beyond the ability of the human mind to comprehend. What we need is a compound prescription of humility, imagination, devotion to the truth and, above all, confidence in the eternal wisdom of nature.

Mind over back pain, by John Sarno, p. 109

Despite all of these genuinely progressive steps, the chiropractic profession here in North America may be slipping backwards. I perceive that we are at risk of returning to the antiscientific and dogmatic traditions that we have worked so hard to shake off during the past several decades. This apparently unrecognized reversion to the uncritical and unskeptical tendencies of early day chiropractic has everything to do with politics and economics and nothing to do with science. For more than a century chiropractors have fended off the efforts of organized, political medicine to ‘contain and eliminate’ this profession. In the process, deep rifts have formed among chiropractors. I’m not speaking here merely of the well-known division between ‘straights’ and ‘mixers,’ but more importantly about the chasm between those who would see chiropractic progress as a scientific healing art and those who are committed to old-time biotheology and ‘phoooolosophy.’ Today, chiropractors are hungry, one might even say desperate, for unity. It is this deeply felt yearning for unity, I believe, which places the scientific integrity of the profession at risk. We are at risk of accepting dogma and pseudoscience and ambiguous platitudes in order to come together.

The Specter of Dogma, by JC Keating

A knowledgeable physical therapist can slowly build up patients’ confidence by reassuring them that there is no structural problem and reminding them of the physiologic reason for the pain ...

Mind over back pain, by John Sarno, p. 92

For evidence-based medicine to succeed, its practitioners must learn to present evidence in a way that resonates. Or, to borrow a phrase from politics, it's not the evidence, stupid — it's the narrative.

Convincing the Public to Accept New Medical Guidelines, by Christie Aschwanden

There are wonders enough out there without our inventing any.

The demon-haunted world, by Carl Sagan and Ann Druyan, p. 59

… this is the way of science and discovery. If you cannot bear the unknown, if pushing half-blind toward an always mutable image of truth becomes not a celebration of the mysterious, but rather a fear of bumping around in the dark, coupled with a refusal to utter the words ‘I don’t know,’ then go back to brightly lit rooms, never question what is written in the science books (including this one), and do not make science your profession. ‘I don’t know’ is the best place for a scientist to be.

Ghosts of Vesuvius, by Charles Pellegrino, p. 25

“ …it is highly unlikely that a structural derangement could produce pain equal in severity to acute muscle spasm.”

Mind over back pain, by John Sarno, p. 75

There is the regular medical scientific world where we understand what an organ is, what fascia is, and why the two are different. Then there is a parallel world, like the Twilight Zone, where people make up fantasies and nontroversies about what fascia is, and what magical properties it supposedly has. It works if you want to make a living on the unaccredited continuing education circuit, but it doesn’t work when trying to communicate with healthcare professionals.

Ravensara Travillian, MT

The fact that patients swear by us does not mean we are actually helping them. Satisfaction is not the same thing as effectiveness.

Chiropractor Preston Long, author of Chiropractic Fraud and Abuse: An insider's lament

After the age of 40, perfectly normal vertebral columns rapidly become rarer and rarer. It is unusual after that age to see spines without x-ray evidence of aging, including thinning of disks and thinning of articular surfaces. The longer a man lives, the more impressive the radiologic changes in his vertebral column become.

The scientific brief against chiropractic, by {College of Physicians and Surgeons of the Province of Quebec}

The account of perception that’s starting to emerge is what we might call the “brain’s best guess” theory of perception: perception is the brain’s best guess about what is happening in the outside world. The mind integrates scattered, weak, rudimentary signals from a variety of sensory channels, information from past experiences, and hard-wired processes, and produces a sensory experience full of brain-provided color, sound, texture, and meaning. We see a friendly yellow Labrador bounding behind a picket fence not because that is the transmission we receive but because this is the perception our weaver-brain assembles as its best hypothesis of what is out there from the slivers of information we get. Perception is inference.

Scratching an itch through the scalp to the brain, by Atul Gawande

We love comfort, and people make a lot of money selling us comfort, but I would challenge the notion that comfort is usually good for us.

Brains Plus Brawn, by Daniel E Lieberman

Falsehood flies, the truth comes limping after.

Jonathan Swift

Most people do not listen with the intent to understand; they listen with the intent to reply.

Stephen R. Covey

The notion that only those who preach the gospel of integrated medicine are able to perform the art of medicine is as ridiculous as it is insulting to everyone in healthcare who does his/her best to meet the needs of their patients. The assumption that unproven or disproven treatments become acceptable simply because they are often administered in a kind and caring fashion is quite simply not true.

The “integrated medicine” straw-man, by Edzard Ernst

It is interesting to speculate how the world got along without back surgery for so long. I suspect that even though the family physicians of seventy-five years ago were unaware of the existence of TMS [same as MPS — Paul], they tended not to take back pain or ‘sciatica’ very seriously. Mustard plasters were widely used and probably brought about relaxation of muscle spasm through the heat generated by the plaster. Sometimes folk medicine is more sensible than ‘modern’ medicine. In any case, I suspect that the low-key, nonthreatening approach to back problems characterized by an earlier time helped to prevent the kind of long-term, disastrous courses that exist today.

Mind over back pain, by John Sarno, p. 31

Humans don’t get to decide what they find threatening, stressful or painful any more than a cat does. That decision is left to ancient unconscious systems that can’t really be reasoned with.

Todd Hargrove, Treat Your Client Like a Wild Animal

To save time, let’s assume I know everything.


A drug is a poison with potentially beneficial side effects.

Dale Favier, Massage Therapist, poet

These doctors [a panel of medical back pain experts at the Ninth World Congress of the International Association for the Study of Pain], who had long experience with people in pain in addition to their traditional training and schooling, had discovered that nothing happens without communication, treatment based on evidence of outcome, and what used to be called a good bedside manner.

Pain, by Marni Jackson, p. 122

To reduce pain, we need to reduce credible evidence of danger & increase credible evidence of safety.

Lorimer Moseley. Explainer: what is pain and what is happening when we feel it?

The daily clinical experience of thousands of massage therapists, physical therapists, and physicians strongly indicates that most of our common aches and pains — and many other puzzling physical complaints — are actually caused by trigger points, or small contraction knots, in the muscles of the body.

The trigger point therapy workbook, by Clair Davies, p. 2

To truly know what works, you have to learn what doesn’t work first.

Chris Brogan

I am sure there are things that can’t be cured by a good bath but I can’t think of one.

Sylvia Plath, The Bell Jar

Be the kind of person who takes supplements — then skip the supplements.

Michael Pollan, Food Rules: An Eater’s Manual

Cheerfulness, up to and including delusion and false hope, has a recognized place in medicine.

Barbara Ehrenreich, Smile or Die: How positive thinking fooled America and the world, 2009

Your best posture is your next posture.

Morgan Freeman

Every disease known to man is caused by blockages in lymphatic system.

Dr RC Guyton, 1861

We have a brain for one reason and one reason only — that’s to produce adaptable and complex movements. Movement is the only way we have affecting the world around us… I believe that to understand movement is to understand the whole brain. And therefore it’s important to remember when you are studying memory, cognition, sensory processing, they’re there for a reason, and that reason is action.

Daniel Wolpert, address at the Fred Kavli Distinguished International Scientist Lecture at the Society for Neuroscience meeting: Neuroscience 2009

Insomnia is a glamorous term for thoughts you forgot to have in the day.

Alain de Botton

In most cases I consider ultrasound less than useless — that's 8-10 minutes wasted that could be used doing something that might actually help.

Jason Silvernail, DPT, Board-Certified in Orthopedic Physical Therapy, in an internet forum discussion

Always keep your mind open — but not so open that your brains fall out!

Scottish proverb

The three most dangerous words in medicine: in my experience.

Mark Crislip, MD

When one tugs at a single thing in nature, he finds it attached to the rest of the world.

John Muir

Life is no way to treat an animal — it hurts too much.

Kurt Vonnegut, 2008, in an interview on CBC Radio One

Physicians performed great philosophical back-flips and other mental acrobatics in a vain effort to reconcile common sense with their theoretical constructs .... Seventeenth- and early-eighteenth-century medicine was based not on scientific method or an experimental approach but on theoretical reconciliation. Fortunately for many patients, the humoral concept of medicine declined throughout the eighteenth century as physicians began studying the actual workings of internal organs and the circulatory system in greater detail. By the nineteenth century, medicine had returned to scientific ground, with an emphasis on observation and experiment rather than hypothesis and a desire for theoretical harmony.

[Meanwhile] the world of medicine was extraordinarily confused, with a great variety of physicians each offering his own personal variation on the humoral theory. To make universal sense of it is nearly impossible; indeed, the theories of many physicians were contradictory. With the layers of speculation building upon each other like the skins of an onion, and physicians tweaking their predecessors’s theories to accommodate glaring inconsistencies ... cures became ever more fanciful and bewilderingly disconnected from reality.

In the quest for a universal theory of disease, much common sense was thrown aside and replaced with learned posturing. People, then as now, are inclined to dismiss trifling inconsistencies in their pet theories when they faithfully believe them to be correct — and perhaps more dangerous and malignant, when they believe a reputation is at stake or money is to be made. Folk wisdom has it that what we wish to be true, we readily believe.

Scurvy, by Stephen Brown, p. 80–84

One of the principle qualities of pain is that it demands an explanation.

Plainwater, by Anne Carson

There is nothing a cold slimy prickling ultrasound wand can do that a pair of warm hands can’t do way better.

Diane Jacobs, Canadian physiotherapist and writer

Reality is that which, when you stop believing in it, doesn’t go away.

Philip K. Dick, “How to Build a Universe That Doesn't Fall Apart Two Days Later” (1978)

Nothing quite like a real medical education experience to put the lie to alternative fantasies.

Jason Silvernail, DPT

[Overpronation] contributes nothing to our understanding — it is not definable, not reliable or valid, not diagnostic, its relationship to injury is not fully understood, and it does not dictate what the most appropriate management plan may be. It should not be replaced, it should be removed.

Ian Griffiths, Overpronation: Accurate or Out of Date Terminology?

Perhaps many patients whom doctors treat as having a nerve injury or a disease have, instead, what might be called sensor syndromes. When your car’s dashboard warning light keeps telling you that there is an engine failure, but the mechanics can’t find anything wrong, the sensor itself may be the problem. This is no less true for human beings. Our sensations of pain, itch, nausea, and fatigue are normally protective. Unmoored from physical reality, however, they can become a nightmare … hundreds of thousands of people in the United States alone suffer from conditions like chronic back pain, fibromyalgia, chronic pelvic pain, tinnitus, temporomandibular joint disorder, or repetitive strain injury, where, typically, no amount of imaging, nerve testing, or surgery manages to uncover an anatomical explanation. Doctors have persisted in treating these conditions as nerve or tissue problems—engine failures, as it were. We get under the hood and remove this, replace that, snip some wires. Yet still the sensor keeps going off.

So we get frustrated. “There’s nothing wrong,” we’ll insist. And, the next thing you know, we’re treating the driver instead of the problem.

Scratching an itch through the scalp to the brain, by Atul Gawande

Why do we persist in this distinction between mental and physical pain when pain is always an emotional experience? What explains the fact that something as universal as pain is so poorly understood, especially in a century of self-scrutiny? Has nobody noticed the embarrassing fact that science is about to clone a human being, but it still can’t cure the pain of a bad back? Americans consumer four tons of aspirin a year, while chronic pain is on the rise. It’s almost as if pain flourishes on our diet of analgesics.

Many medical students receive no more than one hour of instruction in pain management. Some schools don’t even have pain on curriculum, even though pain is the number one reason that sends people to their GPs ... It’s not the fault of physicians — this is how we teach them.

Why are we, the most medicalized of societies, a culture in pain?

Pain, by Marni Jackson, p. 5

Don’t confuse threat and risk. Working at the edge is a risk. But then again, so is walking out your front door.

Cory Blickenstaff, PT

Body is not stiff, mind is stiff.

K. Pattabhi Jois

Marge: You know Homer, it’s very easy to criticize.

Homer: Fun too!

The Simpsons

Following manipulation the patient said, “Oh, that was awful, something terrible has happened to me. That’s awful. Let me up. I don’t want anymore; I can’t stand anymore.” The chiropractor then said “you will be all right. Let me get this other one.” The patient then said “I have had enough, don’t, stop.” The chiropractor continued to manipulate the patient. Immediately following the adjustment she was unable to walk, her vision was impaired, she vomited, and she had a partial paralysis of the throat and vocal cords.

Vertebrobasilar stroke following manipulation, by A Terrett

The origin and ultimate reason for the brain’s existence is not to help us think or feel or create art, but to control the movement of the body.

Todd Hargrove of, nicely paraphrasing Daniel Wolpert’s TED talk, The Real Reason for Brains

American journalists have almost a lust for the View from Nowhere because they think it has more authority than any other possible stance. In pro journalism, American style, the View from Nowhere is a bid for trust that advertises the viewlessness of the news producer. Frequently it places the journalist between polarized extremes, and calls that neither-nor position “impartial.” Second, it’s a means of defense against a style of criticism that is fully anticipated: charges of bias originating in partisan politics and the two-party system. Third: it’s an attempt to secure a kind of universal legitimacy that is implicitly denied to those who stake out positions or betray a point of view. American journalists have almost a lust for the View from Nowhere because they think it has more authority than any other possible stance.

Jay Rosen, The View from Nowhere: Questions and Answers

I used to rely on meta-analysis, but they are worse than laws & sausages, ceasing to inspire respect in proportion as we know how they are made.

Dr. Mark Crislip, "I Never Meta Analysis I Really Like"

Just just because there are flaws in aircraft design that doesn’t mean flying carpets exist.

Ben Goldacre

Should we keep an open mind about astrology, perpetual motion, alchemy, alien abduction and sightings of Elvis Presley? No, and I am happy to confess that my mind has closed to homeopathy in the same way.

Mike Baum, The dangers of complementary therapy, Breast Cancer Res. 2007; 9(Suppl 2): S10

Hopefully we are emerging from an era of fantasy explanations for real phenomena. The authors certainly have to face a community of therapists who are obsessionally committed to explanations for disease and for therapy unsupported by a scrap of evidence except for their claimed therapeutic success.

Professor Patrick D. Wall, FRS, DM, FRCP, in the Foreword to Muscle Pain: Understanding its nature, diagnosis and treatment

Pain is an opinion on the organism’s state of health rather than a mere reflective response to an injury. There is no direct hotline from pain receptors to ‘pain centers’ in the brain. There is so much interaction between different brain centers, like those concerned with vision and touch, that even the mere visual appearance of an opening fist can actually feed all the way back into the patient’s motor and touch pathways, allowing him to feel the fist opening, thereby killing an illusory pain in a nonexistent hand.

Phantoms in the brain, by VS Ramachandran and Sandra Blakeslee

Bourne concentrated on rest and mobility. From somewhere in his forgotten past he understood that recovery depended upon both and he applied rigid discipline to both.

The Bourne Identity, by Robert Ludlum, p. 137

We must somehow find a way to make peace with limited information, eagerly seeking more, without being dogmatic about premature conclusions.

Science and The Game Of 20 Questions, by Val Jones

Many people are afraid of running because between 30 to 70 percent (depending on how you measure it) of runners get injured every year.

from a fascinating talk about the athletic toughness of human beings, Brains Plus Brawn, by Dr. Daniel Lieberman, evolutionary biologist of “Born to Run” fame

Seven days without laughter makes one weak.

Mort Walker

All the known forces depend on virtual particles to carry them (hence carrier particle) across space. For the electromagnetic force, the carrier particles are virtual photons. Electromagnetic radiation also is carried by photons. There has to be a physical means to to get from here to there. A proposed new form of energy, a form of energy that interacts strongly with matter (of which human tissue is an instance), would require such a carrier particle. Reorganizing particle physics to include a new energy and its accompanying particle presumes that something that should have been obvious was overlooked in all the particle experiments analyzed over the years. I wouldn’t hold my breath.

Science and Energy, by Keith Eric Grant

So what is a myth in medicine? It is not everything that is false, but rather concepts that are based on something akin to a story. It is a good story that meniscal tears cause pain and that when they are removed, the pain goes away as well. Showing that pain relief is mainly due to placebo effects means destroying a good story, which might be as unpopular as depriving some colleagues of a good business.

Mythbusting in Orthopedics challenges our desire for meaning, by Per Aspenberg, 547

We need to take the message and spread it: Never assume that someone, somewhere, must have looked at the evidence — or that evidence might have played any part in a decision. If we do this, then we relegate rule-making to those who are susceptible to short-term thinking, tokenism, defensiveness and advancing their own interests. By asking for evidence and insisting on sound reasoning, we can instead work out what is making our lives better and what we don’t need.

Tracey Brown and Michael Hanlon, In the Interests of Safety: the absurd rules that blight our lives and how you can change them

Increasingly, patients are being told that their pain is in their brain. We have no doubt that such messages are delivered by well intentioned clinicians, who are rightly dissatisfied with outdated concepts of the biology of pain. Such dissatisfaction certainly lends itself to ready acceptance of new paradigms, however implausible they may be — fancy proposing that one’s pain is in one’s head when it is clearly in one’s back! It is a fine line, though, between embracing the critical role of brain-held mechanisms in producing pain and presuming that it is in these mechanisms where the pain itself resides.

Our perspective is that pain is emergent. Emergent properties are those that are possessed by entire systems. A system comprises several distinct parts, and these parts interact with one another to give the system its emergent properties. There are two ruling criteria of emergence: that the one system, comprising the same components, can produce a range of emergent properties; and that none of the individual units comprising the system are capable in themselves of producing any of the emergent properties. The temptation is to simplify things a little and state that pain is an emergent property of the brain. Indeed, either or both of us have fallen into this oversimplification in our writing at some stage. However, on what grounds do we confine the system to the brain? A more accurate position is that pain is an emergent property of the person who is suffering it. There is a compelling body of research that clearly challenges a “neurocentric” view of pain and, in so doing, allows the propagation of new conceptual models with which to investigate conditions such as complex regional pain syndrome.

First-person neuroscience and the understanding of pain, by Michael A Thacker and G Lorimer Moseley, 410–1

… The committee has also made official protests to the networks and the Federal Communications Commission about television programs on pseudoscience that are particularly uncritical. An interesting debate has gone on within the committee between those who think that all doctrines that smell of pseudoscience should be combated and those who believe that each issue should be judged on its own merits, but that the burden of proof should fall squarely on those who make the proposals. I find myself very much in the latter camp. I believe that the extraordinary should be pursued. But extraordinary claims require extraordinary evidence.

Broca’s Brain, by Carl Sagan, p. 62

What do you think science is? There is nothing magical about science. It is simply a systematic way for carefully and thoroughly observing nature and using consistent logic to evaluate results. So, which part of that exactly do you disagree with? Do you disagree with being thorough? Using careful observation? Being systematic? Or using consistent logic? … People are saying ‘we don’t need science.’ You don’t need to be logically consistent? You don’t need to be thorough? What is it about the science that you think we don’t need, or you don’t like, or isn’t valuable?

Dr. Steve Novella, responding to an anti-scientific criticism, Skeptics Guide to the Universe episode 292

…this idea, that humans are essentially weak creatures, is actually deeply woven into a lot of the ways in which humans think about our bodies.

Brains Plus Brawn, by Daniel E Lieberman

Just because a published paper presents a statistically significant result does not mean it necessarily has a biologically meaningful effect.

Science Left Behind: Feel-Good Fallacies and the Rise of the Anti-Scientific Left, Alex Berezow & Hank Campbell

Simple intervention — the time spent with a patient — is a very powerful ingredient of the patient-doctor contract. The evidence is against the traditions such as surgery [for back pain] being true — the evidence says it doesn’t work.

Pain, by Marni Jackson, p. 122

How do we convince people in pain that we understand that they are in pain but it’s not just about the tissues of their body? A key conceptual shift that we think is really important is that you can understand that pain is the end result, pain is an output of the brain, designed to protect you … it’s not something that comes from your tissues.

Lorimer Moseley, from his surprisingly funny TED talk, Why Things Hurt 14:33

I cannot give any scientist of any age better advice than this: the intensity of the conviction that a hypothesis is true has no bearing on whether it is true or not.

Advice to a young scientist, by P. B Medawar

It is almost heretical to question this stretching doctrine, yet it is important to disclose that there is no research which proves categorically that there is any need for separate stretching sessions, phases or exercises to be conducted to improve performance and safety. To appreciate this fact, it is useful to return to one of the clinical definitions of flexibility, namely that flexibility refers to the range of movement of a specific joint or group of anatomical tissues. Moreover, flexibility cannot be considered separate from other fitness factors such as strength and stamina. There is no real need to prescribe separate stretching exercises or sessions, since logically structured training should take every joint progressively through its full range of static and dynamic movement. In other words every movement should be performed to enhance flexibility, strength, speed, local muscular endurance and skill, so that separate stretching sessions then become largely redundant.

Facts and fallacies of fitness, by Mel Siff

You have the right not to try to do everything that it is humanly possible to do.


As an orthopedic surgeon, I often pondered one particular breakdown of that [healing] energy, my specialty’s major unsolved problem — nonunion of fractures. Normally a broken bone will begin to grow together in a few weeks if the ends are held close together to each other without movement. Occasionally, however, a bone will refuse to knit despite a year or more of casts and surgery. This is a disaster for the patient and a bitter defeat for the doctor, who must amputate the arm or leg and fit a prosthetic substitute.

Throughout this century, most biologists have been sure only chemical processes were involved in growth and healing. As a result, most work on nonunions has concentrated on calcium metabolism and hormone relationships. Surgeons have also “freshened,” or scraped, the fracture surface and devised ever more complicated plates and screws to hold the bone ends rigidly in place. These approaches seemed superficial to me. I doubted that we would ever understand the failure to heal unless we truly understood healing itself.

The body electric, by Robert O Becker and Gary Selden, p. 29–30

Although [Nikolai] Bogduk has a reputation for having all the answers and being a bit of a ‘needle jockey’ who travels everywhere with his little vial of painkilling bivucaine, his presentation in Vienna surprised his colleagues. Instead of talking up the latest surgical intervention, he spoke about addressing the patients’ fears and anxieties, and ‘getting inside their heads.’ He emphasized that what was most important was to first eliminate ‘red-flag conditions’ that might be (but probably weren’t) causing the back pain, and then to reassure the patient that the back would most probably get better and not worse. He still believed in judicious painkilling, but what was more important in treating back pain, he had found, was communication and reassurance. Preventing acute [back] pain from turning into chronic pain was often a matter of ‘treating the patient nice and convincing him that there is nothing so horribly wrong.’

Pain, by Marni Jackson, p. 120–1

Below is the account of a well-known test, and an embarrassing one for the medical profession. The following famous quiz was given to medical doctors (which I borrowed from the excellent Deborah Benett’s Randomness).

A test of a disease presents a rate of 5% false positives. The disease strikes 1/1,000 of the population. People are tested at random, regardless of whether they are suspected of having the disease. A patient’s test is positive. What is the probability of the patient being stricken with the disease?

Most doctors answered 95%, simply taking into account the fact that the test has a 95% accuracy rate. The answer is the conditional probability that the patient is sick and the test shows it—close to 2%.

Fooled by randomness, by Nassim Taleb, p. 206–7

“Never stand when you can sit, never sit when you can lay down, never stay awake when you can be asleep.” This succinctly summarizes the Darwinian concept of least energy expenditure and survival of the fittest. Biology will always take the easiest (least energy) way to perform a task, and all we have to do is compare which of our concepts of bodily functions is least energy requiring and that will be the most likely path of evolution.

Dr. Steven M Levin, elaborating on an old army aphorism

When all you have is a hammer, everything you see looks like a nail.

Abraham Maslow

My chiropractor says this is because the top of my neck attaches to my head. Is that a common problem?

from the “chiropractors say the darndest things” file, as reported by Dr. Grumpy (Only Outside Sleepy Hollow)

Even if we were to overlook the two former hurdles, there is yet a third one to overcome—are manual techniques or specific exercises effective in modifying inherent postural-structural-biomechanical factors? Can foot mechanics, leg length differences, pelvic tilts, vertebral positions and spinal curves be permanently changed, solely, by these clinical tools?

Eyal Lederman, “The fall of the postural–structural–biomechanical model in manual and physical therapies: Exemplified by lower back pain”

If we teach only the findings and products of science — no matter how useful and even inspiring they may be — without communicating its critical method, how can the average person possibly distinguish science from pseudoscience?

The demon-haunted world, by Carl Sagan and Ann Druyan

Pain is the end result. Pain is an output of the brain designed to protect you. It’s not something that comes from the tissues of the body.

Lorimer Moseley, from his surprisingly funny TED talk, Why Things Hurt 14:33

I don’t care if it’s a scam, as long as long as it works!

a common objection to skepticism in health care

Facts are stubborn things; and whatever may be our wishes, our inclinations, or the dictates of our passion, they cannot alter the state of facts and evidence.

John Adams

We look for medicine to be an orderly field of knowledge and procedure. But it is not. It is an imperfect science, an enterprise of constantly changing knowledge, uncertain information, fallible individuals, and at the same time lives on the line. There is science in what we do, yes, but also habit, intuition, and sometimes plain old guessing. The gap between what we know and what we aim for persists. And this gap complicates everything we do.

Complications, by Atul Gawande, p. 7

Everyone has a special place they store their tension (I’m on shiatsu duty), the same way everyone misspells the same words over and over. Karla stores her tension in her rhomboid muscles, and I remove it. This is making me feel good. That I can do this.

Microserfs, by Douglas Coupland, p. 192

[Bill] Livingston described a lumberjack, a timber feller, who had cut off the tip of his left thumb with an axe. The wound healed, but the scar remained so sensitive that he couldn’t work. Another operation removed a chunk of the remaining thumb, after which the stump was even more painful. Doctors were at a loss to treat him. Livingston took the caseon, hoping to at least ease the man’s pain for brief periods with a local anaesthetic. he found that when he injected the man’s thumb with a local anesthetic, he suddenly felt his arm “relax” for the first time since the accident. After a series of injections, the lumberjack found he could finally put on a glove and eventually use an axe. Livingston felt it wasn’t the procaine that had “cured” his condition, but the interruption and reorganization of the stimulus in the area. The injections seemed to reboot a nervous system that had become stuck in an old modality.

Pain, by Marni Jackson, p. 212