Detailed guides to painful problems, treatments & more

Reading Guide for Professionals

What’s on PainScience.com for therapists and doctors?

This website is for both patients and health professionals. It is always addressed to patients, but professionals appreciate clear, readable, jargon-free information just as much as patients do. Key features here for professionals:

Doctors too? Yes, doctors read this website. Over the years, many physicians have given me a thumbs up for my science-based approach to the subject matter, and they often write with helpful corrections as well. I also stay in touch with several of the physicians at ScienceBasedMedicine.org, where I was the assistant editor for several years.

What’s here? Explained with jargon included

PainScience.com is primarily about conservative manual and physical therapies for muscle pain, low back and neck pain, headaches, frozen shoulder, and repetitive strain injury, especially in the lower leg (plantar fasciitis, shin splints, plantar fasciitis, iliotibial band syndrome, patellofemoral syndrome). I focus on the importance of neurobiological mechanisms of chronic pain, such as sensitization. I constantly chip away at the conceptual dinosaur of the postural-structural-biomechanical model of pain.

I get deep into plausibility and evidence for etiologies and treatments, clinical reasoning, and diagnostic logic. I always consider the role of placebo and non-specific effects of therapeutic interactions, and I bet heavily on the null hypothesis in testing treatment claims.

I don’t offer comprehensive reference information: there are excellent texts for that. So, for instance, I do not systematically describe special orthopedic testing for any condition or provide detailed differential diagnosis charts, but I will translate and explain the implications of a scientific paper about the reliability of a test.

Despite the surprising scope of this one-man show, it’s not a medical publishing empire. My own training and expertise is limited,3 and I am careful to respect my own limits. I particularly avoid pathology-driven chronic pain, invasive treatment methods, and pharmacotherapies.

Musculoskeletal and rehab science geekery

Patients find it difficult to find good help for many kinds of chronic pain problems. Diagnostic wild goose chases are common. Most pain problems slip into a gigantic crack in the medical system between hospital orthopedics and rheumatology. For everything else, we simply don’t much about know why people hurt, and keep hurting. Often we can offer our patients no better than educated guesses. And there is controversy about virtually every kind of thinking and therapy.

PainScience.com tries to make sense of it all. Everything written here was written for love of the topic — I am a musculoskeletal medicine and pain science geek.

Some of my favourite sources

I spend a lot of time on PubMed & I cite from the best sources whenever possible, like The Cochrane Collaboration & The New England Journal of Medicine & PLoS Medicine.

Just who do I think I am?

Please accept my apologies for all the criticism. I often criticize practices that cannot be supported by science. What gives? And who do I think I am? “It seems a poor way to run a business,” commented one irritated massage therapist. “Do you really think it’s smart to criticize your potential customers?” I think it’s smart to be true to my nature, attracting and earning the trust of the readers I respect — the critical thinkers. We can get nowhere in health care without healthy, vigorous debate. I don’t think that’s “negative.”

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

My own top picks for professional readers

  1. Your Back Is Not Out of Alignment — Debunking the obsession with alignment, posture, and other biomechanical bogeymen as major causes of pain. This article challenges the clinical paradigm that has dominated manual therapy for decades. If you only read one article on this website, please read this one.
  2. Pain is Weird — Pain science reveals a volatile, misleading sensation that comes entirely from an overprotective brain, not our tissues. Although quite basic and not quite yet what it should be, many clinicians are not aware of most of this information and really, really should be.
  3. A Painful Biological Glitch that Causes Pointless Inflammation — How an evolutionary wrong turn led to a biological glitch that condemned the animal kingdom — you included — to much louder, longer pain.
  4. Does Fascia Matter? — A detailed critical analysis of the clinical relevance of fascia science and fascia properties. Fascia is hot hot hot right now, but despite all the conferences and fascia-fanaticism it’s just not clear that fascia matters. Find out exactly why.
  5. Most Pain Treatments Damned With Faint Praise — Most controversial and alternative therapies are fighting over scraps of “positive” scientific evidence that damn them with the faint praise of small effect sizes that cannot impress. A short, sweet article about a simple idea that really simplifies a lot of debates about “what works.”
  6. Does Arnica Gel Work for Pain? — A detailed review of popular homeopathic (diluted) herbal creams and gels like Traumeel, used for muscle pain, joint pain, sports injuries, bruising, and post-surgical inflammation. Because Traumeel is homeopathic and therefore a contentious topic, I’ve probably never worked harder to dot my i’s and cross my t’s. This is a really painstakingly constructed analysis. It took weeks of work to produce, and it’s completely free. It’s also one of the most popular articles on the website, second only to the one about Epsom salts.
  7. Quite a Stretch — Stretching science has shown that this extremely popular form of exercise has almost no measurable benefits This is PainScience.com’s original “controversial” article. Stretching was one of the issues that got me writing. Chock full of myths … myths that you may still be passing on to your patients.
  8. Ioannidis: Making Medical Science Look Bad Since 2005 — A famous and excellent scientific paper … with an alarmingly misleading title. This is probably one of the geekiest articles on the site, as well as one of my favourites.
  9. Placebo Power Hype — The placebo effect is fascinating, but its “power” isn’t all it’s cracked up to be.
  10. A Deep Dive into Delayed-Onset Muscle Soreness — The biology & treatment of “muscle fever,” the deep muscle soreness that surges 24-48 hours after an unfamiliar workout intensity.
  11. Trigger Point Doubts — Do muscle knots exist? Exploring controversies about the existence and nature of so-called “trigger points” and myofascial pain syndrome
  12. Statistical Significance Abuse — A lot of research makes scientific evidence seem much more “significant” than it is.
  13. Pain Science Reading Guide for Skeptics — A tour of PainScience.com for readers who have doubts and concerns about the validity and efficacy of popular treatments for injuries and chronic pain.

Notes

  1. Grundy PF, Roberts CJ. Does unequal leg length cause back pain? A case-control study. Lancet. 1984 Aug 4;2(8397):256–8. PubMed 6146810 ❐

    This classic, elegant experiment found no connection between leg length and back pain. Like most of the really good science experiments, it has that MythBusters attitude: “why don’t we just check that assumption?” Researchers measured leg lengths, looking for differences in “lower limb length and other disproportion at or around the sacroiliac joints” and found no association with low back pain. “Chronic back pain is thus unlikely to be part of the short-leg syndrome.” Other studies since have backed this up, but this simple old paper remains a favourite.

    So what’s special about this footnote? You don’t have to take my word that the source is relevant — readers can easily link to the original source material, and check the relevance and quality of the reference. The presentation is attractive and useable. Under the hood, custom tech makes it a snap for me to publish richly cross-referenced, “interactive” bibliographic data — better technology and higher standards for publication than most scientific journals.

  2. Obviously it’s not PubMed or even PEDro (the Physiotherapy Evidence Database) — it’s not an institutionally run and funded database. However, what it lacks in sheer size it more than makes up for with charm, personality and focus. As far as I know, the PainScience.com bibliography is the single largest resource of its kind, consisting of well almost 2000 entries, mostly from mainstream medical journals. And it’s not just a list — it’s a readable, annotated bibliography. Quickly get the gist of a paper, my take on its significance, and anything else that’s noteworthy and interesting. Much better than just reading abstracts!
  3. Massage therapists in my part of the world are surprisingly well-trained — I did a three-year full-time program — but that is, of course, still less than physical therapists and chiropractors, who in turn study much less than any physician. See more information about my credentials.