What works for stubborn aches, pains, and injuries? What doesn’t? Why? SaveYourself.ca reviews your treatment options: hundreds of detailed, free self-help articles and several e-books about common pain problems, constantly updated, and readable enough for anyone but heavily referenced for professionals. (There’s also a giant bibliography.) I serve up the science with some sass — I try to have fun taking this subject seriously. The salamander? More mascot than logo, he’s a symbol for regeneration and unsolved mysteries of biology. ~ Paul Ingraham, publisher
The microblog is bite-sized news items, deep thoughts, and helpful ideas — whatever comes up while I work on making feature articles and books. Quotes and comics, study results and weird science, interesting links, and so on. Subscribe with RSS, Twitter, Facebook and Google, or browse the microblog archives.
This is a video of a two-legged dog, having great fun at the beach.
As summarized by distractify.com:
Duncan Lou is a young boxer discovering the beach for the first time. He happened to be born with two deformed legs, which were removed as a puppy. He has a wheelchair, but he hates it. So instead, he runs full speed unassisted with his two unstoppable fore-legs. When you see him gallivant across the beach, you'll understand. Duncan is pure courage.
So, tell me again how a slight leg length difference or an barely perceptible spinal joint “misalignment” is the cause of someone’s terrible back pain? Biology is fantastically flexible. Minor biomechanical variation is never at the heart of any common, serious pain. In fact, even major ones are often handled gracefully: in dogs or people. Which is not to say that a pup like Duncan Lou won’t grow up to have some pain (he probably will), but it puts minor biomechanical glitches in perspective.
The sketchiest methods will always be promoted the most aggressively.
In spite of my strong general skepticism about stretching, I wouldn’t hesitate to do some for a strained muscle. It’s hardly a big commitment to stretch one muscle a little. If you are gentle, it won’t do any harm. And, as with gentle contraction of the muscle, stretching may help cue healing mechanisms in your muscle to lay down new connective tissue in an tidier way. And this idea is supported by a little shred of evidence from 2004 Malliaropoulos et al that showed that about 40 strained Greek athletes who stretched recovered faster than those who didn’t. How much faster? They regained their range of motion about 22% sooner, and their “rehabilitation period” was about 12% shorter. The researchers reported that this was of “great importance in treating muscle strain injuries.”
I’m not quite that thrilled by those numbers — they’re good, not great. It’s also probably the only study of its kind, and I don’t particularly trust it. But it is promising data that provides a solid reason to experiment with rehab stretching. I do hope it’s true, even it’s not of “great importance”!
“The role of stretching in rehabilitation of hamstring injuries: 80 athletes follow-up”
I’m telling my story: the rather dramatic fate of my massage career, how SaveYourself.ca became profitable, and the nail-biting transition between the two. The introduction is now available on my sleepy little personal blog, Writerly, and the first dozen chapters are queued up — they’ll be freely available while I finish writing the book.
It all began innocently enough, when I got excited by the potential of selling e-books to supplement my massage therapy income, and I started moonlighting and pulling 12-hour days. That’s when the money started to flow. And the trouble…
I keep hearing the claim that taping can increase circulation, and this is one of the main ways that it enhances performance. I’ve made fun of that claim. When I first looked at the results of a 2013 study, I was ready to eat some humble pie and issue a mea culpa: the results of Aguilar-Ferrándiz et al seemed more encouraging than I expected.
Mixed Kinesio taping-compression therapy improves symptoms, peripheral venous flow and severity and slightly increases overall health status in females with mild chronic venous insufficiency.
But @exuberantdoc brought me back to my senses by quipping “compression socks with tape.” I don’t mind being wrong and admitting it, but I don’t think I need to do it today, about this. Circulation is driven pretty much exclusively by metabolic demand — not by minor stimulation of the skin and superficial connective tissues. The idea that tape can increase circulation anywhere near enough to fight fatigue while exercising is extremely wishful thinking. Blood doping, cocaine, and better fitness can fight fatigue — not tape. In someone with venous insufficiency — basically, blood pooling in the legs — you can bind up their calves with tape like compression socks, and that will be … about as helpful as compression socks, of course. There’s not really any reason to use tape for that. If tape (or compression socks) had a measurable circulatory effect on healthy people, now that would be mildly interesting. But it would be downright shocking if it was a robust enough effect to affect athletic performance (let alone elite performance). I’ve updated my taping article with a citation to Aguilar-Ferrándiz et al, plus this perspective:
I’m pleased to announce the first complete professional editing of two of my books — about plantar fasciitis and iliotibial band syndrome. Although the difference will not be obvious to most readers, several hundred improvements and corrections were made to each, and the reading is definitely smoother.
What took me so long? Logistics and cash. Like any truly professional writer, I always knew I needed good editorial help, but that can be hard to find and pay for. Editing a book is a Big Deal. But SaveYourself.ca has grown to the point where it finally got important and affordable, and I was lucky enough to find a skilled, reliable editor: JoAnne Dyer of Seven Madronas Communications. After working with JoAnne on many smaller projects over the last couple years, I asked her to start working on my books. Two down, six to go!
I am often criticized for failing to suggest alternatives when criticizing bad ideas in therapy, especially in my article about “structuralism” (overemphasizing biomechanical factors in therapy). It’s a bogus gripe: failing to suggest a wardrobe for the emperor to wear tomorrow doesn’t make him any less naked today. Structuralism is a deeply flawed basis for therapy regardless of whether anything can readily replace it. But I’ve gone ahead and made some simple suggestions anyway, in a short new conclusion to the article (link takes you directly to the conclusion).
There will be much more on this so-what-does-work theme over the next couple years. I’m just getting started on it.
I enjoy it when extremely different interests overlap. I am a nut for Roman history, and I recently found a reference to massage in a charmingly oddball context: “massage instead of exercise” as an explanation for the corruption and weakness of the Vandals, and how they lost their North African kingdom to the last great Roman General, Belisarius, in the 6th Century.
Almost everything about this historical situation was a little odd. It was odd that a Germanic tribe had migrated all the way to North Africa and taken Carthage from the Romans in the first place. It was odd that Rome had lost Italy as well, yet continued to thrive in the east. Belisarius himself was a remarkable character, almost freakishly competent. And rarely in history has any hostile takeover been as rewarding as the Vandal occupation of Carthage: they got about as rich from it as anyone has ever been, and it should have been easy for them to keep their kingdom.
But perhaps the wealth did make them soft. In Robert Graves’ as-true-as-possible novel about the life of Belisaurius, Count Belisarius, he describes the condition of the Vandals like so:
As for their fighting qualities: these fair-skinned, fair-haired Northerners had now, by the third generation, become acclimatized to Africa. They had intermarried with the natives, changed their diet and yielded to the African sun (which makes for ill-temper rather than endurance) — and to such luxuries as silk clothes, frequent bathing, spiced foods, orchestral music, and massage instead of exercise. This enervating life had brought out strongly a trait common to all Germanic tribes, namely an insecure hold on the emotions.
And so Belisarius beat them. Outrageously outnumbered, far from home, without even the element of surprise, and thanks only to a little good luck, he beat them fair and square and reclaimed Carthage for Rome, before moving on to take Italy back as well. I bet the Vandals really regretted all that enervating massage!
My barefoot running content has been revised and compiled. It’s approaching the point where it’s a fairly in-depth feature article — as opposed to a mere blog “post.” That’s what I do here: I just keep updating and improving articles until you can’t resist sharing them on Facebook!
My main stretching article now includes a section on the failure to treat contracture (a scar-like shortening of soft tissues). Stretching always gets the benefit of the doubt, whether it deserves it or not. Most people and most professionals probably assume that long, intense stretches are an effective prevention/treatment for contracture. It is not an assumption held with much conviction, I imagine — it’s just that stretching always gets the benefit of the doubt, whether it deserves it or not, and it seems to “make sense” that stretching would be a cure for contracture.
Common sense fails again, I’m afraid. Continue reading (link goes directly the new section).
I needed a shrewd disclaimer to use wherever I choose to feature an anecdote on SaveYourself.ca — because smart folks (correctly) get annoyed with me if I rely too much on mere anecdote to make my points here. From now on I will use this text when making my excuses for stooping so low…
I use anecdotes on SaveYourself.ca only with great caution, because they are inherently unreliable. It’s historical fact that there has never been a snake oil so outlandish or even harmful that it lacked for happy customers who swore it worked for them. While people may well “know” what they felt, that does not necessarily mean they understand it. Anecdotes are not even the lowest level of “evidence” — they don’t constitute evidence at all. At best, they are an inspiration to seek the truth of things rigorously. But at the same time, experience is where all investigation must begin. Experience is problematic, but not useless. And so I will cite anecdotes! But only if the source seems unusually bright and articulate; if it doesn’t blatantly confirm a bias; if it echoes something I myself have experienced, or heard often from others (which gives me a higher level of confidence in it); and if it is balanced in general by the best available evidence.
A “new” article about the worst pain I’ve ever personally survived, cobbled together from old blog posts, updated and tuned a bit:
This classic quote applies to a lot of fields of human endeavour:
Now let’s translate that for this website. How does it apply to manual therapy? Well, the number one thing in the last quarter century that professionals have tended to not understand is that structural factors are surprisingly unimportant in pain and rehabilitation. And yet they are convenient, plausible scapegoats, and so it “pays” to sell therapy for them, resulting in an epidemic of expensive barking up the wrong tree. So …
It is difficult to get a man to understand something when his job depends on not understanding it.
It is difficult to get a therapist to understand that structural abnormality is rarely meaningful when his job depends on emphasizing it.
That became a popular tweet last week. I also added it to my article on this topic: Your Back Is Not “Out” and Your Leg Length is Fine.
P.S. This is good example of the kind of thing that just strikes as I’m working on other things — I have updated articles like this probably several thousand times over the years.
I have reluctantly conceded that I do not have the time or resources to make audio versions of my books. The two I have already made (for plantar fasciitis and IT band syndrome, plus several audio articles) will remain available, but there will be no more.
This is just one of several other business development projects I have recently abandoned with a sigh. The truth hurts: I can only do so much. I have recovered from the thrill of making a living online, which inspired a lot of giddy schemes from about 2010 to 2012, and now I’m getting back to my roots: I’m just a writer with a big, nice website, selling some e-books to keep the lights on. It turns out that is plenty of work for one person, forever. Ambitious product development is out of reach unless I start hiring full-time staff, which I will not do — the only kind of business I want to run is the small kind. So no audiobooks, among other things: “just” good articles, books, and a huge bibliography, passionately maintained.
The marble hand illusion study is evidence that the list of inputs the brain uses to form an image of the body is indeed endless. Apparently, the brain even considers what a hand sounds like in determining how it should feel.
Really a delightfully strange illusion.
Here is a meticulous, sensible, and readable analysis of the very best studies of back pain treatments that have ever been done: the greatest hits of back pain science.
“Analgesic effects of treatments for non-specific low back pain: a meta-analysis of placebo-controlled randomized trials”
There is a great deal of back pain science to review, but authors Machado, Kamper, Herbert, Maher and McCauley found that shockingly little of it was worth their while: just 34 acceptable studies out of a 1031 candidates, and even among those “trial quality was highly variable.” Their conclusions are derived from only the best sort of scientific experiments: not just the gold-standard of randomized and placebo-controlled tests, but carefully choosing only the “right” kind of placebos (several kinds of placebos were grounds for disqualification, because of their known potential to skew the results). They do a good job of explaining exactly how and why they picked the studies they did, and pre-emptively defending it from a couple common concerns.
The results were sad and predictable, robust evidence of absence: “The average effects of treatments … are not much greater those of placebos.”
SaveYourself.ca is “all about the science,” but not actually all: I am realistic about the limits of the science, much of which is clearly pretty junky. (And I don’t just mean blatant pseudo-science in fake alt-med “journals” — I’m talking about the weakness of normal, mainstream science.) This is a huge topic, but here’s one simple example of a common problem: control groups that don’t actually control. This is particularly common in back pain science.
Rather than comparing a treatment to a good, carefully selected placebo, most studies use a comparison to a treatment that is allegedly neutral, underwhelming, or placebo-ish. That makes the results hard to interpret: if they work out about the same, it could mean that the treatments are equally effective … or equally ineffective!
So much back pain science has this problem — or any one of a dozen others — that you can effectively ignore at least 80% of it, because it’s so far from the last word on anything. Data like that mostly just muddies the waters.
Good science is essential to solving these problems, but really good studies are also really difficult and rare. See the next post.
Some follow-up from a prominent news item last year: a complete summary of the kerfuffle over the alleged fracture of a baby’s neck by an Australian chiropractor. In a nutshell: we’ll never know for sure what happened, but the chiropractic profession’s response to the allegation was predictably poor and damning, and — as always — chiropractors simply have no business treating children in the first place. See also Dr. Harriet Hall’s summary post on ScienceBasedMedicine.org, Chiropractic Reform: Myth or Reality?
Can a custom shoe prevent injuries by compensating for individual differences in running mechanics?
“Injury reduction effectiveness of assigning running shoes based on plantar shape in Marine Corps basic training”
Knapick et al. gave several hundred Marine Corps recruits motion control, stability, or cushioned shoes for their “low, medium, or high arches.” Those recruits got injured just as much as hundreds of other recruits who were given stability shoes, regardless of their arch shape. It’s a large, good quality experiment that clearly establishes that prescribing special shoes “based on the shape of the plantar foot surface had little influence on injuries.” What “Big Ortho” doesn’t want you to know!
I get hate mail from quacks… but love letters from librarians, for the bibliography-friendly foundations of SaveYourself.ca. New short article about the design and odd technology of this website. Because people are always asking.
I have stopped offering PDF versions of my books. Instead, I’m now offering lifetime access to my web versions. Previously, web versions expired after six months, with the option to buy future editions at a steep discount. Now, every customer can always read the most current version of any book they have ever bought, forever — until the end of the internet, I hope. (I have plans in place to preserve SaveYourself.ca well after my demise, timely or otherwise.)
Customers certainly want PDFs, but that doesn’t mean you should. What a horrible technology! Ugh! I sold them for about 15 months, really nice ones (for PDFs) … and hated every minute of it. They were a bit of a nightmare. It was fingernails on chalkboard for five quarters of business. I’m extremely happy to be done with them, even though it meant abandoning one of the largest programming project I have ever done.
I am a connoisseur of reading technologies. I have been using every imaginable digital publishing and reading technology since the early 1980s, and they are all seriously flawed. I am an expert about this, maybe the only thing I am truly expert about, and I choose to publish exclusively on the web for a long list of good reasons — perhaps it’s foolish and idealistic and stubborn, but I am what I am, and this is just how I do things here, and it makes me happy to show up for work again. So goodbye, PDFs! And hello, lifetime access.
When my customers request refunds, which is unusual, by far the most common reason given is that the book didn’t solve their problem. About half of them add some kind of complaint about my legendary negativity. Here is a typical recent example:
This eBook didn’t decrease my shin pain. Apparently you think nothing works.
Not many self-help books go to great lengths to stifle false hope and unrealistic expectations…but mine do. My shin splints book is not intended to “decrease shin pain,” and I warn readers about that, in several ways, in both the free introduction and in the main text. In fact, I would say it’s impossible to actually read and understand my book and still think that it should have “fixed” anything. It’s an unreasonable expectation of any book… but particularly one that goes well out of its way to caution readers against that expectation!